This blog post is a continuation of everything significant that happened with Obamacare, Medicare, Medicaid, and access to reproductive health care in the United States in 2019. Part Three left off at the end of June of 2019. This blog picks up in July of 2019.

You may want to go back and take a look at the efforts that the Trump administration and the GOP made to destroy people’s access to health care in 2017 and in 2018.

The purpose of this series of blog posts is to make it incredibly easy find information about what happened to health care access during the Trump administration.

July 1, 2019: The Hill posted an article titled: “Overnight Health Care: Panel of judges set for ObamaCare case | Trump officials delay ‘ conscience protection’ rule | Theranos founder to go on trial for fraud next summer”. It was written by Peter Sullivan. From the article:

Panel of judges set for big ObamaCare court case next week

The three-judge panel on the Fifth Circuit Court of Appeals that will hear the lawsuit seeking to overturn the Affordable Care Act was revealed on Monday.

The judges for the July 9 arguments are Carolyn King, Jennifer Elrod and Kurt Englehardt. King was appointed by President Jimmy Carter, while Elrod and Englehardt were appointed by President George W. Bush. That means there are two Republican-appointed judges to one Democratic-appointed judge.

Most legal experts in both parties view the lawsuit’s legal argument challenging the health care law as extremely weak and think that eventually ObamaCare will be upheld.

But there are still a lot of question marks around the case, especially after the court last week asked whether the blue states arguing to uphold the health law even have the legal standing to be involved…

Trump administration delays implementation of ‘conscience protection’ rule

The Department of Health and Human Services (HHS) is delaying the implementation of its “conscience protection” rule until November to give the administration more time to deal with a lawsuit over the policy.

HHS announced in a court filing Saturday that the rule, which was originally scheduled to take effect July 22, would not be implemented until Nov. 22 at the earliest.

A coalition of Democratic-led states filed a lawsuit against the administration in May saying the policy, which would allow health care providers to refuse to provide services on the basis of their religious beliefs, is unconstitutional…

…Background: President Trump announced the policy in May, which proponents say would protect health care workers and institutions from having to violate their religious or moral beliefs by participating in abortions, providing contraception sterilization, or performing other procedures…

July 1, 2019: NPR posted an article titled: “Court Order Delay Of Trump Administration’s Health Care ‘Conscience Rights’ Rule”. It was written by Selena Simmons-Duffin. From the article:

The federal government’s rule designed to support health workers who opt out of providing care that violates their moral or religious beliefs will not go into effect in July as scheduled. The effective date has been delayed by four months, according to court orders.

The “Protecting Statutory Conscience Rights in Health Care” rule was originally issued in May by the Department of Health and Human Services’ Office for Civil Rights. It aligns with that office’s religious freedom priorities and would put new emphasis on existing laws that give health care workers the ability to file a complaint with that office if they are forced to participate in medical care that violates their conscience – such as abortion, gender confirmation surgery, and assisted suicide.

As NPR reported, the rule also expands the type of workers who are able to file this kind of complaint to billing staff and receptionists and anyone else who in any way “assist[s] in the performance” of a procedure…

…Several groups sued the federal government over the rule immediately after it was issued. New York state led a coalition of 23 cities and states in one suit, and three jurisdictions in California also sued, including California state and San Francisco. Yet another plaintiff, Santa Clara County in California’s Bay Area, made the case that the rule put patient safety at risk, since it gave health workers the right to opt out of providing care without prior notice – potentially even in an emergency…

…Santa Clara and several other plaintiffs had filed for a preliminary injunction to prevent the rule from going into effect while the legal process played out…

…The new effective date is Nov. 22 – the federal judge in the California cases make that official over the weekend, and in the New York case, the federal judge certified the change on Monday…

July 1, 2019: CNBC posted an article titled: “Nancy Pelosi’s latest Medicare proposal would pass drug discounts to all consumers”. It was written by Berkeley Lovelace, Jr. From the article:

House Speaker Nancy Pelosi’s latest draft of legislation allowing Medicare to negotiate lower drug prices would also apply those discounts to private health plans across the U.S., according to a senior Democratic aide.

The Department of Health and Human Services is currently prohibited from negotiating drug prices on behalf of Medicare – the federal government’s health insurance plan for the elderly. Pelosi has been working for months on a plan that would give HHS that power, which private health insurers already have. The most recent draft of the legislation proposes to extend those cost savings to private insurance plans, the aide said, asking not to be identified because the legislation is still being drafted and could change.

Kaiser Health News first reported the news…

…It’s unknown if Pelosi’s plan would apply to all drugs. But according to Kaiser, it would authorize HHS to negotiate the prices of the 250 most expensive drugs.

July 1, 2019: The American Medical Association (AMA) posted news titled: “Supreme Court to Medicare: Seek feedback before changing rules”. It was written by Contributing News Writer American Medical Association Tanya Albert Henry. From the news:

A recent U.S. Supreme Court ruling ensures that Centers for Medicare & Medicaid (CMS) officials must tell the public about proposed changes to Medicare benefits – even if they seem minor – and give physicians and other stakeholders a chance to comment on modifications’ potential impact.

Physicians are cheering the ruling, as the outcome is one the Litigation Center of the American Medical Association and State Medical Societies advocated for in a friend of the court brief filed in the case before the high court on behalf of the AMA and the Medical Society of the District of Columbia. Physicians told justices that “even ‘seemingly minor’ modifications in reimbursement determinations give rise to extreme financial consequences for providers and ultimately their patients.”

The majority opinion, written by Justice Neil Gorsuch, opens by saying that in “one way or another, Medicare touches the lives of nearly all Americans,” noting that it provides health insurance for nearly one-fifth of the nation’s population. In explaining its reasoning for requiring the Department of Health and Human Services (HHS) to seek input, the court echoes arguments that the Litigation Center brief made about the importance of a notice-and-comment period for physicians, patients, and other stakeholders…

July 1, 2019: University of Wisconsin-Madison News posted an article titled: “Wisconsin Medicaid expansion lowered antidiabetic drug costs 70%”. It was written by Katie Gerhards. From the article:

…A new study by a team of University of Wisconsin-Madison researchers shows that Wisconsin Medicaid’s 2004 coverage expansion had a tremendous impact on making antidiabetic drugs more affordable for one of the state’s populations that needs them the most: childless adults with low income.

Although Wisconsin did not participate in the Affordable Care Act Medicaid expansion, legislators approved a limited expansion through a Section 1115 Medicaid Demonstration Waiver. Effective 2014, this waiver expands coverage for childless adults earning up to 100% of the federal poverty level.

Previously, this group had been covered by the BadgerCare Plus Core Plan, with covered fewer medications and had higher copays for generic and brand-name drugs. Transitioning from the Core Plan to the more comprehensive Standard Plan dropped out-of-pocket costs for antidiabetic medication by an average of 70 percent per childless adult, or $36.59 per year.

The expanded coverage also correlated with a 4 percent increase in childless adults using antidiabetic medications, such as insulin and oral medications like metformin. That increase is largely driven by a growing number of people using medication, suggesting affordability might have been an obstacle before the coverage expansion…

July 1, 2019: IndyStar posted an article titled: “State calls new rules ‘Gateway to Work.’ Activists call them a ‘poverty trap.'” It was written by Shari Rudavsky. From the article:

…The requirements began Monday. People covered under the Healthy Indiana Plan are expected to work at least 20 hours per month. That number will slowly climb until July 2020, when Medicaid recipients will need to show that they have worked, volunteered, studied, or acted as a caregiver for 80 hours each month.

State officials have said the Gateway to Work program will encourage low-income Hoosiers to find employment and improve lives. They said the program will support Hoosiers as they transition to employment at the same time it requires them to have “some skin in the game.”

Those who oppose the work requirements point to Arkansas, where an estimated 17,000 people have lost health insurance since work requirements went int effect in June 2018.

But officials for the Family and Social Services Administration have said the road map for Indiana looks nothing like the one overseen in Little Rock. They have estimated that about 20 percent of those currently on the Healthy Indiana Plan, or about 85,000 people, will be affected by the work requirement.

At the start, FSSA officials have said they will operate under “an economy of trust” and allow HIP recipients to log their work hours without requiring outside documentation.

Still, activists say they fear the new requirements will lead those in need to lose precious coverage, coverage that many value…

…Even if the system works as well as it can be expected, some recipients could still find it challenging to meet the requirement that they log on monthly to prove their eligibility, said Donna Neidnagel, a Brown County resident who spoke Monday.

Only about a third of people who are full-time residents in Brown County have access to the internet. Many people live in areas where cellphones have no reception…

July 1, 2019: Crain’s Chicago Business posted an article titled: “Illinois hiring hundreds to reduce Medicaid backlogs”. It was written by Stephanie Goldberg. From the article:

Illinois is hiring hundreds of frontline workers to resolve major delays of its Medicaid application and renewal process.

The Illinois Department of Healthcare and Family Services, which oversee Medicaid, and the Illinois Department of Human Services are working together to fill the vacancies, the departments said in a statement today. The first positions are expected to be filled this week.

The Medicaid redetermination process, which reviews eligibility for the state’s nearly 3 million Medicaid beneficiaries, can lead to lapses in coverage. Such gaps are hard on patients, especially those managing chronic conditions, and health systems that don’t get reimbursed for medical services when claims are denied by health plans.

Backlogs, which have increased in recent years, are considered delays of 45 days or more for initial applications and 60 days or more for renewals, the statement says…

…A recently passed a bipartisan Medicaid reform package also aims to reduce the backlogs.

July 1, 2019: The Independent posted an article titled: “Iowa sued for blocking Medicaid from funding reassignment surgery”. It was written by Lily Puckett. From the article:

The ACLU of Iowa has filed a lawsuit challenging a new state law that prohibits the use of Medicaid funding for gender reassignment surgery.

Governor Kim Reynolds signed a bill on 3 May that included language amending the Iowa’s Civil Rights Act so that the state is not required to pay for gender reassignment surgery.

On Friday, The ACLU sued Mr Reynolds, the state and the Iowa Department of Human Services on behalf of One Iowa, a group that advocates for transgender rights, and two transgender Iowans who qualify for Medicaid and whose doctors say they need the surgery to treat gender dysphoria.

The lawsuit filed in the state court asks a judge to declare the measure invalid because it’s unconstitutional and order the state to halt enforcement. It claims the law violates inalienable rights to liberty, safety and happiness and equal protection sections of article 1 of the Iowa Constitution…

…In March, the Supreme Court ruled that the Iowa Department of Human Services cannot block Medicaid from paying for gender reassignment surgery for two transgender women whose doctors recommended the procedure.

Republicans in the Iowa Legislature passed the law being challenged as part of a last minute addition to a human services budget bill responding to that ruling…

July 2, 2019: Politico posted an article titled: “GOP states seek delay in Obamacare case”. It was written by Dan Diamond. From the article:


The GOP-led states seeking to overturn Obamacare requested on Monday that they get an additional 20 days to file a supplemental brief and that the opening argument set for next week to be delayed to “a date of the Court’s choosing” after the filing.

In a letter to the clerk of the 5th U.S. Circuit of Appeals, attorney Kyle Hawkins said these “important” questions “merit a thorough response” that represents the views of all the states. “As of today, it appears unlikely that any such response will be completed by the Court’s July 3 deadline.”…


Plaintiffs suing to stop HHS’s rule to strengthen conscience rights will have their day in court on Oct. 30, a federal judge in California ordered on Monday.

The Trump administration’s rule, which would expand protections for religious-workers to deny health services, was to take effect on July 22, but U.S. District Court Judge William Alsup this weekend postponed the rule’s effect until Nov. 22. HHS was sued by San Francisco city attorney Dennis Herrera, California Attorney General Xavier Becerra and the Democratic-led states…


A coalition of 75 reproductive rights organizations and physicians sent an open letter to FDA calling for the agency and other government officials to remove barriers for patients to access abortion pills. The pills are supplied by a Dutch pharmacist through the website AidAccess.Org, but in March the FDA ordered the site in a warning letter to stop selling unapproved versions of two drugs – mifepristone and misoprostol – to U.S. consumers.

The groups, including Planned Parenthood and National Organization for Women, argued that the medicines have been proven safe and effective and if laws and regulations “were based on science – not politics” they would be readily available…

July 2, 2019: Aid posted “Open Letter – Medication Abortion Access Should Be Based on Science Not Politics”. From the open letter:

In October of 2018, the international group, led by Dr. Rebecca Gomperts, began offering mifepristone and misoprostol, commonly known as medication abortion pills, by mail, to patients in the United States. After an online medical consultation with a patient, Dr. Gomperts writes a prescription and a pharmacy fills the prescription and ships pills to the patient. According to analysis conducted by a research team at the University of Texas at Austin, in its first year of operation, received over 21,000 requests for abortion pills, without any advertising or outreach.

The two-medication combination that is providing has been demonstrated to be safe and effective in extensive research and is the same combination approved for use in the United States by the Food and Drug Administration (FDA). Yet, despite the strong safety record of medication abortion, in March 2019 the FDA sent warning letters to and Dr. Rebecca Gomperts, stating that they are violating the Federal Food, Drug, and Cosmetic Act by offering mifepristone and misoprostol directly to U.S. consumers seeking to end a pregnancy. The agency demanded that immediately cease offering these medications to people in the United States.

If the laws and regulations that determine the terms of abortion access in the United States were based on science – not politics – medication abortion would be widely available in the United States without medically unnecessary restrictions on distribution. Abortion with quality pills delivered by mail directly to one’s home with instructions for use in multiple languages and access to medical counseling and back-up, if needed, should be one of an array of abortion options available, ensuring everyone who needs to end a pregnancy has the freedom and control to do so in a way that best fits their lives. However, due to the politics of abortion, medication abortion has been over-regulated by the FDA, and pushed further out of reach for many by state restrictions.

The high demand for medication abortion by mail should come as no surprise. Access to abortion is under direct threat today, with near-total bans on abortion care recently signed into law in Alabama, Georgia, Kentucky, Mississippi, and Ohio. This is happening in a context in which abortion is already inaccessible for many: 90% of U.S. counties have no abortion clinic. In addition to having to travel a long distance to the nearest abortion clinic, many people have to endure legally-mandated waiting periods. These medically unnecessary waiting periods create further challenges for people who have to take time away from work or school or arrange for childcare. These hurdles may increase the cost of an abortion, which averages $500 in the first trimester and only becomes more expensive as pregnancy progresses. In 35 states and the District of Columbia, Medicaid does not cover abortion care except in rare cases, making abortion financially inaccessible for low-income people. These restrictions are about control and limiting options, not safety or health…

…The risk for a person self-managing an abortion with pills in the United States today is not medical but legal. Since the year 2000, there have been at least 21 known arrests in the United States of people for ending their own pregnancy or helping someone who has made the decision to do so. Some have gone to jail, but even those who have not have had their lives turned upside down by investigations and in some cases have suffered economic and social harm caused by negative media exposure. The threat of investigation, arrest, or punishment is particularly of concern for those who live under heightened government surveillance, including many in immigrant communities. Five states currently have laws on the books that criminalizes self-managed abortion. The fact that these laws are generally outdated and likely unconstitutional does not mean they are inert: they have been used in the last decade to arrest, investigate, and prosecute people who ended or who were suspected of ending their own pregnancies. And in states without such laws, prosecutors who wish to punish people for abortion have used laws that were never intended to apply to self-managed abortion to target people who have ended, or are suspected of ending, their own pregnancies.

The anti-abortion politicians and activists who propose restrictions are attempting to legislate legal abortion out of existence. They are well aware that the FDA’s restrictions and actions are a key element in the success of their own efforts to make abortion inaccessible…

The letter included a list of organizations who signed on to the letter, as well as a list of individual medical professionals. Here are the organizations:

  • Abortion Access Front
  • Abortion Care Network
  • ACCESS Women’s Health Justice
  • Advocates for Youth
  • All-Options
  • Carolina Abortion Fund
  • Catholics for Choice
  • Chicago Abortion Fund
  • Civil Liberties and Public Policy Program
  • Clarinda Regional Health Center
  • Feminist Women’s Health Center
  • Forward Together
  • Gateway Women’s Access Fund
  • If/When/How: Lawyering for Reproductive Justice
  • In Our Own Voice: National Black Women’s Reproductive Justice Agenda
  • Ipas
  • Legal Voice
  • Maine Family Planning
  • Mariposa Fund
  • Medical Students for Choice
  • Midwest Access Coalition
  • NARAL Pro-Choice Arizona
  • NARAL Pro-Choice Colorado
  • National Abortion Federation
  • National Asian Pacific American Women’s Forum (NAPAWF)
  • National Latina Institute for Reproductive Health
  • National Institute for Reproductive Health
  • New Voices for Reproductive Justice
  • Nurses for Sexual and Reproductive Health
  • Pendergrast Consulting
  • Physicians for Reproductive Health
  • Plan C
  • Planned Parenthood Federation of America
  • Progress Florida
  • Public Leadership Institute
  • Religious Coalition for Reproductive Choice
  • SisterLove, Inc.
  • SisterReach
  • Surge Reproductive Justice
  • URGE: Unite for Reproductive & Gender Equality
  • West Virginia Free
  • Whole Woman’s Health / Whole Woman’s Health Alliance
  • Women on Web

July 1, 2019: CBS News posted an article titled: “American Medical Association sues North Dakota over abortion laws”. It was written by Emily Tillett. From the article:

The American Medical Association (AMA), which often shies away from weighing in on overtly political matters, is suing the state of North Dakota over medical practices, which the AMA says directly “contradict reality and science”.

In a lawsuit filed last week, the AMA is challenging the constitutionality of two laws in particular that direct doctors and medical care teams to provide patients with “false, misleading, and non-medical” information about reproductive health. The AMA, in a joint filing with the Center for Reproductive Rights (CRR), argues that the laws violate the First Amendment rights of physicians by forcing them to convey false information and non-medical statements with which they disagree…

…The state laws represent some father most restrictive abortion laws in the country. One law, H.B. 1336, which is set to take effect Aug. 1, compels doctors to tell their patients that medication-induced abortions can be reverse. Under this law, doctors must also give patients government-scripted information on where to find a medical professional who will provide an experimental and unethical treatment to “reverse” an abortion.

The measure targets drug-induced abortions that require two drugs to be taken separately to complete the abortion. Abortion providers are supposed to tell women undergoing this kind of procedure that they might be able to stop the abortion if they’ve only taken the first drug.

The AMA said that medical advice was “patently false”…

…The AMA is also challenging an existing North Dakota law that forces to tell patients that abortion terminates “the life of a whole, separate, unique, living human being.” The medical group argues that the law requires physicians to impart “ideological, government-mandated messages that are false or misleading” to their patients…

…The lawsuit argus that just last term, the U.S. Supreme Court held in National Institute of Family & Life Advocates v. Xavier Becerra that the government cannot regulate the speech of medical professionals to advance controversial ideas or to discriminate based on the content and/or viewpoint of the speaker…

July 2, 2019: Statesman posted an article titled: “Court denies Texas bid to delay Affordable Care Act arguments”. It was written by Chuck Lindell. From the article:

Keeping a legal challenge to the Affordable Care Act on a fast track, a federal appeals court Tuesday rejected a request to delay next week’s oral arguments made by Texas and 19 the states seeking to overturn the law.

The Republican attorneys general, including Ken Paxton of Texas, said they needed more time to research and respond to questions – recently posed by the 5th U.S. Circuit Court of Appeals’ three-judge panel – that could end the appeal and provide a victory for opponents of the law.

With that response due Wednesday, Texas Solicitor General Kyle Hawkins, the top appellate lawyer in Paxton’s agency, asked for 20 additional days to submit the brief, with oral arguments to be reset for sometime afterward.

The appeals court rejected the request but pushed the deadline back two days, giving all sides until 5 p.m. Friday to submit the requested briefs.

The delay was opposed by Democratic-led states and the U.S. House, which are fighting to preserve the Affordable Care Act after a federal judge in Texas – based on a lawsuit filed by Paxton – ruled in 2018 that the law was unconstitutional…

…The law, sometimes known as Obamacare, remains in effect during the appeal…

July 2, 2019: WITF posted an article titled: “Pennsylvania’s own insurance exchange coming next year”. It was written by Marc Levy. From the article:

Pennsylvania is moving to replace the federally operated with its own website to sell Affordable Care Act-compliant policies in a bid to get more people into it and lower their costs.

Gov. Tom Wolf signed legislation Tuesday after it passed the Legislature unanimously last week. The administration unveiled the legislation in June after lining up support from a wide range of business and consumer advocacy groups, as well as leadership in the Republican-controlled Legislature.

Pennsylvania let the federal government know of its intent and is preparing to submit its plans, called a “blueprint,” in the coming weeks.

Wolf’s administration expects to take over some of the marketing and outreach efforts for next year before it unveils its new website next year for enrollment in the 2021 insurance year.

It says it expects it can lower premiums by 5% to 10% for the 400,000 people who buy policies in the marketplace. Wolf’s insurance commissioner, Jessica Altman, said the savings can especially help the roughly 80,000 people who buy policies through, but whose incomes are too high to qualify for a federal tax subsidy…

July 2, 2019: KTVA The Voice of Alaska posted an article titled: “Alaskans lose Medicaid dental benefits after Dunleavy budget cuts”. It was written by Lauren Maxwell. From the article:

After Gov. Mike Dunleavy vetoed $50 million from the state’s Medicaid budget last week, some Alaskans are already starting to feel the effects.

A large chunk of those cuts – $27 million – eliminates dental benefits for adults on Medicaid that in 2018 included approximately 30,000 Alaskans.

On Monday, Anchorage Dental Group began calling its Medicaid patients to tell them their dental benefits were gone. Office Manager Candace Fleming said that included some patients whose treatment wasn’t finished yet…

…The cuts eliminate all services including preventive care like cleanings and fillings – the kind of things that Dr. James Hyer said can keep small problems from getting worse…

…The State said services to children on Medicaid are not impacted by the budget cuts and that adults who need emergency care for immediate relief of pain or acute infection will still be covered.

July 2, 2019: Planned Parenthood posted a press release titled: “Ninth Circus Provides Emergency Relief for Millions of Title X Patients”. From the press release:

The U.S. Court of Appeals for the Ninth Circuit has blocked the Trump-Pence administration’s dangerous Title X gag rule. The court’s order provides much-needed emergency relief to millions of people who access birth control and other reproductive health services through the program.

Title X is the nation’s program for affordable birth control and reproductive health care, which serves four million people each year. Trump’s gag rule makes it illegal for health care providers in the Title X program to refer patients for abortion, and also blocks access to care at Planned Parenthood by imposing cost-prohibitive and unnecessary “physical separation” requirements. Title X helps millions of people struggling to make ends meet – the majority of whom are people of color, Hispanic, or Latino – access birth control, cancer screenings, STI testing, and other essential reproductive health care. Providers who serve nearly half of the patients who get care through Title X have made it clear that the rule would force them out of the program – the administration is putting health care at risk for patients across the country by pushing this rule to go into effect…

July 2, 2019: Center for Reproductive Rights posted a press release titled: “Trump Administration Postpones Denial of Care Rule”. From the press release:

In response to the Trump administration’s announcement that the Denial of Care Rule will no longer go into effect on July 22, the Center for Reproductive Rights, Lambda Legal, Americans United for Separation of Church and State, and the County of Santa Clara issued the following statement:

“As we know from the firsthand accounts of our plaintiffs – health care providers who are on the front lines every day caring for patients – discrimination in health care is dangerous and lives are truly at stake. Confronted with these facts and the flurry of lawsuits showing how the Denial of Care Rule would irreparably harm health care providers and patients across the country, the Trump administration agreed to delay implementation. The Rule invites health care workers to discriminate based on religious or moral objections, targeting LGBTQ people and women seeking reproductive health care. The Rule is unconstitutional and we are ready to take on the Trump administration in this fight.”

On Saturday, June 29, the U.S. Department of Health and Human Services (HHS) stipulated that it will delay the implementation of Denial of Care Rule. A court order put the delay of the rule into effect yesterday. The rule will no longer take effect on July 22 as originally planned; instead the rule will be delayed at least until November 22…

…The new regulation, issued in May by HHS, invites anyone employed by a health care provider – including doctors, nurses, EMTs, administrators, janitors, and clerical staff – to deny medical treatment and services to patients because of personal religious or moral beliefs. Health care facilities that do not comply risk losing federal funding. If allowed to go into effect, the Rule will cause mass confusion among health care providers and is completely infeasible to implement. As a result, some health care facilities – most of which receive federal funding through HHS – may do away with reproductive and LGBTQ services altogether, leaving millions without access to health care.

