Diablo ImmortalDiablo Immortal Closed Alpha: BlacksmithMay 11, 2021Diablo Immortal / Diablo VideosIn this video, my Crusader started off at Level 22. Part of this video is about figuring out where to find the Achievements and how to maneuver through the interface that shows Bounties, dungeons, and more. The main part of this video involves the Blacksmith. The first thing my Crusader did was talk to Xul. He sent her to go fight Lethes, who is in a location called Lord’s Rest. Upon entering, the screen said: “You have entered a solo Story Dungeon.” My initial impressions of Westmarch started forming while I played through this part of the game. I intend to wrote about that, but don’t want to squish it all into this post. Charsi is the Blacksmith of Westmarch. When I record these videos, I cannot hear the sound (due to the setup I have for recording my Diablo Immortal gameplay.) As such, I accidentally misgendered the Blacksmith. If I were able to hear Charsi speak, that would not have happened. I had the opportunity to start to figure out how to use the Blacksmith’s services. It is rather simple, once you understand how to move through the interface. I’m probably going to have to do that a lot before it will feel intuitive. This video also includes the most useful escort quest I’ve experienced in any of Blizzard’s games. If you enjoyed this video, please consider supporting me on Ko-Fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Diablo_Immortal_Closed_Alpha_Blacksmith.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Diablo Immortal Closed Alpha: Mad King’s BreachMay 10, 2021Diablo Immortal / Diablo VideosIn this video, my Crusader started off at Level 20. She made a second attempt at completing the Mad King’s Breach dungeon (after failing it on the first try). In this attempt, I learned that it is possible to complete this Dungeon solo, despite the game’s recommendation that you bring 9 other players with you. I also learned that King Leoric has a “tell” that makes it very clear where he is about to charge. This gives the player a chance to get out of the way. By the end of the video, my Crusader was at Level 22. If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Diablo_Immortal_Closed_Alpha_Mad_King_s_Breach_Completed.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Diablo Immortal Closed Alpha – Early QuestsMay 9, 2021Diablo Immortal / Diablo VideosThis is my first video of the Diablo Immortal Closed Alpha. I decided to play a Crusader that looked like the one featured on the Diablo social media accounts. In this video, my Crusader started out at Level 11. I was mostly learning how to play the game. I play a lot of app games, so that made things easier. My biggest problem was that I kept getting stuck in the scenery, and had not yet worked out how to maneuver effectively in order to not be stuck. This video includes The Festering Woods area and Ashwold Cemetery. It also features some quests that involve Xul and Lethes. It ends with my Crusader standing outside Mad King’s Breach. By then, she was at Level 18. I’m not intending to record every little bit of my game play in the Diablo Immortal Closed Alpha, in order to avoid accidentally exposing people to “spoilers”. If you enjoyed this video, please consider supporting me on Ko-Fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Diablo_Immortal_Closed_Alpha_Early_Quests.mp4Podcast: Play in new window | DownloadSubscribe: RSS... DiabloSeason 23: Torment and RakanothJune 14, 2021Diablo III / Diablo VideosIn this video, my softcore Barbarian started off at Level 70 with 9 Paragon points. The goals this time were to move the difficulty level to Torment I and kill Rakanoth. There are flashing lights in this video. My Barbarian started this video with four pieces of the Wrath of the Wastes set. Having four pieces increases the Whirlwind ability. Usually, I put that one on a mouse button. This time, I put it on the 3 key on my keyboard. I learned that doing it this way is a lot more comfortable for me. After I moved the difficulty up to Torment I, I completed a Torment I difficulty Nephalem Rift. Next I killed Rakanoth. I used my last Greater Rift Key to complete a Greater Rift Torment 10. My Barbarian ended the video with 19 Paragon Points. Objectives completed in this video: Rift And Roll: Finish a level 70 Nephalem Rift on Torment I difficulty or higher.Some Despair to Spare: Kill Rakanoth at level 70 on Torment II difficulty or higher. If you enjoyed this video, please consider supporting me on Ko-Fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Torment_and_Rakanoth.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Cydea and DiabloJune 10, 2021Diablo III / Diablo VideosIn this video, my softcore Barbarian started out at Level 70 with 3 Paragon points. The goals this time were to kill Cydea and Diablo on Master difficulty. Objectives completed in this video: De_Lust: Kill Cydaea at level 70 on Master difficulty or higher. (Chapter III)Falling Away: Kill Diablo at level 70 on Master difficulty or higher. (Chapter III)Third Power Cubed: Equip Kanai’s Cube with armor, weapon, and a ring Legendary power. (Slayer) Completing the De_Lust and Falling Away objectives was all I needed in order to complete Chapter III of the Season Journey. Doing so gives me two more pieces of the “freebie set”, which is Might of the Wastes in Season 23. My Barbarian ended the video with 9 Paragon Points. If you enjoyed this video, please consider supporting me on Ko-Fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Cydea_and_Diablo.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Level 70 BarbarianJune 10, 2021Diablo III / Diablo VideosIn this video, my softcore Barbarian started out at Level 69. The goal was to get him to Level 70. The first thing my Barbarian had to do was empty the loot out of his bag. I failed to do that in between this video and the previous one. My plan was to run some Nephalem Rifts, and I wanted to be able to pick up whatever loot I found that seemed interesting. The second level of the Nephalem Rift had Cuddle Bears, Unicorns, and Twinkleroot flowers. I find them amusing. It made the rest of the Nephalem Rift so much fun! Objective completed in this video: Above & Beyond: Reach Level 70. (Chapter II) Achievements completed in this video: Riftomania: Finish a level 70 Nephalem Rift.Knees & Toes: Reach Level 70 in the Season.Above & Beyond: Reach Level 70. If you enjoyed this video, please consider supporting me on Ko-Fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Level_70_Barbarian.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Malthael and MoreMay 15, 2021Diablo III / Diablo VideosIn this video, my softcore Barbarian stated out at Level 60. This means he was now able to fight Malthael and finish some other things that are part of the Season Journey. There are flashing lights in this video My previous attempt to fight Malthael was earlier this season when I was still playing my Necromancer. The effort did not go well because of lag. My Barbarian, for whatever reason, is not experiencing any lag at all. Objectives completed in this video: Everything: Kill Malthael at level 60 on Hard difficulty or higher. (Chapter II)Exquisiteness: Reforge a weapon property to a socket at the Mystic. (Chapter IV) My Barbarian ended the video Level 61. If you enjoyed this video, please consider supporting me on Ko-Fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Malthael_and_More.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Little BarbarianMay 7, 2021Diablo III / Diablo VideosIn this video, I started playing a Softcore Barbarian. My hope was doing so would get around the unexplained lag issue that I was having with my Necromancer. My Barbarian started out this video at Level 6. The first thing my Barbarian did was run some Nephalem Rifts. He also put some Legendary items into Kanai’s Cube. By the end of the video, my Barbarian was at Level 12. Objective completed in this video: The Rock: Craft a Gem of Imperial or greater quality at the Jeweler. Socketing an Emerald into your weapon increases your Critical Hit Damage, and is a big bonus. (Chapter III) By the end of the video, my Barbarian was at Level 12. If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Little_Barbarian.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Fighting the Lag BossMay 3, 2021Diablo III / Diablo VideosAfter having a serious lag problem in Diablo III while playing the game with a friend, I made some attempts to fix that problem. My Necromancer was stuck and struggling. In this video, my Necromancer started out at Level 63. You can see when the lag hit him because it creates a white circle around his feet. The Malthael fight went just as badly as it did when my friend and I tried it together- mostly due to lag. Objective completed before or during recording this video: Westmarch’s Most Wanted: Obtain an Act V bounty cache. (Chapter II)Soul to Squeeze: Kill Zoltun Kulle at level 60 or higher on Hard difficulty or higher. (Chapter II)Level 1 Seasonal Cubist: Extract a Legendary power using Kanai’s Cube. (Chapter III) After that, having very few options of what I could successfully do with my Necromancer, I ran a set of Act I Bounties in the hopes of obtaining some Jeweler recipes. The lag returned while fighting with skeletons and columns in The Royal Crypts (on Hard difficulty). Eventually, I decided that my best option was to stop playing the Necromancer and level up a Barbarian. If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Fighting_the_Lag_Boss.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Heaven’s Most WantedMay 1, 2021Diablo III / Diablo VideosIn this video, my Softcore Necromancer started at Level 50 and worked on the Heaven’s Most Wanted objective. I only had a little time to play, and this seemed achievable. Objective completed in this video: Heaven’s Most Wanted: Obtain an Act IV bounty cache. (Chapter III) By the end of the video, my Necromancer was at Level 52. If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Heaven_s_Most_Wanted_Expert.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Caldeum’s Most WantedApril 30, 2021Diablo III / Diablo VideosIn this video, my Softcore Necromancer started out at Level 33 and completed a set of Act III Bounties. This video was supposed to be posted before the previously posted video where he hit Level 50. Objective completed in this video: Caldeum’s Most Wanted: Obtain an Act III bounty cache. (Chapter III) If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Caldeum_s_Most_Wanted_Master.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: To Level 50April 25, 2021Diablo III / Diablo VideosIn this video, my Softcore Necromancer hit Level 50! He did this almost completing some Bounties before recording this video, and then finishing them while recording. After completing a set of Act III Bounties, I got the Blacksmith plans for the Sage’s set. It gives you extra Death’s Breaths. The cool thing about this set in Season 23 is that it Emanates. I can make a Follower wear it, and find extra Death’s Breaths – without having to wear the Sage’s set myself. Neither my Necromancer, nor his follower, can wear that set until they hit Level 70. Objectives completed (before or during) this video: Arreat’s Most Wanted: Obtain an Act III bounty cache. (Chapter III)Hot Anvil, Strong Steel & the Real Deal: Craft a level 70 Weapon or Armor piece. (Chapter II)Forged In Fire: Reach level 50. (Chapter 1) If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_To_Level_50.mp4Podcast: Play in new window | DownloadSubscribe: RSS... Season 23: Rainbow Nephalem RiftApril 23, 2021Diablo III / Diablo VideosIn this video, my Softcore Necromancer started out at Level 30. He ran through a Nephalem Rift on Master difficulty in order to level up more. The first level of the Rift was the tile set where one would expect Cuddle Bears and Unicorns. Season Journey objectives completed in (or shortly before) this video: Let’s Get Started: Learn 5 Blacksmith Recipes. (Chapter IV)Penchant for Enchants: Replace a property on an item with Enchanting at the Mystic. Enchanting is very useful for replacing an unwanted primary affix on a near-perfect item. (Chapter II)Master: Complete a Nephalem Rift on Master difficulty or higher. (Chapter III) At the end of the video, my Necromancer was at Level 33. If you enjoyed this video, please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/Season_23_Rainbow_Nephalem_Rift_Master.mp4Podcast: Play in new window | DownloadSubscribe: RSS... PodcastsLetter to my 12-Year-Old Self – Episode 068March 30, 2021Podcasts / Words of JenIn this episode, I read to you a short piece of writing that was inspired by a post on Autostraddle. It is a letter from me to my 12-year-old self, just as “past me” was beginning to try and figure themselves out. I read “Letter to My 12-Year-Old Self” on episode 068 of Words of Jen. If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj068.mp3Podcast: Play in new window | DownloadSubscribe: RSS... Vicious Cycle – Episode 067November 30, 2020Podcasts / Words of JenIn this episode, I read to you a short poem I wrote in 2017 on a Tumblr blog that no longer exists. It is about what it is like to suffer from pollen allergies while trying to get some work done. I read “Vicious Cycle” on episode 067 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj067.mp3Podcast: Play in new window | DownloadSubscribe: RSS... We are in the Wrong Timeline – Episode 066November 27, 2020Podcasts / Words of JenIn this episode, I read to you a poem I wrote in 2017 on a Tumblr blog that no longer exists. It unexpectedly fits right into today’s world. I read “We are in the Wrong Timeline” on episode 066 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj066.mp3Podcast: Play in new window | DownloadSubscribe: RSS... Ice Cream Delivery – Episode 065November 22, 2020Podcasts / Words of JenIn this episode, I read a piece of writing that was originally posted on social media. It is a true story about what happens when an order of ice cream is delivered to the wrong house during the COVID-19 pandemic. I read “Ice Cream Delivery” on episode 065 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj065.mp3Podcast: Play in new window | DownloadSubscribe: RSS... The Can of Tuna Rolled Away – Episode 064November 19, 2020Podcasts / Words of JenIn this episode, I read a piece of writing that was originally posted on a website that no longer exists. The story presents a problem. How were we going to get the can of tuna out from behind the stove? I read “The Can of Tuna Rolled Away” on episode 064 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj064.mp3Podcast: Play in new window | DownloadSubscribe: RSS... How a Washer and Dryer Changed Our Lives – Episode 063November 15, 2020Podcasts / Words of JenIn this episode, I read a piece of my writing that was written in 2013. It is about some of the ways our lives changed after we got our own washing machine and dryer. I read “How a Washer and Dryer Changed our Lives” in episode 063 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj063.mp3Podcast: Play in new window | DownloadSubscribe: RSS... How a Washer and Dryer Changed Our LivesNovember 15, 2020Podcasts / Words of JenI wrote this piece on February 2, 2013, on a blog that no longer exists. Shawn and I received a brand new washer and dryer as a gift from his mother. It surprised me how much having access to a washer and dryer changed our lives. I read “How a Washer and Dryer Changed Our Lives” in episode 063 of my Words of Jen podcast. Shawn’s mom was kind enough to buy us a brand new washer and dryer for Christmas. By “new”, I mean “purchased right from the store”. I don’t mean “replacements for our old ones” because there were no “old ones” to replace. This is the first time that Shawn and I have owned a washing machine and a dryer in our lives. Owning a washer and dryer changed our lives in ways that we did not anticipate. * No more weekly trips to the bank to purchase the roll of quarters we used to need to spend on the machines in the mobile home park “laundry hut”. Each roll cost $10.00. Obviously, this required us to have $10.00 on hand each time we needed to do laundry. That probably sounds easier than it actually was (especially since freelance writing can come with an erratic pay schedule at times). * Shawn no longer has to lug the laundry down to the “laundry hut”, and then return to put it into the dryer, and then return again to lug it all back home. * I no longer have to worry about what strange people he might encounter during these trips, or that a car will come around the corner and run him over. This was more of a worry at night, as Shawn tends to wear all black fairly often and drivers may not see him. * No more having to pick and choose which items get washed this week and which could wait until next week, (when we would be able to get more quarters). Now, everything that requires washing gets washed as needed. * No more being frustrated when the washing machines, or dryers, in the “laundry hut” would eat the quarters that Shawn fed them, and then refuse to do their jobs. No more having to decide if it is better to file a claim with the company that supplies the machines, or to simply give up on ever getting back those stolen quarters. * No more unhappy surprises when a trip to the “laundry hut” revealed that the company that owned the machines had raised the rates since the last time we tried to do laundry. * No more wondering just how expensive one load of laundry would cost next month, next year, or for the years that followed. No more worries that there would come a day when the company that supplied the machines would end their contract with the mobile home park and remove them (leaving us to have to use a laundromat that was farther away from home). * Zero chance of having items from our laundry stolen as they were washing or drying. We never had something go missing (except for the occasional sock). However, as we live near a homeless shelter, there was always the potential for someone to decide to help themselves to our clothing. No one is going to break in to steal a load of laundry from our new washer and dryer. * Things that take a long time to dry can go for another cycle through our dryer – no extra quarters required. Previous to this, we had been resorting to hanging up all the clothes that did not dry all the way on hangers across the bar for the shower curtain (sometimes in both bathrooms). * No more need to drape the bath mats over the railing on the back porch, in the hopes that they will finish drying. Also, no more need to be on the lookout for the various spiders and other insects that decided to hitch a ride inside on the bath mats. * I no longer have to worry that the person who used the washing machine before we did used a laundry soap that I am severely allergic to. This was always a gamble. I don’t have to worry about having freshly washed clothing cause me to break out in hives anymore. We have complete control over exactly what kind of laundry soap goes into our washing machine. We also can be certain that no floral scented dryer sheets are used in our dryer. * There is something about having our very own washing machine and dryer that makes the place we live in feel more like a home and less like a college dorm. I’m not sure how to explain that any better, other than to say it now feels like we are now living like grown-ups are supposed to. * The sounds that the washing machine and dryer make are quite soothing (once I got used to how they were supposed to sound). Unexpectedly, the sounds create a very calm, homelike, environment. It is nice to listen to while I am working on a batch of writing assignments. How a Washer and Dryer Changed Our Lives is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... That Demon Named Pain – Episode 062November 13, 2020Podcasts / Words of JenIn this episode, I read to you a poem I wrote in 2018. (It was temporarily posted on Medium.) The poem is about chronic pain caused by chronic illness. I recorded this on a high pain day because it seemed appropriate. I read “That Demon Named Pain” on episode 062 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj062.mp3Podcast: Play in new window | DownloadSubscribe: RSS... Mind Eraser – Episode 061November 11, 2020Podcasts / Words of JenMy dentist insisted that I take “sedation medication” before my root canal. I was told it would make me feel relaxed. I didn’t know it was a mind eraser. I read “Mind Eraser” on episode 061 of Words of Jen. #NaPodPoMo 2020 If you enjoyed this episode please consider supporting me on Ko-fi. Thank you! https://media.blubrry.com/bookofjen/p/ins.blubrry.com/bookofjen/woj061.mp3Podcast: Play in new window | DownloadSubscribe: RSS... NaPodPoMo 2020November 9, 2020PodcastsSound wave from a podcast I recorded on Garageband in 2013 I am participating in NaPodPoMo 2020. It stands for “National Podcast Post Month” – but it has included international podcasters as well. The goal is to post a total of 30 podcasts during November. Here is a list of the podcast episodes I released during NaPodPoMo 2020: ONE: Words of Jen episode 057 – When the Piggy Bank is Empty TWO: Diablo Video: Season 21: To Level 70! THREE: Words of Jen episode 058 – Dreaming of Buffets FOUR: Diablo Video: Season 21: Master Nephalem Rift FIVE: Words of Jen episode 059 – The Outrage Machine SIX: Diablo Video: Season 21: Queen Araneae SEVEN: Words of Jen episode 060 – Spider is Recalculating EIGHT: Shattered Soulstone episode 282 – Shades of the Nephalem NINE: Diablo Video: Season 21: Lunatics and Bloodmaw TEN: Diablo Video: Season 21: More Paragon ELEVEN: Words of Jen episode 061 – Mind Eraser TWELVE: Diablo Video: Season 21: Torment I Nephalem Rift THIRTEEN: Words of Jen episode 062 – That Demon Named Pain FOURTEEN: Diablo Video: Season 21: Running Greater Rifts Expert FIFTEEN: Words of Jen episode 063 – How a Washer and Dryer Changed Our Lives SIXTEEN: Diablo Video: Season 21: Greater Rifts and Revelations SEVENTEEN: Diablo Video: Season 21: Torment II EIGHTEEN: Words of Jen episode 064 – The Can of Tuna Rolled Away NINETEEN: Shattered Soulstone episode 283 – Ready for Season 22! TWENTY: Diablo Video: Season 21: Cow Level TWENTY-ONE: Words of Jen episode 065 – Ice Cream Delivery TWENTY-TWO: Diablo Video: Season 22: Barbarian Challenge Rift TWENTY-THREE: Diablo Video: Season 22: Nephalem Rift and Leveling Crafters TWENTY-FOUR: Diablo Video: Season 22: Cydaea and The Skeleton King TWENTY-FIVE: Words of Jen episode 066 – We are in the Wrong Timeline TWENTY-SIX: Diablo Video: Season 22: Adria and Vidian TWENTY-SEVEN: Shattered Soulstone episode 284 – MaxRoll TWENTY-EIGHT: Words of Jen episode 067 – Vicious Cycle TWENTY-NINE: Diablo Video: Season 22: Housekeeping THIRTY: Diablo Video: Season 22: Nephalem Rift on Hard Difficulty If you enjoyed these episodes, please consider supporting me on Ko-fi. Thank you!... Book ReviewsThirteen Reasons Why – by Jay AsherOctober 20, 2020Book Reviews / fictionThirteen Reasons Why is a story about a teenager named Hannah Baker who died from suicide. Before ending her life, she recorded a series of cassette tapes in which she explained some of what happened to her that influenced her decision. She arranged to have those tapes sent to the people who had hurt her. This book was becoming popular at a time when I was working in a bookstore. Thirteen Reasons Why was located in the teen/young adult section. There was a day when one of my managers pointed out Jay Asher to me as he stood in the teen/young adult aisle, counting the number of copies of his book that were on the shelf. To be clear, this is an extremely common thing for writers to do. He eventually noticed us, turned around, and waved hello before going back to counting books. Years later, I found a hardcover autographed copy of the book in a thrift store. I live in a college town, and students who are moving back home for the summer tend to donate items that they don’t want to bring back home with them. My best guess is that someone did not want their parents to find this book and assume that their offspring was considering suicide. My visit to the thrift store happened after Netflix launched a TV series based on the book. Some found the series to be controversial because it depicted Hannah’s way of ending her life in graphic detail. (Netflix later removed that scene.) I have not watched the TV series that was based on the book. As such, this review is based entirely on the book itself The majority of Thirteen Reasons Why comes to the reader from the viewpoint of Clay Jensen. He received a mysterious box on his front porch that was addressed to him. Inside was a series of cassette tapes. There was no return address on the box. I’m not entirely certain what year the story takes place it, but it is clear that it is long after it was common for teenagers to record music on cassette tapes to share with a friend or with someone they were dating. We called them “mix tapes” back in the day. Clay doesn’t have anything that he could play the tapes on. Fortunately, his father has what I would have called a “boombox” in the garage. It is here that Clay starts playing the tapes, becoming more and more nervous and upset the more he listen to them. The instructions left by Hannah on the first tape include some warnings. If you received the box of tapes, it meant that you were on at least one of them. Those who find themselves on a tape are to listen to the rest before boxing up the tapes and mailing them to whoever is the focus of the tape after theirs. Failure to send the box of tapes to the next person would result in having all of the tapes released publicly. If that happened, all of the bad deeds and secrets on the tapes would spread. That’s a really potent threat that ensured that the tapes would be passed on. Clay “borrows” a Walkman – the kind that plays cassette tapes – from a friend (without the friend’s knowledge). He embarks on an extremely emotional and stressful journey listening to Hannah’s tapes while walking to different locations on a map that matches where the events of a specific tape happened. The reader learns that Hannah made those maps herself and pushed them into the lockers of the people who she talked about on the tapes. Clay shoved the map into his backpack and was able to dig it out of there. I thought it was really clever of Jay Asher to convey Hannah’s story via cassette tape. There is something really personal about listening to someone’s recorded voice. Having that voice on a cassette tape – a physical, tangible, object – increases the intensity of the shared audio moment. Clay spends several hours focusing on the tapes. Which one was he on? What did he do that hurt Hannah? I could feel his anxiety and nauseousness as he listened to the tapes. What makes this even more dramatic is that Clay really liked Hannah, and they only had a brief moment together before she passed away. The majority of the rest of the book comes to the reader from the viewpoint of Hannah. I found this very interesting because it gives her a voice and allows her to explain what she was thinking, and feeling, before she died. This can only happen in a fictional situation. In reality, people who lose a loved one to suicide are often left with more questions than answers. Without going into “spoilers” I will say that it wasn’t one incident that caused Hannah to decide end her life. Instead, it was a snowball of bullying and bad situations that really hurt her. Thirteen reasons why, each one explained in great detail, on either the A or B side of a cassette tape. While Clay is listening to the tapes, he starts making connections between what Hannah is describing and the confusing things that he saw happen in the months and days before she died. None of those situations made sense to him until after he listened to the tapes and heard Hannah’s side of the story. According to Wikipedia, Thirteen Reasons Why was released in 2007, long after the days when teenagers listened to music on tapes (or CDs, for that matter). Today, people of all ages mostly listen to digital music, and to podcasts of a variety of topics, online. It would be extremely difficult for a person who is a teenager today to follow in the fictional Hannah’s footsteps by recording their pain on a series of cassette tapes. To the best of my knowledge, stores don’t sell packages of cassette tapes anymore, or the Walkman or “boombox” to play the tapes on. I think Jay Asher chose wisely when he decided to have Hannah tell her story through the cassette tapes. Doing so made a nice contrast between Hannah’s recorded voice and the voice in Clay’s head as he agonized about what the tapes would reveal. In addition, he picked a means of sending a note to those Hannah left behind that could not be easily imitated by the teens of today. One big lesson that can be learned from stories like the one in Thirteen Reasons Why is valuable regardless of the age of the reader. Be kind. You cannot always know, for certain, what’s going through another person’s mind, or what is troubling them. A small moment of kindness can potentially make a big difference in the life of a person who is suffering. There are resources for people who are thinking about suicide. The National Suicide Prevention Hotline provides free and confidential support for people in distress, twenty-four hours a day, and all seven days of the week. You can speak to someone in English or in Spanish. They also can connect with people who are deaf or hard of hearing. Thirteen Reasons Why – by Jay Asher is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Father-Mucker – by Greg OlearJuly 28, 2020Book Reviews / fictionFather-mucker is a work of fiction from the viewpoint of Josh Lansky. He (tries) to make his living by pitching ideas to magazines and movie studios. He is a stay-at-home dad who is currently parenting his two young children by himself while his wife is on a business trip. Things do not go as planned. This book is, at times, hilarious. It also offers some interesting insights and commentary on parenting, modern culture, politics, and the problems that come when rumors spread. The title of this book confused my dyslexic brain, and I had to stop and take a closer look at it. The meaning of the title is explained in the story by the main character. It’s not anywhere near as bad a meaning as you may have suspected it would be. Josh and his wife, Stacy, have two preschoolers. Roland is autistic, and his primary interests are “states” (as in the individual states that make up the United States) and light fixtures. He enjoys looking at catalogs and online photos of lamps, bathrooms, and big houses – especially if he can find out what state the house is located in. Maude is the younger sibling. She is very demanding and speaks as though she is royalty. She is physically tough, and Josh thinks she might become a linebacker someday. Near the beginning of the story, Josh gets an email from a parenting magazine that has accepted one of his pitches. They will pay him to do an interview with a former punk-rocker who is now a father. Josh’s son happens to have the punk-rocker’s daughter in his class at preschool. Josh is instantly elated, and then realizes that it might not be easy to find a way to interview the former punk-rocker. All he knows is that Roland really likes the musician’s daughter. Of course, Josh posts this good news on Facebook. His friends are a group of mommies who have set up play-dates at one of their homes. Josh is an honorary mommy. Some of the interesting social commentary starts while Josh is on Facebook. For example, someone he follows plays a game that involves killing vampires. It is the type of game that automatically posts the player’s kills. These types of annoying posts were common back in the earlier days of Facebook. Josh wonders if the number of kills his friend has is a high number, or a low one. He considers the idea that that maybe the friend was actually killing vampires. Josh hadn’t finished his coffee yet. Later, Josh opens a magazine and thinks about the ridiculous names that celebrities choose for their children. Apple. Pilot Inspektor. He later thinks about movie stars who “boink babysitters”… and then, sometimes, divorce their wives and marry the babysitter. At the play-date, one of the mommies quietly tells Josh that she believes that his wife, Stacy, is having an affair. This rumor, of course, has him second-guessing his entire marriage. Sleep deprived and exhausted from being the only parent to his children for several days in a row, Josh struggles with this news. After the play-date ends, Josh returns home with Maude. (Earlier that day, he took Roland to preschool). The babysitter that Josh scheduled to come over and watch Maude arrives. She is twenty-six years old and still in college. He finds her to be ditzy, childish, and annoying. She wants a raise. Josh does not give her a raise. The purpose of the babysitter is to entertain Maude so Josh can go with Roland on a class field trip to a pumpkin patch. To his surprise, the punk-rocker dad is among the other parents who accompany their kids on this field trip. Josh is extremely nervous about how to approach the guy and ask for an interview. And then, all hell breaks loose… for a while. A meltdown occurs. There are difficult choices to be made. Josh must decide whether or not to believe the rumor about his wife cheating on him. He goes back and forth on this, often via flashbacks of unrelated things that happened years ago. As a writer, his mind is searching for the clues he now things he missed. Could she have started seeing one of her ex-boyfriends again? If so… which one? More rumors are spread. Could the husband of one of the mommies be having an affair? The mommy group (Josh included) discuss a rumor about two people who live in town that – supposedly – had sex with each other in a public place while having an affair. It’s like high-school, all over again. A clique of board and frustrated people are spreading gossip in an effort to harm others, to make themselves look better in comparison, or just to pass the time. By the end, the rumors get resolved. The truth is revealed. Some of it was predictable (even for the characters), and some was a mystery right up until the end. I won’t spoil the ending by revealing the outcome. Overall, Father-Mucker is a fast moving story, from the viewpoint of an exhausted dad who is struggling with being a (functionally) single parent for several days in a row. Parents who read this will probably relate to the difficulties and absurdities of potty-training, children throwing tantrums, and the high-pitched scream of a child who has been hurt by another kid in the play-group. As I mentioned, there’s a lot of social commentary about rumors, celebrity quirks, Facebook statuses (and the proper way to respond to them). There are brief glimpses of what Josh and Stacy went through while trying to get Roland on an IEP, and memories about what their life was like before children. I ended up liking Josh Lanksy more than I might have expected. I kept wanting things to work out for him, and hoping that he would, eventually, be able to get some sleep. Father-Mucker by Greg Olear is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... The Great Influenza – by John M. BarryJuly 18, 2020Book Reviews / non fictionThe full title of this book is The Great Influenza – The Story of the Deadliest Pandemic in History. I started reading it during the COVID-19 pandemic. It was a book I’d been meaning to read long before COVID hit, and now seemed like a very appropriate time to start. The influenza pandemic happened about 100 years before the COVID-19 pandemic did. There are so many similarities between how people back then reacted to influenza and how people today are reacting to COVID-19. The book is not for everyone, particularly those who are already overwhelmed by everything involved with the COVID-19 pandemic. That said, I recommend the book to those who happen to enjoy reading about science, and health, and history. The book is presented in a way that resembles a narrative. In other words, it is not just a dry pile of facts and figures. John M. Barry did an excellent job of making scientists and doctors who were involved in trying to stop the spread of influenza into relatable, interesting, people. He noted their skill set, their personalities, and their quirks. I learned a lot from this book. It was astonishing how little we have learned between the influenza pandemic and today. “Spanish Flu” The influenza pandemic was, at the time, referred to as the “Spanish Flu”. But, it didn’t start in Spain. Instead, it started in the United States, in rural Kansas. The pandemic started just before the United States got involved in World War I. The governments of the countries that allied with the United States imposed strict rules about what could, and could not, be published in newspapers, played in movie theaters, or sung. The goal was to prohibit anything that might reduce to morale of the troops. Spain stayed out of the war – or, at least, did not join it – for a long time. As such, the newspapers in the country were free to write whatever was newsworthy. Many people first heard about the influenza pandemic after reading about it in Spanish newspapers. At the time, Spain was one of the countries that had been hit by the virus. People (outside of Spain) started calling the virus “Spanish flu”. The book shows evidence that the influenza virus began in rural Kansas, and spread from there to Camp Funston in Fort Riley, Kansas. The enlisted went from there to other camps, some of which were in France. Young men, from different areas of the United States, were packed into quarters that were not designed to accommodate so many people. Influenza spread through the military very quickly. Today, the (impeached) President of the United States calls COVID-19 “The Chinese Virus“, or “Kung Flu“. It is clear that the COVID-19 virus began spreading in Wuhan, China. But, that’s no excuse for the President to refer to the virus in such racist terms. Overloaded Hospitals The hospitals during the influenza pandemic were as overloaded as the ones today that were hit by a surge of COVID-19 patients. In both cases, people did not understand what they were seeing when it started. Back then, the doctors thought their patients had pneumonia, or that it was “only influenza”. They had no way of knowing how bad this particular strain of influenza actually was, but understood that most influenza cases were mild. Today, doctors diagnosed many patients with pneumonia, when it turned out they most likely had COVID-19. Some were turned away from hospitals (in the United States, for sure, perhaps in other countries) because they weren’t considered sick enough for a bed. Access to testing was problematic, and there are many people who had COVID-19 but were never tested. Meanwhile, the (impeached) President Trump has asked his “people” to slow down the testing. Back then, doctors and nurses were dying as they attempted to provide care for overloaded wards of influenza cases. Today, doctors and nurses are getting sick with COVID-19 as they beg their governors, representatives, senators, and (impeached) president to provide them with enough PPE to keep them safe. Sadly, back then and now, morgues were filled to capacity and hospitals had to find other places to store bodies. In both cases, casket makers were unable to make enough to keep up with the need. Then, and now, people were dying at home. In 1918, part of the problem that people were afraid to help neighbors who had influenza. This was especially true in places where there was a high death rate. It should be noted that President Woodrow Wilson was strongly emphasizing that hospital beds should be reserved for the troops. Doctors and nurses were recruited and sent to camps to help treat enlisted men who had caught influenza. The result was that American civilians were dealing with a doctor and nurse shortage. There was also no infrastructure set up to properly remove the bodies of the deceased. Some families placed the bodies of their dead loved one on the porch. Others had no option but to put the person in a corner, or leave them on the bed they died in. Spouses were sleeping on that bed, and I cannot imagine the level of trauma that caused. Today, there are people dying at home from COVID-19. Their family members are calling paramedics, but the person dies before the ambulance can arrive. In 1918, cities sent out wagons which were used to collect the dead. Police came to the door of the houses of the deceased and put the bodies into the wagon. Again, coffins were scarce, so some bodies were in bags. A few were in boxes that were definitely not coffins. Today, there is a man in Houston, Texas, who is collecting the bodies of the dead. He has a contract with the county, the police, and various funeral homes. Mask Slackers The idea of wearing a mask to prevent the spread of a virus seems to annoy some people. That was true one-hundred years ago, and sadly, is true today. Back then, the Red Cross, which was an extremely helpful force in fighting the influenza pandemic, had women make gauze masks. The surgeons at the time wore gauze masks. So, the prevailing thought was the gauze masks would also help other people to prevent spreading the virus. It should be noted that this effort began after the influenza pandemic had spread widely across the United States. Members of the Red Cross set up tables and tried to hand masks to every un-masked person who walked by. Police at the time were allowed to insist that a “mask slacker” wear a mask. Those without masks had to pay a fine, and could be arrested. Today, a quick glance at social media will reveal that we have plenty of “mask-slackers” who like to gather together in large groups, unmasked, and not engaging in social distancing. They are clearly much more aggressive about their resistance to mask wearing than were like-minded people in 1918. To my knowledge, there aren’t any places in the United States today where people can be fined or arrested for refusing to wear a mask. It is possible that some states or counties are considering it. Today, we wear masks when we want to shop at a grocery store. Back then, people stood outside the store and shouted their order loud enough for the shop workers inside the store to hear them. Another option was to write down a list of what they wanted to buy, leave the list near the door, and wait. Science Takes Time The most frightening thing I learned from this book is how long it can take for scientists to develop a vaccine. The scientists of one-hundred years ago had disadvantages to overcome. Few had managed to create a vaccine – for anything. They had to start from scratch while trying to develop an influenza vaccine. Meanwhile, some doctors still believed that it was “only influenza”, and assumed the virus wasn’t very serious. My assumption is, as the death toll rose, at least some of the doctors realized they were mistaken about how dangerous influenza actually was. Shortly before the influenza virus started infecting people, a huge change was made in regards to the determination of who could be considered a doctor. The medical universities in the United States started out as for-profit. Today, we would probably call them “diploma mills”. The purpose of these schools was to create revenue, which was used to pay the professors salaries. Medical students learned from lectures or books, but never once actually saw a patient. Heaven help the first patient those doctors attempted to treat! Those who truly wished to practice medicine in the United States traveled to Europe to attend their medical schools. Those schools actually taught students the knowledge and skills they would need as a doctor. These students worked on cadavers and, eventually patients, before graduating. In short, what happened was the “diploma mills” were examined by someone who not only had plenty of knowledge about medicine, but also had no qualms about giving the schools the bad grades they deserved. Many closed after that, unable to meet the new criteria. Some merged with real medical schools. Johns Hopkins was formed around this time. Today, as I write this book review, we are approximately six months into the COVID-19 pandemic. We have some wonderful doctors and nurses, but they are suffering from not being able to obtain the PPE that they need in order to prevent catching the virus. There are several different companies that are attempting to develop a COVID-19 vaccine. Science takes it own time, however, and there is no way to be certain when a vaccine will become available. Meanwhile, the death toll continues to rise. Looking Ahead The version of The Great Influenza that I read was published in 2005. It includes a new Afterword that I found to be extremely informative. It delves into SARS, H1N1, and other corona viruses. In addition, John M. Barry offered advice about what the United States should do in order to be prepared for a new pandemic. At the time, Barry stated that we were not prepared at all. He recommended that the United States start making their own vaccines, and not depend upon other countries to supply us with it. In 2004, the United States was relying on Great Brittan for vaccines, and faced a problem when Great Brittan cut the total doses available outside of their country by 50%. Berry also emphasized “surveillance” in the form of what we may recognize as contract tracing. The earlier we identify a new virus, he wrote, the better chance we have to develop and distribute a vaccine. My hope is that the next President of the United States will take the time to read The Great Influenza and learn lessons from it. There is potential that we could have a new President in January of 2021. That person will have the opportunity to put plans in place to prepare for the next pandemic – while continuing to fight this one. Based on what we have seen, the current (impeached) President has little to no interest in protecting Americans from COVID-19. The Great Influenza – by John M. Barry is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... The Sovereignties of Invention – by Matthew BattlesJanuary 26, 2020Book Reviews / fictionThe Sovereignties of Invention is a book of short stories – all of which are at least somewhat creepy. Matthew Battles does a good job of keeping readers in a state of curiosity and wonder, which sometimes leads to dread and horror. This may not be the book for everyone, but I really enjoyed it. If you like stories that include strange situations that leave the reader wondering what happens next, this is the book for you. My favorite story in this book is called “The Gnomon”. It takes place at a technology convention, where everyone is walking around wearing lanyards with little plastic pockets that serve as their admission passes. The Gnomon is a black box that has no discernible ports, no lights, and absolutely no one there to explain what it does. It becomes a topic of conversation as people try to figure out what it might be. Then, it starts following the people who are attending the conference on social media. There is a point where the story goes from an interesting puzzle to true horror. The reader is never given a specific explanation of what The Gnomon is, or why it suddenly reacts the way it did. The first story in the book is called “The Dogs in Trees.” It involves a situation where people are noticing that dogs have started appearing in trees. At first, it seems like a quirky story, but it slowly becomes very disconcerting. Only the dogs seem to know why they’ve taken to the trees. A story called “I After the Cloudy Doubly Beautifully” had me interested in it just from the title alone. A librarian was given the tax of clearing out the “X cage” – a repository of things that didn’t quite fit anywhere else. The librarian finds a mechanical translator machine, that involves ball bearings with letters on them that are spun around inside a glass dome. A ticker tape comes out with the words that it makes. The machine can translate back and forth into several languages. The librarian starts translating things from one language, to another, to yet another one. I found myself wondering what the final translation would sound like. But, something happens before the librarian is finished with the machine. There are other stories that I have not mentioned and will leave the reader to discover for themselves. The Sovereignties of Invention is filled with glimpses of strange and beautiful things that can also be creepy and unnerving. I found myself thinking about these stories long after I’d finished reading the book. The Sovereignties of Invention – by Matthew Battles is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Restoration – by Olaf OlafssonJanuary 13, 2020Book Reviews / fictionThis is a heartbreaking story of love, and loss, and loneliness. It takes place in Italy, in the 1920’s. After the war begins, everything becomes more uncertain than it was before. It is the story of love gone wrong, due to misunderstandings. There are unanswered questions, dripping with regret and second guessing. All of this is set in a breathtakingly beautiful landscape, which provides a vivid contrast to the sadness that some of the characters are experiencing. Alice is a British ex-pat who is living in Florence, Italy with her family, surrounded by other families who are also British ex-pats. She comes from wealthy family, and is expected to marry an Englishman. Instead, she marries Marchese Claudio Orsini, a titled, Italian nobleman who was the son of a landowner. He is ten years older than Alice, which doesn’t bother her. Alice’s mother, however, is completely distraught that her daughter failed to marry an Englishman (like she was supposed to). The two newlyweds fled shortly after their wedding, in an effort to escape all the pointless social necessities. Most of Alice’s family were mean to Claudio, and this made it easier for her to leave her family and start a new life with him. Long story short, they buy a large farm in Tuscany. While they do have a few people who are helping them with the work, there is still much to do. Alice knows nothing about farming, and she has difficulty adjusting. Eventually, she decides she loves this life and never wants to leave. The couple have a son, who is delightful. He becomes sick, ends up in the hospital, and dies while there. His father, Claudio was there when he died. But, Alice was absent, because she left the hospital to visit her lover. This causes a huge rift between Claudio and Alice, one that is not repaired. He leaves one morning to tend to a family who lives on their land – and never returns. Alice is left mourning their son, while also wondering if Claudio would ever return. The sense of loneliness hangs thick and heavy in the air. Time goes on, and the war begins. It eventually enters Tuscany. Refugees are fleeing the countryside as the German army advances. Many end up at the farm, which by now, has a nurse and a make-shift hospital. There are homeless children who become part of a school/orphanage. Food is scarce, and times are very difficult. There is always the threat that the German army will one day come and take the farm. Some of the people Alice (and her workers) are protecting are those that the German army would happily kill. In the midst of all this, a woman arrives at the farm. Her leg is badly injured, and she does not give her name. The reader learns her story in pieces. She was once working for a painter, who became her lover. He refused to leave his wife. The woman has all kinds of doubts about whether she made the right choices, including one that was an indirect type of revenge. The story is heartbreaking, and beautiful, and desperately sad. I feel like most of the unanswered questions are resolved by the end of the book. It is the kind of story that gives the reader a rich, visual, environment to walk around in, filled with people who are longing for someone they cannot have. Restoration – by Olaf Olafsson is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... The Sleepy Hollow Family Almanac – by Kris D’AgostinoDecember 10, 2019Book Reviews / fictionCalvin Moretti dropped out of college and has returned to his parent’s home. He has student loan debt that he must be find a way to pay off. So, he gets a job in something completely unrelated to what he went to college for. His father is sick, and has been laid-off from his lifelong career as an airline pilot. His mother tells Calvin that they are behind on the mortgage and could lose the house. The story is fiction, but feels like something that many families have lived through. The entire story is from the point of view of Calvin. The very first sentence is one that he was thinking, but didn’t actually say out loud. It is: “I work with retards”. Immediately, I decide that I don’t like him. My instant dislike of him probably comes from my background as a teacher and also as a day care worker. I’ve worked with kids who have special needs, and it bothers me immensely when someone refers to intellectually disabled people as “retards”. Calvin is basically a teacher’s aide, and should know better. But, he doesn’t. Calvin moved back into his old bedroom in his parent’s house, and realizes that he has pretty much reverted back to what he was like in high school. He’s listening to the same music, not helping much around the house, and getting wasted with old friends. Other than his job, he has no responsibilities to worry about. Calvin is stunted. I think this is something that can happen to people who return to their parent’s homes after finishing (or dropping out of) college. The situation puts them back into old roles with their parents, and in an unsettling emotional imbalance of power. For whatever reason, I decided to give Calvin a chance, hoping that he would grow up. There were some signs it could happen. For example, he had a notebook where he kept track of how much money he earned, and how much he sent to pay off part of his student loan. He appeared to be trying to be an adult. To be fair, there was a lot working against him. His father, who used to be an airline pilot, got sick and could no longer work. It was a job he loved, and, like many older men who lose their job, he kind of starts falling apart. The dad honestly believes that he is dying. He does have some kind of serious illness, but there is a medical intervention that might fix it. Or, it might not. To come home after dropping out of college, and see one’s father wearing a bathrobe and moping around, would be extremely stressful for most people. The dad starts hoarding things he thinks he will need if the world ends. He also starts carrying around a gun. Calvin’s mother tearfully lets Calvin know that they have fallen behind on the mortgage – far behind. His older brother, who was able to graduate and get a good paying job, has been helping with that as much as he could. I think this may have been the start of Calvin waking up from his regression into his teenage self and his thoughts about making better choices. Speaking of big life decisions, Calvin’s younger sister tells him that she is pregnant. She wants to keep the baby, but doesn’t want anything to do with the baby’s father. The sister is still in high school. By the end of the story, things are resolved in ways that are both a relief and also heartbreaking. Calvin is finally able to not only become an actual adult, but also to meaningfully help out his family. I’m glad I decided to read the book beyond the first sentence, because if I had not, I would have missed out on watching Calvin grow up. One of the most interesting things about this story, other than Calvin and his wandering thoughts, was the way the family interacted. This is not a dysfunctional family, but rather one that has experienced a series of unfortunate events. There is plenty of love, and that’s what helps them to stick together and work things out. The Sleepy Hollow Family Almanac – by Kris D’Agostino is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Drinking Closer to Home – by Jessica Anya BlauNovember 22, 2019Book Reviews / fictionAnna, Portia, and Emery – three siblings who are now adults, have returned to their parent’s home. Their mother, Louise, is in the hospital after suffering what has been described as a “massive” heart attack. The siblings are there to be able to visit their mother at the hospital, and also to provide emotional support for their father. Drinking Closer to Home is about a quirky family, each with their own unique problems. It is about living through situations that I would consider to be neglect, and somehow, being able to come together as a family during difficult times. The title of the book comes from a family story that involved the sibling’s mother when she was a tiny baby. It is the punchline of what, to me, is obviously an instance of severe neglect. I think this small part of the book is what makes the rest of it comprehensible. The members of this family have learned to find humor in situations that were neglectful, dangerous, and emotionally scarring. It is their way of coping. For example, the year that Anna was eleven, Portia was eight, and Emery was three, Louise told the girls that she had decided to quit being a housewife. Anna would be in charge of cooking, and Portia would be in charge of taking care of Emery. No one cleaned the house, and the backyard (including the pool) fell into disrepair. This was not a temporary situation! The book jumps around between the present – with chapters titled “Day 2” that mark time passing while Louise is in the hospital, and the past, with years as chapter titles. My impression is the the majority of the book comes from the viewpoint of one of the siblings. Portia is very pregnant with her second child, and has just gone through a divorce. She is co-parenting her first child with her ex-husband, and missing her daughter. And now, she is also very worried about her mother. Anna is an addict, who has gotten things mostly under control. (She has started eating too much red vines candy while visiting with her mother at the hospital). There is a lot of trauma in her past, in part, due to her own unfortunate choices. Anna is married, but isn’t necessarily monogamous. Emery brought his boyfriend, Alejandro, with him to his parents house. The two are an established couple, and they want to have children. This puts Emery into an uncomfortable position. How does one ask their sisters for their eggs at a time when their mother might be dying? Then, there’s Louise, who has been smoking for decades. The doctors want her to quit, but she’s not interested. Of course, she can’t smoke while she’s at the hospital, especially while recovering from a heart attack and very weak. Louise has her own issues with her parents, and also with her husband, Buzzy’s, parents. Buzzy has his own secrets to deal with. One reason I like this book so much is because the characters are vibrant and resilient. They find a way to keep going, despite using less than advantageous coping mechanisms. Overall, family honestly is very important to all of them. They manage to come together when times are tough. Another reason is because some of it reminds me of my own dysfunctional family. My mother never officially declared she decided not to be a housewife anymore – but that’s what her actions amounted to. Some of my family members were/are hoarders, and the house was never clean. In my case, my family is very toxic, and I needed to separate myself from them. So, I guess what I’m trying to say is that Drinking Closer to Home provides me with an satisfying story that allows me to imagine what it would be like if my family was able to overcome their issues and become functional. Drinking Closer to Home – by Jessica Anya Blau is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Stories for Nighttime and Some for the Day – By Ben LooryOctober 25, 2019Book Reviews / fictionStories for Nighttime And Some for The Day is, as you may have guessed, a book of short stories. One of them could probably fit into a single Tweet! Each short story feels like a parable or a fable. I got the feeling that there was a lesson in each one, if only I could puzzle out what it was trying to tell me. This imaginative collection of stories refuses to hand the reader an obvious answer about what it all means. One of my favorite short stories in the book is called “The Octopus”. It is about an octopus who lives in an apartment. His landlady brings up his mail. All of this is presented as though it is a perfectly normal occurrence. There is a letter from his two nephews, who live in the ocean. The nephews want to come visit, and upon arriving, want their uncle to take them around the city. He wasn’t expecting they would want to do that, and is largely disappointed by having to be a tour guide. When it is time for the nephews to return to the ocean, the octopus needs to make a decision. Should he go back to his apartment, or is it time for him to return to the ocean? My take on this story is that it is about that moment when you look back upon your life, and a big decision you once made… and decide to abandon it in favor of returning to the life you had before. Your understanding of the story may be entirely different from mine. That’s the beauty of the stories in this book! Another story that caught my attention is called “The Book”. A woman buys a book only to find that all of the pages are blank. The bookstore will not let her return it or exchange it. This makes the women irrationally angry at the book. She begins complaining about the book, and her complaints … go viral, so to speak. She unintentionally makes the book even more popular than it would have been had she decided to just forget about it. Years ago, I used to work in a big chain bookstore. Every so often, someone would come in to complain about a book that was currently rising in popularity (or was, at that moment, a best seller). Catholics came in to complain about The DaVinci Code (by Dan Brown) to insist that it was blasphemous and should be removed from the shelves. Confused people, who believed that if their children read the Harry Potter books they would actually learn magic, complained about those books being in the children’s section. The result was always the same. The complaints caused more people to become curious about whatever the controversial book was. In other words, I can relate to this particular short story from personal experience. Other stories in the book are not so dreamy. There are some rather terrifying stories that are creepy and confusing. I didn’t need to know what those stories were about to feel a visceral shiver as I read through them. I found the story about martians being treated as “the help”, and another story about an alien spaceship and two people who fell in love with each other, to be fascinating. Overall, reading these short stories reminded me of when I was a child and exploring the world inside of a new book with wonder and acceptance. Stories for Nighttime and Some for the Day – By Ben Loory is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... The Care and Feeding of Exotic Pets – by Diana WagmanOctober 8, 2019Book Reviews / horrorDespite the title, The Care and Feeding of Exotic Pets, is not a book about how to provide care and comfort to an unorthodox choice of pet. You won’t find this one in your local pet store! Instead, it is an intense, creepy, novel about a woman who is kidnapped by a man who owns a gigantic iguana. Diana Wagman does an excellent job of getting into her characters heads, frightening the reader, and building the intensity of the story as it goes on. I want to take a minute to talk about the cover art. At first glance, the white letters of the title (and the name of the author) pop out. It took a bit longer to see the huge, green, iguana, ominously curling around the title. Winnie is thirty-eight-years old, divorced, and sort of lost. Her husband, Jonathan, left her for a younger woman. Winnie and their daughter Lacy, still live in the home Lacy grew up in. But, things are different now. Jonathan is a somewhat-famous TV game show host. He left Winnie for a twenty-something woman who was a contestant on the show. Jonathan and Winnie are still in touch, in part because they are sharing custody of their daughter. Lacy is a teenager who has become rebellious, and is starting to get in trouble at school. Winnie believes Lacy has started smoking. Winnie wants to still be married. She wanted to grow old with someone. The life she is living now doesn’t feel right to her. As such, she has gone from being a person who kept a tidy home to one who has lost interest in doing laundry. After dropping Lacy at school, Winnie takes her car to the shop for repairs. She is dressed in a tennis outfit (that needs washing). She waits outside for the vehicle that is supposed to take her to where she can obtain a rental car. After getting one, she has plans to go to her tennis lesson. Winnie’s thoughts are a mile away. A car pulls up and stops in front of her. She gets in, without thinking much about it. Slowly, she learns that the man driving the car has no connection to the repair shop or the rental company. This is where the tension starts building. The man who kidnapped Winnie is very troubled. He owns a gigantic, male iguana, which lives in his kitchen. The iguana is ready to mate, and is uncomfortable and irritable. The entire house is kept at a stiflingly hot temperature, for the iguana’s benefit. How can Winnie escape? I spent much of the book wondering if the iguana would eat Winnie. The story gives readers little clues, slowly, that make connections that were not immediately apparent. I’m not going to tell you how it ends. What I will says is this book is intense, and scary, and includes violence. Diana Wagman did an excellent job of making the characters, even the unlikable ones, very real. The Care and Feeding of Exotic Pets – by Diana Wagman is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Where’d You Go, Bernadette – by Maria SempleSeptember 13, 2019Book Reviews / fictionBernadette is a quirky, unbalanced, architect who hasn’t worked in a while. Her husband, Elgin, works for Microsoft. They live in Seattle with their wonderful daughter, Bee. Bee comes home from school with a stellar report card and asks her parents for a trip to Antarctica (a promised reward for good grades). Bernadette disappears shortly before the trip. This leaves her family wondering: “Where’d you go, Bernadette?” I am aware that this book has been made into a movie, but I haven’t watched it yet. Everything I put into this book review is from what I read. The thing I liked the most about this book is the format that the story was presented in. Almost everything is a letter, note, email, or other type of information written by one of the characters and sent to another. The rest comes to the reader from the viewpoint of Bee. My best guess is that there may be other books written this way. But, this one felt unique because it included such a wide variety of things that the reader gets to take a look it. The reader learns about the various characters – their personalities, motivations, desires – by “snooping” on things they wrote that were intended to be private. Another advantage of using this technique of storytelling is that the reader never had to guess which character’s head they were in, or who was speaking. Just look at the bottom of the note, where someone signed their name! The reader isn’t the only one reading things they weren’t meant to see. As the book goes on, it is revealed that the little pieces of writing that connect to either Bernadette or Elgin are a collection that Bee is pouring over. She wants to try and solve the mystery of where her mother went, in the hopes of finding her. Without giving away too much of the story, I can say that part of it is about Bernadette’s past as an architect. She was brilliant, and had an eclectic style that often incorporated salvaged pieces. But then, something happened that she never quite got over. Elgin is described as a “guru” at Microsoft. He’s a bit distant, and tends to focus a lot on his work. As such, he comes across as either oblivious or simply uninterested in socializing with coworkers. Put this together with Bernadette’s agoraphobia, and it kind of explains why the two of them have become disconnected from each other. There is a hysterically funny scene involving a mudslide (and I know that sounds terrible). No one is physically harmed, but there is plenty of property damage. It is the culmination of a “fight” between Bernadette and a character that I found to be unlikable. I believe the reader is supposed to have that reaction to that specific character. There are beautiful descriptions of Antarctica, as seen from a cruise ship. Maria Semple paints a vivid picture, and I felt like I could “see” the different colors of the snow, ice, and sky as I read through that part of the book. As I already mentions, I have not watched the movie that was based on this book. I cannot help but wonder what the visuals in the movie are like. In many ways, this book is about characters who are too wrapped up in themselves to properly form relationships with others. They all have their own reasons for being like that. There is an underlying theme of broken trust and an attempt to repair it. By the end of the book, the mystery of where Bernadette went, and why she went there, is revealed. I found it to be a satisfying ending. The book is funny, and strange, and is has the most delightful way of giving the reader little pieces of the mystery of Bernadette’s disappearance to stitch together. Some of the characters grow, and in doing so, are able to see where they have made mistakes. It leaves the reader with the reassurance that, despite what happened, relationships can sometimes be repaired if everyone involved chooses to work on them. Where’s You Go, Bernadette – by Maria Semple is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... World of WarcraftSprite Darter’s WingsNovember 21, 2020World of Warcraft / World of Warcraft otherThe Sprite Darter’s Wings transmog was given for free to players who have a six-month World of Warcraft subscription. That’s how I got it. Players who don’t have a six-month WoW subscription can buy it for $20.00 from the Blizzard Shop. Enchant your friends and beguile your foes with this eight-piece transmogrification set inspired by the fey dragons of Azeroth. This appearance features cosmetic wings and a mesmerizing mask that make you a sprite to behold and will take the breath away from friend, foe, and dragonkin alike. This colorful transmog set was perfect for Meipo, my Gnome Mage. She is based on one of my Dungeons & Dragons characters named Meepo. (WoW wouldn’t let me have that spelling). Meepo is a Kobold Sorcerer who loves bright colors and shiny things. Each piece of the Sprite Darter set can be found in your Appearances tab. Splitting it up means you have to search around each piece in order to do the entire transmogrification. The advantage of splitting up this transmogrification set into pieces means that a player can pick and choose which parts to transmog. For example, maybe you just want to use the wings – but not the rest of the set. If I remember correctly, it cost one gold for each piece I chose to transmog. Here is the entire Sprite Darter transmogrification set on my Gnome. I honestly love it! The colors and goofiness of the set is perfect for Meipo. This is what the back of the Sprite Darter wings look like. The Sprite Darter set transmog doesn’t match the Steamscale Incinerator. The set matches quite well with the Squeakers, The Trickster mount. It makes Miepo look like a tiny fairy dragon who is riding a mouse. Sprite Darter’s Wings is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Steamscale IncineratorOctober 30, 2020World of Warcraft / World of Warcraft Pets and MountsThe Steamscale Incinerator was offered to players who had six-month World of Warcraft subscriptions. To me, it looks like a steampunk dragon. The World of Warcraft Steamscale Incinerator was presented to players who had six-month World of Warcraft subscriptions on July 9, 2020. It would be waiting for me where the rest of my mounts were located – but it wouldn’t wait forever. “Thanks for purchasing a 6-Month Subscription to WoW! Please, enjoy this majestic mount on us. Claim by January 31, 2021. Not usable in WoW Classic.” A mad gnomish inventor had a dream to ride a dragon, so he created this metal monstrosity. He powered it with a trapped demon, in order to create “an authentic dragon soul,” and did not survive its activation. Here’s what this mount looks like when walking on the ground. (Stormwind City Guard for scale). The Steamscale Incinerator looks awesome when flying at night. The underside of the dragon glows a bright red that seems to pulse. There are two large cogs spinning where the wings attach to the body. I took this screenshot on a whim while flying around Stormwind. Just for fun, I took this screenshot of the Steamscale Incinerator in Ironforge while the 2020 Hallow’s Eve event was taking place. Steamscale Incinerator is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... WoW Classic: EcheyakeeJuly 21, 2020World of Warcraft / World of Warcraft ClassicAt the start of today’s adventure, Vaca was at Level 15. She was ready to take her newly acquired Stonewood Hammer and use it on whatever the quest givers wanted her to kill. She was certain Neverlast was equally ready to go. These screenshots were taken on September 25, 2019. Serga Darkthorn: How goes your hunt, Vaca? Have you found the prowlers? Vaca and Neverlast started their day by turning in the Prowlers of the Barrens quest. It took longer than expected because some of the prowlers lacked claws. The Taurens assumed there was some kind of plague affecting the local wildlife. Serga Darkthorn: Whitemist, Echeyakee in the Tauren tongue, is the king of the savannah cats. He hunts with such stealth, they say he’s like a thin, white mist on the earth. And he kills so fast his prey have no time for fear, or pain. The Tauren say he is both mercy and death. You will learn if that’s true, for I now set you on the path to hunt Echeyakee. His lair is northeast of the Crossroads, among the bones of giant Kodo Go. Blow this horn when you reach his lair. Blow the horn, and he will come. The Taruen decided to take this quest. Did Echeyakee exist? Vaca was certain this would be an exciting battle. All Serga Darkthorn wanted from the kill was Echeyakee’s hide and a report on what the fight was like. The hunt for Echeyakee required Vaca and Neverlast to leave The Crossroads. On the way, they found some very obviously plagued antelope. Neverlast used his fancy Druid skills to heal the plagued antelope. It became healthy again, and appeared to be glowing as it ran off. When the Tauren arrived at what they thought might be the right place, they blew the horns that Serga Darkthorn gave them. After waiting a little while, Echeyakee appeared. He was real! Vaca, being a warrior, rushed into battle to fight this beautiful, dangerous, creature. It was the only way to get the hide that Serga Darkthorn wanted. The battle was difficult, and Vaca may not have survived it if it wasn’t for Neverlast’s ability to heal her with Druid magic. The Tauren were victorious. Echeyakee disappeared right after the Tauren collected its hide. All that was left to do was return to The Crossroads and turn in the quest. On the way back, Neverlast stopped to heal more plagued antelope. They always ran away after he healed them. It was as though they felt better and regained the strength required to run across The Barrens. They came across a herd of antelope. A few that looked fully grown were surrounded by smaller young ones. The Tauren took a moment to stand still and take in the beauty of this world. Vaca hit Level 16 while fighting two Ornery Plainstriders. She survived thanks to Neverlast healing her. The Tauren reluctantly decided to begin working on a quest from Darsok Swiftdagger (who was also at The Crossroads). He wanted Vaca and Neverlast to kill some Harpies and collect 6 Harpy Lieutenant Rings. The rings are only held by Witchling Slayer Harpies. Vaca and Neverlast struggled through their previous battle with harpies. And now, they had to fight the ones that were even tougher! There was a dead Tauren off to the side of where the harpies lived. That’s never a good sign! Neverlast and Vaca started fighting Witchwing Slayer Harpies, each very glad they did not have to do this quest alone. Some of the Harpies dropped Harpy Lieutenant rings. But, not all of them did. Darsok Swiftdagger didn’t mention that before sending the Tauren out on this quest. Neverlast used a Druid spell to hit a harpy from a distance. The harpy immediately flew over to them, where Vaca could fight it without ending up in a mob of Harpies. Neverlast called this technique “fishing for harpies”. Eventually, the Tauren ran out of harpies that were within range. Vaca jumped into a mob, and noticed that the harpies she and Neverlast fought before – that seemed tough at the time – were much easier to kill. Vaca had grown stronger. Meanwhile, Neverlast had gotten into some trouble. Vaca had just finished killing harpies, when she noticed the “parade” that Neverlast was leading. Vaca intercepted the harpies and tried to fight them off. It did not go well for the Tauren. After making a “corpse run”, the Tauren moved away from the harpies and took the high ground. They needed a place to safely rest and recover. When they were ready, the Tauren walked back down the hill and began “fishing for harpies” again. They had not yet obtained enough of the rings they were asked to collect. The Druid spell that Neverlast used was super effective at getting the attention of harpies that had isolated themselves. This was so much more efficient than having to fight a mob of harpies! Eventually, the Tauren decided to return to The Crossroads. First, they handed Darsok Swiftdagger the Harpy Lieutenant Rings he wanted. They were rewarded with some silver. Next, they returned to Serga Darkthorn so they could give her Echeyakee’s Hide. Serga was very interested in hearing about how that battle went. Serga Darkthorn: You’ve beaten Echeyakee, and though his days of hunting are over … his spirit is with you. He will show you the strength found in subtlety, and the honor in mercy. Your path is still long, warrior. Let’s hope you stride it well. Serga Darkthorn had another quest for Neverlast and Vaca. Serga Darkthorn: Now, Vaca, the hunt deepens. Now you must defeat your prey, and then find your way to its lair. Hunt the sunscale raptors to the south. Slay them and remove the feathers they wear. Place the feathers on the scytheclaw nests southwest of the Stagnant Oasis. Show their brethren you do not fear them! By now, after a long day of fighting, Vaca and Neverlast were tired. They decided to spend the night in The Crossroads. The sunscale raptors would still be out there tomorrow. WoW Classic: Echeyakee is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... WoW Classic: HarpiesApril 29, 2020World of Warcraft / World of Warcraft ClassicNeverlast and Vaca had traveled together, fighting a wide variety of creatures and turning in quests. They had no idea how difficult it would be to fight a flock of skinny bird people. These screenshots were taken on September 22, 2019. Today started with Vaca and Neverlast fighting a Lost Barrens Kodo. Vaca, being a Warrior, jumped right in and started swinging. Neverlast, a Druid, healed his impulsive friend. The Tauren would soon learn that fighting Kodos was much easier than fighting Harpies. They needed to collect a few more Prowler claws in order to complete a quest. Strangely, it turned out that many of the Prowlers lacked claws. Vaca and Neverlast assumed that the Prowlers were suffering from the same plague that caused the Zhevra’s to lack hooves. Fortunately, this particular Prowler had some claws. The Tauren would be able to turn in this quest when next they visited The Crossroads. Overall, the day was going pretty well, until they encountered Harpies. The Tauren were asked to collect 8 Witchwing Talons. Little did they know that these winged, annoying, creature would be so difficult to kill. “A fine trophy your head will make, Tauren,” the Harpy threatened. Vaca won this battle, thanks to Neverlast’s help and healing. But, it was a much tougher battle than Vaca was expecting against skinny bird people. “My talons will shred your puny body, Tauren,” the next Harpy yelled. Vaca knew she was much stronger and heavier than this little bird person. She wondered what the Harpies thought the word “puny” meant. Neverlast used a spell and trapped the Harpy in place. It was a good idea. This particular Harpy was tougher than the other ones, and both of The Tauren were getting really tired. Eventually, the last Harpy was down. Neverlast and Vaca finally had gathered up the necessary amounts of Witchwing Talons, and could turn them in to Darsock Swiftdagger at The Crossroads. It was time for a moment of celebration! The next thing to do was to hoof it back to The Crossroads. There was time to enjoy the scenery along the way. Vaca wondered what these big skeletons were. She kept finding them scattered across the land. Maybe they were kodos? On their way through The Forgotten Pools, another Lost Barrens Kodo picked a fight with Vaca. There was no choice but to fight back. You can’t talk a Kodo out of a course of action once they have chosen it. When the battle was over, Neverlast was able to pick up some Thin Kodo Leather. Apparently “thin” is a relative term in this case. Back at The Crossroads, The Tauren climbed a tower and spoke with Darsok Swiftdagger. He was the one who gave them the quest to fight Harpies. It would be great to turn that in and forget all about the horrible bird people. Darsok Swiftdagger: Cut up enough of them yet? Keep slicing and taking trophies. I want 8 Witchwing talons. Neverlast and Vaca happily handed over the Witchwing Talons they collected. They each received some silver coins in return. Harpies are tough to fight, but the pay was worth it. Before The Tauren could start their way back down the tower, Darsok Swiftdagger had something else to say to them. Darsok Swiftdagger: Hahaha. Vaca, Back for more? Good, I like to hear that. This time I want you to assassinate some of the harpy lieutenants in the Dry Hills. Only Witchwing Slayers can be lieutenants, and you can tell them apart by the rings they carry. They are a nasty bunch, but they lead some of the underlings in that area. Taking out 6 of them will be a decisive strike against their matriarchy. Make sure they die painfully, Vaca. We want those harpy wenches to know the idiocy of picking fights with the Horde. Vaca wondered why this tough-talking Orc didn’t go out and fight the harpies himself. But then, she thought about the words Darsok was using. He clearly was afraid of the Harpies, whom he hated in part because they were female. Darsok wanted their matriarchy destroyed. Vaca guessed he saw it as a threat to the Orc’s patriarchal system. It took Vaca a moment to realize that Darsok thought she was a small, male Tauren. The first batch of Harpies were exhausting, and this new group was going to be even tougher. Vaca and Neverlast turned to each other, shrugged, and accepted the quest. Neither were looking forward to it. They decided to rest up before taking on more awful Harpies. Hopefully, the money would be worth the effort. #Blapril2020 WoW Classic: Harpies is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Meipo the Mage – To Level 60!April 25, 2020Adventures of Meipo / World of WarcraftMeipo is the WoW version of one of my Dungeons & Dragon characters. I leveled her up to Level 50 in November of 2019, and eventually got her to Level 60 on February 17, 2020. My plan was to put together a blog about it shortly after that, but I wasn’t able to get around to it until now. Meipo hit Level 50 in Andorhal, so her adventure continues from there. She got in a fight with Darkmaster Gandling, and got pushed up into the air. Meipo was saved by Thassarian and Koltra Deathweaver. After that battle ended, Meipo was able to turn in the Scholomancer quest. Thassarian: Excellently done, Meipo. And now, with the leader of the Scourge forces eliminated from Andorhal, we bide our time. Gandling’s Gloves are a transmog item. Next, Meipo traveled to Chillwind Camp, to talk to Commander Ashlam Valorfist. An Achievement popped up when she arrived: The First Battle for Andorhal Commander Ashlam Valorfist: These farmers from the south wish to take these farms, but I can’t let them enter the plaguelands unprepared. Even with the Scourge gone, danger still looms in the form of the Forsaken. No, we must be ready to fight… and that includes our new visitors. Before doing anything else, however, I would recommend that you travel to Uther’s Tomb, to the east, and place this tribute before his statue to ask for his blessing. Speak with the priest that tends to the tomb when you are finished. She intended to do exactly that…. but got distracted by food instead. Now We’re Cookin’: Cook up one of every Pilgrim’s Bounty dish. Candied Sweet Potato, Cranberry Chutney, Pumpkin Pie, Slow-Roasted Turkey, Spice Bread Stuffing Pilgrim’s Progress: Complete each of the Pilgrim’s Bounty dailies. Can’t Get Enough Turkey, Don’t Forget The Stuffing, Easy As Pie, She Says Potato, We’re Out of Cranberry Chutney Again? Meipo put on all the Pilgrim’s clothing, and used this magic gun to turn some Rogues into turkeys. Short Order Cook: Learn 50 cooking recipes. Issac Allerton gave Meipo a Turkey Caller. It makes a noise like a turkey! It didn’t take long for Meipo to portal back to Stormwind, use the Turkey Caller, and catch all the turkeys she needed. She learned that some of her fire spells would not only stop a turkey from running, but also prepared it for cooking. Meipo also learned that the teleportation spell was extremely useful for getting things done during holiday festivals. Expert Cook: Obtain 225 skill points in the “Classic” category of cooking. Meipo learned the Candied Sweet Potato recipe. Meipo found herself surrounded by turkeys outside Ironforge. Meipo learned the Slow-Roasted Turkey recipe. Meipo hit Level 51 after turning in a cooking quest to Robby Flay. Getting back on track, Meipo flew past Aerie Peak. She noticed, for the first time, that there was a giant stone Gryphon standing on top of it. Meipo arrived at Uther’s Tomb and was greeted by High Priest Thel’danis. Uther the Lightbringer Here lies Uther the Lightbringer First Paladin – Founder of the Order of the Silver Hand Uther lived and died to defend the kingdom of Lordaeron. Though he was betrayed by his most beloved student, we believe that his spirit lives on. He continues to watch over us, even as the shadows close in around our ruined land. His light is the light of all humanity – and so long as we honor his example, it shall never fade. Anonymous Meipo received Uther’s Blessing. High Priest Thel’danis: You and the humans at Chillwind Camp wish to re-take Andorhal? I wish you luck. High Priest Thel’danis: If you truly intend to move forward in this battle for Andorhal… well, perhaps I can help. To the east lies a large crypt. The bottom level of the crypt was once used for storage of weapons and armor…until the Scourge came. Now that the undead have left, the weapons are free for the taking. Most of the weapons are probably rusted and rotten by now, but they will serve better than tunics and pitchforks. Meipo set out to find the Weapons Crate at the bottom of the Crypt in Western Plaguelands. She got temporarily distracted by this sculpture of Uther’s Hammer. Meipo found the Abandoned Crypt and a broken box of weapons. The Abandoned Crypt: Scattered all over the bottom level of the crypt, you find shattered crates that once held weapons and armor. It appears that somebody got here before you did. Meipo got ambushed by skeletons! She fought them with fire. After killing off the skeletons inside the Abandoned Crypt, Meipo gathered up the weapons she could find. Outside, there were more skeletons to fight. The Cryptkeeper’s Belt is a transmog item. Meipo took her collection of weapons, such as they were, to Thurman Grant. She remembered that he was leading a group of farmers who wanted to take back some farmland. But, he didn’t need the weapons. Thurman Grant: I told Commander Valorfist that we could hold our own, and we intend to. I had a little conversation with the death knight general, Thassarian, on my way over here. We farmers plan to help in our own way. We will take control of this farm, begin to cultivate the land… and then when the battle for Andorhal commences, we will attack the Forsaken from the rear. They’ll never expect it. First, we need to get rid of these Forsaken outsiders. Kill some. Then return to me. Meipo found that killing Forsaken with fire was pretty easy – especially if you had a group of farmers helping. The farmers worked surprisingly well as a team. Thurman Grant: In fact, you might still be able to help train some of my men. You probably noticed the abomination outside. We initially tried to fight him, but he didn’t fight back. He seems to want to help out on the farm. Take a group of four settlers and challenge this abomination to combat. He seems to be pretty tough, but with one of him and five of you, I think you’ll have a chance at beating him. Meipo gathered up four settlers and led them to the abomination. There was another group ahead of them, trying to fight the abomination. His name was Gory, and he wasn’t fighting back. Meipo decided to talk to Gory, and learned that he really does want to help out on the farm. He also enjoys standing in the warm sun. Meipo made a friend! She convinced the farmers to stop fighting Gory. Thurman Grant: We can handle things from here. I thank you for your help, Meipo. I assume that when we next meet, it will be in battle. Take care of yourself until then. We’ll get all the help we can get. Meipo earned the A Temporary Peace Achievement. Thurman Grant gave Training Leggings to Meipo. It is a transmog item. Meipo went to the Menders Stead and met Field Agent Kaartish. Field Agent Kaartish: Welcome, mage. As you can see, our camp is a joint expedition between Argent Crusade members and the Cenarion Circle druids, but we welcome all who wish to help heal the land. Miepo met Durnt Brightfalcon. She waved hello, but he didn’t wave back. Durnt Brightfalcon: Word is in from Andorhal, Meipo. The battle has resumed. It has become somewhat well-known among the Alliance forces that you’re a hero of the first battle of Andorhal. Thassarian has requested your presence immediately. Meipo was asked to report to Thassarian at Andorhal in Western Plaguelands. She started going there, but as usual, got a bit distracted on the way. She picked up a Plague Lurker Sample for…. someone. She forgot who. Meipo hit Level 52 while mining for shiny things. Meipo gave all the plague samples she found to Field Agent Kaartish. He was very happy to have them. Field Agent Kaartish: I will need some time to study these samples, Meipo. I will speak to you again when I have completed my analysis. Field Agent Kaartish: We are not the only Argent Crusaders here in the plaguelands. Our headquarters, Hearthglen, lies to the north. Even nearer to the north is a small lumber mill which we also control. Nathaniel Dumah is my main contact at the lumber mill. I encourage you to speak with him, should you find yourself in that part of the woods. Meipo intended to go to the Northridge Lumber Camp. But first… she decided to make more Spiced Bread Stuffing for Caitrin Ironkettle. In doing so, Meipo earned the 50 Daily Quests CompletedAchievement. Meipo made a friend! A Dun Morogh Chicken came up to sit by her campfire while Meipo was cooking. Got My Mind On My Money: Loot 100 Gold. Meipo watched a Dwarf fight a bunch of Goblin Brawlers at Booty Bay. Meipo stopped by the Ruins of Lordaeron to eat some Sweet Potatoes. The Forsaken didn’t seem to mind sharing with her. When Meipo finally made it to the Northridge Lumber Camp, she saw huge spiders everywhere! She decided to use teleport to “nope” on out of there. Meipo hit Level 53 while trying to reach the Pie Chair at Stillwater Pond. These elves were not as friendly as the Forsaken were! Meipo is wearing some combination of the holiday apparel. She also has on a Stormwind Tabard, gloves, and shoulders that are not part of the outfit. The Fine Pilgrim’s Hat is a transmog item. Meipo got lost and ended up in Thousand Needles, where she fought Needlespine Cobras. Meipo ended up in New Thalanaar fighting in a battle that she didn’t understand. These elves wanted help – so she threw fire at their enemies. Meipo fought Snarler in the Lower Wilds. She wasn’t intending to, but he jumped out and snarled at her. Snarler dropped a belt called Captain’s Waistguard of the Quickblade. It was not something Meipo could use. Archaeology involves digging – and that sounded like fun to Meipo. She went to the Ruins of Eldre’thar to see what she could find. Unfortunately, there were angry ghost elves there who tried to attack her. Meipo deployed an ice shield to protect herself. Eventually, she learned how to stay a safe distance away from them, and was able to dig up some interesting artifacts. Meipo learned that the Undead Ravagers in Desolace didn’t like fire! Professional Journeyman: Obtain 150 skill points in a “Classic” category of a profession. Meipo went to Shok’Thokar and fought some Doomguard Invaders. A fishing quest sent Meipo to go find Baby Octopus. They are as big as her! Meipo met Officer Jankie in Tehtris Aran. She stopped Meipo and directed her to Nijel’s Point. It wasn’t a choice. Officer Jankie: Halt! On behalf of the Nijel’s Point Guard, I am under orders to send all able-bodied allies to report directly to Corporal Melkins. I am not authorized to offer any other information. What I can offer is transportation. You are free to use my mount. It will deliver you directly. Dismissed. Shortly after arriving at Nijel’s Point, Meipo met Corporal Melkins. Corporal Melkins: Pentigast! Bring the new gnome up to speed, would you? Captain Pentigast: Yes, yes. Welcome to Desolace, gnome. Sorry we had to be so insistent, but we’re a small outpost, and there are big problems in this region – most of them quite urgent. Bottom line: We need all the help we can muster. To start with, our friend Vahlarriel over there has been getting pretty antsy, insisting that we send a contingent to visit the ruins in the east. Why don’t you go introduce yourself… Vahlarriel Demonslayer was nice to Meipo. “A pleasure to meet you, mage,” he said. Vahlarriel Demonslayer: Simply intolerable! Satyrs of all things, desecrating our sacred lands… Their days are numbered, gnome. I can assure you of that. As soon as we have the numbers, I shall lead a charge that will rid this land of the wicked creatures. For now, though, perhaps you could put my mind at ease? Travel just east of here to Sargeron and scour the ruins. Find the relics of Elune and ensure that they are in good condition. I’ll pay you well for the favor. Meipo hit Level 55 outside of Nijel’s Point. Meipo earned the Thistlefur Cap from finishing a quest. She tried it on, but couldn’t decide if it was better than what she was using before. So, she switched back and forth between them for a while. The Thistlefur Cap is a transmog item. The quests that Meipo was sent to do in Sargeron are a bit strange. First, she visited the Cup of Elune, which wants her to bring it 8 melons. The quest is called: “Nothing a Couple of Melons Won’t Fix.” The markings on the ruins here make one thing clear: There is something special about the old fountain in the Sanctuary of Elune. It would seem that one could expect special power from washing their face in the fountain. First, of course, there would need to be something in the ancient fountain with which to wash. Pondering this problem, you spot a melonfruit at the base of a nearby tree… After filling it with liquid from the melons, you proceed to wash your eyes from the ancient font. Upon opening your eyes, you are able to see the spirits of ancient elves, still faithfully carrying out rituals to their goddess. Spirits of ancient elves appeared. Three were close by the Cup of Elune, and more were wandering around the Sanctuary of Elune. There were spirits of ancient elves around Elune’s Brazier, too. What did the Brazier of Elune want Meipo to get for it? Ten pounds of flesh. Yes, really. According to ancient legend, this ancient brazier was placed her for the performing of sacrifices. From what little you remember of the history, a blessing is bestowed upon the being who places the flesh of Elune’s enemies on the brazier’s burning embers. Looking around, you determine that the satyrs who now possess this reagion would likely qualify. Meipo had no trouble finding Saytrs to fight. Gathering up a total of 10 pounds of Satyr Flesh was kind of icky. One of the Satyr’s dropped Hawkeye’s Cloak. It is a transmog item. Eventually, Meipo was able to gather up the Ten Pound of Flesh that Elune’s Brazier wanted. The divine brazier graciously endows you with a blessing. You feel a deep connection to the distant past having partaken of the ancient blessing granted by this relic. You determine to make as much as you can of this divine gift. Meipo found a statue of Elune’s Handmaiden. She had a quest called: To the Hilt! The handmaiden of Elune! It’s even more glorious than the stories tell. The legends surrounding this relic come to your mind as you draw near it. In ancient time, after battle, the enemies’ weapons were to be cast upon the basin in exchange for a divine gift of some sort. As you ponder this ritual, the glint of steel catches your eye from a nearby weapon rack… After collecting 20 Saytr Sabers from the weapon racks and various Satyrs in the region, Meipo brought them to the statue of Elune’s Handmaiden. With the ritual completed, you are awarded a divine gift. You can’t help but to feel a great sense of honor as you receive one of Elune’s boons. Sandals of Ritual are a transmog item. Meipo received Gloves of Nurture from Vahlarriel Demonslayer. The gloves are a transmog item. Meipo hit Level 56 at Firestone Point. Meipo earned the Pilgrim’s Peril Achievement at Thunder Bluff, will sitting in the Turkey Chair. Pilgrim’s Peril: While wearing either a Pilgrim’s Dress, Robe, or Attire, take a seat at each enemy capital’s Bountiful Table. Orgrimmar, Silvermoon City, Thunder Bluff, Undercity Meipo earned Pilgrim’s Paunch in Exodar while sitting in the Turkey Chair. Pilgrim’s Paunch: Acquire the Spirit of Sharing from a complete Bountiful Table feast at every Alliance capital. Darnassus, The Exodar, Ironforge, Stormwind Meipo earned the “FOOD FIGHT” Achievement outside of Stormwind. “FOOD FIGHT”: Bounce food off a fellow feaster’s head at a Bountiful Table. Meipo earned the Turkey Lurkey Achievement outside of Orgrimmar. There is a story that goes with that screenshot. Meipo was standing outside of Orgrimmar, hoping to turn a Goblin Rogue into a turkey so she could earn the Achievement. She started talking to a fellow Gnome, who just so happened to have a friend who was a Goblin Rogue. The Gnome convinced the Goblin to come by, and the Goblin agreed to be temporarily be turned into a Turkey. Turkey Lurkey: Blast those dirty sneaking Rogues with your Turkey Shooter! Blood Elf Rogue, Dwarf Rogue, Gnome Rogue, Goblin Rogue, Human Rogue, Night Elf Rogue, Orc Rogue, Troll Rogue, Undead Rogue, Worgen Rogue Meipo is riding the Squeakers, the Trickster mount. Together, they look like they fell out of a children’s story or a fairy tale. Meipo earned the Dangerous Love Achievement. Dangerous Love: Assist the Steamwheedle Cartel in stopping the sinister Crown Chemical Co. plot. Meipo hit Level 57 right after completing The Crown Chemical Co. dungeon. Meipo earned the Tough Love Achievement. Tough Love: Defeat the Crown Chemical Co. apothecaries in Shadowfang Keep. Meipo earned the Be Mine! Achievement by eating lots of candy hearts. Be Mine!: Eat the right “Bag of Candies” heart candies listed below: Be Mine!, I’ll follow you all around Azeroth, All yours, I’m all yours, Hot Lips, You’re Mine!, You’re the best!, I LOVE YOU! Meipo earned the Sweet Tooth Achievement by eating a lot of chocolate. Sweet Tooth: Sample the Love is in the Air candies listed below: Buttermilk Delight, Dark Desire, Sweet Surprise, Very Berry Cream It Might Just Save Your Life: Unleash the power of love contained within a holiday necklace. Meipo discovered Ban’ethil Hollow and hit Level 58. Meipo fought Agal (and one of Agal’s friends). Agal dropped the Imbued Pioneer Cloak. It is a transmog item. Meipo helped Oben Rageclaw in the Ban’ethil Barrow Den. Oben Rageclaw: I am finally free of the control of the Gnarlpine. Thank you, Meipo. My spirit may now rest peacefully forever in the Emerald Dream. Perhaps one day we may meet again, young mage. But for now, please accept this reward as a symbol of my gratitude. The Sleeping Robes are a transmog item. Meipo hit Level 59 after she completed The Crown Chemical Co. Dungeon. Meipo fought Ursal the Mauler. She also fought Lord Melenas. His head is a quest item. Meipo brought the quest item to Tallonkai Swiftroot. He gave her boots called Viny Wrappings. I don’t know if they are a transmog item. Meipo earned the Nation of Adoration Achievement. Nation of Adoration: Complete the Lovely Charm Bracelet daily quest for each Alliance capital. A Gift for the High Priestess of Elune, A Gift for the Prophet, A Gift for the Lord of Ironforge, A Gift for the King of Stormwind. Meipo hit Level 60 after she completed The Crown Chemical Co. Dungeon. #Blapril2020 Meipo the Mage – To Level 60! is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Deleting WoW ScreenshotsApril 20, 2020World of Warcraft / World of Warcraft otherOver the years, I have gathered up an abundance of screenshots from several games – including World of Warcraft. My goal is to use up as many of them as I can, since that was the point of taking them in the first place. The WoW screenshots in this blog post are from 2010. I no longer remember the quests, lore, or story line that goes with them. For context, I was using a Mac Mini in 2010. I don’t remember what type of monitor that was. Yes, my keyboard had stickers on it to look like a pirate flag. The mouse pad is of The Scream by Edvard Munch. My Tauren completed some kind of quest. I liked the contrast between the darkness of the cave and the bright light in front of my Tauren. This is Zoeie, a Dranei Shaman. She was my main for a long time. Zoeie is wearing a tabard with a spider web design. The design was changed often, but I liked this one the best. I took this screenshot because Zoeie had been cursed and I thought the glowing skulls, in a cloud of green poison, looked cool. The curse effect is more interesting when in a dark room. While I cannot remember what type of creature this one is, I do recall that it would run towards me and then suddenly stop. It sits and it stares. I’m fairly certain that this thing has undergone several aesthetic changes since 2010. Which one of my characters is looking at the green goo that is pouring down from somewhere? I have absolutely no idea. My shaman got lost in here. I took this screenshot because of the pattern of intertwined branches in the sky. The limited color palette in this screenshot was what caught my attention. Nearly everything is a variety of green. Zoeie is flying somewhere on a griffin. The background of this screenshot uses a very limited gray color palette. I like the way the brightly colored griffin stands out. Zoeie is riding a Striped Frostsaber through Westfall. Both of them look completely out of place. I’ve no idea why I bought her this mount. She’s definitely not a Night Elf, and this was long before mounts were automatically shared across characters. Once again, I’ve taken a screenshot where the subject matter pops out against the background. It was not intentional. Maybe this is just something that happens with people who have a degree in Art Education. Here is what Menethil Harbor looked like before it became flooded. In this one, Zoeie is flying over some ruins. This screenshot feels like something mystical is about to happen. In the center, there is a large stone with a mysterious rune carved on it. Below it, in a circle, is a row of candles (or something similar). A glowing creature is walking towards it. Floating rocks are in the air. This statue of an archer was located in the area where the Night Elves were at. I don’t think it exists in-game today. Or, if it does, it is probably in pieces. My very serious Death Knight, Riglee, is riding Gnome mount that is bouncy. I’ll end this blog post with a screenshot of Bessimu, my Tauren Warrior, riding a bat. Bessimu is wearing a hat from Brewfest. #Blapril2020 Deleting WoW Screenshots is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... WoW Classic: TeamworkApril 12, 2020World of Warcraft / World of Warcraft ClassicThe adventures of Vaca and Neverlast continue! This time, they set out to collect Raptor Heads and Centaur Bracers. If they were lucky, one of the Centaurs would drop a key that would open a chest. These screenshots were taken on September 19, 2019. Vaca started her day by learning how to cook Brilliant Smallfish. Warriors need a lot of food, so it seemed like a good idea to learn the Cooking Skill. Neverlast and Vaca took a flight to where they needed to be in order to complete a few quests they had started. It was much faster than walking there! They fought some Kolkars at The Forgotten Pools. It’s a lovely background to fight a battle in! Neverlast and Vaca make a good team. There’s just something about paring up a Warrior and a Druid that makes battles go well. The Tauren had the opportunity to explore The Forgotten Pools while working on a quest. The Tauren decided to find another area that had Centaurs, hoping that a different group would have more Bracers. There were plenty of Kolkar to fight in the Barrens, but they were too strong. The Tauren were able to separate out a few Kolkar from the crowd, and that almost worked. The disadvantage was that the battles lasted longer, and The Tauren had to take the time to heal up afterwards. They decided to return to The Forgotten Pools, where the Kolkar were easier to fight. This one didn’t have any Bracers, but did drop a Kolkar Booty Key. It was exactly what they needed to open a chest…. that they hadn’t found yet. Neverlast and Vaca celebrated their good luck and took a moment to enjoy the scenery. It’s easy to forget, while the fighting is going on, that there is still beauty in this world. The Tauren had managed to collect six out of the fifteen Centaur Bracers they needed in order to complete a quest. Vaca charged the next two Kolkar they saw, in an effort to speed things up. She knew that Neverlast was right behind her, and that he was very good at healing. The Kolkar Chest was located on top of a structure in the Barrens, near the area where the tougher Kolkar had gathered. Neverlast received 2 Mageroyal and 2 Briarthorn from the chest. It was a Druid quest, and Vaca was happy to help Neverlast complete it. Back to collecting Centaur Bracers. The Tauren now had eight out of the fifteen required for the quest. It was taking longer than expected, but for a Warrior, that just meant more opportunities to practice fighting skills. One would think that two Kolkar (who might have Cenatur Bracers) with two dinosaurs (who had parts needed for a separate quest) would be a lucrative battle. But, no. They didn’t drop anything useful. Vaca was Level 14, and Neverlast was Level 15. The aftermath of this battle was impressive, and worthy of taking a moment to remember it. Back to The Forgotten Pools! After slaying yet another Kolkar (that did not have Centaur Bracers), a small herd of graceful animals ran past Vaca and Neverlast. To Vaca, it looked like a mother deer, leading her babies to safety. Perhaps Neverlast, as a Druid, knew the proper names of these graceful creatures. The Tauren stood still and allowed them to pass by. To switch things up for a while, the Tauren changed targets and went after Sunscale Screechers. They needed to finish a quest that required them to collect the heads of these loud, fast, creatures. All of the Screechers clearly had heads at the start of the battle. Unfortunately, Vaca’s two-handed Goblin Smasher sometimes turned those heads into a pile of goo by the end of the battle, making them unusable. At least, that’s what she figured must have happened, since so many of the Screechers didn’t have a head anymore when The Tauren tried to loot their corpses. These two Kolkar dropped just enough Centaur Bracers for The Tauren to finish the quest. It was a big relief to not have to fight these angry people anymore. The Tauren returned to Rethgar Deathgate, an Orc who stood at the top of a tower in The Barrens. “How goes your hunting?”, he asked. Vaca and Neverlast handed a pile of Centaur Bracers to Rethgar Deathgate. Vaca hit Level 15 and obtained a Stonewood Hammer. It was two-handed, which she preferred, and more powerful than the Goblin Smasher. Next, Vaca followed Neverlast up Dreadmist Peak, so he could complete some kind of Druid quest. It wasn’t something Vaca understood, though he tried to explain it to her. The air grew thick with red colored dust, making it hard to see – and breathe. Vaca wasn’t sure how she would see their enemies before they were right on top of them. The Burning Blade Orcs at the top of this awful place used magic that glowed brightly. That made it much easier for Vaca to see – and hit – them. Together, The Tauren slayed them all so Neverlast could finish his Druid quest – whatever it was. Back to The Crossroads, where Neverlast and Vaca turned in the Raptor Heads to Garzog. He saw the raptors as “thieves”. Vaca didn’t much care what Garzog thought of them – she just wanted to turn in the raptor heads she and Neverlast collected. Bag