Image by chayka1270 from Pixabay 

Before you jump into this blog post, you may want to read Part One and Part Two.

In 2018, the Democratic Party became the majority in the U.S. House of Representatives. The 116th Congress started on January 3, 2019.

The Democrats set out to stop the GOP from destroying Obamacare, Medicare, Medicaid, and other health care that is affordable for low-income and marginalized people.

Unfortunately, the GOP still had the majority in the U.S. Senate, and President Trump, a Republican, was still President of the United States. As such, the shenanigans continued.

January 3, 2019: CNBC posted an article titled: “Nancy Pelosi launches House effort to save Obamacare from death in a Texas Court Case”. It was written by Dan Mangan. From the article:

The House of Representatives on Friday launched a legal effort to help defend Obamacare in a court case that is threatening to kill that landmark health-care reform law, which has led to the expansion of health insurance to millions of Americans.

The House, which as of Thursday is controlled by Democrats and led by Speaker Nancy Pelosi of California, asked a federal judge in Texas to allow it to intervene in the case.

If Judge Reed O’Connor grants that request, it would allow the House to make legal arguments in the dispute going forward, up to and including at the U.S. Supreme Court…

…A lawyer for the House said in a filing in U.S. District Court for the Northern District of Texas that federal legal rules give “the House an unconditional right to intervene” in the case, given that Obamacare was passed into law by Congress, and given that the Trump administration is not defending the law…

…The House said that its “interest in this action… is not adequately represented by the existing parties.”

Pelosi on Friday noted that on Thursday “the new Democratic House took action to protect people with pre-existing conditions and all Americans’ health care” by passing a resolution seeking to intervene in the lawsuit…

January 3, 2019: NPR posted an article titled: “How the Federal Shutdown Is Affecting Health Programs”. From the article:

There seems to be no end in sight for the current partial government shutdown, the third since the beginning of the Trump administration.

For the vast majority of the federal government’s public health efforts, though, it’s business as usual…

…But seven bills are outstanding – including those that fund the Interior, Agriculture and Justice departments – and that puts the squeeze on some important health-related initiatives…

…Since HHS funding is set through September, the flagship government health care programs – think Obamacare, Medicare and Medicaid – are insulated…

…Because Congress has yet to approve funding for the Indian Health Service, which is run by HHS but gets its money through the Department of the Interior, IHS feels the full weight of the shutdown. The only services that can continue are those that meet “immediate needs of the patients, medical staff, and medical facilities”, according to the shutdown contingency plan.

That includes IHS-run clinics, which provide direct health care to tribes around the country. These facilities are open, and many staffers are reporting to work because they are deemed “expected,” said Jennifer Buschik, an agency spokeswoman. But they will not be paid until Congress and the administration reach a deal.

Other IHS programs are taking a more direct hit. For example, the agency has suspended grants that support tribal health programs as well preventive health clinic run by the Office of Urban Indian Health Programs…

January 6, 2019: Forbes posted an article titled: “Pelosi Wants More Americans Subsidized To Buy Obamacare”. It was written by Bruce Japsen. From the article:

…The New Speaker of the U.S. House of Representatives said this weekend she wants changes in the income threshold to allow more Americans to gain subsidies so they can buy individual coverage known as Obamacare. Helping more people get subsidies are among the “couple of things” she would like to do to improve the ACA and expand health coverage to more Americans, Pelosi, a California Democrat, told MSNBC Friday night.

“Raise the income level at which people can get subsidies so more people would be able to get subsidies,” Pelosi told MSNBC’s Joy Reid in an exclusive interview that aired Friday night and this past weekend. “I think that’s very, very important.”

By expanding the pool of American who gain subsidies, that’s good news for insurers Centene, Molina Healthcare, Oscar Health, Bright Health, Cigna, Anthem, and other Blue Cross and Blue Shield plans that have remained in the business of selling ACA-compliant individual coverage…

…Exactly what the income threshold would be raised to is unclear. Pelosi didn’t disclose further details in her MSNBC interview. Hearings, though, are expected on the ACA in several Congressional committees.

The filing mentioned in the article is posted on the Speaker of the House website.

January 8, 2019: Peter V. Lee, Executive Director of Covered California Board of Directors, sent a letter to Seema Verma, Administrator for the Center for Medicare and Medicaid Services. From the letter:

Covered California submits these comments in response to the proposed Program Integrity regulations CMS-9922-P, specifically, on the unnecessary proposal to require separate billing for non-Hyde abortion services. We provide the following comments based on our experience and analysis of the necessary efforts to ensure ongoing sustainability for state-based marketplaces and effective services to the consumers we serve. Through our strong relationships with the 11 health insurance companies participating in Covered California, we have created a robust health insurance market that fosters a competitive environment while empowering consumers to choose plans that give them the best value.

Covered California believes these proposed regulations are unnecessary, would impose a substantial burden, and will not be beneficial for consumers or the individual market. Current rules and processes ensure that funds are segregated, and no federal funs are used for non-Hyde abortion services. Should Health and Human Services (HHS) not withdraw this proposed rule, Covered California requests that HHS delay the effective date to allow time for affected entities to mitigate consumer confusion and implement the required changes to information technology systems.

As proposed, HHS would withdraw its previous guidance, which permits Qualified Health plans (QHP) issuers to satisfy the separate payment requirement in one of several ways, including by sending the enrollee a single monthly bill that separately itemizes the premium amount for non-Hyde abortion services. Currently, HHS also allows consumers to make the payment for non-Hyde abortion services and the payment for all other services in a single transaction. HHS is now promising to require issuers to send – and consumers to pay – two entirely separate bills for the premium attributable to certain (non-Hyde) abortion services and the premium for all other services. Additionally, HHS is proposing that any consumer who failed to pay the full premium in both bills will be terminated for non-payment (subject to state and federal grace periods).

If finalized, this regulation will be confusing for consumers and will likely lead to consumers dropping coverage due to inadvertently not paying the full premium. While HHS asserts that consumer confusion can be mitigated by sending bills only through email or other electronic communication, this does not address the underlying confusion that will occur due to two separate bills being sent to a consumer for their QHP. Not only does this practice conflict with widely accepted industry standards, there is no practical way to implement such a policy as a consumer cannot be forced into forgoing mail as their preferred method of communication. In California, we encourage our consumers to opt into email as their preferred communication but even after our encouragement, 70% of enrollees continue to receive communication via standard mail. HHS’s proposal also does not consider the fact that some individuals do not have consistent access to the internet and would be unable to receive or make their monthly premium payment.

These proposed regulations will impose millions of dollars of new costs and significant operational burdens on Exchanges and QHP issuers, diverting resources from other important work that Exchanges and carriers perform to provide affordable and reliable health coverage to their consumers. For example, Covered California will need to protect the market from known adverse impacts of this proposed regulation by redirecting vital funds from other programs to consumer outreach and marketing…

…These regulations will cause significant consumer confusion and impose serious administrative operational burdens on Covered California. If these new, unnecessary and burdensome regulations are implemented, Exchanges could not possibly put them in place in the time proposed.

January 9, 2019: The House of Representatives voted on a H.Res. 6 – Adopting the Rules of the House of Representatives for the One Hundred Sixteenth Congress, and other purposes. Here is the key part of it:



The House of Representatives finds the following:

(1) Texas, Wisconsin, Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Governor Paul LePage of Maine, Mississippi (by and through Governor Phil Bryant), Missouri, Nebraska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, and West Virginia have filed suit in the United States District Court for the Northern District of Texas, arguing that the Patient Protection and Affordable Care Act… is unconstitutional and should be enjoined by asserting that the Act’s requirement to maintain minimum essential coverage (commonly known as the “individual responsibility provision”) in section 5000A(a) of the Internal Revenue Code of 1986, is unconstitutional following the amendment of that provision by the Act to provide for reconciliation pursuant to titles II and V of the concurrent resolution on the budget fiscal year in 2019… (commonly known as the “Tax Cuts and Jobs Act”).

(2) These State and individual plaintiffs also seek to strike down the entire Patient Protection and Affordable Care Act as not severable from the individual responsibility provision.

(3) On June 7, 2018, the Department of Justice refused to defend the constitutionality of the amended individual provision, despite the well-established duty of the Department to defend Federal statutes where reasonable arguments can be made in their defense…


(a) AUTHORIZATION – The Speaker, on behalf of the House of Representatives, is authorized to intervene, otherwise appear, or take any steps in the case of Texas v. United States … and in any appellate proceedings arising from such case. The Speaker, in consultation with the Bipartisan Legal Advisory Group, is also authorized to intervene, otherwise appear, or take any other steps in any other cases involving the Patient Protection and Affordable Care Act to protect the institutional interests of the House and to defend such Act, the amendments made by such Act to other provisions of law, and any amendments to such provisions, including the provisions ensuring affordable health coverage for those with preexisting conditions.

(b) ROLE OF GENERAL COUNSEL. – The Office of General Counsel of the House of Representatives, at the direction of the Speaker, shall represent the House in any litigation pursuant to this title. The Office of General Counsel may employ the services of outside counsel, including pro bono counsel, or other experts for this purpose.

(c) REPORTS ON AMOUNTS EXPENDED. – The chair of the Committee on House Administration shall cause to be printed in the Congressional Record a statement setting forth the aggregate amounts expended by the Office of General Counsel on outside counsel and other experts pursuant to this title on a quarterly basis, and such statement shall be submitted for printing not more than 30 days after the expiration of each such quarter…

January 9, 2019: The House of Representatives voted on H.Res. 6 – Adopting the Rules of the House of Representatives for the One Hundred Sixteenth Congress, and other purposes.

The vote was 235 YEAS to 192 NAYS, which means it passed.

Almost all of the Democrats voted YEA. Two Democrats did not vote: Lois Frankel (D-Florida) and Stephen Lynch (D-Massachusetts).

Three Republicans voted YEA: Brian Fitzpatrick (R-Pennsylvania), John Katko (R-New York), and Tom Reed (R-New York).

Almost all of the Republicans voted NAY. Four Republicans did not vote: Ken Buck (R-Colorado), Michael Guest (R-Mississippi), Walter Jones (R-North Carolina) and Brian Mast (R-Florida).

January 9, 2019: The Hill posted an article titled: “Dems hit GOP on health care with additional ObamaCare lawsuit vote”. From the article:

The House on Wednesday passed a resolution backing the chamber’s recent move to defend ObamaCare against a lawsuit filed by the GOP states, giving Democrats another opportunity to hit Republicans on health care.

GOP Reps. Brian Fitzpatrick (Pa.), John Katko (N.Y.), and Tom Reed (N.Y.), joined with 232 Democrats to support the measure, part of Democrats’ strategy of keeping the focus on the health care law heading into 2020. The final vote tally was 235-192.

A federal judge in Texas last month ruled in favor of the GOP-led lawsuit, saying ObamaCare as a whole is invalid. The ruling, however, will not take effect while it is appealed.

Democrats framed Wednesday’s vote as proof that Republicans don’t want to safeguard protections for people with pre-existing conditions – one of the law’s most popular provisions…

January 9, 2019: Speaker of the House Nancy Pelosi posted a statement on her official website. The statement was titled: “Pelosi Statement on House Republicans’ Vote Against Families’ Health Care”. From the statement:

Speaker Nancy Pelosi issued this statement after 192 House Republicans voted against a resolution affirming the House’s authority to intervene in the Texas v. United States lawsuit to defend the Affordable Care Act and protect people with pre-existing conditions:

“The health and well-being of children and families across America hang in the balance because of Republicans’ monstrous legal assault on health care. But tonight, 192 House Republicans voted to be full accomplices in the GOP’s effort to destroy protections for people with pre-existing conditions and threaten Americans’ health care.

“In November, the American people spoke loud and clear: the GOP’s war on health care must end, now. Republicans need to listen to their constituents, and finally work with Democrats to protect the health of families across America. This New Democratic House of Representatives will be relentless in defending protections for people with pre-existing conditions and affordable health care.”

January 13, 2019: The Hill posted an article titled: “Judge blocks Trump contraception rule in 13 states”. From the article:

A federal judge on Sunday blocked Trump administration rules that would allow most businesses to opt out of covering contraception for their employees if they have moral or religious objections.

Judge Haywood Gilliam blocked the rules, which were set to go into effect on Monday, in California, Washington D.C., and 12 other states. Gilliam granted a request for a preliminary injunction from those states, but limited the ban’s scope to only the case’s plaintiffs.

California Attorney General Xavier Becerra (D) at the end of December asked Gilliam to block the rules, which would allow more exemptions to ObamaCare’s contraception mandate.

Attorneys general in Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, Washington state and the District of Columbia joined Becerra’s request for an injunction…

January 15, 2019: Health Affairs posted an article titled: “Two Judges Block Final Rules On Exemptions From Contraceptive Coverage Mandate”. It was written by Katie Keith. From the article:

On January 13 and 14, 2019, two courts – one in California and one in Pennsylvania – issued new preliminary injunctions to halt enforcement of the Trump administration’s final rules on religious and moral objections to the Affordable Care Acts (ACA’s) contraception mandate. Those rules were scheduled to go into effect on January 14. The injunction issued in Pennsylvania applies to all 50 states and DC – meaning the new rules that would dramatically broadened religious and moral exemptions to the contraceptive mandate are now on hold. In the meantime, the Obama-era accommodation to the contraceptive mandate remains in effect.

This is the second time that the two judges – Haywood S. Gilliam, Jr. of the Northern District of California and Wendy Beetlestone of the Eastern District of Pennsylvania – have enjoined the contraceptive exemption rules. In December of 2017, both judges issued nationwide preliminary injunctions against the Trump administration’s interim final rules. These cases were appealed to the Ninth Circuit Court of Appeals and the Third Circuit Court of Appeals.

Given the few changes made between the interim final rules and the final rules, this outcome is not surprising. Both courts had concluded that the states were likely to succeed in their claim that the rules were procedurally flawed because they were published without opportunity for public comment. Judge Beetlestone additionally found the interim final rules to be substantively improper under the Administrative Procedure Act (APA). Because the final rules largely maintained the interim final rules, it is unsurprising the she reached the same conclusion here…

The case called State of California, et. al. v. Health and Human Services went to the United States District Court Northern District of California. It was heard by United States District Judge Haywood S. Gilliam, Jr. The judge ruled that the preliminary injunction applies only to the five states – California, Delaware, Maryland, New York, and Virginia – that brought the lawsuit.

The case called “Commonwealth of Pennsylvania and State of New Jersey v. Donald J. Trump, Alex M. Azar II, United States Department of Health and Human Services, Steven T. Mnuchin, United States Department of The Treasury, Rene Alexander Acosta, The United States Department of Labor, and The United States of America – and Little Sisters of the Poor, and Saints Paul and Peter Home” went to the United States District Court for the Eastern District of Pennsylvania. It was heard by United States District Court Judge Wendy BettleStone. Her ruling applies to all 50 states and the District of Columbia.

January 15, 2019: The American College of Obstetricians and Gynecologists posted a statement titled: “ACOG Applauds Nationwide Injunction on Contraceptive Regulations”. From the statement:

Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists, issues the following statement regarding the Trump-Pence administration’s Religious Exemptions and Accommodations for Coverage of Certain Preventative Services Under the Affordable Care Act and the Moral Exemptions and Accommodations for Coverage of Certain Preventative Services Under the Affordable Care Act:

“Access to contraception is an essential component of women’s health care. The American College of Obstetricians and Gynecologists (ACOG) applauds the two federal court decisions that enjoined the implementation of the Trump-Pence regulations that would prevent many women from accessing contraception. ACOG is especially relieved that the Pennsylvania court issued a nationwide injunction, protecting all women throughout the country who would have been negatively impacted by the regulations.