In the lawsuit, the civil rights organizations argue that the rule is unconstitutional because it advances specific beliefs in violation of the First Amendment; violates patients’ rights to privacy, liberty, and equal dignity as guaranteed by the Fifth Amendment; and chills patients’ speech and expression in violation of the First Amendment, all to the detriment of patients’ health and well-being. The lawsuit also asserts that HHS violated the federal Administrative Procedure Act in creating the rule by arbitrarily and capriciously failing to consider the impact on patients and the health care system.

July 3, 2019: The Hill posted an article titled: “Judge blocks Ohio’s ‘heartbeat’ abortion law”. It was written by Jessie Hellmann. From the article:

A federal judge on Wednesday temporarily blocked an Ohio law that would have banned abortions after six weeks of pregnancy.

The law, which bans abortions after a fetal heartbeat is detected, was signed earlier this year by Gov. Mike DeWine (R) and challenged by the American Civil Liberties Union (ACLU) and Planned Parenthood.

It was slated to take effect this month, but U.S. District Judge Michael Barrett issued a preliminary injunction, blocking the law from taking effect while it is challenged in court…

…Barrett wrote in his ruling that the law places an “undue burden” on a woman’s right to obtain an abortion before the fetus is viable, violating Supreme Court precedent.

The law would have been one of the strictest in the nation with no exemptions for cases of rape or incest…

The case is called Preterm-Cleveland, et. al. vs. David Yost, et. al. It is available online. Here are some parts of U.S. District Judge Michael Barrett’s ruling:

…In a nutshell, S.B. 23 bans abortion care at and after approximately six weeks in pregnancy. And, in so doing, according to Plaintiffs – a collection of reproductive clinics and physicians providing abortion care – violates women’s right to privacy as guaranteed by the Fourteenth Amendment…

…At six weeks LMP, many women are unaware that they are pregnant… Typically the menstrual cycle is approximately four weeks long, but varies based on the individual. Assuming a woman has consistently regular periods, she would be considered four weeks pregnant as measured from her LMP when her missed period occurs. Those who have irregular periods – caused by common medical conditions, contraceptive use, age or breastfeeding – or those who experience bleeding during early pregnancy that could be mistaken for a period may not realize that they missed a period…. But assuming a patient does know she is pregnant, there are certain logistical obstacles to obtaining abortion care before six weeks in pregnancy… She will need to schedule an appointment, make sure of payment, arrange for transportation, time off of work and possibly childcare during appointments… A minor patient, unless emancipated, also must obtain written parental consent or a court order… And all patients, regardless of age, must make two in-person trips – at least 24 hours apart – to the clinic before they can obtain an abortion… These reasons explain why the majority of abortions in Ohio – approximately 90% – take place at or after six weeks LMP. … S.B. 23, therefore, will prohibit almost all abortion care in Ohio…

…The Court concludes, based on current United States Supreme Court precedent, that Plaintiffs are certain to succeed on the merits of their claim that S.B. 23 is unconstitutional on its face…

…Plaintiffs argue that their patients will suffer serious and irreparable harm in the absence of a preliminary injunction, because allowing the Act to take effect will prevent Ohio women from exercising their constitutional right to reproductive freedom as protected by the Fourteenth Amendment… Inasmuch as this Court has determined that S.B. 23 places an “undue burden” on a woman’s right to choose a pre-viability abortion, and thus violates her right to privacy guaranteed by the Fourteenth Amendment, we further determine that its enforcement would, per se, inflect irreparable harm…

…[Planned Parenthood of Southeastern Pa. v] Casey acknowledged the State’s “legitimate interest from the outset of the pregnancy in protecting the … life of the fetus that may become a child.”… But that acknowledgement was preceded with the recognition that “[b]efore viability, the State’s interests are not strong enough to support a prohibition of abortion or the imposition of a substantial obstacle to the woman’s effective right to elect the procedure”…. An injunction will preserve the status quo that has been in place for more than 40 years since Roe was decided, and some 25 years since Casey followed…


For the foregoing reasons, Plaintiffs’ Motion for Preliminary Injunction … is GRANTED. Specifically, all Defendants, their officers, agents, servants, employees, and attorneys, and those persons in active concert or participation with them who receive actual notice of this Order, are preliminarily enjoined from enforcing or complying with S.B. 23 pending further Order of this Court…

July 3, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “Judge Blocks Ohio’s Near Total Abortion Ban in ACLU Case”. From the press release:

A federal judge temporarily blocked an Ohio law that would have banned abortion as early as six weeks into pregnancy, before most women know they are pregnant. The American Civil Liberties Union (ACLU), the ACLU of Ohio, and Planned Parenthood brought the lawsuit on behalf of Preterm-Cleveland and other abortion clinics in the state. Senate Bill 23 was signed by Governor DeWine and was scheduled take effect this month.

Ohio is one of more than seven states that have considered similar legislation so far this year. In addition to Ohio, the ACLU has challenged similar abortion bans in Kentucky and Georgia, a near total ban in Alabama, and an 18-week ban in Arkansas, among other litigation. Courts have already blocked identical measures in Kentucky and Mississippi. None of the bans are in effect, and abortion remains legal in all 50 states…

July 3, 2019: Politico posted an article titled: “Appeals court takes up fresh challenge to Trump abortion ‘gag rule'”. It was written by Rachel Roubein and Renuka Rayasam. From the article:

The full 9th U.S. Circuit Court of Appeals on Wednesday said it would take up a fresh challenge to the Trump administration’s overhaul of the federal family planning program just weeks after three of its Republican-appointed judges said the policy change can take effect nationwide while several legal challenges play out.

The appeals court froze the administration’s rule revamping the Title X program while it hears the case, according to Brigitte Amiri, deputy director at the ACLU’s Reproductive Freedom Project.

The court’s order marks the latest turn in a battle over the administration’s changes to the program, which seek to steer federal dollars away from providers such as Planned Parenthood that offer abortions and abortion referrals. Critics have dubbed the Trump policy a “gag rule”.

The order covers several challenges to the rules, but it’s unclear whether they will be heard together or separately…

July 3, 2019: The American Civil Liberties Union posted a press release titled: “Court Blocks Trump Administration’s Attempt to Gut Family Planning Program in Response to ACLU Lawsuit”. From the press release:

The Ninth Circuit Court of Appeals restored a preliminary injunction today in the ACLU’s case against the Trump Administration’s efforts to roll back Title X, the nation’s family planning program.

The decision blocks the implementation of the rule, which would have undermined the health care needs of four million low-income people each year, while the cases argued…

July 3, 2019: Center for Reproductive Rights posted a press release titled: “Judge refuses to block Title X Rule in Maine, jeopardizing healthcare access for thousands of Mainers”. From the press release:

U.S. District Court Judge Lance Walker today denied the Center for Reproductive Rights’ request to block the Trump Administration’s Domestic Gag Rule from going into effect in the state of Maine, jeopardizing the future of Maine Family Planning’s clinics across the state.

In June 2019, on behalf of Maine Family Planning (MFP), the Center for Reproductive Rights made an emergency request to re-block the rule after a federal appeals court overrode lower court decisions that had previously blocked the rule from going into effect nationwide.

Maine Family Planning is the state’s sole Title X grantee and the largest reproductive health care organization in Maine. With this ruling, 85% of abortion clinics in the state of Maine are in jeopardy…

The Domestic Gag Rule Will:

Force healthcare providers that receive federal funding like MFP to stop performing abortions, even though no federal funds are used to finance abortion.

Prohibit doctors at these facilities from making referrals to abortion providers, even when the patient has already decided to have an abortion and directly asks for a referral.

Force doctors to give all pregnant patients prenatal referrals, even when the patient doesn’t want one.

Give Title X funding to non-medical organizations known as “crisis pregnancy centers,” which are designed to look like medical clinics but aim to deter women from getting abortions…

July 3, 2019: The U.S. Court of Appeals for the Ninth Circuit posted its order on the case called State of California v. Alex M. Azar. It was written by Chief Justice Sidney R. Thomas.

Upon the vote of a majority of nonrecused active judges, it is ordered that these cases be reheard en banc pursuant to Federal Rule of Appellate Procedure 35 (a) and Circuit Rule 35-3. The three-judge panel Order on Motions for Stay Pending Appeal in these cases shall not be cited as precedent by or to any court of the Ninth Circuit.

Judges Graber, Christen, and Owens did not participate in the deliberations or vote in these cases.

July 3, 2019: Delaware Online posted an article titled: “For the first time, Highmark looks to lower its Obamacare marketplace rates”. It was written by Meredith Newman. From the article:

For the first time, Highmark BlueCross Blue Shield of Delaware is asking the state to decrease its Obamacare marketplace rates.

Highmark, the only insurer on the Delaware Affordable Care Act marketplace, has proposed decreasing rates by 5.8 percent in 2020, officials said. This is expected affect about 20,000 residents.

Previously, the insurer has increased rates in the double digits. Last year, rates increased by 3 percent, This decrease would only apply to Delawareans who are enrolled on the ACA marketplace, not those who have Medicaid, Medicare and private insurance…

July 3, 2019: Oklahoma’s News 4 posted an article titled: “Oklahoma Medicaid Office: Update address or lose benefits”. From the article:

Oklahoma’s Medicaid agency is warning its SoonerCare members to keep their current address on file with the agency or risk losing their health care benefits.

The Oklahoma Health Care Authority sent out a public reminder Wednesday of the new rule that was signed by Gov. Kevin Stitt last week. The agency says it intends to launch outreach efforts through social media and through outbound phone calls to SoonerCare recipients after hours and on weekends.

Agency officials say the rule is needed to comply with federal guidelines. But advocates for the poor have criticized the policy, saying low-income people move more frequently and that many members will be wrongfully cut from the programs…

July 3, 2019: RappNews posted an article titled: “Free Clinic changes business model to accommodate expanded Medicaid program”. From the article:

As of January 1, an additional 400,000 Virginians gained access to quality, low-cost health insurance through the state’s expanded Medicaid program.

The enduring mission of the Fauquier Free Clinic (FFC) is to provide eligible residents of Fauqier and Rappahannock counties with access to comprehensive medical, dental and mental health care. This year, the clinic’s business model underwent extensive changes to accommodate new and existing patients when Medicaid expanded its services for low-income adults throughout Virginia…

…In Fauquier County alone, 1,700 to 1,800 people have become eligible for Medicaid insurance benefits. In Rappahannock County, 300 to 400 people are now eligible. Throughout the state of Virginia, eligibility has been granted to around 400,000 people.

“Medicaid expansion was a great opportunity for the Commonwealth and Fauquier County to provide health insurance coverage for those most in need,” said FFC board member Gregory Bengston. “Changing our business model to ensure that clinic patients who were now Medicaid-eligible had continued access to health care services was a huge accomplishment”…

July 3, 2019: The Middletown Press posted an article titled: “Appeals court puts Trump abortion restrictions on hold again”. It was written by Gene Johnson. From the article:

Trump administration rules that impose additional hurdles for low-income women seeking abortions are on hold once again.

The 9th Circuit Court of Appeals in San Francisco on Wednesday vacated a unanimous ruling from a three-judge panel and said a slate of 11 judges will reconsider lawsuits brought by more than 20 states and several civil rights and health organizations challenging the rules.

Critics say the rules would force many clinics to find new locations, undergo expensive remodels or shut down…

…With [the three-judge panel’s decision] vacated, the injunction issued by the lower court judges are once again in effect. It’s not clear when new court arguments will be held.

“We are profoundly grateful the preliminary injunction is back in place,” said Clare Coleman, president of the National Family Planning and Reproductive Health Association, which is involved in the cases…

July 3, 2019: Senator Dick Durbin (Democrat – Illinois) posted a press release on his official website titled: “Durbin Calls On Congress To Protect And Strengthen The ACA, Not Undermine It”. From the press release:

With health care advocates once again under attack, U.S. Senator Dick Durbin (D-IL) today stood with advocates and individuals who have been helped by the Affordable Care Act (ACA) to address the Trump Administration’s latest lawsuit seeking to dismantle the health law and call on Congress to strengthen the ACA, not undermine it. Next week, oral arguments will be head on Texas v United States – a lawsuit over the constitutionality of the entire ACA. If the Trump Administration and 20 Republican state Attorneys General (AGs) succeed, the ACA could be struck down, leaving tens of millions of Americans without health care or protections for pre-existing conditions.

“Thanks to the Affordable Care Act, 20 million Americans gained health insurance, including more than one million people in Illinois,” said Durbin. “All of its important and life-saving protections will be gone if President Trump gets his way starting next week in court. I stand ready to work with my colleagues in Congress to protect and strengthen the Affordable Care Act.”

After President Trump’s failed attempt to repeal the ACA two years ago, he turned to the courts to sabotage the health law. Last February, 20 Republican AGs filed a lawsuit over the constitutionality of the ACA – arguing that because the individual mandate penalty was zeroed out in the 2017 Republican tax law, the rest of the ACA should also be struck down.

In December, a District Court judge in Texas sided with the Republican plaintiffs, and the case will go to the 5th U.S. Circuit Court of Appeals in New Orleans next week. If the Trump Administration and Republican AGs succeed, the entirety of the ACA could be struck down, meaning:

  • Protections for people with pre-existing conditions would be eliminated
  • Millions would be kicked off Medicaid
  • Individual insurance markets and premium assistance would be eliminated
  • Seniors on Medicare would face increased prescription drug costs
  • Women could be charged more than men for health care
  • Young people would no longer have access to their parents’ insurance plan up to age 26
  • Annual and lifetime caps on benefits could return
  • There would no longer be guaranteed coverage for preventative screening and contraception services without deductibles or copayments
  • There would no longer be guaranteed coverage for mental health or addiction treatment services

Since the ACA was signed into law in 2010, the uninsured rate in Illinois has fallen by 49 percent. More than one million uninsured Illinoisans now have health insurance thanks to Medicaid expansion and tax credits to purchase Exchange plans, and 90,000 young adults have health insurance by staying on their parents’ plans until age 26. Further, the approximately 5 million Illinois residents with pre-existing conditions now have protections against discrimination from insurance companies, and Illinois seniors have saved an average of more than $1,000 on their prescription drugs due to the ACA’s closing of the Medicare “donut hole” coverage gap.

Last month the House of Representatives passed bi-partisan legislation, Protecting Americans with Pre-Existing Conditions Act, to prevent President Trump from allowing health insurance companies to discriminate against people with pre-existing conditions, yet Senate Majority Leader Mitch McConnell (R-KY) has refused to call up this legislation for a vote. The House has also advanced legislation to crack down on junk health plans and restore funding for insurance sign-ups and outreach.

July 3, 2019: Kaiser Family Foundation posted information titled: “Explaining Texas v. U.S: A Guide to the 5th Circuit Appeal in the Case Challenging the ACA”. It was written by MaryBeth Musumeci. I highly recommend you read it want to understand more about that case.

In this blog post, I will include only the “Looking Ahead” portion of the information.

Oral argument is scheduled for 1:00 p.m. on July 9th, with 45 minutes to be shard among the state intervener-defendants and the House, and 45 minutes to be shared among the state plaintiffs, individual plaintiffs, and federal government. The case will be heard by a panel of three judges, including Judge Carolyn Dineen King (appointed by President Carter), Judge Jennifer Walker Elrod (appointed by President George W. Bush), and Judge Kurt D. Engelhardt (appointed by President Trump). There is no deadline by which the court must issue a decision, but it could come as early as fall 2019.

If the court finds that the individual mandate is unconstitutional and invalidates only that provision, the practical result will be essential the same as the ACA exists today, as amended by the TCJA, without an enforceable mandate. If the court adopts the position that the federal government took during the trial court proceedings and invalidates the individual mandate as well as the protections for people with pre-existing conditions, then the federal funding for premium subsidies and the Medicaid expansion would stand, and it would be up to the states whether to reinstate the insurance programs.

The most far-reaching consequences, affecting nearly every American in some way, will occur if the court decides that the entire ACA must be overturned. The number of non-elderly individuals who are uninsured decreased by 19.1 million from 2010 to 2017, as the ACA went into effect. The ACA made significant changes to the individual market, including requiring protections for people with pre-existing conditions, creating insurance marketplaces, and authorizing premium subsidies for people with low and modest incomes. The ACA also made other sweeping changes throughout the health care system including expanding Medicaid eligibility for low-income adults; requiring private insurance, Medicare, and Medicaid expansion coverage of preventative services with no cost sharing; phasing out the Medicare prescription drug “doughnut hole” coverage gap’ reducing the growth of Medicare payments to health care providers and insurers; establishing new national initiatives to promote public health, care quality, and delivery system reforms; and authorizing a variety of tax increases to finance these changes. All of these provisions could be overturned if the trial court’s decision is upheld, and it would be enormously complex to disentangle them from the overall health care system…

July 5, 2019: The Jamestown Sun posted an article titled: “Number of abortions continues to slide in North Dakota”. It was written by John Hageman. From the article:

The number of induced abortions performed in North Dakota slid for the fourth straight year in 2018, marking the lowest figure since recordkeeping began almost four decades ago, according to new state data.

There were 1,141 induced abortions recorded in North Dakota last year, down slightly from 1,155 in 2017, according to state Department of Health reports. The agency began tracking abortion statistics in 1981.

The state hit a record number of abortions in 1982 with 3,076.

Tammi Kromenaker, the director of the state’s sole abortion clinic, the Red River Women’s Clinic in Fargo, cited Medicaid expansion and the Affordable Care Act’s contraceptive mandate, which the Trump administration has tried to roll back.

“The (ACA) continuing to cover birth control, with no deductible and no co-pay, that is huge for so many families,” Kromenaker said Friday, July 5, noting that North Dakota is following a national trend in seeing abortion decline…

…The Red River Women’s Clinic recently joined the American Medical Association in filing a federal lawsuit against two North Dakota abortion laws they say will force doctors to misinform their patients and violate their medical ethics. That includes requiring physicians to inform patients it may be possible to revers a drug-induced abortion…

July 5, 2019: San Francisco Chronicle posted an article titled: “California offers doctors student-loan help to treat underserved patients”. It was written by Elizabeth Aguilera. From the article:

It’s a trade aimed at getting more doctors to treat poorer patients: California says it will help repay the student loans of 247 selected doctors in exchange for their promise that at least 30% of their caseload will be people enrolled in Medi-Cal.

The $60 million student loan repayment, CalHealthCares, is funded by the state tobacco tax that voters increased three years ago.

It’s all a part of California’s effort to increase the number of doctors who accept Medi-Cal, the state’s Medicaid health insurer of low-income residents, which has been plagued by shortages – due both to the state’s paltry rates for doctors in its provider network and to the substantial increase in the number of residents on Medi-Cal. California has one of the lowest Medicaid reimbursement rates in the country, and patients wait months, or longer, to see specialists.

More than 1,300 doctors and medical residents applied for the benefit which provides up to $300,000 over five years, and those selected were chosen based on their commitment to treat the underserved, their geographic location and their specialities…

…Research indicates that debt is a major concern for physicians nationwide: a 2017 server by an affiliate of the American Medical Association found that half owed $200,000 or more in medical school loans…

…This is the first doctor group to receive funding from the $340 million fund created by Prop. 56 tobacco tax revenue. The state expects there will be at least five more rounds of awards.

Later this summer, the state will announce awards for dentists who applied to participate in the loan repayment program for serving Denti-Cal patients.

Information about that lawsuit can be found on the American Medical Association website.

July 5, 2019: Idaho Press posted an article titled: Idaho seeks public comment on 2nd Medicaid waiver, for same purpose as 1st. It was written by Betsy Z. Russell. From the article:

The Idaho Department of Health and Welfare is taking public comment on a new Medicaid expansion waiver, less than a week after the comment period on a related waiver closed.

Both applications deal with people who earn between 100 percent and 138 percent of the federal poverty level. The intent is to give them the option to buy subsidized private health insurance through the state exchange, rather than shift to Medicaid. The agency announced the new waiver Wednesday, saying the move stems from conversations with the federal Centers for Medicare and Medicaid Services…

…The move stems from actions taken by the Idaho Legislature during the 2019 session. Rather than implement straight Medicaid expansion, as approved by voters, Republican lawmakers adopted a series of conditions and restrictions on the program. One of the conditions was that people in the 100 percent to 138 percent income category be given the choice to remain in the state exchange.

Under current federal rules, people who qualify for Medicaid aren’t eligible for the tax credits that will help lower the cost of private insurance through the state exchange. Consequently, Idaho will need federal approval to enact the Legislature’s will…

July 5, 2019: The Philadelphia Inquirer posted an article titled: “Medicaid enrollment growth driven by families working for large employers, CHOP study finds.” It was written by Sarah Gantz. From the article:

Enrollment in Medicaid and CHIP, the Children’s Health Insurance Program, among children whose parents work full time and earn more than 100 percent of the federal poverty level grew significantly between 2008 and 2016, according to a new study by researchers at the Children’s Hospital of Philadelphia published this month in Health Affairs.

Researchers found the growth was largely driven by families working for large private employers, where health insurance is a standard benefit – but an increasingly unaffordable one.

Employer-sponsored health insurance is still the most common type of health plan for adults under 65 and their children. But employees are spending more and more out of pocket as their wages remain stagnant.

As companies are strained by rising health-care costs, they are shifting more of the burden to their employees. Across the country, employees’ average share of a premium for family coverage increased 57 percent between 2008 and 2016, to $5,277, according to the Kaiser Family Foundation. Deductibles rose from $1,344 to $2,147 for a family during that period.

A study by the Commonwealth Fund found that nearly 24 million people with employer health plans spend at least 10 percent of their income on premiums, out-of-pocket costs, or both.

Meanwhile, Medicaid offers low-cost coverage and possibly more comprehensive benefits for eligible families who are finding that they can’t afford their employer health coverage, said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia and a co-author of the Health Affairs study…

July 8, 2019: The Texas Tribune posted an article titled: “Texas is going to court to end Obamacare. It hasn’t produced a plan to replace it.” It was written by Emma Platoff and Edgar Walters. From the article:

Last year, after a federal judge in Texas declared the entirety of the Affordable Care Act unconstitutional, throwing into question millions of Americans’ health coverage, the state’s Republican leaders promised they would come up with a plan to replace it.

But on Tuesday, a legislative session that seemed to have no room for issues other than property tax reform and school finance, Texas will ask a federal appeals court in New Orleans to end the law in its entirety – without offering a replacement plan.

The conservative crusade against portions of the act, known as Obamacare, has spanned a decade. But Texas’ latest lawsuit, filed in February 2018, became an existential threat to the law after U.S. District Judge Reed O’Connor ruled in December that it is unconstitutional in its entirety. At stake: subsidized health coverage of roughly 1 million Texans, sweeping protections for patients with preexisting conditions, young adults staying on their parents’ insurance plans until age 26, and a host of low-cost benefits available to all people with health insurance, including those covered through their employers.

Texas already has the highest uninsured rate in the nation…

…Attorneys for the state of Texas argue the health law cannot stand since the Republican-led Congress in 2017 zeroed out Obamacare’s individual mandate – a penalty imposed on people who choose to remain uninsured. Democrats had favored the penalty as a way to induce more people to purchase health insurance, with the goal of reaching near-universal coverage. Without it, Texas argues, the whole law must fall.

But the state’s Republican leaders have offered few ideas about what should replace Obamacare, a law that touches practically every aspect of health care regulations and includes several popular protections for patients. Gov. Greg Abbott – a vocal critic of the law – pledged in December that if the law remained struck down on appeal, “Texas will be ready with replacement health care insurance that includes coverage for pre-existing conditions.”

Since then, he’s been quiet on the issue, including during this year’s 140-day Texas legislative session…

July 8, 2019: Planned Parenthood posted a press release titled: “Congress Blocks D.C. Abortion Ban in Spending Bill”. From the press release:

The House of Representatives voted 224-196 to pass a spending bill that survived Republican efforts to include a provision to block District of Columbia residents with low incomes from accessing safe, legal abortion. The provision has been included in previous spending bills and in current law, and the fact that the House FY 2020 Financial Services and General Government Appropriations bill expands access to safe, legal abortion is in part due to the historic number of reproductive health champions in Congress. Unfortunately, the bill retains language in current law that prohibits federal employees and their dependents from purchasing insurance plans that cover abortion…

July 8, 2019: Center for Reproductive Rights posted a press release titled: “Statement on Commission of Unalienable Rights”. From the press release:

On Monday, July 8, Secretary Pompeo announced the creation of a Commission on Unalienable Rights, chaired by Professor Mary Ann Glendon, to advice on “human rights grounded in our nation’s founding principles” based on documents like the Declaration of Independence and the 1948 Universal Declaration of Human Rights (UDHR), for a term of two years.