space is scarce! The Tauren ran into Mankrik at the Crossroads. He gave them two quests to work on: Consumed by Hatred, and Lost in Battle. Mankrik had a lot to say: Mankrik: I came to the Crossroads from the south seeking help, warrior, but I find only cowards who turn their backs on me — even the mighty Thork insults me so. He is a good leader, but his dismissal of my plea causes me great anger. He claims my rage makes me hasty — that it clouds my judgement — but I will not rest until I have vengeance! The Tauren decided to help him out, as soon as they were able to. The Tauren ended their day at Thunder Bluff. Vaca decided to give the pile of wool she collected to Rumstag Proudstrider, who was seeking donations of wool. The Tauren had a shortage of cloth, and Vaca was willing to share what she had found. WoW Classic: Teamwork is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... WoW Classic: Questing for CashApril 5, 2020World of Warcraft / World of Warcraft ClassicVaca is a Tauren Warrior who recently hit Level 13. She, and her friend Neverlast, a Tauren Druid, have been adventuring together through WoW Classic. Today, they traveled around, turned in some quests that they were able to finish, and picked up some new quests they could work on next time. These screenshots were taken on September 17, 2019 Vaca’s day started where she stopped, in Hunter’s Rise near the Warrior Trainer and the Hunter Trainer. It was time to try out some of the new skills she learned. She flew to Thunder Bluff to meet up with her friend Neverlast. Zhevra made good targets for Vaca to test her new skills on. Neverlast and Vaca needed to kill off some Razormane in order to complete a quest. They ran into some helpful players who had the same quest, including a Troll named Zarakhan. It was surprisingly easy to find players who understand the value of joining up with others who are on the same quest as they are. Typically, this group lasts until everyone kills enough of the required enemy to finish their quest. An Orc Warlock named Brynni helped Vaca and Neverlast fight Kreening Snarlsnout. Neverlast marked him with a skull (possibly to help Vaca focus.) Together, they successfully killed Kreening Snarlsnout. Before leaving this area, our group needed to obtain a Supply Box and then take it to Crossroads. Thork: Welcome to the Crossroads, warrior. My name is Thork — I lead the defenses here in the name of the Warchief. Please feel free to make yourself at home. As long as you mind your business, no one should have any problem with you taking up some space. There are many threats to our safety here. If you’ve already become familiar with the lay of the land, speak to the others here — perhaps they have tasks for you to do. Thork is the questgiver who gave us The Disruption Ends quest and the Supplies for the Crossroads quest. Neverlast, Vaca, and Brynni were able to turn in two quests to Thork. Thonk: Cut off the head of their leader, and chaos ensues, Vaca. Learn this lesson well. It will aid you in the future. The boars will flounder without direction, and we will be able to take back the Barrens. He didn’t seem to care how many adventurers banded together to complete this quest. Vaca was rewarded with a Cinched Belt. Thork: How goes your search for the supplies, Vaca? I trust the quillboar fall under your strength easily. It was nice to unload a heavy box of Supplies on to Thork, and to get back some bag space. Our small party ventured out to collect Fungal Spores. The spores weren’t difficult to find. The Kolkars around the spores, however, were dangerous. All three party members died. The Lushwater Oasis was actually sort of pretty. It was nice to look at while taking a short rest after finally gathering up the required number of spores. Vaca hit Level 14 after right after kiling yet another Zhevra. We had a quest to collect Zevhra hooves. Many of them didn’t have hooves, which Vaca and Neverlast found both perplexing and disturbing. Back to The Crossroads to speak with Serga Darkthorn. Serga Darkthorn: How may zhevra have you slain? The Tauren looked at her, and decided not to directly answer that question. Was Serga Darkthorn aware of how difficult it was to find zhevra that actually had hooves? Unsure whether or not she was joking, The Tauren simply handed over the Zhevra hooves they had painstakingly collected. Serga Darkthorn: Not bad, Vaca. Those zhevra hold a lot of strength in their legs. A sharp kick from them on its haunches! It looks like you have some strength in you too. Are you ready for a real challenge? Serga Darkthorn gave us the Prowlers of the Barrens quest. She asked the Tauren to collect 7 Prowler Claws from Savannah Prowlers. The Tauren wondered if the prowlers would all actually have claws, or if they were experiencing the same mysterious plague as the zehvra were. Eventually, they shrugged, accepted the quest, and figured that the effort would at least give them some money. Next, Vaca and Neverlast spoke with Apothecary Helbrim. He was the one who sent them out to get Fungal Spores. Apothecary Helbrim: Do you have the spores, Vaca? There is a concoction I must send to my associate in Thunder Bluff, which requires the spores… Apothecary Helbrim: Ah, good. These spores have rendered nicely. Thank you, Vaca. Neverlast was already making arrangements for the flight to Thunder Bluff. Flying across the Barrens to Thunder Bluff is faster than walking there The Tauren needed to go to The Pools of Vision, which is a small cave system underneath Spirit Rise in Thunder Bluff. There are several Forsaken in there, which seemed very strange to Vaca. She wondered why they weren’t living in their own city. Were these Forsaken outcasts? On her way through the cave, Vaca was stopped by Clarice Foster, who was a higher level than she was. Clarice Foster: Filthy scum! Leaves me for his damn crusade. Because “the Light is the most important thing we have against the threats the undead pose.” Well, what about his children?! What about ME?! Night after night I sat patiently waiting for him… always second to his blasted duty! Well, witness what “justice” brings you, Vaca! He’s dead and I’m bearing the very thing he was trying to stop! Take this piece of junk and put it on his tomb at the Sepulcher. I want nothing to do with it anymore… or him! Clarice pressed a pendant into Vaca’s hand, and told her to look for Yuriv’s Tomb in Silverpine. Vaca didn’t entirely understand what Clarice Forster meant by “the Light”. Maybe these pale people can’t go out in the sun? Neverlast and Vaca found eventually found Apothecary Zamah in the Pools of Vision. They handed off the rendered spores from Apothecary Helbrim, and didn’t ask any questions about what those spores would be used for. Vaca’s day started, and ended, in Thunder Bluff. It was time for a rest. #Blapril2020 WoW Classic: Questing for Cash is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Squeakers, The TricksterApril 2, 2020World of Warcraft / World of Warcraft Pets and MountsSqueakers, the Trickster, is a mount that was released in January of 2020. It was made available to players who had an existing 6-month subscription with a future renewal date. Those who do not have a 6-month subscription to World of Warcraft can purchase Squeakers, the Trickster for $25.00 in the Blizzard Shop. I found Squeakers the Trickster in the Mounts tab. It is wrapped up in a gift box that the player gets to open. The flavor text on this mount says: The locals in Halfhill swear that whenever a batch of grain is missing, a farmworking instrument is misplaced, or a bushel of berries can’t be found, you can hear a mischievous squeaking, and are reminded to slow down and accept what life gives you. Inside is a highly decorated white rat that all of my World of Warcraft characters can use. It even has a saddle! And yes, it does make little squeaking sounds. Here is my Death Knight Gnome, Riglee, riding Squeakers. This mount automatically scales to the fastest riding skill known by each of your characters. It can be used as either a ground mount, or a flying mount, or both. If your character has the flying mount ability, Squeakers can launch itself into the air, while doing a graceful spin. It then stays in the air and you can direct it to where you want to go – just like with any other flying mount. Squeakers will do the graceful spin even if your character doesn’t have flying unlocked. The difference is that Squeakers will land back on the ground after spinning. Here is my Death Knight Gnome, Riglee, flying away on a rat mount with shiny wings! In this screenshot, you can see Squeakers’ adorable little hands and feet! Off they go, seeking adventure! #Blapril2020 Squeakers, The Trickster is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... WoW Classic: Flight PlansJanuary 27, 2020World of Warcraft / World of Warcraft ClassicVaca has acquired a weapon called Goblin Smasher, and is ready to put it to use! She was Level 12, and prepared to go finish some quests. These screenshots were taken on September 12, 2019. The day started with a flight over The Barrens. The goal for Vaca, and her friend Neverlast, was to turn in a quest at Thunder Bluff. Shortly after arriving, Vaca fell right off the ramp. She sat at the bottom, waiting for Neverlast to catch up with her. They turned in the Ride to Thunder Bluff quest to Ahana the Leather Armor Merchant. As you can see, Vaca and Neverlast had matching, fancy, purple cloaks. Ahanu: Ah, a new bundle of hides. I will get to work on these immediately! Thank you, sister. You have done me a great service. Here are some coins to pay for your time and travel costs. Ahanu quickly crafted some leather goods. He put them into a bag (one for each of us to carry) and sent us to to Tal the Wind Rider Master. Tal the Wind Rider Master: Greetings, warrior! What can I do for you? The answer to that question was obvious. Now leaving Thunder Bluff – destination Crossroads. Somewhere along the way, our Wind Riders synced up and became one. After landing on solid ground, Vaca and Neverlast spoke with Jahan Hawkwing at the Crossroads. He is the Leather & Mail Armor Merchant. We gave him Ahanu’s Leather Goods. Jahan Hawkwing: Vaca, you are back from Thunder Bluff? Did you deliver the hides to Ahanu? Eventually, the Tauren found their way to Ratchet. Neverlast and Vaca found the dock, and spoke with Wharfmaster Dizzywig. Wharfmaster Dizzywig: You seek passage on the next ship, or have some item you wish to send aboard it? I honestly cannot remember who we got this quest from, or where we obtained the Secure Crate that Wharfmaster Dizzywig wanted. It didn’t take long to walk from the dock to the Flight Master. Neverlast and Vaca discovered a new flight path! They immediately made use of it! It was easy to see why this place was called Thorn Hill. Neverlast and Vaca make a good team. But, sometimes Warriors get the idea that they can take on more than they actually are capable of fighting. Both of the Tauren ended up here. The Tauren needed to collect a few more body parts from plainstriders in order to finish a quest. Vaca was very close to hitting Level 13. Killing plainstriders for experience points will do! Vaca hit Level 13 after killing a plainstrider. Neverlast was already at Level 13, and had been for a little while. The Tauren spoke with Serga Darkthorn at the Crossroads. She was the one who sent Neverlast and Vaca out to obtain plainstrider parts. Serga Darkthorn: Have you collected the plainstrider beaks? The Tauren handed over the beaks, and completed the Plainstrider Menace quest. What was Serga Darkthorn doing with the plainstrider beaks? It was a mystery. Serga Darkthorn: How many zhevra have you slain? This was a quest that the Tauren hadn’t gotten around to working on yet. Serga Darkthorn wants Vaca and Neverlast to collect zhevra hooves. It wasn’t clear what Serga was going to do with those. The Tauren decided it was better not to ask her about it. Before leaving the Crossroads, Neverlast and Vaca stopped to talk with Thork. He was the one who gave them a quest called Disrupt the Attacks and sent them out to kill Razormane. Thork gave them a new quest called The Disruption Ends. Thork: One of my scouts witnessed an attack on a caravan from Durotar, Vaca. The culprits are indeed from the Razormane tribe of quilboars. One of the quilboars in particular is leading the raids: Kreenig Snarlsnout. He was seen northeast of here, just south of the road from Durotar. If the threat is to be ended, then Kreenig must die. To be sure the attacks cease, though, I say we add insult to injury. Kill Kreenig along with more of their tribe, and return to me when you have his tusk. Before slaughtering more Razormane, Neverlast and Vaca returned to Thunder Bluff. Hunter’s Rise had class trainers that could give them access to new and improved skills. The Hunter Trainer and the Warrior Trainer share this space. Vaca spent some time – and money – getting new skills and upgrading some of the skills she already had. She would have to return here again after leveling up some more and unlocking new skills. This seemed like a good place to stop and take a rest. Much progress was made, and Neverlast and Vaca needed to gather energy to fight the Razormane when next they set out. WoW Classic: Flight Plans is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Out of Spoons (Chronic Illness)Utah Governor Wouldn’t Sign Anti-Trans BillsMay 29, 2021Out of Spoons / Public HealthPhoto by Liviu C. on Unsplash There has been a whole lot of anti-transgender bills going through the legislature of various states. These types of bills all have one thing in common: their entire purpose is to harm people who are transgender. Utah Governor Spencer Cox (Republican) refused to sign an anti-transgender bill that, if passed, would have prevented girls who are transgender from participating in girls K-12 sports. This is good news for not only transgender girls, but also their families. The Governor also signaled he would veto a bill that would prevent young transgender people from accessing appropriate medical care. Utah House Bill 302 was sponsored by Representative Kera Birkeland (Republican). The floor sponsor for this bill was Senator Curtis S. Bramble (Republican). Cosponsors included: Cheryl K. Acton, Melisa G. Ballard, Jefferson S. Burton, Steve R. Christiansen, Michael L. Kohler, Karianne Lisonbee, Steven J. Lund, Phil Lyman, Michael J. Peterson, Candice B. Pierucci, Susan Pulsipher, Adam Robertson, Jeffery D. Stenquist, Mark A. Strong, Jordan D. Teuscher, Norman K. Thurston, Christine F. Watkins, and Ryan D. Wilcox. House Bill 302 was first read in the House on February 3, 2021. The bill was titled: “Preserving Sports for Female Students”. The general description of the bill said: This bill addresses participation in athletic activities reserved for female students in public education. Right away, its clear that this is an anti-trans bill. The sponsors and co-sponsors of this bill have made the incorrect assumption that girls who are transgender are actually boys. This is discrimination against some students specifically because of their gender. The Biden-Harris administration issued an executive order on January 20, 2021, titled: “Executive Order on Preventing and Combating Discrimination on the Basis of Gender or Sexual Orientation“. The purpose of the executive order is to ensure that people who are LGBTQA+ do not face discrimination based on who they are. The executive order gets its validity from two significant lawsuits. One is Bostock v. Clayton County, Georgia, in which Supreme Court Justice Neil Gorsuch ruled that an employer who fires an individual for being gay or transgender violates Title VII. In short, Title VII “makes it unlawful… for an employer to fail or refuse to hire or to discharge any individual, or otherwise discriminate against any individual… because of such individual’s race, color, religion, sex or national origin.” The executive order also gets its validity from Grimm v. Gloucester County School Board. In short, the School Board at first allowed Gavin Grimm, a transgender boy, to use the boy’s bathroom – but then changed their policy after facing intense backlash from parents. The case was heard in the United States Court of Appeals for the Fourth Circuit. The opinion of the court was written by Circuit Judge Floyd, who stated: “At the heart of this appeal is whether equal protection and Title IX can protect transgender students from school bathroom policies that prohibit them from affirming their gender. We join a growing consensus of courts holding that the answer is a resounding yes…” The outcome of this case confirmed that Title IX can protect transgender students from school bathroom policies. If Title IX can do that (which the court said it can) then Title IX can also prevent schools from prohibiting transgender students from playing on the sports team that matches their gender identity. Psychology Today provides a clear answer about gender in a post titled: “How Many Genders Are There?” A person’s gender refers to characteristics that relate to the categories male, female, or some combination thereof. The words “gender” and “sex” are sometimes confused, but a persons sex refers to biological characteristics determined at conception or in utero; a person’s gender is understood by many researchers to be influenced by a range of societal and environmental factors as well as biological factors. A person can be biologically female and experience gender dysphoria or gender incongruence, because they do not identify with their assigned sex.A person might identify as transgender has a gender identity that does not correspond to their biological sex. The term “cisgender” refers to a gender identity that corresponds to one’s biological sex. People whose gender identity feels neither masculine nor feminine, may identify as non-binary… All of this is to say that it is incorrect to presume that a person is a specific gender based on either the person’s genitals or the gender that they were assigned at birth. Employers who discriminate against people who are LGBTQA+ because of their gender are breaking Title VII. Schools who discriminate against students because of their gender are breaking Title IX. Both of those actions are entirely illegal, not only because of the court decisions, but also because of the executive order from President Biden. Merriam-Webster describes the Supremacy Clause this way: a clause in Article VI of the U.S. Constitution declares the constitution, laws, and treaties of the federal government to be supreme law of the land to which judges in every state are bound regardless of state law to the contrary. The Free Legal Dictionary says that preemption is a doctrine based on the Supremacy Clause of the U.S. Constitution that holds that certain matters are of such a national, as opposed to local, character that federal laws preempt or take precedence over state laws. As such, a state may not pass a law inconsistent with the federal laws. In summary, it is good that Utah’s discriminatory House Bill 302 did not get signed into state law. Doing so would have resulted in legal action against Utah and caused harm to transgender students. Here are some pieces of Utah’s House Bill 302 General Description: This bill addresses participation in athletic activities reserved for female students in public education. Highlighted Provisions: This bill: defines terms; requires schools and local education agencies to designate athletic activities by sex; prohibits a student of the male sex from participating in an athletic activity designated for female students; prohibits certain complaints or investigations based on a school or local education agency maintaining separate athletic activities for female students; provides severability clauses; I want to pause here for a moment to clarify that this part of the bill is illegal because it chooses to discriminate against transgender girls by prohibiting them from participating in a girl’s sports team. The bill has nothing to say about transgender boys playing on the boy’s sports team. This is discrimination against trans girls because of their gender. Therefore, it breaks Title IX. The “provides severability clauses” part is significant. This language is placed in bills that the writer, sponsor, and cosponsors know is not legal and/or that it will cause controversy. The severability clause is there in case the state has to defend the bad bill in court. The purpose of the severability clause is to remove a portion of the bill that a court told them to – without having to throw out the rest of the bill. Other parts of the bill also are discriminatory against transgender girls, but use more words to get there: A public school or LEA, or a private school that competes against a public school or LEA shall expressly designate school athletic activities as one of the following, based on sex: “male” or “boys”; “female” or “girls”, or “coed” or “mixed”. A student of the male sex may not participate, and a public school or LEA may not allow a student of the male sex to participate, in a school athletic activity designated as “female” or “girls”; and A government entity or licensing accrediting organization may not entertain a complaint, open an investigation, or take any other adverse action against a school or LEA described in Subsection (1) for maintaining separate school athletic activities for students of the female sex. To summarize, the bill is written in a way that presumes that gender and sex are synonyms. That’s incorrect. This part of the bill is discriminatory because it is prohibiting transgender girls from participating in a girl’s sports team, while allowing cisgender girls to participate on a girl’s sports team. It does not, however, prevent transgender boys from playing on a boy’s sports team. This is discrimination, because it breaks Title IX. The writers of this bill (and its sponsor and cosponsors) are incorrectly identifying transgender girls as boys. This is discrimination – and just plain mean. It is also illegal, because the Courts ruling on the Grimm v. Gloucester County School Board case sets a precedent that clearly states that Title IX allows transgender students to use the bathroom that matches their gender. As such, Title IX also protects transgender girls from being prohibited from playing on the girl’s sports team. In addition, the bill claims that “a government entity or licensing accrediting organization” can’t make a complaint, open an investigation, or otherwise hold a school that discriminates against transgender students accountable for their bad (and illegal) actions. This is the writers, sponsors, and cosponsors attempt to absolve themselves from having to face the consequences of their harmful words and actions. On February 17, 2021, House Bill 302 “Preserving Sports for Female Students” was voted on. The vote was 50 Yeas and 23 Nays (and two Representatives not voting). Here is who voted YEA: Nelson T. Abbott (R)Carl R. Albrecht (R)Cheryl K. Acton (R)Melissa G. Ballard (R)Stewart E. Barlow (R)Kera Birkeland (R)Brady Brammer (R)Walt Brooks (R)Jefferson S. Burton (R)Scott H. Chew (R)Steve R. Christiansen (R)Kay J. Christofferson (R)Joel Ferry (R)Francis D. Gibson (R)Matthew Gwynn (R)Stephen G. Handy (R)Timothy D. Hawkes (R)Dan N. Johnson (R)Marsha Judkins (R)Mike L. Kohler (R)Bradley G. Last (R)Karianne Lisonbee (R)Stephen J. Lund (R)Phil Lyman (R)A. Cory Maloy (R)Jefferson Moss (R)Calvin R. Musselman (R)Merrill F. Nelson (R)Michael J. Petersen (R)Val J. Petersen (R)Candice B. Pierucci (R)Susan Pulsipher (R)Paul Ray (R)Adam Robertson (R)Douglas V. Sagers (R)Mike Schultz (R)Travis M. Seegmiller (R)Rex P. Shipp (R)Casey Snider (R)Lowry V. Snow (R)Keven J. Stratton (R)Jeffrey D. Stenquist (R)Mark A. Strong (R)Jordan D. Teuscher (R)Norman K. Thurston (R)Christine F. Watkins (R)Steve Waldrip (R)Douglas R. Welton (R)Brad R. Wilson (R)Ryan D. Wilcox (R) Here is who voted NAY: Gay Lynn Bennion (D)Joel K. Briscoe (D)Clare Collard (D)Jennifer Dailey-Provost (D)James A. Dunnigan (R)Craig Hall (R)Susanne Harrison (D)Sandra Hollins (D)Brian S. King (D)Karen Kwan (D)Rosemary T. Lesser (D)Ashlee Matthews (D)Kelly B. Miles (R)Carol Spackman Moss (D)Doug Owens (D)Stephanie Pitcher (D)Angela Romero (D)Robert M Spendlove (R)Andrew Stoddard (D)Raymond P. Ward (R)Elizabeth Weight (D)Mark A. Wheatley (D)Mike Winder (R) Here is who did not vote: Steve Eliason (R)Jon Hawkins (R) Why did Utah Governor Spencer Cox refuse to sign HB 302 On February 19, 2021, Deseret News posted an article titled: “Gov. Spencer Cox says he won’t sign transgender sports bill as now written”. It was written by Katie McKellar. From the article: An at-times emotional Gov. Spencer Cox said Thursday he would not sign the current version of the bill making its way through the Utah Legislature to ban transgender girls from participating in girls K-12 sports.“I’m not in a place yet where I’m comfortable with the bill as it stands right now,” Cox told reporters during his monthly news conference with PBS Utah Thursday morning. “Those discussions are ongoing. We still have a lot of work to do.”Cox then paused and teared up.“These kids are… they’re just trying to stay alive,” Cox said. “There’s a reason none of them are playing sports… I just think there’s a better way. And I hope that there will be enough grace in our state to find a better solution.”……”I apologize for getting a little emotional,” Cox told reporters Thursday. “When you spend time with these kids, it changes your heart in important ways, and so I want to try and improve that message and see if we can’t find a better way to work together.”……Cox’s comments come the day after the House voted to approve Rep. Kera Birkeland’s bill following heated debate. It now goes to the Senate for consideration……HB302 is adamantly opposed by groups including Equality Utah and Democrats, who argue it’s “needlessly (targeting) youth who are already marginalized and vulnerable to mental anguish and suicide.”Cox also said he had “threatened to veto” another bill related to transgender issues: HB92 being sponsored by Rep. Rex Shipp R-Cedar City. Shipp’s bill would prohibit doctors from offering any gender reassignment treatment to minors. The original version of that bill, Cox said, had “many, many flaws.” But he said the latest iteration of Shipp’s bill “is closer to what medical standards are now.”……Cox’s comments mean if HB302 has a chance of becoming Utah law, it needs changes unless he decides to allow it to become law without signing it. However, it’s possible the bill might run into some trouble in the Senate, where legislative leaders have hinted it could be altered… According to KUER 90.1 (which appears to be part of the BBC), House Bill 302 – which would have banned transgender girls from competing on girls public school sports teams – passed the Utah house. A Senate committee killed the bill by declining to vote on the legislation. Governor Spencer Cox signaled he would veto the bill. What Did HB92 Say? HB0092 was introduced to on January 19, 2021. (It is also referred to as HB92). The summary of the bill was: “This bill prohibits a physician or surgeon from performing a transgender procedure on aminor “. This bill was absolutely terrible. It not only restricted people who are transgender from receiving the medical care they need, but also prohibited doctors from providing certain types of care to people who are transgender. The bill would make it unprofessional conduct to preform a medically unnecessary puberty inhibition procedure or a sex characteristic-altering procedure on a minor. I cannot help but be aware of the similarities between this discriminatory anti-trans bill and the bills that conservative Republicans create (over and over again) that are intended to prevent people who have a uterus from receiving an abortion. In some cases, those bills also prevent access to contraception. Those types of bills include unnecessary medical procedures and time limitations that a person must endure to get an abortion. HB92 is designed to prevent people who are transgender from accessing the medical care they need – care that conservative Republicans deem “unnecessary”. Put all that together, and it is abundantly clear that the real purpose of these types of bills is to exert control over marginalized people’s bodies and to take away their bodily autonomy. Both types of bills are also used to attack doctors by making them risk their licenses if they dare to provide appropriate medical care to patients. The majority of this bill is hurtful just to read. I’m going to summarize it here. Skip over this part if you need to. Definitions: “Ablative procedure” means a procedure that is expected to excise, vaporize, disintegrate, or remove living tissue, including the use of carbon dioxide lasers and erbium: YAG lasers, and excluding hair removal. In short, this part of the bill would prevent a transgender man from getting what is often referred to as “top surgery”. It would prevent transgender people from having surgery that would change their genitalia. I want to be clear about this – not all people who are transgender want to have those types of surgery. This part of the bill harms those who do want to have surgery. Also, to be clear, not all people who are transgender want to have these types of surgery – and that’s completely valid. The next part of the bill attacks physicians. “ACGME” means the Accreditation Council for Graduate Medical Education of the American Medical Association. “Administrative penalty” means a monetary fine or citation imposed by the division for acts or omissions determined to constitute unprofessional or unlawful conduct, in accordance with a fine schedule established by the division in collaboration with the board, as a result of an adjudication proceeding conducted in accordance with 63G, Chapter 4, Administrative Procedures Act. “Associate physician” means an individual licensed under 58-67-302.8. Put that together, and this part of the bill is telling licensed physicians that will lose their license, will be investigated, and could have to pay a fine or citation if they provide what in reality is appropriate and necessary medical care to a patient who is transgender. This is discrimination based on gender, and that means this law is illegal. The next parts of the bill are underlined, for some reason. “Attempted sex change” means an attempt or effort to change an individual’s body to present that individual as being of a sex or gender that is different from the individual’s biological sex at birth. “Biological sex at birth” means an individual’s sex, as being male or female, according to distinct reproductive roles as manifested by sex and reproductive organ anatomy, chromosomal makeup, and endogenous hormone profiles. This part makes it clear that the writer of the bill fails to understand that sex and gender are not synonyms. I’ve already pointed that out in this blog post by including the information from Psychology Today. There is another part of this bill that would prevent transgender people under the age of 18 from obtaining puberty blockers. “Medically unnecessary puberty inhibition procedure” means administering or supplying to an individual younger than 18 years old, alone or in combination with aromatase inhibitors: gonadotropin-releasing hormone agnostics, progestins, or androgen receptor inhibitors. “Medically unnecessary puberty inhibition procedure” does not include administering or supplying a treatment described in Subsection (17)(a) to an individual younger than 18 years old if the treatment is medically necessary as a treatment for: precocious puberty, idiopathic short stature, endometriosis, or a sex hormone-stimulated cancer. It is obvious that this part of the bill discriminates against transgender young people who seek to prevent having their body develop in ways that do not match the person’s gender. This is discriminatory, because it targets transgender people – while allowing the same medication to be administered to cisgender young people. That part about “precocious puberty” makes it clear that cisgender girls or boys who start puberty early are allowed to have puberty blockers. The bill denies that exact same type of medication to transgender girls or boys. This is discrimination. Pediatrics, the Official Journal of the American Academy of Pediatrics, posted information titled: “Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents”. From the information: …Gender Identity is not synonymous with “sexual orientation,” which refers to a person’s identity in relation to the gender(s) to which they are sexually and romantically attracted. Gender identity and sexual orientation are distinct but interrelated constructs. Therefore, being transgender does not imply a sexual orientation, and people who identify as transgender still identify as straight, gay, bisexual, etc. on the basis of their attractions……Gonadotrophin-releasing hormones have been used to delay puberty since the 1980s for central precocious puberty. These reversible treatments can also be used in adolescents who experience gender dysphoria to prevent development of secondary sex characteristics and provide time up until 16 years of age for the individual and family to explore gender identity, access psychosocial supports, develop coping skills, and further define appropriate treatment goals. If pubertal suppression treatment is suspended, then endogenous puberty will resume… A vote was held on HB0092 (also called HB92) on February 19, 2021. There were 10 YEAS and 3 NAYS. This means the bill was marked as “passed”. According to KUER 90.1 (which appears to be part of the BBC), the other anti-trans bill that would prevent transgender minors from accessing gender affirming health care (hormone therapy, puberty blockers, and surgery) failed. During its first committee hearing, lawmakers sent it back to the Rules Committee after some changes had been made on it. The Rules Committee decided not to give the legislation another public hearing. Governor Spencer Cox said he would veto this legislation. Utah Governor Wouldn’t Sign Anti-Trans Bills is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post, please consider supporting me on Ko-Fi... Biden’s COVID-19 Health Equity Task ForceMay 3, 2021Out of Spoons / Public HealthPhoto by Glen Carrie on Unsplash On January 21, 2021, President Biden issued an executive order titled: “Executive Order on Ensuring an Equitable Pandemic Response and Recovery.” The order called for an emphasis on ensuring the people who were disproportionately affected by COVID-19 would receive the help they needed. It also called for the creation of the COVID-19 Health Equity Task Force. The “Executive Order on Ensuring an Equitable Pandemic Response and Recovery” started with: “By the authority vested in me as President by the Constitution and the laws of the United States of American, and in order to address the disproportionate and severe impact of coronavirus disease 2019 (COVID-19) on communities of color and other underserved populations, it is hereby ordered as follows:” Section 1. Purpose This section starts by pointing out inequities on America’s health care system. “The COVID-19 pandemic has exposed and exacerbated severe and pervasive health and social inequities in America. For instance, people of color experience systemic structural racism in many facets of society and are more likely to become sick and die from COVID-19. The lack of complete data, disaggregated by race and ethnicity, on COVID-19 infection, hospitalization, and mortality rates, as well as underlying health and social vulnerabilities has further hampered efforts to ensure an equitable pandemic response…” The Mayo Clinic posted information on August 13, 2020, titled: “Why are people of color more at risk of coronavirus complications?” It was written by William F. Marshall, III M.D. From the information: Research increasingly shows that racial and ethnic minorities are disproportionately affected by coronavirus disease 2019 (COVID-19) in the United States.According to recent data from the Centers for Disease Control and Prevention (CDC), non-Hispanic American Indian or Alaska Native people had an age-adjusted COVID-19 hospitalization rate at about 5.3 times that of non-Hispanic white people. COVID-19 hospitalization rates among non-Hispanic Black people and Hispanic or Latino people were both about 4.7 times the rate of non-Hispanic white people.While there’s no evidence that people of color have genetic or other biological factors that make them more likely to be affected by COVID-19, they are more likely to have underlying health conditions. Having certain conditions, such as type 2 diabetes, increases your risk of severe illness with COVID-19. But experts also know that where people live and work affects their health. Over time, these factors lead to different health risks among racial and ethnic minority groups… Here are some factors mentioned in the Mayo Clinic information: Racial and ethnic minority members might be more likely to live in multi-generational homes, crowded conditions and densely populated areas such as New York City. This can make social distancing difficult. Many people of color have jobs that are considered essential or can’t be done remotely and involve interacting with the public. In the U.S., according to the CDC, nearly 25% of employed Hispanic and Black or African Americans work in the service industry, compared with 16% of non-Hispanic white workers. Black or African Americans also account for 30% of licensed practical and licensed vocational nurses. Many people of color also depend on public transportation to get to work. These factors can result in exposure to the virus. Members of racial and ethnic minority groups are more likely to encounter barriers to getting care, such as a lack of health insurance or not being paid when missing work to get care. In 2017, according to the CDC only about 6% of non-Hispanic white people were uninsured, while the rate was nearly 18% for Hispanics and 10% for non-Hispanic Black people. Racism also may play a role in health risks. The stress of dealing with racial discrimination can take a toll on your body, causing early aging. This has been linked to underlying conditions, which can increase the risk of severe illness with COVID-19. The executive order continues with: “…Other communities, often obscured in the data, are also disproportionately affected by COVID-19, including sexual and gender minority groups, those living with disabilities, and those living at the margins of our economy. Observed inequities in rural and Tribal communities, territories, and other geographically isolated communities require a place-based approach to data collection and the response. Despite increased State and local efforts to address these inequalities, COVID-19’s disparate impact on communities of color and other underserved populations remains unrelenting…” Kaiser Family Foundation (KFF) published the results of a poll on March 11, 2021. The poll was titled: “The Impact of the COVID-19 Pandemic on LGBT People”. From the findings: There has been little data on how the coronavirus pandemic has impacted the lives of lesbian, gay, bisexual and transgender individuals (LGBT) in the U.S. Drawing on previous research indicating that LGBT individuals are at greater risk of both COVID-19 health and economic outcomes, this analysis examines the reported experiences from self-identified LGBT individuals from two months of KFF COVID-19 Vaccine Monitor and finds that LGBT people have experienced the COVID-19 pandemic differently than non-LGBT people, including being harder hit in some areas: Economic: A larger share of LGBT adults compared to non-LGBT adults report that they or someone in their household has experienced COVID-era job loss (56% v 44%). Mental Health: Three-fourths of LGBT people (74%) say worry and stress from the pandemic has had a negative impact on their mental health, compared to 49% of those who are not LGBT, and are more likely to say that negative impact has been major (49% v 23%). Views: One-third (34%) of LGBT adults say the news has generally underestimated the seriousness of the pandemic (compared to 23% of non-LGBT adults). Three-fourths of LGBT adults (74%) are either “very worried” or “somewhat worried” that they or someone in their family will get sick from the coronavirus, similar to responses from non-LGBT adults (67%). A large share of LGBT adults report being willing to take CDC recommended steps to avoid acquisition/transmission of the virus. …Limited early data available on how LGBT people have experienced the COVID-19 pandemic in the United States (U.S.) has suggested that this group may be disproportionately impacted. The reasons are far-reaching and may include: LGBT individuals being at a greater risk of worse COVID-19 outcomes due to higher rates of comorbidities; working in highly affected industries such as health care and restaurants/food services; living on average on lower incomes than non-LGBT people; experiencing stigma and discrimination related to sexual orientation/gender identity, including in accessing health care and, for transgender individuals, being less likely to have health coverage… Johns Hopkins University posted a report on April 23, 2020, titled: “COVID-19 poses unique challenges for people with disabilities”. From the report: …For people with disabilities, all the general challenges that come with the pandemic certainly apply, but there are additional barriers. The first is communication – getting information can be more difficult for people with vision, hearing, and even cognitive disabilities, as popular news sources may not be accessible, especially when information is changing quickly… Keeping all of us informed is key to the COVID-19 public health response, but information is not accessible to the disability community……The second barrier involves adopting recommended public health strategies, such as social distancing and washing hands. For example, frequent hand-washing is not always feasible for people with certain types of physical disabilities… …public health policies often do not consider people with disabilities, leaving a gap in guidance. Those who have personal aides and caregivers also need to be considered, as they cannot participate in social distancing in the same way that others are……The third, equitable access to health care, is a long-standing barrier worsened by COVID-19. This ranges from getting a coronavirus test to being seen in an emergency room. For instance, drive-up testing may be impossible if you rely on state mobility services. There are also existing barriers in health care settings that are exacerbated as the industry aims to meet the surge of COVID-19 cases. For example, the use of personal protective equipment, including masks, can make communication more difficult for patients with hearing loss……There’s fear that medical resource allocation, including ventilators, may be discriminatory against patients with disabilities, and complaints have been filed in multiple states about these rationing policies… The Centers for Disease Control and Prevention (CDC) posted information on August 19, 2020, titled: “CDC data show disproportionate COVID-19 impact in American Indian/Alaska Native populations”. From the information: The Centers for Disease Control and Prevention (CDC) released a new study that specifically examines how COVID-19 is affecting American Indians and Alaska Natives (AI/AN) – one of the racial and ethnic minority groups at highest risk of the disease. CDC found that in 23 selected states, the cumulative incidence of laboratory-confirmed COVID-19 cases among AI/AN was 3.5 that of non-Hispanic whites.These data also showed that AI/AN who tested positive for SARS-CoV-2 tended to be younger than white non-Hispanic individuals with COVID-19 infection. Compared to whites, a higher percentage of cases among AI/AN individuals were in people under 18 years of age (12.9 percent AI/AN; 4.3 percent white), and a smaller percentage of cases were among AI/AN 65 years or older (12.6 percent AI/AN; 28.6 percent white). Limited data were available to quantify the disparity in COVID-19 incidence, COVID-19 disease severity, and outcomes among AI/AN persons compared with those among other racial/ethnic groups, reinforcing the need to prioritize improved data collection as a key strategy to understand and improve health outcomes.Recent CDC studies have shown that AI/AN are among the racial and ethnic minority groups at higher risk for severe COVID-19 outcomes. Persisting racial inequity and historical trauma have contributed to disparities in health and socioeconomic factors between AI/AN and white populations that have adversely affected tribal communities. The elevated incidence within this population might also reflect differences in reliance on shared transportation, limited access to running water, household size, and other factors that might facilitate community transmission… The last part of the Purpose section says: “Addressing this devastating toll is both a moral imperative and pragmatic policy. It is impossible to change the course of the pandemic without tackling it in the hardest-hit communities. In order to identify and eliminate health and social inequalities resulting in disproportionately higher rates of exposure, illness, and death, I am directing a Government-wide effort to address health equity. The Federal Government must take swift action to prevent and remedy differences in COVID-19 care and outcomes within communities of color and other underserved populations.” Section 2. COVID-19 Health Equity Task Force The second part of the executive order is about setting up a COVID-19 Health Equity Task Force. “There is established within the Department of Health and Human Services (HHS) a COVID-19 Health Equity Task Force (Task Force).” On January 30, 2020, CBS News posted an article titled: “Trump creates task force to lead U.S. coronavirus response”. From the article: President Trump has created a new task force to lead the government’s response to the fast-spreading coronavirus, the White House announced Wednesday.Led by Health and Human Services Secretary Alex Azar and coordinated through the National Security Council, the task force is made up of subject matter experts from across the federal government and has been meeting daily since Monday. Members of the 12-member group include National Security Adviser Robert O’Brian, Centers for Disease Control and Prevention Director Dr. Robert Redfield, and the National Institutes of Health’s Dr. Anthony Fauci.“The task force will lead the administration’s efforts to monitor, contain and mitigate the spread of the virus, while ensuring that the American people have the most accurate and up-to-date health and travel information,” the White House said… President Biden’s executive order describes who will be on his COVID-19 Health Equity Task Force, what the group will do, and other information. “The task force shall consist of the Secretary of HHS; an individual designated by the Secretary of HHS to Chair the Task Force (COVID-19 Health Equity Task Force Chair); the heads of such other executive departments, agencies, or offices (agencies) as the Chair may invite; and up to 20 members from sectors outside the Federal Government appointed by the President.” Xavier Becerra is the Secretary of Health and Human Services (HHS). According to The New York Times, he is the first Latino to serve as health secretary. On March 18, 2021, the Senate confirmed him with a vote of 50-49. Senator Susan Collins of Maine was the only Republican to support his confirmation. Previously, he was California’s Attorney General. The Secretary of Health and Human Services will select someone to be the COVID-19 Health Equity Task Force Chair. Federal members may designate, to perform the Task Force functions of the member, a senior-level official who is a part of the member’s agency and a full-time officer or employee of the Federal Government. Nonfederal members shall include individuals with expertise and lived experience relevant to groups suffering disproportionate rates of illness and death in the United States; individuals with expertise and lived experience relevant to equity in public health, health care, education, housing, and community-based services; and any other individuals with expertise the President deems relevant. Appointments shall be made without regard to political affiliation and shall reflect a diverse set of perspectives. Members of the Task Force shall serve without compensation for their work on the Task Force, but members shall be allowed travel expenses, including per diem in lieu of subsistence, as authorized by law for persons serving intermittently in Government service (5. U.S.C. 5701-5757). At the direction of the Chair, the Task Force may establish subgroups consisting exclusively of Task Force members or their designees under this section, as appropriate. Mission and Work of the COVID-19 Health Equity Task Force: “Consistent with applicable law and as soon as practicable, the Task Force shall provide specific recommendations to the President, through the Coordinator of the COVID-19 Response and Counselor to the President (COVID-19 Response Coordinator), for mitigating the health inequities caused or exacerbated by the COVID-19 pandemic and for preventing such inequities in the future. The recommendations shall include:” Recommendations for how agencies and State, local, Tribal, and territorial officials can best allocate COVID-19 infection, hospitalization, and mortality in certain communities and disparities in COVID-19 outcomes by race, ethnicity, and other factors, to the extent permitted by law; Recommendations for agencies with responsibility for disbursing COVID-19 relief funding regarding how to disburse funds in a manner that advances equity; Recommendations for agencies regarding effective, culturally aligned communication, messaging, and outreach to communities of color and other underserved populations. “The Task Force shall submit a final report to the COVID-19 Response Coordinator addressing any ongoing health inequalities faced by COVID-19 survivors that may merit a public health response, describing the factors that contributed to disparities in COVID-19 outcomes, and recommending actions to combat such disparities in future pandemic responses.” What the COVID-19 Health Equity Task Force will do regarding data collection: “…To address the data shortfalls identified in section 1 of this order, and consistent with applicable law, the Task Force shall:” Collaborate with the heads of relevant agencies, consistent with the Executive Order entitled “Ensuring a Data-Driven Response to COVID-19 and Future High-Consequence Public Health Threats,” to develop recommendations for expediting data collection for communities of color and other underserved populations and identifying data sources, proxies, or indices that would enable development of short-term targets for pandemic-related actions for such communities and populations; Develop, in collaboration with the heads of relevant agencies a set of longer-term recommendations to address these data shortfalls and other foundational data challenges, including those relating to data intersectionality, that must be tackled in order to better prepare and respond to future pandemics; and Submit the recommendations described in this subsection to the President through the COVID-19 Response Coordinator. The next few paragraphs set up more about what the Task Force can do. They may seek the views of health professionals; policy experts; State, local, Tribal and territorial health officials; faith-based leaders; businesses; health providers; community organizations; those with lived experience with homelessness, incarceration, discrimination, and other relevant issues; and other stakeholders. The Federal Advisory Committee Act may apply to the Task Force, and any functions of the President under the Act, (except section 6) shall be performed by the Secretary of Health and Human Services. HHS will provide funding and administrative support for the Task Force (as permitted by law and within existing appropriations). The Chair shall convene regular meetings of the Task Force, determine its agenda, and direct its work. The Chair shall designate an Executive Director of the Task Force, who shall coordinate the work of the Task Force and head any staff assigned to the Task Force. The COVID-19 Health Equity Task Force will terminate within 30 days of accomplishing the objectives set forth in this order, including the delivery of the report and recommendations specified in this section, or 2 years from the date of this order, whichever comes first. Section 3. Ensuring an Equitable Pandemic Response. “…The Secretary of Agriculture, the Secretary of Labor, the Secretary of HHS, the Secretary of Housing and Urban Development, the Secretary of Education, the Administrator of the Environmental Protection Agency, and the heads of all other agencies with authorities or responsibilities relating to the pandemic response and recovery shall, as appropriate and consistent with applicable law:” Consult with the Task Force to strengthen equity data collection, reporting, and use related to COVID-19; Assess pandemic response plans and policies to determine whether personal protective equipment, tests, vaccines, therapeutics, and other resources have been or will be allocated equitably, inducing by considering: The disproportionately high rates of COVID-19 infection, hospitalization, and mortality in certain communities; and Any barriers that have restricted access to preventative measures, treatment, and other health services for high-risk population; Any barriers that have restricted access to preventive measures, treatment, and other health services for high-risk populations; The effect of proposed policy changes on agencies’ abilities to collect, analyze, and report data necessary to monitor and evaluate the impact of pandemic response plans and policies on communities of color and other underserved populations Policy priorities expressed by communities that have suffered disproportionate rates of illness and death as a result of the pandemic; Strengthen enforcement of anti-discrimination requirements pertaining to availability of, and access to, COVID-19 care and treatment; and Partner with States, localities, Tribes, and territories to explore mechanisms to provide greater assistance to individuals and families experiencing disproportionate economic or health effects from COVID-19, such as by expanding access to food, housing, child care, or income support. The next part instructs the Secretary of HHS to provide recommendations to State, local, Tribal, and territorial leaders on how to facilitate the placement of contact tracers and other workers in communities that have been hardest hit by the pandemic, recruit such workers from those communities, and connect such workers to existing health workforce training programs and other career advancement programs. The Secretary of HHS must also conduct an outreach campaign to promote vaccine trust and uptake among communities of color and other underserved populations with higher levels of vaccine mistrust due to discriminatory medical treatment and research and engage with leaders within those communities. Members of the Biden-Harris Administration COVID-19 Health Equity Task Force On February 10, 2021, President Biden announced who would be on the COVID-19 Health Equity Task Force. The Task Force is chaired by Dr. Marcella Nunez-Smith. She is an associate professor of internal medicine, public health, and management at Yale, and is one of the nation’s foremost experts on disparities in healthcare access. According to information posted by Yale, Dr. Marcella Nunez-Smith had called attention to the unequal burden borne by communities of color. She is also associate dean for health equity research, director for the Center for Community Engagement and Health Equity, and the founding director of the Equity Research and Innovation Center (ERIC) at Yale School of Medicine. Dr. Marcella Nunez-Smith grew up in the U.S. Virgin Islands. In the press briefing about the Task Force, it states: “As Chair, Dr. Nunez-Smith will also ask six additional Federal agencies to be represented on the COVID-19 Health Equity Task Force as federal members. This includes the United States Department of Agriculture, Department of Education, Department of Health and Human Services, Department of Housing and Urban Development, Department of Justice and Department of Labor. The twelve Task Force members represent a diversity of backgrounds and expertise, a range of racial and ethnic groups, and a number of important populations, including: children and youth, educators and students; health care providers, immigrants; individuals; public health experts; rural communities; state, local, territorial, and Tribal governments, and unions. Mayra E. Alvarez, MPH is President of the Children’s Partnership, a California advocacy organization working to advance child health equity. Previously, she served in the U.S. Department of Health and Human Services during the Obama-Biden administration, including at the Centers for Medicare and Medicaid Service, the Office of Minority Health, and the Office of Health Reform. She also served as a Legislative Assistant in the US Senate and House of Representatives. She grew up in California, and graduated from the School of Public Health at University of North Carolina at Chapel Hill and the University of California at Berkeley. James Hildreth, PhD, MD is president and chief executive officer of Meharry Medical College, the nation’s largest private, independent historically black academic health sciences center. Dr.Hildreth served previously as the dean of the College of Biological Sciences at University of California, Davis and as a professor and associate dean at Johns Hopkins University School of Medicine. Dr. Hildreth is a member of the National Academy of Medicine an an internationally acclaimed immunologist whose work has focused on several human viruses including HIV. He currently serves on the advisory council for the NIH director and as a member of the FDA Vaccines and Related Biological Products Advisory Committee. Dr. Hildreth has led Meharry’s efforts to ensure that disadvantaged communities have access to COVID-19 testing and vaccines. He graduated from Harvard University as a Rhodes Scholar, from Oxford University with a PhD in immunology and obtained an MD from Johns Hopkins School of Medicine. Andrew Imparato, JD Andy Imparato is a disability rights lawyer and Executive Director of Disability Rights California, where he has spearheaded advocacy on crisis standards of care and vaccine prioritization in the last year. Imparato joined DRC after a 26-year career in Washington DC, where he served as the chief executive of the Association of University Centers on Disabilities and the American Association of People with Disabilities. From 2010-2013, Imparato served as Chairman Tom Harkin’s Disability Policy Director on the U.S. Senate Committee on Health, Education, Labor and Pensions. Imparato’s perspective is informed by his lived experience with bipolar disorder. Victor Joseph was elected by the 42 member tribes to the position of Tanana Chiefs Conference (TCC) Chief/Chairman in March of 2014 and served through October of 2020. As the Chief Chairman he was the principle executive officer for the corporation and presided over all corporate meetings of the member tribes. Prior to being elected TCC’s Chief Chairman Victor was employed as TCC’s Health Director from 2007 to 2014. He worked for TCC a total of 28 years in a variety of leadership positions. He has also served as Alaska Representative on the U.S. Department of Health and Human Services Secretary’s Tribal Advisory Committee and on the Indian Health Services Budget Formulation Committee. Joseph is a tribal member of the Native Village of Tanana. He has extensive experience building strong working relationships with tribal leaders, colleagues, staff, and funding agencies and corporate beneficiaries. Joneigh Khaldun, MD, MPH is the Chief Medical Executive for the State of Michigan and the Chief Deputy Director for Health in the Michigan Department of Health and Human Services (MDHHS). She is the lead strategist for Michigan’s COVID-19 response. Prior to her role in Michigan she was the Director of the Detroit Health Department, where she established a comprehensive reproductive health network and led Detroit’s response to the Hepatitis A outbreak. Dr. Khaldun has held former roles as the Baltimore City Health Department’s Chief Medical Officer and Fellow in the Obama-Biden Administration’s Office of Health Reform in the US Department of Health and Human Services. She obtained her BS from the University of Michigan, MD from the Perelman School of Medicine at the University of Pennsylvania, and MPH in health policy from George Washington University. She practices emergency medicine part-time at Henry Ford Hospital in Detroit. Octavio N. Martinez, Jr. MD, MBA, MPH is the Executive Director for the Hogg Foundation for Mental Health at The University of Texas at Austin. Additionally, Martinez is a Senior Associate Vice President within the university’s Division of Diversity and Community Engagement; clinical professor in the university’s School of Social Work; and professor at Dell Medical School’s Department of Psychiatry. He grew up in Texas, and has a MPH from Harvard University’s School of Public Health, an MD from Baylor College of Medicine, and an MBA and BBA in Finance from The University of Texas at Austin. Tim Putnam, DHA, EMS is President and CEO of Margaret Mary Health, a community hospital in Batesville, Indiana and has over 30 years of healthcare experience. He received his Doctorate in Health Administration from the Medical University of South Carolina where his dissertation was focused on acute stroke care in rural hospitals. He is a past president of the Indiana Rural Health Association and the National Rural Health Association. In 2015 he was appointed by the Governor to the newly created Indiana Board of Graduate Medical Education and has chaired the Board since its inception. Dr. Putnam is also a certified Emergency Medical Technician. Vincent C. Toranzo is an active student from Broward County, Florida. Mr. Toranzo has experience with the inner workings of municipality functions. He serves as the State Secretary of the Florida Association of Student Councils advocating for the inclusion of student voices in their community, such as assistance to foster children and the assurance of students’ safety amidst the COVID-19 pandemic. Mr. Toranzo was awarded the U.S. President’s Award for Educational Excellence and a Citizenship Award for School and Public Services from his local U.S. congresswoman. Mary Turner, RN is an ICU nurse at North Memorial Medical Center in Robbinsdale and in her sixth year as President of the Minnesota Nurses Association (MNA) union – the Minnesota affiliate of National Nurses United. She previously worked at Abbott Northwestern Hospital in Minneapolis for 10 years. Turner has been on the National Nurses United’s Joint Nursing Commission since 2011. She serves as the Chair of the Board for Isuroon, which provides empowerment, culturally sensitive health education, and advocacy for Somali women. Homer Venters, MD is a physician and epidemiologist working at the intersection of incarceration, health, and human rights. Dr. Venters is currently focused on addressing COVID-19 responses in jails, prisons, and immigration detention facilities. Dr. Venters is the former Chief Medical Officer of the NYC Correctional Health Services and author of Life and Death in Rikers Island. Dr. Venters has also worked in the nonprofit sector as the Director of Programs for Physicians for Human Rights and President of Community Oriented Correctional Health Service. Dr. Venters is a Clinical Associate Professor of the New York University College of Global Public Health. G. Robert (“Bobby”) Watts, MPH, MS is the CEO of the National Health Care for the Homeless Council, which supports 300 Health Care for the Homeless FQHC’s and 100 Medical Respite programs with training, research, and advocacy to end homelessness. Watts has 25 years’ experience in administration, direct service, and implementation of homeless health and shelter services. Watts served as Executive Director of Care for the Homeless in New York City for twelve years. He is a graduate of Cornell University and Columbia University’s Mailman School of Public Health from which he holds an MPH in health administration and an MS in epidemiology. Haeyoung Yoon, JD is Senior Policy Director at the National is Senior Policy at the National Domestic Workers Alliance. Over the course of her career, Yoon has worked on low-wage and immigrant workers rights issues. Prior to National Domestic Workers Alliance, Yoon was a Distinguished Taconic Fellow at Community Change. Yoon also has extensive litigation experience and taught at the New York University School of Law and Brooklyn Law School. She recently testified before the House Judiciary Committee’s Subcommittee on Immigration and Citizenship regarding Immigrants as Essential Workers during COVID-19. Yoon received her JD from CUNY School of Law, her MA from Harvard University, and her BA from Barnard College. Biden’s COVID-19 Health Equity Task Force is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... The Biden-Harris Covid-19 Vaccination PlanApril 18, 2021Out of Spoons / Public HealthPhoto by CDC on Unsplash Have you wondered about how the Biden-Harris administration managed to get so many COVID-19 “shots in arms” in such as short period of time? Were you surprised when pharmacies, stadiums, empty stores in dying malls, and pop-up vaccinations sites appeared? All of this is thanks to the Biden-Harris Covid-19 Vaccination plan. “Fact Sheet: President-elect Biden Outlines COVID-19 Vaccination Plan” was posted on January 15, 2021, on what was originally the Biden-Harris Transition website. After Joe Biden was sworn in as President of the United States, and Kamala Harris was sworn in as Vice-President of the United States, that content moved to the White House website. The information posted by the Biden-Harris administration before Inauguration Day shows that they were thinking ahead about how to stop the spread of Covid-19. This contrasts strongly with the Trump Administration’s severe lack of planning. Fact Sheet: President-elect Biden Outlines COVID-19 Vaccination Plan starts with a brief paragraph about the need for effective and equitable vaccinations. It also provides some information about the spread of COVID-19, and the number of deaths. From the Plan: Effectively and equitably vaccinating the U.S. Population will happen through stronger partnerships with states and communities, increased supply, more vaccination sites, and more vaccinators. “The Covid-19 pandemic is getting worse by the day – more people are hospitalized with COVID-19 than ever before, the death rate is up almost 20 percent, and we’re nearing 400,000 deaths total. At the same time, there is a new, more contagious strain spreading across the country and we are woefully behind on vaccinating the U.S. population. “President-elect Biden will confront this historic challenge with the full strength of the federal government – working closely with local communities already in the trenches. He will lead an unprecedented, whole-of-society effort that mobilizes every resource available – across the public and private sectors. It will take every American doing their part. “As we move forward to get vaccines in arms as quickly as possible, we will not leave anyone behind. Communities across the country are counting on it. The health and economic security of our nation depend on it. “Today, the president-elect outlined key highlights of his plan to efficiently and equitably vaccinate the U.S. population. This includes taking action to: … The next portion of the Vaccination Plan is listed out very clearly. Get more people vaccinated Encourage states to allow more people to be vaccinated including individuals 65 and older as well as frontline workers. “The process of establishing priority groups was driven by science, but the implementation has been too rigid and confusing. We now see doses of vaccines sitting in freezers unused while people who want the vaccine cannot get it. President-elect Biden’s plan encourages states to open up eligibility beyond healthcare workers and long-term care facility workers like teachers, first responders, grocery store employees, and anyone who is 65 and older. “It won’t mean that everyone in these groups will get vaccinated immediately, as supply is not where it needs to be. But it will mean that as vaccines become available, they will reach more people who need them. For states with the capacity and supply to further expand, we encourage that as well. The federal government will continue to look to the CDC Advisory Committee on Immunization Practices (ACIP) framework for an equitable, effective vaccination program.” Ensure equity throughout the vaccination process to reach those in hard-to-reach, marginalized communities. “We will ensure that there is equity in the vaccination process by using data to target resources to hard-hit communities, ensuring no out-of-pocket costs for vaccinations, and equitable access to vaccines in marginalized and medically-underserved communities. Partnerships with state, local, and community-based organizations and trusted health care providers, like community health centers, will be central to this effort.” Create more vaccination sites Stand up new, federally-supported community vaccination centers across the country. “Getting as many people vaccinated as quickly as possible will require close coordination between the federal government and all states and territories. Knowing that not all states and jurisdictions have the resources to scale vaccinations at the pace this crisis demands, the Biden-Harris administration will leverage federal resources and emergency contracting authorities to launch new vaccination sites and to expand state and local efforts across the country. “With the support of Federal Emergency Management Administration (FEMA), these sites will mobilize thousands of clinical and non-clinical staff and contractors who will work hand-in-glove with the National Guard and state and local teams. The program will be scaled based on what is working best on the ground for state and local partners, and the communities they serve.” Fully reimburse state deployment of the National Guard to support vaccinations and provide additional FEMA assistance. “President-elect Biden will deploy mobile vaccination clinics in the most hard-to-reach communities and to support those who face challenges accessing vaccination sites, including individuals who live in underseved urban and rural areas. The federal government will partner with states and local providers, including primary care providers, to ensure that they have the resources needed to help get vaccines to the communities they serve. “The federal government will launch targeted programs to engage community health centers, rural health clinics, critical access hospitals, and tribal health services to ensure that we can meet the needs of all communities.” Make vaccines available in pharmacies. “Millions of Americans turn to their local pharmacies every day for their medicines, flu shots, and much more. Nearly 90 percent of Americans live within five miles of a pharmacy. President-elect Biden will quickly jumpstart efforts to increase capacity at chain and independent pharmacies across the country to get Americans vaccinated.” Launch a new partnership with Federally Qualified Health Centers nationwide. “Federally qualified Health Centers (FQHC’s) serve more than 30 million patients each year – one in 11 people nationwide. Many are people of color and many live in rural communities. FQHC patients are often individuals struggling to make ends meet. “Given the role that these providers play in their communities, President-elect Biden will launch a new program to ensure that FQHC’s can directly access vaccine supply where needed. At the same time, the administration will encourage jurisdictions to engage and work closely with health centers in their community vaccination planning. “And to ensure that health centers have the resources they need to successfully launch vaccination programs, President-elect Biden has called on Congress to provide additional funds to support community health centers, and HHS will launch a new program to provide guidance, technical assistance, and other resources to prepare and engage these providers nationwide.” Launch new models to serve high-risk individuals “The administration will make programs available for high-risk congregate settings, including homeless shelters, jails, and institutions that serve individuals with intellectual and developmental disabilities.” Increase supply and get it out the door as quickly as possible Ensure a robust vaccine supply and spur manufacturing “To help people get vaccinated more quickly, the president-elect will maximize the manufacturer of vaccine and vaccine supplies for the country, including the Defense Production Act. This effort will prioritize supplies that could cause bottlenecks, including glass vials, stoppers, syringes, needles, and the “fill and finish” capacity to package vaccines into vials”. The Federal Emergency Management Program (FEMA) has an explanation of the Defense Production Act. The Defense Production Act is the primary source of presidential authorities to expedite and expand the supply of materials and services from the U.S. industrial base needed to promote the national defense. DPA authorities are available to support: emergency preparedness activities conducted pursuant to title VI of the Stafford Act; protection or restoration of critical infrastructure; and efforts to prevent, reduce vulnerability to, minimize damage from, and recover from acts of terrorism within the United States. DPA authorities may be used to: Require acceptance and preferential performance of contracts and orders under DPA Title I. (See Federal Priorities and Allocations System (FPAS)).Provide financial incentives and assistance (under DPA Title III) for U.S. industry to expand productive capacity and supply needed for national defense purposes;Provide antitrust protection (through DPA voluntary agreements in DPA Title VII) for businesses to cooperate in planning and operations for national defense purposes, including homeland security. FEMA also provides information about the Robert T. Stafford Disaster Relief and Emergency Assistance Act, PL 100-707, signed into law November 23, 1988; amended the Disaster Relief Act of 1974, PL 93-288. This Act constitutes the statutory authority for most Federal disaster response activities especially as they pertain to FEMA and FEMA programs. Title IV of the Stafford Act is called “Major Disaster Assistance Programs”. Section 401 “Procedure for Declarations” provides the following explanation of this part of the Stafford Act. “IN GENERAL – All requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State. Such a request shall be based on a finding that the disaster is of such severity and magnitude that effective response is beyond the capabilities of the State and the affected local governments and that Federal assistance is necessary.“As part of such request, and as a prerequisite to major disaster assistance under this Act, the Governor shall take appropriate response action under State law and direct execution of the State’s emergency plan. The Governor shall furnish information on the nature and amount of State and local resources which have been or will be committed to alleviating the results of the disaster, and shall certify that, for the current disaster, State and local government obligations and expenditures (of which State commitments must be a significant proportion) will comply with all applicable cost-sharing requirements of this Act.“Based on the request of a Governor under this section, the President may declare under this Act that a major disaster or emergency exists.” The Defense Production Act, and the Stafford Act, are what gives a president the power to take action in emergency situations in order to provide states with what they need to survive it. The incoming Biden-Harris administration clearly saw that the COVID-19 pandemic is an emergency. There appears to be a potential problem, though. In order to receive emergency aid, a state’s governor would have to request it from the Biden-Harris Administration. My best guess is that the Biden-Harris administration believed that every state Governor would do so, but there was still the possibility that some state governors might decide not to accept the aid. President-elect Biden and Vice President-elect Harris would not be able to directly act on it until after the Inauguration and swearing in ceremonies were over. Planning ahead helped to make it possible for so many people, across the United States, to get vaccinated. Be a reliable partner for states by providing actionable data on vaccine allocation timelines and delivery. “To effectively plan and scale distribution, states and localities rely on both advanced understanding of their allocations and timely delivery of their ordered doses. Under President-elect Biden’s plan, the federal government will provide regular projections of the allocations states and localities will receive. “The federal government will build on the operational plans in place to ensure the effective distribution, storage, and transit of vaccines to states, including support for maintaining or augmenting the vaccine-specific required cold chain. The federal government will also fully leverage the Defense Production Act to fill any distribution gaps, including with respect to any needed refrigeration, transportation, or storage facilities.” Increase vaccine availability while maintaining a commitment to the two-dose schedule. “President-elect Biden’s plan will release the vast majority of the vaccines when they are available, so more people an get vaccinated quickly, while still retaining a small reserve for any unforeseen shortages or delays. To continue ensuring second-dose availability on the timeline recommended by the FDA, the Biden-Harris administration will closely monitor development, production and release of vaccines, and use the DPA as needed to ensure adequate supply for second doses on the timeline recommended by the FDA.” Mobilize more personnel to get shots in arms. Surge the public health workforce to support the vaccination effort. “A diverse, community-based public health workforce is essential to an effective vaccination program. President-elect Biden will address workforce needs by taking steps to allow additional qualified professionals to administer vaccines and strongly encourage states to use their flexibility fully to surge their workforce, including by expanding scope of practice laws and waiving licensing requirements as appropriate. “The federal government, in partnership with states, will provide appropriate training, including thorough use of the U.S. Public Health Service Commissioned Corps. The president-elect will also act swiftly to amend the current COVID-19 Public Readiness and Emergency Preparedness Act declaration to permit certain qualified professionals, including retired medical professionals, that are not licensed under state law to administer vaccines to be able to do so with appropriate training in order to expand the number of qualified professionals able to administer the vaccine.” The Commissioned Corps of the U.S. Public Health Service (USPHS) “is one of the nation’s uniformed services – a branch committed to the service of health. Officers advance our nation’s public health, serving in agencies across the government, as physicians, nurses, dentists, veterinarians, scientists, engineers, and other professionals.” Their mission is: Protect, promote, and advance the health and safety of the nation. They work at the CDC, FDA, Indian Health Service, National Institutes of Health, the Department of Justice, and the Department of Defense. The Declaration Under the Public Readiness and Emergency Preparedness Act for Medical Countermeasures Against COVID-19 was placed on the Federal Register by the Department of Health and Human Services on March 17, 2020, during the Trump Administration. It is also called the PREP Act. The Summary of the PREP Act (at that time) stated: “The Secretary is issuing this Declaration pursuant to section 319F-3 of the Public Health Service Act to provide liability immunity for activities related to countermeasures against COVID-19.” Part of the Supplementary Information included: The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. This Declaration is subject to amendment as circumstances warrant. Another part, Section IV. Limited Immunity, stated: The Secretary must also state that liability protections available under the PREP Act are in effect with respect to the Recommended Activities. These liability protections provide that, “ubject to other provisions of the , a covered person shall be immune from suit and liability under federal and state law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration to or use by an individual of a covered countermeasure if a Declaration has been issued with respect to the countermeasure.” In Section IV of the Declaration, the Secretary states that liability protections are in effect with respect to the Recommended Activities. In other words, the Trump Administration decided that the best way to handle the COVID-19 pandemic was to prevent people from being able to sue “those that manufacture, distribute, administer, prescribe or use Covered Countermeasures.” It wasn’t about protecting the health of the American people at all! On January 28, 2021, about a week after Inauguration Day, the Department of Health and Human Services (HHS) posted: “HHS Amends PREP Act Declaration to Increase Workforce Authorized to Administer COVID-19 Vaccines”. This is the amendment that President Biden mentioned in the Biden-Harris COVID-19 Plan. The Release stated the following: The U.S. Department of Health and Human Services (HHS) today issued a fifth amendment to the Declaration under the Public Readiness and Emergency Preparedness Act (PREP ACT) to add additional categories of qualified persons authorized to prescribe, dispense, and administer COVID-19 vaccines authorized by the U.S. Food and Drug Administration.“To respond to the nationwide public health emergency caused by COVID-19, the Biden Administration is broadening use of the PREP Act to expand the vaccination workforce quickly with additional qualified healthcare professionals,” said HHS Acting Secretary Norris Cochran. “As vaccine supply is made more widely available over the coming months, having additional vaccinators at the ready will help providers and state health departments meet the demand for vaccine and protect their communities more quickly.” Among other things, the amendment: Authorizes any healthcare provider who is licensed or certified in a state to prescribe, dispense, and/or administer COVID-19 vaccines in any other state or U.S. territory.Authorizes any physician, registered nurse, or practical nurse whose license or certification expired within the past five years to prescribe, dispense, and/or administer COVID-19 vaccines in any state or U.S. territory so long as the license or certification was active and in good standing prior to the date it went inactive.Requires any healthcare professional described above to complete Centers for Disease Control and Prevention (CDC) COVID-19 Vaccine Training and, for healthcare providers who are not currently practicing or whose license or certification is expired, requires an on-site observation period by a currently practicing healthcare professional. “Under the PREP Act and the Declaration, a qualified person is a covered person. Subject to certain limitations, a covered person is immune from suit and liability under federal and state law with respect to all claims for loss resulting from the administration or use of a covered countermeasure if a declaration under the PREP Act has been issued with respect to such countermeasures.” As you can see, the Biden-Harris administration does include protection for health care practitioners who administer COVID-19 vaccines, as well as the manufactures of the vaccines, from being sued by a person who was harmed from it. The Trump-Pence administration made that the entire focus of the PREP Act. The Biden-Harris administration’s amendment makes it clear that the most important thing is to make it possible for more people to obtain a COVID-19 vaccine. It puts people first – not corporations. Mobilize a public health jobs program to support COVID-19 response. “President-elect Biden has asked Congress to make an historic investment in expanding the public health workforce, funding 100,000 public health workers to nearly triple the country’s community health roles. These individuals will be hired to work in their local communities to perform vital tasks like vaccine outreach and contact tracing in the near term, and to transition into community health roles to build our long-term public health capacity that will help improve quality of care and reduce hospitalization for low-income and underserved communities.” Ensure the American people have the information and confidence they need to get vaccinated. Launch a federally led, locally focused public education campaign. “The federal government will build public trust through increased transparency, communication around progress and setbacks, and a public education campaign that addresses vaccine hesitancy and is tailored to meet the needs of local communities. The campaign will work to elevate trusted local voices and outline the historic efforts to deliver a safe and effective vaccine as part of a national strategy for beating COVID-19.” The Biden-Harris COVID-19 Vaccination Plan worked! The White House COVID-19 Response Team posted regular updates about how many people have received a COVID-19 vaccination. On January 27, 2021, @WHCOVIDResponse tweeted: “The President set an ambitious goal of administering 100 million shots in our first 100 days. To get there, we’ve got to average about a million shots per day. Just one week in, our trajectory is good and we are all well on our way to hitting that goal.” The tweet includes the following graphic: The graphic says: 7,000,000 Vaccine Doses Administered Since January 20, 2021. Below it are a series of dots where each dot equals 10,000 vaccine doses. On February 3, 2021, @WHCOVIDResponse replied to its previous tweet with a new tweet: “Since last week’s update, we’ve administered another 9 million doses of the COVID-19 vaccine. The steps we’ve taken to increase supply & work directly with states to change the course of the pandemic make a difference in our goal to get 100 million shots in the first 100 days.” The tweet included the following graphic: The graphic says: 16,000,000 Vaccine Doses Administered Since January 20, 2021. Below it is a series of dots. The black dots are toward the bottom Each black dot equals 10,000 doses. A grouping of blue dots each equal 10,000 doses. All the blue dots equal new vaccine doses since January 27th, 2021. On February 10, 2021, @WHCOVIDResponse tweeted: “We’ve been making steady progress over the past few weeks — getting more vaccine supply, getting more vaccinators on the ground, and creating more places to get vaccinated. We’re on track to meet our goal of delivering 100 million shots in our first 100 days in office.” The tweet included the following graphic: The graphic says: 26,000,000 Vaccine Doses Administered Since January 20, 2021. Below it is a series of dots. This time, the black dots are located starting at the left-hand side of the image. The black dots rise to the line of dots third from the top, and decrease in stair steps from there. Each black dot equal 10,000 vaccine doses. There is also a bunch of blue dots that start out on top of the black dots. The blue dots also decrease in stair steps on the right hand side. Each blue dot equals 10,000 vaccine doses, and new vaccine doses since February 3rd, 2021. On February 17, 2021, @WHCOVIDResponse tweeted: “27 days ago, the President launched his comprehensive national strategy to beat this pandemic. We are working every day to execute that strategy and seeing results.” The tweet included the following graphic: The graphic says: 38,000,000 Vaccine Doses Administered Since January 20, 2021. Below it is a series of dots. The black dots start at the bottom of the graphic and continue up to the ninth line from the bottom. The black dots recede in stair steps as they get closer to the left-hand side of the graphic. There are blue dots on top of the black dots. They fill the top nine lines of the graphic, and recede in stair steps on the left-hand side of the graphic. The blue dots fill in gaps left by the black dots stair steps. Each black dot equals 10,000 vaccine doses. Each blue dot equals 10,000 vaccine doses. All the blue dots equal new vaccine doses since February 10, 2021. On February 26, 2021, @WHCOVIDResponse tweeted: “In just five weeks, we’ve administered more shots than any other country, with among the highest percentage of the population fully vaccinated. That progress is because we’re working around the clock to increase vaccine supply, places to get vaccinated, and vaccinators.” The tweet contained a very large graphic: At the top of this graphic, there are a multitude of tiny blue dots. A bracket holds them up. The bracket leads to text that says “For context, 10,000 vaccination doses looks like this”. A line leads down to a circle that has one blue dot at the top of it. The circle has text that says “Just one of these dots holds 10,000 vaccination doses”. A line leads down from the circle into a rectangle that has a lot of black dots at the bottom. This time, they stair step as they reach the right hand side. Each black dot is equal to 10,000 vaccine doses. On top of the black dots are many blue dots. They fill in the stair step where the black dots left off, and continue to the top part of the rectangle that all of these dots are in. Each blue dot equals 10,000 vaccine doses. All of the blue dots together equal new vaccine doses since February 17, 2021. There is larger text in the middle of the graphic that says: 50,000,000 Vaccine Doses Administered Since January 20, 2021. On March 12, 2021, @WHCOVIDResponse tweeted: “Last night the President said that we’re on track to reach his goal of administering 100 million shots in his first 100 days weeks ahead of schedule. While there’s still so much more work to do, this by-the-numbers breakdown of our COVID-19 response outlines how far we’ve come.” The tweet included the following graphic: The top of this graphic says: “An Update On The Biden-Harris COVID-19 Response”. There are no dots on this graphic. Under the heading, it says: “81M Shots Since January 20, 2021.” Drawings of eight syringes are in a line next to it. There is a line under that part. Below it, there is text that says “More than 70% of 75 Year Olds have their first dose”. Next to that is a drawing of a bottle of vaccine with a yellow label. Below that, there is text that says “More than 60% of 65 Year Olds have their first dose.” Next to that is another bottle of vaccine with a yellow label. Off to the side, there is a drawing of a small calendar. The calendar says: “2.2M per day” and there is an arrow pointing away from it, across the calendar page. Below the calendar it says: “7-Day Average of 2.2 Million Vaccinations Per Day.” On March 19, 2021, @WHCOVIDResponse tweeted: “Before President Biden took office, he set a goal of administering 100 million doses of COVID-19 vaccines in his first 100 days, which meant increasing vaccine supply and then turning vaccines into vaccinations. Today, on his 58th day in office, we have reached that goal.” The tweet included the following graphic: The top of this graphic says: “100,000,000 Vaccine Doses Administered Since January 20, 2021.” Underneath that it shows that each black dot equals 25,000 vaccine doses. It also says each blue dot equals 25,000 doses. There is another blue dot next to text that says “New vaccine doses since March 10th.” Below the text, there are about eight lines of blue dots, stair stepping down as they reach the right hand side of the graphic. Below them are a multitude of black dots, slightly stepping up as they reach the right hand side of the graphic. After reaching this goal, President Biden decided to double the goal and attempt to reach 200 million vaccine shots administered in his first 100 days in office. I really like the transparency that the Biden-Harris administration is providing people in regards to the effort to protect people from COVID-19. The Biden-Harris Covid-19 Vaccination Plan is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... More Dental Care During a PandemicJanuary 23, 2021Doctor Appointments / Out of SpoonsPhoto by Shawn Thorpe For whatever reason, I ended up needing a lot more dental care than I expected this year. Trying to see a dentist during a pandemic is difficult. It is also a little weird because of changes made in response to COVID-19. Before you read this blog post, you might want to read the first part: Dental Care During a Pandemic. My next dental appointment was scheduled for August 6, 2020. It wasn’t clear what would take place at that appointment. Would it be a cleaning? Would I be getting a small titanium rod in my jaw (the next step in a tooth-replacement process)? As before, my husband and I had to wait outside the dentist’s office when we arrived. The lobby was closed due to COVID-19 restrictions. I sent a text to the office to let them know I was waiting on a bench across the street. Eventually, the woman who does cleanings came out the back door of the office and waved me over. She used one of those forehead thermometers to check if I had a fever. After passing that test, she directed me inside to the room where the cleanings take place. This was my first cleaning of the year. The previous one got canceled shortly after California did a “stay at home” order in March. At the time, I think many of us believed that following that order would be annoying, but worth it, if the result was the end of COVID-19. I didn’t realize I was getting a cleaning that day until I was directed to the room where it happens. The woman who does the cleaning was in full PPE gear, which I had seen her use on my previous visit. (That visit was a quick check from the dentist to see if the site where a broken tooth was extracted was healing well). The woman who does the cleaning did not know that I had a tooth extracted since the last time she saw me. I had to explain that I somehow broke a permanent cap and what was left of the tooth that was underneath it. She shook her head. “I lot of people have broken their teeth,” she said. “I think it’s from stress because of the pandemic.” It turned out that she and I both had a birthday in the same month. She told me that she didn’t feel like celebrating it this year. “Can’t go anywhere,” she shrugged. I told her I felt the same way, and didn’t do anything special on my birthday this year either. The checkup and cleaning is covered by my insurance, and I wouldn’t have to pay for any of it. The woman who does the cleaning thought I had another cracked tooth. “It looks like a chunk has been taken out of it.” While I remembered the now extracted tooth making a crunch sound when I broke it – I had no memory of another tooth breaking. I have one more permanent cap left in my mouth. The woman who does the cleaning discovered that I was going to need a root canal on that one. The dentist, who came in after the cleaning to do a quick check, agreed. It turns out the broken tooth was not actually broken. He had altered it when the extraction was happening, in preparation for the next steps. This dentist referred me to a dentist in another town for an assessment on whether or not I needed a root canal. I kind of freaked out about that because neither I, nor my husband, drive. Taking an Uber or Lyft – there and back – would be really expensive. My dentist convinced me that having the root canal done in the other town would be less expensive than here. He did this as the receptionist was putting my appointment with him for a root canal into the computer. She seemed displeased that he was making her change that. The strangest thing about having to set up an appointment for a root canal at a dentist I’d never seen before is that I had no way to contact their office. The receptionist at my dentist’s office told me that the other dentist would call me when they were ready to make an appointment. I was told I’d have to negotiate a price with their office. I have absolutely no idea how to budget for this unknown cost. It is also a bit alarming to know that I likely need a root canal – and then to be stuck in limbo waiting for an appointment from a dentist I’ve never seen before. There was nothing I could do but wait. On August 19, I got a call from the receptionist at the dentist’s office that is in another town. She wanted to schedule me for a consultation for a root canal. Unfortunately, the appointment she was offering was on the exact same day that I would be having a titanium rod put in my jaw at my regular dentist’s office. “I have no idea how long it will take me to heal,” I informed her. The next option was an appointment two days from now. I decided to take it. When I was told the appointment would take an hour, so I could fill out paperwork, I convinced the receptionist to email those forms. Neither I, nor my husband, can drive due to our chronic illnesses. We don’t have a car anymore. This means we would be taking the bus to the town the new dentist is in and then walking part of the way to the office. My hope was the appointment would be shorter than expected. After that, my husband and I would be doing the same process in reverse to get back home. The bus would be less expensive than if we took an Uber or Lyft back and forth. At the moment, both ride-sharing companies were fighting a lawsuit that would require them to give their California workers the same benefits as full-time employees. Each one threatened to stop service in California rather than comply with the law. The bus was our only option. Later that day, I got a text from my regular dentist’s office. “Your co-pay for your appointment tomorrow is $605,” the receptionist texted. “I thought my appointment was on the 24th?” I texted back. Receptionist apologizes and clarified that yes, my appointment is on the 24th. “Wrong patient”. It was a huge relief that I was not expected to come up with an extra $605 on top of the $1,500 that the appointment would cost. The next day, I started getting worried about having to go out of town for the consultation on a root canal. The COVID-19 pandemic was ongoing and I, a person with autoimmune issues, was worried about what would happen if the people on the bus chose not to wear masks. The photo at the top of this blog post shows what the sky outside looked like. Smoke was coming from a fire that was too far away for us to have to worry about evacuation. The smoke from that fire drifted here. California’s fire season had begun, and it was really fierce this time around. It was 93 degrees outside at nearly 6 p.m. The weather app on my phone showed a warning about “unhealthy air quality”. The pollen count was 8.0, which was enough to make people who have no allergies cough and wheeze. I had a bad feeling about this. My weather app and the pollen.com app allow me to view data from not only where I live, but also whatever location I want to add. From this, I learned that the temperature in the other town would be 107 degrees tomorrow, and the pollen count would be 10.1. When the pollen count reaches 10 I lose all ability to focus. I stop making sense, cannot focus on anything, and feel extremely sick. The weather app said that the air quality where I live would be “Unhealthy Air Quality” tomorrow. The other town’s air quality would be “Very Unhealthy Air Quality”. Rather than risk my health, I called the out-of-town dentist and listened to the automated message informing me that the office was closed due to COVID-19. Patients who needed emergency dental care could leave a message and would be called back if the dentist thought the person was having an emergency. When the message ended, I stated my name, explained that the weather conditions and the smoke made it dangerous for me to go outside due to my chronic illnesses, and cancelled the appointment. And then I started to worry about how much I would be charged for cancelling an appointment the night before. When I start panicking about money, I have a tendency to push myself into working harder, even if I’m not really well enough for that to be a good idea. I was trying to complete as much of my freelance writing work as possible. It was 4 in the morning, and already 86 degrees outside. The pollen count was 8.5. The weather app warned that the air quality was “Unhealthy Air Quality for Sensitive Groups”. That’s me. I made the right decision to stay inside and away from the excessive heat and the smokey, pollen filled air. Here’s what I wrote on social media about how my day was going: I have a portable air conditioner on, sitting a few feet away from me. It helps lower the temperature in here in the summer, and filters the air somewhat.Nearby is a really good air filter/purifier that does a really good job of filtering out pollen, dust, and other particulate matter.All of the windows are shut, but I can still smell smoke in the air. The mobile home we live in is old and far from being air tight.The air smells like popcorn that has been slightly burned in a microwave.I have started coughing, and am typing this while wearing my thickest cloth mask. The coughing has stopped, for now. The receptionist at the out-of-town dentist called me back and was extremely nice to me. She honestly seemed to understand why I needed to cancel. She looked up some information and discovered that my referral will last for 90 days. There was time to reschedule, and they would call me back for an appointment in mid-September. This gives me enough time to get the titanium rod placed in my jaw at my dentist’s office and recover from it at least a little bit. To my great relief, I was not being charged anything for cancelling the appointment. Later, I learned that several businesses, including some that function as banks, had closed their offices due to the smoke. They didn’t want to expose their workers – or customers – to that danger. On August 23rd, my dentist texted me a form to fill out before my appointment the next day. It was a short questionnaire that was designed to help them figure out if I might have COVID-19. I filled out the questions with “no” to most of them. One question asked if I have any autoimmune diseases. Yes! I have allergies. On August 24th, I got up early so I could be at the dentist’s office in time for my 9 a.m. appointment. My husband and I took a Lyft to the office. The driver was wearing a mask, and so were we. As before, the reception area at the dentist’s office was closed, and I was told to text them when I arrived. Between the last time I was here, and now, the office had three very new wooden benches placed in front of it. We wouldn’t have to wait on the bench across the street anymore. The new benches were comfortable. The dentist gave me Novocaine – this time without epinephrine. (It makes me shake.) The office has the air conditioning blasting through a vent right above my feet. I started shaking, and the receptionist came in with a soft blanket for me to use. The shaking didn’t stop right away. I wasn’t scared. Eventually the dentist figured out that the shaking was because I hadn’t eaten breakfast and my blood sugar dropped. He offered me two different fruit drinks that contained sugar – which should counteract the shaking. Unfortunately, I was allergic to ingredients in both of them. The dentist sent someone to go to the 7-11 and pick up some sugar. The procedure to place a titanium rod into my jaw was absolutely painless. I didn’t feel a thing other than some pressure. From my perspective, it seemed like the dentist was screwing the titanium rod into my jaw, with a tiny Allen wrench. So, this is what it would feel like to be a piece of IKEA furniture! The whole thing was done in about 30 minutes. I watched the required video, and was given some paper that had the same information. The dentist, and the receptionist, both strongly recommended that I take a pain killer BEFORE the Novocaine wore off. I still had plenty of that leftover from when they did the extraction. The receptionist gave me a prescription for an antibiotic, which she said to start taking that day. To my surprise, the receptionist said that I still had some money on my account. I’m absolutely terrible about understanding numbers, especially right after having dental surgery. The total bill that was originally estimated to cost $1,500 was now $1,917. I have no explanation for why the cost increased. My husband had to wait outside for me, so I was texting him to let him know I was done and what the cost of the bill turned out to be. We took a Lyft home. As directed by my dentist, I took a pain killer before the Novocaine wore off. Spent a hazy half-hour or so watching a friend stream a video game on Twitch, and then went to sleep for a while. My husband went back outside while I was sleeping to get the prescription for the antibiotic filled, and I have been taking it as directed. The most interesting part about all of this is that the pain from the dental surgery is not much different in intensity than the pain my sinuses are in when the pollen count is too high. I walk around with this kind of pain all the time, and have grown used to it. This realization is actually kind of alarming. August 26: I have been taking Vicodin, as prescribed and directed by my dentist, to cope with pain from dental surgery. It feels like time stops while I’m under the influence of this medication. August 30: The receptionist at my regular dentist’s office sent me a text. My next appointment will be on September 29 at 11:00 AM. I texted back that I would be there, as requested. The appointment is so the dentist can check on how I am healing after having a titanium implant placed in my jaw, and a tiny metal plate on my gums to protect it. This is very similar to the appointment I had after the extraction, so I know it will be a quick appointment with no cost to me. August 31: The antibiotics I am taking are relatively mild. I’m not having any terrible reactions to them. My biggest problem is that they make me super tired. Between that, and the high pollen count, I am absolutely exhausted and taking way more long naps than typical. There are five more antibiotics left in the bottle. September 1: I finally finished all of the antibiotics! The generic I was given cost $2.11 for 24 capsules. Overall, I didn’t have any terrible side effects from it. The worst part was it made me even more exhausted than typical, and I ended up sleeping more than usual. September 6: The information that came with the antibiotic included a warning that side effects may last for a few weeks after I’ve taken all the medication. The only side effects I had while taken them was (additional) exhaustion. Very unpleasant side effects started today. I am in no danger – just really unhappy about this. Typically, I lose weight too quickly from this specific side effect. And doing so can push my borderline anemia into full anemia. The way to prevent that is to eat more – and I don’t wanna. September 29: Today, I went back to my dentist’s office – again – to have what I was told would be a quick check on the titanium screw that the dentist implanted a while ago. The purpose is to see how well I’m healing so we can do the next – extremely expensive part – as soon as possible. The dental assistant took an x-ray that showed that everything is good. I was given an appointment in early December to come back and start the extremely expensive part. It is unclear to me if this will take more than one appointment. The receptionist asked if the other dentist, the one they referred me to for a consultation about a root canal, gave me an appointment. I explained that I was given an appointment, but then the smoke from the fires got so bad that it was unsafe for me to go outside. I had to cancel and reschedule. “We got a lot of cancellations and reschedules, too”, she explained. She then made it clear that I really needed to call back the other dentist and try to get an appointment as soon as possible. It turns out that the referral only lasts for 90 days, and if they can’t get me in within that time frame – my dentist would have to send a referral all over again. I was feeling okay after leaving the dentist’s office. My husband and took a little walk downtown. I don’t leave the house anymore unless I have to for health care purposes because my immune system sucks, so it was nice to get a little bit of exercise. After returning home, I called the other dentist to get an appointment for a consultation on a root canal. The receptionist gave me an appointment for two days from then, and would be within the time span allowed by the referral. My husband helped me fill out an incredibly lengthy form that the dentist needed in order to assess my need for a root canal. We emailed the form back to the receptionist, who kindly emailed back that they received it. October 1, 2020: My husband hired a driver to take us to my dentist appointment. I have started thinking of this dentist as “second dentist”. It makes it easier for me to keep track of which dentist does what to me. The driver lives in the town that the office of “second dentist” is located. This driver usually takes people to, and