“The Trump-Pence regulations threaten the health of women and families throughout the United States, undermine established law under which comprehensive preventative women’s health care has been widely accessible and disrupt the patient-physician relationship. The California and Pennsylvania courts recognized this harm and understood that contraception is important preventative health care. ACOG, along with other medical societies, submitted amicus briefs in both cases, explaining the very real harms to women and the public health.

“As the nation’s largest professional organization for women’s health care physicians, ACOG recognizes contraception as an integral component of women’s health care and opposes any policy that seeks to restrict or eliminate women’s meaningful access to the full range of contraceptive methods.

“ACOG’s message is simple and consistent: Don’t turn back the clock on women’s health.”

January 17, 2019: The Associated Press posted an article titled: “Trump administration proposes higher ‘Obamacare’ premiums”. From the article:

The Trump administration on Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue…

…The latest details were in a 300-page proposed regulation released Thursday afternoon by the Centers for Medicare and Medicaid Services.

The agency said the reason for the change was to more accurately calculate premium subsidies under the law. About 10 million people who don’t get health insurance on the job purchase individual policies under the ACA, and roughly 9 in 10 receive taxpayer-provided assistance with their premiums.

The administration is also proposing to require insurers that cover abortion to offer a “mirror” plan that does not. The health law allowed insurance to offer coverage for abortions provided they collect a separate premium to cover the cost. Many states, however, have enacted laws that prevent ACA from covering abortion…

…In this regulation, the administration estimated that the government would save about $900 million a year on subsidies, and that 100,000 consumers would drop their coverage…

January 18, 2019: CBS News posted an article titled: “Obamacare premiums could increase next year under proposed rule change”. From the article:

The Trump administration on Thursday announced on Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue.

The roughly 1 percent increase could feed into the Democratic argument that the Trump administration is trying to “sabotage” coverage for millions. The administration said the proposal is intended to improve the accuracy of a complex formula that affects what consumers pay for their premiums….

…The latest details were in a 300-page proposed regulation released Thursday afternoon by the Centers for Medicare and Medicaid Services.

The agency said the reason for the change is to more accurately calculate premiums subsidies under the law. About 10 million people who don’t get health insurance on the job purchase individual policies under the ACA, and roughly 9 in 10 receive taxpayer-provided assistance with their premiums.

The administration is also proposing to require insurers that cover abortion to offer a “mirror” plan that does not. The health law allowed insurers to offer coverage for abortions provided they collect a separate premium to cover the costs. Many states, however, have enacted laws that prevent ACA plans from covering abortion…

…In the regulation, the administration estimated that the government would save about $900 million a year on subsidies, and that 100,000 customers would drop their coverage…

January 20, 2019: Forbes posted an article titled: “As Shutdown Drags On, Worries Emerge About Spikes in Obamacare Premiums”. From the article:

The government shutdown has raised worries some American may have a tough time paying their health insurance premiums for individual coverage purchased under the Affordable Care Act.

Health insurance companies say the shutdown’s impact should be limited to those who didn’t file a timely tax return last year, but members of Congress worry it could be broader given the millions of Americans who buy individual coverage known as Obamacare.

The largely unfunded Internal Revenue Service and U.S. Treasury department handle paying “advanced premium tax credits,” which some Democrats in the U.S. House of Representatives and U.S. Senate say could be delayed and wreak havoc on how premiums are paid…

…The IRS has a role with the ACA’s individual coverage to verify income and other information from health plan enrollees…

…Despite concerns, health insurance companies have yet to report any harm from the shutdown. But health insurers are expected to address the government shutdown as they report their full year 2018 and fourth quarter earnings in the coming weeks…

January 22, 2019: WRVO posted an article titled: “Legislature passes abortion rights bill, Cuomo signs it into law”. It was written by Karen Dewitt. From the article:

The New York State Legislature voted Tuesday to codify the abortion rights in the U.S. Supreme Court decision Roe v. Wade into New York law, and Gov. Andrew Cuomo signed it into law immediately after the vote…

…The measure establishes in New York state law the right to choose abortion without restriction up to the 24th week of pregnancy, and after that, if the life or health of the mother is threatened or the fetus is determined not to be viable.

Senate Democratic Majority Leader Andrea Stewart-Cousins, who achieved her post when Democrats won several seats in last November’s elections, said the bill is a top priority at time when President Donald Trump’s appointments to the Supreme Court threaten the landmark decision…

…The Democratic-led State Assembly already had approved the measure several times. Assembly Speaker Carl Heastie, speaking at a packed press conference attended by supporters, said Republicans who used to lead the Senate blocked the bill from coming up for a vote for 12 years…

…Both houses of the Legislature also approved a measure known as the Comprehensive Contraceptive Act that would ensure that New York’s women have access, through their health insurance policies, to affordable contraception.

The New York Assembly website has more information about the bill titled: “An act to amend the public health law, in relation to enacting the reproductive health act and revising existing provisions of law regarding abortion; to amend the penal law, the criminal procedure law, certain provisions of the public health law relating to abortion; to repeal certain passages of the education law relating to the sale of contraceptives; and to repeal certain provisions of the penal law relating to abortion”.

The New York Assembly website information about this bill also shows the committee votes.

January 22, 2019: Judge Michael D. Huppert, District Court Judge, Fifth Judicial District of Iowa ruled on the case called Planned Parenthood et al v. Governor Kimberly Reynolds et. al. The case is about an anti-abortion law that was passed in Iowa.

This Plaintiffs (Petitioners) in this case were: Planned Parenthood of the Heartland, Inc., Emma Goldman Clinic and Jill Meadows M.D.

The Defendants (Respondents) in this case were: Kim Reynolds, ex. rel. State of Iowa and Iowa Board of Medicine. From the ruling:

…This is an action brought by petitioners challenging the constitutionality of recent legislation passed by the Iowa Legislature (Iowa Code chapter 146C) which would prohibit abortion upon the detection of a fetal heartbeat by means of an abdominal ultrasound, in cases that do not involve a medical emergency or when the abortion is medically necessary (defined generally within the statute as involving rape, incest, miscarriage, or fetal abnormality.). …The petitioners take the position that this legislation violates the due process and equal protection provisions of the Iowa constitution; specifically, they argue within the present motion the such a determination can be made in advance of trial as a matter of law. The respondents resist, primarily on the basis that genuine issues of material fact remain that must await a trial on the merits. For the reasons noted within this ruling, the court agrees with the petitioners and grants the motion for summary judgement…

…The focus of the respondent’s factual challenge to the motion revolves around at what stage of a pregnancy is a fetal heartbeat detectable. While conceding that a fetal heartbeat can be detected as early as six weeks into a pregnancy the respondents content that such detection is ordinarily not detected until later, especially when using an abdominal ultrasound as mandated by the statute. The affidavit of the respondents’ expert, Dr. Kathi Aultman, states that the earliest a fetal heartbeat can be detected abdominally is 7 weeks, with most detected by 8 to 9 weeks, and some not until 12 weeks into the pregnancy…

…Regardless of precisely when a fetal heartbeat may be detected in a given pregnancy, it is undisputed that such cardiac activity is detectible well in advance of the fetus becoming viable. Within Dr. Meadows’ affidavit is the statement that the current 20-week post fertilization statutory limit for abortions under Iowa law…”is a minimum of several weeks before any fetus would be viable…. This contention is not challenged within the respondent’s resistance; to the contrary, the respondents contend that “viability…[is not] material to this case.”… To the contrary, viability is not only material to this case, it is dispositive on the present record…

…While the framework first announced in Roe has been modified over the years, the threshold of viability as a check on the state’s compelling state interest in promoting potential life has remained intact. In Planned Parenthood of Southeastern Pennsylvania v. Casey… (1992)… the United States Supreme Court established an “undue burden” standard in analyzing state restrictions on provability abortions… (“An undue burden exists, and therefore a provision of law is invalid, if its purpose or effect is to place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability”). However, in doing so, the court went out of its way to make it clear that the “adoption of the undue burden analysis does not disturb the central holding of Roe v. Wade…[that] a State may not prohibit any woman from making the ultimate decision to terminate her pregnancy before viability.” … Finally in its most recent discussion of the issue, the United States Supreme Court restated (“assume[d]”) this part of the holding in Roe as reaffirmed by Casey. … Gonzales v. Carhart… (“Before viability, a State ‘may not prohibit any woman from making the ultimate decision to terminate her pregnancy'”)…

…Faced with the uphill battle created by this body of authority, the respondents argue in the alternative that Iowa Code chapter 146C does not impose a ban on abortions, but merely creates a window of opportunity for women to be vigilant in the exercise of their right to terminate a pregnancy; in other words, if women are to be able to exercise this right they must also exercise the concomitant responsibility to monitor the potential of a pregnancy and terminate that pregnancy prior to the detection of a fetal heartbeat. This argument is nothing more than an attempt to repackage the undue burden standard rejected by the Iowa Supreme Court in PPH II….(“[T]he undue burden standard solely measures the impact the regulation has some women’s ability to receive the procedure”). The respondents’ argument, by acknowledging the admittedly narrow amount of time afforded under the statute, “would regulate the individual rights of Iowa women to something less than fundamental.” … In actuality, the argument would probably require women to engage in a level of diligence resembling something along the lines of “mov[ing] heaven and earth,” a type of restriction the Iowa Supreme Court found to be antithetical to the notion of a fundamental right.

In summary, it is undisputed that the threshold for the restriction upon a woman’s fundamental right to terminate a pregnancy (the detection of a fetal heartbeat) contained within Iowa Code 146C constitutes a prohibition of provability abortions. As such, it is violative of both the due process and equal protection provisions of the Iowa Constitution as not being narrowly tailored to serve the compelling state interest of promoting potential life. Accordingly, this court grants the petitioners’ motion for summary judgement and declares Iowa Code chapter 146C unconstitutional and therefore void…

February 1, 2019: Reuters posted an article titled: “U.S. judge throws out Maryland bid to protect Obamacare law”. It was written by Laurence Hurley. From the article:

A U.S. judge on Friday threw out the state of Maryland’s bid to protect the healthcare law known as Obamacare in a ruling that also sidestepped a decision on whether President Donald Trump’s appointment of Matthew Whitaker as acting attorney general was lawful.

In a win for the Republican president, Baltimore-based U.S. District Judge Ellen Hollander said Maryland had failed to show that the Trump administration is likely to terminate enforcement of the 2010 law, officially called the Affordable Care Act.

The claim made by Maryland Attorney General Brian Frosh, a Democrat, “consists of little more than supposition and conjecture about President Trump’s possible actions,” Hollander wrote…

…Frosh said in a statement that Hollander’s decision does not end his effort to defend the law…

February 2, 2019: The Hill posted an article titled: “Trump predicts ObamaCare will be ‘terminated’ by the courts”. It was written by Peter Sullivan. From the article:

President Trump said in an interview published Friday that he thinks ObamaCare will be “terminated,” predicting that a lawsuit challenging the 2010 health care law will succeed…

…Trump was referencing a lawsuit seeking to overturn ObamaCare that was brought by Texas and other GOP-led states. A federal district court judge in Texas ruled against Obamacare in December.

But the decision by the judge, appointed by former President George W. Bush, is being appealed and legal experts in both parties are very skeptical that the lawsuit will ultimately succeed…

February 2, 2019: The Detroit News posted an article titled: “Michigan set to join other Dem states in lawsuits to support Obamacare”. It was written by Beth LeBlanc. From the article:

The state of Michigan will join more than a dozen states with Democratic attorneys general to oppose a Texas federal court ruling that found the Affordable Care Act was unconstitutional.

Democratic Attorney General Dana Nessel and Gov. Gretchen Whitmer said Thursday that Michigan would join a group of intervening states supporting the program known as Obamacare, noting that Michigan has a “strong interest” in the success of the lawsuit…

…If the decision from the Texas federal court is upheld, families across Michigan will struggle to get the care they need, Whitmer said in a statement…

U.S. District Judge Reed O’Connor in December ruled in favor of Republican states challenging the law, finding that when Congress repealed the tax penalty for not buying insurance in 2017 it invalidated the Affordable Care Act.

His ruling, which came at the end of the six-week open enrollment period for the 2019 Obamacare program, will likely be appealed to the U.S. Supreme Court…

…Nessel’s announcement Thursday came shortly after she withdrew the state from eight abortion, discrimination, and religious freedom lawsuits her predecessor entered during his tenure.

February 2, 2019: The Hill posted an article titled: “House Dems to mull bills to overturn ObamaCare actions”. It was written by Peter Sullivan. From the article:

Democrats on the House Energy and Commerce Committee on Wednesday announced that they would hold a hearing next week to consider legislation to overturn conservative actions President Trump has taken on the Affordable Care Act.

The panel will consider bills to overturn Trump’s expansion of cheaper, skimpier insurance plans that Democrats deride as “junk plans,” and to restore funding for outreach efforts to enroll people in ObamaCare plans, funding that was slashed by the Trump administration.

A third bill would overturn guidance from the Trump administration that makes it easier for states to make conservative changes to ObamaCare. The hearing is part of an effort by the New Democratic House majority to highlight what they call Trump’s “sabotage” of the ACA, and take actions to reverse it.

The bills likely have no chance of passing through the GOP-controlled Senate, but they provide Democrats a chance to show their priorities and highlight Trump’s actions.

Rep. Anna Eshoo (D-Calif.), the chairwoman of the Energy and Commerce health subcommittee, announced the upcoming hearing during a separate hearing on Wednesday on a lawsuit brought by GOP-led states seeking to overturn ObamaCare…

…Republicans on Wednesday also reiterated a call they made on Tuesday for a hearing on Medicare For All, saying Democrats should allow the liberal idea to be examined to show its weaknesses…

February 5, 2019: Dallas News posted an article titled: “Abortion, transgender health protections should be ‘wiped permanently’ from Obamacare, says Texas AG Ken Paxton”. It was written by Laura McGaughy. From the article:

Texas Attorney General Ken Paxton has asked a federal judge to ax health protections in the Affordable Care Act for transgender Americans and women seeking abortions.

On Monday, Paxton and leaders from seven other states filed a motion in federal court to undo rules that bar discrimination based on “gender identity” and “termination of pregnancy” in the act, also known as Obamacare.

The enforcement of the protections have been on hold for more than two years, but Paxton says it’s time to eliminate them once and for all…

…The Affordable Care Act prohibits hospitals and other health providers that receive federal money from denying care on the basis of race, color, national origin, age, disability, or sex. In the final months of President Barack Obama’s tenure, his administration released new regulations interpreting “sex” discrimination to include “gender identity” and “termination of pregnancy”, meaning hospitals or health care programs who turn away transgender Americans or women seeking abortions could be denied federal funds.

The implementation of these regulations has been on hold since December 2016, when District Judge Reed O’Connor issued a nationwide injunction prohibiting their enforcement. The federal government wanted revisit its definition of sex, and is expected to rescind these protections, but hasn’t formally done so.