The following is a statement by Stephanie Schmid, U.S. Foreign Policy Council at the Center for Reproductive Rights, about the Commission:

“The Commission is nothing less than a subterfuge for undermining reproductive rights and the rights of marginalized communities including LGBTQ persons.

“Contrary to its asserted purpose, there is no need to redefine or develop foundational principles on human rights. There is a clear and unequivocal consensus by U.N. human rights treaty bodies and independent experts that reproductive rights are human rights, grounded in the right to life, health, equality, non-discrimination and freedom from cruel, inhuman, and degrading treatment, among other rights.

“This new Commission is part of a comprehensive effort by this Administration to erase sexual and reproductive health and rights from global discourse. The State Department has deleted reporting on reproductive rights from its annual Country Reports on Human Rights Practices and the Center for Reproductive Rights currently has two lawsuits pending in the United States District Court for the District of Columbia challenging these cuts. In addition, this Administration has insisted on the elimination of sexual and reproductive health and rights protections from U.N. resolutions, sending a clear message that the United States does not care about the plight of women and girls, nor established international law.

“We are also alarmed by reports that the State Department has not engaged in Congressional consultation in advance of creating this Commission and similar reports that there was no consultation or input from career human rights experts working in the State Department’s Bureau of Democracy, Human Rights, and Labor (DRL). Indeed, this Commission appears to be an attempt to circumvent the State Department’s foreign policy and human rights experts in an effort to pick and choose which rights the United States will respect and promote. This redundant and duplicative Commission is a waste of tax-payer resources, which the House of Representatives recognized when it passed H.R. 2740 which included a provision explicitly prohibiting funds being allocated to this Commission.

“This unnecessary Commission will further compound the Administration’s disengagement, deprioritization, and rollback of human rights and further cede the United States’ leadership in advancing the full spectrum of human rights protections within the United States and globally.”

July 8, 2019: Planned Parenthood posted a press release titled: “State Department Attempts to Redefine Human Rights In Order to Violate Them”. From the press release:

Today, the U.S. Department of State rolled out the Commission on Unalienable Rights, with the stated objective of “promotion of individual liberty, human equality, and democracy through foreign policy.” As outlined by Secretary Pompeo, the intent of the commission is to redefine human rights according to what he calls “America’s founding principles.” The commission is stacked with advisors who have long records arguing against reproductive rights – including access to safe, legal abortion – and against rights for LGBTQ communities, including Chair Mary Ann Glendon, a prominent anti-abortion activist.

Statement from Dr. Leana Wen, President, Planned Parenthood Global:

“The Trump-Pence administration’s new sham commission should be seen for what it really is: an attempt to narrowly redefine human rights in order to violate them. At at time when this administration is attacking reproductive rights, rolling back LGBTQ rights, and detaining children and families under horrific conditions, this commission is nothing more than a thinly veiled attempt to unconscionably exclude specific groups from legal protections. The U.S. should be leading the charge to protect and defend human rights, not undermining them for political gain.”

July 8, 2019: Xavier Becerra tweeted: “The entire #ACA is at risk. In less than 24 hours, my team will be in court defending healthcare for millions of Americans just like Anna and her family. #ProtectOurCare”. The tweet includes a thread of tweets by Anna.

July 9, 2019: New York Attorney General Letitia James tweeted: “!! Today we’re in court to defend the #ACA & #ProtectOurCare because the health & safety of millions of Americans is at risk. Access to quality & affordable healthcare is a basic right. Rolling back the clock is dangerous & irresponsible. We’re ready to fight.”

July 9, 2019: CNBC posted an article titled: “Health-care stocks fall ahead of court arguments over constitutionality of Obamacare”. It was written by Berkeley Lovelace Jr. From the article:

Health-care stocks fell Tuesday ahead of a legal showdown between the Trump administration, a group of Republican-led states and more than a dozen Democratic state attorneys generals over the constitutionality of the Affordable Care Act before the U.S. 5th Circuit Court of Appeals in New Orleans…

…Shares of insurers UnitedHealth, Cigna and Humana were down more than 1% in early afternoon trading. Shares of HCA Healthcare, the largest for-profit U.S. hospital operator, and Tenet Healthcare were down 2% and 3%, respectively. Community Health Systems was falling by more than 7%…

July 9, 2019: Planned Parenthood posted a press release titled: Court Hears Challenge to Affordable Care Act, Risking Health Care for Millions”. From the press release:

The U.S. Court of Appeals for the 5th Circuit will hear oral arguments in Texas v. U.S., a case that seeks to strike the Affordable Care Act (ACA) in its entirety, putting access to health care for millions at risk. Under the ACA, 20 million people gained health care coverage and more than 62 million women have gained coverage for preventable services with no out-of-pocket costs, including birth control, STI screenings, breast cancer screenings, and Pap tests…

…Gutting the ACA would threaten the health and financial security of millions of people:

More than 62 million women now have access to no-copay preventative services, including birth control, STI screenings, and life-saving preventative services such as breast cancer screenings and Pap tests.

Under the ACA, women of color are able to access better preventative care, a step forward in leveling the playing field for communities the have faced years of discriminatory policies that result in poor health outcomes.

Financial assistance to purchase health insurance could be eliminated, threatening millions’ access to private insurance coverage, and coverage for the 12 million people who receive coverage under the ACA’s expansion of Medicaid is also threatened.

Prior to the ACA, routine women’s health conditions were considered pre-existing conditions, including pregnancy.

The Affordable Care Act eliminate “gender rating,” ensuring women do not pay an estimated $1 billion more annually than men for the same health care.

July 9, 2019: Representative Joe Kennedy III tweeted: “This is what the Trump Admin is arguing in court today: – Health care is a privilege – Preexisting conditions can be disqualifying – Low-income patients can’t be treated – Addiction treatment can’t be covered – This nation is too weak to care for all its citizens #ProtectOurCare.”

July 9, 2019: CBS News posted an article titled: “Judges have tough questions for Obamacare backers”. From the article:

The fate of former President Obama’s signature health care law, and its coverage and insurance protections for millions of Americans, was again being argued before a panel of judges – this time a federal appeals court in New Orleans.

Attorneys for states hoping to save President Obama’s health care law were hit with some intense and occasionally skeptical questioning from appellate judges in a New Orleans federal court.

The main issue in Tuesday’s hearing was whether Congress rendered the entire Affordable Care Act unconstitutional when it zeroed out the tax imposed people who don’t buy health insurance.

The law’s supporters say Congress clearly didn’t want “Obamacare” dismantled when it eliminated the tax in 2017. And they said the tax elimination doesn’t destroy the whole law.

But appellate judges Kurt Engelhardt and Jennifer Walker Elrod both noted the law still says people must buy insurance. They questioned whether that command now violates the Constitution. Engelhardt also suggested Congress, not the courts, should choose which parts of the law should be salvaged…

July 9, 2019: Senator Patty Murray tweeted: “ICYMI: Here’s what is at risk today because of the lawsuit being brought by Representatives to undermine families’ health care:” The tweet includes a link to a Seattle Times opinion piece from June of 2019.

July 9, 2019: Politico posted an article titled: “Appeals court skeptical Obamacare can survive”. It was written by Paul Demko. From the article:

A panel of federal appeals judges aggressively questioned whether Obamacare can survive during Tuesday afternoon oral arguments in a case that could upend the 2010 health care law.

Two Republican appointees on the three-judge panel frequently interrupted attorneys to question whether the Affordable Care Act’s individual mandate is unconstitutional and if not whether the entire law could stand without it. The ACA’s future appeared murky after two hours of oral arguments at the 5th Circuit Court of Appeals, but it’s not clear if the judges were ready to uphold a federal judge’s earlier decision invalidating the law…

…Appellate Judge Jennifer Elrod, a George W. Bush appointee, on Tuesday posited that lawmakers – who failed to agree on an Obamacare replacement plan two years ago – deliberately eliminated the mandate penalty because they knew the rest of the law would have to fall. She said perhaps lawmakers thought, “Aha, this is the silver bullet that’s going to undo Obamacare.”

Attorneys for the 20 Democratic-led states that are defending the law, as well as the Democratic-controlled House, countered that Congress clearly intended for the rest of the law to survive when it eliminated the mandate penalty.

“All the court has to do is lookout the text,” said Samuel Siegel, the attorney representing the Democratic-led states.

The three-judge appellate panel is expected to rule in the coming months. They could back the lower court ruling invalidating all of Obamacare or overturn it entirely. The judges may also determine that the elimination of the individual mandate penalty only renders certain parts of the ACA unconstitutional, such as its protections for individuals with preexisting medical conditions. That was the Trump administration’s original stance on the lawsuit before recently embracing the lower court ruling against the entire ACA…

June 9, 2019: California Governor Gavin Newsom tweeted: “The Trump administration is going to court today to try and overturn the ENTIRE Affordable Care Act. – 133 MILLION with pre-existing conditions could lose coverage. – 23 MILLION could lose their health insurance – 12 MILLION could lose Medicaid coverage” The tweet included a link to The New York Times from March of 2019.

June 9, 2019: Former Vice-President Joe Biden tweeted: “Today, the Affordable Care Act is back in the courts – putting the health care of millions of Americans at risk. It’s clear some will stop at nothing to sabotage Obamacare and roll back the progress we’ve made.” The tweet included a link to The New York Times.

July 9, 2019: The New York Times posted an article titled: “Appeals Court Seems Skeptical About Constitutionality of Obamacare Mandate”. It was written by Abby Goodnough. From the article:

…In 90 minutes of oral arguments on whether a federal district judge in Texas was correct in striking down the Affordable Care Act in December, two appellate judges appointed by Republican presidents peppered lawyers with blunt questions while the third judge, appointed by President Jimmy Carter, remained silent.

The two Republican appointees, Jennifer Walker Elrod, appointed by President George W. Bush in 2007, and Kurt Engelhardt, appointed by President Trump in 2018, seemed particularly skeptical of the Democratic defendants’ argument that Congress had fully intended to keep the rest of the law when it eliminated the penalty for going without insurance as part of its 2017 tax overhaul…

…The case, which could make its way to the Supreme Court ahead of those elections, threatens insurance protections for people with pre-existing medical conditions and many other sweeping changes the 2010 law has made throughout the health care system…

…The arguments did reveal some tensions between the Republican states that brought the case, led by Texas, and Mr. Trump’s Justice Department. For example, a lawyer for Texas took issue with a puzzling new Justice Department position – revealed in a May brief – that the ruling should apply to only the 18 plaintiff states, not nationwide. The Republican states would need to evaluate if they had “been the victims of a bait and switch,” said the Texas lawyer, Kyle D. Hawkins.

In another wrinkle, August E. Flentje, a lawyer for the Justice Department, appeared reluctant to answer questions from Judge Elrod about how applying the ruling only to the plaintiff states would work. He was also vague about another new and surprising position the administration mentioned almost in passing in its May brief: that some pieces of the health law, though not its insurance provisions, should be preserved….

…Over all, though, the panel spent the most time on the question of whether the rest of the law should fail if Judge O’Connor was correct in scrapping the insurance mandate – and Judge Elrod and Judge Engelhardt, based on their questioning, seemed to firmly believe he was. Judge Engelhardt asked Mr. Letter, the House lawyer, why Congress could not remedy the situation by writing a new health law or set of laws.

“The could do this tomorrow, ” Judge Engelhardt said, leading Mr. Letter to dryly point out that Mr. Trump would need to sign off on new laws, too.

“And obviously the president would sign this, right?” he asked sardonically. “No, obviously not.”..

…Judge Engelhardt twice asked Mr. Letter why, if Congress fully intended to keep the rest of the health law when it eliminated the penalty for going without insurance in 2017, the Senate, which is controlled by Republicans, had not also sent a lawyer to make that case.

“Why would the Senate not be here to say, ‘Oh, this is what we meant when we wrote this?” he asked. “They’re sort of the 800-pound gorilla that’s not in the room.”..

…The appeals panel also spent a good chunk of the allotted 90 minutes asking questions on a third topic: whether the Democratic states and House of Representatives even have standing to appeal Judge O’Connor’s ruling…

…If the appeals court ultimately decides that neither the House nor the intervening Democratic states have standing, it could either let Judge O’Connor’s ruling stand or vacate it. In any event, the losing party will almost certainly appeal to the Supreme Court…

July 9, 2019: Julián Castro tweeted: “The Trump administration is actively working to undermine our health care system and jeopardize the coverage of 130 million Americans with pre-existing conditions. We must #ProtectOurCare and work to expand, not restrict, access to quality health care.” The tweet included a link to The New York Times article above.

July 9, 2019: Beto O’Rourke tweeted: “We will defend the ACA. We will protect the care of those whose lives depend on it. And we will fight for universal, guaranteed, high-quality health care so every person can see a doctor, afford their prescriptions, and to live to their full potential.” The tweet included a link to The New York Times article above.

July 9, 2019: Governor Jay Inslee tweeted: “800,000 people who have healthcare coverage in WA state are at risk if the Affordable Care Act is struck down. The #ACA has saved lives, strengthened consumer and patient protections for everyone, and is keeping costs from growing unabated. #ProtectOurCare”. The tweet included a link to The New York Times article above.

July 9, 2019: Pete Buttigieg tweeted: “Republicans are putting health care for over 20 million Americans in jeopardy with their latest attack on the Affordable Care Act. Instead of restricting access, we should be expanding health care with Medicare for All Who Want It.” The tweet includes a link to an NPR article.

July 9, 2019: Elizabeth Warren tweeted: “The Trump administration is in court today in their never-ending crusade to destroy health care for millions of Americans. If they succeed, families like Chantel’s would go bankrupt. People would die. #ProtectOurCare.” The tweet includes a video featuring Chantel and her family.

July 9, 2019: Nancy Pelosi tweeted: “Under the ACA, the 130 million Americans w/ pre-existing conditions cannot be discriminated against y their insurer. Their health care costs could skyrocket if the GOP’s Texas v. US lawsuit succeeds in throwing out years of progress on health care. #ProtectOurCare”.

July 9, 2019: Speaker of the House Nancy Pelosi posted remarks on the official Speaker of the House website titled: “Pelosi Remarks at Press Conference on Day of Oral Arguments in GOP’s Texas v. U.S. Lawsuit to Destroy Health Care”. From the remarks:

…Today, the Trump Administration is demanding that the court strike down every last provision of the ACA. Protecting protections for the over 130 million Americans with pre-existing conditions and their families, bans on lifetime and annual limits, as the Leader mentioned, that can have a very devastating impact financially, as well as health-wise, for a family. The Medicaid expansion in the ACA, very important to people born with a pre-existing condition, babies born with a pre-existing condition and families otherwise, savings for seniors on prescription drug cost, the premium assistance that makes health coverage affordable for millions of American families.

As you all know, the Affordable Care Act extended benefits to 20 million people who did not have health care before and that was very important – a major achievement in itself, but that was not the full extent of the bill.

130 million Americans have pre-existing conditions and they are affected by this law case. And, what’s interesting about it is during the campaign, across the country, Republicans were saying, “We’re for preserving the pre-existing medical conditions [protections]” and yet they vote over and over again to prevent it and now they’re taking it to court.

And, the reason they think they have a chance in court is because of what they did on the horrible GOP Tax Scam bill, where they undermined the Affordable Care Act there. Every chance they get, they try to undermine the health and financial security of America’s working families.

The ACA is a pillar of health and economic security, standing alongside Medicare, Medicaid, and Social Security. But the GOP is showing that they want to destroy the Affordable Care Act for America’s families…

…But more than 190 Republicans that day voted to be fully complicit in the Administration’s attempt to tear away health care protections. Families across the nation have called on Congress to ‘Protect Our Care’ and House Democrats are fighting for them…

…Democrats will continue to fight For The People to lower health care costs and the cost of prescription drugs and to protect people with pre-existing conditions…

July 9, 2019: Representative Jerry Nadler tweeted: “Today the Trump Admin is arguing to strike down the entire ACA, turning their back on millions with preexisting conditions. @HouseJudiciary is committed to fighting this GOP assault, and will hold a hearing on the DOJ’s refusal to defend the ACA this month #ProtectOurCare”. The tweet included a link to an NPR tweet.

July 9, 2019: Covered California posted a news release titled: “California’s Initiatives Will Lead to Hundreds of Thousands Gaining Health Care Coverage With Lower Premiums and New Financial Help”. From the news release:

  • California’s individual market will see a preliminary rate change of 0.8 percent in 2020, which is the lowest change since Covered California’s launch, due to new state affordability initiatives designed to lower costs and encourage enrollment.
  • An estimate 922,000 people – including many middle-income Californians – will be eligible from a first-in-the-nation expansion of financial help that builds on the Affordable Care Act and lowers the costs of their health care coverage.
  • Covered California projects that lowering health care costs and reinstating the penalty on individuals who can afford coverage, yet choose to go without insurance, will result in 229,000 people becoming newly covered.
  • All 11 health insurance companies return to the market in 2020, and a major national plan, Anthem Blue Cross, with expand – giving nearly all Californians a choice of two carriers, and 87 percent able to choose from three carriers or more.
  • A Covered California analysis projects that an estimated 922,000 will be eligible for the new state subsidy program that will help lower the cost of their coverage in 2020. The consumers who are projected to benefit from the new state subsidies are:
  • An estimated 235,000 middle-income Californians who previously did not qualify for financial help because they exceeded federal income requirements. They will be eligible to receive an average of $172 per household per month, which will help them save an average of 23 percent off their current premiums. Many of these consumers, particularly those who live in high-cost regions, will see significant savings and annual reductions in their health care premiums in the hundreds or even thousands of dollars.
  • An estimated 663,000 Covered California enrollees who currently receive federal financial help. They will be eligible to receive an average of an additional $15 per household per month which will help them save an average of 5 percent on their current premiums.
  • An estimated 23,000 Covered California enrollees whose annual household income falls below 138 percent of the federal poverty level (FPL), which is less than $17,237 for an individual and $35,535 for a family of four. They will see their premiums for the benchmark plan lowered to $1 per member, per month.

July 9, 2019: Los Angeles Times posted an article titled: “With Obamacare in peril, California reins in rising health insurance premiums”. It was written by Barbara Feder Ostrov and Ana B. Ibarra. From the article:

Premiums on California’s health insurance exchange will rise by an average of 0.8% next year, the lowest increase in the agency’s history, state officials announced Tuesday.

Covered California Executive Director Peter Lee credited two new statewide initiatives for keeping the proposed rate hikes low: Next year, California will be the first state in the country to offer state-funded tax credits to middle-class enrollees, which will be paid for in part by a new tax penalty on Californians who don’t have health insurance…

…Covered California estimates that the state-based tax credits, in conjunction with the new state tax penalty, will result in 229,000 newly insured Californians.

The average rate hike for 2020 is far lower than this year’s average increase of nearly 9% and the five-year average increase of 8.4%. Covered California began offering health plans in 2014 to individuals and families who purchase their own insurance as part of the state’s implementation of the Affordable Care Act, a.k.a. Obamacare…

…The new individual mandate for Californians starts in 2020. The penalty for not having insurance will mirror the one under the Affordable Care Act, which as $695 per adult (and $347.50 per child under 18) or 2.5% of annual household income, whichever is greater. That can amount to thousands of dollars a year.

The revenue from the penalty, plus other state funds, will help pay for state-based tax credits for roughly 922,000 people who purchase insurance through Covered California. As part of the 2019-20 state budget signed by Gov. Gavin Newsom last month, the state will pledge $1.45 billion over the next three years for this effort.

Under the deal, California will become the first state to offer financial aid to middle-income enrollees who make between 400% and 600% of the federal poverty level – many of whom have been struggling to pay their premiums. That’s between about $50,000 and $75,000 a year for an individual and between about $103,000 and $154,500 for a family of four.

Under the Affordable Care Act, people who purchase plans through Covered California and other health insurance exchanges are eligible for federal tax credits only if they make between 138% and 400% of the federal poverty level. People who earn more than 400% of the federal poverty level get no federal aid…

July 9, 2019: Concord Monitor posted an article titled: “Sununu to sign Democrat-backed safeguards to Obamacare provisions”. It was written by Ethan DeWitt. From the article:

Gov. Chris Sununu is poised to sign a Democratic bill that would protect certain portions of the Affordable Care Act by codifying them into state law, his office said.

On Tuesday, Democratic legislative leaders in Concord sent a bill to Sununu that would add a range of provisions into state statute, including a requirement that health insurance plans cover those with pre-existing conditions.

The move comes as a New Orleans federal court takes up oral arguments over the constitutionality of the Affordable Care Act – a high stakes case that threatens funding as well as regulations within the law…

…Senate Bill 4 would add to state law a mandate that insurance plans also cover a range of “essential health benefits” such as coverage for emergency services, maternity care, and rehabilitative services. And it would prevent the re-emergence of lifetime caps on age or expenses for those on certain insurance plans.

Those protections were introduced into federal law by the ACA in 2010 – also known as “Obamacare” – which has faced opposition and legal challenges by several Republican attorneys general and supported by the U.S. Department of Justice…

…For Sununu, support for the bill puts him odds with some in his party. While SB 4 passed the Senate nearly unanimously, it left the House on party lines, after House Republicans argued it would tie the state’s hands in the event the ACA did fall and big decisions needed to be made…

July 9, 2019: The Catholic Health Association of the United States (CHA) posted a news release titled: “CHA Strongly Urges Upholding The ACA In Texas v. United States”. From the news release:

CHA Strongly Urges Upholding the ACA in Texas v. United States

Statement by Sr. Mary Haddad, RSM, President and Chief Executive Officer, Catholic Health Association of the United States

As the U.S. Court of Appeals for the Fifth Circuit considers the constitutionality of the Affordable Care Act (ACA), the Catholic Health Association of the United States (CHA) stands firmly with those defending the law. CHA joined with four hospital organizations earlier this year in filing a brief as amici curiae in support of the Intervenor-Defendants-Appellants in Texas v. United States.

“We believe health care is a basic human right and the effort to eliminate access to affordable health care coverage for millions of Americans is unconscionable,” stated Sr. Mary Haddad. The consequence of being uninsured are significant. Since uninsured patients are often forced to delay receiving necessary care, they are up to four times more likely than insured patients to require affordable hospitalization and emergency care. In addition to being harmful to patients’ health, the lack of coverage adds unnecessary expense to our nation’s health care system and deprives patients with an equitable opportunity for a healthy, productive life.

Under the ACA, we as a nation have taken significant steps toward expanding health care access and coverage, as well as improving our nation’s health care delivery system. Nearly 20 million Americans have gained affordable insurance coverage, including 12 million low-income individuals who have gained coverage through state Medicaid program expansions under the ACA. The law also provides protections for 130 million people with pre-existing health conditions – including 17 million children – all of whom no longer need to worry that they will be denied insurance coverage.

CHA believes that a decision by the Fifth Circuit to strike down the ACA as unconstitutional, if upheld, would reverse the progress we have made, adversely impacting the health of millions of Americans. We believe, as a matter of human dignity, everyone is entitled to health care. Like any basic element of life, health care sustains us and should always be accessible and affordable for everyone – where they need it, when they need it, no exceptions and no interruptions. CHA will continue to work with policy makers to advance the goal of ensuring everyone has access to affordable health coverage and high-quality health care.

July 9, 2019: Daily Memphian posted an article titled: “Pastors urge Lee to request Tennessee drop from Affordable Care Act lawsuit”. It was written by Sam Stockard. From the article:

With arguments set Tuesday in a lawsuit to dismantle the Affordable Care Act, a network of pastors is urging Gov. Bill Lee to request Tennessee drop out of the federal case.

The Southern Christian Coalition made a public appeal for the governor to call on Attorney General Herbert Slatery to remove the state from Texas v. United States. The case is to be argued in the U.S. Fifth Circuit Court of Appeals in New Orleans, and its next stop would be the U.S. Supreme Court.

“I appeal to Gov Lee, as a man of faith and a man of Christian values, to then live up to his values, to care for the least of these, to be compassionate… and to ask Slatery to remove the state of Tennessee from this lawsuit,” said Kelli X, minister of Village Church in Madison.

She argued dismantling the Affordable Care Act would take health care coverage from more than a million Tennesseans, decreasing the number of people able to seek mental health care, possibly causing them to wind up in prison and limiting access to health care for babies born with health problems such as asthma…

…The group points out no plan is in place to provide health care for Tennesseans with preexisting conditions if the law is overturned…

July 9, 2019: Roll Call posted an article titled: “States grapple with Medicaid work requirements”. It was written by Sandhya Raman. From the article:

State action to implement work requirements into their Medicaid programs is heating up, as some states roll out their programs while others are fighting in court to keep them alive.