from, wine tastings. He was happy to drive out of town to pick us up, drop us at the office of “second dentist”, and then take us home after I was all finished. We had a lovely conversation with the driver on the way out (and also on the way back). The office door was locked, and a note said to press a buzzer. A receptionist, wearing a mask, came to the door. She let me in to take my temperature – with one of those “forehead guns” – because it was incredibly hot outside. She then went around to behind a plastic screen and asked for my driver’s license and dental health insurance card. I had to sign some forms by picking up a pen from the “clean pens” can. The pen went into the “dirty pens” can when I was done. A nurse, covered in PPE, walked me into a room and took my blood pressure. She brought up an x-ray of the tooth that might need a root canal on a very large screen that was on the wall. The permanent cap I have on what is left of that tooth was obvious. Unfortunately, the x-ray was unable to show what was under the permanent cap. The dentist came in, also covered in PPE, and asked me a few questions. Everyone I met there was extremely calm and kind. He asked me to take off my mask so he could take a look at the tooth and asses if it needed a root canal. “Second dentist” poked at it with some dental tools, and used one of those little mirrors on a stick to take a closer look. He used some machine behind me to make a dental tool very cold, and I was instructed to raise my hand when I feel the cold. Eventually, I felt the cold. It did not hurt or bother me. After doing the assessment, “second dentist” announced that I probably do need a root canal. He noted what first dentist had already told me – that I had an opening in my gum above that tooth. He also said that I have an infection. When I asked if I needed antibiotics, I was informed that I did not. My body was fighting it. My body was fighting it? I found this hard to believe. When I got home, I started taking an herbal supplement that I got from my acupuncturist. The supplement functions like a mild antibiotic. There was potential that what was left of the tooth under the permanent cap would be insufficient, and he would be unable to do a root canal. If so, then he would put in a temporary cap and send me back to first dentist for an extraction. The nurse pointed out that she thought my insurance required the office to get permission before doing the work. I was left in the dental chair to watch what I assumed was a National Geographic video featuring birds who are trying to attract mates. The nurse returned and confirmed that my insurance requires permission before they can do the root canal. I was sent back to the receptionist, who gave me a pile of forms to fill, initial, and sign. The cost today was $45. The forms held an alarming list of potential things that could go wrong during a root canal. One was listed as “sinus perforation”. The receptionist stopped “second dentist” and the nurse to explain that one. “Second dentist” assured me that would not happen. I let them know I have bad allergies. “Second dentist” recommended I take allergy medication before the next appointment. He also wanted me to take a Sudafed, which is a decongestant. “Second dentist” explained that taking it would prevent me from having what I think of as post nasal drip while the procedure was going on. The paperwork also had an entire page that was focused on “sedation medication”. I had no idea what that was. Long story short, if the insurance approved, “second dentist” would send “sedation medication” to my pharmacy. I was instructed to pick it up immediately. It was important that I bring the medication to second dentist’s office and take the pill there, where they can monitor me. I tried to explain that I have a high pain tolerance, due to fibromyalgia. I also made it clear that it is incredibly difficult to knock me out. The receptionist explained that the purpose was to sedate me so I would be calm while the dentist was working. I ended up agreeing to pick it up from the pharmacy and bring it to “second dentist’s” office. No idea what kind of medication it will be, if it has gluten in it, or if it conflicts with the antihistamines I’m already taking. My husband was waiting for me on the bench outside the office. They only allow the patient to come inside. He contacted our driver, who took us back home. We intend to call on him again if/when second dentist hears back from the insurance company and has permission to grant me an appointment. The pre-authorization price I was given was $1,342. I am mentally and physically exhausted by the thought of the dental work in my near future and the money it is going to cost. October 2: I took a nap earlier today. After waking up, I wondered why I felt so awful. Then I remembered that I have an infection in the gum area where I (might) need a root canal, it is 100 degrees outside at 3PM, and my weather app says the air quality is “Unhealthy”. October 17, 2020: I received mail from my dental health insurance provider. It was a “Pre-Determination of Benefits”. The letter included a chart that showed each and every little piece of the dental care that “second dentist” was going to provide me with. The amounts shown were disturbing. Fortunately, the dental health insurance would actually cover some of it. It still was going to cost me $775 out of pocket. October 18, 2020: I got a second “Pre-Determination of Benefits” letter in the mail from my dental health insurance provider. It was identical to the one that was sent to me the day before. Hmm… I think I see a way for the dental health insurance to cut down on some of their costs. They could send ONE of “Pre-Determination of Benefits” letter to the patient instead of two. October 19, 2020: I got a phone call from the office of “second dentist”. The very kind receptionist was calling to schedule me an appointment for a root canal. She said the dental health insurance approved, and asked me if I received a copy of the cost from the dental health insurance. “Yes!”, I responded. “They sent two copies to me.” The receptionist giggled. She then asked me what day I would be available for the root canal appointment. She didn’t know that I had been sleeping right before she called. This left me a bit flustered. I got out of bed and went to my computer, trying to figure out what day would be best for me. “How about… a Tuesday?” I made a quick decision to pick a day when I didn’t have a Dungeons & Dragons game to play, and when I wouldn’t be planning to record a podcast. “Ok, a Tuesday…” The receptionist offered me an appointment on November 10, and I took it. The appointment would be at 1:00 in the afternoon, and could last until at least 3:30 to 4:00. Why would a root canal take so long? The reason was due to the “sedation medication”. Someone at the office of “second dentist” would call in a prescription for that medication to my pharmacy of choice a week before my appointment. I was to bring it with me to the dental appointment. They would monitor me as I took this medication. The receptionist made it clear that I would need to find someone else to drive me home from the appointment, as I would not be able to safely drive after taking the “sedation medication”. I asked the receptionist for the name of the medication, so I could research it online. This was important, because I’ve had too many bad experiences with medications that had an inactive ingredient that I was allergic to. I asked the receptionist if it was safe for me to take my regular allergy medication the night before I was on the “sedation medication”. She checked with “second dentist”, who said it would be okay to do that. I am not allowed to have food or drink six hours before the appointment. The receptionist explained that this is because I will be in the office for three hours. The first thing I did after the phone call ended was to get online and search for the inactive ingredients of the “sedation medication”. Fortunately, it appears to be gluten-free. This is not the first time I had a root canal. For the first one, the dentist (who has since retired) gave me Novocaine and started working on the procedure after it kicked in. I remember she had the lights in the room dimmed. It will be interesting to see what the “sedation medication” does to me. I have no fear of the dentist or the work he will do on me. If I had to guess, the office of “second dentist” gets a lot of patients who are extremely phobic of dentists. November 4, 2020: I ventured out of my home with my husband, during the pandemic. We both wore masks – because it is the smart thing to do – and the bus required riders to wear them. The purpose of this trip was to pick up the “sedation medication” that “second dentist” prescribed. We figured that, due to the type of medication, the pharmacy would not allow him to pick it up for me. I had to be there in person. My husband said that the pharmacy wanted to see my ID. I woke up with what I call “allergy face”, and took benadryl before going outside. This is not something I would do if I was alone, just in case the benadryl hit stronger than typical. If nothing else, this trip to the pharmacy would force me to stop refreshing The Guardian’s live feed about the election. November 10, 2020: My husband and I, once again, hired a driver to take us to “second dentist’s” office. It was not located in the town we live in. The dentist’s receptionist made it clear that I would NOT be able to drive myself home from this appointment. We were a little early, and the office was closed. Eventually, they let me in. Shawn had to wait outside due to COVID-19 restrictions. Long story short, the receptionist instructed me to take both of the “sedation medication” pills while she watched. They eventually kicked in. I have no conscious memory of having the root canal. I later learned that those pills were a mind eraser. We had to wait for the hired car to come pick us up. My husband later said that the dentist assistant came to the door and explained to my husband about important details that she knew I would not remember. I posted two mostly incoherent posts on social media. I didn’t remember typing them. Apparently, I wanted to let my friends know I was done with the root canal and was ok. The first post said: “Have returned from the dentist. Am on a high ammount of a drug ive never taken before Very sleep and uncoordinated now Dentist sat root canal went well. I,m not feeling any pain at the momet” The second post was one in which I tried to respond to a friend, who replied to my first post. It said: “Im really spacy right now and much less coordinated when tryintg to walk Cant spell mucj oh here right now Sleepy calm hungry Got root canal seems unlikly I need an extraction I’m not making muchsnse sorry” December 1, 2020: Today, I go back to the dentist for what is hopefully the last of 2020’s dental work. I’m not entirely sure what is being done today. It might be the day I get a porcelain tooth placed on the titanium screw that was put into my jaw earlier this year. If so… then I’m likely done with dental work for a while. December 1, 2020: I am back from the dentist. Today, the dentist did a thing that will be used to make my porcelain tooth. (I’m in “fibro fog” right now, so words are difficult). The weirdest thing that happened was when the dentist reached into my mouth and unscrewed the titanium screw in my jaw so he could do the … thing. No pain at all. I feel like a cyborg. I go back in three weeks for the porcelain crown. We have already paid for it. December 22, 2020: Porcelain tooth acquired! Took a little bit for the dentist to take out the titanium screw that was in my jaw and replace it with the titanium screw that is attached to my porcelain tooth. It’s gonna take a little while before this tooth feels normal. All dental work for 2020 is completed and paid off. The only thing I have scheduled for 2021 is a checkup/cleaning in March. More Dental Care During a Pandemic is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... A Timeline of the GOP’s Attempts to Destroy Obamacare – Part 4: December and JanuaryJanuary 19, 2021health insurance / Out of SpoonsImage by David Peterson from Pixabay This blog post covers the damage that the Trump Administration – and the GOP – have done in an effort to restrict and remove access to health care from the American people. The series could be described as “receipts”. The good news is that the Trump Administration ends on January 20, 2021. The Biden-Harris Administration will replace them. Joe Biden was Vice-President during the Obama Administration – when the Patient Protection and Affordable Care Act went into affect. I believe the incoming administration will put great effort into ensuring that people have affordable health care. There is more good news! The results of the 2020 election – including the Georgia runoff election – put Democrats in a good place. We will have a President who is a Democrat, a Democratic majority in the House, and a Democratic majority in the Senate. This blog post also highlights everything that the Democrats (and other people outside of government) have done in an effort to protect American’s access to health care – of all types. That includes protections for DACA recipients and people who are LGBTQ+. You may want to take a look at previous blog posts in this series. Doing so will give you an overall picture of what the Trump Administration and the GOP have done to harm American’s health since 2017. A Timeline of the GOP’s Attempts to Destroy Obamacare – Part One A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Two A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three – Continued A Timeline of the GOP’s Attempt to Destroy Obamacare – Part Four A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: April, May, June A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four; July, August, September A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: October and November December 2020 December 2, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Secures Appellate Court Victory in Lawsuit Challenging Trump Administration Public Charge Rule”. From the press release: California Attorney General Xavier Becerra today secured an order from the Ninth Circuit Court of Appeals affirming a prior preliminary injunction in a multistate lawsuit challenging the Trump Administration’s public charge rule. The rule targets working immigrants and their families by turning the use of critical health, nutrition, and housing programs that supplement their modest incomes into barriers to lawful admission to the United States. The appellate court’s order applies to the multistate coalition and states involved in related Ninth Circuit cases. “We applaud today’s decision blocking the Trump Administration from enforcing its immoral public charge rule while we make our case in court,” said Attorney General Becerra. “As we continue to face an unprecedented economic and public health crisis, forcing hardworking families to choose between basic necessities and maintaining their immigration status is inhumane. Attacking the healthcare of even one community is an attack on us all. Today’s victory is critical, but the fight is not over. We won’t let the Trump Administration’s assault on our immigrant communities go unchecked.”Longstanding guidance by the federal government defined a public charge as a person who is primarily dependent on either public cash assistance for income maintenance or institutional long-term care at the government’s expense. The Trump Administration has sought to expand this definition by declaring that the use of additional government programs constitutes grounds for a public charge determination, including healthcare through Medi-Cal (California’s Medicaid program), nutrition and food support through CalFresh (California’s Supplemental Nutrition Assistance Program), and housing for families through Section 8 housing assistance. The public charge rule has an outsized impact on California, where one in four people are immigrants and one in two children have an immigrant parent. The rule discourages eligible immigrant and mixed immigration-status families, who are not otherwise subject to the rule, from applying for benefits that they need and are entitled to. It also makes it harder for low- and moderate-income immigrants to be admitted into the United States or obtain green cards……Attorney General Becerra is joined in the case by the attorneys general of the Maine, Oregon, Pennsylvania, and the District of Columbia.A copy of the decision is available here. December 2, 2020: American College of Obstetricians and Gynecologists (ACOG) posted a news release titled: “ACOG Appleauds CMS for Finalizing Obstetric Payment Updates, Urges Congress to Act on Gynecologic Care”. From the news release: The following statement was released by Eva Chalas, MD, FACOG, FACS, president of the American College of Obstetricians and Gynecologists (ACOG), and Maureen G. Phipps, MD, MPH, FACOG, chief executive officer of ACOG, on the final rule announced yesterday by the Centers for Medicare & Medicaid Services (CMS) for the 2021 Medicare Physician Fee Schedule:“ACOG applauds the CMS for finalizing the proposed payment update for obstetric services. This is just one of many steps to ensure continued access to quality medical care for pregnant and postpartum women. We strongly encourage state Medicaid programs and commercial payers to follow suit and recognize the importance of fair, equitable payment rates for obstetric services. ACOG and its members advocated for the CMS to amend a prior proposal that would have cut rates for obstetric services and threatened access to quality maternity care and we are pleased that our members’ voices were heard.“ACOG is also unwavering in our commitment to ensuring that women have access to care throughout their lifespan, as the health of women, their families, and their communities depends on it. ACOG is gravely disappointed that CMS finalized deep cuts in surgical services, including gynecologic services and cancer care. At a time when patients experience the consequences of barriers to care daily, cuts could further decimate access to lifesaving care and create additional barriers.“We are also disappointed in the CMS’s disregard for the challenges that frontline health care professionals face in securing personal protective equipment and the rollback of several telehealth provisions at the end of 2021. The CMS had the opportunity to provide stabilization to physician practices and preserve patient access to care by finalizing payment for the increased cost of personal protected equipment and permanently implementing changes to telehealth payment. ACOG is committed to continuing to work to ensure that frontline health care professionals have the PPE that they need and that evidence-based telehealth services are available for our members and their patients.“ACOG has continually advocated for the CMS to value women’s health services equitably and ensure that women’s health services value is on par with other evaluation and management value increases. We are surprised that the agency ignored the voice of the medical community in finalizing these cuts. While the final decision by the CMS is disappointing, Congress has the power to avert these harmful cuts and ensure that people do not face increased barriers to lifesaving care. This action is even more urgent during the COVID-19 pandemic, during which many physician practices are experiencing hardships and even closing.“To ensure that the United States has a foundation for care after the pandemic ends, Congress must act now to preserve patient access to critical gynecologic care.” December 2, 2020: NARAL Pro-Choice America posted a press release titled: “Reproductive Freedom Is Under Threat in States Across the Country”. From the press release: Upon taking office in January, President-elect Joe Biden and Vice President-elect Kamala Harris are poised to begin undoing the Trump administration’s egregious attacks on reproductive freedom over the last four years.However, anti-choice state lawmakers across the country remain determined to criminalize abortion – putting the advancement of their unpopular idelogy above the health and well-being of the American people, even during a still-raging pandemic. Thanks to the efforts of these anti-choice, anti-freedom legislators as well as Trump and Senate Majority Leader Mitch McConnell’s efforts to stack the federal judiciary with judges hostile to Roe v. Wade, reproductive freedom remains in jeopardy:“Anti-choice, anti-freedom lawmakers are determined to do whatever it takes to end the legal right to abortion—and thanks to Trump and Mitch McConnell’s takeover of the federal judiciary, reproductive freedom is in real jeopardy,” said Kristin Ford, national communications director at NARAL Pro-Choice America. “We must remain vigilant as attacks on reproductive freedom continue at the state level and do all that we can to ensure that every body has the freedom to control their own lives, bodies, and futures.”State lawmakers and judges hostile to our fundamental rights are putting reproductive freedom in danger in states across the country: In Arkansas, anti-choice Republicans in the state legislature recently filed legislation to criminalize abortion. The bill’s sponsor said the measure was meant to challenge Roe v. Wade in light of Amy Barrett’s confirmation to the U.S. Supreme Court.A federal appeals court allowed Texas and Louisiana to block Medicaid patients from accessing healthcare at Planned Parenthood health centers. According to the Associated Press, though the Fifth Circuit previously blocked Texas and Louisiana’s bans on Medicaid funding for Planned Parenthood, last month’s decision to allow the bans to proceed comes after the addition of six Trump nominees to the court, four of whom participated in this case.A federal appeals court allowed provisions of Tennessee’s expansive abortion ban passed earlier this year to go into effect, giving the green light to yet another attempt to chip away at the right to abortion.Last week in Nebraska, a law banning a safe and common method of providing abortion care went into effect. Just before Election Day, Donald Trump and Senate Republicans jammed through the confirmation of Amy Barrett, a judge with a record of hostility towards the legal right to abortion, to the Supreme Court. Barrett’s presence on the Court solidifies an anti-choice supermajority on the bench that could threaten our fundamental rights for decades. Dozens of cases that put Roe and access to abortion care at risk are making their way to the Supreme Court. Barrett has already proven her willingness to be the deciding vote on cases weighing ideology versus science, such as when she voted in last week’s 5-4 decision to block enforcement of New York’s public health guidelines that restricted attendance at houses of worship to prevent COVID-19 transmission.The confirmation of Trump nominee Brett Kavanaugh, another justice hostile to reproductive freedom, tipped the Court to an anti-choice majority in late 2018. With a newly minted majority opposing abortion rights, anti-choice state lawmakers launched an all-out assault on Roe in hopes that a challenge would make its way to the Court and lead to the rollback of the landmark case. Bans on abortion were introduced, passed, or signed in 31 states in 2019 alone. December 4, 2020: Senator Chuck Schumer (Democrat – New York) posted a press release titled: “Following National Push Launched In Upstate New York, Schumer Announces Must-Pass National Defense Bill Will Authorize $8 Billion In New Critical Health Benefits For Vets Suffering From Agent Orange-Linked Illnesses”. From the press release: After successfully securing in July an amendment to the Senate’s Fiscal Year 2021 National Defense Authorization Act (NDAA), which expanded the list of diseases associated with Agent Orange exposure, U.S. Senator Charles E. Schumer today announced that the final version of the FY2021 NDAA includes his amendment, which authorizes $8 billion in new benefits for vets suffering from Agent Orange-linked illnesses. Schumer explained that upon the president’s signature, nearly 240,000 veterans around the country who might be suffering from bladder cancer, hypothyroidism and parkinsonism will be able to access healthcare and benefits, numbers that have expanded because of the senator’s amendment associating additional diseases with exposure to Agent Orange.“After years and years of suffering and fighting, I proudly stood shoulder to shoulder with our Vietnam Vets who were exposed to Agent Orange to get Congress to finally take a major step forward so they get access to the medical care they need,” said Senator Schumer. “It’s taken far too long, and we still need to see this change signed into law. But veterans across the country are celebrating today as a victory, and we will work together to get this across the finish line in the very near future so those who put their lives on the line for our freedom can get the healthcare they deserve.”Schumer added, “I’m especially proud today to have expanded access to this incoming influx of benefits by securing an amendment that adds bladder cancer, hypothyroidism, and Parkinsonism to the list of diseases associated with Agent Orange. Our veterans did not hesitate in the face of danger to fight for our country, and we must not nickel and dime them as they fight for their health now.”..…Schumer emphasized the importance of adding added bladder cancer, hypothyroidism, and Parkinsonism to the list of diseases associated with ‘Agent Orange’ exposure, and reiterated just how long this fight has been waged. Last year, the Senator secured a provision in the budget deal requiring OMB and the VA to issue a detailed report to Congress on the delay in adding these conditions to the presumptive conditions list, BUT the report was woefully insufficient and Schumer said those agencies failed to properly explain why they were denying veterans. In addition to the failure to include bladder cancer, hypothyroidism, and Parkinsonism on the Agent Orange presumptive conditions list, the VA has never acted on a 2018 National Academies report that found sufficient evidence of association between exposure to herbicides and hypertension.Schumer also explained that per the Agent Orange Act of 1991, the VA automatically accepts that if a Vietnam Veteran physically served in Vietnam between January 1962 and May 1975, it is probable that the veteran was exposed to an herbicide agent like Agent Orange. Furthermore, the Act established a list of “presumed” diseases that the VA stipulates are caused by Agent Orange exposure. Therefore, if a veteran served in Vietnam at any time between 1962-1975 and is diagnosed with one or more of the diseases VA recognizes as service connected, the VA will compensate the veteran and his or her family. However, even though there has been scientific evidence linking Parkinsonism, bladder cancer and hypothyroidism to Agent Orange exposure, they are not currently on the VA’s list of recognized presumptive conditions.Schumer said if an Agent Orange-related condition isn’t specifically listed on the presumptive conditions list then the VA forces the suffering veterans and their families to argue their claim in a lengthy, bureaucratic appeals process that can last years and often end in a denial. In many cases the veteran will die before the process is even concluded. Schumer said veterans shouldn’t have to wage their own war to gather the scientific facts and medical opinions about hypothyroidism in order to receive the care and benefits needed to treat the illnesses they contracted because they served our nation. Schumer said that is absolutely crucial that thousands of Vietnam-era veterans in New York State receive the healthcare benefits they need and deserve, and final passage of his amendment in the NDAA will allow that to happen. December 4, 2020: Senator Bernie Sanders (Independent – Vermont) posted a press release titled: “Sanders Statement on Manchin-Romney COVID19 Proposal”. From the press release: Sen. Bernie Sanders (I-Vt.) issued the following statement on the Manchin-Romney COVID19 legislative proposal”“Given the enormous economic desperation facing working families in this country today, I will not be able to support the recently announced Manchin-Romney COVID proposal unless it is significantly improved.“Unfortunately, despite long-time Democratic opposition, this proposal provides 100% legal immunity to corporations whose irresponsibility has led to the deaths of hundreds of workers. It would continue to provide a get-out-of-jail free card to companies that put the lives of their workers and customers at risk. In fact, the Manchin-Romney proposal will, through this liability provision, encourage corporations to avoid implementing the common sense safety standards needed to protect workers and consumers – and make a bad situation worse.“Further, during the worst economic crisis since the Great Depression, when over half of our workers are living paycheck to paycheck, when one out of four workers are either unemployed or make less than $20,000 a year, when 92 million Americans are uninsured or under-insured, when tens of millions of people face eviction and when hunger in America is exploding, it is unacceptable that the Manchin-Romney proposal does not even do what the CARES Act did and provide, at the very least, a $1,200 direct payment to working class Americans and $500 for their kids. Tens of millions of Americans living in desperation today would receive absolutely no financial help from this proposal. That is not acceptable.“Last March, with unanimous support in Congress, President Trump signed the $2 trillion CARES Act into law that provided a $600 a week supplement in unemployment benefits and a $1,200 direct payment to every working class adult, $500 per child and significant help for small businesses, states and cities. In October, as part of the negotiating process, the Trump Administration and a bi-partisan coalition in the House supported over $1.8 trillion in COVID-relief that also included another $1,200 direct payment. “Today, however, at a time when the COVID crisis is the worst that it has ever been in the U.S. with record-breaking levels of hospitalization and death, the Manchin-Romney proposal not only provides no direct payments to working families, it does nothing to address the healthcare crisis and has totally inadequate financial assistance for the most vulnerable. That is wrong morally and it is wrong economically if we hope to rebuild the economy.“The American people need help and they need help now. In my view, we have got to make sure that every working class American receives at least $1,200 in direct payments and that we do not provide a liability shield to corporations who break the law.“I look forward to working with my colleagues in the House and Senate to significantly improve this bill. But, in its current form, I cannot support it.” December 4, 2020: Senator Elizabeth Warren (Democrat – Massachusetts) posted a press release on her website titled: “Warren, Pressley Ask Independent Watchdog to Investigate Racial Inequity in Pandemic Response”. From the press release: United States Senator Elizabeth Warren (D-Mass.), a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, and Congresswoman Ayanna Pressley (D-Mass.), a member of the House Committee on Oversight and Reform, sent a letter to Gene L. Dodaro, U.S. Comptroller General, requesting a Government Accountability Office (GAO) report on how COVID-19 relief funds have been distributed to disproportionately affected communities. The request seeks to examine how much federal COVID-19 relief funding went to businesses and providers located in low-income and medically underserved communities, as well as Tribal businesses and health care providers, community health centers, and other organizations serving high-need populations.“The health and economic effects of the pandemic have been especially severe in communities of color and Native communities, yet it is not clear whether federal relief resources have reached these communities in proportion to their need. We, therefore, request an evaluation of supplemental appropriations provided under COVID-19 relief laws, including the Coronavirus Aid, Relief, and Economic Security Act, with regard to how funds have been distributed to disproportionately affected communities,” wrote the lawmakers. The coronavirus pandemic has had a disproportionate impact on communities of color and Native communities. Black, Hispanic/Latino, and American Indian/Alaska Native people are being hospitalized with COVID-19 at higher rates and are dying from COVID-19 at younger ages. People living on tribal reservations are more than four times as likely to have been diagnosed with COVID-19 as the U.S. population as a whole. The same communities have also been hit hardest by the economic fallout: every month since the economic crisis began in March 2020, Black and Latino workers have had significantly higher unemployment rates than white workers, even after adjusting for age and education status.To date, the federal government has spent trillions of dollars to sustain our health system and mitigate the economic fallout during this public health emergency. However, it is not clear whether that relief has successfully reached the communities that are most in need. A survey of Black and Latino business owners found that only 12% of those who applied for a loan from the Paycheck Protection Program were approved for the full amount, and half expected their businesses to permanently close within six months.In health care, a study of the Provider Relief Fund found that hospitals with the most revenue from private insurance received more than twice as much funding per hospital bed as the hospitals with the least private insurance revenue – raising the question of whether funds truly reached health care providers serving communities that are most in need. COVID-19 testing may also be harder to obtain for people of color: one analysis found that testing sites located in predominantly Black and Hispanic neighborhoods of major cities face higher demand than those in predominantly white areas of those same cities, leading to longer wait times. Independent analyses have found that ZIP codes with large white populations have had more testing sites throughout the pandemic than ZIP codes with more people of color, and 35 percent of rural Black Americans live in a “highly vulnerable testing desert.”… December 4, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Leads Coalition Opposing Dangerous HHS Deregulation by the Trump Administration”. From the press release: California Attorney General Xavier Becerra today led a coalition of attorneys general in submitting comments opposing the U.S. Department of Health & Human Services’ (HHS) misguided proposal to automatically “sunset” any HHS regulation that the agency does not review within a short time frame. The rule is an unprecedented and dangerous attempt by the Trump Administration to impede the incoming Biden Administration while the country grapples with the ongoing COVID-19 pandemic. The rule impacts all of HHS’s regulations, putting in jeopardy the Department’s programs and services nationwide. Under the proposed rule, these regulations could abruptly end if not reviewed in the short time frame allotted, threatening critical programs like Medicaid, food safety, and medical and pharmaceutical research. The unlawful rule gives the agency just two years to review the regulations, unnecessarily hamstringing the incoming Administration.“As he’s on his way out, in the midst of a pandemic, the president is sowing chaos in our healthcare system,” said Attorney General Becerra. “This rule is an attempt by the outgoing Trump Administration to make it more difficult for President-elect Biden and his incoming administration to put in place useful policies that will see our country through the pandemic. This medieval proposal places American’s healthcare across the country in jeopardy. We urge Secretary Azar to withdraw this proposal.”In today’s letter, the coalition of attorney’s general argue this deregulation attempt by the Trump Administration will mire HHS in red tape during a global pandemic when the country needs the agency’s resources most, making it nearly impossible for the new Administration to enact new pandemic-related regulations. In addition, the drastic scope of the rule will put trillions of dollars in federal funding on which the states rely at risk.The coalition argues the proposed rule: Is unprecedented and dramatic in scope and poses a threat to the States’ healthcare systems and as a result, the health and safety of the states’ residents;Is legally questionable since it claims to implement the Regulatory Flexibility Act (RFA), which Congress enacted to minimize the impact regulations have on small entities with limited resources. Instead. the rule would add expiration dates to all HHS regulations. Further, HHS lacks the legal authority for such action;Will drain agency resources and create significant uncertainty for state programs that would have to deal with the consequences if they federal regulations they rely on suddenly expired; andIs deeply problematic given it was proposed just a month before a new president takes office and while the country continues to weather the pandemic, and gives the public only 30 days to comment, in spite of the fact that it impacts every HHS regulation. In submitting today’s comment letter, Attorney General Becerra was joined by the attorneys general of Colorado, Connecticut. Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, Wisconsin and the District of Columbia. A copy of the comment letter is available here. December 7, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on Biden-Harris Appointments in Health Care”. From the press release: Speaker Nancy Pelosi issued this statement after President-elect Biden and Vice President-elect Harris announced appointments for key health care roles:“President-elect Biden has nominated an outstanding health care team, whose leadership, will be critical in the fight to crush the coronavirus and defend every American’s right to quality, affordable health care.“Attorney General Becerra is a towering champion of health care, whose strategic leadership, keen intellect and outstanding policy expertise were essential in the defense of the Affordable Care Act in the Courts. As Secretary of the Department of Health and Human Services, he will be a vital force for progress.“Jeff Zeints, Dr. Anthony Fauchi, Dr. Vivik Murthy, Dr. Marcella Nunez-Smith, Dr. Rochelle Walensky and Natalie Quillian bring great understanding and expertise to the challenges to health and financial security facing hard-working American families. Their leadership during this precarious moment will be life-saving, and our Democratic House Majority looks forward to working with this outstanding team.” December 8, 2020: NARAL Pro-Choice America Responds to Hearing on Hyde Amendment’s Discriminatory Ban on Abortion Coverage”. From the press release: Today, the U.S. House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held a hearing on the harms of the racist and discriminatory Hyde Amendment and related abortion coverage bans.NARAL Pro-Choice America President Ilyse Hogue released the following statement in response:“Discriminatory bans on abortion coverage like the Hyde Amendment are designed to push needed care out of reach—particularly for marginalized people who are already burdened by multiple structural barriers that block access to abortion. We must end this harmful policy in order to realize a future where reproductive freedom is a reality for every body, regardless of who they are or how much money they make. Pregnant people with low incomes and women of color must have access to reproductive healthcare that centers their dignity and decision making when they are trying to avoid unintended pregnancy, end a pregnancy, or give birth to healthy children.”The Hyde Amendment refers to a series of bans on coverage of abortion care for those who receive their health insurance through the federal government, including those who are insured through Medicaid, Medicare and CHIP, federal employees and their dependents, military service members, veterans, and their dependents, Peace Corps volunteers, Indigenous communities, women who are incarcerated or held in immigration detention facilities, and people with low incomes in Washington, DC. Abortion coverage bans like the Hyde Amendment disproportionately hurt people already harmed by disparities in our healthcare systems, especially Black and Brown women, transgender and non-binary people, and those with lower incomes.Today’s hearing comes during a momentous year when an invigorated Movement for Black Lives, an unprecedented pandemic, and imperatives for economic justice have all taken center stage and highlighted a system that upholds white supremacy and perpetuates life-threatening racial disparities in healthcare, criminal justice, education, and more. It also comes at a moment when the future of reproductive freedom is front and center now that Trump, Mitch McConnell, and Senate Republicans rammed through the confirmation of Amy Barrett to the U.S. Supreme Court and solidified an anti-choice supermajority on the Court hostile to Roe v. Wade. Their anti-choice, anti-freedom agenda could not be more out of step with the majority of Americans who support reproductive freedom. Polling shows that the majority of Americans support ending the Hyde Amendment and that 77% of Americans support the legal right to abortion.In August, House Majority Leader Nancy Pelosi (D-CA) said that the Hyde Amendment would not be included in funding bills starting next year. U.S. Representative Rosa DeLauro (D-CT), who convened today’s hearing and was elected last week as chair of the House committee that is responsible for funding the federal government’s functions, recently reiterated her commitment to ending the discriminatory budget amendment.During the 2020 Democratic presidential primary, candidates including both President-elect Joe Biden and Vice President-elect Kamala Harris coalesced around the party’s core values by voicing their support for ending the Hyde Amendment’s ban on abortion coverage once and for all. In July, NARAL Pro-Choice America joined a national coalition of progressive groups in their successful effort to urge the Democratic Party to deepen its advocacy for reproductive freedom by reaffirming key proposals included in the 2016 platform such as ending the Hyde Amendment. Politicians should never be allowed to interfere and deny coverage for abortion care based on how much money somebody has or how they get their insurance. December 8, 2020: Representative Ayanna Pressley (Democrat – Massachusetts) posted a press release titled: “Rep. Pressley Continues Fight to End Discriminatory Hyde Amendment”. From the press release: Today, Congresswoman Ayanna Pressley (MA-07), Chair of the Pro-Choice Caucus’s Abortion Rights and Access Task Force, submitted a letter for the Congressional Record to Reps. Rosa DeLauro (CT-03) and Tom Cole (OK-04), Chairwoman and Ranking Member of the House Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies, expressing her unequivocal support for eliminating the Hyde Amendment and all other harmful abortion coverage bans.The Congresswoman’s letter comes as the Committee holds a historic hearing on the harm caused by the Hyde Amendment and the need to repeal the 44 year old policy.“As our nation continues to face a moment of reckoning and transformation, it is absolutely critical that we remain unapologetic in our efforts to dismantle systems of oppression and stand against racist and discriminatory policies that push comprehensive health care—including abortion care—out of reach for our nation’s most vulnerable,” the Congresswoman wrote. “It is clear that the legal right to an abortion has never been enough and it is incumbent upon us to ensure that our policies and our budgets affirm the dignity and worth of all people, no exceptions.”In her letter, Congresswoman Pressley commended Chairwoman Rosa DeLauro and Congresswoman Barbara Lee (CA-13) for their leadership on these issues and for holding today’s hearing and emphasized the need to pass clean appropriation bills to ensure that comprehensive reproductive health care is available to all.“Congress has a responsibility to proactively legislate racial and reproductive justice and meaningfully advance policies that affirm that abortion care is health care and that health care is a fundamental human right,” the Congresswoman continued.First introduced 44 years ago by anti-choice, Republican lawmaker Rep. Henry Hyde in 1976, the Hyde Amendment has been included in federal funding bills every year since. This abortion coverage ban disproportionately harms low-income people, Black, Indigenous and People of Color (BIPOC) communities, transgender and gender nonconforming people, and targets those who receive Medicaid coverage. Currently, an estimated 30 percent of Black women and 24 percent of Latina women of reproductive age are covered by Medicaid — in comparison to just 14 percent of white women. Additionally, research has found that abortion coverage bans like the Hyde Amendment perpetuate cycles of poverty and economic inequality.As Chair of the Pro-Choice Caucus’s Abortion Rights and Access Task Force, Congresswoman Pressley has fought tirelessly to protect comprehensive reproductive health care for all, including abortion care… December 9, 2020: Senator Elizabeth Warren (Democrat – Massachusetts) posted a press release titled: “As Nation Grapples With COVID-19 Surge, Warren, Smith Release Their Findings on National Testing Capacity and Pediatric Testing Availability”. From the press release: United States Senators Elizabeth Warren (D-Mass.) and Tina Smith (D-Minn.), members of the Senate Health, Education, Labor, and Pensions (HELP) Committee, sent a letter to Alex Azar, Secretary of the Department of Health and Human Services (HHS) summarizing the findings from their investigation into the nation’s testing capacity and the availability of pediatric testing and making recommendations for how the federal government can improve national testing infrastructure.On August 26, 2020, Senators Warren and Smith wrote to five of the largest COVID-19 testing laboratories regarding each company’s capacity to process COVID-19 diagnostic tests and deliver prompt results. From the responses to these letters, the lawmakers learned that lab companies experienced a large surge in COVID-19 diagnostic testing needs during the summer surge, straining lab company capacity and slowing test turnaround times in some cases. Supply shortages hampered their efforts to develop additional capacity. They also experienced confusion about payment and reimbursement in different scenarios – for instance, whether insurers or the government was responsible for payment when a test was not considered “medically necessary.”Furthermore, in response to reports that families were having difficulty obtaining COVID-19 testing for their young children, on October 7, 2020, Senators Warren and Smith wrote to the retail providers participating in the HHS Community-Based Testing Sites partnership to ask for information about their policies regarding pediatric testing and their plans to expand testing to more age groups. They found that pediatric testing is becoming more widely available, though most retail providers were not currently offering testing for young children. The responses from the retail providers indicated that the primary barrier to expanding pediatric testing is the providers’ use of “self-swab” test kits, which are difficult for children or their caregivers to use. Additionally, independent pharmacies have had difficulty obtaining the tests needed to participate in the HHS program. Following Senator Warren and Smith’s letters, Walgreens announced that it would begin offering testing for children as young as three years old, and Rite Aid announced that it would offer testing for children as young as 13. “Together, our findings reveal significant gaps in COVID-19 testing capacity, exacerbating the ongoing public health threat. Addressing these problems will require aggressive federal government action. We have previously called for dedicated federal funding and a national testing plan to ensure that everyone who needs a COVID-19 test can access one quickly and easily,” wrote the lawmakers… December 10, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Issues Statement on Unanimous U.S. Supreme Court Decision Upholding States’ Rights to Regulate the Rising Cost of Prescription Drugs”. From the press release: Attorney General Xavier Becerra issued a statement today on the unanimous decision by the United States Supreme Court in Rutledge v. Pharmaceutical Care Management Association that upholds the rights of states to regulate and address the rising cost of prescription drugs. In March, the attorney general led a bipartisan coalition of 46 attorneys general in filing an amicus brief in the Supreme Court supporting the state of Arkansas’ position that federal law does not prevent states from regulating pharmacy benefit managers (PBMs). In the brief, the coalition also argued that regulation of the prescription drug market, including PBMs, is a critical tool states use to protect residents and address the access and affordability of prescription drugs. The Court agreed that federal law does not preempt these widespread and important state regulations.“States are on the frontlines of the fight to keep prescription drug prices down and make them more accessible to those who rely on them,” said Attorney General Becerra. “We are happy the Supreme Court recognized today that states must be able to regulate PBMs, the pharmaceutical middlemen who manipulate drug prices and access. Today’s decision will ensure states are able to improve prescription drug marketplace transparency and protect access to affordable medication.”PBMs act as intermediaries between pharmacies, drug manufacturers, health insurance plans, and consumers. They develop and maintain prescription drug formularies, contract with pharmacies, negotiate discounts with drug manufacturers, and process and pay prescription drug claims, and in this position, they have exercised their market power in a manner that harms consumers.In submitting the amicus brief in March, Attorney General Becerra was joined by the attorneys general of Alabama, Alaska, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and the District of Columbia.A copy of the decision can be found here. December 10, 2020: Senator Bernie Sanders (Independent – Vermont) posted a press release titled: “Sanders, Hawley Introduce $1,200 Direct Payments Amendment to Attach to End-of-Year Legislation”. From the press release: Sens. Bernie Sanders (I-Vt.) and Josh Hawley (R-Mo.) are introducing a bipartisan amendment to attach to must-pass legislation to be considered by Congress, which would provide $1,200 in direct payments to working-class adults and $500 to each of their children. This amendment, similar to what was passed in the CARES Act, would be attached to must-pass legislation to keep the government going. “In the midst of this terrible pandemic and economic crisis, this amendment would make certain that working families get the urgent, direct support they need to survive,” said Sanders. “A direct payment of $1,200 for adults and $500 for kids would help desperate families pay rent and heating bills, put food on the table, and be able to go to the doctor. In the midst of so much economic desperation, Congress cannot go on recess without providing this $1,200 emergency assistance to the American people in their time of need. I look forward to working across the aisle with Senator Hawley to ensure that the United States Senate passes this amendment.”“It would be a dereliction of duty if Congress adjourns for Christmas without having a vote on providing working families with direct payments,” said Hawley. “Working people are struggling. And they should be the first people given relief, not last. The crisis of rising unemployment claims, ever-expanding food lines, evictions, and growing credit card debt has been staring us in the face for months. It’s time we do something about it and provide emergency relief to Americans.”The amendment is modeled on the $1,200 direct payment for working-class adults plus $500 for their children passed by Congress unanimously in the $2.2 trillion CARES Act in March and signed into law by President Trump. Watch Sanders’ and Hawley’s floor remarks on this proposal here. Read the text of the amendment here. December 11, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on Bipartisan, Bicameral Surprise Billing Agreement”. From the press release: Speaker Nancy Pelosi released this statement on the bipartisan, bicameral agreement on legislation to end surprise billing:“The bipartisan, bicameral agreement announced tonight will finally protect patients from surprise bills in both emergency and scheduled care. And with the patient taken out of the middle, the legislation creates a fair process for health care providers and health plans to sort out the out-of-network costs between themselves.“The surprise billing of patients for unexpected out-of-network care is deeply unfair and financially devastating to families. It must be stopped.“I especially congratulate Chairman Frank Pallone of the Energy & Commerce Committee, Chairman Bobby Scott of the Education & Labor Committee, and Chairman Richie Neal of the Ways & Means Committee as well as Senator Alexander, Chair of the Senate Health, Education, Labor & Pensions Committee, for their leadership and dedication in reaching this bipartisan agreement. The House will push for this critical legislation to end surprise billing to be passed as part of the end-of-year package.” December 14, 2020: Senator Bernie Sanders (Independent – Vermont) posted a press release titled: “Sanders on Manchin-Romney Deal: Congress Cannot Go Home Until Working Class Receives $1,200 Direct Payments”. From the press release: Senator Sanders (I-Vt.) issued the following statement in response to the Manchin-Romney COVID19 legislation to be released this afternoon:“As a result of the pandemic, tens of millions of Americans are facing economic desperation. They can’t afford to pay their rent and face eviction, they can’t afford to go to the doctor, they can’t afford to feed their children and they are going deeper and deeper into debt. Congress cannot go home for the Christmas holidays until we pass legislation which provides a $1,200 direct payment to working class adults, $2,400 for couples, and a $500 payment to their children. This is what Democrats and Republicans did unanimously in March through the CARES Act. This is what we have to do today.” December 14, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Leads Bipartisan Coalition on 340B Drug Pricing Program Requirements”. From the press release: California Attorney General Xavier Becerra today joined Connecticut Attorney General William Tong, Kansas Attorney General Derek Schmidt, and Nebraska Attorney General Doug Peterson in leading a bipartisan coalition of attorneys general urging the U.S. Department of Health and Human Services (HHS) to hold accountable drug manufacturers that are unlawfully refusing to provide discounts to federally qualified health centers, hospitals, and other providers that serve vulnerable patient populations through the 340B Drug Pricing Program. The 340B Drug Pricing Program provides discounts to covered healthcare entities that serve uninsured and low-income patients, and helps these providers keep costs low even as prescription drug prices rise. In today’s letter addressed to Health & Human Services Secretary Alex Azar, the attorneys general argue that by withholding or threatening to withhold these critical discounts, drug manufacturers Eli Lilly & Company, AstraZeneca PLC, Sanofi SA, Novartis Pharmaceuticals, Merck & Co., United Therapeutics Corp., and others, put low-income patients at risk of losing access to affordable medications while communities continue to battle the COVID-19 pandemic. The 340B Drug Pricing Program has strong bipartisan support, and Congress has acted numerous times to ensure drug manufacturers continue to comply with the program’s mandates.“While Americans grapple with COVID-19, it is critical that we protect access to affordable care,” said Attorney General Becerra. “Discounts afforded under the 340B Drug Pricing Program are more critical now than ever. They ensure that low-income and uninsured patients have access to affordable medication as they deal with the substantial impact of the pandemic. We call on HHS to hold these non-compliant drug manufacturers accountable and provide immediate relief for healthcare centers and the Americans they serve.”As a condition of having their drugs covered by Medicaid and Medicare Part B, Congress required drug manufacturers to enter into Pharmaceutical Pricing Agreements (PPA) with the HHS Secretary to limit the amount public hospitals, community health centers, and others serving indigent patients have to pay drug manufacturers for medications. These PPAs require the companies to offer each covered medication to providers “at or below the applicable ceiling price”. Instead of complying with their obligations, Eli Lilly & Company, AstraZeneca PLC, Sanofi SA, Novartis Pharmaceuticals, Merck & Co., United Therapeutics Corp., and others have unlawfully refused to provide discounts, potentially depriving Americans who rely on them with essential healthcare resources that they need as the country deals with a public health crisis. Under the 340B Drug Pricing Program, HHS has the authority to address violations of the program by drug manufacturers. For example, HHS may require manufacturers to reimburse covered healthcare centers and/or terminate manufacturers’ PPAs. While HHS has recently published regulations establishing an administrative dispute resolution (ADR) process under which covered entities can file complaints and seek relief, the ADR process is not sufficient to address immediate harm caused by drug companies.In submitting today’s letter, Attorney General Becerra was joined by the attorneys general of Connecticut, Kansas, Nebraska, Colorado, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Vermont, Virginia, Washington, Wisconsin, and the District of Columbia. A copy of the letter to HHS is available here. December 15, 2020: Center for Reproductive Rights posted a press release titled: “Federal Appeals Court Denies Rehearing in Case Challenging Arkansas Abortion Restrictions”. From the press release: The Eighth Circuit Court of Appeals denied today the ACLU and the Center for Reproductive Rights’ request for en banc rehearing of an August 2020 decision that paved the way for Arkansas abortion restrictions to go into effect.With this order, the four Arkansas laws at issue in the case could go into effect as soon as Dec. 22. Absent further court intervention, that would completely block many people from obtaining abortion care and would leave Arkansans with even more limited access to abortion. These laws are just four of the more 480 abortion restrictions states have passed across the country since 2011. These four laws were passed to: Ban the standard method of abortion provided after approximately 14 weeks of pregnancy in Arkansas;Require that patients’ partners or other family members be notified of their abortion;Force the health care center to report a teenage patient’s abortion to local police and allow the state crime lab to indefinitely hold their personal medical information; andForce physicians to request a vast number of medical records for each patient with no medical justification, violating physician-patient confidentiality and delaying – or outright blocking – access to abortion care. “These Arkansas laws represent the worst motives of anti-abortion politicians: to shame, stigmatize, and humiliate abortion patients, and to make abortion care difficult if not impossible to access, ” said Ruth Harlow, senior staff attorney in the ACLU’s Reproductive Freedom Project. “While we’re disappointed with this order from the Eighth Circuit, we’re not backing down — this fight is nowhere near over. To the state of Arkansas: We’ll see you back in court.”… December 16, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Floor Speech in Support of Veterans Health Care and Benefits Improvement Act”. From the press release: Speaker Pelosi: Thank you very much, Mr. Speaker. I thank the gentleman for yielding and for his great leadership. He makes us so proud as Chair of the Veterans Affairs Committee, and I proudly rise in support of H.R. 7105, a strong, bipartisan package of legislation that meets or strives to meet our responsibility to honor the service and sacrifice of those who don the uniform. The strength of this package and its support across the aisle is a testament to the outstanding leadership of Chairman Mark Takano. We are very proud of him, as a Californian, as a Member of this House. And the bill has been all hands on deck effort, and I salute the many Members whose provisions and perspective have strengthened it. Congresswoman Julia Brownley, the Chair of the Health Subcommittee, on the Women’s Veterans Task Force, who has worked tirelessly to achieve gender equity at VA, including, now, through the landmark Deborah Sampson Act, included in this omnibus……Mr. Speaker, last year, many Members were blessed to be able to travel to Europe to mark 75 years the Normandy landing and of the Battle of the Bulge on another visit. I mentioned Johnny, the Senator, at Normandy. At the commemoration of the Battle of Bulge, almost one year ago this day, I met a veteran in his nineties who urged us to pray for peace. To pray for peace… …In that spirit of peace, hope and respect, the Congress has honored our veterans, their families and caregivers with transformative action. From the Blue Water Navy Vietnam Veterans Act to expand benefits to those exposed to Agent Orange, to the really, cruelly unfair Widows Tax and Kiddie Tax – remember that? To passing the COMPACT Act to combat – combat veteran suicide, and to investing nearly $20 billion in VA readiness and pandemic research. Now, the House is building on this bipartisan momentum with this omnibus, which includes provisions from nearly 60 House-passed bills. This bill strengthens veterans’ education, investing nearly $350 million in improving GI benefits for surviving family members, increasing work study options and fellowship opportunities for veterans, securing benefits for those who cannot complete courses due to the pandemic and more. It safeguards veterans’ benefits, including by modernizing the benefit system with commonsense reforms, investing in benefits for surviving spouses and improving eligibility for housing and home loan assistance for National Guard and Reserve Members. This bill protects veterans’ health, including care for those exposed to the coronavirus and burn pits, improving VA scheduling process, increasing reporting from state veteran homes in the light of the COVID outbreaks. This bill is focused on justice, equality and opportunity. And we are particularly proud of the steps taken to help servicemembers transition to civilian work force, and to improve services and VA access to Native American veterans, including eliminating their copays. House Members can take pride in the inclusion of Congresswoman Brownley’s Deborah Sampson Act, the crown jewel in this package and the most comprehensive women’s veterans bill in over a decade. This bill improves the health, benefits, education and VA support system for women veterans, including by repairing – requiring the VA to create the anti-harassment and anti-assault policy, improving women-specific primary care, expanding access to child care and strengthening mental health initiatives. This bill could not be more timely. Last week, the VA Inspector General’s report found an appalling coverup and discrediting of a woman veteran who works in the taskforce that creates – that created this legislation, at the hands of Secretary Wilkie and top VA officials. It is a profound injustice for any patriot with the courage to serve to have to experience having his or her voice silenced and integrity questioned.Congress will not relent until every servicemember, every veteran and every woman can live free from the fear of assault or abuse. This package was drafted in consultation – this is what I’m so proud of because, on a regular basis, we meet with the veterans service organizations and it is their opportunity to tell us what their priorities are……This package was drafted in consultation with leading veterans groups and we’re proud to have the support of the Veterans of Foreign Wars, the American Legion, the Military Officers Association of America, Student Veterans of America, Disabled American Veterans, the National Military Family Association, Iraq and Afghan Veterans of America, the Association of the U.S. Navy, Paralyzed Veterans of America, Veterans Education Success, just to name a few. The list goes on. As we send this package to the President’s desk, House Democrats are ready to take further action to honor our veterans in the next Congress working alongside the Biden- – the Biden-Harris Administration… December 16, 2020: NARAL Pro-Choice America posted a press release titled: “Trump Administration Petitions Supreme Court to Undercut Medication Abortion Care During Global Pandemic”. From the press release: Yesterday, the Trump administration submitted yet another petition to the U.S. Supreme Court seeking to reinstate a U.S. Food and Drug Administration (FDA) rule that requires patients to travel to a health center during a global pandemic in order to obtain medication abortion care. Last week, the U.S. District Court for the District of Maryland upheld an injunction blocking this requirement, making it easier for people to access care without jeopardizing their health by unnecessarily exposing them to COVID-19.In response to news of this petition, NARAL Pro-Choice America President Ilyse Hogue released the following statement:“This petition is just another politically-motivated attempt to block abortion access by a lame duck president hellbent on causing this country as much harm as possible in his final weeks in office. Instead of focusing on a pandemic that has killed more than 300,000 Americans, Trump is focused on blocking people from the time-sensitive essential care they need. Patients’ health and safety must always come first. Especially during this pandemic, healthcare policy should be guided by sound science—not an ideological agenda.”Medication abortion is a safe, effective, and FDA-approved option for ending an early pregnancy. It involves taking two different prescribed medications. The ACLU’s lawsuit challenges the FDA’s current requirement that forces patients seeking medication abortion care to travel to a hospital, clinic, or medical office to pick up the first medication used in the two-step process, mifepristone. The ACLU filed the lawsuit on behalf of the American College of Obstetricians and Gynecologists (ACOG), SisterSong Women of Color Reproductive Justice Collective, and others. December 16, 2020: University of Vermont Medical Center posted a press release titled: “UVM Medical Center Rebukes Baseless Federal Enforcement Actions Threatening Access to Patient Reproductive Rights”. From the press release: The University of Vermont Medical Center sent a letter today to the United States Department of Health Services (HHS) Office for Civil Rights (OCR) reaffirming its compliance with federal laws that provide hospital employees the ablity to opt-out of participating in medical procedures they oppose on religious or personal beliefs, which include reproductive care, sterilizations, blood transfusions, and others. The letter is in response to December 11 and December 14 correspondence from HHS threatening the hospital with federal enforcement stemming from an August 2019 “Notice of Violation” OCR issued to UVM Medical Center and the press, despite lacking any legal authority to do so. The administration’s new threat of litigation is an abrupt turnaround by HHS’s and OCR’s leaders, who agreed late last year to not recommend any further enforcement of OCR’s 2019 allegations, following multiple decisions by federal courts rejecting OCR’s interpretation of the law. In the letter, UVM Medical Center informed HHS that it declined to further alter its opt-out policies and practices in a manner that would create barriers to the delivery of safe, legal, and effective reproductive health care and is also not required by law. In fact, since receiving OCR’s “Notice of Violation” last summer, the hospital has only strengthened its already-compliant provider opt-out policies and practices. For instance, the hospital has improved the way it schedules both patients and staff for pregnancy termination procedures, utilizing regular, designated operating room times for those procedures whenever possible and staffing them with providers who have opted into participating. Through this and other recent changes, UVM Medical Center’s goal is to eliminate those instances – already exceedingly rare – in which employees’ religious or moral beliefs come into conflict with the hospital’s patient care obligations, while enhancing the care provided to patients.“As the primary tertiary care center for our region, we have an obligation to provide access to safe and legal reproductive health care to our patients who rely on us,” said Stephen Leffler, MD, President and Chief Operating Officer of UVM Medical Center. “At the same time, since we were first contacted by OCR last year, we have taken a thorough look at all of our policies and practices and have modified and strengthened them to respect the many beliefs of the thousands of care givers that work here. OCR’s latest threats are not just baseless from a legal standpoint, they’re an attack on reproductive care and we will do everything we can to protect our patients’ access to the services they need.”The response by UVM Medical Center points out that the latest threat by HHS defies recent decisions issued by federal courts across the country, which have rejected the legal theory on which the current presidential administration is relying in its attempt to prevent the hospital from providing pregnancy termination services… December 16, 2020: Planned Parenthood posted a press release titled: “Planned Parenthood Health Centers Selected for New Initiative Aimed at Expanding Patient Access to Contraception”. From the press release: Today, as part of the We’re for Her initiative, Bayer announced that four health centers across the country will recieve grants from Direct Relief to help provide service to regions where there are high unintended pregnancy rates, steep barriers to accessing essential health care, and pressing need for sexual education. Two of the grantees named are Planned Parenthood affiliates, Planned Parenthood Great Plains (PPGP) and Planned Parenthood of Indiana and Kentucky (PPINK); they will each receive $40,000 to fund innovative projects in 2021, focused on expanding reproductive and sexual health and education in Indiana and Arkansas. Statement from Alexis McGill Johnson, president and CEO of the Planned Parenthood Federation of America:“Planned Parenthood is thrilled to work with other nonprofits, corporate partners, and public health organizations to expand people’s access to expert, high-quality care and accurate health information. We’re grateful that Bayer and Direct Relief support sexual and reproductive health care and education, and understand that all people deserve access to the care they need, when they need it, no matter what.“Throughout this pandemic, Planned Parenthood has been working to expand access to essential health care, reaching patients and communities in new and innovative ways, and providing sexual and reproductive health care services and information people need to stay healthy during this unprecedented health and economic crisis. Sexual and reproductive health doesn’t stop for a pandemic, and neither does Planned Parenthood… December 17, 2020: Senator Chuck Schumer (Democrat – New York) posted a press release titled: “Schumer, Gillibrand Announce Nearly $892 Million in Federal Funding For New York’s Hospitals Battling Second Wave Of COVID Pandemic”. From the press release: U.S. Senator Charles E. Schumer and U.S. Senator Kirsten E. Gillibrand announced today that 4,941 hospitals across New York will receive a total of $891,935,762 designated through previous COVID relief bills. The funding comes from the Provider Relief Fund and will make up for at least 87% of lost revenue at all hospitals and providers through Q2.“As New York battles a second wave in COVID cases, our hospitals are once again stepping up to the plate, making incredible sacrifices by putting public health above profit for months, and working ceaselessly to help New York beat back the virus,” said Senator Schumer. “Today’s funding is critical to making up for lost revenues from the first wave and keeping our hospital doors open. New York and its hospitals have been amongst the hardest hit in the nation, and with this funding going out, the continuing frontline fight being waged by our health care system and its incredible workforce will receive the dollars they need, and so very much deserve, to keep saving lives.”“We have asked so much of our doctors, nurses, hospital workers, and public health professionals across New York, and they continue to give it their all on the frontlines,” said Senator Gillibrand. “But the fact remains that they are being stretched to the limit, and are in desperate need of more resources to battle another dangerous surge. Today’s funding announcement is a great step in the right direction, but I won’t stop fighting until Washington delivers critical relief to hospitals and health care providers.”Schumer was the lead author and architect of the ‘Marshall Plan for Healthcare’, included in previous COVID relief legislation, securing hundreds of billions of dollars in support and relief for the health care system. The senators said the funding announced today is the first revenue-based tranche going out to New York’s hospitals.Across the state, hospitals and health systems reported losing hundreds of millions of dollars per month because of cancelled elective procedures, increased staffing and overtime costs, expanded bed capacity, and increased spending on supplies and equipment to meet the surge in COVID patients. As New York experiences a second wave of COVID cases, hospitals are facing huge financial risks again. Schumer and Gillibrand said today’s funding is imperative to keeping the state’s hospitals open and able to serve COVID patients. December 17, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Responds to Trump Administration Attacking California for Safeguarding Reproductive Freedom”. From the press release: Today, the Trump administration announced an inhumane effort to try to strip California of at least $200 million in federal healthcare funds during a global pandemic. This politically motivated announcement in the final days of the Trump administration is intended to punish the state for ensuring that Californians have access to comprehensive health insurance that includes coverage of abortion care.This cruel announcement comes just one day after California surpassed its previous highest number of deaths due to COVID-19 in a single day as cases continue to skyrocket. More than 21,000 Californians have lost their lives due to COVID-19, and the state reported more than 53,000 new cases today alone. In the midst of a public health crisis, we should be strengthening and expanding access to healthcare, not rolling back access or punishing states that work to provide comprehensive coverage to their residents.NARAL Pro-Choice America President Ilyse Hogue released the following statement in response:“The Trump administration’s threat to strip California of hundreds of millions of dollars in critical healthcare funding during a global pandemic is appalling. There is no limit to the destruction Trump is willing to leave in his wake as he is forced from office. He’s clearly attempting to play to a small group of supporters in this attack on healthcare and access to abortion. This pays no attention to the people he is punishing, especially BIPOC communities most hurt by these political games.”NARAL Pro-Choice California Director Shannon Olivieri Hovis said:“California is in the midst of a raging pandemic and the soon-to-be-former president of the United States is using his final days in office to attack funding for healthcare. We are proud that our state is committed to ensuring that Californians have comprehensive coverage for all of their healthcare needs — including abortion care.” The Trump-Pence administration has spent the last four years systematically attacking the right to abortion and undermining reproductive freedom. Now, in the final days of the administration, Trump’s Department of Health and Human Services, led by anti-reproductive freedom Secretary Alex Azar, is arguing that California’s law guaranteeing insurance coverage of abortion care violates the Weldon Amendment, an annual budget rider designed to interfere with policies that expand access to and coverage of abortion care. Ironically, the amendment refers to such policies as “discrimination.” Notably, in 2016, HHS’ Office for Civil Rights rejected complaints about California’s abortion coverage requirement and determined that the requirement does not violate federal law. These kinds of attacks on insurance coverage for the full range of reproductive healthcare, including abortion care, especially hurt communities of color, trans and non-binary people, and those with lower incomes.The Trump administration also announced today that the Department of Justice has filed a lawsuit against the University of Vermont Medical Center in an attack on the hospital’s policies that ensure patient access to reproductive healthcare, including abortion. This outrageous attack on a hospital, in the midst of a global pandemic, is further evidence that the Trump administration will stop at nothing to prioritize attacks on abortion access in its final days. December 18, 2020: BuzzFeed News posted an article titled: “Mitch McConnell Is Trying To Block Mandatory Paid Sick Leave For Workers Who Get COVID”. It was written by Paul McLeod. From the article: Senate Majority Leader Mitch McConnell is pushing to let businesses and governments deny sick leave to workers who fall ill with COVID-19.As Congress negotiates an end-of-year pandemic aid bill, McConnell is trying to block an extension of a paid sick leave program for people who get COVID that expires in two weeks, according to multiple Hill sources with knowledge of the negotiations.Back in March, Congress passed a law mandating that workers are able to draw two weeks of paid sick leave if they contract COVID, two weeks of paid sick leave to care for a quarantining relative, and up to 10 weeks of paid family leave to care for a child whose school or daycare is closed for COVID-related reasons.Those provisions are set to expire at the end of the year. Democrats initially sought to broaden the scope of the program and extend it. Those goals were lowered to merely extending the program for several more months due to Republican opposition, according to one Senate aide. Now Republicans, led by McConnell, are opposing an expansion of the program altogether.Paid sick leave was already watered down to exempt big businesses. Any company with over 500 employees does not fall under the requirement to provide paid leave…Businesses with under 50 employees can also apply for exemptions to the requirement. The federal government is footing the bill for the entirety of paid leave costs for businesses through refundable tax credits.But state and local governments are not eligible for the tax credit and must bear the sick leave costs on their own. Sen. Lamar Alexander, the powerful Republican chair of the Senate Health Committee, said this is why he opposes an extension of the program.“Paid sick leave is a good idea. We do it in my office, the federal government now does it, and many businesses do it. Unfortunately, current paid leave proposals impose billions of dollars in an unfunded mandate on state and local governments,” Alexander said in a statement to BuzzFeed News. “If the federal government wants to require paid leave, the federal government should pay for it.”The federal government can’t pay for it, however, because Republicans are also blocking funding for state and local governments from being included in the bill. This funding was one of the key demands from Democratic negotiators. But it was stripped out of the package, along with a Republican proposal for immunity from COVID lawsuits for businesses, because these were seen as the two most contentious negotiating points… December 18, 2020: Planned Parenthood posted a press release titled: “Administration Puts Health Care Access In Limbo for Texans During the Worst Stretch of a Pandemic”. From the press release: Today, Planned Parenthood is calling on Gov. Greg Abbott to maintain critical health care access for people with low incomes in Texas after the 5th Circuit Court of Appeals issued an order that could allow the state to “defund” Planned Parenthood. This is the latest in a five-year legal battle stemming from Gov. Abbott’s 2015 attempt to block Medicaid patients from getting care at Planned Parenthood health centers in Texas. The federal district court stepped in to prevent this from happening. The night before Thanksgiving, the 5th Circuit Court of Appeals issued a ruling that gave Gov. Abbott permission to continue his attack. During legal battles over the last five years, Planned Parenthood affiliates have continued to serve thousands of patients through the Medical program each year, without incident or complaints from the Abbott administration.Earlier this week, Planned Parenthood affiliates in Texas asked the Abbott administration for time to allow providers time to care for their patients during the COVID-19 pandemic and connect them with new providers. Without this grace period, patients who rely on Planned Parenthood for preventative care would be abandoned during the pandemic and abruptly left scrambling to find care in an already-overloaded Medicaid system.During the most devastating public health crisis Texas has faced in a century, Planned Parenthood is calling on the Abbott administration to halt its efforts to dismantle health care for the most vulnerable Texans. This worsens the dual public health crises – systemic racism and COVID-19 – that disproportionately harm women and people of color who rely on programs like Medicaid. Blocking Medicaid patients from accessing basic health care at Planned Parenthood health centers would be devastating for the more than 8,000 Texans who rely on Planned Parenthood each year for high-quality, affordable services, including birth control, life-saving cancer screenings, STI testing and treatment, and more… December 18, 2020: Planned Parenthood posted a press release titled: “Abbott Administration Puts Health Care Access In Limbo For Texans During the Worst Stretch of a Pandemic”. From the press release: Today, Planned Parenthood is calling on Gov. Greg Abbott to maintain critical health care access for people with low incomes in Texas after the 5th Circuit Court of Appeals issued an order that could allow the state to “defund” Planned Parenthood. This is the latest in a five-year legal battle stemming from Gov. Abbott’s 2015 attempt to block Medicaid patients from getting care at Planned Parenthood health centers in Texas. The federal district court stepped in to prevent this from happening. Then right before Thanksgiving, the 5th Circuit Court of Appeals issued a ruling that gave Gov. Abbott permission to continue his attack. During legal battles over the last five years, Planned Parenthood affiliates have continued to serve thousands of patients through the Medicaid program each year, without incident or complaints from the Abbott administration.Earlier this week, Planned Parenthood affiliates in Texas asked the Abbott administration for time to allow providers time to care for their patients during the COVID-19 pandemic and connect them with new providers. Without this grace period, patients who rely on Planned Parenthood for preventive health care would be abandoned during the pandemic and abruptly left scrambling to find care in an already-overloaded Medicaid system. During the most devastating public health crisis Texas has faced in a century, Planned Parenthood is calling on the Abbott administration to halt its efforts to dismantle health care for the most vulnerable Texans. This worsens the dual public health crises — systemic racism and COVID-19 — that disproportionately harm women and people of color who rely on programs like Medicaid. Blocking Medicaid patients from accessing basic health care at Planned Parenthood health centers would be devastating for the more than 8,000 Texans who rely on Planned Parenthood each year for high-quality, affordable services, including birth control, life-saving cancer screenings, STI testing and treatment, and more.Excerpt of remark from Dr. Bhavik Kumar, medical director for primary and trans care, Planned Parenthood Gulf Coast:“Anytime health care is restricted, people suffer. And it’s important to note that people of color and women rely on publicly funded health care programs like Medicaid at disproportionate rates because of systemic racism and discrimination in our country. There are no two ways about it: Blocking Medicaid patients from care at Planned Parenthood creates yet another sexist and racist barrier to affordable health care at a time when people need it most. Now, we’re asking the Abbott administration to give us time to ensure health care is not disrupted for more than 8,000 Texans. It’s the least they can do for the thousands of people who could soon lose their trusted provider in the middle of a pandemic.”Excerpt of remark from Vanessa Rodriguez, call center manager, Planned Parenthood Greater Texas:“Even before COVID-19 pushed our public health infrastructure to the brink, our patients enrolled in Medicaid had trouble getting an appointment quickly. And importantly, they do not feel safe or comfortable seeking sexual and reproductive health care with any provider. Patients should be able to access health care where they choose and, for many patients, that is at Planned Parenthood.”Excerpt of remark from Jeffrey Hons, president & CEO, Planned Parenthood South Texas:“We implore the state of Texas to, at the very least, do the minimum: Allow Planned Parenthood to continue providing care in the Medicaid program during the current crisis and give our patients time to find other providers, so they don’t go without care during a pandemic. The health care network for Medicaid recipients is not always easy to manage, and care is not always easy to find. The COVID-19 pandemic is exacerbating existing pressures on our safety- net infrastructure. The people who rely on Medicaid are the most vulnerable Texans, and likely experiencing some of the worst economic effects of the pandemic. Forcing people — many of whom are struggling to make ends meet, and care for their families in a global pandemic — to scramble for basic health care is terrible policy, certainly uncharitable, indeed un-American.”.. December 20, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Remarks at Media Availability on Coronavirus Relief & Omnibus Agreement with Leader Schumer”. From the press release: …Our purpose has always been to crush the virus, put money in the pockets of the American people, which we do in this legislation. Sadly, our third purpose to honor our heroes was not fully appreciated by our Republican colleagues and so our support for state and local government, which significant in this legislation, requires more to be done. So, we consider this a first step. And that, again, more needs to be done. And we’re so excited that that will be happening under the Biden-Harris Administration, about 700 hours from now.What I’m excited about in this bill – and it is really the Democratic difference – is what it does for America’s working families. As we see food lines all over the country. It was our legislation that had the initiatives for food, for nutrition, for our children in school and seniors, as well as America’s working families, their rental assistance and so many – let me just say about food, maybe 15 million children in America are food insecure. Many adult food insecure people. Highest percentage of them, I believe, is in the state of Kentucky. Nonetheless, the food, the nutrition piece of it has always been central to our Democratic proposal. With the millions of people on the verge of eviction, we have rental assistance and a moratorium until the Biden Administration. Food, rental assistance, Earned Income Tax Credit and Child Tax Credit for America’s working poor families. The Democratic difference. CDFI, assistance for Community Development Financial Institutions to help small business, minority-owned businesses, women-, veterans-, rural, Native American-owned businesses to participate in a way. Because they’re not big and they don’t have financial relationships, sometimes they are overlooked. But that is central to what our legislation has done. Child care, child care. Children learning, parents earning. Very important, especially in the time of the pandemic, when children cannot actually in many cases, go to school. Therefore, their parents can’t go to work. Child care.In addition, we’re very pleased that investments in transportation system and what that means to our economy, jobs, etc. WRDA is in this legislation. We’re very pleased that bipartisan, bicameral support for WRDA. That is a job creator, as well. The Employment Retention Tax Credit. Some of these things just made it in late this evening. That’s why it’s taking us longer to write the bill to bring it to the Floor. But these are some of the later developments. And, of course, we’re very proud that surprise billing is a part of this. And again, one thing that we didn’t achieve – the money that was left over from the CARES Act: we wanted to have flexibility, so it could be used for revenue loss, as well as Coronavirus expenses by our communities in our states. Republican and Democratic governors, alike, supported that. We did get an extension of one year. So, perhaps, unfortunately, with the spread of the virus, they will have those kinds of expenses. So, in any case, whether it’s education, transportation – let me just say this one thing, because I, from time to time, hear a question here, Mr. Leader: ‘What took so long?’ What took so long is because we could not get our Republican colleagues to crush the virus. I couldn’t understand it. Why would they not want to invest in the science that has told us so importantly that it required testing, tracing, treatment, separation, sanitation and the rest?And when we had the bill in the Heroes Act and even in the smaller Heroes Act, because we reduced the time, they said, ‘We just made a light touch on your language on testing.’ No, 53 percent of it, to take out everything that referred to minority communities. Communities of color was so hard hit and all of this. And now, we see why. They didn’t believe in the science, we knew that. But they did believe in herd immunity. And that’s why they never, they never could come to that first bill pillar, to crush the virus. So, for these and other reasons, we’re on a new path now. I’m proud of the legislation. It’s a first step, we need to do more. But they – what gives us hope is a vaccine, and we have to make that available, free and fairly, equitably distributed in our country and I encourage everyone to be vaccinated. And, again, what gives me hope is that in that 700 hours, Joe Biden will be President of the United States, bringing his values, his commitment to America’s working families to the fore as we prepare for additional legislation. With that, I’m very pleased to, again, welcome our distinguished Democratic Leader of the Senate, praise him for his masterful work last evening, to take us from a place where American working families were shortchanged and left out to dry, except for his brilliance in getting the job done for us. In that spirit, I welcome Leader Schumer to the podium.Leader Schumer: Now, while this bill is far from perfect, nor is it the bill that we would pass if Democrats had a Majority in the Senate, it is a strong shot in the arm to help American families weather the storm. For the 20 million people who would lose unemployment benefits the day after Christmas, help is on the way. To the millions of small business owners who are worried their businesses would go under, help is on the way. To families struggling with less money, direct payments mean help is on the way. To people who might have been evicted from their homes because they didn’t have a job and couldn’t afford it, help is on the way. To those who need food because they have no money because of the pandemic, help is on the way. And to all of America who wants to make sure that the vaccine is distributed free and fairly and quickly, help is on the way.So, this bill is certainly not everything we wanted. Our Republican friends stood in the way of so much, but it is a strong, strong shot in the arm to get things going. We all know that President Trump has made the economy a mess by how he treated the pandemic. We all know that President Biden is entering his presidency in an economic deep hole caused by President Trump. This bill helps him begin to get out of that hole. It is $900 billion. That is the second largest stimulus amount of dollars that has ever gone into the economy. The first being the CARES bill, which we negotiated with Secretary Mnuchin, so it is a lot of money.Unfortunately, the troubles are so deep, the abyss is so, so, so long, that we need more, and this is just a first step. This is an emergency. We need a second bill to continue dealing with the emergency and to start stimulating our economy, so we get back to where we were. And that will be job number one in the new Biden Administration. And whether we have the Majority in the Senate or the Minority, we Democrats are going to push like anything to get a bigger, stronger bill. This bill is a good bill. Tonight is a good night, but it is not the end of the story. It is not the end of the job. Anyone who thinks this bill is enough does not know what’s going on in America, does not look into the eyes of a small business owner who’s losing his business. There are a lot of things in this bill that help New York. I’m very proud of the mass transit provision. I’m very proud of the Save Our Stages provisions. And when it came – comes to state and local, even though the Republicans were relentless against it, we found other ways to aid the states. So, the states will get at least some of the aid they need. The localities and the tribes will get some of the aid they need. But the Republican relentlessness against state aid is just befuddling. Why is it any different when someone who works for the local government loses his or her job and can’t feed their kids or someone from a small business loses it? They’re all for helping the small businesses and so are we, because they employ people. But what’s the difference between that and state and local governments where people are also losing their job and can’t feed their families? Ideology gets in the way, ideology gets in the way. But this bill gives us hope and confidence that we can do more, and we will do more. We must do more. And when we come back in January, that will be job number one, to fill in the gaps, the many gaps left by this bill and to make sure that this bill, a strong measure gets the – does the job by making sure it gets the money to the people as it was intended… Q: Speaker Pelosi, quick question, given how hard it was to get this deal, from May you were fighting. Are you under any illusion it’s going to be easy to this part two next year? Speaker Pelosi. I believe in public sentiment. You know that. And we have a great leader who has the confidence of the people that he is there for them, Joe Biden is. And he would, I think – the soapbox, the bully pulpit that he has to say, ‘We’re here for you. We know what you need, and we are going to fight the fight for you.’ No, I think that it’s – I think we’re going to have a much easier time than we’ve had with the Republican Senate and a Republican President.Leader Schumer. Let me just say something. The number one reason we didn’t get the bill we needed was the Republican Senate. And Donald Trump just obfuscated the whole issue. A Democratic President Joe Biden will be able to focus the American people’s attention on the Senate, the Republican Members of the Senate, who are obstructing, getting in the way of what they need. If Joe Biden says we need $1,200 checks instead of the $600 – they didn’t have any money for checks in their bill. Well, he’ll focus on the American people. If we feel we need more money for Unemployment Insurance, he’ll focus on the American people.And I believe the Republicans who have had – who have been able to hide under Trump’s circus, almost, will no longer be able to do it. I am very optimistic that we can get a lot more done in a Senate, certainly if there’s a Democratic Majority, but even if a Republican Majority remains, with a new President who’s going to focus the issue. He said he’s making COVID his number one issue. Things will be easier, better and will produce even more… December 21, 2020: Center for Reproductive Rights posted a press release titled: “Arkansas Health Care Providers File Emergency Request to Block Anti-Abortion Laws”. From the press release: The ACLU and the Center for Reproductive Rights filed for emergency relief to block four anti-abortion laws from taking effect as early as tomorrow in Arkansas.The action comes after the Eighth Circuit Court of Appeals denied a request for en banc rehearsing last week of an Aug. 2020 decision that paved the way for Arkansas abortion restrictions to go into effect. In their filing today in the U.S. District Court for the Eastern District of Arkansas, the groups asked the court to block the laws that would completely prevent many people from obtaining abortion care, create intrusive and stigmatizing requirements that violate patients’ privacy rights, and would leave the stat with even more limited access to abortion……”Not only are these laws unconstitutional, if they go into effect, they will unnecessarily expose pregnant people to severe and unwarranted harm,” said Jenny Ma, senior staff attorney at the Center for Reproductive Rights. “If a pregnant person is in an abusive relationship or has a hostile home environment, the law requiring clinics to inform a patient’s partner or family of their abortion could seriously threaten their safety. And that’s just one of the laws. We will exhaust our legal options to make sure all of the challenged laws remain blocked.”The lawsuit was filed by the ACLU, the ACLU of Arkansas, the Center for Reproductive Rights, and the law firm of O’Melveny & Myers LLP on behalf of Frederick W. Hopkins, M.D., M.P.H. and Little Rock Family Planning Services. December 21, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Floor Speech on Emergency Coronavirus Relief & Omnibus Agreement”. From the press release: …I do want to speak to the bill that will be on the Floor shortly. It is a good bipartisan bill. It does – is different from bills that have been proposed by the Senate side by the Republican Leader. It does things that his bill never did and that is, it addresses the food needs of the American people. Maybe 15 million children are food insecure in our country and adults as well. Millions of families on the verge of eviction, and this legislation addresses the rental needs and short-term moratorium.We can accept the short-term because we’ll have a new president during the length of that moratorium to extend it further, if necessary. We also have in the legislation direct payments, which were not in the Republican bill – to America’s working families. I would like them to have been bigger, but they are significant and they will be going out soon……In addition to that, the list goes on of some of the very positive things that are on the bill. And, quite frankly, some of them did not – we did not come to agreement until yesterday. Whether we are talking about the WRDA, the Water Resources Development Act, a big jobs bill; it had bipartisan support, but some disagreement over language. And, by the time that was resolved, it pushed the bill from coming to the Floor later.We didn’t have, at the start of the day, sick leave. That is in the bill, almost $2 billion for sick leave. It didn’t have the EITC, the Earned Income Tax Credit for working poor people to have that boost, as well as the Child Tax Credit. It did not have the Employment Retention Tax Credit. Bipartisan support, WRDA and on that.And them, we came to agreement not only on the language, but where that initiative would be placed about. Many of these things need to be precisely written and assembled in order for a bill to come to the Floor, which we anticipate will be not to – pretty soon this morning……I think it would be interesting to point out that as enthusiastic as we are about the PPP provisions in this bill, and we all support them in a bipartisan way, it’s important to note that small businesses – I always say there is nothing more optimistic than starting a small business, maybe getting married – but the optimism, the hope, the dream that people have is completely, shall we say, darkened by this assault of this virus. And that’s why we had to start by crushing the virus. We didn’t do it. We couldn’t pass legislation until now because the Administration simply did not believe in testing, tracing, treatment, wearing masks, sanitation, separation and the rest – scientific approach. It becomes clear to us, now, that they believed in herd immunity, quackery, springing right from the Oval Office, and not denied sufficiently by some of the CDC and the rest……So, now we have a vaccine that we hope will reach everyone as soon as possible. What I – what I’m heartbroken about about this bill, though, is, while we make an attempt to crush the virus, we don’t do it adequately enough in terms of recognizing the toll on people of color. But we will have to do that in the public sentiment of it and in the demands that we make on governors and others who are in charge of the distribution. But we put money in the pockets of American people. We want to do more. But, nonetheless, we are meeting the deadline, December 26, when Unemployment Insurance, which was vital……It’s interesting, I think, to note that when we passed – we passed a number of bills in a bipartisan way, and we’ll pass this one, today. In the course of that, in the CARES Act and follow-up on the PPP bill, and this bill now, we are approaching $1 trillion that we are putting out for PPP. If that is what is needed and is spent effectively, that’s a worthy expenditure, but almost $1 trillion, well over $750 . This bill alone over $300 billion. So, we have PPP now, in order for the private sector to function. In order for us to live our lives, we need to have the public sector: public transportation, public schools, public health, the list goes on……Except Republicans insist on saying, ‘We don’t want to give money to blue states where the coronavirus is.’ It’s in red states, too. It knows no borders and it knows no party, this vicious virus. But, somehow or other, Republicans have said to our heroes, our health care workers, our teachers, our transportation, our police and fire and the rest, sanitation workers – so important – food, food, food – you are not worthy of support because, perhaps, you are in a blue state predominantly, and, therefore, we under-value your contribution to our society, to our economy, and especially now as we try to minister to the needs of people in this coronavirus crisis. Who do you think – these vaccines come into a state, they go from the lab to your arm, magically? No. They have to be received, distributed, administered and done so fairly, equitably and free. Who do you think is going to do those jobs if you don’t respect the role of state and local government in all of this? Don’t think about it as government. Think about it as people. Think about yourself needing all of that.So, I would hope that as we see the need for what we have done in this nearly $900 billion legislation that we’ll vote on today that everyone understands it’s a first step. It’s a first step, as President-elect Biden has said. It’s a first step, and we will need to do more, more to get more virus assistance to crush the virus, but also more money to buy vaccines. We need to have the Defense Production Act in play to hasten the manufacturing of these vaccines, and we need to be able to, as I say, to get the job done, and that takes people. And people need to be respected. Their work needs to be valued. And – again, and their entities for whom – under whose auspices they work, public hospitals, all the rest… …So, when we say it’s a first step, let us embrace it. Let us – you know, let us thank God Chuck Schumer was able to dismantle, in part, the Toomey resolution that would tie the hands of a President to meet the needs of the American people and our economy by exercising Section 13(3) of the national reserve – Federal Reserve Board. So, we got past that, which took a long time. I thought Wednesday night we were finished. This monstrosity reared its head the next morning. Chuck effectively was able to fix it. It’s still – it should not even have been initiated, but nonetheless, fix it in a way – excuse me – Leader Schumer, in a way that enabled us to go forward, and that’s why it’s taken us this long to get here in these last few days……As we review policy and legislation and negotiation and all that, let’s always have in our hearts every single one of the people who have died from the coronavirus. It can be stopped. It can be crushed, but that is a decision, it is a decision and decision to recognize where it is hurting people the most. So, with that, I invite – I look forward to strong bipartisan vote today on this legislation, respecting it for what it does, not judging it for what it does not, but recognizing that more needs to be done. Again, with high praise for all of our chairs and, again, special recognition of Madam Chair Nita Lowey for her last bill on the Floor. I say congratulations to them, all the staff who worked so hard… December 21, 2020: BuzzFeed News posted an article titled: “Businesses Will No Longer Have To Provide Paid Leave For Workers With COVID After Mitch McConnell Objected”. It was written by Paul McLeod. From the press release: Employers will no longer have to provide paid sick leave to workers who get infected with COVID-19 after Senate Majority Leader Mitch McConnell blocked that extension from being included in Congress’s latest coronavirus aid package.In March, Congress passed a law mandating that workers are able to draw two weeks of paid sick leave if they contract COVID, two weeks of paid leave to care for a quarantining relative, and up to 10 weeks of paid family leave to care for a child whose school or daycare is closed for COVID-related reasons.BuzzFeed News previously reported that McConnell was pushing to block the paid leave mandate from being extended. Congressional aides in both parties confirmed Monday that the extension was left out of the aid bill as a concession to McConnell.The bill does extend a refundable tax credit that fully subsidizes the cost to businesses of paying out sick leave until the end of March. Essentially, the federal government will continue to foot the bill for businesses that offer paid leave over the next three months, but it will be optional for businesses to opt into this program and let their employees take time off.The bill is set to pass on Monday night and President Donald Trump is expected to sign it into law soon thereafter……A Senate Republican aide said a deal on a COVID aid bill could have been reached Saturday night, but House Speaker Nancy Pelosi held it up because an extension of the paid leave mandate was not included. The aide said Pelosi held out until Sunday when she settled for the tax credit alone to be included.Democrats said they would keep pushing for paid leave. The party hopes to pass another COVID aid bill next year after President-elect Joe Biden takes office in January… December 21, 2020: U.S. News posted an article titled: “Mixed-Status Households Eligible for Stimulus Checks Under New Coronavirus Aid Package”. It was written by Claire Hansen. From the article: Households with individuals of mixed immigration status will be eligible for stimulus payments under the new coronavirus relief package expected to pass Congress on Monday – a key change from the aid measure passed in March, which excluded millions of people in mixed-status families from direct aid during a pandemic in which immigrants are overrepresented as among front-line workers.House Speaker Nancy Pelosi of California and Senate Democratic Leader Chuck Schumer of New York said in a statement Sunday evening that the new coronavirus relief package includes direct payments of up to $600 per adult and child, including for mixed-status families……The CARES Act, passed by Congress in March, included direct payments of up to $1,200 per adult and $500 per child for individuals who filed taxes in the last two years using a Social Security number.Immigrants in the country illegally, as well as some other immigrants who are legally present in the U.S. but not eligible for a Social Security number, use what is called Individual Tax Identification Number, or ITIN, to pay taxes. Under the CARES Act, not only were people using an ITIN to file taxes ineligible for stimulus payments, but anyone filing jointly with someone using an ITIN was also ineligible for direct checks – meaning that, for example, a U.S. citizen married to an immigrant using an ITIN didn’t receive any money for themselves or their children. The act made an exception for military families……People in mixed-status families sued the government for excluding them from stimulus payments. Democrats and advocates pushed for the next major relief package to include relief for all people who pay taxes, including immigrants in the country illegally who use ITINs, to receive checks, despite opposition from Republicans. It is not yet clear if immigrants using ITINs to pay taxes will be eligible for this new round of checks or if only U.S. citizens or legal residents will be eligible, regardless of who they filed taxes with. December 21, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Dear Colleague on Next Steps in Addressing Health and Economic Crisis”. From the press release: Dear Democratic Colleague,Now that we have completed the coronavirus emergency relief and omnibus package, we must focus on the work to be done in the new Congress.While we have recognized the urgent need for resources to crush the virus so we can open our economy and schools safely, we must also recognize what needs to be done. To that end, we must honor our heroes by supporting state and local government. It is important to know that in the COVID relief bills this year, Congress has appropriated nearly $1 trillion for PPP to save small business jobs but only $160 billion to save the jobs of our heroic frontline workers: our health care, first responders, transportation, sanitation, food and our teachers, our teachers, our teachers. It is also important to note that the GOP insisted on a tax break of $160 billion for the wealthiest America in CARES.The legislation we pass today does acknowledge the role states must play in the distribution and administration of the vaccine, as well as in education and transportation as we go forward. However, state and local budgets are still overwhelmed by coronavirus expenses and revenue losses. As we agreed to the extension of the Coronavirus Relief Fund, I had hoped that Republicans would agree to flexibility, but they did not.Thanks to the good work of our chairs and their committees in the 116th Congress, we are well prepared to develop strong legislation with the Biden-Harris Administration to Build Back Better. The pandemic pulled back the curtain on the disparities in our economy and our society – and it also deepened the divide. In the new Congress, I am proposing a select committee to address economic disparities and promote fair growth. In doing so, Members have emphasized that our path forward must prioritize workforce development, child care and mental health.As we observe the holidays, we carry in our hearts the over 315,000 lives that were lost to the virus, remembering them and their families in our prayers.We advance this bill today as a first step. We have new hope which springs from the vaccine and from the commitment President-elect Biden has to following science. We are ready for the next step… December 21, 2020: Representative Ayanna Pressley (Democrat – Massachusetts) posted a press release titled: “Statement from Rep. Pressley on House Passage of COVID-19 Relief Package”. From the press release: Today, Congresswoman Ayanna Pressley (MA-07) issued the following statement on the House passage of compromise legislation to address the COVID-19 pandemic.