The delay has irked Paxton and other conservative leaders who have fought to outlaw abortion and who oppose extending more rights to gay, lesbian, bisexual, and transgender Americans…

February 5, 2019: Reuters posted an article titled “Insurers as top court to restore Obamacare ‘risk corridor’ payments”. It was written by Nate Raymond. From the article:

The U.S. Government has carried out a “bait-and-switch” by withholding $12 billion owed to health insurers under an Obamacare program aimed at encouraging them to cover previously-uninsured people, an insurers told the U.S. Supreme Court on Monday.

Moda Health Plan Inc and at least three other insurers separately asked the justices to review a June ruling by the U.S. Court of Appeals for the Federal Circuit, which found that Congress had suspended the government’s obligation to make the payments…

February 7, 2019: CBS News posted an article titled: “Supreme Court Chief Justice John Roberts joins liberal justices to block Louisiana abortion clinic law.” It was written by Grace Segers and Jan Crawford. From the article:

Supreme Court Chief Justice John Roberts joined the four liberal members in temporarily blocking a Louisiana law that would have closed some of the few remaining abortion clinics in the state. Justice Brett Kavanaugh wrote the dissenting opinion…

…The Supreme Court did not give a reason for granting the stay…

…The law, originally enacted in 2014, has never taken effect. The Supreme Court temporarily stayed the law last week. Justice Samuel Alito said in a brief order Friday that the justices need more time to review arguments for and against the law. The law requires doctors at abortion clinics to have admitting privileges at a nearby hospital. Should the law go into effect, abortion providers say at least one and maybe two of Louisiana’s three abortion clinics would have to close…

February 12, 2019: The Chicago Tribune posted an article titled: “Kevin McCarthy blames midterm loses on GOP push to roll back health insurance protections”. It was written by Mike DeBonis. From the article:

Speaking privately to his donors, House Minority Leader Kevin McCarthy squarely blamed Republican losses in last year’s midterm elections on the GOP push to roll back health insurance protections for people with preexisting conditions – and in turn blamed his party’s right flank.

McCarthy’s comments, made in a Feb 6 conference call from which The Washington Post obtained partial recordings, represent a vindication of Democratic efforts to elevate health care as an issue in last year’s campaign. And in singling out the House Freedom Caucus, the remarks threaten to rekindle internal resentments inside the House Republican Conference…

…Elsewhere on the call, McCarthy offered a selective account of the 2017 health care battles on Capitol Hill, where Republicans in the House toiled for months to craft an alternative to the Affordable Care Act, narrowly passing a bill in may before watching the Senate abandon the effort three months later.

“When we couldn’t pass the repeal of Obamacare the first way through, an amendment came because the Freedom Caucus wouldn’t vote for” the original House bill, McCarthy said. “That amendment put [the] preexisting conditions campaign against us, and so even people who are running for the very first time got attacked on that. And that was the defining issue and the most important issue in the race.”

McCarthy’s account accurately describes the dynamics of passing the American Health Care Act, the Republican ACA alternative, in 2017: After an initial version of the bill was withdrawn due to opposition from both the Freedom Caucus and GOP moderates, Reps. Tom McArthur, R-N.J., and Mark Meadows, R-N.C., crafted an amendment that would give states the ability to waive protections for people with preexisting conditions…

February 13, 2019: Vox posted an article titled: “Why Democrats aren’t taking up a bill to neutralize Obamacare’s latest legal threat”. It was written by Dylan Scott. From the article:

Democrats are taking up three bills to reverse the Trump administration’s sabotage

The Energy and Commerce Committee will hear testimony Wednesday on a few different bills to reverse the Trump Administration’s attacks on Obamacare, usually the precursor to a bill getting a committee vote and then advancing to the House floor.

  1. A bill to repeal the Trump administration’s expansion of short-term limited-duration plans

Short-term limited-duration health insurance is not required to comply with the ACA’s requirements around preexisting health conditions or essential health benefits. People can be denied coverage based on their medical history, and these plans don’t have to cover basic services like prescription drugs.

And under the Trump administration’s regulations, so-called “short term” insurance – previously limited to lasting just three months – can be renewed for up to 36 months.

The Trump administration projected that 200,000 or so Obamacare customers will switch from marketplace plans to short-term coverage in the coming year. Other groups project even more desertion. Those people will probably be younger and healthier, drawn to the plans by their cheaper prices and because they don’t think they’ll need robust insurance. Actuaries expect that as a result, premiums for Obamacare plans will increase as much as 10 percent on average, unless states move to regulate short-term plans more stringently.

The Democratic bill would repeal the short-term insurance regulations, blocking them from going into effect.

2.  A bill to block the Trump administration’s recent decision to relax regulations for plans sold on the ACA insurance marketplaces

The Trump administration released new guidelines last fall that would loosen some of Obamacare’s rules for waivers that states can seek to pursue their own health care ideas. One provision would allow customers to use the law’s generous tax subsidies to pay for those short-term insurance plans, heightening the risk that more people would abandon Obamacare for Trump-approved coverage. The requirement that any waiver would cover the same number of people would also be also softened, opening up the possibility that states could get approval for waivers that actually cover fewer people.

The Democratic bill would likewise block the Trump administration’s guidance from taking effect and prevent any similar changes from being implemented in the future.

3. A bill to increase funding for Obamacare enrollment and outreach efforts, which have been cut by the Trump administration

The Trump administration slashed federal funding for outreach and enrollment from $100 million to $10 million in its first year and kept outreach funding at that lower level in its second year. Obamacare enrollment fell off slightly in both those years, and research has shown the many uninsured people who are eligible for the ACA’s financial assistance don’t know that the law’s marketplaces exist or that tax credits are available to them so they can buy health coverage.

The Democratic bill would require the administration to perform enrollment and outreach activities and provide $100 million annually for those efforts….

February 19, 2019: The Sun-Sentinel posted an article titled: “Bill aims to protect pre-existing conditions from ‘catastrophic’ Obamacare repeal”. It was written by Ron Hurtibise. From the article:

If Congress or the Supreme Court kills the Affordable Care Act, one of the act’s key provisions – that people with pre-existing conditions have access to health insurance – could be preserved for Florida consumers under a bill advanced by a state Senate committee Tuesday.

How beneficial that access would be without cost controls is not yet known…

…Florida has the largest enrollment of the 39 states that rely on the federal marketplace. During the most recent open enrollment period from Nov. 1 to Dec. 22, more than 1.78 minion Floridians registered. That exceeded the 2018 total of 1.76 million and the 2017 total of 1.71 million.

The bill by Sen. Wilton Simpson, a Republican from Spring Hill, was advanced by a 6-1 vote, with support from two of four Republicans and all for Democrats on the committee. Sen. Jeff Brandes, Republican from St. Petersburg, voted against it, and Sen. Joe Gruthers, a Republican from Sarasota, was absent.

Committee Chairman Doug Broxson a Republican whose Senate district is in the western panhandle, called the protection “the right thing for Florida to do.”…

…But others on the committee questioned why the bill did not address the cost of premiums for the one policy covering pre-existing conditions.

Simpson said “rules and restrictions” could be addressed later…

…The bill still faces additional Senate committees, a full Senate vote, negotiations with the House if that chamber passes a similar bill, and scrutiny from the governor…

February 19, 2019: The Los Angeles Times posted an article titled: “Courts hammer Trump for sabotaging Obamacare, in rulings that could cost the Treasury billions”. It was written by Michael Hiltzik. From the article:

…The most recent beneficiary of a court judgement is the Los Angeles L.A. Care Health Plan, which was awarded nearly $6 million on Feb. 14 by Judge Thomas C. Wheeler of the Court of Federal Claims. Observing that the money was promised by the ACA and that Trump had no right to stiff the insurers, Wheeler wrote that “L.A. Care Should not be left ‘holding the bag’ for taking our Government at its word.”

The money is the so-called cost-sharing reduction written into the ACA. It was designed to cover a subsidy made available to buyers of ACA exchange plans with household income below 250% of the federal poverty limit, or $63,125 this year for a family of four. Those buyers receive not only a subsidy to reduce their insurance premiums, but also an additional subsidy to reduce their deductibles and co-pays…

…So far, more than 90 insurers, including scores brought into court as part of a class-action lawsuit, have won their cases before the Court of Claims. The rulings are coming from Wheeler and his bench colleagues Margaret M. Sweeney, who decided the class-action case on Feb. 15, and Elaine D. Kaplan, who ruled in a Montana case in September. As Bagley observed, “None of these judges bought the Justice Department’s rationale for refusing to pay. And good reason: it’s garbage.”.

What’s most interesting about these rulings, experts say, is that they apply to expenses that the insurers essentially worked their way around in 2018, through a maneuver known as “silver loading.”

Essentially, the insurers calculated their potential losses from the CSR suspension, then raised their premiums for benchmark silver ACA plans to cover the losses. This was done with the agreement of state regulators, including Covered California, which oversees the ACA plans in that state.

Because the benchmark plans also set the levels of premium subsidies for all ACA plans, this turned out to be a boon to millions of ACA buyers – the subsidies increased to the point that they made higher-benefit gold and platinum plans cheaper and, in many cases, made lower-benefit bronze plans free for buyers. The U.S. Treasury ended up eating the higher cost…

…But that brings another wrinkle in the latest court rulings. For the most part, the judges say it doesn’t matter that the insurers worked around the lost cost-sharing reimbursements – the federal government owes them that money anyway, year after year. That’s the source of the $12-billion annual estimate…

February 19, 2019: Journal Sentinel posted an article titled: “Wisconsin GOP senators stand against expanding BadgerCare Plus under Obamacare”. It was written by Patrick Marley. From the article:

Republican state senators made clear Tuesday that they are all but certain to block Democratic Gov. Tony Evers’ plan to expand BadgerCare Plus under Obamacare.

In the state budget he will introduce next week, Evers plans to accept more federal Medicaid money to make BadgerCare available to 76,000 more people. The plan would free up $280 million in state money over two years that could be used for other purposes.

Republicans who control the Legislature are not on board with that idea…

…Republicans control the Senate 19-14 and are expected to finalize the budget without Democratic support.

Republicans need 17 votes to pass a budget through the Senate, and they will be short of that number if Craig, Kapenga and Strobel oppose it…

February 22, 2019: The New York Times posted an article titled: “Trump Administration Blocks Funds for Planned Parenthood and Others Over Abortion Referrals”. It as written by Pam Belluck. From the article:

The Trump administration announced Friday that it will bar organizations that provide abortion referrals from receiving federal family planning money, a step that could strip millions of dollars from Planned Parenthood and direct it toward religiously-based, anti-abortion groups.

The new federal rule is almost certain to be challenged in court. Clinics will be able to talk to patients about abortion, but not where they can get one. And clinics will no longer have counsel women on all reproductive options, including abortion, a change that will make anti-abortion providers eligible for funding.

The rule, which has been expected for months, is the most recent step by the Trump administration to shift the direction of federal health programs in a conservative direction. The administration has expanded the ability of employers to claim religious or moral objections to the Affordable Care Act’s requirement that stye offer employees insurance coverage for contraception. It has channeled funding for teen pregnancy prevention programs and family planning grants into programs that emphasize sexual abstinence over contraception.

Some of these changes are being challenged in lawsuits by groups that support reproductive rights, but the new policies have broad support among evangelicals, who are a big part of the president’s political base.

The rule announced Friday is not a wholesale defunding of Planned Parenthood, a long-held goal of conservatives. Organizations receiving money through the federal family planning program, called Title X, will still be able to perform abortions but will have to do so in a separate facility from their other operations and adhere to the new requirement that they not refer patients to it.

Organizations that receive federal funds have already been prohibited for years from using that money to finance abortion services. The new rule goes a step farther by ordering them to keep separate books for their abortion operations…

…Title X provides $286 million in funding for programs that provide services like birth control, screening for breast cancer and cervical cancer and screening and treatment for sexually transmitted diseases. These programs serve about 4 million patients each year, many of them poor, at more than 4,000 clinics. About 40 percent of those clinics are operated by Planned Parenthood, which receives close to $60 million through the family planning program each year…

…But several medical organization predicted that the new rule would ultimately leave large numbers of patients, especially low-income and minority women, without access to care…

February 24, 2019: CALmatters posted an article titled: “Trump’s under-the-radar $1 abortion bill idea: Will it undermine Obamacare in California?” It was written by Elizabeth Aguilera. From the article:

A little-noticed Trump administration proposal aims to force California’s health exchange insurers to send all their customers a second premium bill every month, for $1 – the amount the state requires to cover unrestricted abortion benefits.

The Resistance State, unsurprisingly, is pushing back. State official fear that many Californians insured through the Covered California exchange will be confused about receiving a second monthly bill, and may even neglect to pay it, putting their coverage at risk. And the insurers warn that the cost and labor involved in sending multiple bills for 1.5 million people could drive up the cost of their premiums…

…The reason for such segregation: Federal programs, including the Affordable Care Act (Obamacare) insurance plans receiving federal subsidies, only allow abortion coverage in cases of rape, incest, or if the mother’s life is in danger, as outlined in the Hyde amendment. Conversely, California law requires insurers to include abortion services in all health care plans – an extra cost which Covered California insurers now collect by factoring an extra dollar in to the total cost of a customer’s existing monthly bill.

That’s not enough, the Trump administration contends.

“The administration is committed to making sure taxpayer dollars are spent appropriately,” said Seema Verma, administrator for the Center for Medicare and Medicaid Services, which is overseeing this proposed change. Her statement added that the goal is simply to enforce existing laws that require “separate” billing for abortion services.

Critics see the $1 abortion bill idea as another Trump attempt to undermine Obamacare and abortion services.

“This policy can only be understood as an attempt to impose an arbitrary political penalty on states offering non-Hyde abortion services,” Blue Shield of California wrote in its opposition letter to the federal government…

…The nonprofit insurers argued in a letter to the federal government that it already has a system in place that segregates abortion fees from federal program dollars, and predicted that the substantial costs involved in sending out double bills and replying to bewildered customers could lead to increased premiums. Blue Shield has 435,000 members in Obamacare plans.

For Blue Shield, the cost could be $4 to $6 million to implement and about $900,000 monthly, Cohen said…

Leading to what is expected to be a national battle over the issue, California on Monday sued the Trump administration seeking to block a new regulation that restricts access to abortion and other family-planning services.

The lawsuit, which was filed in federal court in Northern California against the U.S. Department of Health and Human Services, is the first volley of what is expected to be a barrage of litigation by states, family-planning groups and others challenging restrictions prohibiting clinics that receive federal family-planning money from offering abortions or referring women to abortion services. Oregon’s attorney general said her state and 20 others, including New York, plan to file a lawsuit on Tuesday. Washington officials said last week that they plan to sue.

The filing seeks an injunction against the rules adopted for Title X of the Public Health Service Act, the federally funded program devoted to family planning…

…The rule affects some 4 million mostly low-income people nationwide, [California Atty. General Xavier] Becerra said.

California had the nation’s largest Title X program, serving some 1 million patients annually – more than 25% of all Title X patients nationwide.

The lawsuit says the new rule will affect programs funded through Essential Access Health, including services provided by Planned Parenthood affiliates.

The lawsuit says the new rule will affect programs funded through Essential Access Health, including services provided by Planned Parenthood.