New Hampshire announced Monday it would delay suspending any Medicaid coverage until September because of consumers’ noncompliance with the work requirements. Meanwhile, Indiana on July 1 began the first steps of implementing its work requirements. Court action in three other states is expected in the coming months,

The path to implementing requirements for work or other forms of community service through Medicaid, the health program that covers some of the nation’s poorest individuals, has been tricky and controversial.

MaryBeth Musumeci, associate director at the program on Medicaid and the uninsured at the nonpartisan Kaiser Family Foundation, said the overarching issue is whether requiring work is a permissible objective of Medicaid coverage…

…A June study published in the New England Journal of Medicine found that work requirements are not increasing employment and private insurance coverage…

…Arkansas was the first state to incorporate 80 hour per month work requirements in 2018 for some enrollees, but these are no longer in effect due to a circuit court ruling this year.

New Hampshire became the second state to start phasing in slightly stricter requirements but recently changes them. Starting in June, individuals were supposed to work 100 hours per month, and enrollees would have had until July 7 to report their June hours or risk suspension later this year. Pregnant women and people who are medically frail or have a disability were exempted.

But in late June, New Hampshire’s Democratic-controlled legislature passed a compromise scaling back the work requirements and expanding the exemptions. The legislation allowed the New Hampshire Department of Health and Human Services to delay implementation…

…Indiana rolled out its 20 hours per month requirements on July 1, with stricter requirements being phased in over time. Unlike in Arkansas, compliance is evaluated yearly rather than monthly.

Last year, Arkansas terminated consumers’ coverage after three months of noncompliance, resulting in almost 17,000 individuals being dropped from the program…

…Wisconsin and Michigan are the next states slated to roll out work requirements in late October and January, respectively. Both states also have New Democratic governors.

Maine, which also has a New Democratic governor this year, will not implement its work requirements, but it may not be as simple for Wisconsin and Michigan to reverse course…

…The next legal action expected is for New Hampshire’s program, which will be heard in the U.S. District Court for the District of Columbia.

U.S. District Judge James Boasberg, an Obama appointee who previously ruled that both Arkansas and Kentucky’s programs were invalid, is scheduled for the case…

…Both the Kentucky and Arkansas cases are set to be heard by the U.S. Court of Appeals for the District of Columbia Circuit. The states’ briefings end Aug. 1, and oral arguments are expected by October…

July 9, 2019: Des Moines Register posted an article titled: “ACLU says judge should block Iowa law that could limit Medicaid coverage for transition-related care”. It was written by Anna Spoerre. From the article:

A judge is expected to rule within the next week on a bid to temporarily block an Iowa law that denies mandatory Medicaid coverage to transgender Iowans for transition-related care.

Polk County District Judge David Porter heard arguments Tuesday from the American Civil Liberties Union of Iowa that the law is both discriminatory against and betrays an animus toward transgender individuals…

…The ACLU of Iowa in May sued to block legislation passed in April that allows government entities to opt out of using public insurance money, including Medicaid, to pay for transition-related surgeries. It was filed on behalf of two transgender Iowans – Mika Covington of Central Iowa and Aiden Vasquez of southeast Iowa – and the LGBTQ advocacy group One Iowa.

Added to the health budget bill, the provision allows any state or local government unit or tax-supported district to decline to use public funds for “sex reassignment surgery” or “any other cosmetic reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder or body dysmorphic disorder.”

The law was passed after the Iowa Supreme Court in March ruled that a different ban on using Medicaid funds for transition-related care violated the Iowa Civil Rights Act. The new legislation, in turn, amended the Civil Rights Act.

The lawsuit in question now says the new Medicaid provision runs afoul of the Iowa Constitution. The state Supreme Court did not address that question in its March ruling…

July 9, 2019: Deseret News posted an article titled: “Utah leaders react to the uncertain fate of the Affordable Care Act”. It was written by Kim Bojouquez. From the article:

Utahs are watching closely as the future of the Affordable Care Act is considered by three judges on the other side of the country.

A three-judge panel, two Republican-appointed and one Democrat-appointed, from the U.S. Court of Appeals for the 5th Circuit in New Orleans, heard oral arguments on the constitutionality of the Affordable Care Act, also known as Obamacare, on Tuesday.

In February 2018, Utah Attorney General Sean Reyes joined a 20-state coalition lawsuit against the federal government challenging the lawfulness of the health care law and calling it unconstitutional, after Congress repealed a provision that people without health insurance had to pay a fine…

…Lauren Simpson, policy director for Alliance for a Better Utah, a government advocacy and watchdog organization, said it’s too soon to tell where the judges will lean.

“This is something that’s going to have really serious consequences for Utah. It directly contradicts what we know Utahs want,” Simpson said.

Last November, Utahns voted in support of Proposition 3 to expand Medicaid coverage in the state. But in February, Gov. Gary Herbert signed a replacement to limit Medicaid expansion…

July 10, 2019: Des Moines Iowa Register posted an article titled: “Iowa agrees to give Medicaid management companies 8.6% raises”. It was written by Tony Leys and Stephen Gruber-Miller. From the article:

Iowa’s controversial use of private insurers to run its Medicaid program just got $386 million more expensive.

That’s how much more state and federal money Iowa officials have agreed to pay through this fiscal year for two national companies to manage the giant health care program.

The 8.6% raises will go to Amerigroup and Iowa Total Care, which Iowa hired to insure about 575,000 poor or disabled Iowans whose health care is covered by Medicaid…

…The Medicaid program is jointly financed by federal and state tax dollars, with rates set in closed-door negotiations between the companies and the Iowa Department of Human Services. The increased costs announced Wednesday include a 6.5% boost in state financing, which translates to $115 million, according to a summary posted by Iowa DHS.

The new terms come a year after DHS officials agreed to give Amerigroup and UnitedHealthcare, then the state’s Medicaid managers, a raise of 8.4% in state and federal money for fiscal year 2019. That year’s raise amounted to $344 million, including $103 million more in state money. As a result, legislators had to come up with more money last spring, in the middle of the budget year…

July 10, 2019: The Salt Lake Tribune posted an article titled: “Utah health care panel objects to state’s partial Medicaid expansion plan”. It was written by Benjamin Wood. From the article:

Most members of Utah’s Medical Care Advisory Committee oppose the state’s plan to partially expand Medicaid through the imposition of service reductions, spending and enrollment caps, and patient work requirements.

Ten of the advisory committee’s 19 members – who are appointed by Utah health care entities – signed on to a June 30 letter addressed to the state Department of Health asking local and national administrators to reject proposed changes to Utah’s Medicaid program, which “could risk the health and security of many Utah beneficiaries.”…

…The advisory committee’s objections were made as part of the public comment for a waiver that Utah is seeking from the federal government to implement a scaled-back version of Medicaid expansion approved by lawmakers earlier this year. The Legislature’s plan, SB96, replaced Proposition 3, a full Medicaid expansion initiative approved by voters last year that would have extended Medicaid services to tens of thousands of additional low-income Utahns.

In its letter, the advisory committee highlights four areas of concern with Utah’s waiver request: a per-capita funding scheme that could leave the state liable for increased health care costs without matching federal funds; enrollment caps that could exclude otherwise eligible patients from Medicaid if funding runs dry; a requirement that patients prove they are working, looking for work or engaged in other qualifying activities to participate in Medicaid; and the elimination of some Medicaid benefits for 19- and 20-year-old patients…

…Last month, the Utah Health Policy Project released a report suggesting that per-capita funding could cause Utah’s Medicaid program to face a $39 million budget shortfall by 2024. Budget constraints were among the primary motivations cited by lawmakers in repealing and replacing Proposition 3 with the scaled-back expansion of SB96 intended to control costs…

…Utah’s Medicaid program currently is operating under a temporary waiver, often referred to as the “bridge” plan, which includes a limited expansion population and approval for work requirements, but those work requirements have not yet been implemented…

July 11, 2019: Planned Parenthood posted a press release titled: “Ninth Circuit Denies Emergency Relief From Domestic Gag Rule”. From the press release:

An en banc panel of the U.S. Court of Appeals for the 9th Circuit refused to block the Trump-Pence administration from enforcing the dangerous Title X gage rule. Title X is the nation’s program for affordable birth control and reproductive health care, which serves 4 million people each year. Trump’s gag rule makes it illegal for health care providers in the Title X program to refer patients for abortion, and also blocks access to care through the program at Planned Parenthood by imposing cost-prohibitive and unnecessary “physical separation” requirements. Planned Parenthood will continue its effort to restore the nationwide preliminary injunction and fight to protect health care for millions across the country.

Providers that serve nearly half of the patients who get care through Title X have made it clear that the rule would force them out of the program – the administration is putting health care at risk for millions of patients across the country. Title X helps millions of patients struggling to make ends meet – the majority of whom are people of color, Hispanic, or Latino – access birth control, cancer screenings, STI testing, and other essential reproductive health care…

…Four district court judges had previously blocked the rule, with two judges blocking it nationwide. On June 20, 2019, the 9th Circuit granted the request from the Trump-Pence administration to stay the preliminary injunctions in California, Oregon, and Washington, which allowed the gag rule to be enforced. The 9th Circuit agreed to re-hear the administration’s request for a stay on July 3, 2019. Today’s order makes it clear that while the court is rehearing the request for the stay, the stay remains in place, jeopardizing the care of millions of people who access birth control and other reproductive health services through Title X.

In June, the House of Representatives passed a spending package including strong language blocking the Trump-Pence administration’s Title X gag rule from being implemented. Now, the Senate must push for a spending bill that includes protective language to make sure millions of people can continue to access health care through Title X…

July 11, 2019: Rewire News posted an article titled: “Republicans Get Another Win in Their Fight to Gut Title X”. It was written by Jessica Mason Pieklo. From the article:

The Ninth Circuit Court of Appeals on Thursday ruled the Trump administration’s domestic “gag rule” which bans family planning dollars from going to health-care providers who perform abortions or refer patients for abortion services, can take effect everywhere but the state of Maryland.

The ruling jeopardizes comprehensive reproductive health-care for nearly 4 million people…

…The Trump administration’s changes to the Title X program also mandate a new “physical and financial separation” between a Title X-funded program and a facility that engages in “abortion activities.” This separation must include separate waiting, consulting, examination, and treatment rooms, as well as office entrances and exists. Title X grantees would have to provide different phone numbers and email addresses for those staff members and facilities involved in abortion services. These separation requirements apply to all Title-X funded projects that give referrals to patients who wish to obtain an abortion, as well as any that engage in separately funded advocacy or public education activities that “promote” abortion as determined by the Trump administration.

To obtain Title X funding, providers would have to open and operate an entirely independent facility to merely provide a referral for abortion care…

…First proposed in May of 2018, the administration’s changes had been blocked by the courts from taking effect while lawsuits challenging them proceed. Thursday’s order, however, allows those changes to take effect immediately, except for the separation requirements: Title X grantees will have until March 4, 2020, to comply with those requirements…

July 11, 2019: Los Angeles Times posted an article titled: “Trump’s vaunted kidney initiative depends on Obamacare, which he’s trying to kill”. It was written by Michael Hiltzik. From the article:

President Trump was showered with praise Wednesday when he unveiled an initiative to fix the country’s wretched and ridiculously expensive system for dealing with kidney disease.

Only one problem. Trump’s plan depends on the Affordable Care Act, which he is trying to kill…

…He has eviscerated effective programs at the Department of Health and Human Services and replaced professional policy officials with ideology-driven hacks. His appointees at HHS have routinely approved state-level changes to Medicaid, the nation’s most important healthcare program for low-income Americans, that deprive enrollees of coverage by thousands at a time…

…There’s no question that the nation’s existing method of dealing with end-stage kidney disease is a mess. The most common treatment, dialysis, is so expensive – running an average of $90,000 per year per patient – that Congress in 1973 allowed advanced renal patients to enroll in Medicare at any age. The act effectively made end-stage renal disease the only condition subject to a single-payer program.

That helped turn dialysis into a hugely profitable business. About 10,000 patients were covered in 1973; today more than 750,000 are. Federal spending through Medicare has soared to more than $34 billion a year from $1.1 billion (in current dollars) in 1973…

…Two remedies for this situation have long been obvious. One is to increase the rate of kidney transplants, which sharply reduce the cost of treating kidney disease. But kidneys are hard to come by. More than 100,000 patients in the U.S. are on the waiting list, with only about 21,000 donor organs available per year. Kidney transplants cost an average of about $32,000 and annual post-surgical care only about $25,000.

The other remedy is to preform more dialysis at home, where it’s cheaper than at the dialysis centers operated by DaVita, Fresenius, and other companies, and certainly more convenient for patients. But only about 12% of U.S. patients receive dialysis at home, far less than in most other developed countries.

Trump’s proposal, embodied in an executive order signed Wednesday, aims to increase transplants by covering more of the costs for donors, including lost work time and child care expenses. The White House says that, along with other changes in the transplant system, would double the number of kidneys available for transplant by 2030.

The plan aims to increase the share of patients reviving dialysis at home to 80%. This would be done in part by changing the incentives for providers so they steer more patients to home dialysis (assuming that’s the right choice for them).

The rub is that such changes would require congressional authorization – if it wasn’t for the Affordable Care Act. The act established the Centers for Medicare and Medicaid Innovation, which allow the changes to be made administratively…

July 11, 2019: Planned Parenthood posted a press release titled: “New Multi-State Study Shows Telemedicine Abortion Is as Safe and Effective as In-Person Care”. From the press release:

A new study published in Obstetrics & Gynecology shows that medication abortion via telemedicine is just as safe and effective as when the health care provider is in the same health center as the patient. The study was conducted by Planned Parenthood Federation of America – with researchers from Ibis Reproductive Health and University of California San Francisco (UCSF) Advancing New Standers in Reproductive Health (ANSIRH) – and supports existing evidence that outcomes for medication abortion via telemedicine are comparable with medication abortion provided in person.

The study is the nation’s largest multi-state study of medication abortion via telemedicine to date, with researchers analyzing records from nearly 6,000 patients receiving medication abortion either through telemedicine or in person at 26 Planned Parenthood health centers in Alaska, Idaho, Nevada, and Washington…

Medication abortion has been safe and legal in the U.S. since the FDA approved of its use nearly 20 years ago. It helped ensure that patients are able to make their own private medical decisions, and it has expanded access to reproductive health care.

In a health-center-to-health center model of providing abortion via telemedicine, a patient has an ultrasound scan, laboratory testing, and counseling with health center staff. Telemedicine patients then meet with a provider in another health center through a secure videoconferencing platform, while standard medication abortion patients meet with a provider in person. During the study period, researchers compared rates of ongoing pregnancy, the need for a subsequent in-clinic abortion, and any significant adverse effects between the two groups. Researchers concluded that medication abortion provided remotely offers patients the same effective, high-quality care that they would receive if they were in the same room with the same trained providers. The study also found that complications are very rare for medication abortion via telemedicine, which is consistent with findings from previously published research.

Restrictions and political attacks on access to abortion have left entire swaths of the country without access to safe, legal abortion, disproportionately affecting people with low incomes, people of color, and people living in rural communities. Right now, anti-abortion politicians are pushing burdensome and medically unnecessary bans that effectively prohibit access to medication abortion via telemedicine. Leading medical associations, such as the American College of Obstetricians and Gynecologists (ACOG), agree that these bans are not based in evidence…

July 11, 2019: The Tennessean posted an article titled: “Blue Cross plans to return to Obamacare marketplace in Nashville, Memphis”. It was written by Brett Kelman. From the article:

…The state’s largest insurance company, BlueCross BlueShield of Tennessee, plans to reenter the Affordable Care Act marketplace in Nashville, Memphis and surrounding counties next year, providing another option for residents on Obamacare in these cities. Cigna and Oscar Health, are planning to significantly reduce the cost of their coverage plans.

Although the proposals are not final, it appears Tennesseans will have more options and competitive prices in the coming year, said Kevin Walters, a spokesman for the Department of Commerce and Insurance…

Five insurance companies that currently offer Obamacare coverage plan to continue to do so next year, according to the department. The companies have submitted the following proposals to state regulators for approval:..

Those companies are BlueCross BlueShield of Tennessee, Bright Health, Celtic/Ambetter Insurance, Cigna, and Oscar Health.

July 11, 2019: West Dakota FOX posted an article titled: “North Dakota argues Affordable Care Act’s validity”. From the article:

…North Dakota’s Democratic Party says if the Affordable Care Act is overturned, there would no longer be penalties.

“The penalty for those who don’t carry health insurance, they just reduced that penalty to zero, which essentially means there is no longer a tax,” said Kylie Oversen, Chairwoman of the Dem NPL.

House Dem-NPL legislators proposed an amendment to the insurance commissioner’s budget this past session, in case the ACA would be found unconstitutional. It would require health insurance companies in North Dakota to cover people with pre-existing conditions…

…Insurance Commissioner Jon Godfread says the language on the amendment was unworkable…

July 11, 2019: Military Times posted an article titled: “Yearlong birth control supply for female vets could cut costs and unplanned pregnancies”. It was written by Ariana Puzzo. From the article:

The Department of Veterans Affairs could save about $2 million a year in prenatal, birth and newborn care costs by offering female veterans a year’s supply of birth control pills, researchers say.

The VA does not currently offer an upfront 12-month supply option. Approximately 24,000 women receive oral contraceptives and a policy change could prevent an estimated 583 unintended pregnancies, found Colleen Judge-Golden, an MD, Ph.D. student the University of Pittsburg School of Medicine…

Judge-Golden, the lead author of the paper published Monday in the Journal of the American Medical Association, analyzed the expense of the proposed program with senior author Sonya Borrero, M.D., M.S., the associate director of the VA’s Center for Health Equity Research and Promotion. Research found that money saved on health care costs would exceed the cost of providing larger upfront quantities of birth control pills to women.

Forty-three percent of women receiving three-month increments of birth control will encounter at least one refill gap over a 12-month period that increases the risk of unintended pregnancies, VA data showed. Women outside of the VA who receive one year’s worth of birth control pills were alternatively found to experience fewer refill gaps and less pregnancies…

July 11, 2019: Reuters posted an article titled: “U.S. lawmakers advance bill to boost Puerto Rico Medicaid funding”. From the article:

A bill that would substantially boost federal Medicaid funding for Puerto Rico advanced out of a U.S. House subcommittee on Thursday after lawmakers agreed to work on stricter safeguards in the wake of a government corruption scandal in the territory.

The Health Subcommittee sent the legislation, which would give the bankrupt U.S. commonwealth an additional $12 billion over four years, to the full House Committee on Energy and Commerce.

On Wednesday, U.S. law enforcement officials announced a 32-count indictment and arrests of six people, including two former high-ranking Puerto Rico government officials, who were charged with conspiracy and other crimes in connection with millions of dollars in federal Medicaid and education funds…

…Federal funding to the five U.S. territories to support the healthcare program for low-income residents is capped, often leading to shortfalls during economic downturns or natural disasters like the devastating hurricanes that hit Puerto Rico in 2017 just months after it filed a form of bankruptcy in U.S. District Court…

July 11, 2019: NPR posted an article titled: “Young Undocumented Californians Cheer Promise of Health Benefits”. It was written by Sammy Caiola. From the article:

…California’s governor signed a law Tuesday that approved $98 million to expand Medi-Cal to income-eligible undocumented adults from age 19 until they turn 26, making it the first state in the United States to cover this group. California estimates 138,000 young adults will become insured under the new policy.

While the state has expanded options for children and young adults, most undocumented people in California still have limited access to health care. They can sign up for “restricted” MediCal, but it only covers emergencies and pregnancy-related care. Many people on this plan end ip putting off treatment or turning to county clinics for help.

Supporters who want to further expand Medi-Cal to all residents say that move would boost public health and bring down emergency room costs. California Gov. Gavin Newsom has vowed to make everyone eligible…

…But after months of debate at the California State Capitol, proposals to offer Medi-Cal to all undocumented adults, as well as a push to cover undocumented seniors, were deemed too costly…

…President Donald Trump has also criticized California for offering health insurance to undocumented people…

July 11. 2019: The Hill posted an article titled: “Nearly half of voters less likely to support lawmakers who back ObamaCare repeal.” From the article:

Almost half of Americans say they are less likely to support lawmakers who are in favor of repealing Obamacare, according to a new Hill-HarrisX poll.

The survey, released on Thursday, found that 47 percent of registered voters said they were less likely to cast a ballot for members of Congress who backed a lawsuit that aims to eliminate ObamaCare, compared to 28 percent of respondents who were more likely to support those lawmakers.

Twenty-six percent of voters said it doesn’t matter either way.

Older Americans and minorities were least likely to support lawmakers who favored the ObamaCare lawsuit. The poll found that 58 percent of respondents age 65 and older and 68 percent of African Americans were less inclined to back lawmakers who are opposed to ObamaCare…

…The survey of 1,001 voters was conducted online July 5-6. The margin of error is plus or minus 3.2 percentage points.

July 12, 2019: Planned Parenthood posted a press release titled: “Congress Expands Birth Control Access for Service Members”. From the press release:

The House of Representatives approved two amendments to the Fiscal year 2020 National Defense Authorization Act (NDAA) that would expand contraception and reproductive health care access for service members. Most service members receive health insurance coverage through TRICARE, which currently does not offer comprehensive contraception coverage and reproductive health care resources for service members and their families…

…The amendments were offered by Reps. Jackie Speier (CA-14), Veronica Escobar (TX-16), Katie Hill (CA-25), Deb Haaland (NM-01), Ayanna Pressley (MA-07), Judy Chu (CA-27), and Barbara Lee (CA-13). One amendment adopted into the underlying bill clarifies that all FDA-approved contraceptive methods are covered by TRICARE without a copay, and brings TRICARE in line with the ACA’s birth control benefits. The second amendment passed by a vote of 231-199 establishes a standard family planning education program across all branches of the military, increasing services members’ ability to make the best decisions for themselves and their families.

July 12, 2019: Fauquier Times posted an article titled: “Fauquier Free Clinic changes business model to include additional Medicaid patients”. From the article:

This year the Fauquier Free Clinic, which has a mission to provide eligible residents of Fauquier and Rappahannock counties with access to comprehensive medical, dental, and mental health care, underwent “extensive changes” to accommodate new and existing patients when Medicaid expanded its services for low-income adults throughout Virginia, the clinic said in a news release.

“In the past, our medical patients were not eligible for services if they had any type of medical insurance,” John McMahon, FFC board secretary said in the news release, “Now, approximately 60 percent are Medicaid eligible.”

In Fauquier County, between 1,700 and 1,800 more people are now eligible for Medicaid, according to the clinic news release. In Rappahannock County, 300 to 400 people are now eligible. Throughout the state of Virginia, eligibility has been granted to around additional 400,000 people…

July 12, 2019: Planned Parenthood posted a press release titled: “Planned Parenthood’s Clergy Advocacy Board Condemns the Trump-Pence Administration’s Gage Rule”. From the press release:

An en banc panel of the U.S. Court of Appeals for the 9th Circuit refused to block the Trump-Pence administration from enforcing the dangerous Title X gag rule. Title X is the nation’s program for affordable birth control and reproductive health care, which serves 4 million people each year. The Clergy Advocacy Board of Planned Parenthood Federation of America condemns the Trump-Pence Administration’s dangerous Title X gag rule that makes it illegal for doctors, nurses, hospitals, community health centers, and any other provider in the Title X program to tell patients how they can safely and legally access abortion.

The gag rule also makes it impossible for millions of patients to access birth control at Planned Parenthood health centers across the country.

“We, the Clergy Advocacy Board condemn this gag rule. It brings politicians into the exam room, impairing access to accurate and complete medical information, undermining the patient’s moral agency, harming the poor and those in need, and for blocking access to preventative health care, including contraception.

“We are called as clergy and faith leaders to provide pastoral care to people facing medical decisions. Day in and out, we witness the importance of how our congressional members get or don’t get the help they need, the medical information they need, the benefit of the doctor-patient relationship, and access to the care that arises from these personal, private deliberations.

“Our faiths and pastoral experience also bear witness to the urgency and moral good in available access to all forms of contraception, and in keeping abortion safe and legal.”

July 12, 2019: Center for Reproductive Rights posted a press release titled: “Oklahoma Court Goes Rogue, Upholds Abortion Ban”.