“For nearly nine months now, workers and families in my district and across the country have been left to fend for themselves in the midst of an unprecedented public health and economic crisis that has robbed us of over 300,000 lives and shoved thousands of families into poverty. As a result of Republican stonewalling and negligence, our communities are experiencing record levels of food and housing insecurity, thousands have lost their jobs and our immigrant neighbors have been locked out of federal relief altogether.“I have consistently heard from parents in my district who have exhausted their entire savings to keep the lights on and cover the costs of groceries, diapers and formula. I have heard from evicted seniors, immigrant families going hungry and essential workers deprived of PPE and access to paid leave and sick days. And I have heard from municipal leaders struggling to maintain critical jobs and services as the pandemic continues to worsen.“I have fought every step of the way to strengthen this legislation and center those most impacted. Our fight continues. I want to recognize the grassroots organizing efforts and the partnership of my fellow progressives and Democrats in improving the legislation from where it stood only days ago. There is no doubt that these negotiations have been difficult given the callous disregard of the other side. It is because of our collective advocacy and organizing that direct cash payments are a part of this package, the Federal Reserve’s authority to address future crises has not been severely limited, and that for the first time, mixed-status immigrant families will be able to access these critical resources. As a result of the efforts of Democrats, this package will include billions in rental assistance, resources to support the safe reopening of our schools, our public transportation systems and resources to combat hunger and food insecurity. “While I believe the legislation announced today by Congressional leadership failed to provide the comprehensive relief necessary to meet the scale of the crisis in the communities I represent, I voted yes on the package because it will provide a much needed and long overdue stopgap to help workers and families weather the crisis as we continue fighting for additional relief.“Since the onset of this pandemic, I have fought tirelessly for relief that would truly support our communities. Today’s vote marks a long-overdue step toward delivering relief for the people, but our work is far from over. I will continue to push for bold, comprehensive legislation that meets the moment and sets us on a path to a just and equitable recovery.“These negotiations have underscored just how clear it is that Mitch McConnell does not care about the health and livelihoods of the American people. He has delayed comprehensive relief for months, strangled the Senate’s ability to serve the people, and must be removed from power.“I will continue fighting for the people who sent me to Washington to do just that.” December 22, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi, Schumer Joint Statement on Coronavirus Relief & Omnibus Agreement”. From the press release: “Today we have reached agreement with Republicans and the White House on an emergency coronavirus relief and omnibus package that delivers urgently needed funds to save the lives and livelihoods of the American people as the virus accelerates.“We are going to crush the virus and put money in the pockets of the American people. As part of the agreement, Democrats have secured provisions that include: Accelerating vaccine distribution and crushing the coronavirus: The bipartisan COVID relief package finally recognizes that we cannot get our economy working unless we can get the coronavirus under control. The package provides billions in urgently need funds to accelerate the free and equitable distribution of safe vaccines to as many Americans as possible and as soon as possible, to implement a strong national testing and tracing strategy with billions reserved specifically for combating the disparities facing communities of color, and to support our heroic health care workers and providers.Ends surprise billing: The package includes bipartisan, bicameral legislation that will end surprise billing for emergency and scheduled care.Strong support for small businesses: Democrats secured critical funding and policy changes to help small businesses, including minority-owned businesses, and nonprofits recover from the pandemic. The agreement includes over $284 billion for first and second forgivable PPP loans, expanded PPP eligibility for nonprofits and local newspapers, TV and radio broadcasters, key modifications to PPP to serve the smallest businesses and struggling non-profits and better assist independent restaurants, and includes $15 billion in dedicated funding for live venues, independent movie theaters, and cultural institutions. The agreement also includes $20 billion for targeted EIDL Grants which are critical to smaller businesses on Main Street.Community Development Financial Institutions and Minority Depository Institutions: The agreement includes dedicated PPP set-asides for very small businesses and lending through community-based lenders like Community Development Financial Institutions (CDFIs) and Minority Depository Institutions (MDIs); $9 billion in emergency U.S. Treasury capital investments in CDFIs and MDIs to support lending in low-income and underserved communities, including persistent poverty counties, that may be disproportionately impacted by the economic effects of the COVID–19 pandemic; and $3 billion in emergency support for CDFIs through the CDFI Fund to respond to the economic impact of the pandemic on underserved low-income and minority communities.Rental assistance: Democrats secured $25 billion in critically needed rental insurance for families struggling to stay in their homes and an extension of the eviction moratorium.Strengthens the Low Income Housing Tax Credit: The package enhances the LIHTC to help increase affordable housing construction and provide greater certainty to new and ongoing affordable housing projects.Direct payment checks: Democrats secured a new round of direct payments worth up to $600 per adult and child, also ensuring that mixed-status families receive payments.Strengthened Earned Income Tax Credit & Child Tax Credit: This agreement helps ensure that families who faced unemployment or reduced wages during the pandemic are able to receive a strong tax credit based on their 2019 income, preserving these vital income supports for vulnerable families.Support paid sick leave: The agreement provides a tax credit to support employers offering paid sick leave, based on the Families First framework.Employee Retention Tax Credit: The agreement extends and improves the Employee Retention Tax Credit to help keep workers in the jobs during coronavirus closures or reduced revenue.Enhanced Unemployment Insurance benefits: Democrats averted the sudden expiration of Unemployment Insurance benefits for millions and added a $300 per week UI enhancement for Americans out of work.Nutrition assistance for hungry families: Democrats secured $13 billion in increased SNAP and child nutrition benefits to help relieve the historic hunger crisis that has left up to 17 million children food insecure.Education and child care: The agreement provides $82 billion in funding for colleges and schools, including support for HVAC repair and replacement to mitigate virus transmission and reopen classrooms, and $10 billion for child care assistance to help get parents back to work and keep child care providers open.Historic expansion of Pell Grants: The package includes the largest expansion of Pell Grant recipients in over a decade, reaching 500,000 new recipients and ensuring more than 1.5 million students will now receive the maximum benefit.Broadband access: The agreement invests $7 billion to increase access to broadband, including a new Emergency Broadband Benefit to help millions of students, families and unemployed workers afford the broadband they need during the pandemic.Fights the climate crisis: The agreement includes sweeping clean energy reforms, R&D enhancements, efficiency incentives and extends clean energy tax credits to create hundreds of thousands of jobs across the clean economy. The package also phases out superpollutant HFCs positioning the U.S. to lead the world in avoiding up to 0.5 degree Celsius of global warming.WRDA: The agreement includes the bipartisan Water Resources Development Act of 2020, creating good-paying jobs strengthening and improving the vital water infrastructure that Americans rely on while unlocking the Harbor Maintenance Trust Fund.Global Health: Democrats secured an additional $3.6 billion for a total of $4 billion for GAVI, the international vaccine alliance, recognizing that we are not truly safe until the whole world is safe from the coronavirus. “Importantly, the final agreement does not include several dangerous Republican proposals, including a long-demanded GOP provision that could unjustly put the health of workers at risk and take away their legal recourse, as well as an 11th hour attempt to sabotage the incoming administration’s ability to stabilize the economy and save jobs.“State and local governments will certainly need additional funding to prevent the senseless layoffs of heroic essential workers and critical service cuts. The agreement provides some important new targeted funds for state and local government functions that will help alleviate their overall budget burdens. These targeted funds include the emergency resources for schools, $27 billion for state highways, struggling transit agencies, Amtrak and airports, $22 billion for the health-related expenses of state, local, tribal and territorial government, and an additional year of eligibility for expenses under the CARES Coronavirus Relief Fund.“The emergency relief in this agreement, the second largest in history only to the CARES Act, is an important first step that Democrats look forward to building on under the new Biden-Harris Administration to meet the remaining needs of the American people during this historic health and economic crisis.“The House will move swiftly to pass this legislation immediately, so it can quickly be sent to the Senate and then to the President’s desk for his signature. With the horrifying acceleration of daily infections and deaths, there is no time to waste.” December 22, 2020: BuzzFeed News posted an article titled: “Surprise Medical Billing Is Finally Coming To An End After Congress Reached A Last-Minute Deal”. It was written by Paul McLeod. From the article: Hospitals will no longer be able to hit patients with surprise medical bills under a new law passed by Congress to address the coronavirus pandemic on Monday.Surprise billing happens when someone goes to a hospital covered by their insurance network only to be hit with unforeseeable bills because the doctor or specialist who treated them is out of network. Congress has for years talked about ending the practice, but even two weeks ago it seemed clear that a bill to end surprise medical billing was dead in the water yet again, as more than 115,000 people are currently in US hospitals with COVID-19, according to the COVID Tracking Project.But in a turnaround that stunned observers, Congress finally acted to end the exploitive practice……Insurance companies will now be forced to cover those bills. If there is a disagreement on cost between the insurer and healthcare providers — the doctors, specialists, or hospitals issuing the bills — then the price will be decided by an independent arbiter.The deal only came together after some last-minute changes were made to appease doctor and hospital groups. The final concession, demanded by Senate Majority Leader Mitch McConnell, is that arbitrators are not able to consider Medicare or Medicaid rates — which are much lower than private market rates — when ruling on the cost……While all sides believed patients should not be hit with surprise medical bills, insurers did not want to pick up all the slack and providers did not want to lose their ability to charge higher prices than in-network rates. These industries battled publicly and privately to avoid having to absorb the cost of a fix.What started as a gap in the system was turned into a profit driver for private equity firms. Two private equity giants, Blackstone Group and KKR & Co., bought up the largest physician staffing firms which led to more doctors going out of network and charging exorbitant surprise bills.These private equity firms then created a dark money front group called Doctor Patient Unity and spent tens of millions of dollars successfully opposing legislation to end private billing, denouncing it as “government rate setting.”.…The initial plan hatched between the House and the Senate was to force insurance companies to cover all emergency room bills and allow health providers to charge only the median in-network costs for fees. Providers fiercely opposed this “benchmarking” plan……These late changes softened opposition from providers and raised concerns that doctors and hospitals will be able to continue to inflate prices. The Department of Health and Human Services will oversee the crafting of the arbitration system and a provider-friendly administration in the future could stack the deck in their favor… December 22, 2020: Senator Bernie Sanders (Independent – Vermont) posted a press release titled: “Sanders Statement on Passage of COVID-19 Relief Package”. From the press release: Upon the Senate’s passage of the $908-billion COVID-19 spending package, Sen. Sanders (I-Vt.) issued the following statement:“Tonight, Congress passed a $908-billion COVID-19 relief bill that extends unemployment benefits through the early spring, and provides support for small businesses, schools, healthcare, nutrition, rental assistance, child care, broadband, the Postal Service, as well as funding to help distribute vaccines.“During the last several weeks, I have been working very hard, along with Republican Senator Josh Hawley of Missouri, to provide direct payments to working families throughout the country. Our goal was to replicate what was in the CARES bill of March, which was $1200 for every working-class adult and $500 for each child. While we did not get as much as we wanted, because of opposition from the Republican leadership and too many Democrats, the bill does include a $600 direct payment for every working-class American earning less than $75,000 a year, and a $1,200 direct payment for couples making less than $150,000 a year, plus $600 for each child. That means that the average family of four will receive a direct payment of $2400.“While including these direct payments ultimately improved this bill, given the enormous economic desperation that so many working families across this country are now experiencing, there is no question but that this legislation did not go anywhere near far enough. “When President-Elect Biden assumes office next month and when the Senate comes back into session in January, I will immediately begin fighting for another relief bill to help America’s working families—including another round of direct payments and more relief for the unemployed, the hungry, the uninsured and those who owe back rent and are behind on their mortgage payments. In this unprecedented crisis, it is imperative that we do everything we can to protect the working families of our country, the elderly, the children and the poor.” December 22, 2020: Center for Reproductive Rights posted a press release titled: “Federal Court Blocks Four Arkansas Anti-Abortion Laws Hours After They Took Effect”. From the press release: In response to litigation from the ACLU and the Center for Reproductive Rights, the U.S. District Court for the Eastern District of Arkansas issued an order blocking four anti-abortion laws in Arkansas hours after they took effect. While the laws were in effect today, clinics were forced to cancel appointments and were only able to offer medication abortion.Last week, the Eight Circuit Court of Appeals denied a request for en banc rehearing of an Aug. 2020 decision that paved the way for the abortion restrictions to go into effect. The ACLU and the Center for Reproductive Rights then asked the district court to block the laws that would completely prevent many people from obtaining abortion care, create intrusive and stigmatizing requirements that violate patients’ privacy rights, and leave the state with even more limited access to abortion. The litigation is supported by several medical experts and five previous Arkansas abortion patients who spoke to the devastating impact the laws would have enforced.“Access to abortion in Arkansas has been preserved — for now,” said Ruth Harlow, senior staff attorney in the ACLU’s Reproductive Freedom Project. “We are gratified that the court recognized the irretrievable harm these laws would cause to patients, and that it stepped in quickly. We have a fight ahead of us to ensure that no one is turned away, punished, or humiliated when trying to exercise their right to abortion in Arkansas — and we are not backing down.”“We’re relieved these harmful and unconstitutional restrictions have once again been blocked by the courts,” said Holly Dickson, executive director of the ACLU of Arkansas. “These laws would decimate access to abortion in Arkansas at a time when families are already struggling to get care. It shouldn’t take a court order to force Arkansas politicians to respect the basic human rights of the people they serve. That’s why we’ll continue to fight in the courts, in the capitol, and in communities to defend the right of every Arkansan to make their own personal medical decisions.” “Today, we got a preview of what would happen if these laws took effect permanently,” said Jenny Ma, senior staff attorney at the Center for Reproductive Rights. “It caused uncertainty about whether Arkansans have access to abortion care and forced patients to be turned away, which is absolutely unacceptable. We will continue to fight these laws in court and are relieved they are blocked for now.”The lawsuit was filed by the ACLU, the ACLU of Arkansas, the Center for Reproductive Rights, and the law firm of O’Melveny & Myers LLP on behalf of Frederick W. Hopkins, M.D., M.P.H. and Little Rock Family Planning Services. December 22, 2020: The American College of Obstetricians and Gynecologists (ACOG) posted a news release titled: “ACOG Appalled Congress Declines to Enact Critical Maternal Health Legislation, Calls on Congress to Prioritize Moms in 2021”. From the press release: Maureen G. Phipps, MD, MPH, FACOG, CEO of the American College of Obstetricians and Gynecologists (ACOG), issued the following statement following passage of the year-end legislation that excluded bipartisan maternal health legislation:“ACOG denounces Congress’ failure to enact two critical pieces of bipartisan legislation that prioritized the lives of women and famililes and would have helped eliminate preventable maternal deaths in this country. Amid a global pandemic that threatens to worsen the maternal mortality crisis, Congress chose not to protect our nation’s mothers.“The Maternal Health Quality Improvement Act (H.R. 4995) and the Helping Medicaid Offer Maternity Services Act (H.R. 4996) represent years of congressional and stakeholder collaboration to develop bipartisan legislation that will address our nation’s maternal health crisis.“Although these bills are supported by legislators on both sides of the aisle and recently passed unanimously in the U.S. House of Representatives, the U.S. Senate failed to advance them and Congress neglected to add them to the end-of-the-year legislative package. The United States is the only developed country with a rising maternal morality rate. According to the CDC, approximately 700 women die each year from pregnancy-related complications – that’s two women per day. Congress’ inaction means the difference between life and death for women.“During the COVID-19 pandemic, which has further exposed and exacerbated racial inequities, it is inconceivable that policymakers neglected the opportunity to pass meaningful legislation to eliminate racial disparaties in maternal health outcomes.“While we had hoped to celebrate a victory for America’s mothers before the end of 2020, we applaud the steadfast champions of House-passed H.R. 4995 and H.R. 4996, including Representatives Robin Kelly, PHD, Michael C. Burgess, MD, FACOG, Eliot Engel, Larry Buschon, MD, Greg Walden, and Anna Eshoo. We commit to carry this work forward into the 117th Congress”. December 22, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James Continues Fight to Safeguard Women’s Access to Reproductive Health Care”. From the press release: New York Attorney General Letitia James, as part of a coalition of 20 attorneys general, today continued her leadership in the national fight to ensure women’s reproductive health care is not stifled or infringed upon in any way. In an amicus brief — filed in Memphis Center for Reproductive Health, et al. v. Herbert Slatery, et al. — Attorney General James and the coalition contest the constitutionality of two abortion bans enacted in the state of Tennessee, and urge the court to affirm a lower court injunction that prevents enforcement of the state law that would create barriers to safe, legal abortions and that would disproportionately impact Black, minority, and low-income women. The attorneys general argue that the laws place unconstitutional restrictions on a woman’s right to choose and that they do not promote women’s health care overall.“Time and again, Tennessee has used its power to try and turn back the clocks and unconstitutionally restrict women’s reproductive rights,” said Attorney General James. “This is just another power grab by politicians willing to sacrifice a woman’s right to access an abortion in the process, but we are standing up against these bans because Tennessee’s unlawful efforts to deny women their constitutionally-guaranteed rights will not go unchallenged. This is about protecting women’s bodies, their freedoms, and their choices.”This past summer, Tennessee enacted two different prohibitions on abortions: a so-called “reason ban” and so-called “cascading bans.” The reason ban prohibits abortion at any stage of a pregnancy if a health care provider “knows” that the patient’s decision to terminate the pregnancy is based on a Down syndrome diagnosis, or the sex or race of the fetus. The cascading bans prohibit abortion as soon as a fetal heartbeat is detected, which can be as early as six weeks after gestation. If this six-week ban is invalidated by the courts, the law includes a cascading series of bans that seek to impose the earliest ban that can withstand judicial review. Both of these restrictions would ban abortions before the stage of viability, contrary to the rights recognized by the U.S. Supreme Court. Additionally, because the cascading bans can take effect before some women even know they are pregnant, they amount to an absolute ban on abortion, in violation of clear Supreme Court law.In the brief — filed in the U.S. Court of Appeals for the Sixth Circuit — Attorney General James and the coalition highlight past cases in which the Supreme Court has repeatedly ruled that a state may not prohibit any woman from making the decision to terminate her pregnancy before viability. Additionally, the attorneys general emphasize that women’s health outcomes are advanced by meaningful access to the full range of comprehensive reproductive health care services, including abortion. The attorneys general also cite ample scientific evidence that has established the detrimental impact highly-restrictive abortion laws have on women’s health outcomes, as well as how states’ interests are served by promoting women’s health and ensuring access to abortion services.Further, the coalition points to data that shows that laws — like the one at issue in Tennessee — have a disproportionate impact on Black, minority, and low-income women. Having access to safe, legal abortions leads to better health outcomes, particularly for Black and minority women who are disproportionately represented in Tennessee’s increasing maternal mortality numbers. Low-income women are also disproportionately affected by abortion bans because in states like Tennessee — which have not expanded access to Medicaid — uninsured women are eligible for coverage only while pregnant, and coverage ends 60 days after they give birth. These inequities are exacerbated by the small number of abortion providers in Tennessee and the long distances many women must travel to access abortion services. Attorney General James and the coalition argue states can promote women’s health without curtailing the right to choose. For instance, many states, including New York, provide residents with access to family planning and contraception programs.Despite Tennessee’s claims that its reason ban law is intended to limit discrimination against those with disabilities, such as Down syndrome, the coalition maintains that combating discrimination should not come at the expense of women’s reproductive rights. States can promote medically-accurate, unbiased information to help women make informed reproductive choices. Further, states can support those with developmental disabilities and their families by providing civil rights protections and delivering social and medical services……Joining Attorneys General James in filing today’s amicus brief are the attorneys general of California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia. December 23, 2020: NPR posted an article titled: “Trump Vetos Defense Bill, Setting Up Congressional Vote To Potentially Override Him”. It was written by Claudia Grisales. From the article: President Trump has followed through on his threats to veto the annual defense bill, triggering plans for Congress to return from its holiday break to potentially override him for the first time in his four-year administration.“My Administration has taken strong actions to help keep our Nation safe and support our service members,” Trump wrote in a message to the House of Representatives. “I will not approve this bill, which would put the interests of the Washington, D.C. establishment over those of the American people.”This month, the National Defense Authorization Act won annual congressional approval for its 60th straight year. And the legislation drew overwhelming bipartisan majorities in both chambers, signaling that Congress likely has the support to override Trump’s veto.Because of Trump’s repeated veto threats, Congress has already scheduled voting sessions to override the move during rare floor votes next week. The House is now slated to meet on Monday to override the defense bill veto, while the Senate is scheduled to follow suit on Tuesday……This month, the Senate approved the measure 84-13, while the House passed the bill by a vote of 335-78. This signals that both chambers have more than the two-thirds majority of their members needed to overcome Trump’s rejection of the bill.Supporters had also hoped that backing the plan by a supermajority would send a message to Trump to not veto.However, starting in June, Trump began to signal he would reject the legislation. That month, he took aim at Sen. Elizabeth Warren, D-Mass., who spearheaded a provision in the bill to rename military installations that honor figures from the Confederacy.Then, this month, Trump doubled down on his threats to veto the bill if it didn’t include a last-minute provision to end legal protections for social media companies. But a bipartisan group of lawmakers, including key Republican leaders, proceeded with the legislation even though it didn’t have the repeal Trump demanded……Trump had wanted lawmakers to undo Section 230 of the 1996 Communications Decency Act over his feud with Twitter and other social media companies. Section 230 provides legal protection for technologies over content from third parties and users… December 23, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Dear Colleague on Unanimous Consent Request to Increase Economic Impact Payments”. From the press release: Dear Democratic Colleague,Just when you think you have seen it all, last night, the President said that he would possibly veto the bicameral agreement negotiated between Republicans and Democrats. He said he would do so, unless the economic impact payments were increased by $2,000.In the bipartisan negotiations, Leader Schumer and I repeatedly asked Republicans what would be the highest number the President would accept for direct payments, and they responded with Sphinx-like silence. In the negotiations, they would never go above $600 and in some cases proposed $500.Yesterday, I said that Democrats would go to the Floor and ask for Unanimous Consent to bring up a standalone bill to increase the payments. To do so requires the agreement of the Republican Leader. The agreement is necessary in the House and the Senate.If the President truly wants to join us in $2,000 payments, he should call upon Leader McCarthy to agree to our Unanimous Consent request.We are scheduled to go in for a pro forma session tomorrow at 9:00 a.m. We are awaiting word from Leader Hoyer as to whether Leader McCarthy will agree or reject our Unanimous Consent request.The entire country knows that its urgent for the President to sign this bill, both to provide the coronavirus relief and to keep government open!… December 23, 2020: BuzzFeed News posted an article titled: “Pelosi Is Daring Republicans To Pass $2,000 Direct Checks After Trump Called For Them”. It was written by Paul McLeod. From the article: House Speaker Nancy Pelosi offered Wednesday to immediately pass $2,000 direct checks to US residents, hours after Trump called for them to be included in the coronavirus aid bill that passed Monday.The move puts congressional Republicans in a tough spot. They pushed for smaller stimulus checks during COVID negotiations, only to be immediately undermined by their own president. In a “dear colleague” letter sent to members of the House, Pelosi offered to pass the $2,000 checks by unanimous consent on Christmas Eve if Republicans will go along with it.It’s unlikely that the checks will actually pass. Congress typically does not make changes to massive, negotiated bills after they are passed and Republicans had already railed about the high price tag of the one they voted on. Trump could still veto the coronavirus package if Republicans don’t meet his new demands, delaying the $600 checks and other critical aid Congress agreed to……The debate over checks has made for unusual partnerships. Initially, there were no checks at all in the coronavirus bill. But progressive Democratic Sen. Bernie Sanders and conservative Republican Sen. Josh Hawley teamed up to lead a public pressure campaign demanding the inclusion of $1,200 direct payments similar to what was contained in the CARES Act back in March. They didn’t get that, but negotiators did agree to include $600 checks for most American adults.Under the current wording of the bill, adults who earn up to $75,000 will receive $600 checks, and couples who earn up to $150,000 combined will receive $1,200. Parents will also receive $600 for each child dependent under the age of 17, but no money for older children or adult dependents. For people who earn above $75,000, the size of the checks is phased out at a rate of $5 for every $100 of income, drawing down to zero at $87,000 or $174,000 for joint filers. December 23, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on President Trump Veto of National Defense Authorization Act”. From the press release: Speaker Nancy Pelosi issued this statement on the President’s veto of the bipartisan, bicameral National Defense Authorization Act (NDAA):“The President’s veto of the National Defense Authorization Act is an act of staggering recklessness that harms our troops, endangers our security and undermines the will of the bipartisan Congress. For 60 years, the NDAA has been passed on a bipartisan and bicameral basis. “In a time when our country was just targeted with a massive cyberattack, it is particularly hard to understand the reasoning behind the President’s irresponsibility. Disturbingly, Trump is using his final hours in office to sow chaos, including by denying our servicemembers a long-overdue pay raise and hazard duty pay; our families paid family leave, child care, housing and health protections; and our veterans the benefits that they need and deserve. The President’s veto also deprives our country and allies of tools to protect global security – including for cyber-security.“Trump’s veto violates our national values, as it would block action to rename military bases and infrastructure named after those who served in the Confederacy – which is supported by an overwhelming majority of the American people, by House and Senate Democrats and Republicans and by our servicemembers and top military leaders.“Next week, December 28, the House will take up the veto override with bipartisan support.” December 24, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on House Republicans Blocking Unanimous Consent Request to Increase Economic Impact Payments”. From the press release: Speaker Nancy Pelosi issued this statement on House Republicans blocking Democrats’ Unanimous Consent request to increase impact payments to $2,000 as the President called for:“Today, on Christmas Eve morning, House Republicans cruelly deprived the American people of the $2,000 that the President agreed to support. If the President is serious about the $2,000 direct payments, he must call on House Republicans to end their obstruction.“House and Senate Democrats have repeatedly fought for bigger checks for the American people, which House and Senate Republicans repeatedly rejected – first, during our negotiations when they said that they would not go above $600 and now, with this act of callousness on the Floor.“On Monday, I will bring the House back to session where we will hold a recorded vote on our stand-alone bill to increase economic impact payments to $2,000. To vote against this bill is to deny the financial hardship that families face and to deny them the relief they need.“Hopefully by then the President will have already signed the bipartisan and bicameral legislation to keep government open and to deliver coronavirus relief.” December 24, 2020: Senator Bernie Sanders (Independent – Vermont) posted a press release titled: “Sanders Calls on Mitch McConnell to Pass $2,000 Direct Payments Legislation in the Senate”. From the press release: In response to President Trump’s disapproval of the $908-billion COVID-19 relief package passed by Congress on Monday, Sen. Bernie Sanders (I-Vt.) issued the following statement:“In America today, millions of Americans are facing economic desperation and need help now. I have been calling on Congress for months to pass legislation to provide very working class American with $2,000 a month until the pandemic ends. Now that Senator Schumer, Speaker Pelosi, and President Trump have all indicated strong support for a $2,000 direct payment the ball is in Senate Majority Leader McConnell’s court. I say to Senator McConnell: Let the Senate vote immediately on a stand-alone bill to provide a $2,000 direct payment for the working class and $4,000 for couples. If no Republican objects to that bill, it could pass by unanimous consent today.”Sanders is the co-author, with Senators Kamala Harris (D-Calif.) and Ed Markey (D-Mass.), of the Monthly Economic Crisis Support Act, which would provide $2,000 direct monthly payments to working-class Americans for the duration of the pandemic. December 24, 2020: Representative Ayanna Pressley (Democrat – Massachusetts) posted a press release titled: “Reps. Pressley, Tlaib, Jayapal, Ocassio-Cortez & Omar Introduce Legislation to Provide $2,000 Survival Checks”. From the press release: Today, Congresswomen Ayanna Pressley (MA-07), Rashida Tlaib (MI-13), Pramila Jayapal (WA-07), Alexandria Ocasio-Cortez (NY-14), and Ilhan Omar (MN-05) introduced legislation to provide survival payments of up to $2,000 to families suffering due to the COVID-19 pandemic and the woefully inadequate relief provided to them so far. For months, the congresswomen have been at the forefront of pushing for substantial direct relief for families during the worst public health emergency in our lifetimes.“Families in my district and all across the country are struggling under the weight of this unprecedented crisis,” said Congresswoman Pressley. “We’ve been fighting all along for robust survival checks to help people meet their most basic needs, and the broad support that has emerged is a testament to the power of the people and the urgency of this moment. $2,000 in direct cash assistance will help families weather the crisis while we continue fighting for additional relief that meets the scale and scope of the hurt so many are feeling. Let’s get it done.”While President Trump has indicated support for the $2k direct payments, it is highly doubtful he has done anything to encourage congressional Republicans to support the effort. This morning on Christmas Eve, House Republicans blocked an attempt to provide survival checks.“This holiday season, families are being forced to make incredibly difficult decisions, such as whether they should keep their lights on or buy groceries,” said Congresswoman Tlaib. “They are suffering to no fault of their own. We must protect public health and the economic well-being of those we serve. Providing $2,000 survival checks would give those struggling right now a lifeline as we continue to fight to defeat COVID-19. It’s time for Trump to stop bluffing and get the members of his party in line so that the government can provide this long overdue relief to people across the country during this time of great need.”“It’s long overdue that Congress approves COVID-19 relief that actually meets the scale of this devastating crisis,” said Congresswoman Jayapal. “At the heart of any aid proposal must be putting money directly in people’s pockets so they can put food on the table, keep the heat on, pay their bills and withstand this pandemic. Our legislation for $2,000 survival checks will make it happen at a moment when it matters most.”The text of the bill can be viewed here. The House is expected to convene on Monday, December 28th to take action on showing up for the constituents they serve. December 25, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Congressman Mike Levin Delivers Weekly Democratic Address”. From the press release: “Hi, I’m Congressman Mike Levin. I’m proud to represent North County San Diego and South Orange County, with Marine Corps Base Camp Pendleton at the heart of my district.“As we celebrate the holidays this year, we also mourn the loss of more than 320,000 Americans to this pandemic – including more than 5,500 veterans, a profound tragedy for our nation. Each individual lost was somebody’s parent or grandparent, a son or daughter, a friend or co-worker who will be deeply missed, especially during this holiday season.“The holidays are also challenging for many families who are struggling to make ends meet, for our heroic frontline workers and for small businesses that are trying to endure this pandemic.“I’m proud that Democrats negotiated an emergency coronavirus relief and omnibus package to save lives and livelihoods and crush the virus. This agreement is an important initial step, which we must build on under the Biden-Harris Administration.“We also took important action last week to honor the service and sacrifice of those who have worn the uniform. As Chair of the House Veterans’ Affairs Subcommittee on Economic Opportunity, I was proud to sponsor the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020.“This landmark legislation is the product of years of bipartisan work and the strong leadership of House Veterans’ Affairs Committee Chairman Mark Takano and Senate Veterans’ Affairs Committee Ranking Member Jon Tester. It includes numerous legislative initiatives from dozens of House Democrats and provisions from nearly 60 House-passed bills.“It includes the Homeless Veteran Coronavirus Response Act, a bill I introduced to expand and strengthen VA services for homeless veterans during the pandemic, allowing the VA to use existing funds for a wider range of services.“It includes the Reducing Veteran Homelessness Act, a bill I introduced to fill gaps in HUD-VASH case management.“It includes the Protect the GI Bill Act, a bill I introduced to increase transparency and accountability among educational programs that receive funding from the VA, and it includes the Pandemic Assistance for Student Veterans Act, which will minimize the impact of the pandemic on student veterans.“It also includes the Brian Tally VA Employment Transparency Act to support veterans who are the victims of medical malpractice by the VA or its contractors, and the Bill Mulder Transition Improvement Act to make the transition process easier for servicemembers returning to civilian life.“All of these provisions are critically important for the economic success and financial security of our veterans, and I was incredibly proud to lead them.“However, Speaker Pelosi said it best on the House Floor last week when she called the Deborah Sampson Act, led by Congresswoman Julia Brownley, ‘the crown jewel in this package.’ The Deborah Sampson Act takes long overdue steps to address the inequities and barriers that women veterans face when accessing VA care and benefits.“The legislation expands access to care for women veterans, combats sexual harassment and assault, increases cultural competency for all VA staff and improves data collection to ensure that our nation’s nearly two million women veterans get the care, benefits and resources they’ve earned.“With this legislation, we are fulfilling President Lincoln’s promise to care for those ‘who shall have borne the battle’ and for their families, caregivers and survivors.“While we celebrate this extraordinary accomplishment, I know that many troops, veterans and their loved ones are spending this holiday apart from one another. Please know that I deeply appreciate your service and sacrifice, and House Democrats will keep fighting for you in the new year.“Thank you, and happy holidays.” December 27, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on Trump Signing Bipartisan Coronavirus Relief and Omnibus Funding Bill”. From the press release: Speaker Nancy Pelosi issued this statement after the President signed the bipartisan coronavirus relief and omnibus funding bill:“The signing of the bipartisan, bicameral coronavirus relief legislation is welcome news for the fourteen million Americans who just lost the lifeline of unemployment benefits on Christmas Weekend, and for the millions more struggling to stay afloat during this historic pandemic and economic crisis.“This relief legislation is a down payment on what is needed to crush the virus, put money in the pockets of the American people and honor our heroes – our health care workers, first responders, transit and sanitation workers and teachers. We need to ensure robust support for state and local government to distribute and administer a vaccine, keep workers employed and prevent devastating service cuts – and we must do so as soon as possible.“Now, the President must immediately call on Congressional Republicans to end their obstruction and join him and the Democrats in support of our stand-alone legislation to increase direct payment checks to $2,000, which will be brought to the Floor tomorrow. Every Republican vote against this bill is a vote to deny the financial hardship that families face and to deny the American people the relief they need.” December 28, 2020: Senator Bernie Sanders (Independent – Vermont) posted a press release titled: “Sanders Demands McConnell Hold Vote on $2,000 Direct Payments”. From the press release: Senator Bernie Sanders (I-Vt.) issued the following statement in response to the House of Representatives’ overwhelming 275-134 passage of the $2,000 direct payments for the working class:“The House has passed a $2,000 direct payment for working people. It is time for the Senate to act. This week on the Senate floor Mitch McConnell wants to vote to override Trump’s veto of the $740 billion defense funding bill and then head home for the New Year. I’m going to object until we get a vote on legislation that provides $2,000 direct payment to the working class. Let me be clear: If Senator McConnell doesn’t agree to an up or down vote to provide working people of our country a $2,000 direct payment, Congress will not be going home for New Year’s Eve. Let’s do our job.” December 28, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Floor Speech on Caring for Americans with Supplemental Help Act of 2020”. From the press release: ..I’m interested in the comments made by Mr. Brady, because he said we could be putting more money into small businesses, and we do, indeed, in the COVID package, around $300 billion. And I think it is important to note, Madam Speaker, that that brings it to about almost a trillion dollars since March 27th – 28th – when the President signed the CARES Act, about $950 billion for small business. Nearly a trillion dollars, very important……But, if you want to talk about job creation, I hope the gentleman will join us when we go forward to do state and local: our health care workers, honoring our heroes. They are at risk while losing their jobs and they risk their lives to save lives. We are talking about health care workers. We are talking about police and fire, our first responders. We are talking about transportation, sanitation, food workers. We are talking about our teachers, our teachers, our teachers, the custodians of our children for a large part of the day. They are at risk of losing their jobs because of the failure of the Republican side of the aisle to support funds for state and local governments to honor our heroes.We want to honor them. We cheer them and applaud them. Let’s give them pay. Let’s let them have job security. Let’s give them PPE, the equipment that they need to do their jobs. So, if you want to talk about saving jobs or growing jobs, for the purpose the distinguished gentleman from Texas mentioned, how are we going to administer – focus on the distribution and administration of the vaccine? Where do you think that happens but in city, county and state hospitals in large measure, by health care workers in those places wherever it is distributed on an individual basis? But, they are the heart of the matter. And that is why we need to go forward with another bill that invests in our state and local governments, not to talk about government, but to talk about services: health care services, education, transportation, making our lives possible, making our very existence possible by what they do. And, without them, how do we function? ……So, this $2,000 – which, thank you for bringing to the Floor on Christmas Eve. Was roundly rejected by our Republican – we asked for Unanimous Consent, this could already be, exist as a law if it happened, but it didn’t. So, now, today we have another chance.Some of the Republicans said, ‘Oh, if they really wanted that, they would have called for a vote that day.’ That wasn’t true. It’s important to note that was a pro forma session and you had to have the consent of the Republicans to bring the bill to the Floor. They withheld their consent. So, here we are today, in a legislative day, where we just act with the Majority to bring the legislation to the Floor. I hope it will enjoy a strong bipartisan support. The President of the United States has put this forth as something that he wants to see and part of his signing the legislation yesterday. I hope that will be – that view will be shared by the Republicans in the Senate. Because we will pass this bill today. Either under suspension or under a rule, where it just requires a majority vote. Under suspension, as you know, two-thirds vote, requires Republican, a large number of Republican votes, which I hope we will have, because I do think the American people would love to see that unity on their behalf. We are a consumer economy. Putting money into the hands of the American people is a boost to our economy. Not much. This isn’t a big stimulus package. It’s a – the COVID bill is an emergency supplemental. But this piece will make it, will make it something very important to growing – sustaining our economy……Republicans have a choice. Republicans have a choice: vote for this legislation or vote to deny the American people the bigger paychecks this need. To reject this would be in denial of the economic challenges that people are facing and it would deny them, again, the relief they need. And with that, I urge a strong bipartisan vote for the aptly named CASH act… December 28, 2020: The U.S. House of Representatives voted on H.R. 9051 in a Roll Call vote. The vote was “On Motion to Suspend the Rules and pass the CASH Act”. It received 231 YEA votes and 44 NAY votes – which means it passed the House of Representatives. Votes by Party: Democratic: 231 YEAS, 2 NAYsRepublican: 44 YEAS, 130 NAYsIndependent: 0 YEAS, 2 NAYsTotal: 275 YEAS, 134 NAYS Votes by Representatives (by State): Alabama: Aderholt (R) YEA, Brooks (R) NAY, Byrne (R) NAY, Palmer (R) NAY, Roby (R) NAY, Rogers (R) NAY, Sewell (D) YEAAlaska: Young (R) not votingArizona: Biggs (R) NAY, Gallego (D) YEA, Gosar (R) NAY, Grijalva (D) YEA, Lesko (R) NAY, O’Halleran (D) YEA, Schweikert (R) NAY, Stanton (D) YEAArkansas: Crawford (R) YEA, Hill (R) NAY, Kirkpatrick (D) YEA, Westerman (R) NAY, Womack (R) NAYCalifornia: Aguilar (D) YEA, Barragán (D) YEA, Bass (D) YEA, Berra (D) YEA, Brownley (D) YEA, Calvert (R) YEA, Carbajal (D) YEA, Cárdenas (D) YEA, Judy Chu (D) YEA, Cisneros (D) YEA, Correa (D) YEA, Costa (D) YEA, Cox (D) YEA, Davis (D) YEA, DeSaulnier (D) YEA, Eshoo (D) YEA, Garamendi (D) YEA, Garcia (R) YEA, Gomez (D) YEA, Harder (D) YEA, Huffman (D) YEA, Khanna (D) YEA, LaMalfa (R) NAY, Lee (D) YEA, Ted Lieu (D) YEA, Lofgren (D) YEA, Lowenthal (D) YEA, Matsui (D) YEA, McCarthy (R) not voting, McClintock (R) NAY, McNerney (D) YEA, Napolitano (D) YEA, Nunes (R) NAY, Panetta (D) YEA, Pelosi (D) YEA, Peters (D) YEA, Porter (D) YEA, Roybal-Allard (D) YEA, Ruiz (D) YEA, Sánchez (D) YEA, Schiff (D) YEA, Sherman (D) YEA, Speier (D) YEA, Swalwell (D) YEA, Takano (D) YEA, Thompson (D) YEA, Torres (D) YEA, Vargas (D) YEA, Waters (D) YEAColorado: Buck (R) NAY, Crow (D) YEA, DeGette (D) YEA, Lamborn (R) NAY, Levin (D) YEA, Neguse (D) YEA, Perlmutter (D) YEA, Tipton (R) NAYConnecticut: Courtney (D) YEA, DeLauro (D) YEA, Hayes (D) YEA, Himes (D) YEA, Larson (D) YEADelaware: Blunt Rochester (D) YEAFlorida: Bilirakis (R) not voting, Buchanan (R) NAY, Castor (D) YEA, Crist (D) YEA, Demings (D) YEA, Deutch (D) YEA, Diaz-Balart (R) YEA, Dunn (R) not voting, Frankel (D) YEA, Gaetz (R) NAY, Hastings (D) YEA, Lawson (D) YEA, Mast (R) NAY, Mucarsel-Powell (D) YEA, Murphy (D) YEA, Posey (R) NAY, Rooney (R) YEA, Rutherford (R) YEA. Shalala (D) YEA, Soto (D) YEA, Spano (R) NAY, Steube (R) NAY, Waltz (R) NAY, Wasserman-Schultz (D) YEA, Webster (R) NAY, Wilson (D) YEA, Yoho (R) not votingGeorgia: Allen (R) NAY, Bishop (D) YEA, Carter (R) NAY, Collins (R) not voting, Ferguson (R) NAY, Hall (D) YEA, Hice (R) not voting, Johnson (D) YEA, Loudermilk (R) NAY, McBath (D) YEA, Austin Scott (R) NAY, David Scott (D) YEA,Woodall (R) NAYHawaii: Case (D) YEA, Gabbard (D) YEAIdaho: Fulcher (R) NAY, Simpson (R) NAYIllinois: Bost (R) NAY, Bustos (D) YEA, Casten (D) YEA, Danny K. Davis (D) YEA, Rodney Davis (D) YEA, Foster (D) YEA, Garcia (D) YEA, Kelly (D) YEA, Kinzinger (R) YEA, Krishnamoorthi (D) YEA, LaHood (R) NAY, Lipinski (D) NAY, Quigley (D) YEA, Rush (D) YEA, Schakowsky (D) YEA, Schneider (D) YEA, Shimkus (R) NAY, Underwood (D) YEAIndiana: Baird (R) YEA, Banks (R) NAY, Brooks (R) YEA. Buschon (R) NAY, Carson (D) YEA, Hollingsworth (R) not voting, Pence (R) YEA, Visclosky (D) YEA, Walorski (R) YEAIowa: Axne (D) YEA, Finkenauer (D) YEA, King (R) not voting, Loebsack (D) YEAKansas: Davids (D) YEA, Estes (R) NAY, Marshall (R) NAY, Watkins (R) not votingKentucky: Barr (R) not voting, Comer (R) YEA, Guthrie (R) NAY, Massie (R) NAY, Rogers (R) YEA, Yarmuth (D) YEALouisiana: Abraham (R) not voting, Graves (R) NAY, Higgins (R) YEA, Johnson (R) NAY, Richmond (D) YEA, Scalise (R) NAYMaine: Golden (D) YEA, Pingree (D) YEAMaryland: Brown (D) YEA, Harris (R) NAY, Hoyer (D) YEA, Mfume (D) YEA, Raskin (D) YEA, Ruppersberger (D) YEA, Sarbanes (D) YEA, Trone (D) YEAMassachusetts: Clark (D) YEA, Keating (D) YEA, Kennedy (D) YEA, Lynch (D) YEA, McGovern (D) YEA, Moulton (D) YEA, Neal (D) YEA, Pressley (D) YEA, Trahan (D) YEAMichigan: Amash (I) NAY, Bergman (R) YEA, Dingell (D) YEA, Huizenga (R) NAY, Kildee (D) YEA, Lawrence (D) YEA, Levin (D) YEA, Mitchell (I) NAY, Moolenaar (R) NAY, Slotkin (D) YEA, Stevens (D) YEA, Tlaib (D) YEA, Upton (R) YEA, Walberg (R) NAYMinnesota: Craig (D) YEA, Emmer (R) NAY, Hagedorn (R) not voting, McCollum (D) YEA, Omar (D) YEA, Peterson (D) YEA, Phillips (D) YEA, Stauber (R) YEAMississippi: Guest (R) NAY, Kelly (R) NAY, Palazzo (R) NAY, Thompson (D) YEAMissouri: Clay (D) YEA, Cleaver (D) YEA, Graves (R) NAY, Hartzler (R) NAY, Long (R) NAY, Leutkemeyer (R) NAY, Smith (R) YEA, Wagner (R) YEAMontana: Gianforte (R) NAYNebraska: Bacon (R) NAY, Fortenberry (R) not voting, Smith (R) NAYNevada: Amodei (R) NAY, Horsford (D) YEA, Lee (D) YEA, TItus (D) YEANew Hampshire: Kuster (D) YEA, Pappas (D) YEANew Jersey: Gottheimer (D) YEA, Kim (D) YEA, Malinowski (D) YEA, Pallone (D) YEA, Pascrell (D) YEA, Payne (D) YEA, Sherrill (D) YEA, Sires (D) YEA, Smith (R) YEA, Van Drew (R) YEA, Watson Coleman (D) YEANew Mexico: Haaland (D) YEA, Luján (D) YEA, Norcross (D) YEA, Torres Small (D) YEANew York: Brindisi (D) YEA, Clarke (D) YEA, Delgato (D) YEA, Engel (D) YEA, Espaillat (D) YEA, Jeffries (D) YEA, Katko (R) YEA, King (R) YEA, Lowey (D) YEA, Caroyn B. Maloney (D) YEA, Sean Moloney (D) YEA, Meeks (D) YEA, Meng (D) YEA, Morelle (D) YEA, Nadler (D) YEA, Ocasio-Cortez (D) YEA, Reed (R) YEA, Rice (D) YEA, Rose (D) YEA, Serrano (D) YEA, Stefanik (R) YEA, Suozzi (D) YEA, Tonko (D) YEA, Velázquez (D) YEA, Zeldin (R) YEANorth Carolina: Adams (D) YEA, Bishop (R) NAY, Budd (R) NAY, Butterfield (D) YEA, Foxx (R) NAY, Higgins (D) YEA, Holding (R) NAY, Hudson (R) NAY, Jacobs (R) YEA, McHenry (R) NAY, Murphy (D) YEA, Price (D) YEA, Rouzer (R) NAY, Walker (R) not voting, Wright (R) not votingNorth Dakota: Armstrong (R) – NAY, Bishop (R) NAYOhio: Balderson (R) NAY, Beatty (D) YEA, Chabot (R) NAY, Davidson (R) NAY, Fudge (D) YEA, Gibbs (R) NAY, Gonzalez (R) NAY, Johnson (R) YEA, Jordan (R) NAY, Joyce (R) YEA, Kaptur (D) YEA, Latta (R) NAY, Ryan (D) YEA, Stivers (R) NAY, Turner (R) NAY, Wenstrup (R) NAYOklahoma: Cole (R) YEA, Hern (R) NAY, Horn (D) YEA, Lucas (R) YEA, Mullin (R) not votingOregon: Blumenauer (D) YEA, Bonamici (D) YEA, DeFazio (D) YEA, Schrader (D) NAY, Walden (R) YEAPennsylvania: Boyle, Brendan F. (D) YEA, Cartwright (D) YEA, Dean (D) YEA, Michael F. Doyle (D) YEA, Evans (D) YEA, Fitzpatrick (R) YEA, Houlahan (D) YEA, Joyce (R) NAY, Keller (R) NAY, Kelly (R) NAY, Lamb (D) YEA, Meuser (R) NAY, Perry (R) NAY, Reschenthaler (R) NAY, Smucker (R) NAY, Wild (D) YEARhode Island: Ciciline (D) YEA, Langevin (D) YEA, Scanlon (D) YEASouth Carolina: Clyburn (D) YEA, Cunningham (D) YEA, Duncan (R) NAY, Norman (R) NAY, Rice (R) NAY, Timmons (R) NAY, Wilson (R) NAYSouth Dakota: Johnson (R) NAYTennessee: Burchett (R) NAY, Cohen (D) YEA, Cooper (D) YEA, DesJarlias (R) NAY, Fleischmann (R) NAY, Green (R) NAY, Kustoff (R) NAY, Roe (R) not voting, John W. Rose (R) NAYTexas: Allred (D) YEA, Arrington (R) NAY. Babin (R) NAY, Brady (R) NAY, Burgess (R) YEA, Carter (R) not voting, Castro (D) YAY, Cloud (R) YEA, Conaway (R) NAY, Crenshaw (R) NAY, Cuellar (D) YEA, Doggett (D) YEA, Escobar (D) YEA, Fletcher (D) YEA, Flores (R) YEA, Garcia (D) YEA, Gohmert (R) NAY, Gonzalez (D) YEA, Gooden (R) NAY, Granger (R) YEA, Green (D) YEA, Hurd (R) YEA, Jackson Lee (D) YEA, Johnson (D) YEA, Olson (R) YEA, Roy (R) NAY, Taylor (R) NAY, Thornberry (R) NAY, Veasey (D) YEA, Vela (D) YEA, Weber (R) NAY, Williams (R) NAYUtah: Bishop (R) not voting, Curtis (R) NAY, Marchant (R) not voting, McAdams (D) YEA, McCaul (R) YEA, Stewart (R) NAYVermont: Welch (D) YEAVirginia: Beyer (D) YEA, Cline, (R) NAY, Connolly (D) YEA, Griffith (R) NAY, Luria (D) YEA, McEachin (D) YEA, Riggleman (R) YEA, Scott (D) YEA, Spanberger (D) YEA, Wexton (D) YEA, Wittman (R) NAYWashington: DelBene (D) YEA, Heck (D) YEA, Herrera Beutler (R) YEA, Jayapal (D) YEA, Kilmer (D) YEA, Larsen (D) YEA, Newhouse (R) NAY, Rodgers (R) NAY, Schrier (D) YEA, Smith (D) YEAWest Virginia: McKinley (R) YEA, Miller (R) NAY, Mooney (R) NAYWisconsin: Gallagher (R) NAY, Grothman (R) NAY, Kind (D) YEA, Moore (D) YEA, Pocan (D) YEA, Sensenbrenner (R) NAY, Steil (R) NAY, Tiffany (R) NAYWyoming: Cheney (R) NAY Here is the text of H.R. 9051: To amend the Internal Revenue Code of 1986 to increase recovery rebate amounts to $2,000 for individuals, and for other purposes.AN ACTTo amend the Internal Revenue Code of 1986 to increase recovery rebate amounts to $2,000 for individuals and for other purposes.Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,SECTION 1. SHORT TITLE.This Act may be cited as the “Caring for Americans with Supplemental Help Act of 2020” or the “CASH Act of 2020”.Sec. 2. RECOVERY REBATE AMOUNTS INCREASED.(a) IN GENERAL – Section 6438A of the Internal Revenue Code of 1985, as added by the COVID-related Tax Relief Act of 2020, is amended by striking “$600” each place it appears and inserting “$2,000”, and by striking “$1,200” each place it appears and inserting “$4,000”.(b) EFFECTIVE DATE. – The amendments made by this section are contingent upon the enactment of the COVID-related Tax Relief Act of 2020 and shall apply (if at all) as if included in the enactment of section 272 of such Act.SEC. 3. DEPENDENTS TAKEN INTO ACCOUNT IN DETERMINING CREDIT AND REBATES.(a) Recovery Rebates –(1) IN GENERAL. – Section 6428(a)(2) of the Internal Revenue Code of 1986 us amended by striking “qualifying children (within the meaning of section 24(c))” and inserting “dependents (as defined in section 152)”.(2) CONFORMING AMENDMENTS. – (A) Section 6428(g) of such Code is amended by inserting “and subsection (a)(2) were applied by substituting ‘qualifying children (within the meaning of section 24(c))’ for “dependent (as defined in section 152)” before the period at the end.(B) Section 6428(g) of such Code, as amended by the COVID-related Tax Relief Act of 2020 is amended –(i) in paragraph (1), by striking “qualifying child” each place it appears and inserting “dependent”,(ii) in paragraph (2)(C), by inserting “(determined after the application of subsection (f)(2))” after “subsection (a)(2)”, and(iii) in paragraph (3)(B), by inserting “or dependent” after “child” in both places it apepars.(3) EFFECTIVE DATE.- The amendments made by this subsection are contingent upon the enactment of the COVID-related Tax Relief Act of 2020 and shall apply (if at all) as if included in the enactment of section 273 of such Act.(b) ADDITIONAL 2020 RECOVERY REBATES.-(1) IN GENERAL.- Section 6428A(a)(2) of the Internal Revenue Code of 1986, as added by the COVID-related Tax Relief Act of 2020, is amended by striking “qualifying children (within the meaning of section 24(c))” and inserting “dependents (as defined in section 152)”.(2) AUTHORITY TO MAKE ADVANCE REFUNDS WITHOUT REGARD TO MODIFIED DEFINITION OF DEPENDENT.—Section 6428A(f) of such Code is amended by adding at the end the following new paragraph:“(7) AUTHORITY TO MAKE ADVANCE REFUNDS WITHOUT REGARD TO MODIFIED DEFINITION OF DEPENDENT.—To the extent the Secretary determines appropriate to make or allow the maximum number of advance refunds by the deadline described in paragraph (3)(A)(ii), the Secretary may determine the advance refund amounts under this subsection without regard to the amendments made by paragraphs (1) and (3) of section 3(b) of the CASH Act of 2020.”.(3) CONFORMING AMENDMENTS.—(A) Section 6428A(f)(2)(B) of such Code is amended by striking “qualifying child” and inserting “dependent”.(B) Section 6428A(g) of such Code is amended by striking “qualifying child” each place it appears and inserting “dependent”.(C) Section 6428A(g)(4)(B) of such Code is amended by striking “such child” and inserting “such dependent”.(4) EFFECTIVE DATE.—The amendments made by this subsection are contingent upon the enactment of the COVID-related Tax Relief Act of 2020 and shall apply (if at all) as if included in the enactment of section 272 of such Act.SEC. 4. Budgetary effects.(a) Statutory PAYGO Scorecards.—The budgetary effects of this Act shall not be entered on either PAYGO scorecard maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act of 2010.(b) Senate PAYGO Scorecards.—The budgetary effects of this Act shall not be entered on any PAYGO scorecard maintained for purposes of section 4106 of H. Con. Res. 71 (115th Congress).Passed the House of Representatives December 28, 2020. December 28, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on National Defense Authorization Act Veto Override”. From the press release: Speaker Nancy Pelosi issued this statement after the House voted on an overwhelmingly bipartisan basis to override the President’s veto of the National Defense Authorization Act:“With this overwhelmingly bipartisan vote, the House has upheld our sacred Constitutional responsibility to keep our country and our people safe. The National Defense Authorization Act has been passed on a bipartisan and bicameral manner for sixty years, and it will become law, despite the President’s dangerous sabotage efforts.“The President’s reckless veto would have denied our servicemembers hazard duty pay; our families paid family leave, child care, housing improvements and health protections; and our veterans their benefits. It would have senselessly deprived our allies and country of key protections for global peace and security – including for cyber-security, following a massive attack on the country. And it would have undermined our nation’s values and work to combat racism, by blocking overwhelmingly bipartisan action to rename military bases and infrastructure after officials who served in the Confederacy.“The President must end his eleventh-hour campaign of chaos, and stop using his final moments in office to obstruct bipartisan and bicameral action to protect our military and defend our security.” December 28, 2020: Covered California posted a news release titled: “Amid Surging COVID-19 Pandemic and Impending Enrollment Deadline, Covered California Urges Consumers to Sign Up for Health Care Coverage”. From the news release: With the first open-enrollment deadline approaching this week, Covered California urged consumers to sign up now so they can have their health care coverage be effective on Jan.1.“Covered California is a critical safety net to help people get quality health care coverage during the surging pandemic and ongoing recession,” said Peter V. Lee, executive director of Covered California. “With our first enrollment deadline coming up this week, we want to encourage anyone who needs coverage to check out their options so they can start the New Year with protection and peace of mind.”In response to the pandemic, Covered California extended the enrollment deadline to receive Jan. 1 coverage from Dec. 15 to Wednesday Dec. 30. Consumers who sign up by Dec. 30 will need to pay their first bill in order to have their coverage take effect on Jan. 1.Right now, an estimated 1.2 million Californians are uninsured – even though they are eligible for financial help through Covered California, or they qualify for low-cost or no-cost coverage through Medi-Cal……Get Covered, Stay CoveredCovered California mailed masks to 1.5 million enrollees and asked consumers to take all necessary precautions to help prevent the spread of the virus, while sharing the news about open enrollment.“Getting covered with a mask will help protect Californians and their families and friends; getting covered with a health plan will help protect people if they get sick,” Lee said. “Covered California helps you get access to some of the best doctors and health care facilities in the country, and provides peace of mind during these challenging times where there is so much uncertainty.”… December 29, 2020: Senator Pat Toomey (Republican – Pennsylvania) tweeted: “Congress should continue helping workers who’ve lost their jobs. But blindly borrowing more than $600 billion so we can send $2,000 checks to millions of people who haven’t lost any income is terrible policy. I won’t consent to a vote.” The tweet included a link to a YouTube video. On September 25, 2020, 24/7 Wall street (via MSN) wrote the following: …Senators are paid a salary of $174,000 per year – more than triple the average wage across all American workers of $53,490 and higher than the median earnings of even the best paying jobs in America. Senate majority and minority leaders make even more – $193,400 annually. Further, according to the U.S. Federal Reserve, the typical American family has a net worth of about $97,300. Meanwhile, the estimated median net worth among sitting U.S. senators is around $2.4 million. December 29, 2020: The Hill posted an article titled: “GOP senator says he’ll block consent for $2,000 stimulus checks”. It was written by Alexander Bolton. From the article: Republican Sen. Pat Toomey (Pa.) on Tuesday evening announced he would object to a request to swiftly pass House-approved legislation to increase the amount of direct stimulus checks $2,000.Toomey is one several Republican senators who would object to such a request, including Sens. Ron Johnson (R-Wis.) and Rand Paul (R-Ky.), according to a Senate to a Senate GOP aide……Toomey announced he will retire from Congress at the end of 2022 and that he doesn’t have plans to run again for political office.…His statement shows that Senate Majority Leader Mitch McConnell (R-Ky.) is not the only obstacle to passing legislation approved by the House on Monday to increase the size of direct stimulus checks from $600 to $2,000… December 29, 2020: The Guardian posted an article titled: “McConnell blocks initial Democratic effort for $2,000 Covid stimulus checks”. It was written by David Smith. From the article: A growing number of Republicans on Tuesday backed Donald Trump’s demand to increase coronavirus relief payments to US citizens from $600 to $2,000, though the Senate majority leader, Mitch McConnell, blocked Democrats’ efforts to quickly pass the measure.Trump’s party has been plunged into chaos and conflict over his demands to increase one-off cheques for Americans, a measure that passed the Democratic-controlled House of Representatives on Monday……Put on the spot by Trump, more Republicans on Tuesday abandoned their previous opposition to the higher sum and came over to the president’s side……Final passage of the aid increase in the Senate would require 60 votes and the backing of a dozen Republicans to hand Trump an unlikely victory. The Georgia runoffs could weigh heavily in McConnell’s thinking on whether to allow such a vote to go ahead……McConnell objected, blocking initial consideration of the measure, but was set to come under growing pressure from Democrats and members of his own party to hold an up-or-down vote this week.While blocking immediate consideration of a measure to increase Covid-19 relief payments, he suggested that the Senate would begin to examine the issue along with two others Trump has raised – the integrity of elections and limits on big technology companies……The defense bill is heading to the Senate after the House voted 322 to 87 to override Trump’s presidential veto. It was the first time either chamber of Congress delivered such a rebuke. Some 109 Republicans joined their Democratic colleagues to ensure the required two-thirds majority… December 29, 2020: The Hill posted an article titled: “McConnell blocks vote on $2K checks, signals new package”. It was written by Jordain Carney. From the article: Senate Majority Leader Mitch McConnell (R-Ky.) on Tuesday blocked an attempt by Democrats to set up a stand-alone vote on increasing the amount of recently passed stimulus checks from $600 to $2,000.Senate Democratic Leader Charles Schumer (D-N.Y.) and Sen. Bernie Sanders (I-Vt.) both tried to get consent for the Senate to bring up legislation that passed the House in a 273-134 vote on Monday.The GOP leader did not directly address why he objected, but under the Senate’s rules any one senator can block efforts to set up votes or pass bills.McConnell signaled separately that he could package the increase in direct stimulus checks, with a repeal of a tech shield that has emerged as a top target for Trump and election-related investigations. Trump, in his statement on signing the $2.3 trillion package, said the Senate would “start the process for a vote” that tackles the three issues. “During this process, the president highlighted three additional issues of national significance he would like to see Congress tackle together,” McConnell said.“Those are the three important subjects the president has linked together. This week the Senate will begin a process to bring these three priorities into focus,” he added.McConnell did not provide additional details during his floor speech about how he might bring the measures up. But the GOP leader later filed a bill that would increase the amount of the stimulus checks, repeal a legal shield for tech companies known as Section 230 and create an election commission that would study the November elections.He also started the process for getting his bill and the House-passed measure, known as the CASH Act, on the Senate calendar — which would make them each available for a vote but doesn’t guarantee they will be brought up.But tying the stimulus checks to Section 230 or to Trump’s unsubstantiated claims that widespread election fraud cost him a second term would almost certainly undermine Democratic support for such legislation……Without the cooperation of every senator, the Senate is expected to debate Trump’s veto of an unrelated defense bill until Friday or Saturday, leaving them little to time to bring up and vote on a checks proposal before the start of the 117th Congress at noon Sunday.Democrats want a stand-alone vote on a bill to increase the stimulus checks from $600 to $2,000… December 29, 2020: Senator Charles E. Schumer (Democrat – New York) posted a blog post titled: “Who’s Blocking $2,000 Stimulus Checks? The Republican Senate Majority”. The blog post is on Data for Progress. From the blog post: Throughout this pandemic, working Americans have taken it on the chin. Tens of millions of Americans have lost their jobs through no fault of their own. Nearly 26 million had difficulty putting food on the table in the past week, per a US Census study in early December. By January, 12 million Americans will owe an average of nearly $6,000 in back rent and utility payments. Communities of color and the poorest Americans are bearing the brunt of the current economic crisis, the worst in seventy-five years.As Americans brace themselves for the hardest and darkest stretch of the coronavirus pandemic, the quickest way to help struggling Americans is to send some of their tax dollars right back into their pockets in the form of direct stimulus checks. For weeks, Democrats have pushed for generous direct payments to American families. Unfortunately, our Republican colleagues were only willing to agree to $600 checks in the most recent coronavirus-relief legislation, a pittance compared to the deep hole that many working families have fallen into. So Democrats are fighting to increase the amount of the stimulus checks to $2,000 per adult. Here’s the good news. Over the last few days, the idea of $2,000 checks has bridged the massive political divide here in Washington. On Monday, an overwhelming bipartisan majority in the House of Representatives passed legislation to approve immediate, $2,000 stimulus checks. Senate Democrats, too, strongly support $2,000 checks. Even President Trump supports $2,000 checks. Most importantly, the public supports it as well. A recent Data for Progress poll showed that nearly 80% of likely voters approve of $2,000 in direct financial support, including a majority of Republicans and Democrats who are “strongly” in favor. But here’s the bad news. When I went to the floor to ask the Senate to take up and pass the House bill to provide $2,000 checks, Majority Leader McConnell objected. It is only the latest example of how out-of-touch Senate Republicans are when it comes to helping struggling Americans during the coronavirus pandemic……But some Republican Senators object to these checks…because it might add to the national deficit. These are the same Republicans who added $2 trillion to the deficit in order to give massive tax breaks to billionaires and large corporations, and who fought to include a tax break for three-martini lunches in the most recent coronavirus-relief bill. But now that the economy is on life support, as Americans are queueing up on bread lines and filing for unemployment, and just as a Democratic President is about to take office: all of the sudden the deficit-scolds in the Republican party are back…. December 29, 2020: U.S. News posted an article titled: “Stimulus Checks Gain Momentum in Senate, But McConnell Won’t Commit to Vote”. It was written by Lisa Hagan. From the article: Senate Majority Leader Mitch McConnell objected on Tuesday to Democrats’ requests for an immediate vote on increasing stimulus checks to $2,000 even as momentum builds among more GOP senators for the House-passed bill that’s also backed by President Donald Trump.From the floor, McConnell announced that the Senate will “begin a process” to address all three of Trump’s priorities that he highlighted on Sunday: higher stimulus checks, a review of voter fraud claims from the November election and consideration of reforms to Section 230, the regulation that shields tech companies from lawsuits over user content.For now, the Kentucky Republican is essentially punting on a standalone bill to increase direct payments from $600 to $2,000. And he initially gave little insight or detail on how he’d proceed with Trump’s requests or how he’d tie them all together with only five days left in the legislative session. A new Congress will be sworn in on Jan. 3.Before the Senate adjourned late Tuesday afternoon, McConnell introduced a long-shot bill that combines all of Trump’s demands: $2,000 stimulus checks, the repeal of Section 230, and the creation of a bipartisan committee that would “study the integrity and administration” of the Nov. 3 election. But no votes are currently scheduled, and McConnell could still decide to take up the House-passed checks bill……After McConnell’s announcement committing to move forward with Trump’s priorities, Senate Minority Leader Chuck Schumer of New York and Bernie Sanders of Vermont took to the floor to request immediate consideration and a standalone vote on stimulus checks. But McConnell rejected Schumer’s request for unanimous consent, which only takes one objection to kill the effort. McConnell also objected to Sanders’ request to consider a vote… December 29, 2020: San Antonio Express-News posted an article titled: “Pregnant, immunocompromised, or have allergies? Here’s what you need to know about COVID-19 vaccines”. It was written by Narina Starleaf Riker. From the article: …In December, the U.S. Food and Drug Administration approved emergency use of COVID-19 vaccines made by Moderna and Pfizer-BioNTech. Unlike many other vaccines that use a killed or weakened virus, these new COVID-19 vaccines harness a groundbreaking technology called synthetic messenger RNA — mRNA for short — that directs cells to produce proteins that trigger the immune system to create antibodies.Those antibodies fight the real virus if a person becomes infected.We interviewed Dr. Ruth Berggren, an infectious disease specialist at UT Health San Antonio, to learn more about the vaccines’ safety. She served on a UT Health working group that examined the safety of the Pfizer vaccine and considered how it should be distributed among front-line health care workers……What safety concerns have come up so far?The biggest one is the possibility of having a very severe allergic reaction to one of the vaccine components and a severe allergic reaction we call “anaphylaxis.” That’s the allergic reaction where your throat closes up, and because of swelling back in your throat area, you can’t breathe. Because the vaccine is being given in a closely-monitored medical setting, we treat people who are showing even a glimmer of an anaphylactic reaction with appropriate treatments that can include antihistamines, steroids and then even epinephrine if there’s a real danger of the throat closing off.That’s the big concern. What are people being allergic to that’s causing this? The ingredients of the vaccine are publicly available in multiple places including FDA and CDC documents. Probably the most important ingredient is polyethylene glycol or PEG, which is not a weird or new compound. Polyethylene glycol is what is in the prep that people take when they’re going to go for a colonoscopy, that liquid stuff that you drink. It’s been used chemically to modify drugs that we give people, such as interferon. So this is not a new thing. There are decades and decades of safety information about it, but like everything else, some people could become allergic, just like some people can become allergic to a bee sting.Can you talk about the safety of these vaccines for people who are immunocompromised, such as people who have lupus or Type 1 diabetes?I want to make it really clear that this vaccine is not harmful for people whose immune system is weakened for one reason or another. It does not further harm your immune system, and it doesn’t predispose you to having some problem because you’re immunocompromised. The issue is that people who are immunocompromised need to know that their response to the vaccine may not even come close to being as protective as it is for other people. If my immune system is weak and I get vaccinated, I’ll probably mount some immune response, but I might not mount enough of one to fully protect me from getting infected or to fully protect me from severe disease.We have that note of caution, and people get asked prior to being vaccinated, “Are you pregnant? Are you immunocompromised?,” so that they can be informed of what this vaccine could or could not do for them. But being immunocompromised does not present a safety concern for the vaccine itself.It’s important for the public to know that in the Pfizer vaccine trial, people with well-controlled HIV, as well as people with controlled Hepatitis B and Hepatitis C, were included. And there was no problem in people with well-controlled HIV……Can you talk about what we know about the safety of these vaccines for people who are pregnant or breastfeeding?The Society for Maternal-Fetal Medicine got up front with a statement recommending that pregnant women who are at risk for getting COVID-19 should not be prevented from getting the vaccine and that they should be allowed to make the decision in conjunction with their doctor. There is no evidence that the vaccine harms the fetus, but we also don’t have any large-scale evidence of intentionally giving this vaccine to pregnant women to watch what happens.It needs to be an individualized decision. If a pregnant mom is on the front lines of health care — let’s say she is intubating patients who have SARS-CoV-2 infection — that is a high-risk situation. If you add on that that pregnant woman may have gestational diabetes or hypertension — some of the risk factors for a bad COVID-19 disease outcome — it would be a bad thing to prevent such a woman from getting vaccinated. She should be allowed to have access to it… December 29, 2020: Steven Mnuchin, U.S. Secretary of Treasury tweeted: “.@USTreasury has delivered a payment file to the @FederalReserve for Americans’ Economic Impact Payments. These payments may begin to arrive in some accounts by direct deposit as early as tonight and will continue into next week (1/2)”. This tweet was the start of a short thread. December 29, 2020: Steven Mnuchin, U.S. Secretary of Treasury, tweeted: “Paper checks will begin to be mailed tomorrow. Later this week, you can check the status of your payment at IRS.gov.GetMyPayment (2/2). December 29, 2020: The Hill posted an article titled: “Mnuchin: Stimulus payments to begin arriving Tuesday night”. It was written by Tal Axlerod and Naomi Jagoda. From the article: Treasury Secretary Steven Mnuchin said that stimulus payments from the most recent coronavirus relief package could begin landing in Americans’ bank accounts as early as Tuesday night……He added that paper checks will begin to be mailed Wednesday.The coronavirus relief package, which President Trump signed on Sunday, provided for direct relief payments of up to $600 per adult and per child under 17. Individuals with income of up to $75,000 and married couples with income up to $150,000 are eligible for the full amount, and the amounts are reduced for people with incomes above those thresholds.Treasury and the IRS are issuing payments automatically to people who filed a 2019 tax return, non-filers who recieve certain federal benefits and people who provided their information to the IRS earlier this year through the agency’s web tool for non-filers. Most people will receive their payments by direct deposit, while others will get their payments in the mail in the firm of either a paper check or a debit card. Debit cards will be delivered in a white envelope with the Treasury seal, the IRS said.Under the relief package, the IRS has until Jan. 15 to issue the automatic payments. Eligible people who do not receive their payment or who did not receive some or all of the payment to which they were entitled under March’s CARES Act can claim a tax credit when they file their 2020 tax returns next year. The CARES Act authorized payments of up to $1,200 per adult and $500 per child.The announcement that $600 payments are starting to be sent out comes amid a push by Trump and some lawmakers to increase those payments to $2,000. Treasury said Tuesday that if further legislation is enacted to increase the payment amount, payments that have already been issued will be “topped up” as promptly as they can be. December 29, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Celebrates Passage of Abortion Access Provisions in Massachusetts”. From the press release: Today, the Massachusetts state legislature overrode Republican Governor Charlie Baker’s veto in order to enact legislation that removes critical barriers to accessing abortion care in Massachusetts. This legislation includes key provisions of the ROE Act, a bill that NARAL Pro-Choice Massachusetts, the ACLU of Massachusetts, and Planned Parenthood Advocacy Fund of Massachusetts have advocated for since 2019.Earlier this month, the legislature rejected Governor Baker’s proposed amendments to this legislation and returned it to his desk as written and passed by the legislature. Baker’s amendments would have maintained the Commonwealth’s medically unnecessary barriers to care. Governor Baker subsequently vetoed the original language on Christmas Eve, sparking outrage and criticism from voters and advocates, and today, the legislature overrode the veto to make this critical legislation law.The legislation removes several medically unnecessary barriers to care that existed in Massachusetts law. Specifically, it removes the ban on abortion care later in pregnancy in the case of a lethal fetal diagnosis, ensuring Bay State families can get the compassionate care they need in their home state without having to fly across the country. The section also partially repeals the state’s parental consent and judicial bypass law by allowing 16- and 17-year-olds to make their own decisions about abortion care, making Massachusetts the first state in the country to legislatively roll back a mandated parental involvement law accomplish this. It streamlines the judicial bypass process for young people under 16 by allowing remote hearings, removing the onerous and traumatic burden of having to appear in court before a judge. This new process mirrors existing practices set up during the COVID-19 pandemic and minimizes harmful delays to care. The section also affirmatively codifies the right to abortion into Massachusetts state law.In response to the legislation’s passage, NARAL Pro-Choice Massachusetts Executive Director Rebecca Hart Holder said:“This is a proud day for Bay Staters and supporters of reproductive freedom across the country. Today we repealed laws that have been on the books since 1974. Laws designed to prevent women and pregnant people from accessing abortion care when they need it. For far too long, our outdated abortion laws in Massachusetts did not reflect our values or voters’ widespread support for reproductive freedom. That changes today. By removing these medically unnecessary barriers to care, we have taken a major step toward ensuring that all Bay Staters can get the safe, legal abortion care when and where they need it.” NARAL Pro-Choice America President Ilyse Hogue released the following statement: “The passage of the Massachusetts budget with this key section on reproductive freedom is a huge win. Women and families need understanding, information, and support—not barriers to accessing care. NARAL Pro-Choice America was proud to stand with NARAL Pro-Choice Massachusetts, the ROE Act Coalition, and our more than 72,000 members across the Commonwealth in fighting to ensure that every body has the freedom to control their own lives, destinies, and futures.” A recent poll from Change Research finds that more than 3 in 4 Massachusetts voters believe the state should protect the right to abortion care through state legislation and support the core provisions of the ROE Act—including many provisions included in the FY 2021 budget. More than 4 in 5 voters in Massachusetts do not believe that vulnerable teens seeking abortion care need a courtroom judge, including 77% of Independents and 57% of Republicans. Further, nearly 3 in 5 voters supported repealing the parental consent law.This is a crucial win for reproductive freedom at a time when anti-choice state lawmakers across the country remain determined to criminalize abortion—putting the advancement of their unpopular ideology above the health and well-being of the American people, even during a still-raging pandemic. Thanks to these efforts from anti-choice, anti-freedom legislators—as well as Donald Trump and Senate Majority Leader Mitch McConnell’s efforts to stack the federal judiciary with judges hostile to Roe v. Wade—reproductive freedom remains in jeopardy. NARAL Pro-Choice Massachusetts advocated for this amendment as part of the ROE Act Coalition—a statewide reproductive rights coalition of more than 70 grassroots, community, advocacy, and labor organizations. December 30, 2020: Politico posted an article titled: “McConnell and GOP reject House’s $2,000 stimulus checks”. It was written by Burgess Everett. From the article: Mitch McConnell and Senate Republicans finished off any imminent chance of approving $2,000 stimulus checks on Wednesday, ending a push from President Donald Trump and Democratic leaders to approve bigger direct payments as the congressional term comes to an end.The Senate majority leader said he would not detach the $2,000 checks supported by President Donald Trump from other matters demanded by the president: Stripping legal protections from tech companies and establishing an election fraud commission. He declared that the House’s effort to more than triple the size of $600 checks approved earlier this week has “no realistic path to quickly pass the Senate.”……But Democrats indicated they would not abandon their efforts. Andrew Bates, a spokesman for President-elect Joe Biden, said he supports the House bill and said “it’s imperative that we build on the bipartisan stimulus downpayment.”……Trump continued pressing his case: “$2000 ASAP!” he said on Twitter on Wednesday. Sen. Bernie Sanders (I-Vt.) even printed out massive posters of Trump’s tweets pushing for more cash and read them on the Senate floor……The issue has dominated the Senate even as both parties are preparing to roll over Trump’s veto of the annual defense bill. Sens. Pat Toomey (R-Pa.) and Cornyn battled with Democrats on the Senate floor on Wednesday, spurning requests to hold a roll call vote. Senate Minority Leader Chuck Schumer (D-N.Y.), Sanders and Sen. Ed Markey (D-Mass.) all tried to force votes, but each request was rejected.Sanders and other Democrats said they would not consent to finishing a critical $740 billion defense bill until they got their vote, as did Sen. Josh Hawley (R-Mo.).“All that he has to do is give us an up or down vote on the issue of getting $2,000 to every working class adult in this country,” Sanders said of McConnell after the floor fight. “If he wants to bring up another approach, that’s fine too. But give us an up or down straight forward vote.”……Democrats and some Republicans oppose a blanket repeal, meaning McConnell’s bill probably can’t get 60 votes in the Senate anyway. Moreover, the House is gone for the year, leaving their standalone bill to boost the $600 checks to $2,000 as the only real option at this point.“There is no other game in town besides the House bill. The only way … to get to the American people the $2,000 checks they deserve and need is to pass the House bill and pass it now,” Schumer said… December 31, 2021: Oregon State University posted news titled: “OSU studies find Oregon’s Medicaid expansion improved prenatal care access, birth outcomes”. From the article: A pair of recent studies from Oregon State University found that Oregon’s Medicaid expansion in 2014 has led increased prenatal care among low-income women, as well as improved health outcomes for newborn babies.In the three years after the expansion, one study found that Oregon saw an almost 2 percentage point increase in first trimester prenatal care utilization, relative to 18% of the pre-expansion population who lacked any access to prenatal care in the earlier stages of pregnancy.In the same period, the second study found, Medicaid expansion was associated with a 29% reduction in low birthweight among babies born to women on Medicaid, as well as a 23% reduction in preterm births.Prior to the state’s Medicaid expansion as part of the Affordable Care Act, low-income women who were not otherwise eligible for Medicaid became eligible when they became pregnant. It was estimated that expanding Medicaid to include everyone earning up to 138% of the federal poverty level would extend coverage to an additional 77,000 women of childbearing age.“This means that women are getting preconception care before they’re pregnant,” said lead author Marie Harvey, associate dean for research in OSU’s College of Public Health and Human Sciences. “Then when they become pregnant, they’re more easily able to get prenatal care.”Prior to pregnancy, establishing that connection with a primary care provider means women are able to receive holistic medical and public health care to improve their overall well-being….…The study found almost twice the magnitude of gains in pre-pregnancy enrollment in Medicaid among Hispanic women compared with non-Hispanic white women, Gibbs said.In turn, increased pre-pregnancy enrollment in Medicaid likely contributed to the positive impacts on low birthweight and preterm births, researchers said, as women with health coverage had greater access to preventive care and preconception care… January 2021 January 1, 2021: The Guardian posted an article titled: “Senate overrides Donald Trump’s veto of defense spending bill”. It was written by Edward Helmore. From the article: Donald Trump’s fellow Republicans in the US Senate on Friday took the atypical rebellious step of overriding his veto for the first time in his presidency.The Senate pushed through a bill on defense spending against Trump’s strong objections – just 20 days before he leaves office.Meeting in a rare New Year’s Day session, the Senate secured the two-thirds majority needed to override the veto with bipartisan support two days before a new Congress will be sworn in on Sunday.Eight previous vetoes of legislation have been upheld. Under the US constitution, the president has the power to veto a bill passed by Congress, but lawmakers can uphold the bill if two-thirds of both the House of Representatives and the Senate vote to override it.The Republican-led Senate, following the Democratic-controlled House on Monday, passed the measure without Trump’s support, voting 81-13 on Friday afternoon……The $740bn National Defense Authorization Act (NDAA) determines everything from military programs and construction projects to how to address geopolitical threats.Trump refused to sign it into law because of its failure to repeal Section 230, a federal law that provides a legal liability shield for internet companies, and because it includes a provision stripping the names of Confederate generals from military bases… January 1, 2021: The American Academy of Pediatrics (AAP) posted a press release titled: “AAP Statement on Passage of Global Child Thrive Act”. It was written by Lee Savio Beers, MD, FAAP, President of American Academy of Pediatrics. From the press release: “The American Academy of Pediatrics (AAP) applauds the Global Child Thrive Act becoming law. This vital provision represents important bipartisan effort tha will make significant and necessary strides toward supporting child health around the world.“Pediatricians understand that healthy, nurturing, and safe environments are critical to a child’s lifelong health and development. Without that support, children can face serious consequences to their overall health. Millions of children in low-and middle-income countries suffer from poor development due to inadequate nutrition, lack of stimulation and nurturing care, and exposure to stress. The Global Child Thrive Act will support children globally by integrating proven early childhood interventions – such as training caregivers to provide mental stimulation and nurturing care like singing and reading – into foreign assistance programs that serve children and their families.“The Global Child Thrive Act advanced as part of the National Defense Authorization Act, which also included important AAP-supported provisions that limit potential cuts to medical military personnel, helping to ensure access to needed health care services for military children and families.“Pediatrician advocacy for children extends far beyond our country’s borders. The Academy thanks Senators Roy Blunt (R-Mo.) and Chris Coons (D-Del.) and Representatives Joaquin Castro (D-Texas) and Brian Fitzpatrick (R-Pa.) for their committment to global child health and their leadership on the Global Child Thrive Act. As this legislation becomes law, we look forward to continuing to work with policymakers across the government to support the health of children and families everywhere.” January 3, 2021: CNN posted an article titled: “117th Congress sworn in Sunday amid pandemic”. It was written by Clare Foran, Kristin Wilson and Ted Barrett. From the article: The 117th Congress was officially sworn in on Sunday, bringing an influx of new lawmakers to Capitol Hill amid the ongoing pandemic.The Constitution calls for Congress to convene on January 3 at noon ET — the reason for the rare Sunday session. Newly elected and returning members took the oath of office and the full House of Representatives voted along party lines to reelect Nancy Pelosi as House Speaker.House Democrats kept control of the House in the November elections, but will now have a narrower majority after suffering a string of losses, despite projections that they would win more seats. House Republicans, meanwhile, outperformed expectations and are now poised to add a significant number of GOP women to their ranks in the new Congress. In the Senate, the balance of power still has yet to be decided with all eyes on a pair of Senate runoff elections taking place in Georgia on January 5 that will determine which party controls the chamber… January 5, 2021: Center for Reproductive Rights posted a press release titled: “ACLU and Center for Reproductive Rights Win in Federal Court, Blocking Four Anti-Abortion Laws in Arkansas”. From the press release: In a critical victory for abortion access in Arkansas, the ACLU and the Center for Reproductive Rights secured an order today from the U.S. District Court for the Eastern District of Arkansas blocking four state anti-abortion laws.Last month, that court issued a 14-day temporary restraining order blocking the four laws only a few hours after the Eighth Circuit Court of Appeals allowed them to take effect. During the short time the laws were in effect, Little Rock Family Planning Services was forced to cancel appointments. Today’s ruling will keep the laws blocked while the case continues.“This order will ensure that essential reproductive health care services will remain available in Arkansas,” said Ruth Harlow, senior staff attorney in the ACLU’s Reproductive Freedom Project. “The laws blocked by the court today do nothing but place roadblock after roadblock in front of patients, in violation of their constitutionally protected rights. Arkansas politicians may continue this ruthless attack on abortion, but we will see them in court every time.”If allowed to take effect, the laws would completely prevent many people from obtaining abortion care, create intrusive and stigmatizing requirements that violate patients’ privacy rights, and leave the state with even more limited access to abortion. The litigation is supported by several medical experts and five Arkansas abortion patients who spoke to the devastating impact the laws would have if enforced.“Arkansas legislators took an oath to protect people’s constitutional rights — not trample on them with harmful dictates and restrictions,” said Holly Dickson, executive director of the ACLU of Arkansas. “We’re relieved the court will continue to block these unconstitutional laws while we keep fighting to have them struck down for good.”“Today’s decision brings welcome, but temporary, relief to those seeking time-sensitive and essential abortion care in Arkansas,” said Jenny Ma, senior staff attorney at the Center for Reproductive Rights. “For now, anti-abortion lawmakers have been halted from devastating abortion access in the state. Just last month, we saw the impact of these laws when they took effect for just a few hours: patients were turned away and abortion access was severely limited. We can’t allow that to become the status quo for Arkansas and will continue to fight in court.”The lawsuit was filed by the ACLU, the ACLU of Arkansas, the Center for Reproductive Rights, and the law firm of O’Melveny & Myers LLP on behalf of Frederick W. Hopkins, M.D., M.P.H. and Little Rock Family Planning Services. January 6, 2021: Miami Herald posted an article titled: “Warnock, Ossoff win in Georgia, handing Dems Senate control”. It was written by Steve Peoples, Bill Barrow and Russ Bynum. From the article: Democrats won both Georgia Senate seats — and with them, the U.S. Senate majority — as final votes were counted Wednesday, serving President Donald Trump a stunning defeat in his turbulent final days in office while dramatically improving the fate of President-elect Joe Biden’s progressive agenda.Jon Ossoff and Raphael Warnock, Democratic challengers who represented the diversity of their party’s evolving coalition, defeated Republicans David Perdue and Kelly Loeffler two months after Biden became the first Democratic presidential candidate to carry the state since 1992.Warnock, who served as pastor for the same Atlanta church where civil rights leader the Rev. Martin Luther King Jr. preached, becomes the first African American from Georgia elected to the Senate. And Ossoff becomes the state’s first Jewish senator and, at 33 years old, the Senate’s youngest member… January 7, 2020: Houston Chronicle posted an article titled: “As Texas boots Planned Parenthood, Medicaid clients get 30 days to find new providers”. It was written by Jeremy Blackman. From the article: Thousands of low-income Texans have less than a month to find new providers of birth control, cancer screenings and other non-abortion services as the state moves forward with plans to boot Planned Parenthood from its Medicaid program, according to a letter sent from the state health agency.The nonprofit had asked for at least a six month extension to help recipients transition to new providers, following a November court ruling that allowed Republican officials to stop reimbursing it for Medicaid services. In the letter sent Monday, however, the health agency said it has only until Feb. 3, and is prohibited from accepting any new Medicaid patients.Planned Parenthood served about 8,000 Medicaid recipients last year. The program helps low-income Texans, but many health providers don’t participate because of low reimbursement rates from the state.“The Medicaid network needs more providers, not fewer,” Planned Parenthood said in a statement denouncing the decision, adding that it will harm people of color and women most. “Gov. Abbott knows full well that other providers can’t just absorb Planned Parenthood’s family planning patients — a well-documented fact explained by the experts, including the American Public Health Association.”……In a call last month with reporters, Planned Parenthood South Texas President and CEO Jeffrey Hons said its clinics are some of the only options for low-income communities, especially Black and Latina women who have less access to health care than white women and whose families have been disproportionately impacted by COVID-19.To qualify for Medicaid in Texas, a single woman with a dependent child can’t make more than $196 per month. January 8, 2021: CNN posted an article titled: “Trump administration strikes parting blow at Medicaid with Tennessee block grant”. It was written by Tami Luhby. From the article: Just days before leaving office, the Trump administration took a step toward fulfilling a long-held Republican dream of curbing Medicaid costs and giving states more flexibility to run the program.The Centers for Medicare and Medicaid Services Friday granted Tennessee’s request to turn its federal Medicaid funding arrangement into a so-called modified block grant. It is the first state to receive such permission and is similar to a guidance the agency issued in early 2020.The Biden administration, however, is expected to oppose the approval, which lasts 10 years. While incoming officials can reverse the decision, the state can request a hearing to challenge that determination. The overturning of approvals has rarely, if ever, happened……The Trump administration has encouraged states to make historic changes to their Medicaid programs, including adding work requirements — which is now before the Supreme Court……Tennessee’s waiver shifts federal funding for its TennCare program to a lump sum, which will increase annually based on projected Medicaid spending growth rates in the president’s budget. If enrollment rises or falls more than 1%, the block grant is adjusted accordingly. TennCare currently covers about 1.5 million low-income residents.If the program comes in under budget and meets certain quality metrics, the state can share in the savings. Among the target priorities for the extra funds, officials said, are addressing maternal health, serving individuals with intellectual and developmental disabilities currently on a waiting list to receive services and addressing other state-specific public health crises……The waiver also gives the state more flexibility in administering its program, including limiting the number of prescription drugs covered and changing the optional benefits — such as prescription drugs and physical therapy — it provides without federal approval. Tennessee is one of a dozen states that has not expanded Medicaid to low-income adults under the Affordable Care Act… January 9, 2021: Pink News posted an article titled: “Donald Trump launches “parting assault on the LGBT+ community’ by stripping discrimination protections”. It was written by Lily Wakefield. From the article: Amid the fallout from extremist riots at the US capitol, Trump’s Department of Health and Human Services (HHS) has officially adopted new rules allowing recipients of federal HHS grants to discriminate against LGBT+ people in the name of religious freedom.The final regulations, which were proposed in November, 2019, were released Thursday (7 January) in an 86-page document.They roll back Obama-era rules which ban discrimination by those receiving grants from HHS against people on the basis of age, disability, sex, race, colour, national origin, religion, gender identity or sexual orientation.The rules also rescind the requirement for HHS grantees to “treat as valid the marriages of same-sex couples”.Now, the regulations read: “It is a public policy requirement of HHS that no person otherwise eligible will be excluded from participation in, denied the benefits of, or subjected to discrimination in the administration of HHS programs and services, to the extent doing so is prohibited by federal statute.”Except federal statute does not protect LGBT+ people from discrimination, therefore Trump has effectively given HHS grantees the green light to discriminate against people based on sexual orientation and gender identity.Where the HHS regulations used to require grantees to treat same-sex marriages as valid, they now read: “HHS will follow all applicable Supreme Court decisions in administering its award programs.”While the change allow discrimination under the guise of “religious liberty” in healthcare services like HIV and STI prevention programs, opioid programs and youth homelessness services, adoption and fostering services also come under the HSS department.If faith-based adoption and fostering services are funded by the government, they will be able to refuse to place children with families based on sexual orientation, gender identity or marital status, a change that religious conservatives have been pushing for... January 12, 2021: SCOTUSblog (which is NOT run by the Supreme Court Justices) tweeted: “BREAKING: SCOTUS grants Trump admin request, reverses nationwide injunction that allowed patients to receive abortion-related drugs via mail during the pandemic. Patients will now have to pick up medication in person. Breyer, Kagen, Sotomayor dissent.” The tweet included a link to the Supreme Court’s decision. January 12, 2021: The New York Times posted an article titled: “Supreme Court Revives Abortion-Pill Restriction”. It was written by Adam Liptak. From the article: In the Supreme Court’s first ruling on abortion since the arrival of Justice Amy Coney Barrett, the court on Tuesday reinstated a federal requirement that women seeking to end their pregnancies using medications pick up a pill in person from a hospital or medical office.The court’s brief order was unsigned, and the three more liberal judges dissented. The only member of the majority to offer an explanation was Chief Justice John G. Roberts Jr., who said the ruling was a limited one that deferred to the views of experts.The question, he wrote, was not whether the requirement imposed “an undue burden on a woman’s right to an abortion as a general matter.” Instead, he wrote, it was whether a federal judge should have second-guessed the Food and Drug Administration’s determination “because of the court’s own evaluation of the impact of the Covid-19 pandemic.”