In seeking an injunction, the state argues that the federal agency has exceeded the scope of its statutory authority and acted in a manner that is arbitrary and a violation of the federal Administrative Procedure Act and the U.S. Constitution…

February 26, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a statement titled: “The final Title X Regulations Disregards Expert Opinion and Evidence-Based Practices”. From the statement:

The Department of Health and Human Services has released a final regulation that will significantly limit the health care available to patients under Title X of the Public Health Services Act (Title X). Leading women’s health care provider groups, medical organizations, and physician leaders representing more than 4.3 million health care providers are alarmed by the new regulation which disregards the expertise of the medical and scientific community and evidence-based standards.

“As the only federal program exclusively dedicated to providing low-income patients, including adolescents, with access to family planning and preventative health services and information, Title X plays a vital role in the fabric of America’s family planning safety net. The final regulation is the latest in numerous recent decisions – from rolling back insurance coverage for contraceptives to attempting to eliminate funding for evidence-based teen pregnancy prevention programs – that unravel the threads of this safety net. Together, these decisions compound, leaving women and families with increasingly fewer options for obtaining medically accurate, affordable, and timely access to contraception and preventative care.

“The new regulations weakens existing standards requiring that family planning programs funded through Title X offer a range of evidence-based contraception options. It also conditions federal funding for family planning services on a requirement that providers omit certain information in counseling patients and seeks to exclude a qualified providers from Title X.

“This regulation will do indelible harm to the health of Americans and to the relationship between patients and their providers. By forcing providers to omit critical information about health care and resources available, the final regulation directly undermines patients’ confidence in their care.

“There is no room for politics in the exam room. For the health of the American people, every individual must have access to comprehensive, affordable care in a safe and timely fashion, just as every provider must be able to deliver medically accurate information and care. The administration should retract this regulation and consider the record volume of comments from the medical, scientific, and patient advocacy communities. Family planning policy should be driven by facts, evidence, and necessity, not politics or ideology.”

This press release was signed by:

  • The American College of Obstetricians and Gynecologists
  • The American Academy of Pediatrics
  • The American College of Nurse-Midwives
  • The American College of Osteopathic Obstetricians and Gynecologists
  • The American College of Physicians
  • The American Nurses Association
  • The American Psychiatric Association
  • The American Society for Reproductive Medicine
  • The American Urogynecologic Society
  • The Association for Physician Assistants and Obstetrics and Gynecology
  • The North American Society for Pediatric and Adolescent Gynecology
  • The National Association of Nurse Practitioners in Women’s Health
  • Nurses for Sexual and Reproductive Health
  • The Society for Adolescent Health and Medicine
  • The Society for Academic Specialists in General Obstetrics and Gynecology
  • The Society for Maternal-Fetal Medicine
  • The Society of Family Planning
  • The Society of Gynecologic Oncology

February 27, 2019: CBS News posted an article titled: “Senate rejects “born-alive” bill as anti-abortion advocates reignite “late-term” abortion debate”. It was written by Kate Smith. From the article:

The “Born-Alive Abortion Survivors Protection Act”, a piece of legislation that echoed existing laws and medical practice, had little chance of passing in the Senate on Monday evening. And, as predicted, it ultimately failed.

But its introduction and subsequent debate underscores something larger and more substantial than the bill itself: a push by the conservative right to reframe the reproductive rights debate toward third-trimester abortions…

…The legislation, which fell seven votes short of the 60 it needed to move forward — would have required doctors to provide care to infants who “survive an abortion or attempted abortion.” A similar bill passed in 2002, but the most recent one was different in a key way: It would have imposed fines and potential jail time for doctors who didn’t provide care.

Abortion rights advocates rebuked the legislation and the theoretic surrounding it, saying that the situation described in the bill – infants surviving abortions — is an extreme rarity, only occurring in instances of abnormalities so severe that the fetus has been deemed unviable. “When you’re providing abortion care, this isn’t something that happens, Elizabeth Nash, a senior state issues manager at the Guttmacher Institute, said in a telephone interview with CBS on Monday…

…Mazie Hirono from Hawaii called the bill “a solution in search of a problem.”…

…Democrats pointed out that doctors are already required by federal law to provide care to infants born alive after an attempted abortion. “It is, and always has been, a crime not to,” Hirono said Monday…

March 4, 2019: The Los Angeles Times posted an article titled: “California sues Trump administration over rules restricting abortion access”. It was written by Patrick McGreevy. From the article:

Leading what is expected to be a national battle over the issue, California on Monday sued the Trump administration seeking to block a new regulation that restricts access to abortion and other family-planning services.

The lawsuit, which was filed in federal court in Northern California against the U.S. Department of Health and Human Services, is the first volley of what is expected to be a barrage of litigation by states, family-planning groups and others challenging the restrictions prohibiting clinics that receive federal family-planning money from offering abortions or referring women to abortion services. Oregon’s attorney general said her state and 20 others, including New York, plan to file a lawsuit on Tuesday. Washington officials said last week that they plan to sue.

The filing seeks an injunction against the rules adopted for Title X of the Public Health Service Act, the federally funded program devoted to family planning…

…The rule affects some 4 million mostly low-income people nationwide, [California Attorney General Xavier] Becerra said.

California has the nation’s largest Title X program, serving some 1 million patients annually – more than 25% of all Title X patients nationwide.

The lawsuits said the new rule will affect programs funded through Essential Access Health, including services provided by Planned Parenthood affiliates.

Seeking an injunction, the state argues that the federal agency has exceeded the scope of its statutory authority and acted in a manner that is arbitrary and a violation of the federal Administrative Procedure Act and the U.S. Constitution….

The Los Angeles Times has embedded a copy of the lawsuit into that article. The lawsuit is called State of California, by and through Attorney General Xavier Becerra, v.  Alex Azar, in his official capacity as Secretary of the U.S. Department of Health & Human Services; U.S. Department of Health & Human Services.

March 5, 2019: The American Medical Association posted a press release titled: “AMA files suit to block administration’s Title X restrictions”. From the press release:

The American Medical Association (AMA) today filed a lawsuit to block the Trump Administration’s rule that would decimate the Title X program and limit the medical advice physicians can give their Title X patients. Oregon Medical Association and Planned Parenthood Federation of America joined the lawsuit.

Filed in the United States District Court, District of Oregon, the lawsuit asks the court to block the new rule. The AMA contends the rule would violate patients’ rights under the Code of Medical Ethics, would force doctors to violate their obligation to give honest and informed advice, would withhold federal family planning funding from entities that provide critical medical services to vulnerable populations, and would harm millions of patients who rely on Title X for their reproductive health….

…Congress created the Title X program to ensure that all people – especially low-income women – have access to health care for family planning. Yet, the rule would eliminate current requirements that Title X sites offer a broad range of medically approved family planning options. Through the new rule, the government endorses clinics the refuse to provide all pertinent information to patients – even if the patient requests it – and endorses clinics providing misleading information…

…The lawsuit argues the U.S. Department of Health and Human Services’ proposed rule “blesses biases and incomplete pregnancy counseling where the interests of the patient are no longer paramount.” The rule directs physicians and other providers to give pregnant patients full information about only some of their reproductive health care options while withholding information about others.

The gag rule “threatens the core of family-planning care” by interfering with communication about patients’ health care options, and sets a dangerous precedent of government interference with the patient-physician relationship. The lawsuit notes that if the rule is not blocked, it would undercut the very purpose of Title X and irreparably harm Title X providers, their patients, and the health of the nation.

In the course of its 50-year history, Title X has been an enormous success for patients, their communities and our country. Title X providers serve more than 4 million patients a year. In 2017, Title X provided more than 2.8 million patients with contraceptive services and helped women avoid more than 800,000 unintended pregnancies. Without Title X, the rates of unintended pregnancy and abortion would have been 31 percent higher, according to estimates. Most of these patients served by Title X are economically disadvantaged and live in areas where there are few health care options.

If the rule becomes law, vast swaths of providers would have no choice but to withdraw from Title X entirely. These consequences would be disproportionately felt by the very patients that Title X was meant to help.

The lawsuit filed by The American Medical Association is called American Medical Association; Oregon Medical Association; Planned Parenthood Federation of America, Inc.; Planned Parenthood of Southwestern Oregon; Planned Parenthood Columbia Willamette; Thomas N. Ewing, M.D.; Michele P. Megregian, C.N.M., v Alex M. Azar II, in his official capacity as the Secretary of Health and Human Services; United States Department of Health and Human Services; Diane Foley M.D. in her official capacity as the Deputy Assistant Secretary, Office of Population Affairs; Office of Population Affairs

March 6, 2019: NPR posted an article titled: “Trump’s Overhaul of Federal Family Planning Program Faces Multiple Lawsuits”. It was written by Sarah McCammon. From the article:

Days after its official publication, a new Trump administration rule dramatically overhauling the federal Title X family planning program is facing multiple legal challenges. Several medical and reproductive rights groups, as well as 21 state attorneys general, have filed lawsuits challenging the rule, which bans any organization that provides or refers women for abortions from receiving funds through the program to provide services such as contraception and STD screenings.

The latest lawsuit, filed Wednesday by the Center or Reproductive Rights, aims to block what abortion rights advocates are describing as a “gag rule.” CRR is filing the suit on behalf of Maine Family Planning, the sole Title X grantee in Maine….

…Reproductive rights groups argue a dramatic shift in the Title X program could devastate networks that provide reproductive health care, including contraception, for low-income people.

The filing by CRR follows a pair of related suits filed in federal court in Oregon this week, one by Planned Parenthood and the American Medical Association, and another by the group of 21 state attorneys general. They argue the rule is unconstitutional and interferes with doctor-patient communication in a way that violates federal law, including the Affordable Care Act…

…The National Family Planning and Reproductive Health Association has announced plans to file its own suit in the coming days on behalf of its member clinics in conjunction with a clinic in Washington state. On Monday, Essential Access Health, which administers Title X grants in California, announced a lawsuit challenging the rule on behalf of patients in that state…

…Unless a judge blocks the new rule, it’s set to take effect in a little less than two months.

March 7, 2019: Forbes posted an article titled: “Florida Blue’s Obamacare Enrollment Steady At 1M After Rival Oscar’s Launch”. It was written by Bruce Japsen. From the article:

Blue Cross and Blue Shield of Florida tallied 1.1 million Obamacare enrollees for this year, holding its own amid the aggressive entrance of startup Oscar Health into the fast-growing Orlando market.

Florida Blue has successfully fought off allegations brought by Oscar that the state’s largest health insurer has engaged in monopolistic unfair business practices. Oscar entered the Florida market for the first time this year as part of a national expansion…

…Florida’s nearly 1.8 million Obamacare enrollees account for the biggest share of Amy of the 39 states that use the federal health insurance exchange, which makes it an attractive market for Florida Blue, Oscar and other insurers like Centene to sell individual coverage there. Nationally, enrollment via the federal health insurance exchange was more than 8.4 million, which was down slightly from 8.7 million last year, the Centers for Medicare & Medicaid Services said in January.

Oscar also did well in Florida in its first year offering coverage there. Oscar signed up 31,000 members in the Orlando market, which includes enrollment from Orange, Osceola, Seminole and Lake counties….

March 11, 2019: The New York Times posted an article titled: “Trump Proposes Record $4.75 Trillion Budget”. It was written by Jim Tankersley and Michael Tackett. From the article:

President Trump sent Congress on Monday a record $4.75 trillion budget plan that calls for increased military spending and sharp cuts to domestic programs like education and environmental protection for the 2020 fiscal year.

Mr. Trump’s budget, the largest in federal history, includes a nearly 5 percent increase in military spending – which is more than the Pentagon had asked for – and an additional $8.6 billion for the construction of a wall along the border with Mexico. It also contains what White House officials called a total of $1.9 trillion in cost savings from mandatory safety-net programs, like Medicaid and Medicare, the federal health care programs for the elderly and the poor.

The budget is unlikely to have much effect on spending levels which are controlled by Congress. Democratic leaders in both the House and the Senate pronounced the budget dead on arrival on Sunday, and Mr. Trump’s budgets largely failed to gain traction in previous years, when fellow Republicans controlled both chambers…

…The budget would curb the growth of Medicare and Medicaid, two programs Mr. Trump had previously pledged to leave intact. And it proposes shaving $818 billion from projected spending on Medicare over 10 years and cutting nearly $1.5 trillion from projected spending on Medicaid.

In place of the open-ended federal contribution to Medicaid, Mr. Trump would give states “market-based health care grants” – lump sums of federal money or per capita allotments – totaling $1.2 trillion over 10 years. Congress rejected this idea in 2017 when Republicans proposed it because it would essentially cap Medicaid payments at a fixed level and would not keep pace with rising health care costs.

Mr. Trump also proposed new work requirements for working-age recipients of food stamps, federal housing support, and Medicaid, a move the administration said would reduce spending on those programs by $327 billion over a decade because it would disqualify many who currently receive assistance.

Payments to a variety of health care providers would also be cut. Medicare payments to hospitals for unpaid bills and uncompensated care would be reduced by $136 billion over 10 years. Mr. Trump would cut projected Medicare payments to hospital outpatient departments by $131 billion over 10 years.

In addition, the budget squeezes more than $100 billion over 10 years from Medicare payments to nursing homes and home health agencies that care for Medicare patients who have left the hospital.

The president offers a suite of proposals to lower prescription drug prices,, with federal savings estimated at $69 billion over 10 years. The changes to the drug program may have the effect of increasing premiums for Americans who rely on Medicare, but they would also, for the first time, limit the amount that seniors with very expensive drugs could be asked to pay each year. Some of the plans resemble proposals unsuccessfully offered by President Barack Obama.

And Mr. Trump proposed spending $26 billion less on Social Security programs, the federal retirement program, including a $10 billion cut to the Social Security Disability Insurance program which provides benefits to disabled workers. Those cuts would be achieved in various ways, including more aggressively policing fraud in the program…

March 16, 2019: The New York Times posted an article titled: Judge Blocks Kentucky Fetal Heartbeat Law that Bans Abortion After 6 Weeks”. It was written by Sarah Mervosh. From the article:

A federal judge on Friday temporarily blocked a Kentucky law that prohibits abortion after a fetal heartbeat is detected, which typically happens around six weeks into pregnancy, before many women know they are pregnant.

The measure, which was signed into law on Friday by the state’s Republican governor, Matt Bevin, and was set to take effect immediately, was poised to become one of the strictest anti-abortion laws in the country.

But late on Friday, the judge, David J. Hale of the Western District of Kentucky, ruled the law was potentially unconstitutional. He halted enforcement for at least 14 days to “prevent irreparable harm” until he could hold a hearing…

…The American Civil Liberties Union challenged both measures in a lawsuit filed this week on behalf of EMW Women’s Surgical Center, the state’s only licenses abortion clinic…

…The landscape of the Supreme Court changed last year after Justice Brett M. Kavanaugh, seems as a reliable conservative, replaced the court’s longtime swing vote, Justice Anthony M. Kennedy, who retired. The change added urgency to the question of whether Roe v. Wade, the landmark 1973 ruling that made abortion legal nationwide, would survive the Trump administration.