Today, the Oklahoma district court became the first court in the country to uphold a ban on the standard method of ending a pregnancy after approximately 14 weeks. Judge Cindy Truong ruled from the bench, denying the Center for Reproductive Rights’ request to strike down the law, which has been enjoined since 2015…

…Every other court that has reviewed similar bans has blocked them from taking effect, including in Alabama, Arkansas, Kansas, Kentucky, and Texas. Just last month, the Supreme Court let stand a lower court’s decision, which found an identical ban in Alabama unconstitutional. Major medical organizations, including the American Congress and Obstetricians and Gynecologists (ACOG) oppose these types of bans, writing, “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.”…

…Only four health centers provide abortion services in the entire state of Oklahoma. In addition to the 72-hour mandatory delay. Oklahoma has passed many other laws restricting abortion access, including: a parental consent requirement for minors; a ban on the use of telemedicine to prescribe pills for medication abortion; and restrictions on when private, public, and state health insurance plans can cover abortion services. These laws disproportionately affect populations that already experience barriers to health care, including people fo color, immigrants, and people with low incomes.

July 13, 2019: Reuters posted an article titled: “Democrats take aim as Trump abandons drug pricing plan”. It was written by Ginger Gibson. From the article:

…Trump talked regularly about drug prices during his 2016 campaign, but has failed so far to deliver the changes he promised.

On Thursday, his administration scrapped one of its most ambitious proposals for lowering prescription medicine prices, backing down from a policy aimed at health insurers and raising the possibility of new measures focused on drugmakers.

The abandoned proposal would have required health insurers to pass billions of dollars in rebates from drugmakers to Medicare patients…

…[Robert] Blendon [a political scientist at Harvard University] said Trump, having failed to broker any deals in Congress, made his drug price plan to complicated, and voters are unlikely to see him as having made any strides. That is an opportunity for Democrats to offer their own effort at messaging…

…On Thursday, U.S. Senators Kirsten Gillibrand unveiled a plan to lower drug prices. On Friday, Democrat Amy Klobuchar announced a plan to help lower the cost of pharmaceuticals purchased by seniors. Warren also has a Medicare pricing plan.

Sanders is heading to Canada later this month for an event to highlight the difference in the price of insulin…

…Klobuchar’s proposal, which includes investing in research for a cure for Alzheimer’s disease and improving the stability of Social Security, would allow the government to negotiate Medicare Part D costs, which cover prescriptions for seniors.

Klobuchar, a U.S. senator from Minnesota, would also let people order prescription drugs from countries like Canada, a proposal proponents say would Lowe drug costs…

July 12, 2019: The Rolla Daily News posted an article titled: “Governor Parson signs “Nathan’s Law,” fixes glitch in Affordable Care Act”. It was written by Ron Reports. From the article:

Governor Mike Parson signed House Bill 397 and Senate Bill 514 on Thursday. Both bills fixed an oversight in the Affordable Care Act related to youth formerly in foster care. One of the most popular provisions of the Affordable Care Act is the ability for children to stay on their parents’ health insurance until they turn 26…

The ACA allows children that aged out of the foster care system at 18 to remain on Medicaid until they are 26 years old. However, the language passed in the ACA only required a state to provide Medicaid to that individual if they aged out of that specific foster system. Currently, if a youth aged out of Illinois’s foster system, but moved to Missouri to work, they are not allowed to maintain their public insurance in Missouri…

…Research has shown that access to health care for youth previously in foster care is important because they are more likely to have health complications. Ensuring these youth remain insured helps the broader community by keeping them out of crisis that could lead to emergency room visits or hospitalizations…

…In the fall of 2018, Congress passed and President Trump signed into law a federal fix to this provision within the ACA, but it will not take effect until Jan. 1, 2023. These former foster youth in Missouri will be able to access Medicaid beginning August 28, 2019, when the bill takes effect, according to the nonprofit Kids Win Missouri, whose mission it is to further child well-being…

July 15, 2019: Former Vice President Joe Biden (who is running for President) revealed information about his Health Care Plan.

Here is some of the key parts of Joe Biden’s Health Care Plan:

Giving Americans a new choice, a public health insurance option like Medicare.

  • If your insurance company isn’t doing right by you, you should have another, better choice. Whether you’re covered through your employer, buying you insurance on your own, or going without coverage altogether, the Biden Plan will give you the choice to purchase a public health insurance option like Medicare. As in Medicare, the Biden public option will reduce costs for patients by negotiating lower prices from hospitals and other health care providers. It also will better coordinate among all of a patient’s doctors to improve the efficacy and quality of their care, and cover primary care without any co-payments. And it will bring relief to small businesses struggling to afford coverage for their employees.

Increasing the value of tax credits to lower premiums and extend coverage to more working Americans.

  • …The Biden Plan will help middle class families by eliminating the 400% income cap on tax credit eligibility and lowering the limit on the cost of coverage from 9.86% of income to 8.5%. This means that no family buying insurance on the individual marketplace, regardless of income, will have to spend more than 8.5% of their income on health insurance. Additionally, the Biden Plan will increase the size of tax credits by calculating them based on the cost of a more generous gold plan, rather than a silver plan. This will give more families the ability to afford more generous coverage, with lower deductibles and out-of-pocket costs….

Expanding coverage to low-income Americans.

  • …The Biden Plan will ensure these individuals get covered by offering premium-free access to the public option for those 4.9 million individuals who would be eligible for Medicaid but for their state’s inaction, and making sure their public option covers 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 the states continue to pay their current share of the cost of covering those individuals. Additional, Biden will ensure people making below 138% of the federal poverty level get covered. He’ll do this by automatically enrolling these individuals when they interact with certain institutions (such as public schools) or other programs for low-income populations (such as SNAP)….

…The Biden Plan has several additional proposals aimed directly at cutting the cost of health care and making the health care system less complex to navigate. The Biden Plan will:

  • Stop “surprise billing”… The Biden Plan will bar health care providers from charging patients out-of-network rates when the patient doesn’t have control over which provider the patient sees (for example, during a hospitalization).
  • Tackle market concentration across our health care system… The Biden Administration will aggressively use its existing antitrust laws to address this problem…
  • Lower costs and improve health outcomes by partnering with the health care workforce. The Biden Administration will partner with health care workers and accelerate the testing and deployment of innovative solutions that improve quality of care and increase wages for low-wage health car workers, like home care workers…
  • Repealing the outrageous exception allowing drug corporations to avoid negotiating with Medicare over drug prices… The Biden Plan will repeal the existing law explicitly barring Medicare from negotiating lower prices with drug corporations.
  • Limiting launch prices for drugs that face no competition and are being abusively priced by manufacturers… For these cases where new speciality drugs without competition are being launched, under the Biden Plan the Secretary of Health and Human Services will establish an independent review board to assess their value. The board will recommend a reasonable price, based the average price in the countries (a process called external reference pricing) or, if the drug is entering the U.S. market first, based on an evaluation by independent board members. This reasonable price will be the rate Medicare and the public option will pay. In addition, the Biden Plan will allow private plans participating in the individual marketplace to access a similar rate.
  • Limiting price increases for all brand, biotech, and abusively priced generic drugs to inflation… The Biden Plan will also impose a tax penalty on drug manufacturers that increase the costs of their brand, biotech, or abusively priced generic over the general inflation rate.
  • Allowing consumer to buy prescription drugs from other countries… The Biden Plan will allow consumers to import prescription drugs from other countries, as long as the U.S. Department of Health and Human Services has certified that those drugs are safe.
  • Terminating pharmaceutical corporations’ tax break for advertisement spending. … As president, Joe Biden will end this tax deduction for all prescription drug ads, as proposed by Senator Jeanne Shaheen.
  • Improving the quality of generics… The Biden Plan supports numerous proposals to accelerate the development of safe generics, such as Senator Patrick Leahy’s proposal too make sure generic manufacturers have access to a sample.
  • Ensure Health Care Is A Right For All, Not A Privilege For Just A Few
  • Expanding access to contraception and protect the constitutional right to an abortion… The Biden Plan supports repealing the Hyde Amendment because health care is a right that should not be dependent on one’s zip code or income. And the public option will cover contraception and a woman’s constitutional right to choose.

In addition, the Biden Plan will:

  • Restore federal funding for Planned Parenthood… As president, Biden will reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers the refer for abortions or provide related information and reverse the Trump administration’s rule preventing Planned Parenthood and certain other family planning programs from obtaining Title X funds.
  • …President Biden will rescind the Mexico City Policy (also referred to as the global gag rule) that President Trump reinstated and expanded…
  • Reducing our unacceptably high maternal mortally rate, which especially impacts people of color…California came up with a strategy that halved the state’s maternal death rate. As president, Biden will take this strategy nationwide…
  • Defending health care protections for all, regardless of gender, gender identity, or sexual orientation… President Biden will defend the rights of all people – regardless of gender, sexual orientation, gender identity – to have access to quality, affordable health care free from discrimination.
  • Doubling America’s investment in community health centers… The Biden Plan will double the federal investment in these centers, expanding access to high quality health care for the populations that need it most…
  • Achieving mental health parity and expanding access to mental health care. As Vice President, Biden was a champion for efforts to implement the federal mental health parity law, improve access to mental health care, and eliminate the stigma around mental health. As President, he will redouble these efforts to ensure enforcement of mental health parity laws and expand funding for mental health services…

July 15, 2019: Planned Parenthood posted a press release titled: “Nearly 80 Reproductive Health, Rights, and Justice Organization Unveil Proactive Blueprint for Sexual and Reproductive Health, Rights, and Justice”. From the press release:

Today, a broad and diverse coalition of nearly 80 organizations released a proactive policy agenda for a fully supportive Congress and Administration to advance sexual and reproductive health in the U.S. and around the world. The Blueprint is significant and unprecedented because it is the first time the wide range of reproductive health, justice, and rights organizations have come together to develop a detailed and intersectional policy agenda.

The Blueprint for Sexual and Reproductive Health, Rights, and Justice is centered on five principles:

Ensure sexual and reproductive health care is accessible to all people.

Ensure discriminatory barriers in health care are eliminated.

Ensure research and innovation advance sexual and reproductive health, rights, and justice now and in the future.

Ensure health, rights, justice and wellness for all communities.

Ensure judges and executive officials advance sexual and reproductive health, rights and justice.

The Blueprint is a vision for the future that includes forward thinking ideas to transform sexual and reproductive health, rights, and justice policy domestically and globally, as well as basic and fundamental measures to correct the backtracking that has taken place in recent years.

Guided by the five key principles, the Blueprint lays out many critical policy goals, including:

Coverage of and access to comprehensive sexual and reproductive health care services and qualified providers at no or low cost and without exception for all people, including immigrants, incarcerated individuals, and young people under the age of 18.

Full access to abortion that is best for an individual and their circumstances and comprehensive insurance coverage for care.

Comprehensive pregnancy and material health care strategies that prioritize the health care needs of pregnant and birthing individuals.

Strong non-discrimination protections for patients, including protections that ensure providers’ religious or personal beliefs do not dictate patient care.

Health care system transformation that prioritizes sexual and reproductive health care, including research and development in the field of reproductive health and scientific integrity and transparency in sexual and reproductive health care.

Foreign policy that prioritizes sexual and reproductive health and rights

Robust response to the global HIV/AIDS crisis.

Economic opportunity, freedom from violence, and healthy and safe environments for all individuals, families, and communities.

Selection and conformation of administrative and judicial nominees who will advance sexual and reproductive health, rights, and justice…

The nearly 80 organizations who have endorsed the Blueprint are:

  • Abortion Care Network
  • Advocates for Youth
  • AIDS Alliance for Women, Infants, Children,
  • Youth & Families
  • All-Options
  • All* Above All
  • American Atheists
  • American Jewish World Service
  • American Medical Student Association
  • American Sexual Health Association
  • AVAC
  • Black Mamas Matter Alliance
  • Black Women for Wellness
  • Black Women’s Health Imperative
  • Catholics for Choice
  • Center for Health and Gender Equity (CHANGE)
  • Center for Reproductive Rights
  • Civil Liberties & Public Policy Program
  • Equity Forward
  • Gender Justice
  • Global Justice Center
  • Guttmacher Institute
  • Harambee Village Doulas
  • Healthy Teen Network
  • Ibis Reproductive Health
  • If/When/How: Lawyering for Reproductive Justice
  • In Our Own Voice: National Black Women’s Reproductive Justice Agenda
  • International Women’s Health Coalition Ipas
  • Jacobs Institute of Women’s Health
  • Jewish Women International
  • Maroon Calabash
  • NARAL Pro-Choice America
  • National Abortion Federation
  • National Asian Pacific American Women’s Forum (NAPAWF)
  • National Black Women’s HIV/AIDS Network 
  • National Center for Lesbian Rights
  • National Council of Jewish Women
  • National Family Planning & Reproductive Health Association
  • National Health Law Program
  • National Institute for Reproductive Health
  • National Latina Institute for Reproductive Health
  • National LGBTQ Task Force
  • National Network of Abortion Funds
  • National Organization for Women
  • National Partnership for Women & Families
  • National Women’s Health Network
  • National Women’s Law Center
  • New Voices for Reproductive Justice
  • Not Without Black Women
  • PAI
  • People For the American Way
  • Physicians for Reproductive Health
  • Planned Parenthood Federation of America
  • Population Connection Action Fund
  • Population Council
  • Population Institute
  • Positive Women’s Network-USA
  • Power to Decide
  • Reproductive Health Access Project
  • Secular Coalition for America
  • Sexuality Information and Education Council of the United States (SIECUS)
  • Sierra Club
  • SisterLove, Inc.
  • SisterReach
  • Social Workers for Reproductive Justice 
  • SPARK Reproductive Justice Now!, Inc. 
  • Surge Reproductive Justice
  • The Afiya Center
  • The American Civil Liberties Union
  • The Center for Sexual Pleasure and Health 
  • UltraViolet
  • URGE: Unite for Reproductive & Gender Equity
  • Wisconsin Alliance for Women’s Health 
  • Women with a Vision
  • Woodhull Freedom Foundation

July 17, 2019: Anchorage Daily News posted an article titled: “ACLU sues Dunleavy for veto to Alaska court system over abortion rulings”. It was written by Tegan Hanlon. From the article:

The American Civil Liberties Union of Alaska is suing Gov. Mike Dunleavy over his decision to cut funding to the state court system because of its rulings on abortion.

The ACLU says Dunleavy is retaliating against the courts and seeking to punish them for the decisions he doesn’t agree with in violation of the Alaska Constitution and the separation of powers doctrine…

…The lawsuit was filed Wednesday in Superior Court in Anchorage against Dunleavy and the state of Alaska. It comes as Alaska’s divided legislature wrestles with the governor’s $444 million in vetoes to the state operating budget.

The ACLU targets one of Dunleavy’s vetos: a $344,700 cut to the court system budget. That amount, Dunleavy has said, is equal to the amount the state spent on “elective abortions” last year.

His veto followed years of attempts by Alaska conservatives to bar the state’s Medicaid program from paying for abortions outside of cases of rape, incest, and when the mother’s life is in danger. Each time, they’ve been blocked by the Alaska Supreme Court. Most recently, in February, the court declared two such laws unconstitutional.

A document from the Dunleavy administration explaining the veto says: “The Legislative and Executive Branch are opposed to State funded elective abortions; the only branch of the government that insists on State funded elective abortions is the Supreme Court. The annual cost of abortions is reflected by this reduction.”

That violates the state constitution, says ACLU’s complaint in the lawsuit…

…The ACLU is asking the court to rule that Dunleavy has violated the state constitution by breaching the separation of powers when he issued his veto and by illegally reallocating funding. It also wants the court to order that Dunleavy and the state must restore the $344,700 in funding to the court system…

July 17, 2019: The American Civil Liberties Union (ACLU) of Alaska posted a press release titled: “ACLU Of Alaska Sues To Reverse Governor Dunleavy’s Retaliatory Veto Of Court System Funding.” From the press release:

Today, the ACLU of Alaska filed suit against Governor Dunleavy to block his administration’s attempt to punish the Alaska Court System by vetoing $334,700 in its 2020 budget because the Alaska Supreme Court ruled in a manner at odd with his political views.

The veto is an impermissible exercise of executive authority that attacks Alaskans’ deep commitment to an independent judiciary, violates Alaska’s constitutional separation of powers, and illegally attempts to reallocate budget appropriations.

“Governor Dunleavy admitted outright that his veto was direct retaliation against the Alaska Court System for a court decision at odds with his political views. That isn’t just petty and vindictive; it is a clear assault on the constitutional power of the judiciary and a grossly inappropriate attempt to use money to coerce judges to a political end,” said ACLU of Alaska Executive Director Joshua A. Decker. He continued, “Alaskans don’t want judges making decisions with one eye on how much money politicians will give them if they rule one way or another. That isn’t how we get justice.”

July 17, 2019: Detroit Free Press posted an article titled: “After huge spikes, Obamacare rates in Michigan now falling”. It was written by JC Reindl. From the article:

Sticker prices for many Affordable Care Act-compliant individual health insurance plans will drop next year, a reversal from the huge price hikes sought in past years by insurance companies.

Insurers’ new proposed rates, which would take effect in 2020 if approved, were announced Wednesday by the Michigan Department of Insurance and Financial Services…

…The Blue Care Network of Michigan, an HMO that insures the most people in Michigan’s individual market at about 157,400 people, is seeking to lower its individual plan rates by an average of 1.7% in 2020. And the market’s second-most popular Insurer, Priority Health, is looking to shave it’s rates by 0.1%.

Blue Cross Blue Shield of Michigan, the third most popular choice with 50,600 people, wants to drop its prices by 7.7%…

…About 5% of Michiganders, or 333,000 people, currently get health insurance through these individual plans, which are sold on the website The lower rates will not directly benefit many of those policyholders because more than 80% of those in Michigan who buy individual plans do not pay full sticker price since they receive the ACA’s tax credit subsidies…

…The poorest individuals in Michigan qualify for Medicaid health insurance…

July 18, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a statement titled: “ACOG Statement on Federal Surprise Billing Legislation”. From the statement:

Ted L. Anderson, MD, PhD, president of the American College of Obstetricians and Gynecologists (ACOG) issued the following statement about federal legislation to address surprise medical bills:

“ACOG believes that patients should be protected from unanticipated medical bills for care provided by an out-of-network physician. This problem can extend beyond patients who receive unexpected care in the emergency setting, also impacting patients who have received expected care, such as childbirth or surgery, from a care team that includes an out-of-network provider. We understand that patients are not always able to choose an in-network provider. For example, in situations where care is provided by an out-of-network provider in an in-network setting, patients should not be punished financially for circumstances beyond their control. After all, women who recently had a child should be able to focus on their growing family and their own health and well-being, rather than the burdensome out-of-pocket costs.

“Surprise billing can interfere with the patient-physician relationship. We believe that in order to protect the patient-physician relationship, patients should be absolved from any payment that disputes that arise between physicians and insurers related to out-of-network care. However, we also must ensure that physicians receive fair compensation for the quality of care they provide, and that patients do not face network inadequacy or limitations in access to care. To that end, we support an independent dispute resolution process, such as the proven model in place in New York State. This model enables a neutral third party to evaluate the many variables associated with each case to reach a fair agreement between physicians and insurers that reflects the complexity of the case, the experience of the physician, and insurers that reflects the complexity of the case, the expertise of the physician, and the reasonable rate charged in that geographic area.

“We thank Members of Congress, particularly the physicians in Congress, for their attention to this complex situation and look forward to the refinement and enactment of legislation that both protects patients and ensures the financial sustainability of physician practices.”

July 18, 2019: CBS News posted an article titled: “House votes overwhelmingly to repeal Obamacare “Cadillac” tax”. From the article:

The Democratic-led House of Representatives has overwhelmingly voted to repeal a tax on high-cost health insurance plans under Obamacare known as the “Cadillac tax”.

The 419-6 vote is a signal of bipartisan unity against a key provision of the Affordable Care Act. The 40% tax on high-cost plans is meant to help subsidize other plans under the Affordable Care Act, but it’s become unpopular even among many Democrats…

…Based on Congressional Budget Office estimates, repeal would add $193 billion to the federal deficit from 2022-2029, by removing revenues off the government’s books. The nonpartisan Kaiser Family Foundation expects that about 1 in 5 employers offering health insurance would have at least one insurance plan subject to the tax in 2022, and the share would grow quickly over time.

Before the passage of the ACA, employers used to benefit from offering the expensive plans because they were not taxed on employee health care benefits, while they are taxed on the salaries they pay their employees. Labor unions, in particular, disliked the tax because they’re known for their generous health benefits, and they have argued that the 40% tax would affect their members…

…The president has pledged to introduce a new GOP health care plan, but that has yet to come to fruition.

July 18, 2019: News Observer posted an article titled: “Senate Republicans unite agains Cooper, say budget is ‘hostage’ to Medicaid expansion”. It was written by Dawn Baumgartner Vaughan. From the article:

North Carolina Senate Republicans didn’t like what Democratic Gov. Roy Cooper said about their leaders Wednesday. They responded in a letter signed by all 29 Republican members the state Senate, saying that Cooper is holding the budget hostage over Medicaid expansion.

Talking to reporters after hosting a Medicaid expansion roundtable on Wednesday, Cooper said it was Republican leadership, not rank-and-file legislators, who are holding up budget negotiations…

…It is almost three weeks into the new fiscal year that started July 1, but there’s still no state budget.

The House presented its budget in April, followed by the Senate in May; then they submitted what’s called the conference budget to the governor in June. Both chambers are led by Republicans. Cooper vetoed the budget on June 28, and negotiations have been at a standstill since then. A potential override vote on the veto has been on the House’s calendar for several days, but House Speaker Tim Moore, a Kings Mountain Republican, has yet to call for the vote. At least seven House Democrats and all Republicans would be needed pass a veto override.

The House override vote is tied to a Medicaid expansion compromise bill called NC Health Care for Working Families that would expand Medicaid but include work requirements and premiums. It made it through committee with bipartisan support. However, the Senate has not proposed any sort of compromise on Medicaid…

July 18, 2019: The Neighbor posted an article titled: “Idaho submits Medicaid waiver request.” It was written by Nathan Brown. From the article:

Idaho has submitted its waiver request to let some people who would be covered by Medicaid expansion stay on private insurance.

The “Section 1332 Coverage Choice Waiver” was submitted Monday and, if approved by the Centers for Medicare and Medicaid Services, would give people making between 100 percent and 138 percent of the poverty level the option of getting federal tax credits to buy insurance on the Your Health Idaho state exchanges instead of going on Medicaid when the expansion kicks in on Jan. 1, 2020. An estimated 18,000 Idahoans who have exchange insurance now will qualify for expanded Medicaid coverage and would, without a waiver, have to give up their current policies for Medicaid.

The state has already taken public comment on the proposed waiver, and also took public comment on a “Section 1115” Medicaid waiver that is related to the proposal to let some people stay on the exchange. However, CMS had some additional questions on that waiver request, said Department of Health and Welfare spokeswoman Niki Forbing-Orr, and it isn’t clear if the state needs to submit two waiver requests or just the 1132 waiver. Forbing-Orr said the state is in talks with CMS to see what is required…

…Reclaim Idaho, the group that spearheaded last years Medicaid expansion push and lobbied against putting any restrictions on it during the 2019 legislative session, has come out against the proposal to insure some people on the exchange, saying it could cost Idaho taxpayers more than straight expansion…

…Idaho’s request to spend some Medicaid money on mental health treatment is similar to a waiver that has been allowed in many other states and is expected to be approved. Work requirements, which are the most controversial of the proposed waivers, have been approved in numerous states and the Trump administration supports the idea. The final fate of the concept could be decided by courts through – opponents have sued to block work requirements elsewhere and in March a federal judge sided with them and blocked them in Kentucky and Arkansas.

July 18, 2019: WABE posted an article titled: “Georgia’s Medicaid Waiver Application Process Reaches Next Step”. It was written by Emil Moffatt. From the article:

An effort to expand Georgia’s Medicaid rolls is moving into its next phase…

…The consulting group Deloitte, which got a nearly $2 million contract to prepare Medicaid waivers for the state, painted a deficient picture of Georgia’s health insurance system.

Its number show 14.8 percent of Georgians are uninsured (compared to a national average of 10.5 percent) and the state ranks third in the nation when it comes to the number of rural hospitals at risk of closing.

The data was compiled using numbers from the Department of Insurance plus community and public health data, something Ryan Like with the governor’s office says is unprecedented…

…And now the at the numbers are in, says Like, the 47-member advisory board group made up of lawmakers, medical professionals, health groups and health insurance companies can weigh in…

…In the end, it will be Gov. Brian Kemp who’ll decide what exactly goes into the waiver applications.

The goal is to bring more federal health care dollars to the state without fully expanding Medicaid under the Affordable Care Act.