“Here as in related contexts concerning government responses to the pandemic,” the chief justice wrote, quoting an earlier opinion, “my view is that courts owe significant deference to the politically accountable entities with the ‘background, competence and expertise to assess public health'”.In dissent, Justice Sonia Sotomayor joined by Justice Elena Kagen, said the majority was grievously wrong.“This country’s laws have long singled out abortions for more onerous treatment than other medical procedures that carry similar or greater risks,” Justice Sotomayor wrote. “Like many of those laws, maintaining the F.D.A.’s in-person requirements” for picking up the drug “during the pandemic not only treats abortion exceptionally, it imposes an unnecessary, irrational and unjustifiable undue burden on women seeking to exercise their right to choose.”She suggested that the next administration should revisit the issue.“One can only hope that the government will reconsider and exhibit greater care and empathy for women seeking some measure of control over their health and reproductive lives in these unsettling times,” Justice Sotomayor wrote… January 12, 2021: The American Civil Liberties Union (ACLU) tweeted: “BREAKING: SCOTUS reinstated a federal policy that makes it harder for people to acces abortion care during the pandemic. The policy forces medication abortion patients to needlessly risk COVID-19 exposure by traveling to a health center just to pick up a pill and sign a form.” This tweet was the start of a thread. January 12, 2021: The American Civil Liberties Union (ACLU) tweeted: “This was the court’s first abortion ruling with Justice Amy Coney Barrett’s vote. People of color and people with low incomes, who make up the majority of impacted patients and are suffering from COVID-19 at disproportionate rates, will be particularly harmed by this decision.” January 12, 2021: The American Civil Liberties Union (ACLU) tweeted: “The Biden administration could right this wrong by declaring that it won’t enforce the in-person requirement during the pandemic, in line with the government’s treatment of other medications during this time.” This tweet linked to an article on the ACLU website. This is the last tweet in the thread. January 12, 2021: Forbes posted an article titled: “House Reportedly Imposes Fine On Lawmakers Who Don’t Wear Masks”. It was written by Alison Durkee. From the article: House lawmakers who don’t wear masks on the House floor will now face a $500 fine on their first offense and a $2,500 fine on their second, multiple outlets report, after three Democratic lawmakers tested positive for Covid-19 after sheltering with unmasked Republican colleagues during Wednesday’s seizure of the Capitol……The fines will reportedly come out of the offending lawmakers paycheck, and Politico reports similar fines are being considered for House office buildings.House Speaker Nancy Pelosi’s decision to impose fines follows legislation introduced Tuesday by House Democrats that proposed a fine of $1,000 per day for any member of Congress who doesn’t wear a mask while on the grounds of the U.S. Capitol.House members were already required to wear masks on teh House floor, and Pelosi moved in December to prohibit members of Congress from speaking on the floor if they’re not wearing a mask… January 12, 2021: Center for Medicare & Medicaid Services Seema Verma posted information regarding the withdrawl of the Medicaid Fiscal Accountability Regulation proposed rule. From the information: …This document withdraws a proposed rule that was published in the Federal Register on November 18, 2019. The proposed rule would have established new reporting requirements and codified other Medicaid financing requirments, including related to permissible sources for non-federal share financing… …SUPPLEMENTARY INFORMATION:On November 18, 2019, we published a proposed rule to amend our regulations dealing with grants to states for medical assistance programs, state fiscal administration, payments for services, Medicaid program integrity, and allotments to states and grants… After an internal review of the proposed rule, CMS has decided to withdraw the proposed rule.The proposed rule sought to promote accountability and transparency for Medicaid payments by establishing new reporting requirements for states to provide CMS with certain information on supplemental payments to Medicaid providers, including supplemental payments approved under either Medicaid state plan or demonstration authority, codification of parameters for Medicaid upper payment limit calculations, provider definitions associated with data reporting and Medicaid financing, Medicaid disproportionate share hospital audit requirements and changes to some existing operational processes to better align with technology improvements. This proposed rule also sought to establish additional requirements to ensure that state plan amendments proposing new supplemental payments are consistent with the proper and efficient operation of the state plan and with efficiency, economy, and quality of care. Finally, this proposed rule sought to address the non-federal share financing of supplemental and base Medicaid payments, including states’ uses of health care-related taxes and provider-related donations, and other requirements for sources of the non-federal share.We received approximately 10,188 individual comments (4,225 unduplicated comment submissions) through the extended comment period.1 We received significant comments on the proposed rule regarding its potential impact on states and their budgets, Medicaid providers and Medicaid beneficiary access to needed services. Many commenters stated their belief that the proposed rule did not include adequate analysis of these matters. Numerous commenters indicated that CMS, in some instances, lacked statutory authority for its proposals and was creating regulatory provisions that were ambiguous or unclear and subject to excessive Agency discretion.While we continue to support the intent and purpose of the rule to increase fiscal accountability and improve transparency in the Medicaid program, based on the considerable feedback we received through the public comment process, we have determined it appropriate to withdraw the proposed provisions at this time. Moving forward, we want to ensure agency flexibility in re-examining these important issues and exploring options and possible alternative approaches that best implement the requirements of the Medicaid statute. We also believe it is important to re-examine and fully analyze the proposed Medicaid reporting requirements in consideration of the recent Congressional action through the Consolidated Appropriations Act of 2021 (H.R. 116-133, Pub. L. 116-260) which establishes new statutory requirementsfor Medicaid supplemental payment reporting. This withdrawal action does not limit our prerogative to make new regulatory proposals in the areas addressed by the withdrawn proposed rule, including new proposals that may be substantially identical or similar to those described therein.Finally, the withdrawal of this proposed rule does not affect existing federal legal requirements or policy that were merely proposed to be codified in regulation, including certain provisions related to Medicaid financing and Medicaid Upper Payment Limit (UPL) requirements. For example, without limitation, this includes guidance in State Medicaid Director Letter (SMDL) #13-003, which discussed a submission process to comply with the UPL requirements; SMDL #14-004, which discussed Medicaid financing and provider-related donations; as well as State Health Officials (SHO) Letter #14-001, which addressed health care-related taxes. This withdrawal action does not affect CMS’ ongoing application of existing statutory and regulatory requirements or its responsibility to faithfully administer the Medicaid program The document is scheduled to be published in the Federal Register on January 19, 2021 – the day before President-Elect Biden will be sworn in and will become President of the United States. January 13, 2021: Planned Parenthood posted a press release titled: “Supreme Court Reinstates Medically Unnecessary Barriers to Abortion During COVID-19”. From the press release: Today, the U.S. Supreme Court — which now includes three Trump-appointed justices — granted the Trump administration’s request to reinstate a medically unnecessary barrier to medication abortion during the COVID-19 pandemic. The U.S. Food and Drug Administration’s (FDA) Risk Evaluation and Mitigation Strategy (REMS) restrictions on mifepristone mandate that patients pick up the medication directly from a doctor’s office, hospital, or health center, rather than from a pharmacy or by mail, as allowed for other equally safe medications. During the pandemic, this unnecessary travel can expose patients to needless COVID-19 risks related to transportation, child care, multiple health center trips, and more……In her dissent, Justice Sotomayor wrote:“Due to particularly severe health risks, vastly limited clinic options, and the 10-week window for obtaining a medication abortion, the FDA’s requirement that women obtain mifepristone in person during the COVID-19 pandemic places an unnecessary and undue burden on their right to abortion. Pregnancy itself puts a woman at increased risk for severe consequences from COVID-19. In addition, more than half of women who have abortions are women of color, and COVID-19’s mortality rate is three times higher for Black and Hispanic individuals than non-Hispanic White individuals”By reinstating this unnecessary barrier to critical health care during a global pandemic, this order risks the health of people seeking medication abortion. This harm will be felt most acutely by Black, Latino, Indigenous, and other communities of color who already face disproportionate economic and health outcomes, as well as illness and death, due to COVID-19.Mifepristone is safe, effective, and has been used by more than 4 million people since the FDA approved it 20 years ago. Leading medical associations, such as the American College of Obstetricians and Gynecologists and American Academy of Family Physicians, have maintained that the FDA’s long-standing restrictions on mifepristone are not based on evidence and do not benefit patients. In fact, out of 20,000 prescription medications regulated by the FDA, mifepristone is the only home-use medication required to be dispensed in person… January 14, 2021: Democracy Forward posted an press release titled: “Health Care Providers Sue Trump Admin for Approving Unlawful Georgia Plan to Sabotage Georgia’s ACA Marketplace”. From the press release: Today, Planned Parenthood Southeast and Feminist Women’s Health Center, represented by Democracy Forward, sued Trump’s Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS), among others, for unlawfully approving the State of Georgia’s plan to ignore essential Affordable Care Act (ACA) requirements and block Georgia residents’ access to healthcare.gov. Up to 100,000 Georgians stand to lose their insurance as a result of the plan, which the Trump administration approved via a “Section 1332” waiver of ACA requirements. The plan will do immense damage to Georgia’s health insurance market, force Georgians to shop for insurance throught private brokers and insurance companies, lead more residents to enroll in junk plans, and increase premiums. The plaintiffs’ lawsuit seeks to vacate the Trump administration’s unlawful approval of Georgia’s Section 1332 waiver and a 2018 Trump administration decision that provided the basis for the waiver approval……Nearly 80% of Georgia residents who enroll on the individual market find and purchase their health coverage on healthcare.gov. But, on November 1, 2020, the Trump administration unlawfully approved Georgia’s Section 1332 waiver request, which will terminate the state’s use of healthcare.gov or any other centralized marketplace.In order to grant stats flexibility to innovate in ensuring their residents are able to obtain affordable, high-quality health insurance, Section 1332 of the ACA allows the federal government to grant states waivers of some ACA requirements – but only if states demonstrate that their plans match or surpass the ACA’s benchmarks with respect to coverage, comprehensiveness, affordability, and deficit neutrality.The approval of Georgia’s unlawful waiver takes a wrecking ball to the ACA in Georgia and violates the statutory guardrails designed to ensure that Section 1332 waivers or surpass the ACA’s benchmarks. Georgia’s waiver will: Decrease enrollment by up to 100,000, violating the coverage guardrail;Shift consumers to junk plans that provide inadequate coverage, violating the comprehensiveness guardrail;Increase the premiums consumers must pay to recieve coverage, violating the comprehensiveness guardrail; HHS’s approval of Georgia’s extraordinary waiver request was rushed through in the last months of President Trump’s term with a limited public comment period, in violation of the Administrative Procedure Act. Of the 1,826 total comments HHS received on the waiver, only 8 supported the waiver.HHS’s decision to approve Georgia’s waiver request depended on 2018 guidance it promulgated, which substantially weakened the standards for approving waivers under Section 1332. The guideance thereby encouraged state plans – like Georgia’s – that will drive consumers to junk plans that fall short of the ACA’s coverage requirements. The Trump administration’s rushed approval of Georgia’s unlawful waiver is consistent with its endeavor to sabatoge the Affordable Care Act. For years, President Trump promised to decimate the Affordable Care Act. His administration has made good on that promise by promoting junk plans, slashing the open enrollment period and funding for outreach and navigators, and rolling back key protections enshrined by the law.Democracy Forward filed the lawsuit on behalf of Planned Parenthood Southeast and Feminist Women’s Health Center on January 14 in the U.S. District Court for the District of Columbia. Read the full complaint here. January 15, 2021: SF Gate posted an article titled: “Tennessee OKs Medicaid block grant; fate unclear under Biden”. It was written by Kimberlee Kruesi and Jonathan Mattise. From the article: Tennessee’s GOP-dominant Legislature on Friday approved a contentious decision that would drastically overhaul the state’s Medicaid program, casting quick votes this week in hopes of making it difficult for incoming President-elect Joe Biden’s administration from overturning the deal.The House vote Friday sets in motion a plan that proponents, including Republicans, argue will produce flexibility and savings that can fuel additional health coverage offerings, with a promise that there won’t be eligibility or benefit cuts. Opponents, including many Democrats, are wary of that promise since the plan banks on big savings. They also point out that there’s no guarantee more patients will be eligible under the block grant, unlike their preferred action of expanding Medicaid under the Affordable Care Act.It’s still not a given that Tennessee will actually become the first state to receive funding in a lump sum for its Medicaid program through a block grant. While Tennessee received approval under President Donald Trump’s administration just last week, Biden has opposed block-grant efforts and can rescind the change.That tension fueled Republican lawmakers’ determination to prioritize their approval in the first week of the legislative session. The votes are required under the state law the General Assembly initially passed in 2019. Senators approved the plan Thursday……The rush to finalize approval infuriated the Legislature’s minority Democratic caucus……One reason for the push before Biden takes office is because the Trump administration took steps that could lengthen the process to rescind the deal by extending the waiver period and sending out new guidance on terminating a Medicaid waiver……TennCare, Tennessee’s Medicaid program, insures approximately 1.5 million low-income Tennesseans, including pregnant women, children, caretaker relatives of dependent children and older adults, and disabled adults.Currently, the federal government pays a percentage of each state’s Medicaid costs, regardless of cost increases in any given year. For Tennessee, that means receiving approximately $7.5 billion in federal money for its $12.1 billion Medicaid program, or 65%.Republicans argue the current system gives states little incentive to control expenses because no state pays more than half the total cost… January 15, 2021: Centers for Medicare & Medicaid Services (CMS) posted a press release titled: “Changes to Medicare Advantage and Part D Will Provide Better Coverage, More Access and Improved Transparency for Medicare Beneficiaries”. From the press release: Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that further advances the agency’s efforts to strengthen and modernize the Medicare Advantage and Part D prescription drug programs. The changes finalized today are generally effective for the 2022 plan year and will potentially lower enrollee cost sharing on some of the most expensive prescription drugs. This final rule will allow enrollees to know in advance and compare their out-of-pocket payments for different prescription drugs. The changes will result in an estimated $75.4 million in savings to the federal government over ten years.“The changes in this final rule provide desperately needed transparency on the out-of-pocket costs for prescription drugs that have been obscured for seniors,” said CMS Administrator Seema Verma. “It will strengthen Part D plans’ negotiating power with prescription drug manufacturers so American patients can get a better deal.”As part of the administration’s commitment to promoting price transparency and lowering prescription drug prices, the final rule will require Part D plans to offer a real-time benefit comparison tool starting January 1, 2023, so enrollees can obtain information about lower-cost alternative therapies under their prescription drug benefit plan. Enrollees would be able to compare cost sharing to find the most cost-effective prescription drugs for their health needs. For example, if a doctor recommends a specific cholesterol-lowering drug, the enrollee could look up what the co-pay would be and see if a different, similarly effective option might save the enrollee money. With this tool, enrollees will be better able to know what they will need to pay before they are standing at the pharmacy counter. This follows a similar CMS requirement that Part D plans support a prescriber real-time drug benefit tool that went into effect January 1, 2021. Congress codified a similar requirement for prescriber real-time benefit tools in the recently enacted Consolidated Appropriations Act, 2021 (Public Law No. 116-260).In the Medicare Part D program, enrollees choose the prescription drug plan that best meets their needs. Many plans offering prescription drug coverage place drugs into different “tiers” on their formularies. Today, all drugs on a plan’s specialty tier – the tier that has the highest-cost drugs – have the same level of cost sharing. Under the final rule, CMS is allowing Part D plans to have a second, “preferred” specialty tier with a lower cost sharing level than their other specialty tier. This change gives Part D plans more tools to negotiate better deals with manufacturers on the highest-cost drugs and lower out-of-pocket costs for enrollees in exchange for placing these products on the “preferred” specialty tier.Under the Part D program, plans currently do not have to disclose to CMS the measures they use to evaluate pharmacy performance in their network agreements. CMS has heard concerns from pharmacies that the measures plans use to assess their performance are unattainable or otherwise unfair. The measures used by plans potentially impact pharmacy reimbursements. Therefore, CMS is requiring Part D plans to disclose pharmacy performance measures to CMS, which will enable CMS better understand how such measures are applied. CMS will also be able to report pharmacy performance measures publicly to increase transparency on the process and to inform the industry in its new efforts to develop a standard set of pharmacy performance measures. January 15, 2021: The Texas Tribune posted an article titled: “Trump administration extends health care safety net for uninsured Texans”. It was written by Jolie McCullough. From the article: In the final days of President Donald Trump’s tenure, the U.S. Department of Health and Human Services agreed Friday to extend for 10 years Texas’ health care safety net for uninsured residents.The federal funding agreement, known as the 1115 waiver, reimburses hospitals for the “uncompensated care” they provide to patients without health insurance. It alsopays for innovative health care projects that serve low-income Texans, often for mental health services. Safety-net hospitals have relied on the waiver to serve poor, uninsured Texans, and it was set to expire — alarming a broad coalition of doctors, hospitals and patient advocates who feared the funding could be lost.The new agreement will continue hospital reimbursements until September 2030, but it will allow the innovation fund to expire this year, according to a government letter announcing the waiver extension. A new program will be implemented to partially fund behavioral and mental health clinics.The state’s first 1115 waiver was approved in 2011 and was meant to be a “bridge” to Medicaid expansion under the newly passed Affordable Care Act. But a few months after the signing of the Texas waiver, a U.S. Supreme Court ruling gutted the Medicaid expansion portion of the sweeping federal health law. And Republican leadership in Texas — which has the nation’s highest rate of uninsured residents — stood fast against expanding Medicaid.But state officials have worked to keep the waiver’s federal funding, which was last extended for five years in 2017 by the new federal administration under President Donald Trump. Now, his administration has again extended the waiver as one of its last acts, this time by 10 years… January 16, 2021: The New York Times posted an article titled: “One Sentence in Biden Stimulus Plan Reveals His Health Care Approach”. It was written by Sarah Kliff. From the article: Tucked into President-elect Biden’s $1.9 trillion stimulus plan is a one-sentence provision that could drive billions in federal subsidies to help people afford to buy health insurance.The proposal would do two things: make upper-middle-income Americans newly eligible for premium subsidies on Obamacare marketplaces, and increase the financial help that already goes to lower-income enrollees. Taken together, some experts expect these changes to drive more sign-ups for Healthcare.gov plans after they fell in the Trump era.Democrats have spent much of the last two years pressing for these policies, outlining ideas in candidate platforms and fine-tuning them in congressional legislation. The House even passed a similar proposal this past summer, but none of it had a shot at becoming law with President Trump in office and a Republican majority in the Senate.Now, control of the White House and a slim majority in Congress mean the first real prospect of significantly strengthening Obamacare since it became law in 2010. President-elect Biden’s inclusion of policies to shore up the health law in his first major legislative package has raised those hopes further……The Biden plan would create a new cap — 8.5 percent of an individual or family’s income on premium contributions — for midlevel health plans, something the president-elect had also proposed during the campaign. This policy would mostly affect higher-earning Americans who do not currently qualify for subsidies.Experts do not expect large enrollment gains as a result of this policy, because most higher-income Americans already carry insurance. But it would provide economic relief to families that in some cases are spending 15 percent or even 20 percent of their income on premiums……For Americans just above the current premium subsidy cutoff, the impact could be large: The Center on Budget and Policy Priorities estimates that a family of four earning $110,000 would see monthly premiums for a midlevel health plan fall to $779 from $1,529.The Biden proposal also describes a second policy that appears to be aimed at increasing subsidies for those who already qualify. These are low-income Americans, who make up the majority of those who still lack coverage in the United States. These people already receive help buying coverage, but are still left with paying a monthly premium share that can be unaffordable.For this group, the Biden plan proposes increasing the tax credits to lower health premiums or even “eliminate” them. The proposal does not detail how this would be achieved, but analysts expect the incoming White House to use as a model the legislation that House Democrats passed this summer.That bill lowered the share of income that poor Americans are expected to pay for their coverage. Someone earning 150 percent of the federal poverty line ($19,140 for an individual), for example, would go from paying as much as 4 percent of income for a midlevel health plan to paying nothing if the House Democrats’ proposal became law. January 19, 2021: The Texas Tribune posted an article titled: “Low-income Texans struggle to find new doctors as state officials boot Planned Parenthood off Medicaid”. It was written by Shannon Najamabadi. From the article: Planned Parenthood employees are scrambling to help find new doctors for thousands of low-income patients after Texas officials and a court order booted the women’s health provider from Medicaid, the federal-state health insurance program for the poor and disabled.Experts say there’s a scarcity of places low-income patients can receive non-abortion services like cancer screenings, in part because Texas already has a shortage of doctors who accept Medicaid due to the state’s low payment rates. The coronavirus pandemic has also upended some health providers’ operations and left others with long waiting lists, meaning new patients could face a lengthy delay before they can come in for an appointment. The state’s health commission gave Planned Parenthood’s Medicaid patients until Feb. 3 to find new doctors……Dr. John Thoppil, president of the Texas Association of Obstetricians and Gynecologists, said the reimbursement rates for Medicaid in Texas are low compared to other states — and can be four to six times less than that offered by private insurers……Far fewer people are eligible for Medicaid in Texas than in other states. Adults must be disabled or parents and, even then, a single person with two kids cannot make more than $230 a month to qualify. That’s about $2,760 a year, a fraction of the federal poverty level.Because most people have to be so “destitute” to qualify for Medicaid in Texas, Thoppil said he is just as concerned about access to the state’s Healthy Texas Women program for low- and middle-income residents. A large number of providers listed as participating in the program online, may not be taking new patients, he said……Advocates are skeptical other health care providers will be able to take on thousands of new patients during a pandemic that has already driven up demand for affordable health care… January 19, 2021: The Los Angeles Times posted an article titled: “Four years later, much of Obama’s policy has survived Trump”. It was written by David Lauter and Evan Halper. From the article: As President Trump prepares to leave office, more than 25 million Americans remain covered by the Affordable Care Act, which he tried to repeal; some 650,000 immigrants get the protections from deportation that he tried to rescind and employment continues to shrink in the coal industry, which he promised to revive……But his larger ambitions to uproot key domestic policies of President Obama largely failed. And now Obama’s vice president, Joe Biden, who is scheduled to take the oath of office at noon on Wednesday, will be able to build on the foundations that remain intact, starting with a wave of executive actions he’s expected to take Wednesday……On many of the efforts to uproot Obama’s agenda, Trump also suffered from divisions within his own party. The areas in which he had the greatest success largely enacted goals that “have long been the priorities of the Republican Party” — tax cuts and conservative judges, said Princeton University historian Sean Wilentz. On those topics, Trump largely adopted the party’s agenda, rather than the other way around.By contrast, the unsuccessful effort to repeal Obamacare highlighted Republican divisions.The repeal effort dominated much of the administration’s first seven months, ending in one of the signature images of Trump’s tenure — Sen. John McCain (R-Ariz.), less than a week after surgery and his announcement that he had brain cancer, walking onto the Senate floor, pausing for dramatic effect, then turning thumbs down to defeat the repeal bill.The lengthy congressional debate on repeal increased public support for the healthcare law, and Republican efforts to dismantle it played a major role in Democrats’ winning a majority in the House in the 2018 midterm elections and restoring Pelosi (D-San Francisco) to the speaker’s job.Opposition to the law continued to decline this year during the COVID-19 pandemic. Currently Americans by 53% to 34% view the healthcare law favorably, according to polling by the nonpartisan Kaiser Family Foundation……After his initial defeat on repeal, Trump largely gave up his effort, except for one provision, the requirement that Americans purchase health insurance. That individual mandate had never been enforced, but was the law’s least popular major element. Congress repealed it as part of the tax bill, allowing Trump to claim a symbolic victory. Despite worries by healthcare experts, however, the repeal had relatively little impact on the number of people covered.Trump took other steps to impede the law, and by 2019, the number of uninsured Americans had started to creep back up… A Timeline of the GOP’s Attempts to Destroy Obamacare – Part 4: December and January is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: October and NovemberDecember 2, 2020health insurance / Out of SpoonsThis blog post covers that damage that the Trump Administration – and the GOP – have done in an effort to restrict and remove access to health care from the American people. The series could be described as “receipts”. This blog post has the “reciepts” about the ways that the Trump Administration and the GOP tried to destroy not only the Affordable Care Act, but also Medicaid, Medicare, and other health programs that Americans rely on. This blog post also highlights everything that the Democrats (and other people outside of government) have done in an effort to protect American’s access health care – of all types. That includes protections for DACA recipients and people who are LGBTQ+. You may want to take a look at previous blog posts in this series. Doing so will give you an overall picture of what the Trump Administration and the GOP have done to harm American’s health since 2017. A Timeline of the GOP’s Attempts to Destroy Obamacare – Part One A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Two A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three – Continued A Timeline of the GOP’s Attempt to Destroy Obamacare – Part Four A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: April, May, June A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four; July, August, September October October 1, 2020: American Medical Association (AMA) posted a press release titled: “AMA petitions U.S. Supreme Court to review Title X restrictions”. From the press release: The American Medical Association (AMA) today petitioned the U.S. Supreme Court to review a Court of Appeals decision upholding a 2019 Trump administration rule that imposed drastic changes on the Title X family planning program, inappropriately interfering with open communications between patients and health care professionals. The AMA’s petition was joined by Planned Parenthood Federation of America (PPFA), the National Family Planning & Reproductive Health Association (NFPRHA), the American Civil Liberties Union (ACLU), Essential Access Health (EAH), the Oregon Medical Association and others.The petition asserts that the high court’s review is warranted following conflicting decisions by the Fourth Circuit and Ninth Circuit, leaving unresolved questions of law about an essential federal health care program. The Fourth Circuit found the Title X rule invalid, while the Ninth Circuit upheld the rule.The petitioners argue that until the Ninth Circuit’s erroneous decision is corrected, the administration’s gag rule is harming patient care and causing physicians and other health care professionals to violate ethical obligations by preventing Title X clinics from providing full information to patients about all of their reproductive care options. This marks the first time in recent history the AMA has petitioned the U.S. Supreme Court, further underscoring the government’s significant overstep in issuing the rule.“The AMA strongly believes that our nation’s highest court must step in to remove government overreach and interference in the patient-physician relationship. Restricting the information that physicians can provide to their Title X patients blocks honest, informed conversations about all health care options—an unconscionable violation that is essentially a gag rule,” said AMA President Susan R. Bailey, M.D. “As physicians and leaders in medicine, we are fighting against the government’s intrusion in the exam room while protecting open communication between patients and physicians, which is the foundation of high-quality medical care.”Since its inception a half century ago, Title X has served as a vital public health program, ensuring vulnerable populations—especially low-income women—have access to basic, preventive reproductive health care. In addition to restricting physicians and other health care professionals from providing complete information and appropriate referrals for care to their Title X patients, the administration’s rule withholds federal funding from providers that do offer the full range of family planning services, much to the detriment of the millions of Americans who depend on Title X for reproductive care.The petition states that “the consequences of the rule are clear and stark—and already occurring.” Roughly one in every four Title X providers has withdrawn from the program in response to the rule’s implementation last year, ultimately jeopardizing care for 1.6 million patients nationwide. A recent U.S. Health and Human Services (HHS) estimate supports these figures, acknowledging that Title X services sites decreased by 945 sites and the number of annual patients served in 2019 fell by 21%—despite the Title X rule being in effect for only a few months. In California, for example, it is projected that in 2020, there will be an almost 75% reduction in the number of patients served by Title X in the state. As of August 2020, six states are without any Title X site at all……Over the course of its 50-year history, Title X has been an enormous success for patients, their communities, and our country — serving more than 4 million patients a year with critical, often life-saving reproductive care. Without Title X, the rates of unintended pregnancy and abortions would have been 31% higher, according to estimates. Most of the patients served by Title X are economically disadvantaged and live in areas where there are few health care options.In emphasizing Title X’s immense impact, the petition notes that “for six in 10 women who obtain contraceptive care at a Title X-funded site, that provider was their only source of medical care over the past year.” The petition stresses that patients, physicians, and the health of the nation will be irreparably harmed without the Supreme Court’s review of the case. October 1, 2020: American Medical Association posted news titled: “Why the Supreme Court should take up Title X gag rule”. It was written by Andis Robeznieks, Senior News Writer. From the news: The AMA and other parties have filed a petition requesting that the U.S. Supreme Court review AMA v. Azar, a case that seeks to overturn a Department of Health and Human Services (HHS) gag rule that unlawfully dictates what physicians practicing at facilities funded under the Title X family planning grant program can’t say and must say.“The AMA strongly believes that our nation’s highest court must step in to remove government overreach and interference in the patient-physician relationship,” said AMA President Susan R. Bailey, MD.“Restricting the information that physicians can provide to their Title X patients blocks honest, informed conversations about all health care options—an unconscionable violation that is essentially a gag rule,” Dr. Bailey added. “As physicians and leaders in medicine, we are fighting against the government’s intrusion in the exam room while protecting open communication between patients and physicians, which is the foundation of high-quality medical care.”The case merits Supreme Court review because the questions it raises, according to the petition, “concern the integrity of the patient-provider relationship—founded on open and honest communications, the lynchpin of proper medical care.”These questions “arise in the context of a vitally important federal health care program—with significant real-world consequences,” the petition says.The HHS rule prohibits physicians who provide care at Title X-supported facilities from referring their pregnant patients to an abortion provider—even when their patients seek such referrals—and requires physicians to steer patients toward carrying a pregnancy to term. The Trump administration’s gag rule, which took effect May 3, 2019, also requires physicians with pregnant patients seeking an abortion to provide those patients with irrelevant information on prenatal care. “The gag requirement bans providers from referring their pregnant patients to abortion providers—even when that is the patient’s expressed wish; but it mandates referrals for prenatal care—even when the patient has no such interest,” the petition says. October 1, 2020: Urban Institute posted a brief titled: “Changes in New Mothers’ Health Care Access and Affordability under the Affordable Care Act”. It was written by Stacey McMorrow, Emily M. Johnston, Tyler Thomas, and Genevieve M. Kenney. From the brief: AbstractThough thousands of new mothers gained insurance following impletation of the coverage provisions of the Affordable Care Act (ACA) in 2014, there has been little documentations of changes in their health care access and affordability. This brief examines changes in access to and affordability of health care services for new mothers using data from the National Interview Survey. Comparing data from 2011-13 and 2015-18, we find that mothers were less likely to report having unmet health care needs due to cost and being very worried about paying their medical bills. In 2015-18, new mothers were more likely to report having seen a general doctor and recieved a flu vaccine in the past 12 months than in 2011-13. Even after these improvements, more than 1 in 10 new mothers were uninsured, and nearly 50 percent were at least somewhat worried about paying their medical bills. Proposals to extend postpartum Medicaid coverage for up to one year could benefit some of these mothers, but additional progress would likely require broader coverage expansions through Medicaid or the Marketplace. October 2, 2020: Representative Pramala Jayapal (Democrat – Washington) posted a press release titled: “House Passes Jayapal Resolution Condemning Forced Medical Procedures Conducted on Immigrant Women”. From the press release: The United States House of Representatives passed a resolution today urgently condemning the unwanted, unnecessary medical procedures—including partial and full hysterectomies —performed on immigrant women without their full, informed consent at the private, for-profit Irwin County Detention Center in Ocilla, Ga. H.Res. 1153—co-sponsored by 225 members of Congress and led by U.S. Representatives Pramila Jayapal (WA-07), Annie Kuster (NH-02), Sheila Jackson Lee (TX-18), Sylvia Garcia (TX-29) and Lois Frankel (FL-21)—also calls on the Department of Homeland Security (DHS) to take a series of specific actions including immediately complying with all related investigations. “This resolution mandates a real investigation must happen but it also sends a clear message to doctors contracted by private, for-profit incarceration facilities everywhere that we will not stand by and allow you to treat people this way,” said Congresswoman Jayapal. “We will not stand by and allow history to repeat itself—a shameful history of medical abuse targeting Black people, Indigenous people, people of color, immigrants, poor people and people with disabilities. The women at Irwin, those who have been released and those who have been deported are brave and resilient, and I want them to know that the United States Congress sees you, hears you and will never stop fighting for you.”……The resolution passed less than one week after members of the House Judiciary Committee and Congressional Hispanic Caucus led a Congressional Delegation to the Irwin County Detention Center. It was there that they heard firsthand from numerous women who had unnecessary gynecological procedures—including surgeries involving their reproductive organs—performed on them by Dr. Mahendra Amin without their knowledge or consent. Many of the procedures resulted in sterilization. Today’s resolution also comes just one week after lawmakers on the House Judiciary Committee sent a letter to DHS Acting Secretary Chad Wolf calling on him to urgently take specified actions and immediately respond to a set of pressing document requests. Additionally, 173 members of Congress urged DHS Inspector General Joseph Cuffari to open an immediate and full investigation in mid-September.Investigative reporting by the New York Times released this week confirmed that Dr. Amin consistently performed surgeries on immigrant women’s reproductive organs, “even when it did not seem medically necessary at the time and nonsurgical treatment options were available.” The Times found striking similarities in the medical records and patient files they reviewed, and medical experts concluded that there is a, “pattern of excessively aggressive surgical intervention without adequate trial of medical remedies.” This new reporting was consistent with what at least five attorneys told Representative Jayapal during a Sept. 16 legal briefing after the initial release of Dawn Wooten’s whistleblower report. Today’s resolution condemns performing unwanted and unnecessary medical procedures without the full, informed consent of individuals. It also recognizes that everyone deserves to control their own reproductive choices and make informed choices about their bodies. Additionally, the resolution says that further accountability, oversight and transparency is necessary to protect people in the custody of U.S. Immigration and Customs Enforcement (ICE).The resolution also calls on DHS to take a series of specific actions, including pausing the removal of any individual who experienced any medical procedure at the Irwin County Detention Center and allowing individuals who may have experienced an unnecessary or non-consensual procedure to have immediate access to adequate, safe and consensual medical treatment. Additionally, it calls on DHS to immediately comply with all related investigations and records requests related while ensuring affected individuals are able to freely participate in any investigation without fear of reprisal. Finally, the resolution demands that DHS hold all individuals involved in these incidents accountable and bring them to justice.The resolution was endorsed by 54 organizations including the AFL-CIO; African Communities Together; Alianza Nacional de Campesinas; American Friends Service Committee; American Immigration Lawyers Association; Amnesty International USA; Asian Americans Advancing Justice | AAJC ; Asian Pacific Institute on Gender- Based Violence; Casa de Esperanza: National Latin@ Network for Healthy Families and Communities; Center for Gender & Refugee Studies; Center for Victims of Torture; Church World Service; Congregation of Our Lady of Charity of the Good Shepherd, U.S. Provinces; Freedom for Immigrants; Human Rights First; In Our Own Voice: National Black Women’s Reproductive Justice Agenda; Jewish Women International; Justice for Migrant Women; MoveOn; NARAL; National Advocacy Center of the Sisters of the Good Shepherd; National Asian Pacific American Women’s Forum (NAPAWF); National Coalition Against Domestic Violence; National Council of Jewish Women; National Fair Housing Alliance; National Immigration Law Center; NETWORK lobby for Catholic Social Justice; Oxfam America; People’s Action; Planned Parenthood Federation of America; Project On Government Oversight; Project South; Southeast Asia Resource Action Center (SEARAC); SPLC Action Fund; T’ruah: The Rabbinic Call for Human Rights; Tahirih Justice Center; UnidosUS; United We Dream; Women’s Refugee Commission; Asian Americans Advancing Justice- Atlanta; Church Council of Greater Seattle; Coalition for Humane Immigrant Rights (CHIRLA); Georgia Detention Watch; Georgia Latino Alliance for Human Rights (GLAHR); Illinois Accountability Initiative; Iowa Coalition Against Domestic Violence; Khmer Anti-deportation Advocacy Group (KhAAG); Maine Coalition to End Domestic Violence; Mekong NYC; National Asian Pacific American Women’s Forum (NAPAWF) Seattle Chapter; OneAmerica; Vermont Network Against Domestic and Sexual Violence; Washington State Coalition Against Domestic Violence and Wind of the Spirit Immigrant Resource Center.It was co-sponsored by U.S. Representatives Pramila Jayapal, Sylvia Garcia, Ann McLane Kuster, Sheila Jackson Lee, Lois Frankel, Alma S. Adams, Pete Aguilar, Colin Allred, Cindy Axne, Nanette Diaz Barragán, Karen Bass, Joyce Beatty, Ami Bera, Donald S. Beyer Jr., Sanford D. Bishop Jr., Earl Blumenauer, Lisa Blunt Rochester, Suzanne Bonamici, Brendan F. Boyle, Anthony G. Brown, Julia Brownley, Cheri Bustos, G. K. Butterfield, Salud Carbajal, Tony Cárdenas, André Carson, Matt Cartwright, Ed Case, Sean Casten, Kathy Castor, Joaquin Castro, Judy Chu, David N. Cicilline, Gil Cisneros, Katherine Clark, Yvette D. Clarke, William “Lacy” Clay Jr., Emanuel Cleaver, II, James E. Clyburn, Steve Cohen, Gerald E. Connolly, Jim Cooper, J. Luis Correa, Jim Costa, Joe Courtney, TJ Cox, Angie Craig, Charlie Crist, Jason Crow, Henry Cuellar, Sharice Davids, Susan Davis, Danny K. Davis, Madeleine Dean, Peter DeFazio, Diana DeGette, Rosa L. DeLauro, Suzan DelBene, Antonio Delgado, Val Demings, Mark DeSaulnier, Ted Deutch, Debbie Dingell, Lloyd Doggett, Michael F. Doyle, Eliot L. Engel, Veronica Escobar, Anna G. Eshoo, Adriano Espaillat, Dwight Evans, Abby Finkenauer, Lizzie Fletcher, Bill Foster, Marcia L. Fudge, Tulsi Gabbard, Ruben Gallego, John Garamendi, Jesús “Chuy” García, Jimmy Gomez, Vicente Gonzalez, Josh Gottheimer, Al Green, Raúl M. Grijalva, Deb Haaland, Josh Harder, Alcee L. Hastings, Jahana Hayes, Denny Heck, Brian Higgins, Jim Himes, Kendra Horn, Steven Horsford, Chrissy Houlahan, Jared Huffman, Hakeem Jeffries, Eddie Bernice Johnson, Henry C. “Hank” Johnson Jr., Marcy Kaptur, William R. Keating, Robin Kelly, Joseph P. Kennedy, III, Ro Khanna, Dan Kildee, Derek Kilmer, Andy Kim, Ron Kind, Ann Kirkpatrick, Raja Krishnamoorthi, Conor Lamb, James R. Langevin, Rick Larsen, John B. Larson, Brenda L. Lawrence, Al Lawson, Barbara Lee, Susie Lee, Mike Levin, Andy Levin, Ted W. Lieu, David Loebsack, Zoe Lofgren, Alan Lowenthal, Nita M. Lowey, Ben Ray Luján, Elaine Luria, Stephen F. Lynch, Tom Malinowski, Carolyn B. Maloney, Sean Patrick Maloney, Doris Matsui, Lucy McBath, Betty McCollum, A. Donald McEachin, James P. McGovern, Jerry McNerney, Gregory W. Meeks, Grace Meng, Kweisi Mfume, Gwen S. Moore, Joseph D. Morelle, Seth Moulton, Debbie Mucarsel-Powell, Stephanie Murphy, Jerrold Nadler, Grace F. Napolitano, Richard E. Neal, Joe Neguse, Donald Norcross, Eleanor Holmes Norton, Tom O’Halleran, Alexandria Ocasio-Cortez, Ilhan Omar, Frank Pallone, Jr., Jimmy Panetta, Chris Pappas, Bill Pascrell Jr., Donald M. Payne Jr., Ed Perlmutter, Scott H. Peters, Dean Phillips, Chellie Pingree, Stacey Plaskett, Mark Pocan, Katie Porter, Ayanna Pressley, David Price, Mike Quigley, Jamie Raskin, Kathleen M. Rice, Cedric Richmond, Max Rose, Harley Rouda, Lucille Roybal-Allard, Raul Ruiz, C.A. Dutch Ruppersberger, Bobby L. Rush, Tim Ryan, Linda T. Sánchez, John Sarbanes, Mary Gay Scanlon, Jan Schakowsky, Adam B. Schiff, Brad Schneider, Kim Schrier, David Scott, Robert C. “Bobby” Scott, José E. Serrano, Terri Sewell, Donna Shalala, Brad Sherman, Mikie Sherrill, Albio Sires, Elissa Slotkin, Adam Smith, Darren Soto, Abigail Spanberger, Jackie Speier, Greg Stanton, Haley Stevens, Thomas R. Suozzi, Eric Swalwell, Mark Takano, Mike Thompson, Bennie G. Thompson, Dina Titus, Rashida Tlaib, Paul D. Tonko, Norma J. Torres, Xochitl Torres Small, Lori Trahan, David Trone, Lauren Underwood, Juan Vargas, Marc Veasey, Filemon Vela, Nydia M. Velázquez, Peter Visclosky, Debbie Wasserman Schultz, Maxine Waters, Bonnie Watson Coleman, Peter Welch, Jennifer Wexton, Susan Wild, Frederica Wilson and John Yarmuth. October 2, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Applauds House Passage of Resolution 1153 Condemning Forced Sterilization of Women in Immigration and Customs Enforcement Custody”. From the press release: Today the U.S. House of Representatives passed by a vote of 232-156 House Resolution 1153,which condemns the heinous acts of forced sterilization of immigrant women in Immigration and Customs Enforcement (ICE) custody. This resolution was introduced by Representatives Jayapal (D-WA), Kuster (D-NH), Jackson Lee (D-TX), Garcia (D-IL) and Frankel (D-FL) in response to whistleblower reports of forced sterilizations at the Irwin County Detention Center (ICDC) in Ocilla, GA.“Reproductive oppression and forced sterilization is part of a long history of racist violence in this country. White supremacy has always depended on dehumanization and control over the bodies of women of color,” said Ilyse Hogue, president of NARAL Pro-Choice America. “These utterly unconscionable and barbaric acts against immigrant women are designed to silence us, but we know we must call out this violent attempt to control people, especially immigrant women and women of color. We are grateful to see leadership from Democrats in the House seeking to put an end to these atrocities. The silence from Republican leadership in the House and the fact that the overwhelming majority of Republicans voted no, while unsurprising, speaks volumes.”… October 2, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on House Passage of Resolution Condemning Unwanted Medical Procedures on Immigrant Women”. From the Press Release: Speaker Nancy Pelosi issued this statement after the House passed House Resolution 1153 condemning the infliction of unwanted, unnecessary medical procedures on women in ICE custody:“Today, with the passage of H. Res. 1153, the House has sent a clear and unequivocal message: the infliction of unwanted, invasive and life-altering medical procedures on immigrant women is an appalling human rights abuse that demands immediate and full accountability. I salute Congresswoman Pramila Jayapal and the Democratic Women’s Caucus for their leadership to shine a light on this staggering abuse and to demand answers from the perpetrators.“With this resolution, the House calls on the Department of Homeland Security to protect women: providing those who have been forced to undergo these procedures with the care that they need and ensuring that they can participate in any investigation without the fear of reprisal. And we call on DHS to immediately comply with all investigations and hold all individuals involved accountable, and to bring them to justice.“The profoundly disturbing situation at the Irwin County Detention Center recalls some of the darkest moments of our nation’s history, from the exploitation of Henrietta Lacks, to the horror of the Tuskegee Syphilis Study, to the forced sterilization of a stunning 25 percent of Native American women in the 1970s, to the sterilizations of tens of thousands of Black women in the twentieth century. “Sadly, the heartbreaking truth is that these forced sterilizations are part of a years-long campaign of abuse and neglect of our immigrants – some of the most vulnerable people in our midst – at the hands of this Administration. These reports point to the urgent need to overhaul our unaccountable detention system and its horrific misuse, to ensure that such abuses, and any other human rights abuse, cannot ever again happen.” October 2, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a blog post titled: “House Passes Bill to Give States Option to Extend Postpartum Medicaid Coverage to New Moms”. It was written by Maggie Clark. From the blog post: Medicaid and CHIP cover nearly half of all births each year and have critical roles to play to ensure access to postpartum care that supports the lifelong health of mother and baby together. The Helping MOMS Act, passed with a bipartisan majority voice vote in the U.S. House of Representatives this week, would give states a clearer path to ensure that Medicaid and CHIP support women in the postpartum year as they build an essential bond with their child, setting the family on a healthy path.The bill would give states the option to cover women in pregnancy-related Medicaid and CHIP coverage for one year after delivery, extending their coverage well beyond the current cutoff of 60 days after the end of the pregnancy. Introduced by Reps. Robin Kelly (D-IL), Michael Burgess (R-TX), Lauren Underwood (D-IL), Cathy McMorris Rodgers (R-WA), Ayanna Pressley (D-MA), and Buddy Carter (R-GA), the bill unanimously passed the U.S. House of Representatives.Currently, states can only receive federal matching funds to extend postpartum coverage beyond 60 days through a Section 1115 waiver. Three states (Illinois, New Jersey, Missouri) have applied for some version of a postpartum coverage extension waiver, but no state has been approved by CMS. Even more states– more than 20— are on a path to do the same. Still other states, notably California and Texas, are using state-only funds to offer more limited benefits to a subset of postpartum women.Instead of a waiver application, the bill allows states to submit a Medicaid and CHIP State Plan Amendment (SPA) if they choose to extend coverage for the full postpartum year. States that opt to extend postpartum coverage to women in Medicaid must extend coverage to pregnant women covered in CHIP as well.After the current 60 day postpartum period ends, states could either offer the current Medicaid benefit package that all mandatory populations in the state receive (which for mothers under age 21 would include the EPSDT benefit), or a benefit package determined by the HHS Secretary to be “substantially similar.” The original bill language included a five percentage point increase in the federal matching rate (FMAP) to incentivize states to take up the option, but that language was dropped from the version that passed.In addition to coverage, there’s also an effort to close some research gaps in the search for better birth outcomes for women in Medicaid and CHIP. The legislation directs the Medicaid and CHIP Payment and Access Commission (MACPAC) to publish a report on state Medicaid coverage of doula services and make recommendations for increasing access to doula services in Medicaid. GAO too must publish, two years after enactment, a report on gaps in coverage for pregnant and postpartum women in Medicaid and CHIP and to compare rates of insurance churn and mortality and morbidity in the states that elect the postpartum coverage extension and the states that do not.The bipartisan bill, which now moves to the Senate, responds to the alarming maternal mortality crisis in the U.S., the only developed country in the world where the rate of maternal death is continuing to rise. About 700 women die each year due to pregnancy-related complications. According to the Centers for Disease Control and Prevention (CDC), about 31 percent occur during pregnancy, 36 percent happen during delivery or the week after, and 33 percent of the deaths occur one week to one year after delivery. When Medicaid and CHIP coverage ends at 60 days postpartum, many women become uninsured and miss out on critical access to treatment. Cardiomyopathy, or a weakened heart muscle, is the leading cause of death for women nationally in the week to one year after delivery. About three out of five pregnancy-related deaths are preventable, the CDC reported……This bill is one small piece of a larger national call for improvements in Medicaid coverage for pregnant and postpartum people, including a package of bills known as the “Momnibus” that includes significant improvements in the maternal health care system, such as investments in research, innovative payment models, and specific funding to community-based organizations that are working to improve maternal health outcomes for Black women.For years, advocates, including the National Birth Equity Collaborative, Black Mammas Matter Alliance, American College of Obstetrics and Gynecology, March of Dimes, and other maternal health groups have called for improvements in Medicaid to address maternal health equity, coverage extensions that expand access, and better data to understand the causes and prevention of maternal deaths. October 4, 2020: Senator Alexandria Ocasio-Cortez (Democrat – New York) tweeted: “I want everyone in this country to have the same healthcare I receive as a member of Congress.” October 6, 2020: Openly posted an opinion piece titled: “OPINION: The appointment of Amy Coney Barrett to the Supreme Court should ring alarm bells for the LGBT+ community”. It was written by Richard Saenz, a senior attorney at Lambda Legal. From the opinion piece: If Amy Coney Barrett is confirmed to the Supreme Court, the body, already leaning to the right, would be an ultra-conservative court the likes that we have not seen in decades. The new make-up of the court, made up of nine justices, could slam the courthouse doors shut to many incarcerated people and LGBT+ people or those seeking to hold police officers and prison system accountable.The court could radically change the Eighth Amendment’s prohibition against cruel and unusual punishment. In Farmer v. Breenan, (1994), a case originally filed by Dee Farmer, a Black transgender woman, the court ruled that a prison officials’ “deliberate indifference” to substantial risk of serious harm to an inmate violates the Eighth Amendment.This standard has been applied in thousands of cases, including Lambda Legal’s cases on behalf of LGBT+ people who experienced violence or sexual assault while in custody, or people who were denied medical treatment such as hormone therapy due to a discriminatory policy.A more stringent standard could make it even more difficult for incarcerated people to bring cases against officials – especially given the fact that many of these cases are brought without an attorney.There is already reason for alarm.In the Fifth Circuit Court of Appeals, a Trump-appointed judge flatly stated that a policy that did not authorize sex reassignment surgery or even an individualized assessment of whether such surgery was medically necessary, did not constitute “deliberate indifference”.This ignores decades of what the Eighth Amendment requires and installs a blanket ban against gender confirmation surgery, or even an assessment not just for this plaintiff but for other incarcerated transgender people in this circuit. If other courts were to accept this reasoning, then access to healthcare for incarcerated transgender people will be in increased jeopardy.The modern LGBT+ rights movement was born in response to police violence.This summer millions took to the streets to further protest against police abuses and the killing of Black and brown and LGBT+ people by officers. The question now is whether people can turn to the courts to hold police departments and officers accountable for violating our communities’ rights.Last term, the Supreme Court declined to hear cases involving the legal defense of qualified immunity. Under this doctrine, a case can be dismissed if a police officer’s actions were not “clearly established” as a constitutional violation at the time of the event. This has led to a number of cases being thrown out regardless of how egregious the actions of the officials were. U.S. President Donald Trump has opposed limiting qualified immunity.Finally, an ultra-conservative court undermines our communities’ belief in the criminal legal system. LGBT+ people are entitled, as are all people, to courts that treat them with fairness and respect.Alarmingly, Judge Coney Barrett has referred to transgender women as “physiological males” and made public statements against same-sex marriage. Other Trump appointed judges have also gone out of their way to refer to trans plaintiffs as “gender dysphoric” or refuse to use correct pronouns, in referring to a trans person or misgender them, while ruling against trans people.There is much at stake for LGBT+ people.We know that Trump’s nominees are committed to using the constitution to deny legal protections to this country’s most vulnerable. But this is not the end. We and many others are committed to the fight for equal justice for all. October 6, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Leads Coalition Seeking Supreme Court Review Against Trump-Pence Administration’s Title X Family Planning Rule”. California Attorney General Xavier Becerra, along with Oregon Attorney General Ellen Rosenblum and New York Attorney General Letitia James, yesterday led a coalition of 21 states and the District of Columbia in filing a petition to the U.S. Supreme Court. They join the American Medical Association, the Oregon Medical Association, Planned Parenthood Federation of America, the National Family Planning & Reproductive Health Association, and Essential Access Health in seeking review of the U.S. Court of Appeals for the Ninth Circuit’s decision to uphold the Trump-Pence Administration’s Title X rule, which dismantles the nation’s family planning program. The rule restricts access to critical preventive healthcare and access to birth control and prohibits doctors from providing accurate information to patients on their healthcare options including referrals for abortion.“The Trump-Pence Administration has upended the nation’s family planning network that serves low-income women and families across the country,” said California Attorney General Becerra. “As a result, clinics have closed in many parts of the country and patients are left with no provider for critical reproductive and preventive health services. A patient’s medical decisions are between her and her doctor or healthcare provider, not between her and the President or Vice President. Once again, this Administration is playing games with reproductive healthcare, putting politics ahead of patients. This rule interferes with the practice of medicine and reproductive autonomy. A patient should be able to have honest and frank conversations with her provider and get the care she needs, period. Here in California, we will continue to stand up and fight for the millions of women and families who rely on Title X for healthcare services.” The Title X family planning program is instrumental in the delivery of preventive and reproductive healthcare to low-income women and families. In 2019, the Department of Health and Human Services (HHS) issued a rule imposing major changes on the Title X program including: Limiting the information that can be shared with a patient at a Title X clinic;Prohibiting referrals for abortion, even when a patient specifically requests one;Mandating referrals for prenatal care for all pregnant patients, even if this care is not requested; andRequiring physician and financial separation for clinics for Title X funded services from abortion care Before 2019, the Title X program funded a wide array of critical public health services, including family planning counseling, access to FDA-approved contraceptive methods, pelvic exams, and crucial screenings for high blood pressure, anemia, diabetes, sexually transmitted diseases and infections, and cervical and breast cancer. The Trump-Pence Administration’s new Title X rule, however, has harmed the Title X program nationwide. In 13 states, more than 50 percent of Title X grantees have withdrawn from the program, and several states no longer have any Title X providers. New providers have not filled the gap caused by the withdrawals because these providers don’t provide family planning counseling or birth control. As a result, states have faced increased burdens to meet residents’ needs for essential healthcare.California alone has experienced a significant loss of Title X providers—going from 366 health centers in 38 counties to 229 health centers in only 18 counties. This leaves several rural counties with no Title X providers. As a result of these withdrawals, 38 percent fewer patients were served in 2019 compared to before the rule went into effect. Even before the onset of the COVID-19 pandemic, the Title X family planning network in California was projected to see fewer than 300,000 patients this year.Yesterday’s petition is the latest step in Attorney General Becerra’s efforts to protect the Title X program. In May, he and Nevada Attorney General Aaron Ford filed a multistate amicus brief in the U.S. Court of Appeals for the Fourth Circuit, supporting the City of Baltimore in its lawsuit against the Trump-Pence Administration’s rule. On March 4, 2019, he filed a lawsuit challenging the final rule in the Northern District Court of California, claiming the proposed restrictions to Title X disregard the rule of law and harm California’s healthcare providers and over one million women in our state who relied on Title X for healthcare services. And on July 30, 2018, the Attorney General led a coalition of 13 attorneys general in filing a comment letter opposing the rule.Joining Attorney General Becerra in filing the petition are the attorneys general of New York, Oregon, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Pennsylvania, Rhode Island, Vermont, Virginia, Wisconsin, and the District of Columbia. A copy of the petition to the U.S. Supreme Court is available here. October 6, 2020: Senator Bernie Sanders (Independent – Vermont) tweeted: “I believe every person in America is entitled to the same health care as the President of the United States – with no co-pays, no deductibles and no out-of-pocket expenses. If government-funded health care is good enough for Trump, it is good enough for all of us as a human right.” October 6, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James Leads Coalition Seeking Supreme Court Review of Trump Administration’s Title X Family Planning Rule”. From the press release: New York Attorney General Letitia James today announced she has led a coalition of 22 attorneys general from around the nation in filing a petition asking the U.S. Supreme Court to review a circuit court decision upholding the Trump Administration’s Title X family planning rule, also known as the “gag rule.” The rule dismantles the nation’s family planning program by reducing access to critical reproductive health care services, including birth control and referrals for abortions.“Since day one, the Trump Administration has done everything in its power to deny women access to reproductive health coverage,” said Attorney General James. “By removing so many of the vital and essential services funded by Title X, President Trump and his administration are essentially holding women’s reproductive freedoms captive. These rules are baseless, dangerous, and will prevent millions of women from accessing quality, safe reproductive health care, which is why we are asking the Supreme Court to intervene and protect women’s reproductive rights.”In March 2019, the Trump Administration implemented its gag rule, which places an unlawful and unethical restriction on the ability of health care providers at clinics that receive Title X funds to fully inform patients of the reproductive health services available to them by disallowing referrals for abortions and restricting counseling related to abortions. Another provision requires such clinics to physically segregate abortion services and the provision of referrals for abortion from all Title X funded services — a requirement that is so expensive and so difficult to accomplish that it is driving many providers out of the program and could possibly drive them out of business. Immediately, Attorney General James and Oregon Attorney General Ellen Rosenblum, jointly, led a coalition of 21 attorneys general in filing a lawsuit challenging the Trump Administration’s regulations that threaten essential services provided under federal Title X funding.The Title X family planning program is instrumental in the delivery of preventive and reproductive health care to low-income and underserved women and families. The 2019 rule challenged in this case imposed major changes on the Title X program, including: Limiting the information that can be shared with a patient at a Title X clinic;Prohibiting referrals for abortion, even when a patient specifically requests one;Mandating prenatal care for all pregnant women, even when this care is not requested; andRequiring physical separation of clinics for Title X funded services from abortion care Before 2019, the Title X program funded a wide array of critical public health services, including family planning counseling, access to FDA-approved contraceptive methods, pelvic exams, and crucial screenings for high blood pressure, anemia, diabetes, sexually transmitted diseases and infections, and cervical and breast cancer. But, the Trump Administration’s Title X rule has severely reduced and in some cases caused a total loss of access to many of the services provided by Title X nationwide… October 6, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a blog post titled: “ACA Improved Health Care Access and Affordability for New Mothers, Report Finds”. It was writen by Maggie Clark. From the blog post: We often get asked whether increases in health coverage rates result in more people getting care. In the case of new mothers following the implementation of the ACA’s major coverage provisions in 2014, a recent report from the Urban Institute shows the answer for this group is yes.In the years following the 2014 coverage expansions, new mothers were less likely to report unmet medical care or prescription medication needs, and more likely to have seen a general doctor and received a flu shot than in the years before the coverage expansions took effect.While barriers remain for new mothers to access health care–particularly because pregnancy Medicaid coverage ends just 60 days postpartum–the report findings suggest that the ACA likely contributed to improvements in health care access and affordability for new mothers, and that future coverage expansions could help even more.The report, which is based on data from the National Health Interview Survey (NHIS), defines “new mother” as women ages 19 to 44 with an infant (younger than age 1) whose NHIS record indicates they are the child’s biological or adoptive mother. Because of sample size, the study periods are the years before and after the major 2014 ACA coverage expansions (2011-2013 and 2015-2018, respectively.)During these time ranges, the uninsured rate for new mothers dropped dramatically, from about 20.2 percent in 2011 to 11.3 percent in 2015, and remained steady in the following years through 2018. This translated to new mothers being about 60 percent less likely to have unmet needs for prescription drugs and specialist care after the ACA’s coverage provisions took effect in 2014, the authors found. The report findings also build on the evidence that when states expand Medicaid, more people seek preventive care and avoid preventable complications from diseases such as diabetes and hypertension. A recent study showed that the ACA’s Medicaid expansion closed coverage gaps for pregnant women too.However, the positive results for new mothers were not distributed equally, the report found. Black and Hispanic new mothers still have higher uninsured rates than their white peers, face greater risks of maternal mortality and morbidity, and are less likely to receive postpartum care. The authors also pointed to social barriers, such as lack of transportation, child care, family leave, and the specific barrier of racism for Black women that keep them from accessing quality health care. Future coverage expansions should be designed to reduce inequities for Black and Hispanic women, the authors recommend… October 7, 2020: Center for Reproductive Rights posted a press release titled: “Center for Reproductive Rights Opposes Confirmation of Judge Amy Coney Barrett”. From the press release: Statement of Nancy Northup, President and CEO of the Center for Reproductive RightsFor only the second time since our founding in 1992, the Center for Reproductive Rights is opposing the confirmation of a U.S. Supreme Court nominee. Less than three weeks ago, the American people lost a champion for gender equality and reproductive rights with the passing of Justice Ruth Bader Ginsburg. On September 26, President Donald Trump nominated Judge Amy Coney Barrett to replace her. The Senate majority is rushing a truncated confirmation hearing process to begin on October 12, barely two weeks after Judge Barrett’s nomination. While this is inadequate time for the Senators and public to fully appraise this nominee, her record in opposition to reproductive rights is clear and alarming. Based on the record of her judicial opinions, academic articles, speeches, and public statements, the Center for Reproductive Rights strongly opposes Judge Barrett’s confirmation to serve as an Associate Justice to the U.S. Supreme Court. President Trump has made reversing Roe v. Wade a litmus test for his Supreme Court nominees. Judge Barrett’s record supports that test. From 2010-2016, she was a member in the Notre Dame Chapter of University Faculty for Life. In 2006, she was a signatory on a newspaper advertisement sponsored by St. Joseph County Right to Life. The ad called for an end to Roe v. Wade and Barrett specifically signed onto a statement that she opposes “abortion on demand” and defends “the right to life from fertilization,” an extreme legal position that has implications for contraception, abortion care and fertility treatments. In 2012 she signed onto an advocacy letter that called contraception and sterilization “gravely immoral and unjust” and wrongly characterized emergency contraception as “an abortion-inducing” drug. She subscribes to the judicial philosophy of originalism that rejects constitutional protections for abortion rights. Her writings are clear that she does not view Roe as a “super precedent” and the principle of stare decisis would not be a restraint to overturning Roe. In the two abortion rights cases that have come before her as a federal appellate judge, Judge Barrett joined opinions that suggest upending Supreme Court law on both the substantive right to abortion and the procedural safeguards that allow the right to be vindicated in court. In sum, Judge Barrett’s approach to constitutional interpretation, opinions as a federal appellate judge, and vitriolic public advocacy disparaging contraception, opposing abortion, and defending “the right to life from fertilization” lay bare a deep disagreement with the established constitutional protections for reproductive rights. Indeed, Judge Barrett has the most extreme record in opposition to reproductive rights as any Supreme Court nominee since the rejected nomination of Judge Robert Bork over 30 years ago. Moreover, Judge Barrett has criticized the Supreme Court’s decisions upholding key provisions of the Affordable Care Act (ACA), which has expanded reproductive health insurance coverage to millions, including affordable contraceptive and maternity care. This is especially troubling, as the Supreme Court will be hearing the next challenge to the ACA on November 10. We do not make our decision to oppose Judge Barrett lightly. We win cases before a wide range of federal judges, who have been appointed by both Republican and Democratic presidents. As an organization that litigates cases in federal courts, including in the Supreme Court, we are rigorous about factual accuracy and careful legal analysis. We are a nonpartisan, nonprofit organization that does not support or oppose political parties or candidates. The stakes of this nomination could not be higher. Since the election of President Trump, states have accelerated their decades-long campaign to end abortion services and there are dozens of cases heading toward the Supreme Court. Some are test cases to overturn Roe v. Wade or to render it meaningless by upholding laws that make abortion impossible to access. The Supreme Court’s vital role in protecting and upholding civil rights and liberties – including reproductive rights – cannot be compromised by a nominee fundamentally hostile to our constitutional rights. October 7, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Warns of Pence’s Anti-Choice Radicalism Ahead of Vice Presidential Debate”. From the press release: As Senator Kamala Harris (D-CA) and Vice President Mike Pence prepare to face off during tonight’s vice presidential debate, expect Pence to attack reproductive freedom. As the Republican Party often does, Pence will likely spew disinformation and attack abortion rights to distract from the Trump-Pence administration’s failed leadership and the illegitimate nomination of Amy Coney Barrett to the U.S. Supreme Court. This debate comes just days after President Donald Trump again pushed lies and fear-mongering about abortion, a tactic he often turns to when he’s in hot water. NARAL Pro-Choice America President Ilyse Hogue released the following statement ahead of this evening’s debate:“Though Americans are already casting ballots, the Trump-Pence administration is prioritizing ramming through a Supreme Court nomination. Instead, they should be providing much-needed relief to Americans. The stakes have never been higher: Our reproductive freedom, our rights, and our democracy are at stake. Senator Kamala Harris has proven her prowess and leadership in her role on the Senate Judiciary Committee and as a senator committed to justice for all people. We know she will do the same tonight on the debate stage, not letting Pence off the hook for his regressive and oppressive politics that have harmed so many people in this country. We need proven leaders like her and Vice President Joe Biden now more than ever. There’s no question that this ticket will fight tirelessly for reproductive freedom and work to undo the damage to our fundamental rights waged by Pence and Trump. That’s why we are committed to doing everything we can to make sure they win the White House this November.”Vice President Mike Pence has made his disdain towards Roe v. Wade clear time and again, saying that the case should be “consigned to the ash heap of history.” The Trump-Pence administration is poised to do just that thanks to its nomination of Amy Coney Barrett to the Supreme Court, a judge with a record of hostility towards reproductive freedom who has even signed on to an ad calling Roe “barbaric.” Polls confirm that the Trump-Pence administration and Mitch McConnell’s rush to confirm Barrett is wildly unpopular. Despite the fact that the American people have already begun casting their ballots, the Republican Party remains laser-focused on ramming through Barrett’s confirmation and continuing their long-standing campaign to stack our courts and gut our rights. Pence has long prioritized his anti-choice fanaticism over the health and well-being of those he was elected to serve. He flouted life-saving public health guidance this summer when he embarked on a reckless multi-state tour of fake women’s health centers during the COVID-19 pandemic. As NARAL Pro-Choice America and Global Strategy Group’s new language guide to accurate reporting on abortion explains, these anti-choice organizations, sometimes referred to as “crisis pregnancy centers,” lie to, shame, and mislead those seeking an abortion to block them from accessing care… October 7, 2020: California Attorney General Xavier Bacerra posted a press release titled: “Attorney General Becerra Leads Coalition in Support of Healthcare Rights for Transgender Americans”. From the press release: California Attorney General Xavier Becerra today led a coalition of 17 states and the District of Columbia in filing an amicus brief supporting the plaintiffs in Kadel v. N.C. State Health Plan. The plaintiffs, Maxwell Kadel, Jason Fleck, Connor Thonen-Fleck, Julia McKeown, Michael D. Bunting, Jr., C.B., and Sam Silvaine, all state employees and their families, sued the North Carolina State Health Plan for denying health coverage. Specifically, the plaintiffs seek coverage for gender dysphoria or other gender-affirming treatment, arguing that Section 1557 of the Affordable Care Act (ACA) protects transgender individuals from discrimination in healthcare and requires the State to provide them with coverage.“All people should have access to healthcare, period. This includes transgender individuals who have a right to live their lives with dignity, free from discrimination,” said Attorney General Becerra. “Here in California, we have laws that protect transgender Americans from discrimination in accessing state services and benefits, including healthcare. We’ve seen the positive outcome that ensuring equality brings to our communities. We will continue to fight for equality for all transgender Americans.”The ACA provides millions of Americans with access to quality, affordable health insurance coverage. It also prevents discrimination in healthcare through Section 1557, which extends prohibitions on sex discrimination to healthcare programs and services. Section 1557 expressly prohibits health programs and activities receiving federal financial assistance, including medical providers, health systems, and health insurers, from discriminating against individuals on the basis of race, color, national origin, sex, age, or disability.In today’s brief, the coalition argues that by denying transgender individuals coverage for gender-affirming treatment and gender dysphoria, the North Carolina State Health Plan violated Section 1557’s anti-discrimination mandate. Systematic and widespread discrimination against transgender people in healthcare is what Section 1557 aims to prevent and combat. Instead, the Health Plan’s discriminatory tactics put the lives of transgender people at risk by denying them treatment known to improve their physical and mental health. The brief also argues that Section 1557 should be applied uniformly across the country in order to protect Americans from discrimination as Congress intended. The ACA’s reforms, along with state laws like California’s, which prohibit health insurers from excluding coverage for transgender health services, have significantly increased access to healthcare for LGBTQ+ individuals and their families. Allowing the North Carolina State Health Plan to selectively deny coverage to certain disadvantaged groups, like transgender people, causes uncertainty and confusion for people who are already reluctant to seek medical care. Applying Section 1557 uniformly will give all transgender Americans confidence that they will receive quality healthcare no matter where they are……In filing the amicus brief, Attorney General Becerra was joined by the attorneys general of Colorado, Delaware, Hawaii, Illinois, Maine, Massachusetts, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Wisconsin, and the District of Columbia. A copy of the amicus brief is available here. October 8, 2020: NPR posted an article titled: “Supreme Court Punts on Abortion Pills, Allowing them to be Mailed – For Now”. It was written by Nina Totenberg. From the article: The U.S. Supreme Court has refused, for now, to reimpose FDA regulations that require women seeking medication abortion to pick up the prescribed pills in person at a clinic instead of by mail.The court’s decision came Thursday night on a 6-to-2 vote that rejected an emergency appeal from the Trump administration.The challenge to the Food and Drug Administration regulation was brought by the American College of Obstetricians and Gynecologists after the the agency relaxed similar regulations for other drugs — including opioids — in order to limit patients’ exposure to COVID-19 during the pandemic. The FDA refused to relax the same rule for those with prescriptions for abortions with pills in the first 10 weeks of pregnancy.Federal Judge Theodore Chuang in Maryland ruled in favor of ACOG, declaring that requiring such in-person pickups of pills during a pandemic posed “a substantial obstacle to women seeking an abortion.” The Supreme Court has long ruled that such substantial obstacles unconstitutionally interfere with a woman’s right to terminate a pregnancy.On Thursday night, the Supreme Court turned down the Trump administration’s attempt to block the lower court order. But the decision was more of a punt than a long-lasting decree.The high court said it would hold the Trump administration’s request “in abeyance” to permit the district court judge to promptly consider other efforts by the administration to “dissolve, modify, or stay” its previous order if “relevant circumstances have changed.” And the justices said that their decision did not indicate their views on the merits of the case should it come to them again.The language of the one-paragraph order seemed to suggest that the court was simply unwilling to make any decision in an abortion case three weeks after Justice Ruth Bader Ginsburg died, and just days before the U.S. Senate is scheduled to take up the nomination of Judge Amy Coney Barrett as Ginsburg’s replacement… October 8, 2020: The American College of Obstetricians and Gynecologists (ACOG) posted news titled: “Recent Research Study: HPV Vaccination Substantially Reduces Risk of Invasive Cervical Cancer”. From the news: A recent Swedish study published in the New England Journal of Medicine assessed the association between HPV vaccination and the subsequent risk of invasive cervical cancer. During the study period, the researchers evaluated 1.7 million girls and women, 10 to 30 years old, for cervical cancer. The findings showed that, among Swedish girls and women 10 to 30 years old, quadrivalent HPV vaccination was associated with a substantially reduced risk of invasive cervical cancer, especially in women who were immunized at a younger age.ACOG recommends that obstetrician–gynecologists and other health care professionals should strongly recommend HPV vaccination to eligible patients and stress the benefits and safety of the HPV vaccine. Health care professionals play a critical role and should assess and vaccinate adolescent girls age 11–12 years and previously unvaccinated young women during the catch-up period (ages 13–26 years). Additionally, health care professionals may use shared clinical decision making with previously unvaccinated women aged 27–45 years, considering the patient’s risk for acquisition of new HPV infection and whether the HPV vaccine may provide benefit.Read the full research article. October 8, 2020: Planned Parenthood posted a press release titled: “Supreme Court Leaves in Place Suspension of Medically Unnecessary Barrier to Abortion During COVID-19 – For Now”. From the press release: Today, the U.S. Supreme Court delayed ruling on the Trump administration’s attempt to reinstate a U.S. Food and Drug Administration (FDA) requirement that subjected patients to unnecessary COVID-19 exposure risks during the pandemic to access a safe medication for early abortion care.The FDA’s Risk Evaluation and Mitigation Strategy (REMS) restrictions on mifepristone mandate that patients pick up the medication directly from a doctor’s office, hospital, or other health center – rather than from a pharmacy or by mail, as allowed for other equally safe medications.The court’s decision to delay acting on the administration’s request follows the death of Supreme Court Justice Ruth Bader Ginsburg, a staunch advocate for reproductive health care and rights. While the court’s decision on the government’s request is delayed for now, 16 other cases on abortion access are one step away from the Supreme Court……PPFA joined the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), and the American Academy of Pediatrics (AAP), and other leading health care organizations in signing onto an amicus brief opposing the Trump administration’s attempt… October 8, 2020: Senator Cory Booker (Democrat – New Jersey) posted a press release titled: “Booker, Blackburn Introduce Bipartisan Legislation to Help Improve Maternal Health Outcomes for Pregnant Veterans”. From the press release: U.S. Senators Cory Booker (D-NJ) and Marsha Blackburn (R-TN) introduced a bipartisan bill, Delivering Optimally Urgent Labor Access for Veterans Affairs, or the DOULA Act, to establish a pilot program to encourage the use of doulas in the Veterans Health Administration to support pregnant veterans and improve maternal health outcomes.A study in 2010 by the National Center for Biotechnology Information found that veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom who experienced pregnancy were twice as likely to have a diagnosis of depression, anxiety, posttraumatic stress disorder, bipolar disorder, or schizophrenia as those who had not experienced a pregnancy, which can lead to many complications during childbirth.This has led to an increasing number of doula organizations and veteran stakeholders coming together to advocate for the placement of doulas in the Veterans Health Administration as a support for pregnant veterans.A 2013 study published in the Journal of Perinatal Education found that “expectant mothers matched with a doula had better birth outcomes than did mothers who gave birth without involvement of a doula.”“Maternal mortality in the United States is a public health crisis that demands urgent action,” said Senator Booker. “Providing increased access to doula care for veterans—especially those who are survivors of military sexual trauma or experiencing a mental disorder—is a proven, effective way to improve health outcomes for mothers and children and support our veterans.”“Mental health resources must be readily available for our veterans, and pregnant veterans are no exception,” said Senator Blackburn. “The support of a doula during childbirth has proven to help women feel more at ease as their child comes into the world.“Under the Delivering Optimally Urgent Labor Access for Veterans Affairs, or the DOULA Act, the Department of Veteran Affairs would be required to measure the impact that doula support services have on pregnant veterans birth and mental health outcomes. The pilot program would allow for six Veterans Integrated Service Networks (VISN), three with the highest percentage of female veterans, and three with the lowest rate of female veterans, to participate and compare results regarding barriers to care. If done successfully, it will lower childbirth complications and incentivize veterans to receive VA care during and after their pregnancy.The Delivering Optimally Urgent Labor Access for Veterans Affairs Act was borne out of conversations Senator Booker had with female veterans at a roundtable he hosted on Veterans Day in 2018. Full text of the bill can be viewed here. October 8, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a report titled: “Children’s Uninsured Rate Rises by Largest Annual Jump in More Than a Decade”. It was written by Joan Alker and Alexandra Corcoran. From the report: Key Findings After reaching a historic low of 4.7 percent in 2016, the child uninsured rate began to increase in 2017, and as of 2019, jumped back to 5.7 percent. This increase of a full percentage point translates to approximately 726,000 more children without health insurance since the beginning of the Trump Administration when the number of uninsured children began to rise. Much of the gain in coverage that children made as a consequence of the Affordable Care Act’s major coverage expansions implemented in 2014 has now been eliminated.The number of uninsured children increased every year during the Trump Administration. The largest increase was observed between 2018 and 2019 when, despite a strong economy, the number of uninsured children was the largest annual jump seen in more than a decade. Moreover, since this data was collected prior to the pandemic, the number of uninsured children is likely considerably higher in 2020, as families have lost their jobs and employer-sponsored insurance, though it is impossible to know yet by precisely how much.One-third of the total increase in the number of uninsured children from 2016 to 2019 live in Texas. The state saw by far the greatest coverage loss over the period with an estimated 243,000 more children living without health coverage. Florida has the next biggest loss, adding about 55,000 children to the uninsured count over the three-year period. As a consequence, 41 percent of children’s coverage losses during the Trump Administration occured in Texas and Florida. Twenty-nine states experienced an adverse change for children from 2016 to 2019. The only state that bucked national trends and significantly reduced its number of uninsured children during this three-year period was New York.These coverage losses were widespread across income, age, and race/ethnicity, but were largest among White and especially Lationo children (who can be of any race). IntroductionFor many years, the United States was on a positive trajectory in reducing the number and rate of uninsured children; in 2016, the nation attained a historic low of 3.6 million uninsured children. This progress occured as a result of expansions of public coverage – primarily Medicaid and the Children’s Health Insurance Program (CHIP) – and was accelerated by the implementation of the Affordable Care Act’s (ACA) major coverage expansion in 2014. As employer-sponsored insurance became increasingly unaffordable for dependents, public coverage ameliorated the impacts of private coverage losses for children. However, the number of uninsured children began to increase in 2017 as Medicaid enrollment began to decline, and Figure 1 shows, reached 4.4 million in 2019. This represents an increase of 726,000 children during this three-year-period. The rate of uninsured children rose a full percentage point from 4.7 percent to 5.7 percent. Much of the gain in coverage that children made as a consequence of the ACA’s major coverage expansions has now been eliminated. Moreover, the most recent year of data (2018 to 2019) shows the biggest one-year loss in children’s coverage during this time period, with 320,000 more children being uninsured. These coverage losses occured in a healthy economy with the lowest unemployment rate in decades prior to the economic shocks and job losses associated with the COVID-19 pandemic. October 9, 2020: Senator Kamala Harris (Democrat – California) posted a press release titled: “Harris, Leahy, Booker Press Chairman Graham Not to Conduct Supreme Court Hearings Without COVID-19 Testing Procedures In Place”. From the press release: U.S. Senator Kamala D. Harris (D-CA) on Friday joined Senators Patrick Leahy (D-VT) and Cory Booker (D-NJ) in pressing Judiciary Committee Chairman Lindsey Graham (R-SC) not to proceed with Supreme Court confirmation hearings next week unless stringent COVID-19 testing procedures are implemented immediately. Pointing out that two Judiciary Committee members have tested positive for COVID-19 and others have thus far refused to be tested, the senators told Graham that without testing procedures in place, the hearings could threaten the safety and health of all who attend in person. The senators wrote, “In the wake of news that Senators Lee and Tillis tested positive for COVID-19 after attending the White House event announcing Amy Coney Barrett’s nomination to the Supreme Court, Judiciary Committee Democrats asked that you postpone her confirmation hearings to ensure that we don’t risk the health and safety of fellow Senators, Senate staff, other Senate employees, as well as Judge Barrett and her family. To date, we understand that you plan to proceed with these hearings on October 12, 2020, despite the serious risks they present. We urge you against unsafely moving forward with these hearings while no clear testing regime is in place to ensure that they do not become another super-spreader of this deadly virus.”The senators continued, “Without these precautionary measures in place, Senators, Senate staff, press, Judge Barrett and her family will face a serious, unnecessary risk of contracting COVID-19. We also have a moral responsibility to protect the workers who make it possible for us to do our jobs in the Senate each and every day. Absent these protocols, you are ignoring CDC best practices and may force Senators to participate in this hearing remotely which, for such a consequential hearing, would be entirely unprecedented. As Chairman of the Senate Judiciary Committee, your first and foremost obligation is to ensure the safety and well-being of Committee members and staff. We urge you to honor that obligation in the days ahead.” Full text of the letter can be found HERE. October 9, 2020: Senator Cory Booker (Democrat – New Jersey) posted a press release titled: “Veterans’ Organizations Endorse Booker Bill to Help Improve Maternal Health Outcomes for Pregnant Veterans”. From the press release: Last week, U.S. Senator Cory Booker (D-NJ) introduced a bipartisan bill, Delivering Optimally Urgent Labor Access for Veterans Affairs, or the DOULA Act, to establish a pilot program to encourage the use of doulas in the Veterans Health Administration to support pregnant veterans and improve maternal health outcomes. This legislation was borne out of various veteran organizations and leaders such as the Disabled American Veterans (DAV), Service Women’s Action Network, NJ SOS Veteran Stakeholders group, and advocate Lucy Del Gaudio speaking out on the importance to improve maternal health outcomes for pregnant veterans.A study in 2010 by the National Center for Biotechnology Information found that veterans returning from Operation Enduring Freedom and Operation Iraqi Freedom who experienced pregnancy were twice as likely to have a diagnosis of depression, anxiety, posttraumatic stress disorder, bipolar disorder, or schizophrenia as those who had not experienced a pregnancy, which can lead to many complications during childbirth.This has led to an increasing number of doula organizations and veteran stakeholders coming together to advocate for the placement of doulas in the Veterans Health Administration as a support for pregnant veterans.A 2013 study published in the Journal of Perinatal Education found that “expectant mothers matched with a doula had better birth outcomes than did mothers who gave birth without involvement of a doula.”“Maternal mortality in the United States is a public health crisis that demands urgent action,” said Senator Booker. “Providing increased access to doula care for veterans—especially those who are survivors of sexual trauma or living with mental illness—is a proven, effective way to improve health outcomes for mothers and children and support our veterans.”“Pregnancy, labor and delivery, and the early days of motherhood can be difficult in the best of circumstances, but for women veterans, they can be further complicated by physical and mental health conditions related to military service,” said Disabled American Veterans (DAV) National Legislative Director Joy J. Ilem. “We owe our veterans the care they need, and the D.O.U.L.A. Act would offer much-needed support to women veterans at a time when they need it most. We thank Senators Booker and Blackburn for taking the needs of pregnant women veterans into account and working to establish this unique pilot program to foster better health outcomes for mother and baby as well as encourage veterans to continue using VA’s comprehensive care services, during and after pregnancy.”“The Service Women’s Action Network (SWAN) strongly supports Senator Cory Booker’s D.O.U.L.A Act of 2020. This legislation will provide veterans who are new mothers with trusted support as they begin the joyful journey of motherhood,” said Lory Manning, Captain, US Navy Retired, Director of Government Relations for the Service Women’s Action Network (SWAN).“Thank you Senator Booker for taking the time to listen to the needs of our women veterans and taking action. It’s one step in getting women veterans the healthcare they deserve,” said Co-chair of NJSOSVETS Stake Holder Group Dave Pearson. “We look forward to working with you in the future in giving our veterans a voice and helping to get the services they deserve.”“Survivors of trauma need to feel fully supported, calm, and confident during their childbirth experience,” said Co-chair of the SOSVETS Stakeholder Groups Women Veteran Subcommittee Lucy Del Gaudio. “The DOULA for VA Act will do that just. This will ensure that women, non-binary, and transgender veterans practicing holistic medicine and wellbeing will be fully supported. I truly appreciate the support that Senator Booker has provided to our sisters in arms and Senator Blackburn for co-sponsoring this bill. It’s an honor and a privilege to work with them both.”Under the Delivering Optimally Urgent Labor Access for Veterans Affairs, or the DOULA Act, the Department of Veteran Affairs would be required to measure the impact that doula support services have on pregnant veterans birth and mental health outcomes. The pilot program would allow for six Veterans Integrated Service Networks (VISN), three with the highest percentage of female veterans, and three with the lowest rate of female veterans, to participate and compare results regarding barriers to care. If done successfully, it will lower childbirth complications and incentivize veterans to receive VA care during and after their pregnancy.The DOULA Act was introduced last week by Senators Cory Booker (D-NJ) and Marsha Blackburn (R-TN).Full text of the bill can be viewed here. October 9, 2020: Lambda Legal posted a press release titled “The Senate Judiciary Committee Must Oppose Amy Coney Barrett”. From the press release: Today, Lambda Legal sent a letter to the Senate Judiciary Committee urging the members to oppose Judge Amy Coney Barrett, President Trump’s nominee to fill the seat of the late Justice Ruth Bader Ginsburg on the United States Supreme Court. The rushed confirmation hearings are scheduled to begin on Monday, October 12, while voting for the next president and one-third of the senate is already underway. “Judge Amy Coney Barrett’s record is filled with red flags that should disqualify her from sitting on the U.S. Supreme Court. Given her perverse, reactionary judicial philosophy, Judge Barrett is unfit to fill the seat, much less the shoes, of the late Justice Ruth Bader Ginsburg,” said Sasha Buchert, Senior Attorney at Lambda Legal. “Furthermore, this rushed confirmation process undermines the integrity of the Court and betrays the legacy of Justice Ginsburg. The politically motivated decision of the Senate Judiciary Committee to rush this confirmation process will further jeopardize the reputation of the Court, which must have the respect and confidence of the people in order to be effective. Our country cannot afford having the Supreme Court be seen as just another political branch—unbalanced and wielding disproportionate power.“There is so much at stake for LGBTQ people and everyone living with HIV right now because so much of our civil rights progress has happened in the courts,” Buchert added. “Decades of hard work have led to legal victories such as the right to marry the person we love, to protect our families, to access health care and make decisions about our bodies. Judge Amy Coney Barrett’s record is fundamentally at odds with basic guarantees of equality, liberty, justice and dignity under the law for our communities. It is impossible for LGBTQ people to have confidence in Judge Barrett as her publicly available record makes clear that she would be unable or unwilling to respect and affirm our rights to equal protection of the laws.”In 2016, then-Professor Barrett gave a presentation in which she expressed that marriage should not be viewed as a fundamental right for same-sex couples and instead should be decided on a state-by-state basis. This approach mistakenly erases the duty of courts to enforce everyone’s constitutional rights. If followed, it would deny equal liberty, dignity and autonomy to LGBTQ people, women, racial minorities and any other marginalized community historically denied those rights. In a lecture discussing issues that could soon be before the Supreme Court, then-Professor Barrett took the troubling and legally unsound position that transgender people are not protected by federal protections against sex discrimination. Justice Gorsuch explained why her view is wrong in the Court’s Bostock v. Clayton County decision of this past June. More disturbing yet, she mischaracterizes transgender people. She has opined that “people will feel passionately on either side about whether physiological males who identify as females should be permitted in bathrooms especially where there are young girls present.” This ill-informed misgendering and disrespect of transgender people, and in particular of trans youth, ignores that it is transgender people who are at widespread risk of assault and discrimination. Spreading such inflammatory ignorance is dangerous to their very lives and ability to fully participate in public life.Further analysis of Amy Coney Barrett’s record reveals opinions that would immediately threaten the Affordable Care Act—which has expanded health care coverage for more than 20 million people, and helped countless LGBTQ people and those living with HIV who are more than twice as likely to be uninsured. She also has showed her lack of concern for racial equity – an important duty of our federal courts – when she denied rehearing of a decision that allowed a company to segregate its employees by race, violating a core tenant of Brown v. Board of Education. October 9, 2020: Center for American Progress posted an article titled: “Repealing the ACA Would Create Chaos for the Disability Community During a Pandemic”. It was written by Rebecca Cokley. From the article: …The Patient Protection and Affordable Care Act (ACA), enacted in 2010, was a game-changer for the disability community and was in some ways comparable to the Americans with Disabilities Act (ADA) in terms of the impact the law had on peoples’ lives. While much of the law’s importance has centered on its anti-discrimination protections for people with preexisting conditions—which do have a significant effect on people with disabilities and chronic health conditions—there are a multitude of lesser-known provisions that have had a life-changing impact on the United States’ 61 million people with disabilities and their families, both in terms of their health and their wallets.On November 10, the Supreme Court is expected to hear oral arguments in California v. Texas, a lawsuit backed by the Trump administration and state attorneys general that seeks to invalidate the entire ACA—including its protections for people with preexisting conditions. The vacancy on the Supreme Court in the wake of Justice Ruth Bader Ginsburg’s recent passing has left President Donald Trump and the Senate majority scrambling to fill the seat with a conservative justice who will side with them in repealing the 10-year old law. If the ACA is repealed, the ramifications for people with disabilities and their families will be widespread and catastrophic—and dramatically exacerbated in the midst of a pandemic. As the Centers for Disease Control and Prevention notes, “ome people with disabilities might be at a higher risk of infection or severe illness because of their underlying medical conditions.”