But legal experts have suggested that any developments, at least in the near term, will most likely come at the state level, with states succeeding in smaller cases that limit – but not eliminate – the right to an abortion. Other states, including Iowa and North Dakota, have passed similarly prohibitive fetal heartbeat measures only to have them swiftly voided by the courts…

March 20, 2019: Courier Journal (part of the USA Today network) posted an article titled: “Judge bars another Kentucky abortion bill Gov. Bevin signed into law”. It was written by Deborah Yetter. From the article:

A federal judge has blocked Kentucky from enforcing another new abortion law, one day after it was signed into law by Gov. Matt Bevin.

U.S. District Judge David Hale late Wednesday ordered the state to temporarily halt enforcement of House Bill 5, which bans abortion for reasons of race, gender, or disability of the fetus.

Hale’s order comes five days after he blocked temporarily another new state law signed last week by Bevin, Senate Bill 9, which bans abortion in Kentucky once a fetal heartbeat is detected, usually around six weeks into a pregnancy. Opponents have argued it’s essentially a ban on abortion because many women don’t realize they are pregnant that early…

…Hale’s temporary orders blocking both laws are good for 14 days until he can hold a hearing on the matter.

The ACLU is asking the federal judge to block both laws indefinitely until he rules on whether they are constitutional…

The American Civil Liberties Union had sought the orders from Hale after filing a lawsuit last week, challenging both new laws as unconstitutional…

March 20, 2019: Concord Monitor posted an article titled: “State, national organizations sue Trump administration to stop N.H. Medicaid work requirement”. It was written by Ethan DeWitt. From the article:

Group of state and national organizations are suing the federal government to halt New Hampshire’s Medicaid expansion work requirement, arguing that the program will unlawfully lead to low-income residents being kicked off their health insurance.

In a filing in the U.S. District Court for the District of Columbia submitted Wednesday, the organizations, including New Hampshire Legal Assistance (NHLA), contend that the Centers for Medicare and Medicaid Services (CMS) violated the tenets of the Medicaid Act by granting New Hampshire the authority to require individuals work 100 hours a month in order to receive health benefits.

“Our concern is that folks who are eligible and working will in fact lose coverage,” Dawn McKinney, policy director at NHLA. “The majority of folks in New Hampshire on Medicaid are in working households, and their concern is just even having to file additional paperwork or navigate these requirements will cause them to lose coverage.”

The class action lawsuit includes four New Hampshire plaintiffs, each of whom the organizations say will struggle to fulfill the 100-hour-per-month work requirement…

…In an interview, Department of Health and Human Services Commissioner Jeff Meyers said that the department has been working to ensure that no one was unfairly denied coverage under the work requirement, and would continue implementing the requirement until court intervened…

…Joining the NHLA in filing the lawsuit are two national organizations, the New York-based National Center for Law and Economic Justice and the Washington, D.C.-based National Health Law Program, which is serving as lead counsel. The latter organization has served as lead counsel for the two continuing federal lawsuits against the programs in Kentucky and Arkansas…

March 21, 2019: Planned Parenthood posted a press release titled: “Breaking: Gov. Signs Sweeping Abortion Ban in Mississippi”. From the press release:

Today, Mississippi’s Governor signed a dangerous and unconstitutional six-week abortion ban. This law bans abortion in the state before many women even know they are pregnant. Mississippi is one of 15 states to introduce six-week abortion bans this year as part of an aggressive anti-abortion agenda sparked by the Trump administration and the addition of Brett Kavanaugh to the Supreme Court. Despite state politicians and courts continuing to erode Roe v. Wade and abortion access, poll after poll shows Americans want to protect access to safe, legal abortion. If Roe is overturned, 25 million women of reproductive age could lose abortion access altogether. In Mississippi, women could immediately lose access to abortion if this new law is allowed to take effect.

Several other states, like Oklahoma, Kentucky, and Tennessee, are actively pursuing legislation that would immediately ban abortion outright if Roe v. Wade is overturned. With Kavanaugh on the Supreme Court and Trump in the White House, it’s clear that anti-abortion politicians are emboldened — pushing lies and misinformation about abortion, and doing just about anything to make abortion inaccessible in this country.

While some politicians push these harmful policies, Trump has also ignited a powerful counter-trend in positive policies. In fact, reproductive rights advocates in more than half the sates are fighting back, advancing legislation that would protect and expand access to reproductive health care including safe, legal abortion…

…Court after court, including in North Dakota, Iowa, Kentucky, and Mississippi, have struck down similar bans finding them unconstitutional. Yet Mississippi is ignoring well-settled law and putting women and doctors at risk in the process.

The press release included a statement from Dr. Leana Wen, President of Planned Parenthood Federation of America:

“Mississippi’s six-week abortion ban is a dangerous policy that criminalizes a safe, standard medical procedure and will endanger women’s lives. I know firsthand just how important it is for doctors to have the ability to provide the care that our patients need. Patients must be empowered to make their own health care decisions, in consultation with their doctor and their family, and doctors must be able to provide health care to our patients without the threat of prison time. We cannot accept a world where the right to abortion care depends on where you live or how much money you make. Planned Parenthood will fight to ensure our patients have access to safe, legal abortion in Mississippi and across the country.”

March 21, 2019: The New York Times posted an article titled: “Mississippi Bans Abortions if Heartbeat Can Be Heart. Expect a Legal Fight.” It was written by Timothy Williams and Alan Blinder. From the article:

Phil Bryant, the Republican governor of Mississippi, on Thursday signed a bill largely banning abortions once doctors can detect a trace of a fetal heartbeat with an ultrasound, a milestone that can come as early as six weeks into pregnancy.

Mississippi is only the latest state to press for the strict abortion limit – the sort that has already been passed and then blocked in the courts in states including Kentucky, which approved it earlier this month, and Iowa, where a law passed last year was struck down by a state court in January. Another 10 states also are debating bills to ban abortions once fetal heartbeats are found, a point at which some women and girls are not yet aware that they are pregnant….

…The measures clash with Supreme Court decisions that have recognized a woman’s right to an abortion until a fetus is viable outside the womb, usually around 24 weeks into pregnancy. And opponents of abortion say that is part of the intent: To land a new case before the Supreme Court in hopes of setting sharper limits or even an outright ban. The confirmation of Justice Brett M. Kavanaugh – and the potential shifting of the court’s direction – has provoked new urgency among critics of abortion…

…Florida, Missouri, Ohio, Tennessee, and Texas are among the states expected to approve fetal heartbeat measures this year…

..In several states this year, including Oklahoma, seek to add abortion to felony homicide laws, potentially sending doctors to prison…

And a relatively new strategy in limiting abortions would ban the procedure if the reason for it was Down syndrome. Utah, Arkansas, Missouri and Kentucky are considering such bills this year, which also prohibit abortions based on gender, race, or color. Kentucky’s law signed Tuesday by Gov. Matt Bevin, was temporarily blocked by a federal court judge the next day.

Ohio, Tennessee and several other states are also considering so-called trigger laws, which would immediately ban abortions if Roe v. Wade was overturned. Arkansas approved a trigger law last month…

…Arkansas, which five years ago saw a court strike down its ban on abortions after 12 weeks if a heartbeat could be detected, this month narrowed the period from 20 weeks to 18 weeks, in which abortions are permitted under state law. Asa Hutchinson, the state’s Republican governor, signed the bill into law last month…

…Mississippi, which as a single abortion clinic, often takes some of the country’s most aggressive stands against abortion rights. In November, a federal judge blocked state law that would have banned abortions after 15 weeks…

…If the courts ultimately uphold Mississippi’s 15-week ban, a similar law will take effect in Louisiana.

March 21, 2019: Wisconsin Public Radio posted an article titled: “JudgeBlocks GOP Laws Passed In Lame Duck Session”. It was written by Shawn Johnson. From the article:

A judge has struck down the laws Wisconsin Republicans passed in December’s lame-duck session of the Legislature, restoring powers to Democratic Gov. Tony Evers, if only temporarily.

Dane County Judge Richard Niess ruled Thursday that all of the laws and appointments passed by legislators were unlawful because they met in what’s known as an “extraordinary session,” which isn’t explicitly allowed under the state constitution.

“There can be no justification for enforcement of the unconstitutional legislative actions emanating from the December 2018 ‘Extraordinary Session’ that is consistent with the rule of law,” Niess wrote…

…Neiss rejected a request by the attorney for GOP legislators who would have “stayed” his decision, or kept the lame-duck laws in effect while this case is appealed. But the final say in the case still falls to the Wisconsin Supreme Court, where conservatives hold a 4-3 majority…

March 21, 2019: The Hill posted an article titled: “Wisconsin withdraws from multistate lawsuit seeking repeal of ObamaCare”. It was written by Owen Daugherty. From the article:

Wisconsin Gov. Tony Evers (D) and Attorney General Josh Kaul (D) announced Thursday they would remove Wisconsin from a multistate lawsuit seeking to repeal the Affordable Care Act, commonly known as Obamacare.

Kaul filed a motion in court Thursday asking that Wisconsin be removed from the lawsuit just hours after a judge issued a temporary block on a law introduced last year by Republican lawmakers aimed at limiting Evers’s powers.

The laws limiting Evers’s and Kaul’s powers were signed by former Gov. Scott Walker (R) last year during a lame-duck legislative session. While the laws were quickly challenged and ultimately blocked, they limited the new leadership from getting Wisconsin out of the ObamaCare repeal lawsuit until now.

The GOP-controlled Legislature passed the laws in December in an unscheduled “extraordinary session” after Walker lost his bid for a third term to Evers…

…Republican legislative leaders said they would appeal the judge’s decision…

March 22, 2019: Modern Healthcare posted an article titled: “Study: Reinsurance to cost feds $30 billion to support ACA insurers”. It was written by Robert King. From the article:

Adopting a nationwide reinsurance program to bolster Affordable Care Act insurers would cost the U.S. $30.1 billion over three years, according to a new study.

The study published Thursday in the Journal of Health Care Organization, Provision, and Financing projects that a reinsurance program with an 80% payment rate for expenditures between $40,000 and $250,000 would cost the federal government $9.5 billion in 2020 or $30.1 billion from 2020-2022.

The $30 billion over three years is close to the $10 billion-per-year reinsurance pool for ACA marketplaces that the insurance industry wants Congress to consider. However, that proposal has run into partisan clashes over whether or add anti-abortion language to the new funding, an issue the doomed efforts in the last Congress to approve ACA stabilization.

The study looked at out-of-pocket expenditures by individuals from 2015 to 2017 under an annual survey of individual households called the Current Population Survey Annual Social and Economic Supplement. It also looks at healthcare spending data from 2007 to 2016 from Medical Expenditure Panel Survey Household Component…

The study was titled: “Estimated Costs of a Reinsurance Program to Stabilize the Individual Health Insurance Market: National- and State-Level Estimates”.

March 22, 2019: App. (part of the USA Today Network) posted an article titled: “Phil Murphy: NJ getting its own Obamacare marketplace to guard against Trump.” It was written by Michael L. Diamond. From the article:

New Jersey will operate its own health insurance marketplace in 2021 in a bid to guard against the Trump administration’s attempt to unwind restrictions of the Affordable Care Act, Gov. Phil Murphy said Friday.

The decision would make New Jersey the 12th state to create its own exchange under the health care law, commonly nicknamed Obamacare. Until now, it has used an exchange operated by the federal government. And it could help the state give more residents more time to sign up.

“Because we are operating on the federal exchange, we are subject to the whims of the Trump administration and directly impacted by its effort to damage and destabilize the market,” Marlene Caride, commissioner of the state Department of Banking and Insurance, said in a statement…

…The move by Murphy is the latest step in his attempt to shore up the Affordable Care Act, a President Barack Obama-era law that has been under fire from President Donald Trump…

March 22, 2019: Vox posted an article titled: “Idaho voted to expand Medicaid. Republican lawmakers are trying to roll it back”. It was written by Dylan Scott. From the article:

Idaho Republicans are working to roll back the Medicaid expansion approve by their voters in November, another case of GOP lawmakers refusing to accept a Democratic mandate to expand health care to their constituents under the Affordable Care Act, and a reminder of the complicated legacy left by the Supreme Court’s 2012 decision on the health c are law.

The Idaho ballot referendum passed overwhelmingly in November, 61 percent to 39 percent. The initiative called for a no-frills expansion, extending eligibility to 138 percent of the federal poverty level ($17,200 for an individual, $29,400 for a family of three), as written in the ACA. If implemented, it would offer health insurance to an estimated 120,000 of the state’s poorest residents.

But under a bill passed by the Idaho House on Thursday, Medicaid eligibility would be expanded only partially, up to 100 percent of the poverty level. People above that threshold (roughly 40,000) would have to purchase private coverage through the state’s insurance marketplace set up under the ACA instead.

In addition, Medicaid beneficiaries would be required to work 20 hours a week, look for work, or be in school in order to continue receiving benefits. Exceptions would be made for children, the elderly, parents, and people “physically or intellectually unfit for employment.” If a person failed to meet that work requirement, they would lose their insurance coverage for two months before being allowed to reapply for Medicaid.

There was bipartisan opposition to this plan in the Idaho House, but the bill still passed with ease because of the overwhelming Republican majority. The Idaho Senate is advancing its own plan, which preserves the full Medicaid expansion and merely includes a provision to help beneficiaries access job training and other work-related activities. Benefits would not be conditioned on work, as in the House bill….

March 25, 2019: The National Law Review posted an article titled: “In Reversal, DOJ Now Says Whole ACA Unconstitutional”. It was written by Nate Robson. From the article:

The Justice Department now believes the entire Affordable Care Act is unconstitutional, a reversal from its position this past summer when the government said changes to the individual mandate were unconstitutional but severable from the whole law.

A Justice Department filing Monday night said the government believes a district court judge’s ruling that the entire Obama-era health care law is unconstitutional should be affirmed. Main Justice has a long tradition of defending the constitutionality of federal laws, and, while there are exceptions, it’s rare for the department to refuse to defend federal statutes.

Judge Reed O’Connor of the U.S. District Court for the Northern District of Texas ruled in December that a congressional tax law passed in 2017 – which zeroed out the penalty imposed by the ACA’s individual mandate – rendered the entire health care law unconstitutional.

The law, however, remains in effect while the ruling is being appealed to the U.S. Court of Appeals for the Fifth Circuit.

The Justice Department’s change in course comes nearly two months after now-Attorney General Bill Bar told senators during his confirmation that he was open to reconsidering the government’s stance in the case…

The National Law Review embedded a copy of the U.S. Department of Justice’s letter to the U.S. Court of Appeals for the Fifth Circuit. It said:

The Department of Justice has determined that the district court’s judgement should be affirmed. Because the United States is not urging any portion of the district court’s judgement be reversed, the government intends to file a brief on the appellees’ schedule.

March 25, 2019: Reuters posted an article titled: “Obamacare enrollment drop marginally for 2019”. From the article:

Enrollments in healthcare plans for 2019 through the Federal Obamacare marketplace dropped marginally by 300,000 from last year, according to U.S. government figures released on Monday.

The decrease in plan selections could likely be due to lower demand for exchange coverage, the Centers fro Medicare and Medicaid Services (CMS) said.

About 11.4 million people signed up for 2019 healthcare plans, according to CMS.