July 19, 2019: The Hill posted an article titled: “Federal judge upholds Trump’s expansion of non-ObamaCare plans”. It was written by Jessie Hellmann. From the article:

A federal judge on Friday upheld the Trump administration’s expansion of health insurance plans that don’t meet ObamaCare’s coverage requirements.

U.S. District Judge Richard Leon in Washington ruled against the insurance companies that sued the administration in an attempt to block the rules…

…The plans aim to “minimize the harm and expense” for individuals who might otherwise decide not to purchase insurance because of high premiums, Leon added.

The Trump administration issued a regulation last year allowing short-term health care plans to last up to 12 months instead of three. These plans were originally intended as an option for individuals who need to bridge a gap in health insurance coverage.

But the administration extended the length of time they can be sold to provide customers with more affordable options.

The plans generally cost less because they don’t have to comply with coverage requirements set by the Affordable Care Act (ACA), such as maternity care and prescription drugs.

The short-term plans can also deny coverage to sick people, which ObamaCare insurers are prohibited from doing…

…The Association for Community Affiliated Plans (ACAP) the plaintiff in the case, said in a statement that it would appeal the decision…

…The Trump administration has been looking for ways to dismantle ObamaCare through regulation after Congress failed to repeal it in 2017…

July 19, 2019: Iowa Public Radio posted an article titled: “Judge Dismisses Lawsuit On Medicaid Funding for Transgender-Related Surgeries”. It was written by Natalie Krebs. From the article:

A Polk County judge has dismissed a lawsuit to overturn a law that would allow organizations using public insurance dollars – like Medicaid – to opt out of covering gender-affirming surgery.

The lawsuit was filed by the ACLU on behalf of Mika Covington and Aiden Vasquez, two transgender plaintiffs on Medicaid who are seeking the procedure. It asks for the law to be ruled unconstitutional under the state’s Civil Rights Act.

The legislature passed the provision as part of a health budget bill in April and it was signed into law by Gov. Kim Reynolds in May.

It came just weeks after a state Supreme Court decision struck down a decades-old ban on using Medicaid dollars for transition-related surgery.

Polk County Judge David Porter wrote in his ruling released this week that the injunction sought by the ACLU is not “ripe for judicial consideration” because Covington and Vasquez have not yet exhausted the administrative appeals process through the Department of Human Services, which oversees Medicaid.

At a hearing last week, Assistant Attorney General Thomas Odgen told the judge the language of the law does not actually ban funding…

…But it does allow the government insurance program to refuse to provide the surgery…

July 19, 2019: Forbes posted an article titled: “Don’t Slash Medicare in Last-Minute Budget Agreement”. It was written by Sally Pipes, who covers health policy as President of the Pacific Research Institute. From the article:

…White House officials are feverishly negotiating with congressional leaders to raise the debt ceiling and reach a two-year budget deal that averts more than $126 billion in automatic spending cuts.

Democrats want the deal to dramatically raise domestic spending levels. Republicans want to offset those increases with cuts elsewhere. So on Thursday evening, the president sent House Speaker Nancy Pelosi a list detailing $574 billion of possible spending cuts and reforms. One of those proposed offsets would fundamentally transform Medicare’s “Part D” prescription drug benefit.

I’ve long advocated systemic reforms to Medicare. And the White House is right to call for offsets. But it’d be a mistake to target Part D, a successful, comparatively free-market program that helps nearly 45 million Americans afford their prescriptions. The proposal would hurt vulnerable seniors and stifle medical innovation…

….The program’s success stems from its market-based structure. Private insurers sponsor plans and sell them to seniors. The government subsidizes and regulates these plans, but otherwise, it doesn’t interfere. This forces insurers to compete with each other fir beneficiaries’ business.

This market competition helps keep beneficiaries’ premiums down. The average Part D premium totaled just over $39 a month in 2019, a decrease of 4% from the previous year…

…Medicare Part D is one of the government’s only successful entitlement programs precisely because it relies on private-sector competition. Adjusting the program could lead to higher premiums for beneficiaries and fewer new therapies. Let’s hope the White House and Congress find a smarter way to offset the cost of any budget deal.

July 24, 2019: National Organization for Women (NOW) posted a press release titled: “NOW Applauds Arkansas Decision to Protect Abortion Rights”. From the press release:

Judge Kristine Baker ruled today to temporarily block three anti-abortion laws the would have left Arkansas residents with only one clinic providing abortion care. Currently, Arkansas has two such clinics, and only one of them performs abortions after 10 weeks into a pregnancy. That clinic would not have been able to meet new burdensome requirements under one of the blocked bills.

The National Organization for Women applauds Judge Baker for ruling against these bills and temporarily preventing Arkansas from becoming the seventh state with only one abortion clinic, a dangerous situation that puts the who do not have the resource to travel out of state in danger.

We know that these bills were not passed to protect women’s health – because women are safest when they have access to affordable, accessible abortion care, not when clinics have their hands tied or are forced to close. This ruling stands as a strong refusal to value the ideological extremism of a few over the health, safety, and constitutional rights of Arkansas women.

July 24, 2019: Mother Jones posted an article titled: “A New Study Found that 15,000 People Died Because Their State Didn’t Expand Medicaid”. It was written by Abigail Weinberg. From the article:

Approximately 15,600 people died between 2014 and 2017 as a result of their states refusing to expand Medicaid coverage under the Affordable Care Act, according to a new working paper by the National Bureau of Economic Research.

The ACA promise to expand Medicaid coverage to individuals whose income was at or below 138 percent of the federal poverty level, but a 2012 Supreme Court ruling left it up to states to decide whether to expand coverage. Today, 14 states have not yet adopted Medicaid expansion, and three others have adopted it but not yet implemented it.

The paper studied mortality rates in expansion states and in non-expansion states before and after the increased Medicaid coverage was implemented. It found that, in states that had expanded Medicaid, 4,800 fewer Medicaid-eligible individuals between the ages of 55 and 64 died per year than in non-expansion states…

…Harold Pollack, a health policy expert at the University of Chicago, said that NBER’s finding seemed plausible and that the number of people affected could actually be greater…

…Several Republican governors have refused to expand Medicaid in their stats, even though the federal government finances most of the costs of expansion, likely because the legislation is associated with Barack Obama’s presidency. Still, Medicaid expansion polls well even in red states, and has been favored by voters in states with Republican governors, such as Utah.

July 25, 2019: The Guardian posted an article titled: “Doctor claiming to ‘reverse’ abortion was told to stop using medical school’s name”. It was written by Jessica Glenza. From the article:

A doctor who has said he invented a procedure to “reverse” abortion has for years falsely claimed an affiliation to a prestigious US medical school, the Guardian can reveal.

A medication abortion or “self-managed” abortion, is an FDA approved procedure and is administered through two doses of medicine over 48 hours. Medication abortions now represent nearly one-third of all abortions nationally, according to the Guttmacher Institute. There is no reversal procedure.

But Dr George Delgado, the medical director of Culture of Life Family Services in San Diego, claims to have invented a “reversal”, in which women are given a large dose of progesterone following the first dose of a medicated abortion.

Delgado’s assertions about the “reversal” procedure have been denounced as “unproven and unethical” in a statement from America’s largest association of women’s doctors, the American College of Obstetricians and Gynecologists. His work has been described as an “unmonitored research experiment” in an article in the New England Journal of Medicine.

Despite condemnation from the medical community, Delgado’s claims have been adopted by some Republican state legislators as part of a wider campaign to undermine women’s reproductive rights. North Dakota legislators recently passed a law forcing doctors to tell patients medication abortions are reversible, the fifth state to do so in 2019…

…Delgado had been listing an affiliation with the University of California San Diego (USD), even after the university asked him to stop last year.

Delgado worked in UCSD’s department of family medicine as a voluntary clinical associate professor beginning in 2005, but left in June 2011, according to the school. The school could not describe the scope of Delgado’s duties, but said his position was unpaid, and may have been “as little as teaching a class once a year”, according to the university spokesperson Scott LaFee.”..

July 29, 2019: Senator Kamala Harris released her Medicare For All plan. It is a plan intended to be a transition from what we have now to Medicare for All. This plan would go into effect if she becomes President of the United States. Here are some key points of that plan:

Who will be covered under Medicare for All and what benefits will be offered?

Medicare for All will provide every individual in America with access to comprehensive health care. It will cover all medically necessary services, including emergency room visits, doctor visits, hearing aids, vision, dental, mental health and substance use disorder treatment, and comprehensive health care services. These benefits will be covered – no deductibles, and no copays for high-quality care. The plan will also have strong caps on out-of-pocket costs. It will also empower the Secretary of Health to negotiate for lower drug prescription drug prices. My health plan will give more Americans more options to gain access to the health care they need.

Under my Medicare for All plan, we will also expand the program to include other benefits Americans desperately need that will save money in the long run – for instance, an expanded mental health program including Telehealth and easier access to early diagnosis and treatment, and innovative patient navigator programs to help people identify the right doctor and understand how to navigate the health system. It will provide a serious auditing of prescription drug costs to ensure Americans aren’t paying more for their prescription drugs than other comparable countries; a comprehensive maternal & child health program to dramatically reduce deaths, particularly among women and infants of color; and meaningful rural health care reforms, such as increasing residency slots for rural areas with workforce shortages and expanding loan forgiveness for rural health care professionals, to promote high-quality access to people regardless of their zip code.

Will I be able to keep my doctor under Medicare for All?

Yes. 91% of eligible doctors participate in the Medicare program today. Envision a program where you can walk into a doctor’s office knowing that they are in-network and you can walk out without worrying about your out-of-pocket costs or a surprise medical bill. My plan recognizes that doctors, nurses, and your entire health care team who provide high-quality care will have a voice in their workplace and be paid at appropriate rates under my plan.

How does this plan work and how will we transition to Medicare for All?

Under my Medicare for All plan, we will immediately allow people to buy into a Medicare Transition Plan through an extended 10-year phase-in period.

We will automatically enroll newborns (with an opt-out provision for families with employer-sponsored insurance) and the uninsured into a Medicare Transition Plan, and provide a commonsense path for employers, employees, the underinsured, children, and others on federally-designated programs, such as Medicaid or the Affordable Care Act exchanges, to transition into the Medicare Transition Plan. The Medicare Transition Plan will provide enhanced benefits with limited cost-sharing requirements and financial assistance for those who qualify based on income. During the transition, seniors will be able to keep their Medicare with immediate coverage of additional benefits such as dental, vision and hearing aids.

Second, after the 10-year transition period, we will have a new Medicare framework where most Americans will be in an expanded and improved public Medicare plan. In my Medicare for All system, similar to Medicare Advantage today, private insurance plans can contact through Medicare and compete with the public Medicare plan. However, these private Medicare plans will be subject to stricter consumer protection requirements than under current law, such as getting reimbursed by Medicare for less than the cost of the public Medicare plan to ensure taxpayers aren’t subsidizing insurance company profits. Americans can then choose whether to stay in the public Medicare plan or opt-out into a private Medicare plan.

What about employer-based plans?

During the transition period, employees can continue to provide private health coverage to employees. However, employers will also have the opportunity to provide health care for employees through the Medicare Transition Plan, with a shared responsibility payment. Employees will also have the option on their own to buy into the Medicare Transition Plan during the transition period.

Following the transition period, under my Medicare for All system, employers will have the option to provide a private Medicare plan for their employees that will be certified by the Medicare program, similar to how employers can offer Medicare Advantage today. Employees could choose to be in that employer Medicare plan, a different private Medicare plan, or the public Medicare plan…

How does your plan affect people with disabilities?

People with disabilities will also transition to the Medicare system and have access to comprehensive long-term services and supports, as well as necessary equipment and assistance devices. Under my Medicare for All plan, long-term services and supports will be consumer-directed and provided in home- and community-based settings, unless the individual chooses otherwise…

How does your plan affect Medicaid?

Medicaid will transition to the Medicare for All system, which will ensure that all current Medicaid benefits for low-income individuals will be covered. States will be required to make maintenance effort payments to the Medicare program equal to the amounts they currently spend on Medicaid and CHIP, which will grow with inflation.

Does your plan eliminate all private insurance?

No. Under my Medicare for All system, the power of big insurance companies will be greatly diminished. After the transition period, private insurance will only exist in two ways

1…Under my plan, private health insurers can compete with the new public Medicare plan, as long as the plans they offer adhere to strict requirement like those laid out below. This would function similarly to how Medicare Advantage operates within the Medicare system today….

In my Medicare for All system, Medicare will continue to set the rules of the road for these plans, including price and quality, and private insurance companies will play by those rules, not the other way around. But unlike the current program, these private Medicare plans will be held to stricter consumer protection standards than they are today, such as getting reimbursed less than what the public Medicare plan will cost to operate…

2. People will be able to purchase supplemental insurance covering services not included under Medicare for All, such as medical insurance for traveling abroad and cosmetic surgery. Employers will still be able to offer their employees retiree supplemental coverage through a private insurance plan…

July 30, 2019: Planned Parenthood posted a press release titled: “Breaking: Planned Parenthood takes Missouri to court over one of nation’s most restrictive abortion bans”. From the press release:

Today, Planned Parenthood, along with partners at the ACLU and law firm Paul, Weiss, Rifkind, Wharton & Garrison LLP took the state of Missouri to court to stop an unprecedented number of abortion bans from taking effect in the state. If the bans are allowed to go into effect, abortion would be outlawed at nearly every stage of pregnancy. Missouri is one of 12 states to ban abortion just in the first half of this year. State politicians, emboldened by the Trump-Pence administration, have passed a total of 26 abortion bans nationwide in 2019 alone.

In May, Missouri Gov. Mike Parson signed House Bill 126, one of the nation’s most restrictive abortion laws, despite massive public outcry. The law also imposes a long list of medically unnecessary restriction designed to shame people who choose to end their pregnancy. This isn’t a coincidence – with Kavanaugh on the Supreme Court, anti-abortion politicians are racing to overturn Roe v. Wade…

July 30, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “Planned Parenthood and ACLU Take Missouri To Court Over Abortion Bans”. From the press release:

Planned Parenthood, the ACLU, and the ACLU of Missouri, along with law firm Paul, Weiss, Riftkind, Wharton & Garrison, LLP, took the state of Missouri to court today to stop an unprecedented number of abortion bans from taking effect in the state. If the bans are allowed to go into effect, abortion would be outlawed at nearly every stage of pregnancy…

…”Unless they are blocked by the court, these extreme laws would outright ban the vast majority of abortions in Missouri,” said Andrew Beck, senior staff attorney at the ACLU Reproductive Freedom Project. “The impact would be devastating for Missourian seeking abortion care and would be felt mostly by low-income patients and people of color. Politicians have no business dictating personal medical decisions, and we will not stand for it: the ACLU, along with our partners, is in this fight until these laws are blocked once and for all, and everyone who needs an abortion in Missouri can get one.”

In May, Missouri Gov. Mike Parson signed House Bill 126, one of the nations’ most restrictive abortion laws. The law also imposes a long list of medically unnecessary restrictions designed to shame people who choose to end their pregnancy. Missouri is one of 12 states to ban abortion just in the first half of this year…

…Political attacks and targeted restrictions have left Reproductive Health Services of Planned Parenthood of the St. Louis Region as the last remaining health center that still provides abortion in the state. These restrictions – which blocked the only other health center in Missouri from providing abortions – include requiring doctors to perform invasive and medically unnecessary pelvic exams; a 72-hour mandatory delay for patients accessing abortion, which forces patients to make two trips to the health center; and demanding abortion providers hold local hospital and admitting privileges.

August 1, 2019: WBTV 3 posted an article titled: “Blue Cross NC is seeking approval to lower Obamacare rates for its customers again”. From the article:

People who are Affordable Care Act participants in North Carolina could see a decrease in their insurance bills come January.

Blue Cross and Blue Shield of North Carolina, the only insurance company to provide Affordable Care Act coverage in all 100 N.C. counties, has requested an average ACA rate decrease of 5.2% for individuals.

The ACA rates have to be approved by the N.C. Department of Insurance, which Blue Cross N.C. expects to happen in late August. The insurance company also requested a average rate decrease of 3.3% for small business ACA plans.

Open enrollment in ACA plans, also called Obamacare, begins on Nov. 1 and ends Dec. 15…

…The company isn’t releasing detailed information on regional pricing right now, but will release more information after getting approval from the Department of Insurance…

…The insurance company said the rate decreases were made possible by reducing internal operating expenses, and shifting care to value-based provider reimbursement – paying for the value of services provided to the patients, not the quantity…

…The company said the rate decrease request was also possible because the state legislature didn’t add regulatory burdens on the company.

August 1, 2019: Center for Reproductive Rights posted a press release titled: “Record Support in Congress for Bill to Protect Abortion Access”. From the press release:

The Center for Reproductive Rights applauds the more than 200 Members of Congress who have signed on to cosponsor the Women’s Health Protection Act of 2019, a bill to preserve equal access to abortion everywhere. As of today, the Women’s Health protection Act has 203 cosponsors in the House of Representatives.

The Women’s Health Protection Act was introduced in the House by U.S. Representatives Judy Chu (D-CA), Lois Frankel (D-FL), and Marcia Fudge (D-OH) on May 23, 2019, with 173 original cosponsors. The bill was referred to the House Committee on Energy and Commerce. Senators Richard Blumenthal (D-CT) and Tammy Baldwin (D-WI) introduced an identical bill in the Senate with 42 original cosponsors.

The Women’s Health Protection Act establishes a statutory right for health care providers to provide, and their patients to receive, abortion services free from medically unnecessary restrictions and bans…

..The surge in support comes as state legislatures continue to pass restrictive abortion laws designed to dismantle the constitutional protections recognized by the Supreme Court in Roe v. Wade, and repeatedly upheld by the Court since then. Despite these legal guarantees, 18 states have enacted 46 new laws this year that prohibit or restrict abortion, including nine unconstitutional pre-viability bans on abortion.

The Women’s Heath Protection Act would prohibit bans and medically unnecessary restrictions that single out abortion and impede access to care. These include six-week, eight-week, and 15-week bans, requirements that providers give patients medically inaccurate and false information, and state-mandated medical procedure including unnecessary ultrasounds…

August 3, 2019: Arizona Central posted an article titled: “Florida senator wants to block abortion votes unless legislature is at least half women”. It was written by James Call. From the article:

A Florida state senator wants voters to decide whether a male-dominated state legislature should be allowed to limit a woman’s access to abortion.

State Sen. Lauren Book filed a bill tax calls for a constitutional amendment that would prohibit the Florida House of Representatives and Senate from voting on a bill the would affect access to abortions unless at least half of the members of the chamber are women…

…A supermajority of the Florida legislature in both chambers are men. They make up 70-percent of the House (84 of 120 members). And it’s the same in the Senate where 12 women senators (30-percent) are among the 40-member chamber.

SB 60 would create a constitutional amendment for voters to decide whether to block a legislative vote on proposals that would limit access to an abortion unless 50% of the chamber is female.

Book, a Democrat, said the measure is in response to recent attempts to restrict abortion services with measures like the so-called fetal heartbeat bill approved in six states earlier this year. Those bills prohibit abortion in the first trimester when a heartbeat is detected…

…More than a dozen abortion bills were filed last session by Florida lawmakers – none made it to a floor vote. But state Rep. Mike Hill earlier told the Tallahassee Democrat he intends to file a heartbeat bill again in 2020.

Last session, his proposal failed to gain a committee hearing. It is likely that Book’s bill may face the same fate in the Republican-controlled Senate…

August 4, 2019: Reuters posted an article titled: “Trump administration considers September unveiling of healthcare plan: WSJ”. It was written by Katanga Johnson. From the article:

U.S. President Donald Trump’s administration is considering unveiling, as early as September, his healthcare plan as part of his presidential re-election campaign strategy, the Wall Street Journal reported on Saturday.

The plan would lay out an alternative to former President Barack Obama’s Affordable Care Act, which has been challenged by Republicans in court, and could include coverage for people with pre-existing conditions and a variety of insurance options, the Wall Street Journal said, citing unnamed sources.

Trump has not signed off on the tentative plan, the newspaper said, describing ongoing debate about the plan and the timing for the roll-out. Polling shows that healthcare is a top concern for voters leading up to the election.

The White House did not immediately respond to a request for comment on the timing…

August 5, 2019: Wisconsin State Journal posted an article titled: “Wisconsin Democrats try again for Medicaid expansion”. It was written by David Wahlberg. From the article:

Democratic state lawmakers said Monday they will try again to expand Medicaid as allowed under federal health law, a move the Republican-controlled Legislature has repeatedly opposed.

Sen. Jon Erpenbach, D-West Point, and Rep. Daniel Riemer, D-Milwaukee, said they would introduce a standalone bill to expand Medicaid eligibility to 133% of the federal poverty level and accept additional federal funding under the Affordable Care Act.

Republicans this year cut Medicaid expansion from Democratic Gov. Tony Evers’ budget, and most legislative Republicans have opposed the move since it became possible in a statement,

Under the plan, eligibility for the state-federal health program would increase from 100% of the poverty level to 133%. The federal government would pay at least 90% of the cost, up from its regular 60% share for most people on Medicaid.

Taking Medicaid expansion in 2014 would have saved the state $1.1 billion through 2019, according to the nonpartisan Legislative Fiscal Bureau…

…Assembly Speaker Robin Vox, R-Rochester, has called the proposal a “massive welfare expansion.” His spokesman didn’t immediately respond to a request for comment.

Wisconsin is among 14 states that have not expanded Medicaid as allowed under the ACA, also known as Obamacare.

It is the only one of those states that has no gap in coverage for people with low incomes. Wisconsin’s Medicaid program covers people up to the poverty level, unlike those in the other states, and the subsidized private insurance on the Obamacare exchange is available for people who make more.

August 6, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “Federal Court Blocks Arkansas Abortion Bans and Restrictions”. From the press release:

A federal district court judge in Arkansas has issued a preliminary injunction blocking a set of abortion bans and restrictions from taking effect while a lawsuit challenging the laws proceeds. Last month, the court issued a 14-day temporary restraining order, which was set to expire today.

The laws included a ban on abortion starting at 18 weeks of pregnancy, a ban on abortion based on the patient’s reason for seeking care, and a law prohibiting qualified physicians from providing abortions. The lawsuit was filed by the ACLU, the ACLU of Arkansas, Planned Parenthood Federation of America, and the law firm of O’Melveny & Myers, LLP on behalf of Little Rock Family Planning Services, Planned Parenthood of Great Plains (PPGP), and two physician providers, challenged three laws….

The ACLU has embedded the preliminary injunction from the United States District Court Eastern District of Arkansas Western Division on the ACLU’s website.

…Had the challenged laws been permitted to take effect, people in the state would be left with a single health center which could provide only limited medication abortion care.

August 7, 2019: Vox posted an article titled: “Why this law could be a bigger threat to Roe v. Wade than near-total abortion bans”. It was written by Anna North. From the article:

…But an Arkansas law requiring physician certification could have nearly the same effect without banning the procedure outright – and it might have a better shot at surviving a court challenge.

The law imposes new certification requirements on doctors who provide abortions, which abortion rights advocates say are medically unnecessary. It would also cause Little Rock Family Planning, the only clinic in the state that provides surgical abortions, to shut down. The state’s one other clinic provides only medication abortions, which are only available in the first 10 weeks of pregnancy, leaving the Arkansas law to essentially function like a 10-week ban…

…For now, the law is on hold – one of three Arkansas abortion laws a federal judge temporarily blocked on Tuesday from going into effect. But Arkansas Attorney General Leslie Rutledge has already filled an appeal, and some experts think that laws like the one in Arkansas have a better chance of getting a Supreme Court hearing than more extreme, and unpopular, near-total bans. If Roe v. Wade does fall, the law that topples it may look more like Arkansas’s than Alabama’s.

Passed by the state legislature last session, the law would have required that doctors who provide abortions in the state be board-certified or board-eligible in obstetrics and gynecology. Doctors who are not OB-GYNs – for example, family medical physicians or internal medicine physicians – routinely provide abortions in Arkansas and elsewhere. But under the new law, they wouldn’t be able to…

…The Arkansas law was scheduled to go into effect last month, but Judge Kristine Baker issued an eleventh-hour temporary restraining order blocking the law along with two other restrictions: a ban on all abortions after 18 weeks’ gestation, and a ban on abortions because of fetal Down syndrome diagnosis. Because the order was set to expire Tuesday, she issued a longer-term injunction blocking enforcement of the laws while the ACLU pursues its case…

August 7, 2019: Mother Jones posted an article titled: “Trump’s Anti-Obamacare Insurance Plans Are Ripping People Off”. It was written by Abigail Weinberg. From the article:

The so-called “junk insurance” plans the Trump administration promotes may be helping insurance companies more than patients.