…Repealing the ACA would harm people with COVID-19…Individuals who have contracted the coronavirus will face unique health care needs both now and in the future. As scientists and those in the medical profession continue to learn more each day about the virus that causes COVID-19, it is increasingly clear that the long-term effects of the coronavirus are still unknown. More than 7 million people in the United States have been infected with the virus since March and, as such, would likely be considered by insurance companies to have preexisting conditions. Some COVID-19 “long haulers,” or those for whom the effects of the coronavirus have lasted months, are experiencing aggressive side effects of the virus, including paralysis, blood clots, respiratory distress, and cardiac disease. COVID-19 survivors are also finding themselves medical anomalies, facing not only confusion among medical personnel about best courses of treatment but also an inability to receive in-person peer support, a staple in the disability community that has been limited due to social distancing. If the ACA is repealed, millions of Americans who have had COVID-19 will likely find themselves unable to obtain or maintain insurance, as was the case for millions of Americans before the law took effect.The White House and Senate majority failed to respond to the virus when it first emerged and are now actively working to destroy their health care in the courts and legislature, further affecting people with disabilities. The Safe to Work Act, backed by Sen. John Cornyn (R-TX) and 23 other Republican co-sponsors, proposes allowing employers to waive the ADA and other civil rights laws to discriminate against employees with a history of the coronavirus. The Leadership Conference on Civil and Human Rights called the Safe to Work Act “an extreme bill that would protect businesses at the expense of working people and the public by shifting the burden of the pandemic onto those who are most vulnerable to the health and economic impacts of this crisis.”Repealing the ACA would lead to coverage losses among people with preexisting conditionsFirst and foremost, repealing the ACA would roll back anti-discrimination protections for people with preexisting conditions. It is not commonly understood that people with preexisting conditions are regarded as people with disabilities under the ADA, meaning they are covered under the ACA’s anti-discrimination protections and the reasonable accommodations that come with it.This provision also made it easier for people with disabilities to leave a job and find another one without fear of being denied insurance coverage or jumping through arduous hoops to get covered. People with disabilities no longer had to weigh serious concerns about accessing coverage—which in the past may have caused them to stay in a job that paid poorly or that they had advanced beyond professionally or even to take a job out of state that offered the benefits they needed. The ACA helped guarantee the disability community was not disproportionately penalized when pursuing a career based on their own desires and personal choices rather than out of fear of losing health care. Repealing this law in the midst of a public health and economic crisis would mean a drastic curtailment of autonomy for millions of people……Repealing the ACA may mean a return to annual or lifetime caps on coverage…Prior to the passage of the ACA, insurance companies could enact annual or lifetime caps, or limits, on the benefits policyholders received. Depending on the severity of someone’s disability, or the age at which they acquired it, they could hit their lifetime cap at an expedited rate. This was common for young children with significant disabilities. The fear of an ACA repeal is also a fear that coverage caps will increase the likelihood of institutionalization. Making families pay for all additional medical costs above annual or lifetime limits would force them to make an unconscionable choice between the right of people with disabilities to live in the community, as established in Olmstead v. L.C., and families’ ability to pay for it. For survivors of COVID-19, ongoing health care costs will be highly unpredictable, as the virus’s long-term health effects are only beginning to be understood.Medicaid expansion, made possible by the ACA, has expanded care and increased employment among people with disabilitiesThe ACA also allowed states to expand Medicaid, extending eligibility for the program to people with incomes up to 138 percent of the federal poverty level. This has allowed many more people with disabilities to access health care without having to go through the long process of disability determination. It has also allowed people with disabilities who have slightly higher incomes to access benefits.Medicaid expansion has also increased employment rates among people with disabilities. Prior to expansion, people with disabilities had to go through the disability determination program and meet stringent income and asset limits for coverage. This prevented many people with disabilities from entering employment or returning to work after acquiring a disability due to the fear of making too much money to access needed health care. In states that expanded Medicaid, employment of people with disabilities increased from 41.3 percent to 47 percent, compared with a decrease from 43.5 percent to 41.4 percent in states that did not. Indeed, many of the states that are continuing to battle the pandemic—including Ohio, Pennsylvania, West Virginia, and California—each have hundreds of thousands of enrollees in Medicaid expansion… October 9, 2020: Lambda Legal posted a press release titled: “Lambda Legal Urges Senate Judiciary Committee to Oppose Confirmation of Amy Coney Barrett”. From the press release: Today, Lambda Legal sent a letter to the Senate Judiciary Committee urging the members to oppose Judge Amy Coney Barrett, President Trump’s nominee to fill the seat of the late Justice Ruth Bader Ginsburg on the United States Supreme Court. The rushed confirmation hearings are scheduled to begin on Monday, October 12, while voting for the next president and one-third of the senate is already underway. “Judge Amy Coney Barrett’s record is filled with red flags that should disqualify her from sitting on the U.S. Supreme Court. Given her perverse, reactionary judicial philosophy, Judge Barrett is unfit to fill the seat, much less the shoes, of the late Justice Ruth Bader Ginsburg,” said Sasha Buchert, Senior Attorney at Lambda Legal. “Furthermore, this rushed confirmation process undermines the integrity of the Court and betrays the legacy of Justice Ginsburg. The politically motivated decision of the Senate Judiciary Committee to rush this confirmation process will further jeopardize the reputation of the Court, which must have the respect and confidence of the people in order to be effective. Our country cannot afford having the Supreme Court be seen as just another political branch—unbalanced and wielding disproportionate power.“There is so much at stake for LGBTQ people and everyone living with HIV right now because so much of our civil rights progress has happened in the courts,” Buchert added. “Decades of hard work have led to legal victories such as the right to marry the person we love, to protect our families, to access health care and make decisions about our bodies. Judge Amy Coney Barrett’s record is fundamentally at odds with basic guarantees of equality, liberty, justice and dignity under the law for our communities. It is impossible for LGBTQ people to have confidence in Judge Barrett as her publicly available record makes clear that she would be unable or unwilling to respect and affirm our rights to equal protection of the laws.”In 2016, then-Professor Barrett gave a presentation in which she expressed that marriage should not be viewed as a fundamental right for same-sex couples and instead should be decided on a state-by-state basis. This approach mistakenly erases the duty of courts to enforce everyone’s constitutional rights. If followed, it would deny equal liberty, dignity and autonomy to LGBTQ people, women, racial minorities and any other marginalized community historically denied those rights. In a lecture discussing issues that could soon be before the Supreme Court, then-Professor Barrett took the troubling and legally unsound position that transgender people are not protected by federal protections against sex discrimination. Justice Gorsuch explained why her view is wrong in the Court’s Bostock v. Clayton County decision of this past June. More disturbing yet, she mischaracterizes transgender people. She has opined that “people will feel passionately on either side about whether physiological males who identify as females should be permitted in bathrooms especially where there are young girls present.” This ill-informed misgendering and disrespect of transgender people, and in particular of trans youth, ignores that it is transgender people who are at widespread risk of assault and discrimination. Spreading such inflammatory ignorance is dangerous to their very lives and ability to fully participate in public life.Further analysis of Amy Coney Barrett’s record reveals opinions that would immediately threaten the Affordable Care Act—which has expanded health care coverage for more than 20 million people, and helped countless LGBTQ people and those living with HIV who are more than twice as likely to be uninsured. She also has showed her lack of concern for racial equity – an important duty of our federal courts – when she denied rehearing of a decision that allowed a company to segregate its employees by race, violating a core tenant of Brown v. Board of Education. Read Lambda Legal’s letter here: https://www.lambdalegal.org/in-court/legal-docs/20201009_letter_amy-coney-barrett-opposition-supreme-court October 12, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Denounces Senate Republicans’ Disgraceful Priorities as Amy Coney Barrett Confirmation Hearings Begin”. From the press release: This morning, the Senate Judiciary Committee began confirmation hearings for Amy Coney Barrett. More than 7 million voters have already cast their ballots and less than a month remains until Election Day. Still, Senate Republicans continue to prioritize ramming through another Trump justice to the U.S. Supreme Court instead of addressing the suffering the COVID-19 pandemic is causing to our health, safety, and economic well-being.NARAL Pro-Choice America President Ilyse Hogue released the following statement in response:“Two things are clear: Barrett poses a clear and present danger to our fundamental rights and this hearing is part of an illegitimate and craven power grab that could affect our Courts for a long time. Plowing ahead with the confirmation of a Supreme Court justice this close to Election Day is an attack on our democracy that we won’t forget. It’s disgraceful for Senate Republicans to continue this partisan charade to maintain control no matter the results of November’s election, all while refusing to help people struggling in the midst of the still-raging pandemic. No confirmation should be considered until after Inauguration Day, period.”Amy Coney Barrett’s record on reproductive freedom is clear. She has suggested that Roe v. Wade is an “erroneous decision.” She also signed onto an ad calling the landmark ruling “barbaric” and failed to disclose it in the documents submitted to the Senate ahead of her confirmation hearing. She sided with states trying to restrict abortion access, joined anti-choice groups in opposing the Affordable Care Act’s birth control benefit, and is connected to a group that calls for criminalizing in vitro fertilization. Her nomination comes after Trump’s promise to the Radical Right to only consider jurists hostile to reproductive freedom. It’s a vow he ran on in 2016 and doubled down on in a recent campaign letter to the anti-choice movement.Rather than letting the American people decide, Trump and Mitch McConnell are teeing up one of the most rushed confirmation processes in history in a massive power grab. For the last four years, the Trump administration, Mitch McConnell, and Senate Republicans have waged war on our fundamental rights and our democracy. That’s why we know we must do all that we can to flip the Senate, expand our majority in the U.S. House of Representatives, and send Vice President Joe Biden and Sen. Kamala Harris to the White House… October 12, 2020: Elle posted an article titled: “Senator Gary Peters Shares His Abortion Story”. It was written by Laura Bassett. From the article: United States Senator Gary Peters, a low-key, moderate Democrat from Michigan, is in a very tight re-election race that could decide whether his party wins the Senate. But’ he’s not the type of guy who typically makes national headlines…. So it may come a as a surprise that with this story, he will become the first sitting senator in American history to publicly share a personal experience with abortion.“It’s a story of how gut-wrenching and complicated decisions can be related to reproductive health, a situation I went through with my first wife,” he told me in a phone interview Sunday afternoon.In the late 1980s in Detroit, Peters and his then wife, Heidi, were pregnant with their second child, a baby they very much wanted. Heidi was four months along when her water broke, leaving the fetus without amniotic fluid—a condition it could not possibly survive. The doctor told the Peters to go home and wait for a miscarriage to happen naturally.But it didn’t happen. They went back to the hospital the next day, and the doctor detected a faint heartbeat. He recommended an abortion, because the fetus still had no chance of survival, but it wasn’t an option due to a hospital policy banning the procedure. So he sent the couple again home to wait for a miscarriage. “The mental anguish someone goes through is intense,” Peters says, “trying to have a miscarriage for a child that was wanted.”As they waited, Heidi’s health deteriorated. When she returned to the hospital on the third day, after another night without a natural miscarriage, the doctor told her the situation was dire. She could lose her uterus in a matter of hours if she wasn’t able to have an abortion, and if she became septic from the uterine infection, she could die.The doctor appealed to the hospital’s board for an exception to their anti-abortion policy and was denied. “I still vividly remember he left a message on the answering machine saying, ‘They refused to give me permission, not based on good medical practice, simply based on politics. I recommend you immediately find another physician who can do this procedure quickly,’” Peters recalls.The Peters were able to get into another hospital right away because they were friends with its chief administrator. Heidi was rushed into an emergency abortion that saved her uterus and possibly her life. The whole experience was “painful and traumatic,” Heidi shared in a statement. “If it weren’t for urgent and critical medical care, I could have lost my life.”…Reflecting on the experience now, Senator Peters says it “enacted an incredible emotional toll.” So why go public with it? “It’s important for folks to understand that these things happen to folks every day,” he explains. “I’ve always considered myself pro-choice and believe women should be able to make these decisions themselves, but when you live it in real life, you realize the significant impact it can have on a family.”… October 12, 2020: Lambda Legal posted a press release titled: “What You Need to Know About Amy Coney Barrett”. From the press release: On Monday, October 12, at 9 am Eastern, the Senate Judiciary Committee began confirmation hearings for Judge Amy Coney Barrett to the United States Supreme Court.It is impossible to overstate how consequential a Justice Coney Barrett would be to the rights of LGBTQ people and everyone living with HIV.Lambda Legal has done a deep dive into her record with respect to the issues that affect our communities the most and put the following guide together explaining exactly what is at stake. Marriage EqualityJudge Barrett’s approach to questions of constitutionally protected personal liberty is not only inconsistent with, but would seek to roll back, landmark decisions that have been essential to the ability of LGBTQ people to live authentically, to protect their families, and to make deeply personal decisions without fear of government interference. In 2016, then-Professor Barrett gave a presentation in which she expressed that marriage should not be viewed as a fundamental right for same-sex couples and instead should be decided on a state-by-state basis. This approach mistakenly erases the duty of courts to enforce everyone’s constitutional rights. If followed, it would deny equal liberty, dignity and autonomy to LGBTQ people, women, racial minorities and any other marginalized community historically denied those rights. Just last week, Justices Clarence Thomas and Samuel Alito authored a troubling statement in a case involving Kim Davis, the clerk in Kentucky who sought a special exception for issuing marriage licenses to same-sex couples. In their statement, they took issue with the majority opinion in Obergefell v. Hodges, the case that made marriage equality the law of the land, saying that individual states should have been able to “resolve this question through legislation” and claimed the Court wrongfully “bypassed that democratic process.” It is clear that if confirmed, Justice Barrett would be in good company.In 2015, Coney Barrett signed onto a letter that said that she supports “marriage and family founded on the indissoluble commitment of a man and a woman.”Transgender RightsIn a lecture discussing issues that could soon come before the Supreme Court, then-Professor Barrett expressed the legally unsound and troubling view that transgender people are not protected by Title IX’s federal prohibitions against sex discrimination in the context of education programs.Judge Barrett’s approach has been soundly rejected by jurists spanning the political spectrum, perhaps most authoritatively twenty years ago by her mentor, Justice Scalia, for a unanimous Supreme Court, and most recently reaffirmed by Justice Gorsuch for a six-member majority in Bostock v. Clayton County, which extended federal protections against sex discrimination to LGBTQ employees. Equally, if not more disturbing, is how Judge Barrett has characterized transgender people. For example, she has opined that “eople will feel passionately on either side about whether physiological males who identify as females should be permitted in bathrooms especially where there are young girls present.” (emphasis added). This misgendering of transgender people, particularly of transgender youth, callously disregards the legitimacy of their identity. Furthermore, this rhetoric invokes defamatory falsehoods suggesting not only that transgender girls are not truly girls, but that they somehow pose a threat to cisgender girls. Judge Barrett’s ardent but misguided views about transgender people deserve particular scrutiny due to the number of issues likely to come before the Supreme Court soon, including Title IX’s protections for transgender students, the Trump administration’s ban on military service by transgender people, and numerous rule changes adversely affecting the ability of transgender people to work, stay in school, receive medically necessary care, and fully participate in public life.Health CareDespite the Affordable Care Act’s success in making coverage available for millions and although our country is suffering through the worst health crisis in a century, the U.S. Supreme Court will hear oral arguments about the constitutionality of the ACA just one week after the election. LGBTQ people and people living with HIV are more than twice as likely to be uninsured as the general population. Also, the judicial repeal of the ACA would unwind the progress made in significantly decreasing uninsured and underinsured rates for people living with HIV following the passage of the ACA. It is beyond question that Judge Barrett’s supporters, including President Trump, know they can count on her to remain consistent in her academically fringe view that the ACA is unconstitutional. Given her public positions and the partisan nature of the debates about the law’s fate, any claims to believe she would have an open mind if elevated cannot be credited.In 2017, then-Professor Barrett wrote that Justice Roberts “pushed the Affordable Care Act beyond its plausible meaning to save the statute” in NFIB v. Sebelius (SCOTUS case upholding the individual mandate a tax valid under the Taxing power). Access to health care is an issue of profound importance to LGBTQ people and people living with HIV. The Affordable Care Act (ACA) has expanded health care coverage for over 20 million people and has saved and improved untold numbers of lives. In addition, over 130 million people in the U.S. (including millions of Coronavirus survivors) suffer from preexisting conditions.Reproductive RightsIn 2006, Judge Barrett signed onto a full-page newspaper ad demanding an end to legal abortion. Following a pattern set by many Trump administration nominees, Judge Barrett then failed to disclose this information on her Senate Judiciary Committee questionnaire. Notably, Professor Barrett also has expressed her hostility towards contraceptive insurance by joining a letter in 2012, referring to the ACA’s birth control insurance coverage as “Unacceptable.” Her position reflects not only her personal view that human life should be protected from the moment an egg is fertilized, a view far outside the mainstream, but also that our legal system should support that view despite the equally sincere religious and moral beliefs of those who disagree and whose lives would be directly affected. If views about reproductive health care were to become the law of the land, many thousands of couples – LGBTQ and not – who have depended on infertility medicine to become parents would not be able to start families. Racial EquityWe are also deeply troubled by Judge Barrett’s apparent lack of commitment to racial equity. In one especially troubling case, Judge Barrett denied rehearing of a decision in favor of a company that had segregated its employees by race. She took this position despite the explanation given by the dissent that the policy had violated the core teaching of Brown v. Board of Education, that “separate is inherently unequal, because deliberate racial segregation by its very nature has an adverse effect on the people subjected to it.” Judge Barrett’s complicit acceptance of racial segregation in a contemporary workplace is deeply disturbing and demonstrates a profound misunderstanding or minimization both of the harms of such a policy and the overriding responsibility of federal judges to enforce the statutory and constitutional bans on such racialized abuses of power.Affiliation with Anti-LGBTQ OrganizationsJudge Barret has also given lectures for a law student training program sponsored by the Alliance Defending Freedom (ADF), an organization dedicated, among other goals, to recriminalizing same-sex relationships, to preventing marriage equality, and now to expanding religious rights to refuse services to same-sex couples, both married and unmarried, and to exclude transgender people from public life. ADF’s overseas advocacy defends harsh criminal penalties for same-sex intimacy and supports forced sterilization of transgender people. In the United States, ADF is among the largest, best known, and most extreme of the many anti-LGBT legal organizations. Judge Barrett’s decision to affiliate herself with this organization demonstrates a marked lack of respect and concern for the countless LGBTQ people who are denied services, shunned, and otherwise harmed due to the advocacy of organizations like ADF. It is impossible to believe that she would be able to administer fair and impartial justice to members of a group she has so disdained. October 12, 2020: Senator Kamala Harris posted a press release titled: “Harris: Republicans Are Rushing Confirmation to Strike Down Affordable Care Act”. From the press release: U.S Senator Kamala D. Harris (D-CA), a member of the Senate Judiciary Committee on Monday participated in the hearing to consider the nomination of Judge Amy Coney Barrett to the Supreme Court of the United States. Senator Harris spoke out against Senate Republicans’ attempt to jam through a nominee who will take away healthcare from millions of Americans – all while our nation is in the midst of a deadly pandemic. In her statement, Harris highlighted that the legacy of Justice Ruth Bader Ginsburg and the rights she fought to protect are at stake with Barrett’s nomination. Harris demanded the committee wait to confirm a new Supreme Court justice until after the American people – who are currently voting – have the chance to decide who they want in the White House.Key Experts: This hearing has brought together more than 50 people to sit inside of a closed door room for hours while our nation is facing a deadly airborne virus. This committee has ignored commonsense requests to keep people safe.Senate Republicans have made it crystal clear that rushing a Supreme Court nomination is more important than helping and supporting the American people who are suffering from a deadly pandemic and a devistating economic crisis.A clear majority of Americans want whomever wins this election to fill this seat. And my Republican colleagues know that. Yet they are deliberately defying the will of the people in their attempt to roll back the rights and protections provided under the Affordable Care Act.Republicans finally realized the Affordable Care Act is too popular to repeal in Congress, so now they are trying to bypass the will of voters and have the Supreme Court do their dirty work.By replacing Justice Ruth Bader Ginsburg with someone who will undo her legacy, President Trump is attempting to roll back Americans’ rights for decades to come.Every American must understand that with this nomination, equal rights under law is at stake. Our voting rights are at stake. Workers’ rights are at stake. Consumer rights are at stake. The right to safe and legal abortion is at stake. Holding corporations accountable is at stake.And again there is so much more.I believe we must listen to our constitutients and protect their access to health care, and wait to confirm a new Supreme Court justice until after Americans decide who they want in the White House. A full transcript of Harris’s statement is posted in that press release (under the bullet-point section. October 13, 2020: American Journal of Preventative Medicine posted a study titled: “Women’s Reproductive Rights Policies and Adverse Birth Outcomes: A State-Level Analysis to Assess the Role of Race and Nativity Status”. It was done by May Sudhinaraset; PhD, Dovile Vilda; PhD, Jessica D. Gipson, MPH, PhD; and Maeve E. Wallace, MPH, PhD. From the study: Introduction:Reproductive rights policies can potentially support or inhibit individuals’ abilities to attain the highest standard of reproductive and sexual health; however, research is limited on how broader social policies may differentially impact women of color and immigrants in the U.S. This study examines the associations among state-level reproductive rights policies, race, and nativity status with preterm births and low birth weight in the U.S….…Results:Compared with women in states with the most restrictive reproductive rights policies, women living in the least restrictive states had a 7% lower low birth weight risk… In particular, low birth weight risk was 8% lower among Black women living in the least restrictive states than among their counterparts living in the most restrictive states… In addition, low birth weight risk was 6% lower among U.S.-born Black women living in the least restrictive states than among those living in the most restrictive states, but this was marginally significant. …No other significant associations were found for race-nativity-stratified models.Conclusions:Women living in states with fewer restrictions related to reproductive rights have lower rates of low birth weight, especially for Black women……Discussion:Despite the increasing restrictions on reproductive rights in recent years, there are remarkably few empirical studies assessing the association between state-level restrictive reproductive policies and adverse birth outcomes by nativity status and race/ethnicity. This study aligns with other research that has found that women living in less restrictive versus those living in more restrictive states have better birth outcomes. Moreover, this study find that less restrictive policy environments were particularly protective for Black women, with evidence that this may be especially true for U.S.-born Black women.These findings provide evidence for important policy levers that could be implemented to improve women’s reproductive health generally, with particular benefits for U.S.-born Black women, such as increasing abortion access and mandatory sex education in schools. The U.S. has a long history of oppressive reproductive policies and ideologies that results in the devaluation of certain lives, mainly racial/ethnic minorities. Past examples include the passage of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and the racist stereotypes of Black mothers as welfare queens to control reproduction, the eugenics movement; and the country’s history of involuntary and nonconsensual sterilization, especially among immigrant, Black, and incarcerated women. Moreover, new contraceptive technologies have been targeted to Black women, and several states have introduced legislation to restrict sex- and race-selective abortion policies, which are devoid of scientific justification and only serve to propagate stereotypes targeting Asian, Latina, and Black women and to restrict reproductive rights.There were no significant associations for foreign-born women. This suggests that other factors beyond nativity status may explain the association between reproductive rights and birth outcomes, such as documentation status, length of time in the U.S., social support networks, and broader policy climates. Undocumented women may be systematically excluded from public benefits altogether, whereas those living in mixed-status families may experience spillover/chilling effects owing to social proximity with targeted individuals. Moreover, recent immigrants are more likely to experience a health advantage in regard to birth outcomes, whereas others have found that broader restrictive immigration policies increase adverse birth outcomes among Latinas. Corroborating previous literature, this study also found that the extent to which states collaborate with federal immigration authorities was associated with higher rates of LBW.When considered jointly, both race/ethnicity and nativity played a role in shaping the risk for adverse birth outcomes associated with the state’s reproductive rights climate. That is, the findings showed significant associations between LBW and states’ reproductive rights climate among U.S.-born but not among foreign-born Black women. This finding is in line with the growing literature on the context-dependent nature of race as a determinant of population health. It may be that U.S.-born Black women’s reproductive health is shaped by the accumulation of insults to health accrued over their lifetime (and even over generations before them) living within a systematically racist society. Foreign-born women, on the other hand, may have had less time exposed to the historical and contemporary features of structural racism that restrict access to health-promoting resources and opportunities among people of color in the U.S. It should be noted, however, that fully adjusted interaction models and stratified models showed marginal significance, and therefore, these results may be due to chance. However, these significant findings persisted in the models run with different combinations of covariates (i.e., state-level poverty instead of poverty and opportunity index) for U.S.-born Black women. Future studies should explore this finding further, including qualitative studies to further examine the lived experiences of Black women….…Conclusions:Reproductive rights policies play a critical role in advancing maternal and child health outcomes. Further studies should assess specific evidence-based policies, particularly highlighting women’s lived experiences of policy exclusion or inclusion, and the effects on women and newborn health… October 13, 2020: Facebook posted information in their Newsroom titled: “Supporting Public Health Experts’ Vaccine Efforts”. It was written by Kang-Xing Jin, Head of Health, and Rob Leathern, Director of Product Management. From the post: The COVID-19 pandemic has highlighted the importance of preventive health behaviors. While public health experts agree that we won’t have an approved and widely available COVID-19 vaccine for some time, there are steps that people can take to stay healthy and safe. That includes getting the seasonal flu vaccine. So today we’re announcing new steps as part of our continued work to help support vaccine efforts. These include: Launching a new flu vaccine information campaign on Facebook, including new product features that provide additional vaccine-related content.Rejecting ads globally that discourage people from getting a vaccineWorking with global health partner on campaigns to increase immunization rates… …Prohibiting Ads that Discourage VaccinesToday, we’re launching a new global policy that prohibits ads discouraging people from getting vaccinated. We don’t want these ads on our platform.Our goal is to help messages about the safety and efficacy of vaccines reach a broad group of people, while prohibiting ads with misinformation that could harm public health efforts. We already don’t allow ads with vaccine hoaxes that have been publicly identified by leading global health organizations, such as the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC). Now, if an ad explicitly discourages someone from getting a vaccine, we’ll reject it. Enforcement will begin over the next few days……Ads that advocate for or against legislation or government policies about vaccines – including a COVID-19 vaccine – are still allowed. We’ll continue to require anyone running these ads to get authorized and include a ‘Paid for by’ label so people can see who is behind them. We regularly refine our approach around ads that are about social issues to capture debates and discussions around sensitive topics happening on Facebook. Vaccines are no different. While we may narrow enforcement in some areas, we may expand it in others…. October 13, 2020: Center for Reproductive Rights posted a press release titled: “Texas Ban on Standard Abortion Procedure Struck Down by Federal Appeals Court”. From the press release: In a victory for Texans, the U.S. 5th Circuit Court of Appeals today struck down a Texas measure that would have banned the standard method of abortion after approximately 15 weeks of pregnancy, known as D&E. This lawsuit was filed in 2017 by Whole Woman’s Health — which operates three health clinics in the state of Texas — several Planned Parenthood affiliates, and other Texas abortion providers, represented by the Center for Reproductive Rights, Planned Parenthood Federation of America, Morrison & Foerster, and Patrick J. O’Connell. In the decision, Judge James L Dennis wrote, “ unduly burdens a woman’s constitutionally-protected right to obtain a previability abortion,” and that the law “also forces abortion providers to act contrary to their medical judgment and the best interest of their patient by conducting a medical procedure that delivers no benefit to the woman.”Doctors who violate the ban would have faced up to two years in prison. Major medical organizations including the American College of Obstetricians and Gynecologists (ACOG) strongly oppose these types of abortion bans, noting, “These restrictions represent legislative interference at its worst: doctors will be forced, by ill-advised, unscientifically motivated policy, to provide lesser care to patients. This is unacceptable.” Courts have blocked similar bans in Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, and Oklahoma. Last year, the Supreme Court declined to review a lower court decision striking down a D&E ban in Alabama. “Today’s win is an important one for people not only in Texas but across the country,” said Amy Hagstrom Miller, President and CEO of Whole Woman’s Health. “Everyone deserves to benefit from advancements in medicine and from expert medical care, no matter where they live. With this victory, our physicians can continue to practice to the highest level of their training, and Texans will continue to benefit from their expertise. We are proud, once again, to lead the charge challenging bad laws and ensuring that all Texans get the healthcare they deserve.” “Today’s decision puts a stop to Texas’ strategy to ban one abortion procedure after another until it is all but inaccessible,” said Nancy Northup, president and CEO of the Center for Reproductive Rights. “Politicians should never decide what medical procedures a patient can and cannot receive. This ruling follows decades of Supreme Court precedent and the Fifth Circuit has joined every other federal court in striking down these types of bans.” ……The decision comes four months after the Supreme Court struck down a medically unnecessary Louisiana law in June Medical Services v. Russo — a case brought by the Center for Reproductive Rights. If that law had been allowed to take effect, it would have closed all but one of the remaining health centers providing abortion in Louisiana. In 2016, the Supreme Court struck down an identical law in Texas that shuttered half the abortion clinics in the state in Whole Woman’s Health v. Hellerstedt. The Supreme Court ordered the state of Texas to pay $2.3 million in attorney’s fees for that case. “Today’s ruling means that my colleagues and I can continue to provide the highest quality medical care for our patients. The state’s attempt to interfere in private, deeply personal health care decisions by banning the most common method of abortion at this stage of pregnancy would have put patients in danger and punished doctors for using our best medical judgment, training, and expertise,” said Dr. Bhavik Kumar, abortion care provider, Planned Parenthood Center for Choice (serves Houston and southeast Texas). “Unfortunately, extremist politicians’ ongoing attempts to restrict access to abortion — method by method, state by state — until it is completely out of reach are all too familiar to physicians like myself. Thankfully, the court today affirmed what we have always known: that private medical decisions should stay between patients and the doctors they trust with their health care.”Just six months ago, Gov. Greg Abbott and Attorney General Ken Paxton successfully exploited the COVID-19 pandemic to temporarily ban abortion in Texas for approximately one month. While the abortion ban was in effect, patients were forced to travel hundreds of miles to access the care they needed.Since 2011, state politicians have passed more than 480 restrictions on abortion. Texas already has many onerous laws and regulations that make it harder for Texans to access abortion, including state-mandated biased counseling, a two-trip requirement and mandatory 24-hour delay in care, a ban on the use of telemedicine to provide medication abortion, a parental consent and notification law, and many more.This lawsuit challenging Texas’ ban on D&E procedures was filed in 2017 in the U.S. District Court for the Western District of Texas on behalf of Whole Woman’s Health, Planned Parenthood Center for Choice, Planned Parenthood of Greater Texas Surgical Health Services, Planned Parenthood South Texas Surgical Center, Alamo Women’s Reproductive Services, Southwestern Women’s Surgery Center, and several individual physicians. The plaintiffs are represented by the Center for Reproductive Rights, Planned Parenthood Federation of America, Morrison & Foerster who is serving as pro-bono counsel, and Austin attorney Patrick J. O’Connell. October 13, 2020: Slate posted an article titled: “Amy Coney Barrett Explained Why She Doesn’t Care About Preexisting Conditions”. It was written by Jeremy Stahl. From the article: …On Tuesday, as expected, the Democrats put the matter directly to the nominee. Barrett has expressed disagreement with the court’s reasoning in the 2012 case that upheld the Affordable Care Act, but when asked now, she emphasized that California v. Texas involves a completely different question than the previous decision did. Specifically, she said, the new case is about “severability”—that is, whether, with the act’s insurance mandate now cut down to zero, the rest of the statute can survive on its own or must also be abandoned.By Barrett’s account, this is a narrow legal question. If the question is decided a certain way, 20 million Americans will lose their health coverage and 100 million people will lose their protections for preexisting conditions. Nevertheless, Barrett told the committee that the upcoming case “doesn’t present the issue” of preexisting condition protections.Here, despite her efforts to tell the committee as little as possible about her beliefs, Barrett revealed an enormous amount about her judicial philosophy. In her opening statement on Monday, she told the committee that “courts are not designed to solve every problem or right every wrong in our public life.” Evidently, that meant real-world consequences of the decisions she may make should not be relevant to her, the Senate, or the general public.Here is that revelatory exchange, in which the ranking minority member, Sen. Dianne Feinstein, told a story about a constituent of Wisconsin Sen. Tammy Baldwin’s who, because of a cascade of health care expenses, depended on the ACA’s protections to be able to afford treatment…As you can see, Barrett answered that the case the court would soon be hearing had nothing to do with those protections, as far as she understood it. Here’s the text of the exchange:Feinstein: Jimmy is a 34-year-old and member of the Wisconsin state Legislature. In 2010 a drunk driver hit the family’s car as they were returning home from celebrating Jimmy’s 24th birthday. Jimmy’s mother, father, and little brother were killed in the accident. Jimmy was paralyzed from the waist down. His medical recovery was intense. As Jimmy as has said, “Doctors managed to patch me up with dozens of stitches and multiple surgeries and about a pound of steel in my spine.” But soon after, his insurance company told him he was nearing his lifetime maximums and he would have to pay for the rest of his health care expenses. As Jimmy explains: “With hundreds of thousands of dollars still left to go, I didn’t know what I was going to do. I was scared, I was terrified, I was just a student, I didn’t have that kind of money.” Fortunately, a few days later, the insurance company sent him a different letter. This one informed him that the provisions of the ACA had kicked in, which meant there were no longer lifetime maximums and his care would be covered. In Jimmy’s own words, “I was able to put my life back together and I credit the Affordable Care Act for that.” Judge Barrett, how should the loss of the ACA’s protection against lifetime caps, caps that can be used to end coverage for lifesaving care, factor into a court’s consideration of the validity of the ACA?Barrett: Senator, so far as I know, the case next doesn’t present that issue. It’s not a challenge to preexisting conditions coverage or to the lifetime maximum relief remote cap.This is a technical distinction so fine as to cross over into dishonesty. Barrett professes not to see how, if she made a ruling in a case that would strip away protections from people with preexisting conditions, that case would be a challenge to those protections. The people would only be losing their protections incidentally as she decided the completely different question of severability.Later, Vermont Sen. Patrick Leahy asked a series of questions about whether Barrett had any awareness of how many people would lose protections if she were to rule against the ACA after being elevated to the Supreme Court. She responded that she had no clue.And here’s the text of the exchange:Leahy: Do you know how many Americans have obtained insurance through the Affordable Care Act?Barrett: I do not.Leahy: It’s more than 20 million. And do you know how many children under the age of 26 are able to stay on their parents’ insurance because of the Affordable Care Act?Barrett: I do not.Leahy: It’s 2.3 million. And do you know how many Americans are covered under the Affordable Care Act’s Medicaid expansion?Barrett: I do not.Leahy: It’s a little more than 15 million. … If the Republicans are successful in what they’re trying to do on Nov. 10, then Alex and actually 60,600 other Vermonters enrolled in Medicaid expansion are going to be left behind. And if you contract COVID-19, that’s seen as a preexisting condition. Do you know approximately how many million Americans have tested positive for the coronavirus and survived?Barrett: I do not.Leahy: It’s more than 7,700,000. Those are people now considered to have a preexisting condition. And one of the most common preexisting conditions is diabetes. The CDC estimated about 1 in 10 Americans has diabetes. The ACA’s Medicaid expansion is the single most important factor for expanding access to affordable insulin. Leslie is a Vermonter diagnosed with diabetes at the age of 25. For years she has depended on Medicaid to keep her alive and out of bankruptcy. … Do you have an idea how much her insulin would increase?Barrett: No, I do not.Leahy: I wouldn’t expect you to. There’s no reason you should. Leslie’s cost would more than triple—go up to $11,215 a year.Barrett doesn’t need to know the cost of insulin; she doesn’t need to know how many people in this country have COVID-19; she doesn’t need to know how many millions of Americans are covered under Medicaid expansion or under the Affordable Care Act as a whole. It’s not the courts’ job to “right every wrong,” even if those wrongs are directly caused by the decision the court would make… October 13, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Continues Fight to Stop Trump Administration Dangerous “Healthcare Refusal Rule”. From the press release: California Attorney General Xavier Becerra today filed a brief in the Ninth Circuit Court of Appeals continuing the fight against the Trump Administration’s unconstitutional and illegal “Healthcare Refusal Rule.” The broad, unfettered Rule jeopardizes the health and safety of Californians by allowing anyone remotely involved in a healthcare transaction—from doctors to ambulance drivers or front office staff— to deny care. This exemption would open the door to discrimination, particularly against women, LGBTQ individuals, people of color, individuals in rural and low-income communities, and endanger the timely delivery of critical lifesaving care. In the brief, Attorney General Becerra reasserts that the Rule violates the U.S. Constitution and the Administrative Procedure Act, arguing that the District Court was correct to vacate the rule in its entirety. “In the midst of a devastating pandemic, the Trump Administration continues to heartlessly attack Americans’ access to lifesaving healthcare by allowing a blank check for discrimination which will leave our communities vulnerable to loss of care or stigmatized for receiving basic care,” said Attorney General Becerra. “The Healthcare Refusal Rule dangerously and unlawfully throws open the doors to discrimination, going so far as to allow an EMT worker to leave a woman to bleed out by the side of the road. It’s unconscionable that the government would push this heartless rule. California will continue fighting for the right to healthcare and to ensure that this illegal rule will never take effect.”The Trump Administration’s rule vastly and illegally expands federal law and coerces state compliance by threatening federal funding. For California, nearly half a trillion dollars of federal funding is at stake. The State of California has laws and regulations to protect access to healthcare while respecting “conscience” objections, in accordance with numerous existing federal conscience provisions. However, the Healthcare Refusal Rule issued by the Trump Administration’s U.S. Department of Health and Human Services (HHS) goes far beyond existing provisions, creating a broad exemption that risks access to care. The new rule would allow anyone remotely involved in a healthcare transaction – from front desk staff to emergency personnel to private entities – to object not just for religious reasons, but for “moral, ethical, or other” reasons as well.In the brief, the attorney general asserts that the Rule would compromise patient access to care, and encourage discrimination against vulnerable patient populations, including women, people of color, LGBTQ individuals, and rural and low-income communities. The Rule would also have devastating impacts on patients and employers: the rule does not require any notice be given to patients who are refused care, and it provides no guidance for employers who must navigate how to accommodate these refusals. Furthermore, the Rule contains no exception for patients who need emergency care, thus threatening serious, potentially irreversible, harm to those in need of life-sustaining care. HHS’ counsel has even conceded that the Rule would permit an ambulance driver to cease driving in the middle of Central Park “en route to hospital…upon learning that the patient sought emergency care for ectopic pregnancy,” and that an employer’s failure to accommodate that ambulance driver could “result in a loss of federal funding.” These harsh outcomes not only conflict with federal law, but would greatly undermine California’s longstanding efforts to ensure access to emergency care for its residents.Attorney General Becerra also argues that the Rule violates the Administrative Procedure Act and the U.S. Constitution’s Spending Clause by threatening federal funding for California’s programs that provide crucial health, education, and labor services, including: $63 billion for healthcare services such as Medi-Cal;$1.5 billion for public health initiatives including emergency preparedness and vaccination programs;$6 billion for in-home supportive services;$2.5 billion for child welfare and refugee assistance$3.8 billion for educational programs, including child care and state preschool programs, migrant education, adult education, education for homeless children, special education, and vocational education; and$900 million for providing short-term income to unemployed individuals, funding local workforce development, and providing services to job seekers and employers… …Attorney General Becerra filed today’s brief alongside Santa Clara County, the City and County of San Francisco, Trust Women Seattle, Los Angeles LGBT Center, Whitman-Walker Clinic, Inc., Bradbury Sullivan LGBT Community Center, Center on Halsted, Hartford Gyn Center, Mazzoni Center, Medical Students For Choice, The Association of LGBT+ Psychiatrists, American Association of Physicians For Human Rights: Health Professionals Advancing LGBT Equality, and individual plaintiffs. A copy of the brief can be found here October 13, 2020: Former Vice President Joe Biden (Democrat) tweeted: “Donald Trump has been trying to throw out Obamacare for years. And now he sees an opportunity to finally get it done, all while ignoring the will of the people. We can’t let him.” October 14, 2020: Planned Parenthood posted a press release titled: “Federal Court Strikes Down Tennessee’s Forced Waiting Period for Abortions”. From the press release: Today, a federal district court struck down a Tennessee law that forced patients to wait at least 48 hours before they can access abortion services, after receiving in-person, state-mandated counseling written by anti-abortion politicians. The law had been in effect since 2015. Roughly half of the states in the U.S. have similar forced waiting period laws on the books. The case was brought by reproductive health care providers in the state, represented by the Center for Reproductive Rights, Planned Parenthood Federation of America (PPFA), Kramer Levin Naftalis & Frankel LLP, Barrett Johnston Martin & Garrison, LLC, and Jessee & Jessee. In the decision, Judge Bernard Friedman wrote, “Defendants’ suggestion that women are overly emotional and must be required to cool off or calm down before having a medical procedure they have decided they want to have, and that they are constitutionally entitled to have, is highly insulting and paternalistic – and all the more so given that no such waiting periods apply to men.” He went on to write, “It is apparent that this waiting period unduly burdens women’s right to an abortion and is an affront to their ‘dignity and autonomy,’ ‘personhood’ and ‘destiny,’ and ‘conception of . . . place in society.’” ……This decision comes four months after the Supreme Court struck down a medically unnecessary Louisiana law in June Medical Services v. Russo. If that law had been allowed to take effect, it would have closed all but one abortion clinic in Louisiana. The Center is challenging waiting period measures in Arizona, Florida, Louisiana, Mississippi, and Oklahoma. PPFA, the ACLU, and the Center are also challenging a waiting period measure in North Carolina. These laws have particularly harsh consequences for those who already face systemic barriers to comprehensive reproductive health care, including individuals with low incomes, people of color, people living in rural areas, and individuals in abusive relationships, which are compounded by the mandatory delay and two-trip requirement. At trial in September 2019, Tennessee abortion providers testified that most patients are waiting much longer than 48 hours. The providers also testified that after this waiting period took effect in 2015, they saw a decrease in the number of patients with low incomes obtaining abortions at their facilities and a rise in the number of patients obtaining procedures later in pregnancy. Tennessee has one of the highest poverty rates in America, with poverty disproportionately impacting women, especially those who already have children. Delays in accessing abortion increase the costs associated with the procedure, and although abortion is extremely safe throughout pregnancy, the medical risks increase as pregnancy progresses. Major medical associations denounce these restrictions, and the American College of Obstetricians and Gynecologists (ACOG) states these laws “marginalize abortion services from routine clinical care and are harmful to women’s health.” In addition to the mandatory delay, Tennessee laws impose other barriers on abortion access, including limits on when state and public insurance can cover abortion services, a ban on the use of telemedicine to administer medication abortion, and a requirement that minor patients obtain parental consent. The Center and PPFA are currently challenging a series of abortion bans passed earlier this year in Tennessee and a law that forces doctors to tell their patients false information about medication abortion. Both laws are currently blocked. October 14, 2020: Senator Tammy Baldwin (Democrat – Wisconsin) tweeted: “Republicans in Congress tried repeatedly & failed to repeal the #ACA in Congress. So Trump’s Justice Department is asking the Supreme Court to overturn the health care law completely, including protections for people with pre-existing conditions #WhatsAtStake”. October 14, 2020: Lambda Legal posted a press release titled: “Advocates Urge Federal Court to Affirm Ruling Striking Down Trump Administration Denial of Care Rule”. From the press release: Today, Lambda Legal, Americans United for Separation of Church and State, the Center for Reproductive Rights, and the County of Santa Clara filed an answering brief with the U.S. Court of Appeals for the Ninth Circuit urging the court to affirm a lower court ruling striking down the Denial of Care Rule proposed by the U.S. Department of Health and Human Services (HHS).In that earlier ruling issued in November, 2019, U.S. District Court for the Northern District of California Judge William H. Alsup found the proposed Denial of Care Rule “saturated with error,” and struck the rule down in its entirety. Judge Alsup became the third judge in rapid succession last November to vacate the rule, joining judges for the Eastern District of Washington and Southern District of New York.“There is no rationale for breathing life into a rule Judge Alsup found ‘so saturated with error’ that he could find literally no aspect of it that passed constitutional muster,” said Camilla Taylor, Director of Constitutional Litigation, Lambda Legal. “Three separate federal judges last November recognized the Denial of Care Rule for what it is, an egregious and unconstitutional attack on women, LGBTQ people and other vulnerable populations. It deserved to be relegated to the dustbin of history, and it deserves to stay there.” The Denial of Care Rule, which was issued in May, 2019, by the U.S. Department of Health and Human Services, invited any health care worker – including doctors, nurses, EMTs, administrators, janitors and clerical staff – to deny medical treatment, information and services to patients because of personal religious or moral beliefs. Health care facilities risked losing essential federal funding if they did not grant employees carte blanche to deny services. Because the rule was confusing and infeasible to implement, many health care facilities would likely have been forced to eliminate services such as reproductive and LGBTQ care, leaving millions across the United States without access to critical health care.On November 6, 2019, the U.S. District Court for the Southern District of New York issued a ruling in State of New York v. HHS completely vacating the Denial of Care Rule. The next day, November 8, 2019, Judge Stanley Bastian of the U.S. District Court for the Eastern District of Washington ruled from the bench in State of Washington v. Azar, agreeing with the ruling out of New York. Judge Alsup’s ruling in three cases combined for argument – County of Santa Clara v. HHS, City and County of San Francisco v. Azar, and State of California v. Azar – issued on November 19, 2019.In addition to the County of Santa Clara, which runs an extensive health and hospital system that serves as a safety-net provider for the county’s 1.9 million residents, the plaintiffs in County of Santa Clara v. HHS include: the health providers Bradbury-Sullivan LGBT Community Center in Allentown, Pa.; Center on Halsted in Chicago; Hartford GYN in Connecticut; Los Angeles LGBT Center; Mazzoni Center in Philadelphia, and Whitman-Walker Health in Washington, D.C.; the associations AGLP, GLMA, and Medical Students for Choice; and five doctors. Read today’s filing here. In addition to the three cases combined in County of Santa Clara v. HHS, the Ninth Circuit has also added State of Washington v. Azar for purposes of the appeal. October 14, 2020: Planned Parenthood posted a press release titled: “Texas Ban on Standard Abortion Procedure Struck Down by Federal Appeals Court”. From the press release: In a victory for Texans, the U.S. 5th Circuit Court of Appeals today struck down a Texas measure that would have banned the standard method of abortion after approximately 15 weeks of pregnancy, known as D&E. This lawsuit was filed in 2017 by Whole Woman’s Health — which operates three health clinics in the state of Texas — several Planned Parenthood affiliates, and other Texas abortion providers, represented by the Center for Reproductive Rights, Planned Parenthood Federation of America, Morrison & Foerster, and Patrick J. O’Connell.In the decision, Judge James L Dennis wrote, “ unduly burdens a woman’s constitutionally-protected right to obtain a previability abortion,” and that the law “also forces abortion providers to act contrary to their medical judgment and the best interest of their patient by conducting a medical procedure that delivers no benefit to the woman.”Doctors who violate the ban would have faced up to two years in prison. Major medical organizations including the American College of Obstetricians and Gynecologists (ACOG) strongly oppose these types of abortion bans, noting, “These restrictions represent legislative interference at its worst: doctors will be forced, by ill-advised, unscientifically motivated policy, to provide lesser care to patients. This is unacceptable.” Courts have blocked similar bans in Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, and Oklahoma. Last year, the Supreme Court declined to review a lower court decision striking down a D&E ban in Alabama……The decision comes four months after the Supreme Court struck down a medically unnecessary Louisiana law in June Medical Services v. Russo — a case brought by the Center for Reproductive Rights. If that law had been allowed to take effect, it would have closed all but one of the remaining health centers providing abortion in Louisiana. In 2016, the Supreme Court struck down an identical law in Texas that shuttered half the abortion clinics in the state in Whole Woman’s Health v.Hellerstedt. The Supreme Court ordered the state of Texas to pay $2.3 million in attorney’s fees for that case. Just six months ago, Gov. Greg Abbott and Attorney General Ken Paxton successfully exploited the COVID-19 pandemic to temporarily ban abortion in Texas for approximately one month. While the abortion ban was in effect, patients were forced to travel hundreds of miles to access the care they needed.Since 2011, state politicians have passed more than 480 restrictions on abortion. Texas already has many onerous laws and regulations that make it harder for Texans to access abortion, including state-mandated biased counseling, a two-trip requirement and mandatory 24-hour delay in care, a ban on the use of telemedicine to provide medication abortion, a parental consent and notification law, and many more.This lawsuit challenging Texas’ ban on D&E procedures was filed in 2017 in the U.S. District Court for the Western District of Texas on behalf of Whole Woman’s Health, Planned Parenthood Center for Choice, Planned Parenthood of Greater Texas Surgical Health Services, Planned Parenthood South Texas Surgical Center, Alamo Women’s Reproductive Services, Southwestern Women’s Surgery Center, and several individual physicians. The plaintiffs are represented by the Center for Reproductive Rights, Planned Parenthood Federation of America, Morrison & Foerster who is serving as pro-bono counsel, and Austin attorney Patrick J. O’Connell. October 14, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Joins Coalition in Fight Against Pharmaceutical Company AbbVie Inc.’s Anticompetetive Practices”. From the press release: California Attorney General Xavier Becerra yesterday joined a coalition of 20 state attorneys general in filing an amicus brief in the U.S. Court of Appeals for the Seventh Circuit to address significant issues of antitrust and anticompetitive pharmaceutical agreements involving AbbVie Inc.’s drug, Humira. AbbVie employed numerous strategies to prevent any competition to Humira, including entering into multiple anticompetitive agreements with rival drug companies that allowed AbbVie to raise the price of Humira and limit options for patients. Humira is used to treat inflammation that leads to autoimmune diseases such as Crohn’s disease, ulcerative colitis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis.“California residents spend billions of dollars on prescription drugs like Humira,” said Attorney General Becerra. “When companies like AbbVie are allowed to monopolize the market and hike up the price of these drugs, they put the lives of Californians at risk. During a global pandemic when people have more to worry about than ever, they shouldn’t also have to worry about whether they can afford their prescription medication. My office will continue to tackle these dangerous, collusive pay-for-delay agreements head on.”Humira is the world’s largest selling drug, generating sales of some $20 billion a year and costing approximately $39,000 per year for treatment. AbbVie’s anticompetitive agreements, known as pay-for-delay agreements, allowed rival companies to compete against Humira outside the United States in 2018. But the agreements required the rival companies to delay the introduction in the U.S. of a competitive counterpart to Humira until 2023. With these pay-for-delay agreements, AbbVie could freely raise the price of Humira in the U.S. by 6.2 percent in 2019 followed by a 7.4 percent increase this year. While Humira prices are increasing in the U.S., they are decreasing in Europe where there is competition. Humira’s sky-high price tag and its scheme to protect the inflated Humira price hurts employers, patients, insurers and the government, who all shoulder the burden of those inflated prices. In California, Assembly Bill 824, which went into effect on January 1, 2020, gives the Attorney General a stronger platform to investigate and prosecute these illegal and harmful drug pricing practices.In the brief, the coalition argues: The District Court misapplied the U.S. Supreme Court’s decision in FTC v. Actavis, Inc. (Actavis) to AbbVie’s agreements with its competitors. In Actavis, the U.S. Supreme Court held that the Federal Trade Commission could challenge pay-for-delay agreements under federal antitrust law. The attorneys general argue the lower court decision effectively resurrects the very antitrust immunity that the U.S. Supreme Court specifically rejected in FTC v. Actavis. They assert that the lower court’s approach will embolden other pharmaceutical companies to fashion illegal settlements to creatively evade scrutiny.The Appeals Court should follow the majority of the Courts of Appeal and apply the California Motor Transport rule to serial sham petitioning. Four U.S. Courts of Appeals have reached this conclusion, and in cases alleging serial sham petitioning, the court is presented with more information and is therefore better equipped to assess whether AbbVie misused the government process to curtail competition… …In yesterday’s filing, Attorney General Becerra joined the attorneys general of Washington, Colorado, Connecticut, Delaware, Idaho, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Mexico, New York, North Carolina, Oregon, Rhode Island, Virginia, and Wisconsin. A copy of the brief is available here. October 14, 2020: The Texas Tribune posted an article titled: “New Texas rule lets social workers turn away clients who are LGBTQ or have a disability”. It was written by Edgar Walters. From the article: Texas social workers are criticizing a state regulatory board’s decision this week to remove protections for LGBTQ clients and clients with disabilities who seek social work services.The Texas State Board of Social Work Examiners voted unanimously Monday to change a section of its code of conduct that establishes when a social worker may refuse to serve someone. The code will no longer prohibit social workers from turning away clients on the basis of disability, sexual orientation or gender identity.Gov. Greg Abbott’s office recommended the change, board members said, because the code’s nondiscrimination protections went beyond protections laid out in the state law that governs how and when the state may discipline social workers……The nondiscrimination policy change drew immediate criticism from a professional association. Will Francis, executive director of the Texas chapter of the National Association of Social Workers, called it “incredibly disheartening.”He also criticized board members for removing the nondiscrimination protections without input from the social workers they license and oversee……The Republican-led Texas Legislature has long opposed expanding nondiscrimination protections to LGBTQ Texans in employment, housing and other areas of state law.Alice Bradford, the board’s executive director, said she received an email from the governor’s staff recommending the change Friday, three days before the board’s Monday vote.The vote happened during a joint online meeting of the social work board and the Texas Behavioral Health Executive Council, which oversees a host of regulatory agencies for professions related to mental health……The social work board’s ban on discriminating against clients based on sexual orientation was approved in 2010, Francis said, and gender identity and expression protections were added in 2012.The board fielded comments from the public after it had already changed the rule. Austin social worker Tracy Abzug told board members that “it’s actually quite disturbing to me that the Texas State Board of Social Work Examiners has agreed today to lower our standards as it relates to discrimination towards sexual orientation and gender identity.”… October 14, 2020: Center for Reproductive Rights posted a press release titled: “Federal Court Strikes Down Tennessee’s Forced Waiting Period for Abortions”. From the press release: Today, a federal district court struck down a Tennessee law that forced patients to wait at least 48 hours before they can access abortion services, after receiving in-person, state-mandated counseling written by anti-abortion politicians. The law had been in effect since 2015. Roughly half of the states in the U.S. have similar forced waiting period laws on the books. The case was brought by reproductive health care providers in the state, represented by the Center for Reproductive Rights, Planned Parenthood Federation of America (PPFA), Kramer Levin Naftalis & Frankel LLP, Barrett Johnston Martin & Garrison, LLC, and Jessee & Jessee.In the decision, Judge Bernard Friedman wrote, “Defendants’ suggestion that women are overly emotional and must be required to cool off or calm down before having a medical procedure they have decided they want to have, and that they are constitutionally entitled to have, is highly insulting and paternalistic – and all the more so given that no such waiting periods apply to men.” He went on to write, “It is apparent that this waiting period unduly burdens women’s right to an abortion and is an affront to their ‘dignity and autonomy,’ ‘personhood’ and ‘destiny,’ and ‘conception of . . . place in society.’”“We hope today’s decision serves as a wake-up call to lawmakers trying to interfere with patients’ personal medical decisions,” said Autumn Katz, Senior Counsel at the Center for Reproductive Rights. “Patients do not need politicians to dictate their decision-making process. Patients should be trusted to make decisions about their own families and health care. This law is demeaning and actually harms patients by imposing unnecessary costs and pushing abortion later in pregnancy.” “We are so glad that we can now schedule our patients for care in a manner that centers their needs, not the political vagaries of our state government,” said Rebecca Terrell, executive director of CHOICES Memphis Center for Reproductive Health.“Today’s decision is a win for patients who deserve to be trusted, free of shame and stigma, to make the best health care decisions for themselves and their families. With 17 abortion-related cases one step away from the Supreme Court — including one from Tennessee banning abortion at nearly every stage of pregnancy — it’s clear that the right to access safe, legal abortion is under attack like never before,” said Ashley Coffield, President & CEO, Planned Parenthood of Tennessee and North Mississippi. “So many patients in our region regularly face barriers to care due to a lack of nearby health centers and systemic inequities that make it harder for people with low incomes and people of color to access care. Intrusive, unnecessary, and medically dangerous restrictions like the 48-hour waiting period only make it harder to access basic health care. At Planned Parenthood, we empower people with the information and the care they need to decide the course of their own lives. We will continue to defend their right to bodily autonomy, against any politician or bill that threatens it, no matter what.”This decision comes four months after the Supreme Court struck down a medically unnecessary Louisiana law in June Medical Services v. Russo. If that law had been allowed to take effect, it would have closed all but one abortion clinic in Louisiana.The Center is challenging waiting period measures in Arizona, Florida, Louisiana, Mississippi, and Oklahoma. PPFA, the ACLU, and the Center are also challenging a waiting period measure in North Carolina.These laws have particularly harsh consequences for those who already face systemic barriers to comprehensive reproductive health care, including individuals with low incomes, people of color, people living in rural areas, and individuals in abusive relationships, which are compounded by the mandatory delay and two-trip requirement. At trial in September 2019, Tennessee abortion providers testified that most patients are waiting much longer than 48 hours. The providers also testified that after this waiting period took effect in 2015, they saw a decrease in the number of patients with low incomes obtaining abortions at their facilities and a rise in the number of patients obtaining procedures later in pregnancy. Tennessee has one of the highest poverty rates in America, with poverty disproportionately impacting women, especially those who already have children.Delays in accessing abortion increase the costs associated with the procedure, and although abortion is extremely safe throughout pregnancy, the medical risks increase as pregnancy progresses. Major medical associations denounce these restrictions, and the American College of Obstetricians and Gynecologists (ACOG) states these laws “marginalize abortion services from routine clinical care and are harmful to women’s health.”In addition to the mandatory delay, Tennessee laws impose other barriers on abortion access, including limits on when state and public insurance can cover abortion services, a ban on the use of telemedicine to administer medication abortion, and a requirement that minor patients obtain parental consent. The Center and PPFA are currently challenging a series of abortion bans passed earlier this year in Tennessee and a law that forces doctors to tell their patients false information about medication abortion. Both laws are currently blocked. October 14, 2020: Lambda Legal posted a press release titled: “Advocates Urge Ninth Circuit Court of Appeals to Affirm Ruling Striking Down Trump Administration Denial of Care Rule”. From the press release: Today, Lambda Legal, Americans United for Separation of Church and State, the Center for Reproductive Rights, and the County of Santa Clara filed an answering brief with the U.S. Court of Appeals for the Ninth Circuit urging the court to affirm a lower court ruling striking down the Denial of Care Rule proposed by the U.S. Department of Health and Human Services (HHS).In the earlier ruling, issued in November, 2019, U.S. District Court for the Northern District of California Judge William H. Alsup found the proposed Denial of Care Rule “saturated with error,” and struck the rule down in its entirety. Judge Alsup became the third judge in rapid succession last November to vacate the rule, joining judges for the Eastern District of Washington and Southern District of New York……The Denial of Care Rule, which was issued in May, 2019, by the U.S. Department of Health and Human Services, invited any health care worker – including doctors, nurses, EMT’s, administrtators, janitors and clerical staff – to deny medical treatment, information and services to patients because of personal religious or moral beliefs. Health care facilities risked losing essential federal funding if they did not grant employees carte blanche to deny services. Because the rule was confusing and infeasible to implement, many health care facilities would likely have been forced to eliminate services such as reproductive and LGBTQ care, leaving millions across the United States without critical access to care.On November 6, 2019, the U.S. District Court for the Southern District of New York issued a ruling in State of New York issued a ruling in State of New York v. HHS completely vacating the Denial of Care Rule. The next day, November 8, 2019, Judge Stanley Bastian of the U.S District Court for the Eastern District of Washington ruled from the bench in State of Washington v. Azar, agreeing with the ruling out of New York. Judge Alsup’s ruling in three cases combined for argument – County of Santa Clara v HHS, City and County of San Francisco v. Azar, and State of California v. Azar – issued on November 19, 2019.In addition to the County of Santa Clara, which runs an extensive health and hospital system that serves as a safety-net provider for the county’s 1.9 million residents, the plaintiffs in County of Santa Clara v. HHS include: the health providers Bradbury-Sullivan LGBT Community Center in Allentown, Pa.; Center on Halsted in Chicago; Hartford GYN in Connecticut; Los Angeles LGBT Center; Mazzoni Center in Philadelphia, and Whitman-Walker Health in Washington, D.C.; the associations AGLP, GLMA, and Medical Students for Choice; and five doctors. Read today’s filing here. In addition to the three cases combined in County of Santa Clara v. HHS, the Ninth Circuit has also added State of Washington v. Azar for purposes of the appeal.More information about County of Santa Clara v. HHS is available here October 15, 2020: Senator Jack Reed (Democrat – Rhode Island) tweeted: “Having #healthinsurance can be the difference between life & death. The Trump Admin is suing in federal court to get #SCOTUS to strike down the #ACA & eliminate critical health protections for millions of Americans. We must #ProtectOurCare. The best way to do that is to vote.” October 15, 2020: Center for Reproductive Rights posted a press release titled: “Center’s Legal Analysis Outlines Judge Barrett’s Extreme Record on Reproductive Rights”. From the press release: …The Center for Reproductive Rights has issued an analysis of the judicial rulings, writings and public advocacy of Amy Coney Barrett, President Trump’s nominee to the U.S. Supreme Court to replace Justice Ruth Bader Ginsburg. Based on the analysis, the Center concludes that Judge Barrett “stands all too ready, if not eager, to undermine women’s basic liberty rights”—including the right to abortion. Based on these findings, the Center opposes Judge Barrett’s confirmation.The Center conducted an extensive review of Judge Barrett’s judicial rulings during her three years as an Appellate Court judge, her academic writings and speeches as a law professor at Notre Dame Law School, and her public statements and advocacy. Those records, according to a recent statement issued by the Center, show that “Judge Barrett has the most extreme record in opposition to reproductive rights of any Supreme Court nominee since the rejected nomination of Judge Robert Bork over 30 years ago.“ Highlights of the Center’s analysis include: On the U.S. Court of Appeals for the Seventh Circuit, Judge Barrett ruled against abortion rights both times the issue was before her. In those cases, she joined opinions that suggest upending Supreme Court law on both the substantive right to abortion and the procedural safeguards that allow the right to be vindicated in court.In the first case, Planned Parenthood v. Indiana Department of Health, in 2018, the opinion suggested that the government can ban abortion based on a woman’s reason for having one.In the second case, in 2019, Planned Parenthood v Adams (later Box), the opinion questioned long-standing precedent that abortion providers may challenge restrictive laws before they go into effect.Judge Barrett subscribes to a judicial philosophy of originalism that rejects constitutional protections for abortion rights. Her writings make it clear that she does not view Roe v. Wade as a “super precedent” and she has suggested that if confronted with a conflict between precedent and her interpretation of the Constitution, she would side with the latter and overturn precedent – endangering settled law on abortion rights.She has publicly advocated to end Roe v. Wade and defends “the right to life from fertilization,” an extreme legal position that has implications for contraception, abortion care and fertility treatments. The stakes of this nomination could not be higher. The next Supreme Court justice will hear cases impacting people’s lives for generations to come – not only on issues of reproductive rights, but on access to health care, voting rights, LGBTQ rights, and disability rights. On abortion rights alone, more than a dozen cases are in the Supreme Court pipeline – some test cases to overturn Roe v. Wade or to chip away at Roe’s protections to make them meaningless.The Supreme Court’s vital role in protecting and upholding civil rights and liberties cannot be compromised by a nominee fundamentally hostile to our constitutional rights. The Center for Reproductive Rights opposes the confirmation of Judge Amy Coney Barrett – and urges all supporters of reproductive rights to tell their Senators to vote no on her confirmation. October 15, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Takes Action to Ensure Californians Have Access to Mental Health Care”. From the press release: California Attorney General Xavier Becerra today urged California’s four largest health insurance providers: Anthem Blue Cross, Blue Shield of California, Health Net of California, and Kaiser Permanente, to demonstrate their compliance with state and federal mental health parity laws. In letters addressed to each of the managed care insurance companies, the Attorney General requested information that would help determine if they are providing coverage for mental health benefits and services without putting limitations or conditions on the coverage that are more restrictive than permitted by the law. Equal treatment for mental health conditions in insurance plans is mandated by state and federal laws, including the California Mental Health Parity Act, the federal Mental Health Parity and Addiction Equity Act of 2008, and the Affordable Care Act (ACA). The plans have until November 16, 2020, to voluntarily comply with the information request.“One out of every six Californians experiences some type of mental illness, which is why it is important to ensure our mental health laws are being followed,” said Attorney General Becerra. “It is the job, mandated by the law, of health insurance providers to make access to care for mental health conditions as accessible as care for a medical illness. Now, when people are seeing their mental health worsen as they navigate the COVID-19 pandemic, is a critical time to ensure those who need it have access to care.”Despite multiple laws, including the California Mental Health Parity Act and the ACA, which expanded access to mental health treatment across the country, many Californians still struggle to find appropriate mental health treatment. Many Californians with insurance are also exponentially more likely to go out of network for mental health treatment than for medical services. According to a survey by the Kaiser Family Foundation/California Health Care Foundation, two-thirds of the individuals surveyed reported that they or one of their family members sought but were unable to locate mental health services.In order to investigate mental healthcare coverage, the Attorney General requested documents and information that would ensure Anthem Blue Cross, Blue Shield of California, Health Net of California, and Kaiser Permanente are following mental health parity laws. A copy of the letter to Anthem Blue Cross is available here.A copy of the letter to Blue Shield of California is available here.A copy of the letter to Health Net of California is available here.A copy of the letter to Kaiser Permanente is available here. October 15, 2020: National Organization for Women (NOW) posted a press release titled: “Women Won’t Tolerate Mitch McConnell and Lindsey Graham’s Trickery”. From the press release: The Senate Judiciary Committee wasn’t even finished hearing testimony on the nomination of Judge Amy Coney Barrett to the U.S. Supreme Court when Lindsey Graham railroaded her onto the agenda for a final confirmation vote. He knows that he has no time to spare to make his goal of a final Senate floor vote just days before the election. Amy Coney Barrett couldn’t be a more dangerous choice for women, families, and the future of our democratic freedoms. Her record speaks for itself and shows that she is not someone who will work on behalf of the American people. In fact, she has consistently proven she will not hesitate to suppress our civil rights and freedoms. She has been outspoken in her opposition to the Affordable Care Act and called for the “barbaric legacy” of Roe to end. She took thousands of dollars from a group that was designated an anti-LGBTQIA+ hate group and affirmed a ruling that allowed a company to segregate its employees by race. Judge Barrett repeatedly ruled against the rights of immigrants, said Title IX protections do not extend to transgender Americans, and wrote that Supreme Court justices should not follow precedent with which they disagree. Graham and McConnell know that if Donald Trump loses the election, and the Republicans lose their Senate majority, they will face tough questions from their constituents that they cannot answer. Why have they enabled Trump to divert the work of the Senate away from the urgency of Covid relief for so long? Why should a lame-duck Senate be allowed to radically redefine the Supreme Court? Why are they hijacking the Senate agenda in the middle of a global pandemic to seat Amy Coney Barrett on the Supreme Court—where she can enshrine their opposition to abortion rights, equal pay, paid leave, affordable health care, voting rights, consumer protections, and other progressive policies for generations to come? We know the answer. It’s because they want to hijack democracy and steal another Supreme Court seat for Donald Trump. They don’t want to be held accountable for any of their actions or take the time to listen to what the overwhelming majority of this country has to say. But as Kamala Harris would say, “we’re speaking.” We’re speaking up for democracy, equality, and justice. NOW calls on Democrats in the Senate to do everything they can to stop this vote from coming to the floor this month. We will be turning our words into action with our votes—and the Senate must deal with the consequences. October 16, 2020: Former Vice President Joe Biden tweeted: “We need a president who will expand access to health care – not one who does everything he can to tear it away.” October 16, 2020: The Kansas City Star posted an article titled: “KC hospitals ‘bursting at the seams” with record numbers of COVID-19 patients”. It was written by Anna Spoerre. From the article: Some Kansas City area hospitals, facing their biggest influx of coronavirus patients since the pandemic began, are refusing ambulances because their beds are already filled, according to a leading doctor at St. Luke’s Health System.On Wednesday night, eight metro hospitals and emergency departments reported such high volumes of patients that they temporarily stopped accepting ambulances, Marc Larsen, Operations Director of Saint Luke’s COVID Response Team, said in a phone interview Thursday.Two of the eight were part of the St. Luke’s system, according hospital spokesperson, who did not identify the other medical centers.As of 1 p.m. Thursday, five were still diverting ambulances for all who weren’t in most critical need, such as stroke, heart attack and trauma patients, Larsen said. When this happens, alternative care areas accept the patients instead.“We’re bursting at the seams in the metropolitan area, and really across the state and the region,” said Larsen, who is also an emergency physician.The worsening conditions in Kansas City come as Missouri reports record hospitalizations and rural Kansas hospitals say they are under pressure.On Wednesday, Ascension Via Christi Hospital in Pittsburg, Kansas, put out a statement saying they are pausing elective and non-emergent procedures because of capacity concerns.In western Kansas, about 300 miles west of Kansas City, more than 50 employees at the Gove County Medical Center have been infected with the virus, the hospital said in a statement Tuesday. At least 25 staff members have recovered and two are hospitalized.In Kansas City, the St. Luke’s Health System hit a record number of COVID-19 patients — more than 100 — on Tuesday, more than double their August average. They had 90 coronavirus patients across their hospitals as of Thursday afternoon.The situation has worsened over the course of the year. In May and June, the hospital system averaged 15 patients a day. In July and August it was 50. In September, 63. In the first 14 days of October, Larsen said, St. Luke’s averaged 85 patients a day.The worsening conditions in Kansas City come as Missouri reports record hospitalizations and rural Kansas hospitals say they are under pressure.On Wednesday, Ascension Via Christi Hospital in Pittsburg, Kansas, put out a statement saying they are pausing elective and non-emergent procedures because of capacity concerns.Through this growth, the volume of sickest patients remains high, he added. As of Thursday, 25 of the 90 patients with coronavirus were in the intensive care unit.Some pre-operation and recovery rooms are being transformed into ICUs, Larsen said.“All of the systems across the metropolitan area are continually struggling with having adequate capacity for the surge that we are continually seeing and experiencing,” Larsen said.He pointed to New York City, Louisiana and Texas as examples of what can happen when hospital systems reach capacity.“I worry that if we don’t start taking this seriously as a metropolitan area, we’re going to be the next New York,” he said. “We’re going to be the next hot spot, because though we have a lot of hospitals, we have a lot of capacity in the area, we are filling up fast.”Larsen noted that flu season, when hospitals are often taxed with more patients, is not yet in full swing. He said it was the important that people get a flu shot this year… October 16, 2020: Kaiser Family Foundation (KFF) posted information titled: “KFF Health Tracking Poll – October 2020: The Future of the ACA and Biden’s Advantage On Health Care”. From the information: Key Findings The confirmation hearings for Judge Barrett, President Trump’s appointment to fill the Supreme Court seat previously held by Justice Ginsburg, are underway this week and the future of the ACA’s protections for people with pre-existing conditions have been front-and-center. The latest KFF Health Tracking Poll finds a large majority of the public – including majorities of Democrats (91%), independents (81%), and Republicans (66%), now say they do not want to see the Supreme Court overturn the ACA’s pre-existing condition protections. The share who do not want to see these protections overturned has increased by double digits from one year ago for each group.Six in ten adults say they do not want to see the Supreme Court overturn the entire ACA, up 10 percentage points from one year ago. This includes majorities of both Democrats (89%) and independents (66%), but three-fourths of Republicans still want to see the entire law overturned. Overall views of the Affordable Care Act are slightly more positive this month, with 55% of the public saying they view the law favorably. This ties its highest favorability measured in ten years of KFF polling (tied with February 2020).Vice President Biden has the advantage over President Trump on all health policy issues included in the survey including at least a 20 percentage point advantage on who voters think has the better approach (Biden or Trump) to make decisions about women’s reproductive health choices and services, including abortion, family planning, and contraception (57% v. 34%), determining the future of the ACA (57% v. 37%), and maintaining protections for people with pre-existing health conditions (56% v. 36%). He also holds an advantage on surprise medical bills, the coronavirus outbreak and distribution of a vaccine, and lowering health care costs for individuals.While both presidential candidates say they have plans to ensure pre-existing condition protections, most Democrats and independent say they do not think President Trump has a plan to maintain such protections. Slightly more than half (53%) including majorities of Democrats (90%) and independents (57%) say they “do not think President Trump has a plan to maintain protections for people with pre-existing health conditions.” On the other hand, a large majority of Republicans (85%) say President Trump “has a plan” to maintain these protections afforded by the ACA. The Affordable Care Act and the Supreme CourtThis week marked the beginning of the U.S. Senate’s confirmation hearings for President Trump’s appointment to fill the seat held by the late Justice Ruth Bader Ginsburg. One of the major focuses of the Senate Judiciary Committee’s hearings for Judge Amy Coney Barrett has been her views of the constitutionality of the 2010 Affordable Care Act (ACA). The Court is set to hear oral arguments for California v. Texas, a case backed by the Trump administration challenging the future of the law, on November 10th.Eight in ten adults (79%) say they do not want to see the Supreme Court overturn the protections for people with pre-existing conditions established by the Affordable Care Act and a majority of U.S. adults (58%) also say they do not want to see the Supreme Court overturn the entire 2010 law. Majorities of Republicans (66%), independents (81%), and nine in ten Democrats (91%) say they do not want to see the Supreme Court overturn the pre-existing condition protections in the ACA. Nine in ten Democrats (89%) and two-thirds of independent (66%) also say they do not want to see the Supreme Court overturn the entire law while three-fourths of Republicans (76%) say they would like to see the entire law overturned……The ACA’s protections for people with pre-existing medical conditions has been a dominant issue in the 2020 presidential campaign since the passing of Supreme Court Justice Ginsburg and larger shares of the public now saying they do not want to see these protections overturned (up 17 percentage points from last November). A majority of Republicans now say they do not want to see the pre-existing condition protections overturned (up 19 points from last year), and while majorities of Democrats and independents had previously said they did not want to see these protections overturned, the share among these groups has also increased (16 percentage points and 18 points, respectively)……While both presidential candidates say they intend to ensure pre-existing condition protections, most Democrats and independent say they do not think President Trump has a plan to maintain such protections. Slightly more than half (53%) including majorities of Democrats (90%) and independents (57%) say they “do not think President Trump has a plan to maintain protections for people with pre-existing health conditions.” On the other hand, a large majority of Republicans (85%) say President Trump “has a plan” to maintain these protections afforded by the ACA. While President Trump signed an executive order on Sept. 24th saying people with pre-existing conditions should be able to obtain health insurance at an affordable rate, the order does not guarantee coverage if the ACA is overturned… October 16, 2020: NARAL Pro-Choice America tweeted: “Healthcare is on the line right now. Let that sink in. In the middle of a pandemic, another Trump Justice paves the way to gut the #ACA and take healthcare away from millions of Americans. #WeDissent @OurCourt” October 16, 2020: Senator Maria Cantwell (Democrat – Washington) tweeted: “If the #ACA is struck down, the # of uninsured Washingtonians could double. More than 21 million Americans could lose heath insurance coverage. Taking away health care options during a pandemic that has left millions of Americans out of work is dangerous & unconscionable.” October 16, 2020: Senator Catherine Cortez Mastro (Democrat – Nevada) tweeted: “Republicans in Congress have tried to repeal the #ACA over 70 times. Americans have made it clear that they don’t support repeal. So Republicans have resorted to far-fetched arguments in the courts and jamming through an unfit #SCOTUS nominee to dismantle the law.” October 16, 2020: Senator Tom Udall (Democrat – New Mexico) tweeted: “#SCOTUS will hear a case on the #ACA a week after the election. If Trump’s rushed nominee is on the bench, 130 million Americans – and 834,700 New Mexicans – could lose protections for preexisting conditions. This is #WhatsAtStake.” October 16, 2020: California Governor Xavier Becerra posted a press release titled: “Attorney General Becerra Fights Latest Challenge to California’s Landmark Anti-Pay-for-Delay Law”. From the press release: California Attorney General Xavier Becerra yesterday filed a brief opposing the Association for Accessible Medicine’s (AAM) latest attempt to challenge Assembly Bill 824 (AB 824), the California law that tackles illegal, anticompetitive deals between pharmaceutical companies known as pay-for-delay agreements. These so-called “pay for delay agreements” happen when a brand name drug maker enters an agreement and pays money to a generic company to keep them off the market. This results in fewer choices for patients and higher costs. AAM, a group of generic drug manufacturers, is seeking another preliminary injunction in its second lawsuit challenging the legislation. In July, the U.S. Court of Appeals for the Ninth Circuit ruled in the Attorney General’s favor, rejecting AAM’s initial challenge of AB 824 and preliminary injunction request.“Californians shouldn’t have to pay extra to pad the profits of pharmaceutical companies,” said Attorney General Becerra. “Our state’s anti-pay-for-delay law helps protect families from paying outrageous prices for life-saving medication. AAM already challenged this law before and lost in court. We believe we will be successful against them again.”AB 824 went into effect on January 1, 2020, and became the first law in the country to combat illegal, secretive pay-for-delay agreements. In a pay-for-delay agreement, one drug company pays its competition to delay the research, production, or sale of a competing version of its drug. As a result, pay-for-delay agreements stifle competition and allow pharmaceutical companies to raise the price of medications to often exorbitant amounts, leaving patients with few options and in many cases, the inability to afford their prescriptions.In the brief, Attorney General Becerra argues that as in its previous attempt, AAM does not have standing to challenge AB 824. The Attorney General also argues that AAM’s motion for preliminary injunction should be denied because: AAM is not likely to succeed on the merits;AAM has not demonstrated imminent and irreperable harm; andEnjoining AB 824 would not be in the public interest …A copy of the brief is available here. October 16, 2020: Kaiser Family Foundation (KFF) posted information titled: “KFF Health Tracking Poll – October 2020: The Future of the ACA and Biden’s Advantage On Health Care”. It was written by Ashley Kirzinger, Lunna Lopes, Audrey Kearney, and Mollyann Brodie. From the information: Key Findings: The confirmation hearings for Judge Barrett, President Trump’s appointment to fill the Supreme Court seat previously held by Justice Ginsburg, are underway this week and the future of the ACA’s protections for people with pre-existing conditions have been front-and-center. The latest KFF Health Tracking Poll finds a large majority of the public – including majorities of Democrats (91%), independents (81%), and Republicans (66%), now say they do not want to see the Supreme Court overturn the ACA’s pre-existing condition protections. The share who do not want to see these protections overturned has increased by double digits from one year ago for each group.Six in ten adults say they do not want to see the Supreme Court overturn the entire ACA, up 10 percentage points from one year ago. This includes majorities of both Democrats (89%) and independents (66%), but three-fourths of Republicans still want to see the entire law overturned. Overall views of the Affordable Care Act are slightly more positive this month, with 55% of the public saying they view the law favorably. This ties its highest favorability measured in ten years of KFF polling (tied with February 2020).Vice President Biden has the advantage over President Trump on all health policy issues included in the survey including at least a 20 percentage point advantage on who voters think has the better approach (Biden or Trump) to make deciisions about women’s reproductive health care choices and services, including abortion, family planning, and contraception (57% v. 34%), determining the future of the ACA (57% v. 37%), and maintaining protections for people with pre-existing conditions (56% v. 36%). He also holds an advantage on suprise medical bills, the coronavirus outbreak and distribution of a vaccine, and lowering health care costs for individuals.While both presidential candidates say they have plans to ensure pre-existing condition protections, most Democrats and Independent say they do not think President Trump has a plan to maintain such protections. Slightly more than half (53%) including majorities of Democrats (90%) and independents (57%) say they “do not think President Trump has a plan to maintain protections for people with pre-existing health conditions.” On the ohtehr hand, a large majority of Republicans (85%) say President Trump “has a plan” to maintain these protections afforded by the ACA… October 16, 2020: Planned Parenthood posted a press release titled: “Federal Court Reinstates Kentucky Law That Was Designed To Eliminate Abortion Access In The State”. From the article: The Sixth Circuit Court of Appeals ruled today to uphold a Kentucky law that was used by former Governor Bevin to try to close abortion clinics and cut off access in the state. The court’s decision forces the Commonwealth’s two clinics, EMW Women’s Surgical Center and Planned Parenthood of Indiana and Kentucky, to apply for an unnecessary waiver from the health department every 90 days to continue providing abortion services.Today’s ruling lifts a 2018 injunction from the District Court and reinstates a politically motivated, medically unnecessary requirement that clinics obtain a written transfer agreement with a local hospital and a transport agreement with an ambulance in order to operate. Despite evidence that these agreements serve no medical benefit to patients, and that abortion is one of the safest medical procedures, the Sixth Circuit still overturned the 2018 ruling from the lower court. Short of further action by the courts, health care providers’ only recourse is to navigate this needless red tape every 90 days. If at any time the governor refuses to grant the waiver, Kentucky could become the first state without any abortion providers.In his dissenting opinion, Judge Clay wrote: “Today, the majority openly disregards our standard of review and discards binding precedent. In doing so, it condones the evisceration of the constitutional right to abortion access in Kentucky…At the end of the day, no matter what standard this Court is bound to apply, the majority’s decision today is terribly and tragically wrong.”The Commonwealth has passed numerous burdensome restrictions on abortion care in recent years, including an attempt to ban abortion when many people do not even know they are pregnant. The law at issue in this case is similar to abortion restrictions previously passed in Texas and Louisiana, both struck down by the Supreme Court in Whole Woman’s Health v. Hellerstedt and June Medical Services v. Russo, respectively. It is just one of more than 480 restrictions on abortion passed by states since 2011 as part of a coordinated, nationwide effort to push abortion care out of reach.“This law threatens abortion access in the state. When health care access is attacked, it is Black and Brown people who are forced to navigate racist and discriminatory systems and who suffer the most,” said Alexis McGill Johnson, president and CEO, Planned Parenthood Federation of America. “Let me be clear: we will not allow Kentucky to be the first state in the country without a single abortion provider. Planned Parenthood Federation of America will continue working with our partners to ensure every person can access the care they need no matter who they are, where they live, or how much they earn, no matter what.”……This case was brought by the American Civil Liberties Union, the ACLU of Kentucky, and Lynch, Cox, Gilman & Goodman P.S.C. on behalf ofE.M.W Women’s Surgical Center, and Planned Parenthood Federation of America and Orrick on behalf of Planned Parenthood of Indiana and Kentucky. October 17, 2020: Former Vice President Joe Biden (Democrat) tweeted: “In the middle of a pandemic, President Trump is trying to eliminate Obamacare and increase health care costs for millions. Now, he’s rushing through a U.S. Supreme Court justice to help him get it done. It’s unconscionable. Make no mistake: Health care is on the ballot.” October 17, 2020: Former Vice President Joe Biden (Democrat) tweeted: “As president, I’ll protect and build on Obamacare by: Giving Americans the choice to buy a new public option Lowering premiums, deductibles, and co-pays Standing up to prescription drug corporations We’re going to make sure every American has access to the care they need.” October 17, 2020: Senator Catherine Cortez Masto (Democrat – Nevada) tweeted: “Trump and Republicans in Congress claim they’re concerned about people with preexisting conditions, but their actions say otherwise. If they really want to help folks with preexisting conditions, why don’t they withdraw their lawsuit that could overturn the #ACA?” October 20, 2020: Urban Institute posted a blog post titled: “Overturning the ACA Would Increase Uninsurance among People of All Ages, Races, and Ethnicities”. It was written by Linda J. Blumberg, Michael Simpson, Matthew Buettgens, Jessica Banthin, and John Holahan. From the blog post: …In our recent analysis, we found if the Supreme Court overturns the ACA, an additional 21.1 million people nationwide would be uninsured in 2022. We also found the following consequences of eliminating the ACA: 9.3 million people would lose income-related subsidies for marketplace insurance in 2022;Medicaid and Children’s Health Insurance Program coverage would decline by 15.5 million people in 2022; andfederal government spending on health care would fall by $152 billion per year in 2022. Based on this study, we produced additional, state-level estimates on the effects of coverage by age group… and race and ethnicity… if the ACA is overturned… Some of our key findings include:1) Invalidating the ACA will increase uninsurance among the nonelderly in every age group. Children ages 18 and younger will feel the smallest effect because their pre-ACA eligibility for public insurance coverage (through Medicaid and the Children’s Health Insurance Program) is greatest. Still, 1.7 million more children will be uninsured, an increase of 48 percent. Adults ages 50-64 will experience a 95 percent increase in uninsurance, an additional 5.6 million people. And 4.9 million young adults ages 19-26 will be uninsured, a 76% increase compared with current law. Adults ages 27 to 49 will experience a 60 percent increase in uninsurance, 8.8 million more uninsured.2) States experiencing the largest coverage gains under the ACA will experience the largest increases in the uninsured. These states include those that expanded Medicaid eligibility under the law, those with high enrollment rates in the ACA-subsidized Marketplaces, and those that had high uninsurance rates before implementation of the law.For example, Pennsylania and Michigan are among the most populous states that will have the largest percent increases in the uninsured if the ACA is overturned. In Pennsylvania, the uninsurance rate among young adults will climb by more than 170 percent (to 27 percent uninsured). For adults ages 27 to 49, the uninsurance rate will increase will increase by 152 percent (to 20 percent uninsured), and for adults ages 50 to 64, by 154 percent (to 16 percent uninsured). In Michigan, the uninsurance rate for young adults will increase by nearly 200 percent (to 31 percent uninsured), by more than 150 percent for adults ages 27 to 49 (to 23 percent uninsured), and by 148 percent for adults ages 50 to 64 (to 18 percent uninsured).Among states that have not expanded Medicaid eligibility, Florida will experience the largest increases in the uninsured in both absolute numbers and percentage terms because the state has high enrollment in the ACA Marketplace. In Florida, the insurance rate among young adults will increase 35 percent (to 36 percent uninsured). For 27-to-49-year-olds, it will increase 52 percent (to 30 percent uninsured), and for 50-to-64-year-olds, it will increase 89 percent (to 25 percent uninsured).3) People of all races and ethnicities will experience large increases in uninsurance. Again, the largest increases across rates and ethnicities will occur in states that expanded Medicaid eligibilty under the law. In 10 states with insufficient sample sizes to measure the effects (Michigan, California, Idaho, Montana, New Mexico, Utah, Washington, New Jersey, Virginia and Ohio), uninsurance rates will more than double among American Indians and Alaska Natives. In Louisiana, Kentucky, Michigan, Indiana, and Pennsylvania, uninsurance rates for non-Hispanic Black people will nearly triple or more. Uninsuraed non-Hispanic white people will more than double the number in 29 states. Uninsurance among the Hispanic population will more than double in Pennsylvania and New Mexico.4) States that did not expand Medicaid eligibility under the ACA stand to lose somewhat less coverage, but uninsurance will still increase substantially among people of all races and ethnicities. Across all nonexpansion states combined, uninsurance among American Indians and Alaskan Natives will increase 26 percent (to 23 percent uninsured). Among Asian and Pacific Islander populations, uninsurance will increase by 25 precent (to 21 percent uninsured). Among non-Hispanic Black people, uninsurance will increase by 34 percent (to 19 percent uninsured). The number of uninsured Hispanic people will increase 15 percent in these states (to 33 percent uninsured). Uninsurance among non-Hispanic white people will increase 36 percent (to 15 percent uninsured), and uninsurance among other races and ethnicities will increase by 28 percent (to 14 percent uninsured)……However, the implications of the policies of the law being invalidated have far greater reach than we can estimate, because virtually all insurers, providers, and households across the nation have been affected by the law’s many provisions. Policymakers have straightforward legislative options that could protect the ACA as it is operating under current law if they are passed before the court issues its decision; thus far, Congress has not passed bills to do so. October 21, 2020: Senator Kamala Harris (Democrat – California) tweeted: “Tearing down the Affordable Care Act has been one of Republicans’ top priorities for more than a decade. They’ve tried 70 times to repeal or roll back the ACA in Congress. Now, they’re rushing through Trump’s Supreme Court nominee to ensure it finally happens.” October 21, 2020: Senator Kamala Harris (Democrat – California) tweeted: “Today, I joined @SenWarren in urging the administration to stop supporting a lawsuit to strike down the Affordable Care Act. It’s unconsscionable, especially during a pandemic. And it has to stop.” October 21, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James Continues Fight to Stop Health Care Discrimination Promulgated by Trump Administration.” From the press release: New York Attorney General Letitia James today announced she has led a coalition of 22 attorneys general in continuing the fight to stop the Trump Administration’s attempts to make it easier for health care providers to refuse to provide necessary and desired health coverage to individuals on the basis of their health care providers’ “religious beliefs or moral convictions.” In an amicus brief filed in support of the states of California and Washington in their lawsuits brought against the U.S. Department of Health and Human Services (HHS), Attorney General James leads the coalition in opposing the Trump Administration’s ‘Refusal-of-Care’ rule. Attorney General James led her own lawsuit against the Trump Administration’s ‘Refusal-of-Care’ rule in May of 2019.