The agency also said it was issuing guidelines to allow issuers to continue certain health plans, often referred to as “grandmothered” plans, by one year. Such plans do not meet all the rules under Obamacare laws…

March 25, 2019: Atlanta Journal-Constitution posted an article titled: “Georgia lawmakers approve Kemp’s plan for Medicaid, Obamacare waivers”. It was written by Greg Bluestein and Ariel Hart. From the article:

The Georgia Legislature on Monday approved Gov. Brian Kemp’s proposal to give his office new powers to pursue “waiver” programs that could pave the way for a limited Medicaid expansion and ease insurance costs for some poor and middle-class Georgians.

Senate Bill 106 cleared the Georgia House by a 104-67 vote mostly among party lines after more than an hour of tense debate. The proposal, which has previously passed the Senate, now heads to Kemp’s desk and he said he will “very quickly” sign it into law.

Kemp unveiled the proposal shortly after his election with a promise it would improve government-funded health care access. He also vowed it wouldn’t lead to outright expansion of the Medicaid program, which he campaigned against during the governor’s race.

It was staunchly opposed by Democrats, who say full-on expansion is the only way to spur the economy, cover hundreds of thousands of Georgians and help rural hospitals. Some appealed to the chamber’s pride: House Minority Leader Bob Trammell called it an “abdication” because it gives the governor broad new authority without requiring any final legislative sign-off…

March 26, 2019: The Guardian posted an article titled: “Trump administration pushes to completely gut Obamacare in dramatic escalation”. It was written by Erin Durkin. From the article:

The Trump administration now believes that the entire Affordable Care Act should be struck down, a major shift in the federal government’s position and one that could endanger health coverage for millions of Americans with pre-existing conditions.

In a letter on Monday night, the justice department said it is now backing a Texas Judge’s controversial December ruling that the healthcare law known as Obamacare is unconstitutional.

Throwing out the law would end healthcare coverage for millions of people – getting rid of publicly subsidized health insurance plans sold on exchanges, the expansion of Medicaid, protections for people with pre-existing conditions, and rules letting children stay on their parent’s insurance until the age of 26…

…Until this week, the government’s position was that only part of the law – like its rules prohibiting insurance companies from denying health insurance or charging more to people with pre-existing conditions – should be struck down…

…A group of 21 Democratic states are appealing, since Trump’s justice department would not defend the law…

…Experts said the justice department’s new filing represented a dramatic shift in policy…

March 26, 2019: Donald Trump tweeted: “The Republican Party will become “The Party of Healthcare!”.

March 26, 2019: The Guardian posted an article titled: “Trump expands global gag rule that blocks US aid for abortion groups”. It was written by Julian Borger. From the article:

The Trump administration has expanded its ban on funding for groups that conduct abortions or advocate abortion rights, known as the global gag rule, and has also cut funding to the Organization of American States for that reason.

The new policy was announced on Tuesday by the secretary of state, Mike Pompeo…

…The Trump administration has already expanded the reach of the funding ban which dates back to the Reagan administration, to apply to all US healthcare assistance, totaling about $6bn.

The extension of the policy announced by Pompeo would not only cut funding to foreign non-governmental organizations directly involved in abortions or abortion rights advocacy, but also those who fund or support other groups which provide or discuss abortion.

Critics of the policy, also known as the Mexico City rule, say it has led to deep cuts in funding for family planning, women’s and reproductive health programs. Studies have shown that it has increased the number of abortions where the policy has been strictly enforced, by decreasing access to contraceptives and other family planning support. And by forcing women to seek backstreet abortions, the critics say it leads to more deaths of mothers and babies.

Aid groups have said that the reduction of funding for primary health care clinics has affected treatment for other widespread diseases like TB, malaria and HIV….

…Pompeo also said the state department would more strictly enforce a rule that bans funding for organizations the debate the issue of abortions, saying that would affect the Organization of American States (OAS)…

…Pompeo did not provide a dollar amount for the reduction of OAS contributions or name the OAS organ he was referring to. A letter signed by Republican senators in December, claimed that the Inter-American Commission on Human Rights and Inter-American Commission on Women were lobbying for the legalization of abortion in Latin American countries where it is banned…

March 26, 2019: The Democrats in the U.S. House of Representatives created a plan to improve the Affordable Care Act. Here is some information about H.R. 1884 – To amend the Patient Protection and Affordable Care Act to improve affordability of, undo sabotage with respect to, and increase health insurance coverage, and for other purposes.

This bill was sponsored by Representative Frank Pallone Jr. (Democrat- New Jersey). It has 102 co-sponsors:

  • Richard E. Neal (D-Massachusetts)
  • Robert C. “Bobby” Scott (D-Virginia)
  • Steny H. Hoyer (D-Maryland)
  • Kim Schrier (D-Washington)
  • Gilbert Ray Cisneros Jr. (D-California)
  • Diana DeGette (D-Colorado)
  • Kathy Castor (D-Florida)
  • Lori Trahan (D-Massachusetts)
  • Angie Craig (D-Minnesota)
  • Ann M. Kuster (D-New Hampshire)
  • Raul Ruiz (D-California)
  • Brendan Boyle (D-Pennsylvania)
  • Colin Z. Allred (D- Texas)
  • Cheri Bustos (D-Illinois)
  • Lucy McBath (D-Georgia)
  • Ben Ray Lujan (D-New Mexico)
  • Ted Lieu (D-California)
  • Scott H. Peters (D-California)
  • Frederica S. Wilson (D-Florida)
  • Abigal Davis Spanberger (D-Virginia)
  • Harley Rouda (D-California)
  • Lauren Underwood (D-Illinois)
  • Antonio Delgado (D-New York)
  • Susie Lee (D-Nevada)
  • Lisa Blunt Rochester (D-DE at Large)
  • Lloyd Doggett (D-Texas)
  • Jimmy Gomez (D-California)
  • Debbie Dingell (D-Michigan)
  • Donna E. Shalala (D-Florida)
  • Lois Frankel (D-Florida)
  • Anna Eschoo (D-California)
  • Albio Sires (D-New Jersey)
  • Darren Soto (D-Florida)
  • Shelia Jackson Lee (D-Texas)
  • William R. Keating (D-Massachusetts)
  • Haley M. Stevens (D-Michigan)
  • David J. Trone (D-Maryland)
  • Max Rose (D-New York)
  • Ann Kirkpatrick (D-Arizona)
  • John B. Larson (D-Connecticut)
  • John Lewis (D-Georgia)
  • Pramlia Jayapal (D-Washington)
  • Sylvia R. Garcia (D-Texas)
  • Joe Courtney (D-Connecticut)
  • Linda T. Sanchez (D-California)
  • Val Butler Demmings (D-Florida)
  • Stephanie N. Murphy (D-Florida)
  • Madeline Dean (D-Pennsylvania)
  • Steve Cohen (D-Tennessee)
  • Mike Thompson (D-California)
  • Bobby L. Rush (D-Illinois)
  • Joseph D. Morelle (D-New York)
  • Katie Hill (D-California)
  • Brian Higgins (D-New York)
  • Susan A. Davis (D-California)
  • Julia Brownley (D-California)
  • Bill Pascrell Jr. (D-New Jersey)
  • Elissa Slotkin (D-Michigan)
  • Eliot L. Engel (D-New York)
  • Andy Kim (D-New Jersey)
  • Earl Blumenauer (D-Oregon)
  • Jahana Hayes (D-Connecticut)
  • TJ Cox (D-California)
  • Mark Takano (D-California)
  • Daniel T. Kildee (D-Michigan)
  • Tom Malinowski (D-New Jersey)
  • Andy Levin (D-Michigan)
  • Jared F. Golden (D-Maine)
  • Jefferson Van Drew (D-New Jersey)
  • Debbie Mucarsel-Powell (D-Florida)
  • Raul M. Grijalva (D-Arizona)
  • Adriano Espaillat (D-New York)
  • Janice D. Schakowsky (D-Illinois)
  • Chellie Pingree (D-Maine)
  • Eleanor Holmes Norton (D-MP At Large)
  • Gregorio Killi Camacho Sabian (D-MP-At Large)
  • Thomas R. Suozzi – (D-New York)
  • Ron Kind (D-Wisconsin)
  • Eddie Bernice Johnson (D-Texas)
  • Michael F. Doyle (D-Pennsylvania)
  • Doris O. Matsui (D-California)
  • Jason Crow (D-Colorado)
  • Katherine M. Clark (D-Massachusetts)
  • Denny Heck (D-Washington)
  • Chris Pappas (D-New Hampshire)
  • Suzanne Bonamici (D-Oregon)
  • Alcee L. Hastings (D-Florida)
  • John P. Sarbanes (D-Maryland)
  • Jackie Speier (D-California)
  • Paul Tonko (D-New York)
  • C.A. Dutch Ruppersberger (D-Maryland)
  • Theodore E. Deutch (D-Florida)
  • Rosa L. DeLauro (D-Connecticut)
  • Jamie Raskin (D-Maryland)
  • Nanette Diaz Barragan (D-California)
  • Grace F. Napolitano (D-California)
  • Ami Bera (D-California)
  • Chrissy Houlahan (D-Pennsylvania)
  • Sharice Davids (D-Kansas)

March 26, 2019: The Center on Budget and Policy Priorities posted information titled: “House Bill Would Make Significant Progress on Health Care Affordability and Coverage”. It was written by Aviva Aron-Dine. From the information:

House legislation introduced today would lower health insurance premiums by hundreds or thousands of dollars per year for more than 13 million people and extend coverage to millions more. The bill, introduced by Reps. Frank Pallone, Richard Neal, and Bobby Scott (chairs of the three committees with jurisdiction over major health care programs), would substantially improve financial assistance for people purchasing coverage through the Affordable Care Act (ACA) marketplaces, strengthen protections for people with pre-existing health conditions, and reverse Trump Administration actions that have made it harder for people to learn about and enroll in coverage.

Making coverage more affordable. The bill, the Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019, would guarantee almost all consumers an option to purchase health insurance for low- moderate – and middle-income individual market consumers, reducing premiums for more than 13 million people.

  • The bill would make financial assistance more adequate for low- and moderate- income people. While people with incomes below 400 percent of the poverty line are already eligible for premium tax credits that help them afford marketplace coverage, data suggest that low- and moderate-income people still face the greatest challenges affording coverage and care. The new bill would increase premium tax credits, thereby reducing premiums, for these customers…
  • The bill would eliminate the income cap on premium tax credits. That means that people with incomes over 400 percent of the federal poverty line (about $50,000 for a single person, about $100,000 for a family of four) would receive financial assistance if benchmark premiums exceed 8.5 percent of their incomes. This change would be especially important to middle-income people, older people, and others with especially high premium burdens….
  • ..Premium tax credits under the bill would automatically phase out at higher income levels, because premiums are generally less than 8.5 percent of income for high-income people.
  • The bill would allow families whose out-of-pocket premiums for employer-sponsored coverage exceed 9.86 percent of income to instead purchase individual market coverage with financial assistance. Currently, people with offers of employer coverage are ineligible for premium tax credits if the premium they would pay for self-only coverage is less than 9.86 percent of income. The bill would base affordability determinations for families on the amount they would pay for family coverage (fixing the so-called “family glitch”).

Expanding coverage. The bill would make lower-cost coverage available to all 12 million of the marketplace-eligible uninsured (40 percent of those who remain uninsured despite coverage gains under the ACA), as well as to some of the 2.7 million uninsured who are currently ineligible for marketplace subsidies due to an offer of employer coverage. Millions of people would gain coverage as a result…

…Protecting people with pre-existing conditions. The ACA put in place crucial protections for people with pre-existing conditions. It prohibits insurers from denying coverage or charging higher premiums based on health status, prohibits annual and lifetime limits on coverage, and requires plans to cover essential health benefits such as prescription drugs, mental care, and substance use treatment. The Trump Administration has sought various ways around the protections, but the new bill would reverse these actions:

  • It would reverse the Administration’s expansion short-term health plans. These plans are exempt from the ACA’s protections. They can and do deny coverage or charge higher premiums based on health status, exclude key benefits, and impose annual limits.
  • It would reverse the Administration’s expansion of association health plans. These plans are also exempt from many ACA protections. That lets them structure benefits and premiums to attract healthier-than-average firms and individuals, increasing premiums for people with pre-existing conditions who continue to purchase ACA coverage in the individual or small group markets.
  • It would revoke Administration guidance encouraging states to seek waivers directly and indirectly undermining pre-existing conditions protections.
  • It would undo Administration changes that weaken standards for what individual market plans have to cover….

March 26, 2019: Senator Bernie Sanders (Independent) tweeted: “We must defend the ACA from Trump’s assault and protect people’s existing coverage. However, protecting the ACA will not fully solve the health care crisis. To finally guarantee health care as a right, we must take on the insurance industry and pass a Medicare for All bill.

March 26, 2019: National Nurses United posted a press release titled: “Statement from National Nurses United President Zenei Cortez, RN: New Bill Introduced by Speaker Pelosi Fails to Address Underlying Needs for Providing Comprehensive Health Care” From the press releases:

In response to Speaker Pelosi’s supposed new “sweeping” health care legislation unveiled today, National Nurses United President Zenei Cortez, RN issued the following strongly-worded statement:

“Poll after poll has shown that the majority of Americans favor a Medicare for All, single-payer health care system over a profit-driven health insurance system. There are tens of thousands of volunteers across the country door knocking and phone banking in support of improving and expanding Medicare for All. The Medicare for All Act of 2019 (H.R. 1384) is backed by over 100 members of Congress and will guarantee health care for everyone – real patient choice, not the restrictions imposed by all private health insurance plans, without devastating out of pocket costs. We nurses find the new legislation proposed by Speaker Pelosi’s office disappointing and totally inadequate to address the health care crisis confronting our country. Now is not the time for watered-down, incremental measures that will only put a Band-Aid on a broken health care system.”

“We urge Speaker Pelosi to put the full weight of the Democratic caucus behind H.R. 1384. Nurses demand a health care system that is based on patient need, not profits. At a moment when the Trump Administration is actively seeking to overturn the entire ACA, Democrats have an opportunity to show real leadership with the transformative change that will most protect all Americans. National Nurses United, along with our allies, will continue to build the grassroots movement for genuine health care justice and to push to pass Medicare for All.”

March 26, 2019: The American College of Obstetricians and Gynecologists (ACOG) posted a statement titled: “ACOG Statement on DOJ’s Reversal of Position regarding the Affordable Care Act”. From the statement.

Lisa Hollier, M.D., M.P.H., president of the American College of Obstetricians and Gynecologists, issues the following statement regarding the U.S. Department of Justice’s decision to contend that the entire Affordable Care Act is unconstitutional, in a reversal of its prior position:

“The Affordable Care Act is an American success story. The American College of Obstetricians and Gynecologists (ACOG) strongly opposes the administration’s decision yesterday to reverse its prior position and support the full invalidation of the Affordable Care Act. ACOG calls on the U.S. Court of Appeals for the Fifth Circuit to uphold the law. Invalidation of the ACA will have a significant and devastating impact on the health and well-being of all Americans, especially women and families.

“The Affordable Care Act put in place landmark women’s heath protections that are now part of the fabric of our nation. More than 55 million women have gained access to preventative services, including mammograms and contraception with no cost-sharing. And 8.7 million women have the peace of mind of having meaningful maternity care coverage.

“ACOD remain vigilant in opposing any attacks on women’s health and stands firmly in support of our patients’ access to the comprehensive coverage guaranteed by the Affordable Care Act.

“ACOG’s message is simple and consistent: Don’t turn back the clock on women’s health.”