Short-term, limited-duration health insurance plans – Obamacare workarounds that do not have to copy to the Affordable Care Act – spend less than ACA-compliant plans on medical care, according to a data published last week in the National Association of Insurance Commissioner’s 2018 Accident and Health Policy Report, as Modern Healthcare reported.

For every dollar paid in premiums on UnitedHealthcare’s short-term health plans, 37 cents are spend on medical claims. At Cambia Health Solutions, just 9 percent of premium costs go to medical care. The rest of the money goes to administrative expenses or is kept as profit. On average, the report found that among the five health insuraers the earn the most in short-term insurance premiums, 39.2 percent of premiums were going to pay for patients’ medical care…

…ACA-compliant plans are required to spend 80 percent of premiums on medical care. Essentially, Obamacare set a cap on the percentage of profit health insurance companies can make off premiums, forcing them to spend the majority of their funds on actual medical services. If an insurance company ends up charging higher premiums than that 80 percent rate, the insurers have to send out rebates…

August 8, 2019: Roll Call posted an article titled: “Senate GOP plans to divert health, education funds to border wall”. It was written by Paul M. Krawzak. From the article:

Senate Republicans are looking to pay for President Donald Trump’s border wall in part by putting about $5 billion less into the largest domestic spending bill, several people with knowledge of the process said.

That move signals a likely fight over wall funding, as well as over Trump’s ability to reprogram or transfer funds to the border, when the fiscal 2020 appropriations process resumes after Congress returns in September.

According to several people familiar with the process, Senate Appropriations Chairman Richard C. Shelby, an Alabama Republican, wrote an allocation for the fiscal year 2020 Labor-HHS-Education spending bill, that is about $5 billion lower than it would have been to provide funding for the wall…

…Shelby’s provision for wall funding is not surprising. At the very least, it sets the table for a negotiation with the Democrat-led House, which did not include any wall funds in its Homeland Security bill, and sought to tie the administration’s hands in transferring military and other funds to the border project.

In the Senate, it takes 60 votes to end debate to pass appropriations bills. While many Senate Democrats are expected to oppose the $5 billion in wall funds, one former GOP aide said the Labor-HHS-Education bill may be “generous” enough to attract Democrats’ support despite their objections…

…Senate Democrats will also have the chance to argue for changes more to their liking in a conference over House and Senate bills…

August 8, 2019: The Hill posted an article titled: “Graham promises ObamaCare repeal if Trump, Republicans win in 2020”. It was written by Jessie Hellmann. From the article:

Sen. Lindsey Graham (R-S.C.) said this week that Republicans would push to repeal ObamaCare if they win back the House and President Trump is reelected in 2020.

“If we can get the House back and keep our majority in the Senate, and President Trump wins reelection, I can promise you that not only are we going to repeal ObamaCare, we’re going to do it in a smart way where South Carolina will be the biggest winner,” Graham said in an interview with a South Carolina radio station.

“We’ve got to remind people the we’re not for ObamaCare.”

Graham’s repeal bill, introduced in 2017, would eliminate major sections of ObamaCare, including subsidies that help people buy insurance and the Medicaid expansion the covers low-income adults in 36 states and Washington D.C.

The bill would essentially shift money from states like California that expanded Medicaid to states that didn’t, like South Carolina. Such a move could force some states to cut health care services and reduce eligibility…

…Graham on Tuesday touted his bill, which would allow states to opt out of consumer protections, like those that prevent insurers from charging people with pre-existing conditions more for coverage…

August 9, 2019: Pueblo Chieftain posted an article titled: “Health advocacy group backs Affordable Care Act in Pueblo”. It was written but Zach Hillstrom. From the article:

Stage 4 cancer survivor and Denver resident Laura Packard rolled up to the Pueblo office of Republican Sen. Cory Gardner on Friday in a large van resembling an ambulance to deliver a petition asking Gardner to support a resolution protecting the Affordable Care Act.

Packard and Hillary Glasgow, the president of the Southern Colorado Labor Council, made the stop at Gardner’s Office as part of the Health Care Emergency Tour – a 22-city tour highlighting Republican efforts to overturn the ACA hosted by the health care advocacy organization Protect Our Care.

“We’re here going to Sen. Gardner’s office in Pueblo to drop off a petition asking him to sign on to Sen. (Jeanne) Shaheen’s resolution to protect the Affordable Care Act and stop the court case that threatens protection for everyone,” Packard said…

…The resolution sponsored by Shaheen that Packard referenced seeks to sway the Department of Justice to reverse its decision supporting a December ruling of a Texas court, which found the ACA o be unconstitutional…

Packard, who was diagnosed with stage 4 cancer in April 2016, underwent six months of chemotherapy treatment and one month of radiation and was finally declared in remission at the beginning of 2018.

She was insured both before and after the ACA was passed, and said one of the primary reasons she is taking part in the Health Care Emergency Bus Tour is to protect others like her, who have preexisting conditions that could disqualify them from receiving insurance if the ACA is repealed…

August 9, 2019: IndyStar posted an article titled: “Here’s how Pete Buttigeig would improve rural health care”. It was written by Chris Sikich. From the article:

Democratic presidential hopeful Pete Buttigeig released a second major policy proposal this week, delving into how he would reform health care for rural Americans.

The South Bend mayor points to the widening gap between rural and urban life and how each needs different approaches.

Some of the ideas are familiar pitches from stump speeches, such as expanding access to Medicare, while others sound new, including increasing the available of doctors through a variety of means.

Buttigeig released the 10-page proposal in an email to supporters Friday. It calls for significant taxpayer investment in programs like Medicare, Medicaid, the Affordable Care Act, and numerous grants, though it is unclear precisely how much it would cost or how he would pay for it. His campaign did not immediately return a phone call…

August 9, 2019: South Bend Mayor Pete Buttigeig, who is running for president, released a 10-page plan called Securing a Health Future for Rural America. Here are some key points from his plan:

Guarantee an affordable health insurance option through Medicare for All Who Want It:

  • Implement Medicare for All Who Want It. This approach makes a Medicare-type insurance plan available for all people. This plan will make coverage more affordable by creating incentives that encourage corporate insurers to compete with the cheaper Medicare-type plan. It will also give people more choice in health care options, which is critical in rural areas the frequently face a shortage of coverage options. If corporate insurers don’t lower costs to deliver something dramatically better than what is available today, competition will lead us toward Medicare for All.
  • Increase and expand access to federal subsidies for marketplace coverage. Pete will increase subsidies for low-income Americans and expand the subsidies to middle-income Americans. The subsidies from the ACA have made affordable for many low-income Americans, and we know that more generous subsidies would help improve both affordability and coverage.

Dramatically reduce care shortages in rural areas by increasing the number of physicians and other health providers, with an emphasis on primary care, maternal care, mental health, and addition providers.

  • Expand the Public Service Loan Forgiveness Program (PSLF) and the National Health Service Corps. We will expand PSLF program beyond government-, and not-for-profit- based employment to include employment in rural private hospitals and practice groups. We will also restructure the program so that rather than relieving all the debt at the end of a 10-year period, the PSLF will forgive a portion of loan debt annually.
  • Increase Medicare reimbursement rates – and encourage states to increase Medicaid reimbursement rates – for providers working in medically underserved areas. Increasing rural providers’ reimbursement rates will help make it more sustainable for them to treat patients in rural settings and help avoid hospital closures.
  • Expand funding for training models that incentivize medical students and residents to work in rural communities. This includes development and expansion of graduate medical education (GME) and rural residency training track (RTT) programs and supports other initiatives to rebalance GME training funds from urban settings – where 99% of the funding goes – to rural ones. This can include decoupling GME funding from hospitals and instead tying it to Federally Qualified Health Centers (FQHCs) Rural Health Clinics (RHCs) and community-based programs.

Assure universal access to prevention and treatment for mental illness and addiction, and invest in making communities livable, resilient, and healthy.

  • … To address this crisis, we will begin by prioritizing ensuring universal access to effective treatment, such as therapy and medication to treat opioid addiction, and enforcing mental health parity. We will also train communities to address sigma and better support each other through a pillar of our National Service Plan, the Community Health Corps. These policies, and more, will be fully articulated in a forthcoming mental health and addiction policy plan.

Reduce maternal morality rates by expanding access to high quality care and support before, during, and after pregnancy.

  • Ensure coverage for and access to the full range of reproductive health care and family planning services in rural areas, including through increased funding for Title X family planning, and protection of Medicaid expansion and the ACA’s Essential Health Benefits that provide preventive reproductive care for women with no cost sharing.
  • Support the Rural MOMS Act. The Act will improve data collection of maternal mortality and morbidity in rural areas, develop grants to establish regional networks of care, support telehealth initiatives and infrastructure specific to maternal health, and train family medicine physicians, nurse practitioners, doulas, and other professionals to provide maternal care services in rural settings.
  • Support the MOMMA Act, Maternal CARE Act, MOMS Act, and MOMMIES Act. These Acts require training to address implicit bias and racism in hospitals and other health care settings, expand Medicaid coverage for one year postpartum, expand evidence-based programs shown to reduce disparities in pregnancy outcomes, such as the maternal safety bundles developed by the Alliance for Innovation on Maternal Health, and establish pregnancy medical home demonstrations to improve continuity of care.

Make it easier for patients to be treated at or near their home by investing in telehealth.

  • Massively expand coverage of high-speed broadband Internet across the country by the end of the first term. This policy will be fleshed out in a forthcoming policy plan for rural communities and small towns.
  • Help health providers purchase and implement the technology necessary to provide telehealth services by doubling the funding for the Federal Communication Commissions (FCC) Rural Health Care Program to $1 billion annually. This includes support for the FCC’s Connected Care pilot program, which will develop telehealth programs for rural veterans and low-income people.
  • Expand the types of care settings that can receive reimbursement for telehealth services. This expansion will include outpatient rehabilitation centers and other locations outside traditional health care settings.
  • Allow health professionals to get compensated for virtually treating patients at home, including for annual wellness visits, chronic care management, acute visits, and remote patient monitoring.

August 12, 2019: ABC WKBW Buffalo posted an article titled: “Health insurance premiums to drop under Affordable Care Act”. From the article:

Health insurance premiums are set to drop next year under the Affordable Care Act.

The Department of Financial Services (DFS) announced Premium Rates for 2020 on Monday. According to a news release issued by the department, “rates for individuals are more than 55% lower than prior to the establishment of the NY State of Health in 2014, adjusting for inflation but not counting federal financial assistance that the ACA makes available to many consumers purchasing insurance. Approximately 326,000 New Yorkers are currently enrolled in individual commercial plans.”

The DFS, “reduced overall Insurers’ Requested Rate for Individual Coverage from 9.2% to 6.8%, saving consumer over $50million.”…

August 12, 2019: Politico posted an article titled: “Trump to deny green cards to immigrants receiving public benefits”. It was written by Ted Hesson. From the article:

The Trump administration issued a final rule Monday that allows for federal officials to deny green cards to legal immigrants who have received certain public benefits or are deemed likely to do so in the future.

The “public charge” regulation – pushed by White House senior advisor Stephen Miller and other hard-line officials – is the latest part of President Donald Trump’s vast immigration crackdown. While Trump has railed against migrants arriving at the U.S.-Mexico border, the new regulation represents his most ambitious effort yet to restrict legal immigration has he gears up for his 2020 reelection campaign…

…Still, the contentious policy is already triggering legal challenges, with one pro-immigrant group, the Los Angeles-based National Immigration Law Center, announcing this morning that it will file suit…

…A collection of public health associations, educators, and pro-migrant activists have argues the public charge rule will force patients to forgo essential services for their children. Both House and Senate Democrats criticized the measure after a draft version published in October.

The benefits covered under the regulation include food stamps, welfare, Medicaid, and housing assistance. Even before the administration issued a proposed rule last year, agencies across the country reported decreased enrollment in a federal nutrition program aimed and pregnant women and children.

The overall thrust of the regulation, which will be effective October 15, is unchanged from the proposed version, but there are some notable differences outlined by USCIS in a related summary released Monday.

The regulation will not consider enrollment in Children’s Health Insurance Program toward a public charge determination. The draft published this fall asked whether CHIP – which provides low-cost coverage to families that earn too much to qualify for Medicaid – should be included in the list of benefits.

In addition, the use of Medicaid by children, pregnant women, and new mothers during a 60-day period after going birth will not lead to being labeled a public charge. The final also dropped a prescription drug subsidy program, known as Medicare Part D, from a list of restricted benefits.

The final regulation specifically noted that the use of the WIC program, a supplemental food benefit for low to moderate-income pregnant women, infants, and children, would not contribute to a public charge determination.

While the Homeland Security Department acknowledged it was “plausible” the regulation could have a chilling effect driving families away from the nutrition program, the department stopped short of qualifying the phenomenon…

August 12, 2019: The Hill posted an article titled: “Data shows drop in coverage among people ineligible for ObamaCare subsidies”. It was written by Peter Sullivan. From the article:

Health insurance enrollment decline among people who do not qualify for financial help under ObamaCare as premiums rose to make coverage less affordable, new federal data shows.

The data release by the Centers for Medicare and Medicaid Services (CMS) on Monday shows that enrollment declined by 1.2 million people, or 24 percent, between 2017 and 2018 among people with incomes too high to qualify for ObamaCare subsidies.

In contrast, in the same period, enrollment ticked up by 300,000 people among those with lower incomes who did qualify for financial help under ObamaCare.

The data illustrates that while ObamaCare remains stable given the subsidies available to lower-income people, premium increases helped drive away people with higher incomes, experts said…

…Cynthia Cox, another Kaiser Family Foundation expert, pointed out that the individual market for health insurance, including both those who receive and do not receive ObamaCare subsidies, is still larger than it was before the Affordable Care Act (ACA).

“There were about 10.6 million people signed up ON the exchange markets in early 2019,” she wrote on Twitter. “Plus, there are a few more million people signed up OFF-exchange”.

“Pre-ACA, the entire individual market was about 10.5 million people,” she added.

August 12, 2019: The Sacramento Bee posted an article titled: “Charity case spending by California hospitals has plunged in wake of Affordable Care Act”. It was written by Harriet Blair Rowan. From the article:

California hospitals are providing significantly less free and discounted credit to low-income patients since the Affordable Care Act took effect.

As a proportion of their operating expenses, the state’s general acute-care hospitals spent less than half on these patients in 2017 than they did in 2013, according to data the hospitals reported to California’s Office of Statewide Health Planning and Development.

The biggest decline in charity care spending occurred from 2013 to 2015, when it dropped from just over 2 percent to under 1 percent. The spending has continued to decline, though less dramatically, since then.

The decline was true of for-profit hospitals, so-called nonprofit hospitals and those designated as city, county, district or state hospitals.

Health experts attribute the drop in charity care spending largely to the implementation of the federal Affordable Care Act, popularly known as Obamacare. The law expanded insurance coverage to millions of Californians, starting in 2014, and hospitals are now treating far fewer uninsured patients who cannot pay for the care they receive…

…The data on charity care comes from most of the state’s general acute-care hospitals but does not include Kaiser Permanente hospitals, which are not required by the state to report their charity care totals…

…Nonprofit “hospitals get tax-exempt status, but they don’t get it for free,” said Ge Bai, associate professor of accounting and health policy at Johns Hopkins University. Charity care “is part of the implicit contract between hospital and taxpayers.”

Bai sees the reduced spending on charity care as part of a trend of nonprofit hospitals acting more like their for-profit counterparts.

Many nonprofit hospitals “no longer consider charity care their primary mission,” she said. “They are making more and more money but they are dropping their charity care.”…

August 12, 2019: Kaiser Family Foundation posted information titled: “Changes to “Public Charge” Inadmissibility Rule: Implications for Health and Health Coverage”. Here are the key takeaways from the information:

In August 2019, the Trump Administration announced a final rule that changes the public charge policies used to determine whether an individual applying for admission or adjustment of status is inadmissible to the U.S. Under longstanding policy, the federal government can deny an individual entry into the U.S. or adjustment to legal permanent resident (LPR) status (i.e. a green card) if he or she is determined likely to become a public charge.

  • Under the rule, officials will newly consider use of certain previously excluded programs, including non-emergency Medicaid for non-pregnant adults, the Supplemental Nutrition Assistance Program (SNAP) and several housing programs, in public charge determinations.
  • The changes will create new barriers to getting a green card or immigrating to the U.S. and likely lead to decreases in participation in Medicaid and other programs among immigrant families and their primarily U.S.-born children beyond those directly affected by the new policy. Nationwide, over 13.5 million Medicaid and CHIP enrollees, including 7.6 million children, live in a household with at least one noncitizen or are noncitizen themselves and may be at risk for decreased enrollment a result of the rule.
  • Decreased participation in these programs will contribute to more uninsured individuals and negatively affect the health and financial stability of families and the growth and healthy development of their children.

August 12, 2019: Planned Parenthood posted a press release titled: “Planned Parenthood Responds to Trump Administration’s “Public Charge” Rule”. From the press release:

Today, the Trump-Pence administration’s Department of Homeland Security released its final public charge rule, a harmful rule designed to keep families separated and to dissuade immigrants from accessing health care and meeting other basic needs. Under this new rule, people could be denied visas, green cards, and entry into the U.S. simply because they have received any one of a broad range of public benefits they are legally allowed to access, including health care, nutrition assistance, and housing assistance. The rule will likely take effect on or around October 15, 2019.

Statement from Alexis McGill Johnson, Acting President, Planned Parenthood Federation of America:

“This is a racist and cruel attack against immigrants, on the heels of massive raids that have torn apart families, and racist and hateful rhetoric from the president himself. These relentless attacks on immigrants by the Trump-Pence administration have contributed to a culture of fear in immigrant communities, and keep far too many from seeking the health care they need.

No one’s health or safety should be at risk because of their immigration status. If this harmful rule goes into effect, it would have a devastating impact on millions of people including our patients. Planned Parenthood is committed to standing with all immigrants. Living in a safe and healthy environment alongside their family is part of living a healthy, complete life.

This administration is punishing people simply for taking care of their health, for feeding their families, or for putting a roof over their heads. This is inhumane. No person should be punished for meeting their basic needs, or for caring for their families.

August 12, 2019: CBS News posted an article titled: “Tennessee to push for total abortion ban with sights on Supreme Court”. It was written by Kate Smith. From the article:

After struggling to pass a six-week abortion ban earlier this year, Tennessee lawmakers are now considering one of the most restrictive abortion laws in the country: a total ban on the procedure.

On Monday and Tuesday, the state’s judiciary committee will hear testimony from more than 20 witnesses and debate an 11-page amendment to its stalled “fetal heartbeat” bill. If the changes are adopted, the legislation will ban abortion once a woman knows she’s pregnant.

The committee, which has seven Republicans and two Democrats, is expected to accept the changes. The amended bill would be put up for a vote in January 2020, when the legislature reconvenes.

This week’s summer study comes as states have raced to pass legislation restricting abortion, hoping to challenge Roe v. Wade, the 1973 Supreme Court decision that protects access to the procedure. This year six states — Arkansas, Georgia, Kentucky, Louisiana, Mississippi and Ohio — passed so-called “heartbeat” bills, legislation that bans abortion after cardiac activity can be detected in a fetus. Missouri passed an eight-week ban in May, and Alabama went a step further passing an near-total abortion ban.

Tennessee nearly joined those conservative states with House Bill 77, a “fetal heartbeat” bill that doesn’t provide exceptions for victims of rape or incest.

It passed the state’s House in March but stalled in the Senate when conservative leaders questioned the efficacy of the bill, said state Senator Kerry Roberts, who serves on the state’s judiciary committee, in a telephone interview with CBS News…

…Rather than cutting off access to abortion after cardiac activity is detected, the amendment redefines fetal viability. Federal standards, based on past Supreme Court decisions, consider viability to mean when a fetus can survive on its own outside the womb. In Tennessee, policy makers have proposed that viability is when a pregnancy can be detected…

August 13, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a press release titled: “Joint Statement of America’s Frontline Physicians Opposing Public Charge Final Rule”. From the press release:

The Department of Homeland Security issued a final regulation that changes long-standing rules governing how and whether immigrants can be determined to be a “public charge;” widens the scope of programs considered by the government in making such a determination; and serves as a barrier to accessing health care for legal immigrants, as doing so can now serve as a basis for denying individuals green cards or U.S. visas.

In response, the Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Osteopathic Association, American College of Physicians, and American Psychiatric Association, collectively representing more than 597,000 of America’s frontline physicians, issued this statement:

Our organization, which represent more than 597,000 physicians and medical students, are united in expressing our deep concern and opposition to the final public charge regulation issued by the Department of Homeland Security (DHS). The regulation upends decades of settled policy with regard to public charge and makes it much more likely that the lawfully present immigrants may not seek health care, whether preventative services or treatment, when faced with illness, since doing so could be used to deny green cards or U.S. visas, or even lead to deportations.

Rather than face that threat, impacted patients currently served by our members almost certainly will avoid needed care from their trusted physicians, jeopardizing their own health and that of their communities. Many of our members have already witnessed this chilling effect among their own patient populations, with patients avoiding health services and programs out of fear. The public charge final rule not only threatens our patients’ health, but as this deferred care leads to more complex medical and public health challenges, it will also significantly increase costs to the health care system and U.S. taxpayers. Most important, the order puts a governmental barrier between physicians and patients and stands in stark contrast to the mission our organizations share: ensuring meaningful access to health care for patients in need.

We urge DHS to rescind the public charge final rule and work with us to ensure broader access, improved quality, and more affordable care for our patients.

August 13, 2019: WHYY posted an article titled: “Pa. N.J. health experts warn new Trump immigration rule will increase uninsured”. It was written by Nina Feldman. From the article:

The Trump administration is making it more difficult for some immigrants who are in the United States legally and receiving certain public benefits to be granted permanent legal status here.

As it stands, if people are considered likely to become a “public charge” to the state, that will be counted against them in their applications for green cards. The new rule, which was announced Monday and will be published the Federal Register Wednesday, will expand the definition of “public charge” to include those on public benefits such as Medicaid, food stamps, and housing vouchers.

In New Jersey, the Department of Human Services estimated that as many as 200,000 eligible women and children enrolled in Medicaid and CHIP could be affected y the chilling effect of the proposed rule…

…Although the new rule does not include enrollment in CHIP, the Children’s Health Insurance Program, as a cause for public charge designation, researchers and advocates are worried that parents will confuse that insurance program with Medicaid, causing their kids – many of whom are U.S.-born citizens – to lose health insurance…

…The new rule expands the number of factors to be considered in public charge designations. On top of receiving public benefits like Medicaid, Medicare Part D, and subsidized public housing, the adjusted rule also considers a person’s income and part-time student status…

August 13, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “ACLU Of Arkansas Tells Trump Admin: Don’t Roll Back Health Care Rights”. From the press release:

The ACLU of Arkansas urged the United States Department of Health and Human Services not to roll back critical nondiscrimination protections for vulnerable people and communities. In comments submitted yesterday objecting to proposed changes to the Health Care Rights Law, Section 1557 of the Affordable Care Act, the ACLU of Arkansas stressed the devastating health consequences for transgender people, those seeking reproductive health care including abortion, as well as people of color, people who are disabled, those with limited English proficiency, and others.

“No one should be blocked from care for being themselves. But two years after attempting to eliminate protections for pre-existing conditions, the Trump administration is once again putting the health of Arkansans at risk by proposing to roll back critical nondiscrimination protections for our most vulnerable communities,” said Jayme Womack, policy director for the ACLU of Arkansas. “Health care discrimination causes lasting and life-threatening harm to people’s health and well-being, and transgender and non-binary people are especially vulnerable to being denied care.”…

…Since taking office, the Trump administration has attempted to roll back protections for transgender people in education, the military, prisons, and homeless shelters, in addition to health care. It has also supported allowing insurance companies to discriminate and deny care to people with pre-existing conditions like cancer and diabetes.