“As we continue to battle a public health crisis that has only been exacerbated by the Trump Administration’s incompetence, the Department of Health and Human Services is still doing what it can to make it easier for health care providers to deny health coverage to millions of Americans,” said Attorney General James. “The ‘Refusal-of-Care’ rule gives health care providers free license to openly discriminate and deny care to patients, masking their bigotry and hatred in an invisible cloak of religious freedom. The courts have rejected this hatred every step of the way and we are confident they will do the same once again.”In May 2019, the Trump Administration’s HHS introduced a final rule that would vastly and unreasonably expand the ability of health care providers to deny patients access to certain lawful and medically needed procedures, services, and information, including that related to abortion, sterilization, and aid-in-dying — all while purporting to implement various federal conscience statutes. In reality, however, the rule violates the careful balance Congress struck in the underlying statutes by simultaneously expanding the job functions that objectors may refuse to perform based on their personal views and severely restricting the actions that employers may take to plan for and accommodate such objections while ensuring that patients receive uninterrupted care. The rule would disproportionately impact women and members of the LGBTQ+ community.Every federal court that has considered the rule has agreed that it is not authorized by law and has accordingly vacated the rule in full, including the U.S. District Court for the Northern District of California and the U.S. District Court for the Eastern District of Washington. After those losses, the Trump Administration appealed to the U.S. Court of Appeals for the Ninth Circuit. Attorney General James and the coalition filed this amicus brief in support of California and Washington in that appeal.The coalition argues, in the amicus brief, that the rule’s definition of “discrimination” is inconsistent with statute and is thus contrary to the Administrative Procedures Act and that HHS acted arbitrarily and capriciously in promulgating the rule. Specifically, HHS failed to acknowledge that the redefinition of “discrimination” represented a change in position, failed to consider the reliance interests created by HHS’s own past guidance as to the scope of the federal conscience statutes’ anti-discrimination provisions, and relied on empirical justification for the rule that is contradicted by the administrative record.Further, the coalition explains that the rule not only threatens to harm countless patients in disrupting their access to medically necessary care, but also places at risk billions in critical federal health care funding that Congress has appropriated to the states… October 21, 2020: NARAL Pro-Choice America posted an press release titled: “NARAL Pro-Choice America President Ilyse Hogue Responds to Latest Evidence of Amy Barrett’s Extremism and Hostility to Reproductive Freedom”. From the press release: This afternoon, news broke that Democrats on the Senate Judiciary Committee will boycott tomorrow’s planned vote to advance Amy Barrett’s confirmation to the U.S. Supreme Court. Their move will send a clear message about this power grab less than two weeks before Election Day, when over 42 million Americans have already voted. The development comes on the heels of Barrett submitting responses to written questions from senators following her Senate Judiciary Committee hearing. In response to questions from Senator Sheldon Whitehouse (D-RI), she flat out refused to answer whether states could make abortion care a felony if Roe v. Wade is overturned or punish people seeking abortion care with the death penalty. She also refused to answer whether states could prosecute people for using contraception if Roe is overturned. This after Barrett refused to answer even basic questions in the hearing. Meanwhile, Senate Republicans tried to play coy about their agenda to end legal abortion and Barrett’s role in realizing their decades-long goal of overturning Roe v. Wade. Now we have even more cause for concern. “Amy Barrett’s refusal to make clear that putting a woman to death for seeking abortion care is wrong and should never be permitted is both shocking and disqualifying,” said Ilyse Hogue, president of NARAL Pro-Choice America. “This country has a clear consensus around basic freedoms and rights and these non-answers not only undermine those, but put them in perilous danger. We strongly applaud the Senate Democrats making clear how egregious and antidemocratic this entire process is by refusing to dignify it with their presence. We will be outside with them calling attention to the dystopian future this nominee represents where women and pregnant people are controlled and criminalized by politicians with a malicious agenda.” October 21, 2020: The American College of Obstetricians and Gynecologists posted a statement titled: “ACOG Statement on Recent Waiver Approvals that Limit Medicaid Coverage”. From the statement: Maureen G. Phipps, MD, MPH, chief executive officer of the American College of Obstetricians and Gynecologists, released the following statement:“ACOG is deeply disappointed that, by recently approving restrictive state Medicaid waivers in Georgia and Nebraska, the Centers for Medicare & Medicaid Services (CMS) continues to make Medicaid coverage and access to Medicaid-covered services more difficult for our patients to obtain. Medicaid was established to ensure that health care is available to all who are eligible, without condition. The waivers that CMS has approved in recent weeks and months serve the sole purpose of making coverage less accessible and will ensure that the program fails to meet its essential mission.“These Medicaid changes will no doubt fall heaviest on low-income women. Women represent almost two-thirds of those at risk of losing coverage under work requirements. Further, women have increased health care needs compared to men, so may be negatively affected by the excessive out-of-pocket costs imposed in these waivers. Rather than punishing women by making it harder for them to access health care, the government should be focusing on how improved access to reliable health coverage, including Medicaid coverage to 12 months after delivery, can address the ongoing maternal mortality crisis and, importantly, help us improve health equity across the country. Moreover, the approval of these waivers runs counter to the stated goal of the Department of Health and Human Services to improve maternal health outcomes.“It is especially unsettling that CMS and state bureaucrats are moving forward with restrictive health care policies in the middle of an unprecedented pandemic, which has already cost more than 200,000 lives across the country and underscores the critical importance of the Medicaid protram. Health care coverage must be reliable and stable for all of our patients now as we continue to battle COVID-19. Taking coverage away from those who have already been disproportionately impacted by the virus will certainly cost additional lives.” October 22, 2020: California Governor Gavin Newsom (Democrat – California) tweeted: “We’re in a pandemic. We need the Affordable Care Act.” October 22. 2020: California Attorney General Xavier Becerra posted a press release titled: “Members of Congress, Medical Associations, Policy Experts, Nonprofits, States, Counties, and Cities Support Fight Against Healthcare Refusal Rule”. From the press release: California Attorney General Xavier Becerra today announced that a diverse group that includes members of Congress, state attorneys general, healthcare providers, healthcare policy experts, and more filed amicus briefs this week in the U.S. Ninth Circuit Court of Appeals supporting California’s fight against the Trump Administration’s unconstitutional and illegal “Healthcare Refusal Rule”. The rule, which was halted by multiple courts, would allow anyone involved in healthcare to deny care to an individual for religious, moral, ethical, or other reasons. This exemption would open the door to unfettered discrimination, particularly against women, LGBTQ individuals, people of color, and individuals in rural and low-income communities.“A diverse coalition consisting of individual citizens, elected leaders, experts, advocacy groups and others have helped shed light on the substantial negative impact of the Trump Administration’s Healthcare Refusal Rule on our healthcare system,” said Attorney General Becerra. “As we continue to battle a global pandemic, now is the time to ensure access to quality care, not create barries to care.”In a brief filed this month, the Attorney General reasserted that the Trump Administration’s Healthcare Refusal Rule violates the U.S. Constitution and the Administrative Procedure Act, arguing that the District Court was correct to vacate the rule in its entirety. The amici support California’s fight to protect marginalized communities from potential healthcare discrimination resulting from the rule. The amicus briefs highlight the human cost of allowing this rule to stand. Rachael Lorenzo, Mindy Swank, and Meghan Eagen, three individuals who were denied essential, stabilizing treatment because medical professionals refused to provide emergency abortions: Mindy’s story: “Even though Saint Francis and Genesis knew that Mindy’s pregnancy was not viable and would ultimately put her life in danger if not terminated, doctors delayed the emergency care she needed. Not only did this risk the loss of Mindy’s ability to have children in the future and lead to the prolonged suffering of her baby after birth , but it also put her life in jeopardy and resulted in lasting emotional trauma.”A copy of the brief is available here.Coalition of 158 Members of the U.S. Congress: “Congress has consistently sought to protect and expand access to medical care in the United States, including by passing the Affordable Care Act in 2010, and in other statutes and legislation enacted over the last fifty years. HHS’s Rule is one in a series of more recent attempts to turn back this progress and limit access to care, especially abortion care.”A copy of the brief is available here.Coalition of 21 states and the District of Columbia: “That unprecedented redefinition poses severe disruptions to Amici States’ health care systems and our ability to deliver seamless patient care while accommodating conscience objections, and is thus particularly harmful to Amici States’ interests as health care providers, employers, and regulators.”A copy of the brief is available here.Coalition of cities and counties: “The Final Rule invites providers of emergency care to discriminate against the distressed patients they are duty-bound to treat, and attempts to undermine local governments’ antidiscrimination policies and laws in the provision of healthcare with the threat of withdrawal of critical federal funding.”A copy of the brief is available here.American Public Health Association: “By permitting any individual who works at a healthcare facility to elevate their personal beliefs above the health needs of the patient, the Rule disregards the most core principles of public health.”A copy of the brief is available here.Coalition of leading medical organizations: “The Rule endangers patients in emergency situations…For example, when a registered nurse anesthetist lodges a last-minute objection to assisting a patient with an urgent need, and s/he cannot be replaced because all colleagues are in COVID-19 ICUs, the patient may die. The COVID-19 crisis thus heightens the dangers the Rule threatens to the provision of necessary and urgent care.”A copy of the brief is available here.National Center for Lesbian Rights and a coalition of 27 nonprofit organizations: “The Final Rule will compound barriers to health care for LGBTQ people, particularly those who are transgender, by inviting health care workers to refuse services or referrals to LGBTQ people.” A copy of the brief is available here.The Williams Institute, and a coalition of experts on the health of lesbian, gay, bisexual, and transgender people: “Being denied healthcare can be devastating. Being denied care for discriminatory reasons compounds that harm and can result in avoidance of necessary care in the future. In turn, the minority stress associated with healthcare denials contributes to health disparities for the LGBT population.”A copy of the brief is available here.Institute for Policy Integrity: “It is difficult to imagine how a rule could cause more workers to assert a right to deny care without also causing an increase in denials of care. HHS cannot have it both ways.” A copy of the brief is available here. October 22, 2020: National Organization for Women (NOW) posted a press release titled: “NOW Denounces Senate Judiciary Committee’s Illegitimate Push for Amy Coney Barrett”. From the press release: The only way Donald Trump and Mitch McConnell were going to get away with stealing another Supreme Court nomination was to do what they always do— break rules and rig the system. After forcing into practice a new standard for filling a Supreme Court vacancy before a presidential election, they went back on their own new rules and are now rushing to hold a floor vote on Amy Coney Barrett days before the election. Amy Coney Barrett’s nomination is being rushed through to consolidate conservative power and turn back the clock on voting rights, reproductive freedoms, and access to health care. This has been a cynical, partisan political exercise from the beginning. NOW calls on Senators to use whatever tools are at their disposal to push this vote past the election. Republican Senators who lost their races because of Donald Trump may realize they can redeem their place in history after years of enabling him by what they do in a lame-duck session – which includes passing years of legislation currently in the Senate graveyard and voting “nay” on Amy Coney Barrett’s confirmation. NOW is more motivated than ever – to show how the largest, grassroots feminist force in history will turn the tide in this election. We will elect a new president, the first woman vice president, and a feminist Senate—that will soon vote on a feminist nomination to the Supreme Court. October 22, 2020: Lambda Legal posted a press release titled: “Senate Judiciary Committee Advances Nomination of Anti-LGBTQ Judge, Amy Coney Barrett to Supreme Court”. From the press release: Today, pressing ahead in flagrant disregard of longstanding rules and procedures, Senate Republicans voted unanimously to advance the nomination of Judge Amy Coney Barrett to the United States Supreme Court. Senate Democrats on the committee walked out from the vote in protest and were counted as absent. The nomination, which Senate Republicans are jamming through at breakneck speed, now moves on to a full Senate floor vote. Judge Barrett could be confirmed as soon as Monday, October 26. In response, Lambda Legal CEO Kevn Jennings issued the following statement:“Rushing a U.S. Supreme Court nomination like this is reckless and just plain despicable. This has been an affront to our democracy and the will of the American people, 35.9 million of whom have already cast ballots and the majority of whom believe the next president should choose Justice Ruth Bader Ginsburg’s replacement. This shouldn’t even be happening. Every Senator who will soon vote on this nomination has a choice to make; our democratic values or partisan ideology.“It is impossible for LGBTQ peopel to have confidence in Judge Barrett. During the hearings, she refused to answer questions about some of the most pressing issues facing our nation’s highest Court and refsused to say whether she believed cases that are the backbone of the legal rights of LGBTQ people – such as Lambda Legal’s landmark case, Lawrence v. Texas, which decriminalized same-sex intimacy,and Obergefell v. Hodges, which legalized same-sex marriage – were correctly decided. She even used loaded and outdated terms like ‘sexual preference,’ which is explicitly intended to erase our identities and deny the validity of our claim to equal protection under the law. We can read between the lines of her coded language and what we’re reading isn’t good. Nothing we heard allayed our concerns, and much of what we heard raised red flags about what her confirmation will mean for the LGBTQ community.” October 22, 2020: California Attorney General Xavier Becerra posted a press release titled: “Members of Congress, Medical Associations, Policy Experts, Nonprofits, States, Counties, and Cities Support Fight Against Healthcare Refusal Rule”. California Attorney General Xavier Becerra today announced that a diverse group that includes members of Congress, state attorneys general, healthcare providers, healthcare policy experts, and more filed amicus briefs this week in the U.S. Ninth Circuit Court of Appeals supporting California’s fight against the Trump Administration’s unconstitutional and illegal “Healthcare Refusal Rule.” The rule, which was halted by multiple courts, would allow anyone involved in healthcare to deny care to an individual for religious, moral, ethical, or other reasons. This exemption would open the door to unfettered discrimination, particularly against women, LGBTQ individuals, people of color, and individuals in rural and low-income communities.“A diverse coalition consisting of individual citizens, elected leaders, experts, advocacy groups and others have helped shed light on the substantial negative impact of the Trump Administration’s Healthcare Refusal Rule on our healthcare system,” said Attorney General Becerra. “As we continue to battle a global pandemic, now is the time ti ensure access to quality care, not create barriers to care.”In a brief filed this month, the Attorney General reasserted that the Trump Administration’s Healthcare Refusal Rule violates the U.S. Constitution and the Administrative Procedure Act, arguing that the District Court was correct to vacate the rule in its entirety. The amici support California’s fight to protect marginalized communities from potential healthcare discrimination resulting from the rule. The amicus briefs highlight the human cost of allowing this rule to stand… October 22, 2020: Urban Institute posted a brief titled: “Urgent Action Needed to Address Children’s Unmet Health Care Needs During the Pandemic”. It was written by Stacey McMorrow, Dulce Gonzalez, Clara Alvarez Caraveo, and Genevieve M. Kenney. From the brief: AbstractIt has become increasinglyclear that the pandemic has had dramatic spillover effects on the reciept of health care services unrelated to the coronavirus. In this brief, we review the evidence on children’s unmet needs during the pandemic and identify promising strategies to address these gaps, as well as barriers to widespread implementation of these strategies. We find large declines in childhood vaccinations in 2020 compared with prior years and serious concerns about children’s access to specialized therapies and mental health services. Children of color, children with special health care needs, children in families with low incomes or members with limited English proficiency, and children in rural areas face higher risks of unmet health care needs. We also find that health care providers have implemented several strategies to encourage reciept of needed care during the pandemic, including telehealth options, mobile clinics, pharmacist-administered vaccines, and expanded school-based services. But limitations in funding, access to internet-enabled devices,and interpretation and translation services can prevent widespread and successful adoption of these strategies.Thus, more coordinated, publicly funded, and focused efforts to reduce children’s unmet needs are urgently needed. State Medicaid and Children’s Health Insurance Programs, and the private managed-care plans that cover many children in these programs, have both policy tools and financial resources that could help address the declines in preventive care receipt among their child enrollees. Targeted to federal funding to underresourced providers and communities and more concerted efforts to incorporate children’s health needs into policies for both in-person and virtual education would also be beneficial. Without these efforts to address children’s needs and reduce long standing inequities, racial and socioeconomic disparities in children’s health and health care access will likely widen as the pandmeic continues. October 23, 2020: WBUR posted an article titled: “Overturning The Affordable Care Act Would Be Catastrophic – Especially For People With Disabilities”. It was written by Elizabeth Warren and Matthew Cortland. From the article: For the 61 million Americans who live with a disability, there’s an important date on the calendar this fall: November 10, the day the Supreme Court will hear a case about whether to overturn the Affordable Care Act. President Donald Trump and Senate Republicans have picked a Supreme Court nominee whose position is clear: she doesn’t like the ACA, or the previous court rulings that upheld it. There is so much at stake.Before the ACA, the disability community faced critical barriers to high-quality medical care. Health insurers could deny or cancel coverage for people with pre-existing conditions — including millions of people with disabilities. Insurers regularly imposed “lifetime limits” on their coverage, a gut punch for people with disabilities whose medical needs cost a lot of money. For babies born prematurely and children with disabilities, this sometimes meant hitting their lifetime caps before they were even old enough for school.This lack of basic health protections put people with disabilities in an economic bind, too. Many were forced to hold on to dead-end, low-paying jobs for the sake of keeping health insurance they couldn’t find anywhere else. Meanwhile, if people with disabilities couldn’t find insurance and had to turn to Medicaid, they could only qualify by going through a cumbersome disability determination process and declaring their inability to work. If they wanted to work, they were forced to give up their insurance — an impossible choice no one should have to make.The ACA made a lot of progress. It banned the cruel practice of lifetime limits, ensuring that children with disabilities and their families won’t have to go bankrupt to get the care they need. It protected people with pre-existing conditions. It ensured that people with disabilities could buy insurance in the Marketplace and expanded the Medicaid program, making it easier to get high-quality, affordable care without leaving the job market. In fact, Medicaid expansion increased employment rates among people with disabilities. And for young people with disabilities, being able to stay on their parents’ insurance until the age of 26 means the opportunity to build a career for themselves, without having to worry about whether they will continue to have access to life-saving health care.The ACA didn’t just expand access to health insurance. It also meant that people with disabilities could actually get the high-quality services and treatments they need. The Community First Choice Program in the ACA helps states provide home- and community-based services that allow people with disabilities to live with their families and in the community, rather than in institutions. Especially at a time when people living in nursing homes, assisted living facilities, and group homes are at heightened risk from the COVID-19 pandemic, these supports are more crucial than ever. We still have a long way to go: I’m fighting in Congress for better funding for home- and community-based services and better oversight of nursing homes and assisted living centers. But overturning the ACA would reverse all the important gains we’ve made.The ACA also ensured that mental health care is treated as exactly what it is: health care. People with disabilities have higher rates of depression and may face barriers to getting treatment for mental and behavioral health conditions. The ACA made mental and behavioral health treatment an Essential Health Benefit — one that all insurers are required to cover.All of these guarantees were important before the pandemic, but they are even more essential now. More than 7 million people in the United States have been diagnosed with COVID-19. Many of these survivors may have long-lasting health effects that we are only beginning to understand. In other words, the number of Americans with pre-existing conditions is growing every day. Without the ACA in place, anyone who ever tested positive for COVID-19 could be denied coverage because of a pre-existing condition. At the same time, economic turmoil and social isolation have created a mental health crisis. There has never been a greater need for quality, accessible, affordable mental health care.With the election just days away, the president, Senate Majority Leader Mitch McConnell, and their enablers are trying to ram through Amy Coney Barrett’s nomination before the American people have a chance to make their voice heard. They want her on the bench on November 10 to help accomplish what Republicans have been trying to do since the beginning: end the ACA and rip health care away from 21 million people, including millions of people with disabilities.But we won’t tolerate it. Disabled people are used to uphill battles, and they know how to persist. Together, we’re fighting to stop this nomination and to make our voices heard by sharing our stories and voting to protect the health care that people with disabilities — and all Americans — deserve. October 23, 2020: Georgetown University Health Policy Institute Center for Families and Children posted a blog post titled: “What’s New for 2021 Marketplace Enrollment?” From the blog post: On November 1, the eight open enrollment period begins for marketplace coverage under the Affordable Care Act. This year there are several policy changes that could have an impact on the affordability of plans on the marketplace including:… Public Charge Rule: Beginning Feburary 24, 2020, the current test to determine a person’s application for admission to the U.S. or permanent residency expanded. Previously, only an applicant’s use of two public benefits – cash assistance and institutional long-term care – were negatively effected when making a public charge determination. The Trump Administration expanded this policy to include an individual’s application for health programs such as Medicaid (with some important exceptions including reciept of Medicaid for children under 21) and the Supplemental Nutrition Assistance Program (SNAP) as factors for consideration. Application and enrollment in marketplace coverage and the application for and use of premium tax credits and cost-sharing reductions, however, will not be negatively factored into the public charge test. Though this rule has been finalized nationwide, the expansion has been blocked in New York, Connecticut and Vermont…ACA Litigation at SCOTUS: The constitutionality of the Affordable Care Act (ACA) will again be considered by the United States Supreme Court. A decision on this case is not expected until Spring 2021 and until that happens the ACA’s insurance reforms, the marketplaces, and federal assistance remains in place…New Special Enrollment Period (SEP) for Individuals Newly Eligible for Advanced Premium Tax Credits (APTCs): In prior years, individuals who were covered under an employer-sponsored plan or a plan purchased through the marketplace could access a SEP if they became newly eligible for APTCs. However, individuals who purchased an individual market plan outside of the marketplace (“off-marketplace”) could not. In 2020, HHS expanded this opportunity to allow individuals who are enrolled in off-marketplace plan and who experience a decrease in income that makes them newly eligible for APTCs to use a SEP to enroll in an on-marketplace plan. However, this may not be immediately available in all states, and consumers may have to contact the marketplace call center to access the opportunity…Retroactive Effective Dates: CMS has streamlined its rules and processes for retroactive coverage for consumers who recieve a special enrollment period, a favorable appeal decision, or a processing delay. Consumers have the option to pay the premiums for all the months of retroactive coverage, or only pay the premium for one month of coverage and receive prospective coverage only…Two Payment Rule for Abortion Services: A federal judge has enjoined a Trump Administration regulation that requires insurers to send two separate monthly bills, one for abortion coverage and one for coverage of all other service. Pending the outcome of this litigation, consumers are still able to pay their monthly premium a single transaction.Contraception Mandate: In July of 2020, the U.S. Supreme Court ruled that federal rules expanding exemptions to the ACA’s contraceptive coverage requirement could go into effect. These rules, previously subject to a nationwide injunction, allow eligible organizations including employers, insurers, and universities to exclude contraceptive coverage on the basis of “sincerely held religious beliefs or moral convictions.” While previously, the federal government required these entities to provide an accomodation so that plan enrollees could still access contraceptive coverage, that accommodation process is now optional. Some plan enrollees could still access contraception coverage. The rules are subject to further legal proceedings… October 25, 2020: The Hill posted an article titled: “Lesley Stahl: Giant health care book in Trump interview had ‘no comprehensive health care plan'”. It was written by Brooke Seipel. From the article: CBS’s Lesley Stahl said the giant book presented to her as the president’s health care plan after President Trump walked out of a “60 Minutes” interview had “no comprehensive healthcare plan.”The moment took place just after Trump cut short an interview last week. Press secretary Kayleigh McEnany then walked in to deliver what she said was the White House health care plan, warning it was a little heavy. Stahl can be heard saying, “I can’t lift it” in the interview.Then, in a voiceover for Sunday’s “60 Minutes” episode, Stahl says the book lacked a health care plan.“Kayleigh McEnany, gave us a heavy book she described as the president’s health care plan. It was filled with executive orders and congressional initiatives, but no comprehensive healthcare plan,” she said… October 25, 2020: CBS Philly posted an article titled: “Sen. Bob Casey Says Affordable Care Act Now In Danger With Amy Coney Barrett’s Assured Confirmation To Supreme Court”. From the article: Pennsylvania Sen. Bob Casey says the Affordable Care Act is now in danger with Judge Amy Coney Barrett’s assured confirmation to the Supreme Court. On Sunday night, Casey joined other Democratic senators on a Zoom call.The Affordable Care Act faces a legal challenge before the Supreme Court.The senators fear Barrett will cast the deciding vote to overturn the law.Casey says the elimination of the ACA would have a negative impact on Pennsylvania.“Much is at stake. You all know the numbers, the 135 million with preexisting conditions translates into 5-and-a-half million in Pennsylvania,” Casey said. “The 23 or so million who would lose coverage that had gained it translates into 1, or one of the 23, million.”The Supreme Court will hear the challenge to the Affordable Care Act on Nov. 10. October 25, 2020: Senator Diane Feinstein (Democrat – California) tweeted: “I voted AGAINST advancing Judge Barrett’s nomination today. She represents the conservative vote to overturn the Affordable Care Act, strip protections from Americans with pre-existing conditions, overturn Roe v. Wade and undermine many other fundamental rights.” October 26, 2020: Senator Kamala Harris (Democrat – California) tweeted: “It’s this simple: Republicans are trying to bypass the will of voters and have the Supreme Court dismantle the Affordable Care Act.” October 26, 2020: Senator Kamala Harris (Democrat – California) tweeted: “Today Republicans denied the will of the American people by confirming a Supreme Court justice through an illegitimate process – all in their effort to gut the Affordable Care Act and strip health care from millions with pre-existing conditions. We won’t forget this.” October 26, 2020: Senator Diane Feinstein (Democrat – California) tweeted: “I just voted against Judge Barrett’s confirmation. The American people want an independent jurist, not one who Republicans rushed onto the Supreme Court to help strike down the Affordable Care Act, end women’s reproductive rights and strip away voting rights.” October 26, 2020: California Attorney General Xavier Becerra tweeted: “Our fight continues. One week after Election Day, I’ll be at the Supreme Court to stop Trump and his GOP allies from dismantling the Affordable Care Act. We intend to win.” October 26, 2020: Oregon Governor Kate Brown (Democrat – Oregon) tweeted: Accessible, affordable health care saves lives. Now the Supreme Court is poised to rip away protections in the middle of a pandemic. Thanks to the Affordable Care Act, up to 94% of Oregonians have had health care coverage. Without the ACA? 546,000 + Oregonians could lose coverage.” October 26, 2020: Senator Dick Durbin (Democrat – Illinois) tweeted: “I am deeply concerned about Judge Barrett’s views on the Affordable Care Act – along with her downright refusal to answer questions about whether a President could delay an election, whether tehre should be a peaceful transfer of power, and the legality of voter intimidation.” October 26, 2020: Planned Parenthood Affiates of Calfornia tweeted: “Tonight’s confrmation of Amy Coney Barrett is a devistating attack on reproductive rights. But in CA — your right to critical health care is still protected, and Planned Parenthood is going to fight like hell to ensure it stays that way. But we need you to VOTE #WeDissent”. This was the start of a short thread. October 26, 2020: Planned Parenthood Affiliates of California tweeted: “In the legacy of Justice Ginsburg, we commit to not only fight to protect the rights she fought for – repro rights, affordable health care, racial equity, gender equity – but to work with CA’s leaders to close the widening gap between rights and true access. #WeDissent #SCOTUS” October 26, 2020: Planned Parenthood Affiliates of California tweeted: “With Barrett’s confirmation, 17 abortion-related cases one step from #SCOTUS, and the #ACA are about to be considered, the future of our health care is on the line. We need CA leadership @CAgovernor @AssemblyDems @CASenateDems to work to ensure health care access is protected #WeDissent”. This was the last tweet in the short thread. October 26, 2020: California Attorney General Xavier Becerra tweeted: “Our fight continues. One week after Election Day, I’ll be at the Supreme Court to stop Trump and his GOP allies from dismantling the Affordable Care Act. We intend to win.” October 26, 2020: Speaker of the House Nancy Pelosi (Democrat – California) tweeted: “President Trump and Senate Republicans have committed an act of supreme despiration: jamming through a Supreme Court nominee just days before Election Day as part of their years-long campaign to destroy Americans’ health care.” October 26, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Denounces Senate Republicans’ Illegitimate Confirmation of Amy Barrett to the Supreme Court”. From the press release: Senate Republicans today jammed through Amy Barrett’s confirmation to the Supreme Court, in spite of her record of anti-choice, anti-freedom extremism and as over 61 million Americans have already voted in the presidential election. With roughly a week left until Election Day, Republicans disregarded the will of the people, who believe that the next president should have filled the vacancy on the Court and that the Senate should prioritize much-need COVID-19 relief instead. NARAL Pro-Choice America President Ilyse Hogue released the following statement in response to this illegitimate confirmation: “This power grab by Donald Trump and Mitch McConnell is a shameful attack on our democracy. Amy Barrett’s extreme position on our fundamental rights is disqualifying. We know that they cannot be shamed, so we will see every single Republican who has played a role in this charade at the ballot box.”Further underscoring the Trump administration’s willingness to put its own political agenda above the health and well-being of the American people, they are planning to recklessly hold an in-person swearing-in ceremony for Barrett this evening. The event is scheduled to take place despite the fact that her nomination ceremony is believed to have been a “superspreader” event… October 26, 2020: Center for Reproductive Rights posted a press release titled: “Center for Reproductive Rights Statement on the Confirmation of U.S. Supreme Court Justice Amy Coney Barrett”. From the press release: Statement of Nancy Northup, President and CEOToday, in a deeply divided nation while an election is already underway, the U.S. Senate confirmed Amy Coney Barrett as an Associate Justice to the U.S. Supreme Court by a vote of 52-48. The American public deserved a comprehensive vetting and full assessment of the legal views of the person nominated to replace Justice Ruth Bader Ginsburg. What the public got was a shamelessly truncated and woefully partisan process. Justice Barrett’s academic writings, court decisions, and public advocacy reveal a legal view that the U.S. Constitution does not protect an individual’s personal liberty to make decisions about their reproductive health. This has incredibly troubling implications for the Supreme Court’s settled jurisprudence that the Fourteenth Amendment protects the right to access contraception and abortion care. Counter to her clear and documented record of extreme opposition to reproductive rights, Justice Barrett testified in her Senate Judiciary Committee hearing that she would join the Court with no agenda. Only time will be the judge of that. Dozens of abortion-rights cases are heading toward the Supreme Court and one is already there; the state of Mississippi is seeking review of its 15-week abortion ban, which the Center for Reproductive Rights successfully blocked in the lower courts as unconstitutional under Roe v. Wade. Also in the pipeline are other cases we are litigating on abortion access, contraception, and the ability to make our own healthcare decisions. The stakes are too high for us to back down. We go to court because it matters to people’s lives. We don’t bring cases to vindicate abstract legal theories; we bring cases to ensure that the promise of the Constitution is realized for everyone. The Supreme Court has long recognized the fundamental truth that control over reproductive decisions critically impacts “he ability of women to participate equally in the economic and social life of the Nation.” We see this every day in the way women in the U.S. live their lives. The overwhelming majority use contraception. One in four will make the decision to end a pregnancy. Increasingly, people are turning to assisted reproduction in creating their families. Millions have already benefited from the Affordable Care Act, including gaining access to maternal health care, no co-pay contraception, and coverage for pre-existing conditions. And when access to reproductive healthcare is burdened, when clinics are closed, and when healthcare is unaffordable, the consequences fall hardest on Black, Indigenous and people of color, rural communities and people living in poverty. This is why we go to court. Daunting challenges are ahead but we are undaunted. We will fight in the courts. We will push for federal and state legislation that will remove barriers to accessing reproductive healthcare, including the Women’s Health Protection Act and the EACH Woman Act. October 26, 2020: National Organization for Women (NOW) posted a press release titled: “NOW Denounces Amy Coney Barrett’s Confirmation to SCOTUS”. From the press release: Amy Coney Barrett says when it comes to interpreting the Constitution, she’s an “originalist” in the mold of her mentor, Antonin Scalia. This means that she interprets the Constitution exactly how the authors wrote it. However, the white male authors of the Constitution (many of whom were also slave owners) left out women, people of color, religious minorities, and LGBTQIA+ people. According to this interpretation, none of these groups are considered people deserving of equal rights. And that’s exactly how Justice Amy Coney Barrett will treat these groups. She has been groomed to overturn many of the important equality gains of the last 60 years, starting with a challenge to the Affordable Care Act that will come before the Court a week after Election Day. She has been outspoken in her opposition to abortion care, affordable birth control, LGBTQIA+ rights, and environmental protections, and she told the Senate she thought the science of climate change is still “in dispute.” NOW knows that even if Amy Coney Barrett and a conservative-leaning SCOTUS are not willing to defend our right to equality, that our voices still matter and we will not stop until we are heard. We’re reminded of how crucial a progressive, feminist majority in the Senate is to the future of the Supreme Court, and the women’s rights agenda. NOW members are even more energized than ever to turn out the largest feminist voting force in history to defeat Donald Trump, elect Joe Biden and Kamala Harris, and flip the Senate. We know what’s at stake—everything. October 26, 2020: Senator Kamala Harris (Democrat – California) posted a statement titled: “Harris Statement on Confirmation of Judge Amy Coney Barrett”. From the statement: U.S. Senator Kamala D. Harris (D-CA), a member of the Senate Judiciary Committee, on Monday released the following statement on her vote against the confirmation of Judge Amy Coney Barrett to be Associate Judge of the Supreme Court of the United States.“Senate Republicans jammed through this nomination in the middleof an election where over 60 million Americans have already voted. Senate Republicans have ignored the will of the people, decideing instead to replace Justice Rute Bader Ginsburg – who devoted her life to fighting for equal justice – with someone who was selected to undo her legacy.“President Trump repeatedly made it clear that he would only nominate judges who would get rid of the Affordable Care Act. President Trump and Senate Republicans are determined to take away health care coverage and protections for people with pre-existing conditions. On November 10, Trump administration lawyers will be before the Supreme Court arguing to strike down the Affordable Care Act in its entirity. This is a big reason why Senate Republicans rushed this confirmation. If they succeed, millions of people will lose access to health care in the middle of a devistating pandemic that has killed over 225,000 Americans and sickened millions more.“The American people see this confirmation for what it is: an illegitimate move that will set our country back for generations. Access to health care is now in jeopardy. Our voting rights are now in jeopardy. Workers’ rights are now in jeopardy. LGBTQ equality is now in jeopardy. The right to a safe and legal abortion is now in jeopardy. The ability to address a changing climate is now in jeopardy. And so much more.I share the American people’s outrage at this rushed process to confirm a nominee who has the potential to do great harm.” October 26, 2020: Speaker of the House Nancy Pelosi posted a press release titled: “Pelosi Statement on Confirmation of Justice Amy Coney Barrett”. From the press release: Speaker Nancy Pelosi issued this statement after the Republican Senate confirmed Amy Coney Barrett to the U.S. Supreme Court:“Eight days from Election Day, after 60 million Americans have already cast their ballots, President Trump and the GOP Senate have committed an act of supreme desperation by jamming through a Supreme Court justice – all so they can achieve their years-long campaign to destroy Americans’ health care.“Now, Americans must continue to make their voices heard in the election. Congress will have to reverse the damage of a radical Republican court and defend pre-existing condition protections together with every other benefit and protection of the Affordable Care Act.“With this usurped Supreme Court seat, the President is ripping away millions of families’ health care in the middle of a pandemic that has infected over 8.6 million and killed nearly one-quarter of a million Americans. In her confirmation hearing, Justice Barrett refused to answer whether she believes that Medicare is constitutional. She refused to acknowledge the scientific fact that climate change is happening, saying she isn’t a scientist, calling it ‘controversial.”“The President’s Supreme Court manipulation threatens the very values and rights that define and distinguish our nation: a woman’s constitutional right to make her own medical decisions, the right of LGBTQ Americans, the right of workers to organize and collectively bargain for fair wages, the future of our planet and environmental protections, voting rights and the right of every American to have a voice in our democracy.“We must have a Congress that is prepared to remedy what the Supreme Court will do to undermine the health, financial security, and well-being of American families.” October 26, 2020: Former President Barack Obama tweeted: “In the middle of a pandemic, this administration is trying to dismantle the Affordable Care Act in the Supreme Court. Here’s how Joe and I fought to expand health care, protect millions of Americans with preexisting conditions, and actually get it done:” The tweet includes a link to an article titled: “The President Looks Back on His Toughest Fight“. It is in The New Yorker and was written by Barack Obama. October 26, 2020: Lambda Legal posted a press release titled: “Lambda Legal Responds to Confirmation of Amy Coney Barrett to Supreme Court”. From the press release: This evening, with a 52-48 vote, the Senate confirmed Judge Amy Coney Barrett to the United States Supreme Court. In response, Lambda Legal CEO Kevin Jennings issued the following statement:“This is a dark day for our justice system and American democracy. The Supreme Court of the United States, the court of last resort for justice in our country, should not be up for a power grab, but that is exactly what happened today. Amy Coney Barrett deeply alarmed us during her confirmation hearings when she refused to say whether she believed cases that are the backbone of the legal rights of LGBTA people – such as Lambda Legal’s landmark case, Lawerence v. Texas which decriminalized same-sex intimacy, and Obergfell v. Hodges, which legalized same-sex marriage – were correctly decided. We fear that all the progress we have made in recent years is now at risk.“But as perverse as this nomination and forced confirmation against the will of American voters has been, we are not deterred. We have fought for the rights and dignity of LGBTQ people and everyone living with HIV for almost 50 years, and we will not stop now. Party politics may have prevailed today, but Lambda Legal will continue to fight; our communities can count on that.”Read Lambda Legal’s letter to Senate members opposing the nomination of Judge Amy Coney Barrett to the Supreme Court: https://www.lambdalegal.org/in-court/legal-docs/20201022_letter_amy-coney-barrett-opposition-supreme-court-senate October 28, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a blog post titled: “Georgia’s Medicaid Waiver is Fiscally Foolish and Anti-Family”. It was written by Joan Alker and Allexa Gardner. From the blog post: On October 15th, the Centers for Medicare and Medicaid Services Administrator Seema Verma traveled to Atlanta to announce the approval of Georgia’s “Pathways to Coverage” Section 1115 Medicaid demonstration. The approval is the latest in CMS Administrator Verma’s ideological crusade to “reframe” Medicaid and promote her signature initiative — work requirements. The creation of a maze of complex rules to ensure that people don’t get health care when they need it will drive up administrative costs and discriminate against parents with young children who will find it nearly impossible to pass the many tests presented in the state’s demonstration.Interestingly, the state’s companion and dangerous Section 1332 proposal, which was expected to be approved at the same time, has still not been approved. CMS has said it is working with the state to “finalize the terms and conditions for approval.”The state’s Medicaid approach is the kitchen sink of bad ideas that have been bumping around for years and found a home together in Georgia’s misguided approach. Administrator Verma and Governor Kemp’s mutual antipathy toward the Affordable Care Act has led to this misguided approach under the facade of “expanding” coverage. The state’s proposal will not qualify for the ACA’s enhanced 90% match, so, as a consequence, the state will receive its regular match rate of 67% (currently enhanced by 6.2% during the public health emergency) for those individuals who do get coverage after navigating an extremely difficult set of barriers including work reporting requirements.Currently, Georgia is one of 12 states that has not expanded Medicaid and has some of the highest uninsured rates in the nation for both children and adults. The state also has significant health disparities, yet only provides Medicaid coverage to adults who are parents and deep in poverty — below 35 percent of the federal poverty level ($634 per month for a family of three)……Under the approved demonstration, adults between ages 19 and 64 with incomes under 100 percent of the federal poverty level (FPL) must meet a requirement of 80 hours of work or “qualifying activities” (i.e. work hours or “community engagement”) per month to be eligible for Medicaid coverage. Once enrolled, these individuals must complete and report 80 hours of work or qualifying activities every month to maintain their health coverage. People with incomes between 50 percent ($905 per month for a family of three) and 100 percent FPL ($1,810 per month) are also required to pay a monthly premium to maintain coverage. It will not only be very difficult for individuals to break through these enrollment barriers, but it will also be arduous for them to maintain coverage. Individuals will have their benefits suspended, and will eventually be disenrolled from Medicaid, if they fail to meet the work requirements or pay their monthly premiumsIf that wasn’t enough, CMS also approved the elimination of 3-month retroactive coverage, non-emergency medical transportation (NEMT) services, and hospital presumptive eligibility (the first state to receive approval to do so). Other approved elements include cost-sharing and copayments for non-emergency use of the emergency department.The entire demonstration was approved under (a)(2) expenditure authority, which our colleague Andy Schneider has written about as part of Administrator Verma’s new litigation strategy to impose work requirements and other restrictions without being stopped by the courts. For a demonstration that claims to expand coverage, almost all of the provisions actually limit benefits and put low-income beneficiaries’ health coverage at risk.The per person cost of the demonstration is high and few would get coverage — especially when compared to the number of people who would be covered under a standard Medicaid expansion. Over the five-year demonstration period, the state estimates approximately 64,300 individuals will be covered (pg. 17 of cover letter). There are no meaningful budget neutrality estimates provided to show the estimated number of beneficiaries enrolled by year, or the total cost of the demonstration, nor does the state provide any hard estimates of the administrative costs that would result from such a complex system of rules. Because of the kitchen sink of approved policies with proven disenrollment effects, the state likely won’t come close to its predicted enrollment.The state previously estimated that if Georgia fully expanded Medicaid without the work requirements and other barriers to coverage, between 486,500 and 598,300 adults would be covered once the program reached full enrollment. This means at full enrollment, which is unlikely given all of the red tape, Georgia’s waiver will only cover 11% to-13 % of the potential expansion population with the state paying a greater share of the per-person cost, bringing far fewer federal dollars into the state, and incurring much higher administrative costs...…Of the 12 work requirement approvals, Georgia’s is one of the harshest we have seen for parents. Because meeting the work requirement is a condition of eligibility, the demonstration provides no exemptions for individuals who may not be able to meet the work requirement because they are taking care of children. Every other state work requirement includes an exemption for parents or caregivers with dependent children, at least until age 6.As a result of these restrictions, parents will be the least likely to gain coverage. There are no accommodations made for parents who may need child care – child care is not a qualifying activity for meeting the requirement nor are there any flexibilities for parents of children with disabilities. Child care is unaffordable for many low-income families, creating a barrier for parents to be able to meet the work requirement… October 29, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a blog titled: “National Strategy Needed to Close Health Care Gaps, Protect Children’s Health and Well-Being”. It was written by Kelly Whitener. From the blog post: …The new research from the Urban Institute should serve as a wake-up call to policymakers……Well-child visits and vaccination rates are down, children with special needs are struggling to access needed care, and adolescents are missing out on impotant reproductive health care. Prolonged worry and stress brought on by the pandemic are harmful to mental health for both children and parents. The authors point out that approximately 35 percent of adolescents reported receiving their mental health services in schools before the pandemic so the transition to virtual learning has likely decreased children’s access to behavioral health care. All of the challenges posed by the pandemic add to existing pediatric behavioral health workforce shortages that could lead to the social and emotional needs of children being further neglected.The good news is there are known solutions. Modifications to in-person health care have made it safer for children to continue to seek preventative care. Expanded access to telehealth and hybrid care models, with both virtual and in-person components, have made it easier for families to access needed care without unnecessary exposure to the novel Coronavirus. Outreach and education campaigns from state leaders and health care providers have helped parents stay informed about the importance of ongoing preventative care and how they can meet their children’s health care needs safely.The bad news is that without intervention from federal leaders, these interventions will not be distributed evenly, modified to remove remaining barriers, or targeted to children who need them most. States, providers, and child health advocates have been pushing the federal government for more support for months, but there’s been no movement on meaningful COVID relief in the Senate since March. Thankfully, states have intervened when possible and there is more they can do while we continue to wait for Godot……Lawmakers left Washington earlier this wek, but their work is far from done. November November 1, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi Statement on First Day of Open Enrollment in the ACA Insurance Marketplaces Across the Country”. From the press release: Speaker Nancy Pelosi released this statement on the first day of open enrollment for Affordable Care Act marketplaces for 2021, which runs from November 1, through December 15:“Affordable health coverage is more essential than ever during the pandemic. While Republicans try to tear down the Affordable Care Act in the Supreme Court, families can enroll knowing that Democrats in Congress stand ready to defend and strengthen pre-existing conditions protections and every other benefit of the ACA. Despite Republicans ‘ continued sabotage campaign, millions of Americans will have access to quality, affordable plans, with most people using the Marketplaces qualifying for financial help and, as a result, many will be able to find plans for as little as $10 per month.“Democrats will continue our work For The People to lower health care costs and prescription drug prices while protecting the pre-existing condition benefit for all Americans.” November 2, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becera Condemns Latest Trump Administration Attack on Health and Well-Being of Immigrant Families”. From the press release: California Attorney General Xavier Becerra today led a coalition of state and local governments in a comment letter condemning the Trump Administration’s new efforts to restrict family-based immigration through a proposed regulation that directly threatens state health care systems and efforts to combat the coronavirus. The proposed rule by the U.S. Department of Homeland Security (DHS) would force many U.S. citizens and green card holders to sacrifice the reciept of benefits for which they qualify – including Medicaid and the Supplemental Nutrition Assistance Program – to preserve their best opportunity to sponsor a family member for lawful permanent residency. The proposal is part of the Trump Administration’s ongoing effort to racially transform public charge law. In the comment letter, the coalition urges the Trump Administration to immediately withddraw the rule and postpone consideration of any similar rules until after the resolution of the ongoing global pandemic and national public health emergency.“Keeping citizen and immigrant families apart is a cruel but defining characteristic of the Trump Administration,” said Attorney General Becerra. “DHS’s proposal runs counter to America’s core values and the law. It threatens public health in the middle of a pandemic. No family should ever be forced to choose between accessing healthcare and food assistance or bringing the family together in this time of pandemic.”On October 2, 2020, DHS proposed a new regulation to drastically alter requirements for affidavits of support, which are contracts signed by a sponsor to show that their close family member who is applying for a green card is not likely to become dependent on the government. Among the harsh changes sought, DHS has proposed a joint-sponsor requirement when sponsors or their household members have received a public benefit for which they qualify within the 36-month period prior to the execution of an affidavit of support. The proposed rule would disqualify individuals from serving as a joint sponsor if they have received such a benefit within the same time period. It would preclude sponsors from pooling their income with the income of other relatives who reside with them and are willing to promise support for the intending immigrant if needed, except where the relative is the sponsor’s own spouse. The proposal also needlessly subjects sponsors and their household members to onerous documentation requirements. Ultimately, the new requirements would significantly hinder family unification and — like the public charge rule — penalize modest income and working-class families for accessing public benefits for which they are eligible — all during an economic and public health crisis of historic proportions that has infected more than 9.1 million Americans and resulted in the deaths of more than 229,000 people across the country.In the comment letter, the attorneys general assert that the proposed rule will: Deter eligible U.S. citizens from receiving critical public benefits, endangering public health;Generate confusion with regards to immigration laws and increase administrative burdens on state and local governments;Weaken states’ response to the pandemic by sowing distrust in government services and creating reluctance to seek needed healthcare — exacerbating the disparate impacts of the pandemic on our communities; andViolate federal statutes, failing to pass muster under laws such as Immigration and Nationality Act and the Administrative Procedure Act.. …In filing the comment letter, Attorney General Becerra is joined by the attorneys general of Delaware, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Virginia, Washington, Wisconsin, and the District of Columbia, as well as the Cook County State’s Attorney, Corporation Counsel of New York City, and County Counsel of the County of Santa Clara County.A copy of the comment letter is available here. November 2, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a blog post titled: “New CMS Rule Would Weaken Families First Continuous Coverage Protection in Medicaid”. It was written by Edwin Park. From the blog post: On October 28, the Trump Administration announced that it would weaken the current continuous coverage protection for Medicaid beneficiaries by permitting states to cut or scale back benefits and increase cost-sharing charges.The Families First COVID-19 relief legislation provided a temporary 6.2 percentage point increase in the federal Medicaid matching rate (FMAP) through the end of the calendar year quarter in which the current public health emergency expires (PHE). Because the Secretary of Health and Human Services extended the PHE through at least January 20, 2021, this means the FMAP increase remains in effect through at least March 31, 2021.Under a maintenance-of-effort (MOE) requirement, as a condition of receiving the increased Families First FMAP, state Medicaid programs must not implement eligibility standards, methodologies and procedures that are more restrictive or charge higher premiums than were in place on January 1, 2020. They must also cover COVID-19 testing and treatment without cost-sharing. They must also not disenroll any beneficiaries who were enrolled as of March 18, 2020 (or newly enrolled beneficiaries after such date) through the end of the month in which the PHE ends. That means that state Medicaid programs must maintain enrollment through at least January 31, 2021. This last “continuous coverage” requirement is critical to ensuring that low-income individuals and families have access to health coverage and to needed care during the pandemic……CMS, however, is issuing a new interim final rule reversing its earlier sound reading of the continuous coverage requirement. Under the most harmful change, state Medicaid programs would now be permitted to eliminate optional benefits such as dental coverage and reduce the amount, duration and scope of covered benefits (like imposing lower visit limits or adding other utilization controls), compared to what was covered on March 18, 2020. They may also now increase co-payment and other cost-sharing levels (subject to federal limits) and require nursing home residents to contribute more to the monthly cost of their care (known as post-eligibility treatment of income), above what was required on March 18, 2020.In addition, states would be permitted to transfer beneficiaries from one eligibility category to another if they are no longer eligible under their original category, even if it may reduce the benefits available to them. For example, if an expansion state has opted to cover 19 and 20 year-olds under their child eligibility category, the continuous enrollment protection would no longer require the state to maintain the young person in the child eligibility category when they turn age 21 and could instead transfer them to the adult expansion group. This, however, means the beneficiary would lose access to the comprehensive Early Periodic Screening Diagnostic and Treatment (EPSDT) benefit. Similarly, a near-elderly Medicaid beneficiary enrolled in the expansion who turns age 65 and becomes eligible for Medicare could be switched to the Medicare Savings Programs (which only covers Medicare premiums and cost-sharing, not other Medicaid benefits that may not be covered by Medicare)……Finally, CMS indicates that a state would not be out-of-compliance with the continuous coverage requirement if it disenrolls a beneficiary who was not validly enrolled in the first place (the eligibility determination was erroneous or the result of fraud and abuse). Beneficiaries found enrolled in two or more states who fail to respond to a request for information related to residency may also be disenrolled. In addition, states that have opted to cover full benefits for lawfully residing children and pregnant women in in the first 5 years after entry into the United States would be required to limit their coverage to emergency services if individuals are found to no longer meet the definition of such children and pregnant women.These changes would be effective immediately (upon public display of the interim final rule). Notably, while CMS issued its original interpretation of the continuous coverage requirement as guidance, it is now reversing it through an interim final rule. That both makes these changes harder for a different Administration to modify procedurally but also essentially takes away meaningful public comment, as these changes will already be in effect well before any comments are submitted, let alone considered. November 3, 2020: The Denver Post posted an article titled: “Colorado Prop 115 results: Ban on most later-term abortions defeated”. It was written by Judith Kohler. From the article: A ban on most abortions at 22 weeks or later in pregnancy was defeated Tuesday night as voters rejected the fourth attempt since 2008 to more stringently regulate abortions in Colorado.About 1.6 million voters, or 59.2%, rejected Proposition 115 with 83% of the vote counted, while 1.1 million, or 40.8%, supported it.Proponents, who said they had strong grassroots support, were vastly outspend by opponents. Proponents spent $505,488, compared to opponents’ nearly $9 million, according to the Colorado News Collaborative’s FollowtheMoneyCO project.The ballot measure would have subjected doctors ever attempting to perform a later-term abortion to misdemeaner charges and at least a three-year suspension of their license. The only exception would have been for an abortion that is immediately required to save the woman’s life….…those campaigning against Proposition 115 said it would have undermined women’s rights to reproductive health……Colorado was the first state in the country to decriminalize abortion, passing a law in 1967 to allow the procedure in cases of rape, incest, if the woman’s life was threatened or if the unborn child might have birth defects.The vote on abortion restrictions came as the confirmation of Amy Coney Barrett to the U.S. Supreme Court has raised the stakes for the fate of Roe vs. Wade, the 1973 ruling that legalized abortion. Barrett has been involved in organizations opposed to abortion… November 3, 2020: Lift Louisiana posted news titled: “Louisiana Coalition for Reproductive Freedom Responds to Passage of Amendment 1”. From the news: Louisiana voters approved Amendment 1, which explicity states there is no righ to an abortion and the funding of an abortion in the Louisiana Constitution. The Louisiana Coalition for Reproductive Freedoms (LCRF), which is a statewide alliance of organizations and individuals, fought against the amendment for a number of reasons including that it would deny the personal freedom of bodily autonomy and would hurt already marginalized communities: BlackIndigenouspeople of coloryoung peopleundocumented peoplepeople living on low or no income; and people experiencing homelessness; andLGBTQ+ people Everyone should have the right and freedom to make decisions about their bodies and whether, when, and how they become a parent. Proponents of the amendment tried to say it would prevent public funding of abortion, but state and federal laws have prohibited public funds from being used for abortion services in Louisiana for more than 40 years.The right to an abortion is still unconstitutionally protected by the United States Supreme Court’s Roe v. Wade decision, but Amendment 1 could prevent a judicial intervention for abortion rights should Roe ever be overturned. With Amy Coney Barrett’s confirmation to the Supreme Coirt, there are many who feel Roe is in jeopardy. Louisiana, which has passed 89 abortion-restrictive laws since the 1973 Roe decision, has only three remaining abortion care facilities, making it one of the most difficult states to obtain abortion care… November 3, 2020: The Hill posted an opinion piece titled: “COVID-19 could become a widespread pre-existing condition in a post-ACA world”. It was written by Carter C. Price (a senior mathematician at the nonprofit, nonpartisan RAND Corporation who worked on the COMPARE microsimulation model to study the impact of health reform.) It was also written by Raffaele Varadavas (a mathematician at RAND and a member of Pardee RAND Graduate School faculty who constructs and analyzes epidemic models.). From the article: On Nov. 10, the U.S. Supreme Court will hear oral arguments in Californai v Texas, a cast that asks: When Congress eliminated the penalty for not carrying health insurance, did that make the whole Affordable Care Act (ACA) unconstitutional? In the midst of the pandemic, this question takes urgency for COVID-19 survivors.If the ACA is struck down, protections for pre-existing conditions will go with it. That could mean tens of millions of Americans could be charged higher premiums or even denied health insurance coverage altogether……Given the chronic problems associated with some COVID-19 cases, it is possible that some insurers would place restrictions on anyone who had a confirmed case of COVID-19. As of late October, there have been about 5.8 million confirmed cases among people under the age of 65 (and therefore not eligible for Medicare in most circumstances), and those numbers keep rising. If a history of COVID is considered to be a pre-existing condition, access to affordable insurance will be greatly diminishedfor those in the South and parts of the Great Plains (North and South Dakota, in particular) and Midwest.Access to testing was limited in the earlier days of the pandemic, so many other COVID-19 infections were not identified. But some of those may be detected in the future with antibody testing. A portion of this population may also have significant long-term health consequences, and insurers may want to avoid that risk, which would put a total of 23 million people or more at risk of being flagged with a pre-existing condition.More than a quarter of people in the state of New York could be at risk of being flagged as having had a pre-existing condition based on antibody testing. Louisiana, Illinois and states in the mid-Atlantic and portions of New England also have high levels of positive antibody tests that could be considered signs of a pre-existing condition. These numbers will only grow and could be more than two or three times as high or higher before the pandemic is under control. In practice, it may be challenging for insurance companies to exclude or apply rescission on all COVID-19 survivors without a positive test, but this does suggest a scale of the population who may be vulnerable.COVID-19 has not spread evenly through the population. Black and Latino populations, low-income Americans and essential workers have been particularly hard hit. In a world without the ACA, this would, perversely, mean that the demographic groups most affected by COVID-19 will have the least access to affordable health care.The threat of being denied insurance because of a COVID-19 diagnosis could also change behavior. Specifically, individuals might avoid getting tested. Conversely, the same threat may encourage some people to take precautions like wearing face masks and social distancing and to get vaccinated when available… November 4, 2020: The RAND Blog posted a blog post titled: “COVID-19 Could Become a Widespread Preexisting Condition in a Post-ACA World”. It was written by Carter C. Price and Raffaele Vardavas. From the blog post: On November 10, the U.S. Supreme Court will hear oral arguments in California v. Texas, a case that asks: When Congress eliminated the penalty for not carrying health insurance, did that make the whole Affordable Care Act (ACA) unconstitutional? In the midst of the pandemic, this question takes an urgency for COVID-19 survivors.If the ACA is struck down, protections for preexisting conditions will go with it. That could mean tens of millions of Americans could be charged higher premiums or even denied health insurance coverage altogether……Without these ACA protections, there are several ways that an insurance company might consider COVID-19 to be a preexisting condition to discriminate against applicants and policyholders.Given the chronic problems associated with some COVID-19 cases, it is possible that some insurers would place restrictions on anyone who had a confirmed case of COVID-19. As of late October, there have been about 5.8 million confirmed cases among people under the age of 65 (and therefore not eligible for Medicare in most circumstances), and those numbers keep rising. If a history of COVID-19 is considered to be a preexisting condition, access to affordable insurance will be greatly diminished for those in the South and parts of the Great Plains (North and South Dakota, in particular) and Midwest……Access to testing was limited in the earlier days of the pandemic, so many other COVID-19 infections were not identified. But some of those may be detected in the future with antibody testing. A portion of this population may also have significant long-term health consequences, and insurers may want to avoid that risk, which would put a total of 23 million people or more at risk of being flagged with a preexisting condition……The threat of being denied insurance because of a COVID-19 diagnosis could also change behavior. Specifically, individuals might avoid getting tested. Conversely, the same threat may encourage people to take precautions like wearing face masks and social distancing and to get vaccinated when available… November 7, 2020: Joan Alker (ED of Georgetown Center for Children and Families) tweeted: “Goodbye and good riddance to Medicaid work requirement waivers”. November 9, 2020: Planned Parenthood posted a press release titled: “More than a Dozen Countries Call for U.S. to Advance Sexual and Reproductive Health and Rights as Part of U.N. Review”. From the press release: Today, as part of the Universal Periodic Review (UPR) process, representatives from United Nations (UN) member states offered recommendations to the U.S. on how to correct recent human rights abuses. Many representatives focused on regressive policies from the Trump administration, and its allies across the U.S. government, that attack sexual and reproductive health and rights. With the election of President-elect Joe Biden and Vice President-elect Kamala Harris, two champions for sexual and reproductive health, this critical work of restoring policies that advance human rights can begin……The UPR process involves a review of the human rights records of all UN member states every four years, with the aim of improving the human rights situation on the ground. Planned Parenthood Federation of America submitted a report for the UPR on the U.S. human rights record, including recommending to overturn the Title X and global gag rules and to repeal the Hyde and Helms Amendments. During today’s session, the following countries offered recommendations to the U.S. to ensure universal access to sexual and reproductive health, and address policies that limit access to family planning through the Title X program and restrict funding for sexual and reproductive rights, including abortion, through U.S. foreign aid: Australia, Austria, Canada, Denmark, Iceland, Finland, France, Luxembourg, Malaysia, Mexico, Netherlands, New Zealand, Norway, and the United Kingdom.These damaging policies that restrict sexual and reproductive health access have been in place, and been harming people across the globe, for years. But tragically, the COVID-19 pandemic has magnified health care disparities, in turn impacting reproductive rights. In the U.S., one in three women have reported delays in accessing sexual and reproductive health care, with this rate even higher among Black and Hispanic women. Similar disruptions are occurring in other countries and are exacerbated by U.S. policies like the global gag rule.The impact of these regressive policies are clear. Upon taking office, the Biden administration must end the global and domestic gag rules so that health care providers and patients can speak freely about all reproductive healthcare options. The administration must also propose a budget that reflects a committment to sexual and reproductive health – including ending the Hyde and Helms Amendment. November 9, 2020: American Civil Liberties Union (ACLU) posted news titled: “The Affordable Care Act – and With It, Our Civil Rights – Are Under Attack”. It was written by Lousie Melling, Deputy Legal Director and Director of Ruth Bader Ginsburg Center for Liberty. From the news: …But the Affordable Care Act is now imperiled. This week, the Supreme Court will hear arguments in California v. Texas – a case that puts this critical law in jeopardy of being struck down in its entirety. While most legal scholars think such a ruling unlikely, any decision striking the law would have devistating ramifications for the civil liberties advancements that the ACA has provided. And it would have particlarly cruel and deadly consequences in the midst of a pandemic and recession. Dismantling the ACA now would exacerabate the longstanding, systemic disparities in access to health care, economic opportunities, and other resources faced by Black, Latinx, and disabled people in this country – disparaties that are now approaching epic proportions in light of the pandemic.The Affordable Care Act made huge advancements for many groups of people to whom stable health insurance and health care were often denied, whether because of express discrimination or the effects of discrimination.Women: The ACA bars sex discrimination, full stop. This means, for example, that at long last insurers may no longer charge women higher rates. The ACA as implemented covers care long excluded from insurance coverage that was seen as exclusively women’s care: mammograms, screenings for cervical cancer, contraception coverage and counseling, lactation support, and prenatal care. These forms of discrimination had material consequences. Before passage of the Affordable Care Act, women were estimated to spend 68 percent more than men in out of pocket health care costs. The ACA takes aim at discrimination that perpetuates gender inequity, including the discrimination in health care that perpetuates gender disparities in wealth.LGBTQ people: The ACA’s bar on sex discrimination also means that LGBTQ people can’t be subject to discrimination in federally funded institutions, public health care programs, or by insurance companies. The ACA eliminates barriers that many LGBTQ people previously faced in receiving health care — a crucial step toward ensuring health care is accessible to all — regardless of gender identity or sexual orientation.People of color: The ACA makes important strides to address racial injustice in health care as well. It bars discrimination based on preexisting conditions, a provision critical to ensuring that those who are sick — and thus most in need of health insurance — aren’t effectively barred from accessing it. While this provision is important to people of all races, it is also an essential part of beginning to redress the health disparities that reflect the legacy of race discrimination in the country. This is evident in the higher rates of hypertension among Black people, for example, and the disproportionate rates of COVID-19 infections and deaths among Black and Latinx communities. The data is striking: Because of the ACA, between 2013 and 2017, the coverage gap between Black and white Americans declined from 11 to 5.3 percentage points. Similarly, during the same period, the coverage gap between Hispanics and non-Hispanic whites dropped from 25.4 to 16.6 percentage points. Additionally, the ACA expanded Medicaid for people whose income is below 138 percent of the federal poverty level. In short, the ACA has helped make important strides in reducing racial, ethnic and economic disparities in in access to health care and coverage. People with disabilities: The ACA has been a life saver for people with disabilities. It protects against coverage limitations based on preexisting conditions or lifetime limits, and guarantees coverage of services for mental illnesses and developmental disabilities. It provides access to long-term, home-based health care, which can mean the difference between institutionalization and independence for people with disabilities. And it expressly precludes discrimination in access to health care based on disability.People experiencing poverty: The ACA also expanded Medicaid for people up to 138 percent of the federal poverty level — although not every state availed itself of the option, despite its literal life-giving opportunities. Prior to the ACA’s passage, Medicaid eligibility for parents was limited to those with very low incomes (often below 50 percent of the poverty level), and adults without dependent children were ineligible under federal rules, regardless of their income level, according to a report from the Kaiser Family Foundation.The ACA is part of the path to equity — remedying systems of oppression and discrimination — that runs to the core of living or dying, particularly during the time of COVID-19. As we said in our 2012 brief, the ACA “advances the twin goals of liberty and equal protection.” The ACA is worth fighting for. Our civil liberties and civil rights are worth fighting for. November 9, 2020: California Attorney General Xavier Becerra posted a press release titled: “On Eve of Oral Arguments in the U.S. Supreme Court, Attorney General Becerra Issues Statement in Defense of the Affordable Care Act”. From the press release: California Attorney General Xavier Becerra today issued a statement on the Affordable Care Act (ACA) ahead of tomorrow’s oral arguments before the United States Supreme Court in the healthcare repeal case, California v. Texas. The California Attorney General’s Office is leading a coalition of 20 states and the District of Columbia in defense of the ACA including the law’s protections for people with preexisting conditions, public health investments, and Medicaid expansion, among others. In the midst of rising COVID-19 cases and deaths nationwide, the Trump Administration and the Texas-led state coalition are risking the healthcare of millions of Americans and financial support for states. The State of California alone, would stand to lose an estimated $160.2 billion in federal program funding, and millions of people would lose their healthcare coverage as a result of the loss of the ACA.“COVID-19 has made one thing undeniable: We must safeguard the Affordable Care Act – lives depend on it,” said Attorney General Becerra. “Every nation around the world has had to confront the devistating impact of the global pandemic. The United States, under President Trump’s watch, continues to set records going in the wrong direction. Millions infected, hundreds of thousands dead. As if on cue, the Trump Administration cavilerly continues its march to dismantle the ACA and strip Americans of their healthcare. We will do everything we can to defeat this unprecedented assault on a critical federal law by a sitting president.”……Every American could be affected if the ACA is destroyed. In particular, the following is at stake: Healthcare for the 20 million Americans who are able to afford insurance either through Medicaid expansion or thanks to tax credits and employer-sponsored plans through healthcare exchanges, such as Covered California;Guaranteed coverage for the 133 million Americans who have a pre-existing condition, including 17 million kids, and benefit from the law’s protection against discrimination and higher costs based on health status;Healthcare for young adults under the age of 26 covered by a parent’s plan;Families of children with chronic health conditions who are currently protected from lifetime insurance limits; andFunding for our nation’s public health system, including investments in local and state public health systems that help during the pandemic, FDA biosimilars which power drug costs, and more including Medicare payment reforms, Indian Health Services, and work to fight the opioid epidemic… November 9, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James Defends ACA on Eve of Supreme Court Oral Arguments”. From the press release: New York Attorney General Letitia James today continued her strong defense of the Patient Protection and Affordable Care Act (ACA) ahead of tomorrow’s oral arguments before the United States Supreme Court in the health care repeal case, California v. Texas. Attorney General James and a coalition that includes 20 states and the District of Columbia are defending the many provisions of the ACA — including coverage of preexisting conditions, public health investments, and Medicaid expansion, among others — against the Trump Administration and a Texas-led state coalition seeking to dismantle the health care reform law that has provided new coverage to at least 20 million Americans. The Trump Administration and the Texas-led state coalition’s actions are even more dangerous given their attempts to strip health care coverage away from millions of Americans as coronavirus disease 2019 (COVID-19) deaths and infections — which hit numerous highs last week — continue to rise exponentially across the nation.“For years, Donald Trump and Republicans across the country have tried to repeal the ACA and strip health coverage away from millions of Americans, but we will continue to fight this assault on our health care,” said Attorney General James. “Even more dangerous is that this attack comes in the middle of the COVID-19 pandemic, which has killed more than 237,000 Americans and infected more than 10 million. That’s 10 million Americans who now have a pre-existing condition and who Republicans want to charge more for coverage. Eight years ago, the Supreme Court ruled that the ACA was legal, so we will not allow President Trump and his Republican allies to dismantle the ACA, piece-by-piece, or undo all the progress made since the law’s passage after failing to get Congress to do its dirty work.”……The lawsuit — originally filed by a Texas-led coalition and later supported by the Trump Administration — argued that a Republican-led Congress rendered the ACA’s individual mandate unconstitutional when it reduced the penalty for forgoing coverage to $0. They further argued that the rest of the ACA should be held invalid as a result of that change. Attorney General James and a coalition of attorneys general defended the ACA in its entirety, supported by a bipartisan group of amici, including scholars, economists, public health experts, hospital and provider associations, patient groups, counties, cities, and more. While the U.S. Court of Appeals for the Fifth Circuit held the individual mandate to be unconstitutional, it declined to further rule on the validity of the ACA’s remaining provisions. The court instead sent the case back to the U.S. District Court for the Northern District of Texas to determine whether the problem with the mandate requires striking down the whole law. In January, however, Attorney General James and the coalition petitioned the Supreme Court for expedited review to protect Americans’ health care and resolve the uncertainty created by the Fifth Circuit decision. The Supreme Court granted review of the case in March for the upcoming term.In addition to New York, the coalition arguing before the Supreme Court tomorrow includes the attorneys general of California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Massachusetts, Michigan, Minnesota (by and through its Department of Commerce), Nevada, New Jersey, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia, as well as the governor of Kentucky. November 9, 2020: Senator Bernie Sanders (Independent – Vermont) tweeted: “Every year, 68,000 Americans die because they can’t afford to go to a doctor on time – almost 200 people a day. Health care is a human right. Lack of health care is a death sentence. We must guarantee health care to everyone through a Medicare for All, single-payer program.” November 9, 2020: American Academy of Pediatrics posted a news release titled: “Leading Children’s Health Groups Urge Lawmakers and Administration to Address Troubling Trends in Children’s Uninsurance”. From the news release: Leading children’s health groups are urging comprehensive and immediate action by Congress and the Administration to protect and improve access to health care coverage for all children. The call to action comes on the heels of recent data from the U.S. Census Bureau showing that 320,000 fewer children had health insurance coverage in 2019 than in 2018, even before the COVID-19 pandemic. Today, a new report from the Georgetown University Center for Children and Families shows that in 2019, an estimated 4.4 million children did not have health insurance coverage, an increase of 726,000 or nearly 20 percent more children without insurance since 2016, when the nation reached a historic low in children without coverage. The child uninsured rate has grown from 4.7 to 5.7 percent over the same time period.The American Academy of Pediatrics, Children’s Defense Fund, Family Voices, First Focus on Children, Georgetown University Center for Children and Families, March of Dimes, and the National Association of Pediatric Nurse Practitioners issue the following statement:“Our organizations are sounding the alarm over the growing number of children without health insurance. Recent data show the largest increase in the number of uninsured children in more than a decade. A new report today shows that years of progress in covering more children has been eroded, with widespread coverage losses across income, age, racial and ethnic groups.“Since 2016, the number of uninsured children has grown each year. Especially concerning is that these 2019 numbers do not reflect the devistating consequences of the COVID-19 pandemic and economic downturn this year, which has caused millions of families to lose jobs and employer-sponsored insurance. These data underscore that the children’s health coverage landscape was already headed in a dangerous direction, even before the pandemic hit.“Without health care coverage, children’s health suffers. Often, no coverage means no care, which means fewer preventive screenings to catch conditions before they become severe and costly. It means no access to affordable dental coverage, vaccines, or prenatal services for pregnant mothers. While the latest data show that children across all regions and income levels experienced coverage losses in 2019, the greatest coverage losses were among Hispanic children. The COVID-19 pandemic, which has had a disproportionate impact on communities of color, only exacerbates the impact on children and families who lack access to affordable, comprehensive and high-quality health coverage. We know that children without health coverage could also suffer long-term harm, ending up in poorer health, with less emotional attainment and less financial security in adulthood.“Before the pandemic, the Administration’s actions – such as the public charge rule, which has reduced immigrant families’ willingness to enroll their children in Medicaid and the Children’s Health Insurance Program (CHIP), and other problematic policy changes that impeded access to Medicaid and the CHIP and private insurance – are contributors to this erosion of children’s coverage. The ongoing global pandemic and subsequent economic recession lead us to believe coverage losses for children will only continue to get worse.“Children need health care coverage that they can rely on. Congress took the first step to protect children and families by providing greater financial support for Medicaid in the Families First Coronavirus Response Act, along with its continuous coverage protections ensuring that children, pregnant women, and families won’t lose Medicaid coverage due to red tape during the pandemic. We call on Congress and the Administration to advance policies that ensure all children and families have health care coverage, not policies that stand in the way of making that possible. Our children’s futures depend on our ability to act now.” November 10, 2020: The American College of Obstetricians and Gynecologists (ACOG) posted news titled: “ACOG Statement on the Affordable Care Act”. From the news: The following is a statement from Eva Chalas, MD, FACOG, FACS, President of the American College of Obstetricians and Gynecologists (ACOG), and Maureen G. Phipps, MD, MPH, Chief Executive Officer of ACOG, regarding the challenge to the Patient Protection and Affordable Care Act (ACA) before the U.S. Supreme Court:“The ACA has revolutionized access to care for tens of millions of women by helping them obtain meaningful health coverage, ensuring that essential care is covered by insurers, and protecting patients from unfair practices. ACOG urges the Supreme Court to recognize that overturning the ACA will leave tens of millions of patients without reliable access to care. In any year, this would be devastating, and during a global pandemic, it is unconscionable and would be one of the most singularly disruptive acts to be committed during this public health crisis.“Years of data clearly demonstrate how the ACA has changed lives by improving patient access to care, reducing out of pocket costs, enhancing peace of mind, and bettering the health and wellbeing of so many individuals and families.“ACOG is hopeful that tens years after its historic enactment, the ACA will continue to stand. Moving forward, we are eager to work with policymakers to build on the advances of the ACA to continue to protect meaningful health coverage, eradicate preventavle maternal mortality, and achieve health equity in the United States.”Access the amicus brief that ACOG filed with other major medical associations. November 10, 2020: National Organization for Women (NOW) posted a press release titled: “We Refuse To Go Backwards, We Must Protect Our Health Care”. From the press release: Donald Trump packed the Supreme Court with justices the could count on to strike down the Affordable Care Act (ACA). Today, in the midst of a global pandemic when health care is needed most, we are watching to see if Amy Coney Barrett, Brett Kavanaugh, and Neil Gorsuch deliver the goods to the outgoing President.Women and the most vulnerable in our society know what’s at stake today. The repeal lawsuit, supported by the Trump administration, will be heard by the Supreme Court in California v. Texas and could end ACA as we know it.The ACA is what allows parents to keep their children on their health insurance plans until age 26, ensures women are able to obtain preventative care services such as mamograms, and helps protect access for birth control. Prior to the ACA, women could be charged more for insurance and could be denied maternal coverage like pregnamcy care and childbirth. Additionally, insurance companies could deny LGBTQIA+ individuals insurance coverage, services related to gender transition, or charge higher rates based on sexual orientation or gender identity.Perhaps the most alarming aspect of a ACA repeal would be the loss of the prohibition against denying coverage for those with pre-existing conditions. According to the Department of Health and Human Services, this could impact anywhere between 50 and 129 million individuals. And as the COVID pandemic takes an exponential toll on Americans and the nation’s mental health, if the ACA is overturned, mental illness and even COVID-19 itself may soon be the most common pre-existing condition.The ACA’s essential health benefits ensure everyone with insurance can have comprehensive care, including mental healthcare, maternity care, and more. NOW members are monitoring today’s arguments carefully. These justices cannot allow themselves to be used as partisan pawns, intent on eviscerating our healthcare system. It is the duty of the Supreme Court to uphold the Constitution and protect our civil rights and liberties.We refuse to go back to a dangerous time when insurance companies could deny or charge more for coverage and discriminate against the millions of people with pre-existing conditions. Repealing access to health care, with no alternative plan in sight moving forward, will only put the lives of women and families at risk. November 10, 2020: New York Attorney General Letitia James posted a press release titled: “Attorney General James’ Statement on ACA Supreme Court Oral Arguements”. From the press release: New York Attorney General Letitia James and a coalition that includes 20 states and the District of Columbia today defended the Patient Protection and Affordable Care Act (ACA) in the United States Supreme Court in the health care repeal case, California v. Texas. The coalition defended the many provisions of the ACA agaisnt the Trump Administration and a Texas-led state coalition seeking to dismantle the health care reform law that has provided new coverage to at least 20 million Americans.“The Affordable Care Act has been the law of the land for a decade now, but President Trump, his administration, and Republicans allies are trying to take us backwards in time by stripping health coverage away from millions of Americans,” said Attorney General James. “Today, Donald Trump and Republicans fought to kick children off their parents’ health care plans, fought to rip health coverage away from the 133 million with pre-existing conditions, fought to charge women more for no other reason than being a woman, fought to increase the cost of prescription drugs for seniors, and fought to deprive millions of Americans access to quality, affordable health care. Time after time, President Trump and his Republican allies have failed to get Congress to do its dirty work and has instead attempted to dismantle the ACA, piece-by-piece. We are confident the court will reject Republicans’ arguments today, just like it did in 2012, and that we will prevail in protecting Americans’ right to health care.”Every American across the nation could be affected if the ACA is dismantled. At risk is: Health care for the 20 million Americans who are able to afford insurance either through Medicaid expansion or thanks to tax credits and employer-sponsored plans through health care exchanges.Guaranteed coverage for the more than 133 million Americans who have a pre-existing health condition, including 17 million kids, that benefit from the law’s protections against discrimination and higher costs based on health status.Health care for young adults under the age of 26 covered by a parent’s plan.Health care for families of children with chronic health conditions who are currently protected from lifetime insurance limits.Funding for our nation’s public health system, which includes investments in local and state public health systems that have helped during the COVID-19 pandemic; FDA biosimilars, which power drug costs; and more, including Medicare payment reforms, Indian health services, and work to fight the opioid epidemic. The lawsuit — originally filed by a Texas-led coalition and later supported by the Trump Administration — argued that a Republican-led Congress rendered the ACA’s individual mandate unconstitutional when it reduced the penalty for forgoing coverage to $0. They further argued that the rest of the ACA should be held invalid as a result of that change. Attorney General James and a coalition of attorneys general defended the ACA in its entirety, supported by a bipartisan group of amici, including scholars, economists, public health experts, hospital and provider associations, patient groups, counties, cities, and more. While the U.S. Court of Appeals for the Fifth Circuit held the individual mandate to be unconstitutional, it declined to further rule on the validity of the ACA’s remaining provisions. The court instead sent the case back to the U.S. District Court for the Northern District of Texas to determine whether the problem with the mandate requires striking down the whole law. In January, however, Attorney General James and the coalition petitioned the Supreme Court for expedited review to protect Americans’ health care and resolve the uncertainty created by the Fifth Circuit decision. The Supreme Court granted review of the case in March for the upcoming term.In addition to New York, the coalition that argued the case before the Supreme Court included the attorneys general of California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Massachusetts, Michigan, Minnesota (by and through its Department of Commerce), Nevada, New Jersey, North Carolina, Oregon, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia, as well as the governor of Kentucky. November 10, 2020: National Women’s Law Center posted a press release titled: “NWLC responds to Supreme Court’s ACA oral arguements”. From the press release: Today, the newly comprised U.S. Supreme Court will hear oral arguments to decide whether or not the Affordable Care Act (ACA) is constitutional, the first with Justice Amy Coney Barrett, who was confirmed just a week before the election.Invalidation of the ACA will force at least 20 million people to immediately lose health care, in addition to critical reforms and protections that ended discriminatory and harmful insurance industry practices that disproportionately impacted wimen as highlighted in our amicus brief.Because of the ACA: Insurance companies are prohibited from denying coverage based upon pre-existing conditions, and 68 million women with pre-existing conditions have access to health coverage.The practice of charging women significantly more than men for the same health insurance is banned, saving them approximately $1 billion a year.Expanded Medicaid eligibility covers 18% of women across the country, including 27 percent of Latinas and 31 percent of Black women ages 15-44.There is a broad federal protection against discrimination in health care based on race, color, national origin, age, disability, or sex, including gender identity, sex stereotyping, pregnancy, termination of pregnancy, childbirth, or related medical conditions.Plans must cover women’s preventive services without out-of-pocket costs, including breast and cervical cancer screenings; comprehensive breastfeeding support services; and the full range of FDA-approved methods of contraception for women and related education and counseling. Over 64 million women now have coverage of preventive services without cost-sharing.Plans must cover a baseline of essential health benefits for individual and small group insurance, including maternity and newborn care, preventative services, mental health and substance abuse disorder services, and prescription drugs.Insurance companies are prohibited from setting lifetime limits on coverage.Young adults can stay on their parents’ health insurance plan until they turn 26. The following statement is from Fatima Goss Graves, president and CEO of the National Women’s Law Center (NWLC):“It’s deeply disturbing that this politically motivated effort to take health coverage away is at the Court for a third time, while COVID-19 cases continue to skyrocket. The Court should see this for what it is: Trump’s agenda to destroy the ACA, without a legal basis. People across the country know what’s at stake, and a decisive majority just voted for progress. People need and deserve expanded access to health care, especially during a pandemic. We will fight to make this a reality, no matter the decision of the Court.” November 10, 2020: U.S. News posted an article titled: “Obamacare’s Birth Control Coverage May Have Reduced Unplanned Pregnancies”. It was written by Cara Murez. From the article: When Obamacare made contraception affordable, the rate of unplanned pregnancies among poor Americans declined, a new study reports.The Affordable Care Act’s (ACA) elimination of out-of-pocket costs for birth control was tied to fewer births in all income groups, but especially among poorer women, the new research found. In fact, the lowest income group had a 22% decline in births after the law as passed.“Our findings suggest that expanded coverage of prescription contraception may be associated with a reduction in income-related disparities in unintended pregnancy rates,” said lead author Dr. Vanessa Dalton. She’s an obstetrician-gynecologist at Michigan Medicine Von Voiglander Women’s Hospital, in Ann Arbor……For the study, the researchers examined birth rates among 4.6 million women aged 15 to 45 who had employer-sponsored health plans between 2008 an 2013, before the ACA eliminatd cost-sharing for contraceptives. It compared those rates to the time period between 2014 and 2018, after the ACA (also known as Obamacare) was passed.The investigators found lower birth rates, as well as a decrease in women not filling their birth control prescriptions.The ACA included contraception as a preventative service that most employer-sponsored insurance plans were required to provide. This gave women access to birth control, including long-acting forms of birth control such as intrauterine devices, with no co-pays or deductible payments… November 10, 2020: Speaker of the House Nancy Pelosi (Democrat – California) posted a press release titled: “Pelosi, Schumer Joint Statement on Supreme Court Oral Arguments for Trump-GOP Lawsuit to Strip Health Care Coverage from Millions of Americans”. From the press release: House Speaker Nancy Pelosi (D-CA) and Senate Democratic Leader Chuck Schumer (D-NY) today issued the following joint statement on the Supreme Court hearing of the Trump-Republican backed lawsuit to strip health care protections from millions of Americans during a global pandemic:“Today, the Trump-Republican plan to repeal the Affordable Care Act and strip health care away from millions of Americans during a global pandemic was on full display as the California v. Texas lawsuit was heard by the Supreme Court. Republicans have tried and failed to repeal the ACA at least 70 times in Congress and twice through the courts, but as it was heard in today’s oral arguments, the Supreme Court must be deferential to Congress’s intent and uphold the law. With their legal argument detached from reality, Senate Republicans rushed through the nomination of Judge Amy Coney Barrett to the Supreme Court just days before the election, in an obvious attempt to make good on President Trump’s promise to only appoint judges who would ‘terminate’ the ACA.