March 26, 2019: The American Hospital Association posted a press release titled: “Statement on the Department of Justice Decision on the Affordable Care Act”. It was posted by Rick Pollack, President and CEO of the American Hospital Association. From the press release:

America’s hospitals and health systems oppose the Department of Justice’s (DOJ) misguided decision calling on the courts to strike down the Affordable Care Act in its entirety. The position is unprecedented and unsupported by the law or the facts. Millions of Americans would lose the coverage they have relied on for years. We have made too much progress in coverage and access to care for patients to go backwards.

If courts were to adopt the DOJ position, Medicaid expansion would be reversed and protections for people with pre-existing conditions would cease to exist.

March 26, 2019: The American College of Physicians posted a press release titled: “Internists Say that Trump Administration Stance on ACA Lawsuit Threatens Health of Millions”. From the press release:

The American College of Physicians (ACP) strongly opposes the Trump administration’s call to strike down the entire Affordable Care Act (ACA). These actions will potentially jeopardize health care coverage for millions of Americans and their families. ACP firmly believes that provisions established by the ACA, including protections for patients with pre-existing conditions, are constitutional and must be upheld.

While ACP welcomes discussions to improve the health care law, overturning the law would leave many Americans uninsured and make it extremely difficult for patients, particularly those who are chronically ill and underserved, to enroll in affordable and quality coverage plans. ACP fears that if the federal appeals court agrees with the Department of Justice and declares the ACA invalid, it would undermine patients with pre-existing conditions, destabilize the insurance market, and make health care simply inaccessible for many patients. Additionally, premium subsidies to make coverage affordable would end, annual and lifetime limits on coverage would return, federal funding for Medicaid expansion would be terminated, and seniors would no longer have access to no-cost preventive services.

When the initial ruling in Texas vs. the United States was issued against the ACA, ACP opposed the decision and urged the ruling to be overturned. In an amicus curiae brief filed in the case, ACP, together with the American Medical Association, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry strongly opposed any lawsuit that would risk key health care provisions for patients put in place by the ACA.

ACP urges the court to uphold the tenets of health care and protect vulnerable patients, especially those with pre-existing conditions. We will continue to advocate for policies that will put patients first and keep essential protections in place.

The amicus curiae brief is available to view online.

March 26, 2019: Reuters posted an article titled: “Second Wisconsin judge blocks Republican-backed laws curbing Democratic governor’s powers”. It was written by Brendan O’Brien. From the article:

A Wisconsin judge on Tuesday blocked several laws passed by Republican state lawmakers during a December lame-duck session intended to curb the powers of newly elected Democratic Governor Tony Evers, the second such ruling in the past week.

Dane County Circuit Judge Frank Remington issued a temporary injunction on legislation that requires lawmakers to approve discontinuing or settling lawsuits by the attorney general, allows them to dictate how governmental documents are written and gives them the ability to halt state rules written by Evers, court documents showed.

Remington said in his ruling that the labor unions that brought the lawsuit were likely to succeed in showing the laws violate the separation of powers provision in the state constitution.

It was the second ruling against the series of statutes passed in the last days of former Republican Governor Scott Walker’s administration. Democrats had criticized the legislation as a last-minute power grab…

Remington did not issue a temporary injunction on laws that allow lawmakers to intervene in legal challenges to state statues and new enterprise zones….

March 26, 2019: The CT Mirror posted an article titled: “As DOJ asks court to invalidate the ACA, Connecticut joins legal fight to defend it.” It was written by Ana Radelat and Jenna Carlesso. From the article:

Just as the Trump administration notified a federal court it would challenge the constitutionality of the Affordable Care Act, Connecticut joined other states in stepping up their legal defense of Obamacare.

In a filing Monday with the 5th U.S. Circuit Court of Appeals, the Justice Department said it agreed with 15 Republican attorneys general that the elimination of the “individual mandate,” the requirement that most Americans have health insurance, invalidated the entire ACA…

…”This is a cruel attack on Connecticut families and on the American people. It’s pure political cruelty,” said Connecticut Attorney General William Tong, who is fighting the legal challenge to the ACA at the court of appeals.

Connecticut and 20 other Democratic attorneys general, led by California Attorney General Xavier Becerra, filed an opening brief on Monday in the 5th Circuit in defense of the health care law…

…The Democratic-controlled U.S. House of Representatives has also intervened to ask the ACA be upheld in its entirety…

March 27, 2019: The Texas Tribune posted an article titled: “Three Texas abortion bills pass committees, gaining momentum in Senate”. It was written by Arya Sundaram. From the article:

A Senate panel approved a controversial abortion bill Wednesday regarding the rare cases of infants who survive the procedure. It’s one of three anti-abortion bills that Lt. Gov. Dan Patrick has listed among his priorities. All three have been approved by committees and sent to the full Senate.

The Health and Human Services Committee approved the infant protection bill with a 6 to 2 vote. Senate Bill 23, filed by Sen. Lois Kolkhorst, the committee chair, gives teeth to an already existing statute that grants legal protections to children born after a failed abortion attempt. Doctors who fail to provide appropriate medical treatment would be charged with a third-degree felony and have to pay a fine of at least $100,000.

The bill is part of a national Republican response to abortion advocates’ efforts to roll back regulations on late-term abortions in states like New York and Virginia.

The U.S. Senate rejected a national version of SB 23 last month, which prompted the state-level response in Texas…

…Legislators and advocates who support abortion rights, however, say that the practice is very rare and unfairly criminalizes doctors. Texas reported zero live birth resulting from an abortion between 2013, when the Department of State Health Services started collecting the data, and 2016, the most recent year for which data is available…

…Meanwhile, another of Patrick’s priority bills, Senate Bill 22, would prohibit state and local governments from funding abortion providers.

The bill from state Sen. Donna Campbell, R-New Braunfels, is the latest in a series of state decisions to slash government funding for abortion providers in Texas. In 2011, the Legislature cut the state’s family planning budget by two-thirds in an effort to limit funding for abortion providers like Planned Parenthood. In late 2016, the state kicked Planned Parenthood out of the state’s Medicaid program and cut off $3.1 million in funding – and a federal appeals court upheld that decision in January.

These efforts don’t affect funding at the local level – which SB 22 seeks to change.

Anti-abortion legislators singled out the Planned Parenthood’s downtown Austin clinic, which the city leases to the organization at a very low rate – a relationship that may be severed if SB 22 becomes law…

…The Alternatives to Abortion Information Act, Senate Bill 24 proposed by Sen. Eddie Lucio, a Democrat from Brownsville, would clarify an existing statute that requires a patient to receive certain information before getting an abortion, including a list of agencies that offer alternatives to abortion.

The Senate State Affairs Committee unanimously approved the bill Monday.

SB 24 states that a physician must hand the patient a hard copy of the materials – an important clarification, according to Joe Pojman, the executive director for the Texas Alliance for Life. Current law says the information must be provided in a conversation or online…

…On Wednesday night, state Rep. Matt Krause, R-Fort Wort, added an amendment to the 2020-21 state budget that would pump $52 million into the controversial Alternatives to Abortion program, which contracts with providers the refer pregnant woman and adoptive parents to social services…

March 27, 2019: Mercer posted a survey titled: “New Mercer Survey: Employers Overwhelmingly Support Preserving Coverage for Pre-existing Conditions”. From the survey:

According to a new Mercer survey conducted last month of nearly 600 employers of all sizes about their views on a number of health policy issues, the vast majority of respondents – 95% – believe it’s important that Congress preserve coverage for pre-existing conditions should the ACA be overturned. Before the ACA was signed into law, the majority of larger employers voluntarily offered group health plans that covered pre-existing conditions for individuals who lacked prior continuous creditable coverage (even though such coverage could have been delayed under pre-ACA HIPPA rules). Along with other ACA mandates, such as removing annual and lifetime dollar limits on essential health benefits, the ACA’s requirement that employer-sponsored group health plans cover pre-existing conditions for all individuals regardless of prior coverage could only have caused costs to rise….

…This issue has moved into the spotlight again following Monday’s legal filing by the US Department of Justice urging 5th Circuit Court of Appeals to uphold a lower court ruling that strikes down the ACA in its entirety (Texas v. United States…). This is a change in direction for the Justice Department, which had argued that only certain parts of the ACA should be struck (like the ban on pre-existing conditions exclusions), after originally declining to defend the case at all. At the time, the Justice Department did not seek to strike down other parts of the ACA, such as Medicaid expansion and federal subsidies for individual coverage purchased on the public exchange. Now, the Justice Department says it agrees with the judge’s entire opinion and won’t challenge any part of that ruling as the case heads through the appeals process, and potentially to the Supreme Court.

While employer health plan sponsors could voluntarily choose to continue pre-existing conditions without limitations, they clearly support Congressional action to maintain the mandate that bans such exclusions. In addition to believing, along with the majority of Americans, that protecting individuals with pre-existing conditions is the right thing to do, making it a universal requirement takes coverage availability off the table when people are making decisions to leave or stay in a job or look for a new one….

March 27, 2019: American Psychiatric Association posted a news release titled: “Joint Statement on Administration’s Position on Texas V United States”. From the news release:

Our organizations, which represent a combined membership of more than 560,000 physician and medical student members are alarmed by the Administration’s announcement that they will no longer defend any part of the Patient Protection and Affordable Care Act (ACA) in the federal case Texas v United States. This decision places the health care of millions of Americans, including those with pre-existing health care conditions, in jeopardy.

As physicians who provide a majority of care to individuals for physical and mental conditions, we know these insurance reforms and protections are essential to ensuring access to affordable health coverage for more than 130 million Americans, including the more than 31 million individuals between the ages of 55 and 64 who have at least one pre-existing condition.

Throughout the 2018 election, the President and Members of Congress from both parties emphasized their commitment to protecting individuals with pre-existing health conditions. This announcement by the Administration explicitly contradicts that promise. Elimination of these protections would result in millions facing limited access to health care coverage and higher cost as a result of insurers being allowed to return to discriminatory coverage and pricing practices.

The DOJ’s new position, if accepted by the courts, would endanger not only essential protections for persons with preexisting conditions, but other programs that millions of Americans depend on to ensure their access to affordable health care. These include federal funding for Medicaid expansion, premium subsidies to make coverage affordable in the individual market, and the ban on annual and lifetime limits on coverage. In addition, insurers would no longer be required to cover essential health care such as maternity care, pediatric services, cancer screenings, prescription drugs, and mental health and substance use disorder treatments. Additionally, dependent coverage up to age 26 would be discontinued, seniors would no longer have access to no-cost preventative services, and women could again be charged more for coverage simply because of their gender.

Our organizations strongly disagree with the DOJ’s position. We fully support the protections and programs established by the ACA that are essential to ensuring access to care. We strongly urge the Administration to reverse its position in Texas v. United States, and even if it does not do so, we hope and expect that the appellate courts consider the impact on patients and rule against overturning the law.

Our organizations stand ready to collaborate with the Administration and Congress on policy solutions to increase access to affordable health care and provides all individuals, regardless of they gender, race, and health status; and provide reasonable protections against discrimination in coverage and pricing.

March 27, 2019: United States District Court for the District of Columbia Judge James E. Boasberg (nominated by former President Barrack Obama), issued his ruling on a case titled: Ronnie Maurice Steward, et. al. V Alex M. Azar II, et. all. The case was about the Commonwealth of Kentucky’s Medicaid work requirements.

Here are some key points from the ruling:

  • Kentucky HEALTH, which the Secretary (of Health and Human Services, Alex Azar II) initially approved on January 12, 2018, that Kentucky could condition Medicaid eligibility for a large portion of its beneficiaries on work or community-engagement requirements and impose several additional obligations intended to make Medicaid more like commercial insurance.
  • Plaintiffs – Kentucky residents currently enrolled in Kentucky HEALTH, believed the Secretary’s approval to be unlawful. The United States District Court for the District of Columbia agreed with the plaintiffs.
  • The court found that Secretary Azar “never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens” and thus promote a central objective of the Medicaid Act. The court found that Secretary Azar had not grappled with Kentucky’s estimate that a substantial number of people were likely to lose coverage under Kentucky HEALTH.
  • The Court vacated the approval of Medicaid work requirements and remanded HHS for further review.
  • Last November, Secretary Azar reproved the Medicaid work requirements program under somewhat different reasoning. Plaintiffs maintain that the Secretary has still not adequately considered Kentucky HEALTH’s likelihood to cause significant coverage loss.
  • Judge Boasberg wrote:

…The Supreme Court, in holding that Congress could not require states to adopt that Medicaid expansion by conditioning all their Medicaid funding on a decision to do so, explained that states could not be compelled to engage in a program not bargained for with “a gun to the head”… Kentucky, it seems, has now picked up that gun by threatening to de-expand Medicaid.

Defendants urge the Court to adopt the proposition that the Secretary need not grapple with the coverage-loss implications fo a state’s proposal as long as it is accompanied by a threat that the state will de-expand – or indeed, discontinue all of Medical. By definition, so this argument goes, any number of people covered by an experimental Medical program would be greater than the number if there were no Medicaid at all; as a result, any demonstration project that leaves any individual on a state’s Medicaid rolls promotes coverage.

The Court cannot concur that the Medicaid Act leaves the Secretary so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose. As a consequence, once again finding the reapproval was both contrary to the Act and arbitrary and capricious, the Court will vacate it and remand it to HHS for further review….

Here is another interesting part of the Judge’s ruling:

…Taken to its logical conclusion, the Secretary’s position thus makes little sense. Under his reasoning, states may threaten that they wish to de-expand, or indeed do away with all of Medicaid – for fiscal reasons or no reason at ll – if the Secretary does not approve whatever waiver Medicaid requirements they wish to obtain. The Secretary could then always approve those waivers, no matter how few people remain on Medicaid thereafter because any waiver would be coverage promoting compared to a world in which the state offers no coverage at all.

Remarkably, when asked for a limiting principle to this proposition during oral argument, Defendants did not give one… Could a state decide it did not wish to cover pregnant women? The blind? All but 100 people currently on Medicaid rolls? The Secretary offers no reason that his position would not allow for any of those results…

March 27, 2019: The Washington Post posted an article titled: “A job-scare town struggles with Arkansas’s first-in-nation Medicaid Work rules”. It was written by Amy Goldstein. From the article:

…This community [Marianna, Arkansas] – scarce on jobs and among the poorest in a poor state – provides an early reality check on how hard it is to carry out President Trump’s vision of a social safety net that requires most able-bodies people to work, or try to work, in exchange for government health benefits. Nearly 10 months ago, Arkansas became the first place in the nation to impose work requirements on the part of Medicaid that expanded under the Affordable Care Act. Seven other states have won the Trump administration’s blessings to begin the same idea soon, and seven more are waiting in line…

…”I am a big van of work and people working,” said Rep. Reginald Murdock (D), a veteran state legislator from Marianna. But with jobs so scarce here, even at at time of low unemployment statewide, “threatening people with their insurance wasn’t a proper way to do it.”

On Wednesday afternoon, a federal judge in Washington threw a significant roadblock into Arizona’s program, issuing an opinion saying the rules “cannot stand,” and in a separate decision, rejecting the start of a similar program in Kentucky for a second time – decisions likely to have ripple effects on states with similar aspirations. The same jurist, U.S. District Judge James Boasberg, had delayed Kentucky’s imposition of work requirements last summer, ruling that Trump’s health aides had inadequately considered the effects on people needing insurance.