On October 8, the Supreme Court will hear arguments in a case involving Aimee Stephens, who was fired because she is transgender. While a federal appeals court and the federal agency in charge of workplace discrimination complaints have said that transgender people are protected from discrimination, the Department of Justice reversed positions under the Trump administration. However, in both health care and employment, the Trump administration cannot erase decades of court decisions saying trans people are protected under laws prohibiting sex discrimination…

August 13, 2019: The American Civil Liberties Union (ACLU) posted “ACLU Comment On Proposed Changes To Section 1557 Of The Health Care Law”. It is a letter that the ACLU sent to the U.S. Department of Health and Human Services Office for Civil Rights. From the letter:

…The American Civil Liberties Union (“ACLU”) submits these comments on the proposed rule published … with the title “Nondiscrimination in Health and Health Education Programs or Activities” (the “Proposed Rule” or “Rule”)…

…The Proposed Rule is yet another attempt by the Trump Administration (the “Administration”) and the Department of Health and Human Services (the “Department” or “HHS”) to undermine access to health care for the most vulnerable individuals and communities, while emboldening discriminatory and dangerous denials of care. Instead of combatting discrimination in access to health care and insurance coverage, the Department set out to weaken anti discrimination protections for transgender, non-binary, and gender-nonconforming people, who already face threats of violence and discrimination in all aspects of their lives. Further, case after case has confirmed that transgender people are protected under the antidiscrimination statute, Section 1557, which the Administration cannot change even if this rule is finalized.

The Proposed Rule also rolls back protections for people who face discrimination on other grounds. The Proposed Rule explicitly narrows the scope of Section 1557’s anti discrimination protections and implicit invites health care providers to deny access to care. The Department offers these dangerous amendments, despite its original position that discrimination in health care leads to adverse health outcomes and exacerbates existing health disparities in underserved communities. It thus sanctions and completely disregards these harms to individuals trying to access health care and coverage. The proposed changes are contrary to the statutory language and reverse the reasoned policy decisions of the current regulations implementing the statute. As a result, the Proposed Rule will fail to accomplish its stated goal to decrease confusion instead of increasing the burdens and costs of compliance.

For these reasons, as well as the ones that follow, we recommend that the Department decline to finalize any part of the Proposed Rule…

August 13, 2019: The American Medical Association (AMA) posted a press release titled: “AMA condemns efforts to remove patient nondiscrimination protections.” From the press release:

In formal comments today, the American Medical Association (AMA) spoke out against the Trump administration’s misguided proposal to remove anti-discrimination protections related to sexual orientation, gender identity, and the termination of pregnancy across a wide variety of health care programs and insurance plans.

The AMA noted that the proposal perverts the nondiscrimination provisions included in the Affordable Care Act by drastically limiting coverage protections despite decades of case law recognizing these protections.

The letter said: “This proposal marks the rare occasion in which a federal agency seeks to remove civil rights protections. It legitimizes unequal treatment of patients by not only providers, health care organizations, and insurers, but also by the government itself – and it will harm patients. Such policy should not be permitted by the U.S. government, let alone proposed by it.”

The letter concludes: “HHS should not finalize the proposed rule, but rather should redefine their efforts toward advancing health care access and equality for all. The AMA remains ready to assist with such efforts.”

The full text of the letter can be downloaded here.

August 14, 2019: Planned Parenthood posted a press release titled: “New Filing: Unless Ninth Circuit Intervenes by August 19, Planned Parenthood, Which Serves 40 Percent of the 4 Million Title X Patients, Will be Forced Out of The Title X Program”. From the press release:

Facing an HHS-imposed deadline of Aug. 19, Planned Parenthood today informed the 9th Circuit Court of Appeals that unless it intervenes, Planned Parenthood entities who are Title X grantees will be forced out of the Title X program by August 19 – putting access to affordable birth control at risk for people across the country. Planned Parenthood health center serve 40 percent of the 4 million Title X patients, and have been a part of the Title X program since its inception.

Title X is the nation’s only dedicated program for affordable birth control and reproductive health care. The gag rule makes it illegal for any provider in the Title X program to tell patients how or where to access abortion, and imposes cost-prohibitive and unnecessary “physical separation” restrictions on health centers that provide abortion – moves that are clearly meant to push Planned Parenthood health centers and other reproductive health care providers out of Title X. HHS – which has asked all direct grantees to submit a plan for complying with the unethical gag rule by August 19 – even awarded $1.7 million in Title X funding this year to the Obria Group in California, an anti-abortion group that has made clear they “do not provide contraceptives.”…

…Congress is also looking to take long-term action to protect Title X. In June, the House of Representatives passed a spending package including strong language blocking the Trump-Pence administration’s Title X gag rule from being implemented. Now, the Senate must push for a spending bill that includes protective language to make sure millions of people can continue to access health care through Title X…

…Planned Parenthood is not the only direct grantee who will be forced out under the Trump Administration’s unethical gag rule – in total, the gag rule would force providers that serve nearly half of all Title X patients out of the program. So far, five governors (HI, IL, NY, OR, WA) have made clear that the could not participate in the Title X program if the gag rule was implemented, two state legislatures (MA and MD) have passed laws to that effect, and the only Title X direct grantee that serves the state of Maine has made clear they would not participate in Title X under the gag rule. In total, these eight states and Planned Parenthood health centers collectively serve 47 percent of the Title X patients in the Unites States…

August 14, 2019: The American Civil Liberties Union (ACLU) posted a statement titled: “ACLU Comment On Department of Labor Proposal To License Discrimination In The Name of Religion”. From the statement:

Ian Thompson, senior legislative counsel for the American Civil Liberties Union, issued the following statement in response to a rule proposed today by the Department of Labor:

“Once again, the Trump administration is shamefully working to license taxpayer-funded discrimination in the name of religion. Nearly one-quarter of the employees in the U.S. work for an employer that has a contract with the federal government. We will work to stop this rule that seeks to undermine our civil rights protections and encourages discrimination in the workplace.”

August 16, 2019: California Attorney General Xavier Becerra posted a press release on his official website titled: “Attorney General Becerra Leads Coalition of Five Attorneys General, Files Suit Challenging Trump Administration Public Charge Rule”. From, the press release:

California Attorney General Xavier Becerra today led a multistage coalition in challenging in court the Trump Administration’s Inadmissibility on Public Charge Grounds Final Rule, known as the “Department of Homeland Security (DHS) Public Charge Rule.” The lawsuit, filed in the U.S. District Court for the Northern District of California, claims the Rule targets working immigrants and their families by creating unnecessary new barriers to lawful admission to the United States. The Rule discourages hardworking eligible families from accessing critical health, nutrition, and housing programs that supplement their modest wages and help them make ends meet. The Rule creates such a strict standard that, if it were applied to citizens across the country, a substantial portion would be considered likely to be a ‘public charge’…

…Public benefit programs are designed to help working families make ends meet and ensure strong, healthy families in California. Current guidance by the federal government defines a public charge as a person who is primarily dependent on either public as assistance for income maintenance or institutional long-term care at the government’s expense. The Rule declares that use of additional government programs, including nutrition and food support through CalFresh (California’s Supplemental Nutrition Assistance Program), healthcare through MediCal (California’s Medicaid program), and housing families through Section 8 housing assistance, now constitute grounds for a public charge determination. These changes would discourage many immigrants and mixed immigration-status families, who are not otherwise subject to the rule, from accessing benefits for which they are eligible and entitled. It will also make it harder for hard-working, low and moderate-income immigrants to be admitted into the United States or get green cards.

In the lawsuit, the Attorneys Generals argue that the rule:

  • Violates the Equal Protection Guarantee of the Fifth Amendment: The Rule will disproportionately block admission of non-white, non-European immigrants from Asia, Latin America, and Africa. It will also prevent higher numbers of immigrants of color from extending their visas or becoming lawful permanent residents, and ultimately create more obstacles in the path to U.S. citizenship.
  • Arbitrary and Capricious: The Rule punishes immigrants for participating in widely used public benefits programs that are designed to mitigate economic inequality and bolster self-sufficiency, particularly among low wage workers. The Rule also fails to adequately assess the costs that increasing the poverty of families and U.S. citizen children will have on the Nation, its states, and communities.
  • Contrary to Law: The Rule is contrary to law, interfere with the states’ rights to protect their residents, and exceeds the Administration’s authority under federal immigration law by circumventing congressional intent…

…Joining Attorney General Becerra in filing the lawsuit are the Attorneys General of Maine, Oregon, Pennsylvania, and the District of Columbia. A copy of the complaint is available to view online on the California Office Of Attorney General website.

August 16, 2019: The Hill posted an article titled: “Appeals court again allows Trump family planning rules to go into effect”. It was written by Tal Axelrod. From the article:

A U.S. appeals court Friday again declined to block new rules from the Trump administration that prohibit clinics that receive federal funds from referring patients for abortions.

The 9th U.S. Circuit Court of Appeals rejected a lawsuit from over 20 states, Planned Parenthood and the American Medical Association to suspend the rules while their case against them is litigated, according to The Associated Press.

A three-judge panel and an 11-judge panel had already ruled that the rules can go into effect while the administration appeals district court rulings against them. Oral arguments are slated to commence next month.

Planned Parenthood, the nation’s chief abortion provider, said this week it would leave the federal Title X program Monday unless the administration’s rules are blocked. The group stopped using Title X family planning funds last month after the restrictions were announced but told the Department of Health and Human Services (HHS) it would stay in the program while it sues over the changes.

Planned Parenthood has been a staple in the program for decades, serving about 40 percent of all Title X patients and receiving millions of dollars in federal funds…

August 26, 2019: ABC News posted an article titled: “Judge expected to rule Tuesday on injunction of abortion law”. It was written by Summer Ballentine and Margaret Stafford. From the article:

A federal judge says he will issue a ruling Tuesday that will determine whether Missouri’s new abortion law banning abortions at or after eight weeks of pregnancy will take effect as scheduled this week.

During a court hearing on Monday, Planned Parenthood and the American Civil Liberties Union asked U.S. District Judge Howard Sachs to issue a temporary restraining order to stop the law from taking effect on Wednesday until a legal challenge against it is decided. Sachs told attorneys had a draft of his written ruling ready, but that he wanted to consider Monday’s arguments before issuing it on Tuesday. He did not indicate how he would rule.

The law is scheduled to take effect Wednesday. It would also ban abortions based solely on race, sex, or a diagnosis indicating the potential for Down syndrome.

Claudia Hammerman, an attorney for Planned Parenthood and the American Civil Liberties Union, argued that earlier abortion-related rulings from courts across the country, including the U.S. Supreme Court, make it clear the bans are unconstitutional because they address abortions before the fetus is considered viable outside the womb, which can be from 24 to 28 weeks…

…The Missouri law in question also includes an outright ban on abortions except in cases of medical emergencies, but that would only take effect if the landmark 1973 U.S. Supreme Court’s Roe v Wade ruling that legalized abortion nationwide is overturned…

August 26, 2019: NBC News posted an article titled: “Idaho must provide sex reassignment surgery for trans inmate, court rules”. It was written by Tim Fitzsimons. From the article:

Depriving a transgender inmate with severe gender dysphoria of sex reassignment surgery is a form of “cruel and unusual punishment,” a federal appeals court ruled Friday, affirming a lower court ruling.

The 9th U.S. Circuit Court of Appeals ordered the state of Idaho to provide the surgery for trans inmate Adree Edmo. The ruling is the first time an appeals court has ordered a state to provide gender-affirming surgery to a prisoner, and the decision is at odds with a ruling issued earlier this year by the 5th U.S. Circuit Court of Appeals.

Idaho’s Republican governor, Brad Little, vowed to appeal the decision to the U.S. Supreme Court…

…”Responsible prison authorities were deliberately indifferent to Edmo’s gender dysphoria, in violation of the Eight Amendment,” the 9th Circuit ruling stated, adding it was established that “Edmo had a serious medical need, that the appropriate treatment was GCS [gender confirmation surgery], and that prison authorities had not provided that treatment despite full knowledge of Edmo’s ongoing and extreme suffering and medical needs.”…

August 27, 2019: BBC News posted an article titled: “US judge blocks Missouri eight-week abortion ban”. From the article:

A US federal judge has temporarily blocked Missouri from enforcing a law banning nearly all abortions in the state after eight weeks of pregnancy.

The law was set to take effect on Wednesday.

It would ban abortions after eight weeks except in cases of medical emergency.

US District Judge Howard Sachs said it was not to be enforced, “pending litigation or further order of the court…

…”While federal courts should generally be very cautious before delaying the effect of State laws, the sense of caution may be mitigated when the legislation seems designed, as here, as a protest against Supreme Court decisions,” Mr Sachs wrote in his opinion on Tuesday.

A portion of the legislation prohibiting abortions based solely on race, sex or a diagnosis indicating the potential for Down syndrome was permitted to take effect…

…The law, dubbed Missouri Stands With The Unborn, would outlaw performing an abortion in nearly all cases.

Exemptions would be made for medical emergencies, but not pregnancies caused by rape or incest.

Doctors who performed abortions more than eight weeks into pregnancy would face five to 15 years in prison.

A woman who had an abortion would not be held criminally liable…

August 28, 2019: The American Civil Liberties Union (ACLU) posted a press release titled: “Victory: Appeals Court Upholds Block On Unconstitutional Abortion Restrictions”. From the press release:

The 7th Circuit Court of Appeals today upheld a preliminary injunction against a restrictive abortion law, SEA 404, that would have imposed undue burdens on young women’s personal medical decisions.

The American Civil Liberties Union of Indiana challenged the law on behalf of Planned Parenthood of Indiana and Kentucky (PPINK) and its patients. In 2017, a federal district court blocked the law from taking effect, concluding that it “places an unjustifiable burden on mature minors in violation of the Fourteenth Amendment.”

SEA 404 included an unnecessary and dangerous add-on to Indiana’s existing parental consent law, which the lawsuit asserts would endanger young women in vulnerable circumstances. The U.S. Supreme Court has held that a minor who is unable or unwilling to obtain parental consent for an abortion must be allowed to obtain an abortion if a judge determines that she is sufficiently mature to make the best decision herself or if an abortion is in her best interests. Indiana has long had such a procedure.

SEA 404 would burden a minor’s ability to obtain an abortion by allowing parents to be notified, even in cases which a judge has determined that a young woman is mature enough to make the decision herself. The evidence in the case demonstrated that the notice provision might lead to young women being harmed or harming themselves.

Ken Falk, Legal Director at the ACLU of Indiana, released the following statement: “This decision affirms that the state must continue to provide a safe alternative for young women who – whatever their circumstances – are unable to talk to their parents about this difficult and personal decision. Legislators need to stop targeting women with invasive hurdles and start respecting the rights of all Hoosiers to make their own personal medical decisions. These heavy-handed restrictions would have burdened young women’s constitutional rights and put their health and safety at risk.”…

August 29, 2019: BBC News posted an article titled: “US hospital ‘forced’ Catholic nurse to assist with abortion”. From the article:

The US government has accused a hospital in Vermont of violating the civil rights of a nurse by forcing her to help carry out an abortion.

The nurse, who has not been named, said she told the hospital that she could not take part in pregnancy terminations because of her religious beliefs.

Health care workers are protected under federal law from discrimination based on their religious or moral beliefs.

The University of Vermont Medical Center (UVMC) denies the allegations…

…The incident took place in 2017 and the nurse, who is a Catholic, no longer works at the hospital.

On Wednesday, the Department of Health and Human Services warned UVMC that it had 30 days to comply with civil rights law or it could face funding cuts…

…This is the first action of its kind since the department created a conscience and religious freedom division last year. The Trump administration has supported religious freedom measures.

In a statement, the hospital said the allegations “were not supported by the facts.”…

September 4, 2019: Reuters posted an article titled: “U.S. Judge approves CVS purchase of insurer Aetna”. It was written by Diane Bartz. From the article:

A federal judge reviewing a Justice Department decision to allow U.S. pharmacy chain and benefits manager CVS Health Corp to merge with health insurer Aetna said in Wednesday that the agreement was in fact legal under antitrust law.

Judge Richard Leon of U.S. District Court for the District of Columbia had been examining a government plan announced in October to allow the merger on condition that Aetna sell its Medicare prescription drug plan business to WellCare Health Plans Inc. Both deals have already closed.

Leon had initially balked at approving the merger conditions and insisted on hearing from critics of the deal, but finally decided to grant the motion to approve the consent agreement…

…Critics of the CVS-Aetna deal included the American Medical Association and the AIDS Healthcare Foundation.

Another critic, U.S. PIRG, expressed skepticism that savings from the merger would end up in consumers’ pockets…

September 4, 2019: The American Medical Association (AMA) posted a statement titled: “Court ruling in CVS-Aetna merger leaves patients unprotected”. The statement was attributed to Patrice A. Harris, M.D., M.A., President, American Medical Association. From the statement:

“Despite an unprecedented review that dragged many details of this merger into the light, today’s decision ultimately fails patents, will likely raise prices, lower quality, reduce choice, and stifle innovation. The American people and our health system will not be served well by allowing a merger that combines health insurance giant Aetna Inc. with CVS Health Corporation – the nation’s largest retail pharmacy chain, specialty pharmacy, pharmacy benefits management (PBM) and Medicare Part D Stand-Alone Prescription Drug Plan (PDP) insurer.

” For patients and employers struggling with recurrent increases to health insurance premiums, out-of-pocket costs, and prescription drug prices, it’s hard to find any upside to a merger that leaves them with fewer choices. Nothing in the deal guarantees reductions on insurance premiums or prescription drug costs. As for promised efficiency savings, that money will likely go straight to CVS’s bottom line. CVS made no commitment to pass much-hyped savings onto consumers through lower premiums or drug costs.

“We know from history that when health insurance and pharmaceutical benefit management markets are ruled by only a few massive companies, patients pay a steep price. The court found our concerns ‘warranted serious consideration’ and sufficient to hold an unprecedented judicial review that included a hearing with expert testimony. Regulators should now be on notice of the antitrust risks associated with the CVS/Aetna merger, and must vigilantly monitor the conduct of the merged fire to make sure this colossal new entity does not hurt patients in the PBM services, health insurance, retail pharmacy, speciality pharmacy, and PDP markets, which are already highly concentrated.

“Although this outcome is not what we fought for, the AMA is optimistic that this case and the thorough examination of its underlying facts are a sign of things to come. When the public interest is harmed by health care mergers, courts charged with scrutinizing DOJ merger settlements must not be a rubber stamp.”

September 4, 2019: NBC News posted an article titled: “Reproductive health clinics serving Latinas grapple with ‘domestic gag rule'”. It was written by Nicole Acevedo. From the article:

Latinas who provide reproductive services in areas with few options for low-income women and women of color are grappling with a new Trump administration rule that can limit clinics’ access to federal funding, making it harder to offer affordable care to women.

In the Rio Grande Valley of Texas, where 92 percent of the population is Hispanic and many are immigrants or lack health insurance, “our bodies and our health have become political pawns,” says Lucy Ceballos Félix, associate director of field advocacy in Texas for the National Latino Institute for Reproductive Health.

At issue is the “domestic gag rule” that went into effect at the end of August, stating that health clinics can’t receive specific federal funding – known as Title X – designated for family planning and other reproductive health services if abortions are performed at the facility of if specialists refer patients to centers where they can get abortions.

Clinics are now facing a choice: halt family planning consultations or services that include abortion as a viable option and keep receiving Title X funds; or, like Planned Parenthood, withdraw from the federal family planning program and continue to offer full services at their facilities while looking for alternative sources of funding such as donations or private grants…

…The Department of Health and Human Services argues the new restrictions should not be considered a “gag rule” because it doesn’t prohibit health care providers from counseling patients on abortion.

But the rule explicitly states that if a Title X funded center “encourages, promote, advocates, supports, or assists with, abortion” the clinic would be considered one “where abortion is a method of family planning” – therefore ineligible for family planning funds…

…Even though abortions are legal, advocates say the Trump administration is using anti-abortion rhetoric to defund reproductive health services…

September 5, 2019: NPR posted an article titled: “California Again Considers Making Abortion Pills Available At Public Colleges”. It was written by April Dembosky. From the article:

…Public university health centers in California do not perform abortions. But state lawmakers are expected to pass a bill in the coming weeks that would require student health centers at all 34 state campuses to provide medication abortions. If the measure becomes law, it will be the first of its kind in the U.S.

The bill’s supporters say they want to remove the obstacles women face accessing medical abortion off campus…

…While a consortium of women’s groups that support abortion rights has promised to pay for all the required ultrasound equipment and upfront training costs of providing the abortion pill on campus, eventually universities would likely need to dip into tax dollars or student fees for ongoing costs…

…The State Legislature has until mid-September to pass the bill, and the governor has a month after that to sign or veto it.

The bill mentioned in the above article is SB-24 Public Health: public university student health centers: abortion by medication techniques. It was originally introduced by Senator Leyva in December of 2018. Here are some key parts of the bill:

  • The bill would require, on and after January 1, 2023, each student health care services clinic on a California State University or University of California campus to offer abortion by medication techniques, as specified. The bill would require the Commission of the Status of Women and Girls to administer the College Student Health Center Sexual and Reproductive Health Preparation Fund, which the bill would establish.
  • The bill would continuously appropriate the moneys in that fund to the commission for allocations to each public university student health care clinic for specified activities in preparation for providing abortion by medication techniques, thereby making an appropriation. The bill would provide that its requirements would be implemented only if, and to the extend that, a total of at least $10,290,000 in private moneys is made available to the fund in a timely manner on or after January 1, 2020.
  • Abortion care is a constitutional right and an integral part of comprehensive sexual and reproductive health care.
  • The state has an interest in ensuring that every pregnant person in California who wants to have an abortion can obtain access to that care as easily and as early in pregnancy as possible. When pregnant young people decide that abortion is the best option for them, having early, accessible care can help them stay on track to achieve their educational and other aspirational life plans.
  • All California public university campuses have on-campus student health centers, but none of these health centers currently provide abortion by medication techniques. Abortion by medication techniques is extremely safe, highly effective, and cost effective. Abortion by medication techniques is an essential part of comprehensive sexual and reproductive health care, and should be accessible at on-campus student health centers.
  • Staff at on-campus student health centers include health professionals who are licensed to provide abortion by medication techniques. Under current California law, all residency programs in obstetrics and gynecology include training in abortion. Physicians, nurses practitioners, physician assistants, and certified nurse-midwives are legally authorized to perform abortions by medication techniques. Any clinician legally authorized to provide abortion, but not currently trained to provide abortion by medication techniques, can be trained inexpensively to do so, and such training falls within the requirements of continuing education for medical providers.

September 5, 2019: ABC News posted an article titled: “Texas hoping to revive law on burial of fetal remains”. It was written by Kevin McGill. From the article:

Texas attorneys asked a federal appeals court Thursday to revive the state’s requirement that fetal remains from abortions and miscarriages at health care facilities be buried or cremated.

A three-judge panel of the 5th U.S. Circuit Court of Appeals in New Orleans gave no indication when it would rule following the arguments. One panel member raised the possibility that a decision could be delayed until after the Supreme Court rules in a pending Louisiana abortion regulation case. No date for consideration has been set in that case.

The law, blocked last year by U.S. District Judge David Ezra, requires that fetal tissue remains from abortions, miscarriages, or ectopic pregnancies at health care facilities, including abortion clinics, be buried or cremated. It requires that ashes from cremation of such remains be scattered “in any manner as authorized by law” or buried. It says they cannot be placed in a landfill..

…Ezra also found that the law imposes a burden on women seeking abortions because it “increases the grief, stigma, shame, and distress of women experiencing an abortion, whether induced or spontaneous.”…

…The case was heard by the 5th Circuit’s chief judge Carl Stewart, a nominee of President Bill Clinton; Judge Rhesa Barksdale, nominated to the court by President George H.W. Bush; and Judge Gregg Costa, nominated by President Barack Obama…

…The 5th Circuit is already holding a decision on another Texas abortion regulation case in abeyance pending action in the Louisiana case.

September 6, 2019: Kaiser Health News posted an article titled: “Groupons For Medical Treatment? Welcome To Today’s U.S. Health Care”. It was written by Lauren Weber. From the article:

Emory University medical fellow Dr. Nicole Herbst was shocked when she saw three patients who came in with abnormal results from chest CT scans they had bought on Groupon…

…Similar deals have shown up for various lung, heart and full-body scans across Atlanta, as well as in Oklahoma and California. Groupon also offers discount coupons for expectant parents looking for ultrasounds, sold as “fetal memories”…

…For Paul Ketchel, CEO and founder of MDsave, a site that contracts with providers to offer discount-priced vouchers on bundled medical treatments and services, the use of medical Groupons and his own company’s success speak to the brokenness of the U.S. health care system.

MD Save offers deals at over 250 hospitals across the country, selling vouchers for anything from MRIs to back surgery. It has experienced rapid growth and expansion in the several years since its launch. Ketchel attributes that growth to the general lack of price transparency in the U.S. health care industry amid rising costs to consumers…

…But Dr. Andrew Bierhals, a radiology safety expert at Washington University in St. Louis’ Mallinckrodt Institute of Radiology, warned that such deals maybe leading patients to get unnecessary initial scans – which can lead to unnecessary tests and radiation…


A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three – Continued is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

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