“With support for the ACA at an all-time-high, Republicans are still waging a decade-long war against Americans’ health care protections. If the Trump-GOP lawsuit is successful, more than 20 million Americans could lose their health care coverage, 130 million Americans with pre-existing conditions could lose protections, and drug costs could skyrocket for seniors. Republicans voted just weeks ago to greenlight this lawsuit but still falsely try to claim they will protect Americans with preexisting conditions. It is clear that striking down the ACA is what Republicans want.“Democrats believe this lawsuit has no merit, and we will continue to fight to make coverage more affordable for all Americans.” November 11, 2020: Center for Reproductive Rights posted a press release titled: “Court Lets Part of Tennessee Abortion Ban Take Effect”. From the press release: Today, a 6th Circuit Court of Appeals panel granted a request from the state of Tennessee, letting part of a law take effect that prohibits abortion based on a patient’s reason, including a potential Down syndrome diagnosis or the sex or race of the fetus. These “reason bans” were signed into law in July as part of a larger abortion bill that also contains a series of gestational age bans prohibiting abortion starting at six weeks in pregnancy — all of which were immediately blocked by a lower court.Today’s ruling will allow the reason bans to take effect while the litigation continues. The groups that brought this case will be going back to the district court later tonight to ask for a temporary restraining order blocking these reason bans once again, on the grounds that it is a violation of the constitutional right to abortion before viability. These kinds of reason bans inflict harm by peddling stigma around abortions and stereotypes of Asian Americans and Black and brown communities, and by attempting to co-opt the mantle of disability rights.“These bans are just another way anti-abortion politicians are attempting to limit the constitutional right to abortion care and to create stigma,” said Nancy Northup, president and CEO of the Center for Reproductive Rights. “Decisions about whether and when to continue or end a pregnancy are best made by the individual and their family. We will continue to fight these bans in the courts.”……More than a dozen states have passed similar reason bans. Tennessee’s gestational age bans, which would ban abortion at nearly every stage of pregnancy starting as early as six weeks, remain blocked through this same lawsuit.Tennessee has many additional abortion restrictions on the books, including a ban on the use of telehealth for medication abortion; limits on when state and public insurance can cover abortion services; and a requirement that minors obtain parental consent. A federal district court struck down the state’s 48-hour waiting period for abortion in October in a case litigated by the Center and Planned Parenthood. The Center, Planned Parenthood, and the ACLU filed another case challenging the state’s medication abortion “reversal” law in August, and that law has been temporarily blocked from taking effect.The case was filed by the Center for Reproductive Rights, Planned Parenthood Federation of America, the American Civil Liberties Union, and the ACLU of Tennessee on behalf of the Memphis Center for Reproductive Health, Planned Parenthood Tennessee and North Mississippi, Knoxville Center for Reproductive Health, carafem, and two abortion providers in Tennessee. November 11, 2020: National Women’s Law Center posted an article titled: “What you might have missed this week: Voters Protect Abortion Access in Colorado but Louisiana Legislators Pass Yet Another Anti-Abortion Measure”. It was written by Anna Rodriquez. From the article: …ColoradoProp 115 would have banned abortion after 22 weeks gestation, with no exceptions for health or individual circumstances. The proposal was intentionally confusing and a threat to people who become pregnant as a result of rape, people whose health is endangered by carrying a pregnancy to term, and pregnant people with a lethal fatal diagnosis. Bans on abortion like Prop 115 particularly target Black, Latinx, and Indigenous people; LGBTQ+ people; people with low-income; and folks who live rurally.A coalition lead by Abortion Access for All, among others, successfully defended Coloradans’ access to abortion care yet again. This was the fourth time in twelve years Coloradans have voted against anti-abortion ballot measures. Lucy Olena, Campaign Manager at No on 115 Campaign’s stated, “when we build a diverse movement and educate people about the complex realities of abortion later in pregnancy, voters unite to reject the bans.”This is another example of how Colorado is a leader on reproductive health, rights and justice, but this win is not just a victory for Coloradans. Colorado has become a safe-haven for out-of-state families, many who travel from states, like Texas, due to abortion restrictions.LouisianaLouisianans have faced an onslaught of medically unnecessary abortion restrictions, with anti-abortion legislators passing over 89 abortion restrictions since the passage of Roe, well above any other state. Just a few months ago, the Supreme Court slapped down one of Louisiana’s anti-abortion laws, in June Medical Services v. Russo, but Louisiana lawmakers are still at it – no matter the consequences for Louisiana families and healthcare providers.Anti-abortion legislators got their wish when voters approved Amendment 1. The Amendment adds language to the state constitution stating “to protect human life, a right to abortion and the funding of abortion shall not be found in the Louisiana Constitution.”… November 12, 2020: American Civil Liberties Union (ACLU) posted news titled: “President-Elect Biden’s Reproductive Freedom To-Do List”. It was written by Georgeanne M. UsovA, Legislative Counsel. From the news: After four years of attacks on our reproductive rights and health by the Trump administration and the anti-abortion legislators it has emboldened around the country, there is much to repair. When President-elect Biden and Vice President-elect Harris take office, their administration must make it a top priority to not just undo the damage, but to take bold, visionary steps to make reproductive health care — including abortion — accessible to all, regardless of their income or ZIP code. Congress, too, has a key role to play in ensuring that everyone is afforded the dignity to make our own decisions about our lives.Here are just a few of the many items that should top our elected officials’ to-do list:Reverse dangerous Trump administration regulations targeting reproductive health care including: The refusal of care rule, which aimed to dramatically expand health care institutions’ and workers’ ability to withhold and obstruct access to essential, even life-saving medical care and information — with no regard for patients’ well-being. While it was rightly struck down in court, it is one of many attempts by the Trump administration to invoke religious or personal beliefs to justify discrimination, particularly against LGBTQ people and people seeking reproductive health care. The Biden administration must ensure that religious liberty is never used as a license to discriminate, and that patients’ needs always come first in health care.The rule undermining the ACA’s birth control benefit, which allows employers and universities to deny their employees or students insurance coverage for contraception by invoking religious or moral objections. This is yet another example of how the Trump administration has discriminated against those seeking health care under the guise of protecting religious liberty. In July, the Supreme Court allowed this discriminatory rule to take effect, potentially robbing hundreds of thousands of people of their no-cost birth control coverage, and forcing employees and students to instead pay out of pocket. The Biden administration must guarantee that no one is denied birth control coverage because of where they work or where they go to school.The rule that has devastated Title X, the 50-year-old family planning program that has provided 4 million patients with low or no incomes with affordable birth control, cancer screenings, STI testing and treatment, and other critical preventive care. The rule prohibits family planning clinics that participate in the program from referring patients for abortion care and imposes other onerous and dangerous requirements. It has resulted in the widespread loss of Title X providers and reduced access to family planning services for those who rely on the program. The Biden administration must restore and rebuild the critical Title X program. Ensure safe access to medication abortion during the pandemic and beyond.During the pandemic, the Trump administration went all the way to the Supreme Court to make it as difficult as possible for people to safely access medication abortion care — specifically mifepristone, a prescription medication that has been used to safely end early pregnancies and treat early miscarriages for 20 years. The administration has refused to allow patients to obtain their prescription by mail, insisting that patients travel to a health center solely to pick up a pill, subjecting patients to needless COVID-19 risks. This is despite the Food and Drug Administration having suspended similar requirements for other, far less safe medications during the pandemic. The ACLU won in court, blocking the in-person requirement during the pandemic, but the Supreme Court will soon consider the Trump administration’s request to reinstate it.This in-person dispensing requirement is part of a longstanding package of outdated, medically unnecessary FDA restrictions that, even prior to COVID-19, have obstructed access to medication abortion — particularly for people with low incomes and communities of color. The Biden administration must immediately pause enforcement of the mifepristone in-person dispensing requirement during the public health emergency. And the FDA should undertake a comprehensive review of the full set of restrictions on mifepristone to ensure that, beyond the pandemic, patients’ access to this safe, effective medication is based on the latest science and medical evidence. Make the Hyde Amendment history once and for all.President-elect Biden has pledged his support for ending the Hyde Amendment, a harmful ban on abortion coverage for people enrolled in Medicaid and other insurance programs. For decades, Hyde and related bans have pushed abortion care out of reach for people struggling to make ends meet, particularly women of color — the same communities that face severe health care disparities as a result of structural inequality and are now being hit hardest by the pandemic and economic crisis. Now it’s time for Biden to take the critical first step toward ending these discriminatory coverage bans by striking Hyde and all related abortion coverage restrictions from his first budget. This, along with calling on Congress to pass the EACH Woman Act to lift coverage bans, will send a clear message that this administration will work to make abortion not only legal, but also accessible to all. Enact a natiowide safeguard against state restrictions.States have passed more than 460 politically motivated laws to push abortion care out of reach over the last decade çefforts buoyed recently by Trump’s appointment of multiple Supreme Court justices. These laws range from bans on abortion from the earliest days of pregnancy, to laws that interfere with the provider-patient relationship like forced ultrasounds and mandatory delay periods, to clinic shutdown laws that force patients to travel long distances (paying for transportation, lodging, and child care in the process) to obtain care. These restrictions have so severely eroded access to care across vast regions of the country, leaving the right to abortion effectively hollow for many people. President-elect Biden should also call for swift passage of the Women’s Health Protection Act to address the crisis of state attacks on abortion access. WHPA would put a stop to these state attacks and, paired with EACH, would make care more affordable and accessible for people throughout the country… November 12, 2020: Lambda Legal posted a press release titled: “West Virginia Medicaid Participants and State Employees File Lawsuit to Challenge Unlawful Ban on Transgender Health Care Coverage”. From the press release: A federal lawsuit challenging West Virginia’s blanket exclusions for coverage of gender-affirming care in West Virginia’s Medicaid and state employee health insurance plans was filed today. The class-action lawsuit was filed in the U.S. District Court for the Southern District of West Virginia on behalf of Christopher Fain, a Medicaid participant; and Zachary Martell and Brian McNemar, a dependent and state employee, respectively. The suit was filed by Lambda Legal, Nicholas Kaster, PLLP, and the Employment Law Center, PLLC.“Transgender and nonbinary West Virginians are denied coverage for essential, and sometimes life-saving, gender-confirming care – while cisgender West Virginians recieve coverage for the same kind of care as a matter of course. The exclusions of gender-confirming care in West Virginia’s state health plans are unconstitutional and discriminatory, and deny transgender and nonbinary West Virginians basic dignity, equality, and respect,” said Avatara Smith-Carrington, Tyrone Garner Memorial Fellow at Lambda Legal and lead attorney on the case.Fain v. Crouch is a class action lawsuit challenging blanket exclusions of coverage for gender-affirming care in West Virginia’s state health plans. The blanket exclusions of coverage for care are stated expressly in the health plans offered to Medicaid participants and to state employees. West Virginia’s state health plans serve approximately 564,000 Medicaid participants and 15,000 state employees……Christopher Fain studies nonprofit leadership at Marshall University and works at a clothing store in Huntington. He is enrolled in Medicaid, the nation’s largest healthcare provider for low-income individuals, but the program does not cover his testosterone prescription, forcing Mr. Fain to cover his care out-of-pocket, creating a stressful and inequitable financial burden. The Medicaid plan’s exclusion of coverage for his care has caused Mr. Fain economic hardship and humiliation.Zachary Martell is married to Brian McNemar, who works as an accountant at a state hospital. Both Mr Martell and Mr McNemar rely on the state employee health plan for coverage. Mr. Martell – who receives coverage for care as Mr. McNemar’s dependent – has been denied coverage both for his prescriptions and office visits with his healthcare provider becasue the state employee health plans explicitly exclude coverage of “treatments associated with gender dysphoria.” As a result, Mr. Martell and Mr. McNemar have been forced to pay out-of-pocket for Mr. Martell’s care and, at times, even delay or forego care altogether……Learn more about the case: https://www.lambdalegal.org/in-court/cases/fain-v-crouchRead the complaint: https://www.lambdalegal.org/in-court/legal-docs/fain_wv_20201112_complaint November 12, 2020: Georgetown University Health Policy Institute Center for Family and Children posted a blog post titled: “What Can We Expect from Biden Administration on Work Requirement Waivers?”. It was written by Joan Alker. From the blog post: …As we have blogged about countless times, this group of “demonstrations” is nefarious policy that doesn’t support employment but does seem to result in people losing their health insurance. Promoting this approach has been a centerpiece of CMS Administrator Seems Verma’s legacy and part of a larger pattern of efforts by the Trump Administration to eliminate the Affordale Care Act, hobble Medicaid, and generally limit access to public coverage.So, what should we expect from a Biden-Harris Administration, the team that made access to health insurance a central tenet of their campaign, when they take office in January 2021? How easy is it to say goodbye and good riddence to these demonstrations?First, let’s review the basic law of Section 1115 demonstration waivers. States apply to the Secretary of Health and Human Services for permission to use federal funds to try out and evaluate new approaches to improving Medicaid coverage, As the recent litigaition on work requirement waivers has reminded us all – they are only granted at the discretion of the Secretary of Health and Human Services. And the Secretary of HHS must determine that the demonstration project is “likely to assist in promoting the objectives of title…XIX”……It is worth noting that no state is currently implementing work requirements – as a consequence of judicial intervention, states voluntarily delaying them, or postponed implementation. Moreover, while Medicaid’s disenrollment freeze associated with the public health emergency remains in efect, no state could terminate anyone’s Medicaid coverage for non-complyance with a work reporting requirement……Every waiver approval has a long list of “terms and conditions” many of which are boilerplate material that appear in every Medicaid demonstration. Either party – the state or federal government may terminate the demonstration. For a state to wind down a demonstration there are more conditions involved including public notice and comment etc. Federal CMS may withdraw approval of waivers “at any time if it determines that continuing the waivers… would no longer be in the public interest or promote the objectives of title XIX”. The state is guaranted the right to a hearing to challenge the federal determination……So there is no question that a new Secretary can unwind these demonstrations but when and how that will happen remains to be seen. It is not possible that this will happen overnight, but an early and strong signal of the intention of a new Biden Administration would be to quickly withdraw the 1/11/18 “Dear State Medicaid Director” letter issued by the Trump Administration encouraging states to apply for “community engagement” waivers. This would also have the effect of letting states know that pending or future requests for work requirements will not be granted… November 17, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra Secures Victory in Lawsuit Defending Medicaid In-Home Supportive Service Workers”. From the press release: California Attorney General Xavier Becerra today secured a court decision blocking the Trump Administration’s efforts to implement a rule that would have undermined the rights of more than half a million healthcare workers in California’s In-Home Supportive Services (IHSS) Medicaid program, and several hundred thousand more workers nationwide. In California, these workers have the right to collectively bargain for better wages, benefits, and training, which results in a more stable, quality IHHS program for beneficiares. The court held that the rule would have unlawfully created barriers for states to deduct employee benefits and union dues from workers’ paychecks, a practice which makes it easier or workers to stand up together for their workplace rights and to provide quality home-and community-based care to those in need. The court found that the Trump Administration’s rule was illegally promulgated and vacated it.“When the President attacks unionized healthcare workers, he puts the care of hundreds of thousands of vulnerable Californians at risk. Now more than ever, our healthcare workers are heroes serving on the front lines of the pandemic, and should be applauded for their work,” said Attorney General Becerra. “Fortunately, the court saw through the administration’s faulty posturing and sent them packing. This ruling is a victory for our state and for the collective bargaining rights of homecare workers who play a vital role in our healthcare system. Together, we’ll continue to stand up for workers every step of the way.”……Attorney General Becerra was joined in the case by the attorneys general of Connecticut, Illinois, Massachusetts, Oregon, and Washington.A copy of the decision is available here. November 19, 2020: National Women’s Law Center posted an article titled: “Celebrating the Wins: A Reminder the ACA is Working”. It was written by Lauren Wallace. From the article: …Here’s what we do know. The National Women’s Law Center has calculated that – thanks to the ACA – 84.3 million women have insurance coverage of preventative services, including birth control, without out-of-pocket costs (166 million people total). This is a 5% increase from 2019, meaning that nearly 3 milion more women had no-cost birth control coverage in 2020 than they did the year before. While this news alone is enough to rejoice in celebration, there’s even more to enjoy! A new study conducted by the University of Michigan reports that eliminating out-of-pocket costs for birth control is tied to narrowing the disparity in unintended pregnancy rates between lower-and higher-income women who have employer-sponsored health insurance. The investigators not only found that birth control benefit reduced unintended pregnancies, but also reduced the rate of women not filling their birth control prescriptions…. November 18, 2020: Center on Budget and Policy Priorities updated research titled: “States’ Experiences Confirm Harmful Effects of Medicaid Work Requirements”. It was written by Jennifer Wagner and Jessica Schubel. From the research: Beginning in 2018, the Trump Administration encouraged states to adopt policies taking Medicaid coverage away from people not meeting work requirements. While 12 states received approval for these policies, several were blocked by the courts, and none are currently in effect. But data from Arkansas’ ten-month implementation of its policy and brief implementation in Michigan and New Hampshire provide direct evidence of these policies’ harmful effects. A large fraction of people subject to the policies lost coverage or were at risk of losing coverage. In Arkansas more than 18,000 people – nearly 1 in 4 of those subject to work requirements – lost coverage over the course of just seven months. In New Hampshire, almost 17,000 people, or about 40 percent of those subject to work requirements, would have lost coverage had state policymakers not put the policy on hold. Some 80,000 Michiganders – nearly 1 in 3 of those subject to work requirements – were in danger of losing coverage had a court not stopped the policy.In all three states, evidence suggests that people who were working and people with serious health needs who had been eligible for exemptions lost coverage or were at risk of losing coverage due to red tape. Large numbers of beneficiaries in both states reported that they didn’t know about the work requirement or whether it applied to them. It’s likely that people with disabilities were paritcularly at risk.Taking coverage away from people not meeting work requirements also increases financial hardship and reduces access to care. A survey of people with low incomes in Arkansas and neighboring states showed that the people who lost coverage because of Arkansas’ work requirements experienced adverse consequences, including having problems paying off medical debt and delaying care or forgoing medications because of cost.Arkansas’ work requirement increased uninsured rates without increasing employment, studies by Harvard researchers found. In both an initial and a follow-up survey of people with low incomes in Arkansas and neighboring states, researchers found evidence that Arkansas’s policy increased uninsured rates; people who lost Medicaid did not transition to other coverage. The researchers found no evidence that it increased employment. …In January 2018, the Trump Administration began approving state work requirements in Medicaid, which the federal government had never previously permitted. Between June 2018 and March 2019, Arkansas, the first state to implement a work requirement, required some enrollees in the Affordable Care Act’s (ACA) Medicaid expansion to document that they worked or engaged in work-related activities (e.g., job training or volunteer work) for at least 80 hours per month, unless they reported that they qualified for limited exemptions. In June 2019, New Hampshire began implementing its work requirement, requiring all expansion enrollees to work or engage in work-related activities for 100 hours each month or obtain an exemption. And in January 2020, Michigan began implementing its work requirement, requiring all expansion enrollees to work or engage in work-related activities for 80 hours each month or obtain an exemption.In March 2019, a federal district court vacated the Department of Health and Human Services’ (HHS) approval of Arkansas’ work requirement policy (and a similar waiver in Kentucky, which had not yet been implemented), thereby preventing Arkansas from continuing to implement it. In February 2020, a federal appeals court upheld this decision, which the Trump Administration is now appealing to the Supreme Court. New Hampshire voluntarily suspended its work requirement in July 2019. A few weeks later, the same federal district court vacated HHS’ approval of New Hampshire’s policy, and in March 2020, it vacated HHS’ approval of Michigan’s work requirement policy as well.Arkansas is the only state to have taken coverage away from people for not meeting work requirements, but Michigan and New Hampshire did not pause their requirements until they were on the brink of doing so. Thus, all three states’ experiences provide important information about who loses coverage and why as a result of these policies.The Trump Administration has approved similar policies in other states, but due to court decisions, voluntary moratoriums states have adopted, and federal protections put in place during the pandemic, none of the others have been implemented (at least to date)……A study by Harvard researchers found that the uninsured rate among low-income Arkansans aged 30-49 – the group potentially subject to work requirements – rose from 10.5 percent in 2016 to 14.5 percent in 2018, after the work requirement took effect. There was no similar increase for low-income Arkansans of other ages or for low-income people aged 30-49 in other, similar states. This finding refutes claims, for example from HHS Secretary Alex Azar, that most people leaving Medicaid due to the policy did so because they found jobs with health insurance……Work Requirements Endanger People With DisabilitiesWhen the Centers for Medicare & Medicaid Services (CMS), in announcing the Administration’s support for Medicaid work requirements, notified states that the policies must comply with the Americans with Disabilities Act, we and others warned that protecting people with disabilities would prove impossible without extensive efforts. Indeed, Arkansas didn’t adequately explain beneficiaries’ rights under the Act, and it lacked a comprehensive system for providing reasonable modifications to protect people with disabilities, such as modifying the hourly requirement or providing support to help people meet the reporting requirement. Due to the lack of protections and the design of the work requirement itself, individuals with disabilities lost coverage and may face serious harm as a result. In fact, “people with disabilities were particularly vulnerable to losing coverage under the Arkansas work and reporting requirements, despite remaining eligible,” a Kaiser Family Foundation study concluded.Losing coverage is especially harmful to people with disabilities who rely on regular care to manage their conditions. Coverage interruptions and subsequent gaps in care can lead to increased emergency room visits, hospitalizations, and admissions to mental health facilities. In addition, the financial risk from medical expenses and debt is high for people with disabilities, who are already a greater risk of homelessness; additional financial hardship could make it harder for people with disabilities to afford other necessities like housing and food, which could contribute to bankruptcy or homelessness and further jeopardize their health… November 20, 2020: Lambda Legal posted a press release titled: “Lambda Legal Condemns Eleventh Circuit Ruling Striking Down Palm Beach County Conversion Therapy Ban”. From the press release: The U.S. Court of Appeals for the Eleventh Circuit today reversed a lower court ruling and struck down local Palm Beach County, Florida, and the City of Boca Raton ordinances banning so-called conversion therapy on minors. Lambda Legal CEO Kevin Jennings issued the following statement:“The City of Boca Raton and Palm Beach County joined states and municipalities across the country who have properly banned the discredited and harmful practice of so-called ‘conversion therapy’ on minors in order to protect LGBTQ youth. Laws prohibiting this dangerous practice have withstood legal challenges in numerous courts. Today’s decision is a marked departure from precedent and an incredibly dangerous decision for our youth.“So-called ‘conversion therapy’ is nothing less than child abuse. It poses documented and proven critical health risks, including depression, shame, decreased self-esteem, social withdrawal, substance abuse, self-harm and suicide. Youth are often subjected to these practices at the insistance of parents who don’t know or don’t believe that the efforts are harmful and doomed to fail: when these efforts predictably fail to produce the expected result, many LGBTQ children are kicked out of their homes.“Both judged joining today’s decisions were appointed by President Trump. We fear that today’s decision may be the tip of the iceburg in terms of the harm that may come from a federal judiciary that has been packed for the last four years with dangerous ideologues. The damage done by this misguided opinion is incalcuable and puts young people in danger. November 22, 2020: Senator Bernie Sanders (Independent – Vermont) tweeted: “Health care is a human right, not a job benefit. We cannot continue spending twice as much per capita as any other country, while 92 million are uninsured or under-insured, and 68,000 die unnecessarily each year. Medicare for All is coming sooner or later. Let’s make it sooner.” November 23, 2020: Senator Maria Cantwell (Democrat – Washington) tweeted: “The Affordable Care Act stops companies from charging women more than men for the same health care plan. And the #Medicaid expansion in the #ACA has helped people in every corner of the State of Washington. That’s why it is so important to keep fighting for the ACA.” November 23, 2020: Planned Parenthood posted a press release titled: “Federal Court Allows Texas Politicians To Block Health Care Access for Medicaid Patients”. From the press release: Today, the 5th Circuit Court of Appeals ruled that Texas politicians will be able to block Medicaid patients from accessing care at Planned Parenthood health centers. These terminations are a blatantly political attack that will jeopardize critical health care access for Texans with low incomes during a global pandemic. This ruling has not yet taken effect, and for now Planned Parenthood health centers in Texas continue to serve Medicaid patients across the state. Today’s ruling is the latest in a long history of Texas’ attempts to score political points with relentless attacks on Planned Parenthood and access to health care. Earlier this year, Gov. Abbott blocked access to time-sensitive, essental abortion care in the early days of the COVID-19 pandemic, forcing some patients to travel hundreds of miles to neighboring states for the care they need. And during the 2019 legislative session, Texas politicians passed Senate Bill 22 – banning local governments from partnerships with trusted provideres, such as Planned Parenthood, for health care and education services.Generations of racism and discriminatory policies force a disproportionate number of people of color and women to enroll in public health programs like Medicaid. When politicians attack Medicaid patients, people of color and women who already navigate inherently discriminatory systems with fewer freedoms than others, lose the ability to choose the best provider for them. It’s just one more assault against the same communities that face unjust, systemic barriers to basic human rights, including access to affordable health care, education, and housing……Three additional states – Tennessee, South Carolina, and Idaho – have pending Medicaid waivers in front of Centers for Medicare & Medicaid Services that would restrict the ability of people enrolled in Medicaid to access Planned Parenthood health centers. Numerous other states have tried to terminate Planned Parenthood providers from Medicaid for baseless reasons, but most have been blocked by courts from doing so.This decision follows years of attempts by Texas to cut off Medicaid patients from Planned Parenthood based on a series of elaborate, false, and debunked claims peddled by the Center for Medical Progress. In 2011, Texas replaced its own state-funded program when the Obama administration refused to allow the Texas to exclude Planned Parenthood and other abortion providers from its Medicaid program. Earlier this year, the Trump administration allowed federal funds to go back into Texas’ failed program. November 23, 2020: The American College of Obstetricians and Gynecologists (ACOG) posted news titled: “ACOG Updates Committee Opinion on Increasing Access to Abortion”. From the news: In updated guidance, the American College of Obstetricians and Gynecologists (ACOG) reaffirms its longstanding position that access to safe abortion is a necessary component for comprehensive health care. The updated Committee Opinion on Increasing Access to Abortion responds to an increasingly restrictive policy environment and outlines specific legislative, structural, societal, and financial barriers that must be addressed in order to protect and expand equitable access to abortion care. The document also explains how stigma and fear of violence can be just as powerful as other factors in imposing barriers to care.Although abortion is extremely safe, it is often targeted for medically unnecessary, arbitrary requirements that restrict the ability of patients to access abortion care. Specifically, the Committee Opinion calles for the cease and repeal of: bans on abortion at arbitrary gestational ages,requirements that only physicians or obstetrician-gynecologists may provide abortion care,telemedicine bans,restrictions on medication abortion,requirements for mandatory counseling and forced delay before obtaining care,ultrasound requirements,mandated parental involvement, andfacility and staffing requirements known as Targeted Regulation of Abortion Provider (TRAP) laws. “Abortion is important to the health and lives of our patients, yet access remains a legislative and regulatory target at both the state and the federal levels,” said Eva Chalas, MD, FACOG, FACS, President of ACOG. “Data have shown that when abortion is restricted, our patients’ health suffers. That’s why ACOG is committed to leading the medical community in pursuing evidence-based policies and structural change that will make essential abortion care accessible and available.”“For the sake of patients across the country, we must continue to advocate for the repeal of barriers to abortion access and for patient-focused, constructive policies to protect the health and well-being of patients and to promote equitable care,” said Daniel Grossman, MD, who contributed to the Committee Opinion. “But beyond that, we must work together as a community to address the stigma and fear that prevents some patients from getting the care they need and that prevents some clinicians from offering comprehensive reproductive medical care that includes abortion.”“Restrictions and barriers on access to abortion care disproportionately impact those who are historically marginalized from medical care more broadly. This includes young people, people of color, those living in rural areas, those with low incomes, and individuals who are incarcerated” said Jamila Perritt, MD, MPH, Chair of the ACOG Committee on Health Care for Underserved Women, which issued the guidance. “Focusing our efforts on improving access for communities most affected by these barriers and restrictions will improve health outcomes for all.”Protecting comprehensive reproductive health care access is a policy priority for ACOG. This year, ACOG secured a nationwide temporary injunction against the U.S. Food and Drug Administration’s in-person dispensing requirement for mifepristone, providing many ACOG members with the option of prescribing medication abortion to patients through the duration of the COVID-19 pandemic without exposing themselves and their patients to unnecessary risk of infection or travel delays. November 23, 2020: Lambda Legal posted a press release titled: “Lambda Legal Takes Blue Cross Blue Shield of Illinois to Court Over Anti-Transgender Policy”. From the press release: Today, Lambda Legal and Sirianni Youtz Spoonemore Hamberger PLLC filed a federal lawsuit challenging Blue Cross Blue Shield of Illinois’s (“BCBSIL”) administration of a blanket exclusion of gender-affirming care in an employer-provided health insurance plan provided by Catholic Health Initiatives Franciscan. The lawsuit was filed in the United States District Court for the Western District in Washington in Tacoma on behalf of a 15-year-old transgender boy “C.P.”, and his parent, and argues that the exclusion is in direct violation of the nondiscrimination provisions under Section 1557 of the Affordable Care Act.“My son needs the medical care that will allow him to live, be healthy, and to thrive. However, because he is transgender, I have to fight and jump through hoops for him to have access to the care that he needs, is legally entited to and that he deserves,” said Pattie Prichard, C.P.’s mother and the primary beneficiary on the employer-provided health benefit plan that BCBSIL administers. “This denial also sends a message to my son and all transgender people, that their health care needs aren’t real or they’re not worthy of care. I won’t accept that.”BCBSIL is a “covered health entity” under the ACA, which means BCBSIL cannot, and it has represented that it does not, discriminate on the basis of race, national origin, sex, age, and disability. The ACA’s Section 1557, which BCBSIL agrees it must abide by, prohibits discrimination on the basis of sex and gender identity, such as in the provision of transition-related care. As such, BCBSIL cannot administer the discriminatory terms of the health plan provided by Pattie Pritchard’s employer – St. Michael Medical Center in Bremerton, Washington, which is part of the Catholic Helath Initiatives Franciscan Health System, now known as CommonSpirit Health.“The law is clear, Blue Cross Blue Shield of Illinois cannot deny C.P., or any transgender person, the health care that he needs,” said Omar Gonzalez-Pagan, Senior Attorney and Health Care Strategist for Lambda Legal. “Section 1557 of the ACA expressly prohibits categorical bans on gender-affirming care because it is discrimination on the basis of sex, plain and simple. BCBSIL cannot adopt or administer discriminatory terms on behalf of others. As a covered entity under the ACA, BCBSIL has to play by the same rules as everyone else, no exceptions.”……C.P. is a dependent on his mother’s employer-provided health insurance plan and began receiving medically necessary gender-affirming care three years ago. Recently, however, C.P. and his family were informed that some of his care would not be covered because of an exclusion of any care “for or leading to gender reassignment surgery”, including the same care and medical interventions that other cisgender patients receive without question or problem. C.P.’s family has had to pay out-of-pocket for his care, causing unnecessary financial stress……The case is C.P. v. Blue Cross Blue Shield of Illinois and is being litigated by Lambda Legal Senior Attorney and Health Care Strategist Omar Gonzalez-Pagan, Law and Policy Director Jennifer C. Pizer and Eleanor Hamburger of Sirianni Youtz Spoonemore Hamburger PLLC, in Seattle, Washington.Read the complaint here: https://www.lambdalegal.org/in-court/legal-docs/cp_wa_20201123_complaintLearn more about the case here: https://www.lambdalegal.org/in-court/cases/cp-v-bcbsil November 25, 2020: Senator Bernie Sanders (Independent – Vermont) tweeted: “The year 2020 has been very difficult for mental health. The pandemic, isolation and economic downturn has greatly increased depression, anxiety and suicidal ideation. When we talk about real health care reform, we mean a major expansion of mental health services.” November 27, 2020: Senator Bernie Sanders (Independent – Vermont) tweeted: “The United States cannot continue to be the only major country not to guarantee health care to all. Too many people are unnecessarily dying, getting sick or going bankrupt because of thsie cruel and dysfunctional system. Health care is a human right, not a privilege Let’s do it”. November 29, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a report titled: “HIV and Medicaid Expansion: Failure of Southern States to Expand Medicaid Makes Elimination of HIV Infection in the United States Much Harder to Achieve”. It was written by Adam Searing, JD, MPH and Adaora A. Adimora, MD, MPH. From the report: Key Findings Advances in public health programs and medical treatment mean HIV can be treated successfully in the long term, improving the health of individuals and significantly reducing the spread of the infection. Ending the HIV epidemic in the United States is achievable. However, lack of health coverage is a major barrier to success in the fight against HIV as without health coverage, individuals are unable to access medical treatment that can improve their health and minimize the spread of HIV.These medical treatments combined with a robust health campaign, have led to a decline in HIV infection and transmission in many states. The HIV epidemic has slowed. Approximately 45 percent of all people living with an HIV diagnosis in the U.S. live in the South despite the region containing only about one-third of the total U.S. population. In addition, more than half (52 percent) of all new HIV diagnoses in 2017 were in the South.Medicaid expansion is a key building block to ending the HIV epidemic. Unfortunately, 12 states – largely in the South – are still refusing the federal funding for Medicaid expansion and leaving many people and families who could benefit from HIV interventions still lacking access to comprehensive health coverage. Only 5 percent of people with HIV remain uninsured in states that have been implemented the Medicaid expansion, compared to a 19 percent uninsured rate among people with HIV in non-expansion states. Expanding Medicaid would significantly improve health care in coverage for people with HIV and their families and move the U.S. forward in the public health fight to end the HIV epidemic IntroductionAdvances in public health programs and medical treatment mean HIV can be treated successfully in the long term, improving the health individuals and reducing the spread of the virus. While the federal government has multiple initiatives aimed at addressing and eventually eliminating HIV, a fundamental base to ensure successful health outcomes for people with HIV and the families is access to comprehensive, affordable health care coverage. A proven way to increase levels of coverage is for states to expand Medicaid under the federal Affordable Care Act (ACA).Unfortunately, the 12 states—largely in the South—still refusing the federal funding for Medicaid expansion leave many people and families who could benefit from HIV interventions still lacking access to comprehensive health coverage. Expanding Medicaid would significantly improve health care and coverage for people with HIV and their families. Medicaid is the key building block to ending the epidemic. States that have not expanded medicaid coverage experience moreHIV infections and higher mortality rates from the condition. Failure to prioritize Medicaid expansion in dealing with HIV ignores extensive research and the fact that the center of the epidemic in the United States—the South—is also the center of resistance among states to expanding Medicaid. Federal and state plans to reduce and eliminate HIV infection must acknowledge the important role of Medicaid expansion.Layered on top of the HIV epidemic is the current COVID-19 pandemic. Striking parallels between the response to HIV and COVID-19 were pointed out earlier this year in the course of the pandemic. The urgency of dealing with COVID-19 severely complicates the ongoing response to the HIV epidemic, making response to HIV and multiple other public health challenges more difficult. However, the basic fact remains that successful response to the HIV epidemic requires more health coverage through Medicaid expansion. A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: October and November is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Key Things to Know About Joe Biden’s Health Care PlanOctober 25, 2020Out of Spoons / Public HealthPhoto by Gustavo Fring from Pexels Joe Biden’s health care plan is built upon the Affordable Care Act (also called ACA or “Obamacare”). It is not a direct copy, however. Joe Biden’s health plan starts with the ACA, and builds up from there. The purpose is to make sure everyone can afford good health insurance coverage. Building on the Affordable Care Act Making it More Affordable Right now, families and individuals that make between 100% and 400% of the federal poverty index may receive a tax credit to help them pay for premiums on ACA insurance purchased through the Marketplace. The dollar amount eligible families and individuals receive was designed to ensure that families don’t have to pay more than a certain percentage of their income on health insurance premiums. The dollar amount of of the tax credit that eligible families and individuals receive was based on a silver plan. But, that amount is still too high for some eligible families or individuals to pay for. Another problem hits families that make more than 400% of the federal poverty level (which is about $50,000 for a single person and $100,000 for a family of four). These people don’t qualify for financial assistance in the form of a tax credit that can be used to pay for their ACA health insurance premiums. This makes ACA plans too expensive for them to afford. Joe Biden will fix this problem by eliminating the $400,000 cap on tax credit eligibility. Doing so would allow individuals and families who make more than 400% of the federal poverty level to be eligible for tax credits that they can use on an ACA plan from the Marketplace. The Biden Plan is also going to increase the size of tax credits by basing them on a gold plan – the most generous plan on the Marketplace – instead of the silver plan. Doing so gives more people the ability to afford more generous coverage. Expanding Medicaid The Affordable Care Act expanded Medicaid eligibility for low-income Americans. Unfortunately, governors and legislators in some states, including Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Wisconsin and Wyoming, still refuse to expand Medicaid eligibility. Some states have tried to implement work requirements in order for low-income people to be eligible for Medicaid. On March 27, 2019, U.S. District Judge James Boasberg blocked Kentucky from implementing their work requirements and Arkansas from continuing its program. At the time, more than 18,000 Arkansas enrollees had lost Medicaid coverage since that work requirement mandate began. Judge Boasberg said that the approval of work requirements by the Department of Health and Human Services “is arbitrary and capricious because it did not address… how the project would implicate the ‘core’ objective of Medicaid: the provision of medical coverage to the needy.” In February of 2020, residents of Kentucky and Arkansas brought an action to the U.S. Court of Appeals for the District of Columbia. Their argument was that Secretary of Health and Human Services Alex Azar “acted in an arbitrary and capricious manner when he approved Medicaid demonstration requests for Kentucky and Arkansas” (referring to the work requirements). Joe Biden believes that access to affordable health insurance shouldn’t depend on the politics of the state that you happen to live in. The Biden Plan will ensure that people who are eligible for Medicaid – but aren’t getting it due to the politics of their state government – will get Medicaid coverage. The coverage will come through the premium-free public option, which will cover the full scope of Medicaid benefits. States that have already expanded Medicaid will have the choice of moving the expansion population to the premium-free public option (as long as those states continue to pay their current share of the cost covering those individuals). Biden’s plan will ensure that people making below 138% of the federal poverty level get covered. They will automatically be enrolled in the premium-free public option when they interact with certain institutions (such as public schools), or other programs for low-income people (such as SNAP). What is the Public Option? Biden’s Plan includes something for people that don’t like “Obamacare”. It is called the public option. It is similar to the premium-free public option that people who are eligible for Medicaid would receive. Those who make too much money to be eligible for Medicaid can purchase a public option health insurance like Medicare. To be clear, the public option is not a “Medicare for All” plan. In my opinion, it might serve as the basis upon which a true “Medicare for All” plan could be built up from. At the start, however, the public option plan will require people to pay for it. The good news is that, just like with the Medicare we know today, the public option would reduce costs for patients by negotiating lower prices from hospitals and other health care providers. It will better coordinate among all of a patient’s doctors to improve efficacy and quality of care. Primary care will be covered without any co-payments. Whether you’re covered through your employer, buying your health insurance on your own, or going without coverage altogether, Biden will give you the choice to purchase a public health insurance option like Medicare. Small businesses that find themselves struggling to afford health insurance coverage for their workers could find relief though the public option plan. Vox has an article that was written by Matthew Yglesias in July of 2019 that provides a good explanation of why Biden’s public option plan would be a great choice for many people: …Medicare pays lower unit prices than almost any private health insurance plan because it’s such a big program that it’s able to drive a very hard bargain. Biden is promising to unleash that same bargaining power on behalf of a public option available to all Americans — which should generate an insurance option that is cheaper for patients and stingier to providers. That’s why the Partnership for America’s Health Care Future — a joint venture of the American Medical Association, the American Hospital Association, and a bunch of other health industry groups — don’t like it. Industry likes the idea of government-subsidized health care but hates the idea of government-orchestrated bargaining over prices.But that’s why Biden’s proposal would be a much bigger deal than the hypothetical ACA public option. By using Medicare purchasing power, the public option would deliver lower premiums, which would make it a very attractive option for all kinds of people who currently have private insurance. Nobody would be “forced” onto the public plan, but in practice lots of people would opt for it… Lowering the Cost of Prescription Drugs Companies that make prescription medications currently do not have to negotiate with Medicare over drug prices. This causes the cost of medications to be too high for many people who are covered by Medicare (including seniors and people with disabilities). Biden’s plan will change that by repealing the existing law that explicitly bars Medicare from negotiating lower prices with drug corporations. Remove that law, and pharmaceutical companies will have to negotiate lower prices with Medicare. The result will be much lower costs on prescription drugs for people who are currently covered by Medicare. It will also benefit those who chose to purchase Biden’s public option. In addition, Biden’s Plan will limit launch prices for biotech drugs that have little to no competition. Under the Biden Plan, the Secretary of Health and Human Services will establish an independent review board to asses the value of biotech drugs. The board will recommend a reasonable price, based on the average price in other countries. This is called external reference pricing. In short, it means finding out what a medication costs outside of the United States, and negotiating with pharmaceutical companies for a reasonable price. This will lower the cost of prescriptions for people who use Medicare or the public option. Biden’s Plan will also allow private “Obamacare” plans that participate in the individual Marketplace to access a similar rate. Biden’s Plan will also allow consumers to buy prescription drugs from other countries. Personally, I think this is a fantastic idea! It would force pharmaceutical companies to lower their costs in order to compete with the less expensive medications from outside of the United States. Biden’s Plan also will improve the price of generic medication by accelerating the development of safe generics. This could be done via The CREATES Act that would ensure that generic manufacturers have access to a sample of a brand name drug. But Wait, There’s More! Here are more things that Biden will do to protect people’s access to health care: Stop “Surprise Billing”: Would put an end to unexpected medical bills that consumers get stuck with because they had no way of knowing that a specialist at a hospital who treated them was not part of their insurance company’s network. Biden’s plan would bar health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider they see (for example, during a hospitalization). California passed a law in 2017 that banned “surprise billing”.Expand Access to Abortion: Biden’s supports repealing of the Hyde Amendment. That controversial amendment was passed in 1976 (just a few years after Roe v. Wade). It barred federal Medicaid funds from being used for abortion – except for instances in which the woman’s life would be endangered by carrying out the pregnancy. The Hyde Amendment prevents low-income pregnant people who want an abortion from obtaining one because they can’t use Medicaid to pay for it. Reverse the Trump Administration and states assault on women’s right to choose: Biden will work to codify Roe v. Wade and his Justice Department will do everything in its power to stop state laws that prevent pregnant people from getting abortion.Biden will rescind President Trump’s “Mexico City Policy”. It is also called the “Global Gag Rule” because it prevents global health organizations that provide help for malaria and HIV/AIDS in developing countries from providing that aid if they also offer information on abortion services.Restore Federal Funding to Planned Parenthood: Biden will reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information. Biden will reverse the Trump Administration’s rule preventing Planned Parenthood and other family planning programs from obtaining Title X funds. Those funds are used to provide contraception, treatment of STIs, preventative services (screening for breast and cervical cancer), pregnancy tests and counseling, and educational programs.Reduce the Maternal Mortality Rate: Biden will institute a strategy that California came up with in which “crash carts” are used in hospitals to ensure that doctors can save the life of a person who has a hemorrhage while giving birth (or after giving birth). The maternal death rate for Black women is more than three times higher than the rate for non-Hispanic white women. The “crash carts” halved California’s maternal death rate.Defending Health Care Protections for All, Regardless of Gender, Gender Identity, or Sexual Orientation: Biden will overturn the Trump Administration rule that removed the “ObamaCare” nondiscrimination protections for sex and gender identity. It was released during Pride Month and targeted people who are LGBTQ+. It allowed doctors, receptionists, janitors, and anyone else working in a health care office to deny care to people who were LGBTQ+, and to people who were seeking contraception or abortion.Expanding Access to Mental Health Care: Biden will continue to make efforts to ensure enforcement of mental health parity laws and expand funding for mental health services. Key Things to Know About Joe Biden’s Health Care Plan is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... Chronic Illness MomentsOctober 19, 2020Out of Spoons / Spoonie WritingPhoto by Pascal Meier on Unsplash What’s worse than struggling with chronic illneses? The answer to that question would be suffering through fall pollen season, while California is on fire, during a pandemic. In this blog, I have a collection of things I posted on social media while exhausted, sick, and on various drugs that somewhat alleviate my chronic illnesses. June 7: Earlier today, smoke came into my home through open windows. BBQ, I assumed. Windows got closed. Air conditioner turned on for filtering. I took Benadryl so I can breathe. Previous to smoke in air, I was wheezing due to the super strong winds we are having here. It kicks up dust, etc. Been avoiding Twitter, but went there just now. Turns out there’s a vegetation fire not too far away from me. The winds blew the smoke over here. Don’t worry, I am safe. June 10: I am having a really hard time focusing on anything today. Could be the heatwave. Could be * waves generally at 2020 * June 11: Back from acupuncture. Doing well! Acupuncture office is going all out on protecting people from COVID-19. Restaurants across the street have started to open up. NO ONE is wearing masks but me. My county has been getting more and more COVID-19 cases since people decided to stop wearing masks and stop social distancing. I expect things to close again real soon. June 16: Woke up today with a whole bunch of fibromyalgia pain starting at my hip and radiating through that leg (as fibro does). I suspect I “slept funny” and the pain started then. But, being asleep, I didn’t notice it until it I woke up. Have taken CBD. Waiting to see if that makes things better. If not – I have wine. I hope everyone else’s day is better than mine. June 17: This week, the mobile home park has had workers put “slurry” on the roads. This comes after ripping out, and improving the roads in… I think it was October. The roads with slurry look good. They managed to avoid covering what is being used as a sidewalk in the middle of the roads (that was designed to drain away rain water and that has new sewage pipes underneath it). Today, they added the slurry on the road right outside my home. It is making me miserable sick. Having a high pain day Taking appropriate meds In hopes of sleeping (June 26 haiku) Still a high pain day Benadryl helped a little I’m giving it time (June 26 haiku) Anemia sucks Crossed over the borderline Am lost in a fog (July 2 haiku) Acupuncture day! I feel so much better now. And had a great nap (July 14 haiku) July 19: My day started with my body deciding to reject all the food I’d eaten. Not happy about this at all! July 19: Just learned that the building that includes the office where I go to acupuncture is currently on fire. July 19: Update: It is being described as a construction fire. It turns out the address the fire department listed is NOT the building my acupuncturist’s office is in. The pollen count is Seven point eight today and I’m malfunctioning (August 5 haiku) August 18: Bought a box of cookies from the grocery store and had them delivered (with other groceries). Before doing so, I went to the cookie company’s website and looked up the ingredients in these cookies. Either the ingredients on the website were outdated, or I missed it. These chocolate chip gluten free cookies have rosemary in them. It tastes like pine. A quick check of Wikipedia says rosemary is related to pine. I’m very allergic to pine (and fir, etc.). Spat out the cookie and am now on Benadryl. I’m safe, just really annoyed. August 23: The pollen count today is 8.0. I will be itchy and uncomfortable all day long. The weather app on my phone has yet another warning that says “Smoke”. Pollen.com says tomorrow will be 8.1 and will go up from there. Wednesday will be a 9.0, and Thursday is gonna be 9.6. I’m going to be physically miserable for a while. August 26: The pollen count today is 9.5 Tomorrow will be the same. Friday is gonna be 9.8. Saturday will be 10.3, and Sunday will be 10.8. I will not remember anything that happens on days that hit 10 or higher. August 28: The pollen count today is 9.9. It’s gonna be in the tens for… let’s see… in the four days coming up. This is REALLY BAD (and painful). I may become too delirious to type. September 2: The pollen count today 10.8. Tomorrow will be 10.4. This is gonna hurt. It is the start of a new month, so I’m trying real hard to get some paid writing work done before the pollen makes me absolutely useless. September 4: Pollen count today is 10.4 Not happy about it. September 6: Today the pollen count is 9.6 I am itchy and grumpy. Trying to write as much stuff for pay as I can before my body requires medication. The medication will (hopefully) reduce the itching. But it will also make it harder for my dyslexic self to write. September 6: The local college recorded a temperature of 120 degrees today. It is the most official recorder of weather temperatures in town. Our AC has been on all day – it is still incredibly hot in here at 5:30 PM. There is a grass fire burning over on the other side of town. Videos online show that there are already fire trucks and firefighters there. Overhead, a scout plane from the fire department circles. The fire is not close enough, or big enough (at this moment) to put us at risk of having to evacuate. This explains why my weather app is warning me about smoke. September 6: There is now a second fighter plane marking the site of the fire from the air. My husband thinks he heard a helicopter – which could be doing air drops to put out the grass fire. September 6: About half an hour ago, local fire department tweeted that the fire activity has diminished significantly. 50 acre fire. No reported structure losses (so far). Forward progress has been stopped. People closer to the fire than I am are being evacuated. The city is providing a city bus to take people to a nearby shopping mall. The bus has AC. My husband and I are not in any danger from the fire – other than the smoke in the air. We have windows shut and the AC on. It is still too warm in here at nearly 7 p.m. California has declared a stage 2 emergency (regarding the usage of electrical power). “Consumers should prepare for outages. Conservation will be critical for avoiding or limiting power interruptions.” In short, its possible our power could go out at any moment. Which means we will have to open the windows to prevent our home from becoming even hotter inside than it is now. Which means we will be breathing in smoke from the fire. I’m hoping our power stays on. September 6 (hours later): Good news! The stage one emergency has been lifted (about an hour ago). This means my husband and I do not have to worry about our power suddenly being shut off. The evacuation orders have been lifted for the fire. (We were never under evacuation orders). Forward progress on the fire has been stopped. Fire crews are continuing to work on the fire. September 7: The pollen count today is 9.4. The is the thirteenth day in a row where the pollen count is way too high for me to be comfortable. The weather app says there is still enough smoke in the air to have reason to keep the windows shut. Gonna be 100 degrees today at around 1:00 P.M. And the mobile home park is in the midst of yet another construction project. Fortunately, this one isn’t located immediately outside my house. Instead, large trucks haul debris past my house all day long. September 7: Right now, my weather app says it is 102 degrees outside. The airport, which is the official record of temperature, says 108 was the high overall today. When I rolled out of bed around 3 in the afternoon (I’m nocturnal) my weather app said it was 106 degrees here. There is still a lot of smoke in the air, so we can’t open the windows… again. We have AC. Pollen count is 9.4 – which is very unpleasant. Today’s new fire is described by the local fire department as “a fully engulfed vehicle fire with threat to vegetation.” It appears this fire is nearly out at the time I am writing this. That fire is not near me, but there’s a chance smoke from it will drift over here. There are a lot of things I love about California – but fire season isn’t one of them. Especially during a heat wave that takes place during fall pollen season. September 9: Today, the pollen count is 9.4. It’s not good, but it is better than the tens that came before it. The heat wave has ended, and the weather here is comfortable for the first time in I can’t remember how long. The weather app on my phone still says there is smoke in the air. My air purifier has needed a new filter for a while now. Today, my husband put a new one in. This involves washing off a reusable part and and letting it dry before putting it back into the machine. For an hour or so, I was sitting inside my home with a face mask on, to filter the dust. Am now on Benadryl. I’ve already taken most of my allergy meds (and can take a different one in a few hours). Not a good day. But I’ve been worse. Here’s where I began losing track of the days. September 10: Today, the pollen count is 9.4. Again. My weather app says today will be a high of 80, which sounds pretty good. The app no longer shows a smoke warning, but the sky outside is definitely full of smoke – again. Today’s fire (well, one of them) is in another county and far enough away for my husband and I not to have to worry about evacuation. September 10 (hours later): The pollen count today is 9.4 (again). That makes five days in a row with pollen count in the nines. It has been 17 days in a row where the pollen is too high for me. My weather app says fog – not smoke – which is a pleasant change. Sun isn’t up yet, so I’ll check later to see if it is just fog – or if it is fog and smoke, or whatever. I’m exhausted. I’m trying to get some paid work done while I can. I’ve been sleeping more than usual. Today is only September 10? It feels like we should be farther through this month than we are. September 10: Update: The sun has come up and there is a thick fog in the air. It looks like the kind of “fog” we get when the clouds over the ocean roll in. My weather app is, once again, giving me a smoke warning. Which means what I’m seeing outside is a mix of fog and smoke from fires. I started getting allergy symptoms and some coughing before I looked out the window to see what today was like. This sucks. September 11: Today’s pollen count is 9.2 – a tiny tiny improvement over yesterday. It has now been six days in a row where the pollen count has been in the nines and… either 18 or 19 days where the pollen count has been too high for me to be comfortable. I’ve lost track, despite literally writing it down. My weather app is giving me a smoke warning. Again. Yesterday, the Clean Air Twitter account for my county said: “Smoke impacts across have increased. Air quality levels have degraded into the MODERATE level with some occasional spikes of Unhealthy for Sensitive Groups. If you smell smoke, see ash falling, or are experiencing symptoms, head indoors. People on Twitter, who live in or near the places that are on fire on the West Coast have been experiencing symptoms including nausea, migraine, vomiting, exhaustion. I’ve been nauseous for days, despite not going outside, and (mostly) having the windows closed. I assumed it was due to allergies, but no. It’s smoke. September 11: Took a long nap. When I woke up, my weather app had an “Unhealthy Air Quality” warning. The Clean Air Twitter account for my county said (hours ago, when I was sleeping) the Air Quality Alert is in effect due to smoke impacting . Smoke is expected to continue to impact on my county this weekend. This sucks. September 12: The pollen count today is 9.0. It is going down, but is still in the nines, which is bad for me. The weather right now is 52 degrees and the high will be 78 degrees. That sounds good! The weather app is giving me an “Unhealthy Air Quality Warning for Sensitive Groups”. That’s me. If I had to guess, I would suspect the air quality warning is due to smoke from a fire – or many fires – that are located somewhere else. Smoke has drifted over to where I am at. Again. September 13, 2020: It is just a few minutes after 3 AM, and it is 54 degrees outside, which seems about right for this time of year, at this time of day, in California. My weather app has a “Unhealthy Air Quality for Sensitive Groups” warning. Again. This is likely due to the smoke that has blown here from the multitude of fires on the west coast. The pollen count today is 9.1, which is too high for me to be comfortable, no matter how much allergy medication I take. It has been nineteen days in a row where the pollen count has been too high for me. I haven’t bothered to count the days with too much smoke, because the thought of doing so is overwhelming. I managed to take a shower, several hours ago, something I find difficult when I am sicker than usual for long stretches of time. Tiny amounts of progress. Best I can do at the moment, as I struggle to focus on anything with almost no motivation to try and be productive. September 14: Yesterday, I took a long nap and woke up because my fibromyalgia decided to act up while I was sleeping. It is not fun to wake up with leg pain so bad it feels like I’ve stabbed. Took some CBD and it quickly eased my pain. Pain is exhausting, and I used all my spoons dealing with it. Went back to sleep after that. Fibromyalgia is triggered from stress. It can be physical or mental, or a mix of both. I suspect that this was, in part, triggered by the high pollen count plus smokey air. My body is working too hard as a result. Also, the pajama pants I was wearing are tapered. My calves have too much muscle for the space the tapered part provides. Move wrong while wearing them, and fibro makes me pay for it. Solution? Cut the tapered part open so my legs fit. Not pretty, but seems to be working. Will know how well it works when next I sleep. September 14: It is almost 5 in the morning here, and the weather app says it is 55 degrees outside. Weather app also has a “Unhealthy Air Quality” warning – which means another day of smoke. Yesterday, my husband took out the trash and picked up the mail. The mail boxes in this mobile home part are located near the dumpsters. My husband returned, saying he could smell smoke while he was out there. Felt sick after breathing that for just a few minutes. The air purifier next to me has three lights: Blue = good. Purple = not so good. Red = bad. He left the door open for just a few minutes and the smoke was bad enough to make a red light. The pollen count today is 8.8, which is the lowest its been in… gonna guess about 20 days. Still too high for me. But moving in the right direction. September 14: Going to sleep now, in the hopes doing so will give me enough spoons to do something fun and/or productive after I wake up. September 15: The weather app right now, at almost 7 am says it is 52 degrees outside. For the first time in a long time, the background is of a nice, clean, blue sky with clouds. It is apparently a lie. The weather app has yet another “Unhealthy Air Quality” warning. Yesterday, I listened to a local news video that pointed out that the hardware stores have run out of air purifier machines. That’s how bad the smoke is in my county. I’m fortunate to have had an air purifier for years AND a fresh filter for it. The air purifier has three colors: Blue = good. Purple = not so good. Red = bad. At the moment, it is purple. It’s been switching between purple and red for hours. The pollen count today is 8.8, which is moving in the right direction, but still too high for me to be comfortable. I need the smoke to go away. I need the pollen count to be seven or below for a least a week straight before I can begin to recover and maybe even feel better. September 16: My weather app says it is 54 degrees outside right now, in California, at a little after four in the morning. The weather app says “Partly Cloudy”. Just a few hours ago, it gave me the “Unhealthy Air for Sensitive Groups” warning, due to smoke in the air. Not sure I trust that the smoke has cleared between now and then. I’ll check back later. The pollen count today is 8.9, which may as well be a 9. This day is going to hurt, and my sinuses are already very irritated due to the many days and nights of pollen and smoke. I am, quite literally, mad at the world itself right now. September 17: I slept through most of yesterday, and have very little ability to focus on anything right now. September 25: My period started 37 days after the previous one began. This is extremely frustrating because I desperately want to be in menopause. I was diagnosed with borderline anemia in high school. Every time I have a period – I cross over that border and become anemic again. It takes roughly about a month before I grow the blood back. And then I get a period and it starts all over again. There are no words for me to use to explain how exhausting anemia is. If you’ve experienced it – then you know. Add the exhaustion that my fibromyalgia causes, and I’m just super tired all the time. The thing that is incredibly disappointing is that menopause will cure my borderline anemia (because I wouldn’t be losing blood every damn month anymore). It is the only one of my chronic illnesses that has the potential to go away. But, that’s clearly not going to happen anytime soon, because my body refuses to allow me to have nice things. October 3: My weather app says it is 70 degrees outside right now – at about 4:30 AM. Not bad. It also says there is “haze” and has given me a warning that says: “Unhealthy Air for Sensitive Groups”. I suspect the unhealthy air has drifted here from whatever fire(s) are still burning in California. Another day of keeping the windows closed, turning the AC on, and hoping PG&E doesn’t decide to randomly shut off our electricity with no warning. Might be a “wear a mask inside” kind of day, depending on how much smoke/haze seeps into our very old mobile home. October 8, 2020: I had acupuncture earlier today and then did absolutely nothing of financial value after returning home. Just goofed off on the internet. It was nice! Helped clean a bird cage Now I am on Benadryl Am floating away (October 8 haiku) October 9: Had just enough energy today to take a walk with my husband to pick up food from a nearby Thai place. We both wore masks, of course. We had to walk by a lot of construction sites that put particulate matter into the air. After returning home with the food, my husband checked his watch and said we had walked a little over a mile. I ended up sleeping for about 12 hours straight, due to fibromyalgia. October 15: My husband and I took our completed mail-in-ballot for the 2020 General Presidential Election to the County Clerk Recorder’s office downtown. We took a Lyft, and had a nice conversation with a driver who seemed very interested in voting. He wore a mask, as did my husband and I. Nearly everyone inside the was wearing a mask. After handing our ballots to a masked employee, and having the envelope checked to make sure that we signed it and dated it, we were able to place out ballots into a small box on the desk. It was nice outside, so we took a short walk to a restaurant that we enjoy. All of the workers wore masks. All of the customers who came inside the restaurant also wore masks. After obtaining food, we got into another Lyft and went home. The food was tasty. October 16: I spent most of to day dealing with muscle cramps because I dared to take a short walk while having fibromyalgia the day before. It wasn’t the worst experience, but it definitely slowed me down and made me more exhausted than usual. October 19: Fall Pollen Season finally ended. I determine the ending by frequently checking pollen.com, and writing down the pollen count for each day. When I get seven days in a row where the pollen count is 7.0 or lower – I declare that pollen season over! Chronic Illness Moments is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites. If you enjoyed this blog post please consider supporting me on Ko-fi. Thank you!... A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: July, August, SeptemberSeptember 28, 2020health insurance / Out of SpoonsImage by Comfreak from Pixabay This blog post is part of a series provides information about what President Trump – and the GOP – have done in an effort to restrict and remove access to health care from the American people. The series could be described as “reciepts”. The series also highlights everything that the Democrats have done in an effort to protect American’s access to health care – of all types. This includes protections for DACA recipients and people who are LGBTQ+ You may want to take a look at the previous blogs in this series. Doing so will give you an overall picture of what the Trump Administration and the GOP have done to harm American’s health starting in 2017. A Timeline of the GOP’s Attempts to Destroy Obamacare – Part One A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Two A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three – Continued A Timeline of the GOP’s Attempt to Destroy Obamacare – Part Four A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Four: April, May, June July July 1, 2020: NPR posted an article titled: “Oklahoma Votes For Medicaid Expansion Over Objections of Republican State Leaders”. It was written by Jackie Fortier. From the article: Voters in Oklahoma narrowly approved a ballot measure Tuesday night to expand Medicaid to eligible adults who need health insurance. Oklahoma is now the 37th state to expand Medicaid under the Affordable Care Act; coverage will begin a year from now, on July 1, 2021.Based on the final unofficial count, the measure passed with just over a 6,000-vote margin — less than one full percentage point……In Oklahoma, Medicaid expansion will likely help drive down the state’s 14% uninsured rate, the second highest in the nation after Texas. It’s estimated that at least 200,000 Oklahomans will be newly eligible for Medicaid, with enrollment potentially climbing even higher as millions lose their jobs amid the pandemic.Under 2020 poverty guidelines, expanded Medicaid coverage would provide health insurance to a single adult making less than $17,608 annually, or adults in a family of four making less than $36,156 annually….…The language used in the ballot measure ensures that Medicaid expansion is enshrined in the state’s constitution, which would make it extremely difficult for Republican Gov. Kevin Stitt or the Republican-controlled legislature to dismantle the expansion in the future… July 1, 2020: Senator Kamala Harris posted a press release titled: “Harris, Murray, Colleagues to Barr: Reverse Anti-LGBTQ Position, Protect Transgender Workers from Discrimination”. From the press release: Following the U.S. Supreme Court’s landmark decision in Bostock v. Clayton County, Ga., which held that Title VII of the Civil Rights Act of 1964 protects LGBTQ workers from discrimination, U.S. Senators Kamala D. Harris (D-CA) and Patty Murray (D-WA) on Tuesday sent a letter to Attorney General William Barr demanding the Department of Justice (DOJ) reverse its anti-LGBTQ position that federal law does not shield transgender workers. The senators called on Barr to immediately rescind a 2017 memorandum issued by former Attorney General Jeff Sessions articulating the Justice Department’s current anti-transgender stance. In 2017, Senators Harris and Murray led their colleagues in a letter condemning then Attorney General Sessions’s discriminatory memorandum.“We strongly urge you to rescind a 2017 U.S. Department of Justice memorandum in which former Attorney General Jeff Sessions ordered DOJ to take the position that transgender workers are not protected from workplace discrimination under Title VII of the Civil Rights Act of 1964.” The senators wrote that the Supreme Court’s decision “compels DOJ to rescind the Sessions memorandum,” which “misstates the law, poses an ongoing threat to the well-being of transgender workers, and invites liability for employers that misguidedly rely upon it.”The senators continued, “In light of the landmark Bostock decision, there can remain no justification for leaving in place an enforcement policy that flatly contradicts Supreme Court precedent. Accordingly, we call on you to rescind the Sessions memorandum immediately.”Joining Harris and Murray on the letter are Senators Sherrod Brown (D-OH), Amy Klobuchar (D-MN), Chris Van Hollen (D-MD), Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Bernard Sanders (I-VT), Mazie K. Hirono (D-HI), Patrick J. Leahy (D-VT), Jeffrey A. Merkley (D-OR), Ron Wyden (D-OR), Jack Reed (D-RI), Tina Smith (D-MN), Bob Menendez (D-NJ), Cory A. Booker (D-NJ), Kirsten Gillibrand (D-NY), Elizabeth Warren (D-MA), Tim Kaine (D-VA), Tammy Duckworth (D-IL), Robert P. Casey, Jr. (D-PA), Christopher A. Coons (D-DE), Richard J. Durbin (D-IL), Jacky Rosen (D-NV), Catherine Cortez Masto (D-NV), Michael F. Bennet (D-CO), and Tom Carper (D-DE). A full copy of the letter can be found HERE July 1, 2020: Speaker of the House Nancy Pelosi posted a press release titled: “Pelosi Statement on Passage of H.R. 2, The Moving Forward Act”. From the press release: Speaker Nancy Pelosi issued this statement on the passage of H.R. 2, the Moving Forward Act, House Democrats’ transformative infrastructure package For The People:“Today, House Democrats have taken a bold step to move America forward, as we deliver on our For The People promise to increase paychecks by rebuilding America with green, resilient, modern and job-creating infrastructure by passing H.R. 2, the Moving Forward Act. I salute Chairman Peter DeFazio and all the Chairs of the Committees of Jurisdiction, and especially our Freshmen who have invigorated Democrats’ mission to revitalize America’s infrastructure.“H.R. 2 takes bold, broad and transformational action to rebuild our infrastructure, while addressing key injustices in America, which have been laid bare by the COVID-19 crisis. We are proud that this legislation addresses environmental justice, including by investing boldly in affordable housing, expanding affordable high-speed Internet to underserved rural and urban communities, and ensuring that all have access to clean water. H.R. 2 makes a strong down payment in a clean energy future and solving the climate crisis, as we create millions of good-paying jobs and rebuild our highways, bridges, transit, rail, airports, ports and harbors to improve safety, reduce gridlock and put America on a path to zero pollution.“We urge Leader McConnell and the GOP Senate to join the House in supporting this transformative legislation For The People. As Americans across the country come together to peacefully demand justice, equality and progress, the Congress must meet this moment by moving our country forward with real action.” July 2, 2020: American College of Obstetricians and Gynecologists (ACOG) posted a joint statement titled: “Joint Statement from Women’s Health Groups, Medical Groups on June Medical”. From the joint statement: The American College of Obstetricians and Gynecologists joins the American Academy of Nursing, American Academy of Pediatrics, American College of Osteopathic Obstetricians and Gynecologists, American College of Physicians, American Public Health Association, North American Society for Adolescent and Pediatric Gynecology, Society for Maternal-Fetal Medicine, and Society of OB/GYN Hospitalists in issuing this statement.The medical community celebrates the decision of the Supreme Court of the United States in the case of June Medical Services v. Russo. This decision confirms once again that our justice system will not tolerate restrictions on our patients. However, we recognize that the law overturned in this case was just one example of a litany of restrictive policies that seek to interfere with the patient-clinician relationship. We also know that access to care continues to be delayed or denied for many women due to systemic inequities and inequalities. With the Supreme Court once again protecting the right to access safe, legal abortion, we now call on lawmakers to stop passing harmful, burdensome laws that target our patients. Policymakers must refrain from attempting to mandate if, when, and how we can provide them with the care they need. It is time to stop legislating medical practice and it is time for all lawmakers to recognize that reproductive health care is a critical part of comprehensive health care for all patients. As clinicians and public health practitioners, we advocate for patients every day and in many ways. The decision in June Medical Services encourages us to continue to do so, and we will remain vigilant in our demand for patient-focused policies that will help us achieve health equity. July 2, 2020: California Attorney General Xavier Becerra tweeted: “As groups supporting the healthcare repeal lawsuit submit amicus briefs about why they think “the #ACA must fall”, remember what’s at stake: #ProtectOurCare” July 2, 2020: California Attorney General Xavier Becerra tweeted: “Protections for 133 million Americans with pre-existing conditions,” July 2, 2020: California Attorney General Xavier Becerra tweeted: “Coverage for 12 million Americans receiving insurance through Medicaid expansion” July 2, 2020: California Attorney General Xavier Becerra tweeted: “$900 million in grants to improve public health through the Prevention and Public Health Fund,” July 2, 2020: California Attorney General Xavier Becerra tweeted: “Essential health benefits like prescription drug coverage and hospital stays, and other patient protections.” July 2, 2020: California Attorney General Xavier Becerra tweeted: “The Trump Administration is fighting to rip away our healthcare during a global pandemic that has infected millions of Americans with no signs of stopping. Our coalition of 20 States + DC is ready to go to the Supreme Court to #ProtectOurCare. Lives are at stake.” July 2, 2020: New Times SLO posted an article titled: “Continued care: In the face of Trump’s rollback of LGBTQ-plus health care protections, Planned Parenthood isn’t going anywhere”. It was written by Malea Martin. From the article: Between a landmark Supreme Court ruling for the LGBTQ-plus community and a Trump administration rule that goes in the opposite direction, this year’s Pride Month has been one for both victory and distress for members of the queer community.But no matter what the federal government decrees, Planned Parenthood Central Coast wants residents to know that they will continue to get the services they need.“Regardless of your sexual orientation or gender identity, where you’re from, the language you speak, or whether you’ve had an abortion, every person deserves access to health care, free from judgement and discrmination,” Planned Parenthood Central Coast CEO and President Jenna Tosh said. “I think especially during a public health crisis, any rule that makes it harder for marginalized people to access health care is unconscionable.”U.S. Rep. Salud Carbajal (D-Santa Barbara) echoed this sentiment, saying that the Trump administration “is looking at every way to continue to undermine , in this case health benefits, to members of the LGBTQ community.”Tosh explained that the Trump administration’s June 12 ruling, which rolls back nondiscrimination protections for sex and gender identity put in place by the Affordable Care Act, will allow “health care providers, hospitals, and insurance companies that recieve federal funding to refuse to provide or cover services such as LGBTQ health care.”But, she said, this will not have any immediate impact on Planned Parenthood patients’ ability to get access to care……In addition to welcoming folks regardless of their sexual orientation or gender identity, Planned Parenthood Central Coast started providing general affirming care about a year ago, Tosh said… July 2, 2020: ABC 27 News posted an article titled: “High court won’t hear abortion clinic ‘buffer zone’ cases”. It was written by Jessica Gresko. From the article: The Supreme Court on Thursday turned away pleas from anti-abortion activists to make it easier for them to protest outside clinics, declining to wade back into the abortion debate just days after striking down a Louisiana law regulating abortion clinics.The justices said in a written order that they would not hear cases from Chicago and Harrisburg, Pennsylvania, where anti-abortion activists had challenged ordinances that restrict their behavior outside clinics.As is usual, the justices did not comment in turning away the cases. The order from the court noted Justice Clarence Thomas would have heard the Chicago case……On Thursday, one of the two cases the court declined to take up involved an ordinance passed by the city counsel in Harrisburg, Pennsylvania’s capital, in 2012 that made it illegal to “congregate, patrol, picket or demonstrate” in a zone 20 feet from a health care facility. Anti-abortion activists sued, arguing that the ordinance violates their free speech rights. Lower courts have upheld the ordinance, however, ruling it doesn’t apply to “sidewalk counseling,” where individuals who oppose abortion offer assistance and information about alternatives to abortion to those entering a clinic.The second case the court turned away on Thursday involved a Chicago ordinance that regulates the space 50 feet from the entrance of any abortion clinic or other medical facility. In that space, a person cannot come within 8 feet of another person without their consent to hand them information or engage in “oral protest, education, or counseling.” The ordinance was modeled on a statute upheld by the Supreme Court in 2000……The court’s announcement that it would not hear the cases comes on the heels of its decision Monday that a Louisiana law requiring doctors who perform abortions to have admitting privileges at nearby hospitals violates abortion rights the court first announced in the landmark Roe v. Wade decision in 1973. The decision divided the court’s conservatives and liberals 5-4 with Chief Justice John Roberts joining his four more liberal colleagues to strike down the law.It was the first big abortion case of the Trump era and a surprising defeat for abortion opponents, who thought that the court’s new conservative majority with two members appointed by President Donald Trump would start chipping away at abortion access.As a result of the decision, the justices also on Thursday ordered lower courts to revisit cases involving Indiana abortion laws previously blocked by courts. One required a woman to have an ultrasound 18 hours before having an abortion and the other would have made it tougher for girls under age 18 to get an abortion without their parents’ knowledge.In their decision earlier this week, the justices told lower courts how to determine whether a restriction is permissible or puts an unconstitutional obstacle in the way of women who want an abortion. July 6, 2020: Representative Ayanna Pressley (Democrat – Massachusetts) posted a press release on her official website titled: “Rep. Pressley Statement on Inclusion of Hyde Amendment in Labor-HHS Appropriations Bill”. From the press release: Today, Congresswoman Ayanna Pressley (MA-07) released the below statement following release of the proposed FY 2021 Appropriations bill for the Departments of Labor, Health and Human Services, and Education, and related agencies.“For generations, the Hyde Amendment has restricted the constitutional right to safe and legal abortion care for millions– disproportionately impacting our most vulnerable, low-income, Black, Brown and Indigenous communities.When I say it is time to legislate our values and write budgets that affirm the dignity and worth of Black and Brown lives, I mean it.Let me be clear, discriminatory abortion bans like the Hyde Amendment are blatantly racist and perpetuate systems of oppression and white supremacy that target people of color–especially Black people–and their bodily autonomy.This first ever pro-choice majority in the House of Representatives has a mandate and a responsibility to stand up for reproductive rights and justice for all, not just those who can afford it. This is a racial justice issue.We know that Black women are statistically denied access to medical care across the board. Their pain is delegitimized and their lives devalued by a broken for profit health care system.I am deeply disappointed to see that the Hyde Amendment was included in the House LHHS funding bill. Black and Brown people should not have to continue to wait to have their humanity and freedoms recognized. I intend to work with my colleagues to finally repeal Hyde when the bill comes to the House floor and I will file an amendment to do just that.” July 7, 2020: New York Attorney General Letitia James posted a press release titled:” Attorney General James Continues to Take on Trump Administration’s Anti-Abortion Rule as Coronavirus Pandemic Rages On”. From the press release: New York Attorney General Letitia James today continued her leadership in the national fight to ensure women’s reproductive health care is not stifled or infringed upon in any way during the coronavirus disease 2019 (COVID-2019) public health crisis. Attorney General James co-led a multistate coalition of nine attorneys general in asking the U.S. Department of Health and Human Services (HHS) to withdraw a new interim final rule or delay implementation of it as the nation continues to battle COVID-19. In response to the pandemic, the interim rule only delays for 60 days a previously-implemented HHS rule that threatens to potentially kick millions of women across New York and the rest of the nation off their health plans if they fail to comply with a technical billing issue related to abortion coverage. The coalition argues that the final rule is not only unlawful, but that it would harm states and insurers, as well as consumers seeking reliable health coverage during the COVID-19 pandemic. Additionally, the coalition highlights that a 60-day delay is not a sufficient remedy to the problems posed by the final rule.“As the number of confirmed coronavirus infections continue to rise exponentially across the nation, it is unconscionable that President Trump and his administration continue to move forward with plans that risk stripping women of their health coverage at this time — something that endangers us all,” Attorney General James said. “Instead of repeatedly focusing on cutting off women’s access to reproductive health care, the Trump Administration should be expanding health coverage for all Americans, so that no one is left without the coverage they need as we continue to battle COVID-19. But the origin of this rule is no doubt rooted in the president’s anti-choice ideology that aims to take us backwards almost half a century, which is why our coalition will never stop fighting against this burdensome and controlling regulation that strips women of their constitutional right to an abortion.”Issued by HHS in December 2019, the final rule reinterprets Section 1303 of the Patient Protection and Affordable Care Act (ACA) by requiring qualified health plans that participate in the state exchanges, like the New York State of Health, to send two separate monthly bills for payments of a health insurance premium — even if no abortion service is provided — and collect separate monthly payments for abortion services to all consumers. One bill would be for the premium amount attributable to abortion coverage (and would need to be at least one dollar) and a second bill would compromise the premium amount attributable to the remaining covered services, which may include services like primary doctor appointments, hospital visits, and other services covered by insurance. If a consumer misses even a single one-dollar payment, that individual could lose all health coverage on the exchange. HHS itself has conceded that requiring separate bills and separate payments will inevitably lead to confusion, putting more than 160,000 New Yorkers who have already enrolled in a qualified health plan this year alone at risk of losing coverage if they inadvertently fail to make full premium payments on time. Additionally, the new rule places unreasonable burdens on health insurers by requiring them to make onerous administrative changes in the middle of the plan year, instead of at the end of the plan year — when all other benefit and rate changes are made. In January, Attorney General James and the coalition filed a multistate lawsuit arguing that HHS’s onerous and confusing requirement threatens women’s access to abortion and puts millions at risk of accidentally losing their health insurance coverage. In late March, the coalition filed a motion for summary judgment in the lawsuit, calling for the courts to immediately vacate the rule because it violates federal law and is inconsistent with the Affordable Care Act. And in early April, the coalition sent a separate letter to HHS arguing against final implementation of the rule, as the nation was first responding to the COVID-19 public health crisis that required every resource of the federal government to be focused on the pandemic. Following the onset of COVID-19, HHS issued the interim final rule that is the focus of today’s letter — delaying enforcement of the separate abortion billing rule by a mere 60 days — purportedly to allow insurers additional time to address immediate challenges posed by the pandemic.In today’s comment letter, the coalition argues that the interim final rule: Forces states and insurers to make onerous changes in the middle of the plan year, because the 60-day delay is insufficient;Burdens states, state agencies, and insurers, and hampers their efforts to respond to the COVID-19 pandemic; andEndangers the gains recently made through several exchanges’ special enrollment periods… July 7, 2020: EMILY’s List posted a press release titled: “EMILY’s List Puts Five More House Republicans “On Notice” For Targeting Women’s Rights”. From the press release: Today, EMILY’s List, the nation’s largest resource for women in politics, expanded its “On Notice” opposition program to include five more House Republicans. EMILY’s List is calling out incumbent Republicans for their anti-women and anti-family records and is working to flip governorships, congressional seats, and legislative chambers from red to blue by electing pro-choice Democratic women in the upcoming 2020 election.“With just over four months until the general election, EMILY’s List is expanding its On Notice program to include five House Republicans who have actively worked to impede progress and strip women of their fundamental rights. These members have cosponsored dangerous legislation, including the Born-Alive Abortion Survivors Protection Act, a desperate attempt by Republicans to instill fear and spread misinformation about abortion. From supporting a party pushing to repeal health care in the midst of a global pandemic to pandemic to prioritizing big corporations over the small business owners they were elected to represent, it is clear that these Republicans must be voted out. EMILY’s List is actively targeting these flippable districts. We look forward to replacing these members with pro-choice Democratic women who will serve as true champions for women and working families.”The following Republicans are included in EMILY’s List’s of House targets. The full “On Notice” list, including Senate, statewide, and state legislative targets, can be found online here. Rep. French Hill (AR-02)Rep. Doug LaMalfa (CA-01)Rep. Tom McClintock (CA-04)Rep. Joe Wilson (SC-02)Rep. Dan Crenshaw (TX-02) July 7, 2020: California Attorney General Xavier Becerra posted a press release titled: “Attorney General Becerra: Separate Abortion Billing Rule Threatens Health Coverage During the Pandemic, A 60-Day Delay Won’t Fix What’s Broken”. From the press release: California Attorney General Xavier Becerra and New York Attorney General Letitia James today led a coalition of nine attorneys general in filing a comment letter opposing the U.S. Department of Health and Human Services’ (HHS) new interim final rule relating to their unlawful 2019 rule for health Exchanges under Section 1303 of the Affordable Care Act (ACA). The Separate Abortion Billing Rule requires consumers to make two separate payments for healthcare – one for their insurance premium and a separate one-dollar payment for abortion coverage – or risk losing their coverage altogether. The interim final rule would delay implementation of the new Separate Abortion Billing Rule by 60 days – despite states and the healthcare industry asking for more time or to halt the rule altogether. The coalition argues that the final rule is unlawful, would harm states, insurers, and consumers seeking reliable health coverage during the COVID-19 pandemic, and highlights that a 60-day delay is not sufficient remedy to the problems posed by the final rule. “The Trump Administration’s unlawful Separate Abortion Billing Rule puts Americans’ healthcare at risk in the midst of a pandemic, just as they need it most. A 60-day delay won’t fix what’s broken,” said Attorney General Becerra. “Issuing a rule halfway through the plan year that burdens our health system and risks consumers’ healthcare is simply irresponsible. It’s our duty to protect Americans’ healthcare, including women’s access to safe and legal abortion care.”On December 27, 2019, HHS issued a final rule requiring qualified health plans participating in health Exchanges to send and collect separate bills—one for a health insurance premium and one of at least one dollar for abortion coverage. If a consumer misses the one-dollar payment, they could lose all coverage. This onerous and confusing requirement threatens women’s access to abortion and puts health insurance coverage at risk for millions of individuals. HHS itself has conceded that requiring separate bills and separate payments will inevitably lead to confusion, putting more than 1.4 million enrollees in California alone at risk of losing coverage if they inadvertently fail to make full premium payments on time. Furthermore, the rule places unreasonable burdens on health insurers by requiring them to make onerous administrative changes in the middle of the plan year, instead of the end of the plan year, when all other benefit and rate changes are made. On January 30, 2020, Attorneys General Becerra and James filed a lawsuit contesting the final rule. Following the onset of the COVID-19 pandemic, HHS issued an interim final rule, delaying enforcement of the Separate Abortion Billing Rule by 60 days, purportedly to allow insurers time to address immediate challenges posed by the pandemic.In the comment letter, the coalition argues that the interim final rule: Forces states and insurers to make onerous changes in the middle of the plan year, because the 60-day delay is insufficient;Imposes significant burdens given that insurers and state agencies must work through the summer months to establish and adjust new premium rates for the following open enrollment period;Burdens states, state agencies, and insurers and hampers their efforts to respond to the COVID-19 pandemic; andEndangers the gains recently made through several Exchanges’ special enrollment periods. Attorney General Becerra was joined in filing today’s comment letter by the attorneys general of New York, Colorado, Maine, Maryland, Oregon, Vermont, Washington, and the District of Columbia. A copy of the comment letter is available here. More information on the Attorney General’s ongoing lawsuit challenging the final rule is available here. July 7, 2020: NARAL Pro-Choice America posted a press release titled: “NARAL Pro-Choice America Responds to Inclusion of Discriminatory Anti-Choice Amendment in House Democrats’ Spending Bill”. From the press release: NARAL Pro-Choice America President Ilyse Hogue released the following statement in response to Democrats in the U.S. House of Representatives including the discriminatory Hyde Amendment, an anti-choice policy restricting coverage for abortion care for those who receive their health insurance through the federal government, in the FY’ 21 Labor-HHS-Education appropriations bill:“Every day that the Hyde Amendment remains in place, it hurts women of color and women with low incomes just as it was intended to from the day Henry Hyde introduced it in 1976. It’s disappointing that, despite having a majority and the most pro-choice slate of elected officials ever serving in the U.S. House of Representatives, Democratic leadership has chosen to include a discriminatory abortion coverage ban in this year’s appropriations bill. The Hyde Amendment restricts access to abortion for those already facing the greatest hurdles to getting the time-sensitive and essential care they need. While we appreciate the spending bill’s inclusion of other pro-choice priorities, such as blocking the Trump administration’s dangerous refusal of care rule and its attempt to roll back nondiscrimination protections under Section 1557 of the Affordable Care Act, it isn’t enough.As our country faces a public health crisis and a long-overdue uprising against entrenched white supremacy and structural racism, we must be more committed than ever to ending barriers to care like Hyde, which disproportionately affects communities of color and people with low incomes, so that every body is free to make their own personal decisions about pregnancy free from political interference.”Restrictions on abortion care like the anti-choice Hyde Amendment endanger women and families already facing enormous hurdles to accessing care, especially Black and Brown women and those with low incomes. At a time when the freedoms enshrined by Roe v. Wade face unprecedented attack, the 2020 Democratic presidential field coalesced around the party’s core values—including ending the Hyde Amendment’s ban on abortion coverage once and for all.We know that abortion is front and center for Democrats: Support for abortion rights is at an all-time high and polling confirms reproductive freedom is a major issue for Democratic voters in particular. These values are non-negotiable to the 77% of Americans who support the legal right to abortion in the United States. July 8, 2020: Bloomberg Law posted an article titled: “Top Court Backs Religious Rights in Contraceptive, School Cases”. It was written by Greg Stohr. From the article: The U.S. Supreme Court struck two blows for religious rights, including a decision that upholds Trump administration rules giving employers a broad right to refuse to offer birth control through their health plans.The justices also gave religious organizations a bigger exemption from discrimination suits, throwing out bias claims filed by two teachers who were fired by Roman Catholic grade schools in California. Both decisions Wednesday were 7-2 as Justices Stephen Breyer and Elena Kagan joined the court’s five conservatives in the majority.The decisions came as the court said it will issue the last opinions of its term on Thursday. Those will include rulings on subpoenas for President Donald Trump’s financial records from Congress and a New York grand jury.The contraceptive ruling, which stems from an Obamacare guideline requiring health plans to include free coverage, lets Trump’s administration expand a narrower religious exemption offered under President Barack Obama. Critics say the new exemption could leave tens of thousands of women without ready access to birth control.The ruling focused more on federal administrative law than religion. Writing for the court, Justice Clarence Thomas said the Affordable Care Act gives administrators “broad discretion” to carve out religious and moral exemptions. The law itself doesn’t explicitly mention birth control, instead requiring cost-free “preventive care and screenings” and leaving it to a federal agency to determine what’s included.Dissenting Justice Ruth Bader Ginsburg pointed to a government estimate that between 70,500 and 126,400 women would immediately lose access to free contraception.“This court leaves women workers to fend for themselves, to seek contraceptive coverage from sources other than their employer’s insurer, and, absent another available source of funding, to pay for contraceptive services out of their own pockets,” Ginsburg wrote.The ruling leaves open the possibility the exemption could be narrowed if Democrat Joe Biden wins the presidential election and revises the policy.The Trump administration issued its rules in Nov