Twin opinions cast doubt on the Trump administration’s re-envisioning of the public health insurance program, telling federal health officials they must reconsider the two states’ applications with an eye toward the effect on poor people who depend on such coverage.

Both Arkansas Gov. Asa Hutchinson (R) and the U.S. Department of Health and Human Services Secretary Alex Azar had suggested the Arkansas program was helping people become more independent, contending most people who lost benefits have found steady work. But the state lacks data so far to back that up…

March 27, 2019: United States District Court for the District of Columbia Judge James E. Boasberg (nominated by former President Barrack Obama), issued his ruling on a case titled: Charles Gresham, et al. v Alex M, Azar II, et. all. The case was about the the state of Arkansas’s Medicaid work requirements.

Here are some key points from the ruling:

  • The case was brought by ten Arkansans who came to the Court in 2018 seeking to undo the work requirements the state added in 2018 to its Medicaid program. They sued the Secretary of Health and Human Services in August 2018, arguing that the federal government’s approval of the state’s new requirements violated the Administrative Procedure Act and the Constitution.
  • Plaintiffs pointed to the similarity of this case and the Kentucky Medicaid work requirements case. The Judge determined: “Despite the protestations in its (and intervenor Arkansas’s) briefing, HHS conceded at oral argument that the administrative decision in this case shares the same one” (as the Judge identified in the Kentucky case.
  • “The Court’s job is thus easy in one respect, the Secretary’s approval cannot stand.”
  • The Judge concluded: “For the foregoing reasons, the Court will grant Plaintiff’s Motion for Summary Judgment and deny Defendants’ Cross-Motions. A separate Order consistent with this Opinion will issue this day, remanding the matter to HHS”.

Here are some key parts of the Judge’s ruling:

To be approved (for Medicaid), state plans must comply with certain minimum parameters set out by the Medicaid Act… One such provision requires states to “make[e] medical assistance available” to low-income individuals…. Until recently, that group included pregnant women, children, and their families; some foster children; the elderly; and people with certain disabilities…

…In 2010, however, Congress enacted the Patient Protection and Affordable Care Act (ACA), colloquially known as Obamacare, “to increase the number of Americans covered by health insurance…. Under that statute, states can expand their Medicaid coverage to include additional low-income adults under 65 who would not otherwise qualify…

…Arkansas’s Medicaid program dates back to 1970. For most of the program’s history, the state maintained among the most stringent eligibility thresholds in the nation for adults, covering only the aged, disabled, and parents with low incomes… That changed with the passage of the ACA. While states had a choice after NFIB not to expand Medicaid, Arkansas was one of those which opted to do so…In its first two years, the program provided health coverage to more than 278,000 newly eligible individuals, helping to lower the uninsured rate from 19% to 11%… The program became known as Arkansas Works in January 2017…

  • The Judge noted that in 2017, the Trump administration took over from President Obama. The Department of Health and Human Services (in short) allowed states to change their Medicaid programs.
  • Governor Asa Hutchinson proposed three substantial amendments to Arkansas Works. First, he proposed to shift income eligibility for the expansion from 33% to 100% of the Federal Poverty Line. … Second, he proposed to “institute work requirements as a condition” of continued Medicaid coverage. Third, he proposed to eliminate retroactive health coverage. The state did not estimate the effects these amendments would have on Medicaid coverage…
  • On March 5, 2018, Secretary Azar approved Gov. Hutchinson’s amendments and limits to retroactive coverage, concluding they were “likely to assist in improving health outcomes” and “incentivize beneficiaries to engage in their own health care.”

Under the new work requirements, most able-bodied adults in the Medicaid expansion populations 19-49 must complete each month 80 hours of employment or other qualifying activities – or earn income equivalent to 80 joins of work… Compliance was required to be reported monthly through an online portal…

…Various groups of persons are exempt, including the medically frail, pregnant women, full-time students, and persons in drug- or alcohol-treatment programs. Nonexempt individuals who do not report sufficient qualifying hours for any three months in a plan year are disenrolled from Medicaid for the remainder of that year and not permitted to re-enroll until the following plan year…

  • Since the program began, more than 16,900 individuals have lost Medicaid coverage for some period of time for not reporting their compliance… It is not known what percentage of these individuals completed the work requirements but did not report versus those who did not engage in the work itself
  • Conclusion: For the following reasons, the Court will grant Plaintiff’s Motion for Summary Judgement and deny Defendants’ Cross-Motions. A separate Order consistent with this Opinion will issue this day, remanding the matter to HHS.

March 27, 2019: Idaho Statesman posted an article titled: “A federal court ruling shook up Wednesday’s Idaho Senate hearing on Medicaid”. It was written by Audrey Dutton. From the article:

A federal court’s ruling on Medicaid work requirements in other states threw Idaho lawmakers for a loop – coming in the middle of a hearing Wednesday afternoon on that very topic.

As a result, an Idaho Senate committee rejected a House bill that would have implemented work requirements here…

…The bill requires low-income adults to work, volunteer or participate in job training as a condition of getting Medicaid. It carves out exemptions for several groups – parents, caregivers, people with disabilities, college students, and others.

The Idaho Senate Health and Welfare Committee had just spent two hours hearing from people with opinions on the bill.

Then, the news broke…

…The Senate Committee was informed of the court ruling. Members started asking questions: What does this mean for Idaho? Are the work requirement rules in HB 277 similar to those in Arkansas and Kentucky’s laws? How similar?

After talking about the court’s ruling and the questions it raises for Idaho’s proposal, the committee vote 7-2 to hold the bill in committee…

March 27, 2019: Kaiser Family Foundation posted information titled: “As All States Streamline Medicaid Enrollment and Renewal Processes, New Eligibility Requirements Pursued By Some States Could Increase Administrative Complexity and Reduce Coverage”. From the information:

All states continue to implement new Medicaid enrollment and renewal processes that can connect individuals to coverage more quickly and reduce administrative paperwork, finds KFF’s annual 50-state survey of Medicaid eligibility and enrollment policies. At the same time, some states are pursuing new eligibility requirements, such as work requirements and monthly premiums that would push coverage in the opposite direction, increasing the complexity of enrollment processes and potentially reducing coverage…

…In the 14 states that had not adopted the Medicaid expansion, eligibility for parents and other adults remained very limited. The median eligibility level for parents in these states was 40 percent of poverty ($8,532 per year for a family of three). In Texas, eligibility is limited to 17 percent of the federal poverty level or less than $4,000 per year for a parent in a family of three. Other adults were ineligible regardless of income in all these states except Wisconsin.

…some states are seeking and implementing new eligibility rules, often through waivers. Such measures include imposing work requirements, mandatory health risk assessments, charging monthly premiums, eliminating retroactive eligibility, delaying coverage until the first premium payment and locking enrollees out of coverage if they fail to pay premiums or renew their eligibility on time. Many of these measures require complex and costly documentation and administrative efforts, which can raise barriers to coverage and contribute to coverage losses, in contrast to the push for increased coverage and streamlined enrollment processes under the ACA…

The full survey is titled: “Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey. It was conducted by KFF and Georgetown University’s Center for Children and Families.

March 27, 2019: WGBH posted an article titled: “Mass. House Approves Title Bill with Bipartisan Support”. It was written by Chris Lisinski. From the article:

The Massachusetts House voted with bipartisan support Wednesday to allocate up to $8 million for family planning providers, a move that uses state dollars to replace federal funding lost under a rule change targeting abortion services.

Members voted 139-14 to authorize state funding through the end of fiscal year 2020 to cover whatever Massachusetts clinics lose under the new Trump administration rule. The bill could go before the Senate as soon as Thursday, and Republican Gov. Charlie Baker has indicated he plans to support it as well…

…In February, the Trump administration announced it would no longer direct Title X funding, which supports family planning services for low-income residents, toward any clinic that provides or refers abortions. The rule change faces a legal challenge from 21 states, including Massachusetts, but it will go into effect in May if it is not blocked in court…

…Massachusetts providers received $6.1 million from Title X in 2017, according to the Planned Parenthood League of Massachusetts, although it is unclear exactly how much of that would be affected under the administration’s new rule.

[Ways and Means Committee Chair Aaron] Michlewitz told reporters about $1.6 million of the $8 million allocated would be in place through the end of fiscal year 2019 and the remainder would be available for fiscal year 2020. Lawmakers are preparing for a situation in which the state receives no Title X money whatsoever.

About 75,000 Massachusetts residents, a vast majority of whom earn less than $30,000 a year, would be impacted by the cut in funding, according to Michlewitz. Opponents of the rule change, who refer to it as a “domestic gag rule,” say the move would limit access to crucial health services”…

March 27, 2019: the American Academy of Family Physicians posted a statement titled: “Family Physicians Alarmed by DOJ’s Request to Invalidate Affordable Care Act”. From the statement:

“The Department of Justice support of the district court’s December ruling to strike down the Affordable Care Act should alarm everyone. The ultimate outcome of this case will determine whether tens of millions of Americans will have access to necessary – and often lifesaving – medical care.

“As a result of the ACA’s patient protections, insurers cannot discriminate against patients with pre-existing conditions such as asthma, diabetes or cancer. They cannot rescind coverage when a patient becomes sick. The ACA requires coverage of preventative care, laboratory tests, maternity care, emergency room services and other essential benefits. It prohibits insurance companies from capping annual or lifetime benefits and prevents discrimination against patients due to their age, medical history or gender.

“Family physicians support these provisions in the ACA. The American Academy of Family Physicians would support legislative efforts to improve the ACA by expanding coverage and making services more affordable. However, eliminating the ACA is not the way to accomplish this. The AAFP will be steadfast in our support of patient protections as we continue to work for policies that ensure our patients get the care we need, when they need it.”

March 28, 2019: The Hill posted an article titled: “Arkansas governor asks Trump to appeal decision on Medicaid”. It was written by Jessie Hellmann. From the article:

Arkansas Gov. Asa Hutchinson (R) said he’s asked the Trump administration to appeal a federal judge’s Wednesday decision to block the state’s Medicaid work requirements…

…HHS hasn’t said what its next steps will be, but Hutchinson said the administration is committed to work requirements for Medicaid…

…Judge James Boasberg of the U.S. District Court for the District of Columbia, an Obama appointee, ruled Wednesday afternoon in two separate cases that the Trump administration didn’t consider whether the work requirements met the objective of Medicaid: to provide coverage to needy populations.

More than 18,000 people have lost coverage since the work requirements took effect last summer…

March 28, 2019: News Channel 9 ABC posted an article titled: “Georgia’s Kemp signs bill authorizing Medicaid waiver.” From the article:

Georgia’s Republican governor has signed legislation giving his office wide leeway to reshape the state’s health care system.

Gov. Brian Kemp on Wednesday signed the “Patients First Act,” authorizing the state to pursue a Medicaid waiver.

If approved, a waiver could give Georgia the flexibility to expand Medicaid more conservatively than federal rules typically allow. The legislation caps eligibility for any expansion to those at or below federal poverty level, limiting the number of Georgians who would ultimately be covered…

…Many Democrats opposed the plan, saying it would cover fewer people and cost more than full Medicaid expansion…

March 28, 2019: The U.S. District Court for the District of Columbia released the ruling by U.S. District Judge John D. Bates on the case titled: “State of New York, et. al. v. United States Department of Labor, et. all”. From the ruling:

Eleven states and the District of Columbia have sued the Department of Labor (“DOJ”), alleging that its final rule interpreting the definition of “employer” in the Employee Retirement Income Security Act of 1974 (“ERISA”), … is unlawful under the Administrative Procedure Act (“APA”),… DOL’s interpretation of the term “employer,”… impacts the treatment of certain healthcare plans under both ERISA and the Patient Protection and Affordable Care Act (“ACA”),… The States charge that DOL’s Final Rule stretches the definition of “employer” beyond what ERISA’s text and purpose shall bear. For the reasons that follow, the Court agrees.

ERISA governs employee benefit plans arising from employment relationships. It provides that some employer associations acting “in the interest of” employer members are sufficiently employer-like to fall within the statue’s scope. Health plans offered by these associations may qualify as single ERISA plans, a designation that confers regulatory advantages under the ACA. For decades, DOL has interpreted these provisions narrowly so as to only allow so-called “bona fide associations” with close economic and representational ties to their employer members to qualify as “employers” under the statute.

In 2018, the DOL abruptly reversed course, issuing the Final Rule challenged in this case. The Final Rule allows virtually any association of disparate employers connected by geographic proximity to qualify as ERISA plans. These associations no longer have to be viable apart from offering an association health plan (“AHP”) and may form solely for the purpose of creating an AHP. In addition, the Final Rule brings sole proprietors without any employees within ERISA’s scope by counting them as both “employers” and “employees.” Because the ACA defines terms key to its implementation – including “employer” and “employee” – according to the definition of these terms in ERISA, the Final Rule expands AHPs in a way that allows small businesses and some individuals to avoid the healthcare market requirements imposed by the ACA.

The Final Rule is clearly an end-run around the ACA. Indeed, as the President directed and the Secretary of Labor confirmed, the Final Rule was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA… But equally important for the analysis that follows, the Final Rule does violence to ERISA. The Final Rule scraps ERISA’s careful statutory scheme and its focus on employee benefit plans arising from employment relationships. It purports to extend ERISA to cover what are essentially commercial insurance transactions between unrelated parties. In short, the Final Rule exceeds the statutory authority delegated by Congress in ERISA. For the reasons that follow, the Final Rule’s provisions defining “employer” to include associations of disparate employers and expanding membership in these associations to include working owners without employees are unlawful and must be set aside…

March 28, 2019: Bloomberg posted an article titled: “Trump’s Group Health Plan Rules Struck Down as ACA ‘End-Run'”. It was written by Erik Larson and John Tozzi.

One of President Donald Trump’s health-care initiatives intended as a cheaper alternative to Obamacare suffered a crucial defeat when a judge ruled the policy violates the Affordable Care Act.

U.S. District Judge John Bates in Washington on Thursday blocked new rules governing so-called association health plans, or AHPs, which let businesses and individuals to band together to create group health plans that offer less expensive coverage than the ACA – but without some of its protections….

…The final rule is clearly an end-run around the ACA,” Bates, a 2001 appointee of Republican president George W. Bush, said in the ruling. “Indeed, as the president directed, and the secretary of labor confirmed, the final was designed to expand access to AHPs in order to avoid the most stringent requirements of the ACA.”…

…The case is State of New York v U.S. Department of Labor, 18-cv-1747, U.S. District Court, District of Columbia (Washington).

March 28, 2019: The Hill posted an article titled: “Rick Scott to introduce amendment protecting pre-existing conditions amid ObamaCare fight.” It was written by Tal Axelrod. From the article:

Sen. Rick Scott (R-Fla.) is set to introduce an amendment to the budget Thursday to protect health care coverage for people with pre-existing conditions.

Though the budget is a nonbonding document, the move comes as Republican senators seek to regain their footing after being caught off guard by the Trump administration’s renewed push to fully repeal the Affordable Care Act…

“I don’t think there was any heads-up on anything that he was going to say,” Senate Finance Committee Chairman Chuck Grassley (R-Iowa), whose panel has jurisdiction over health care, said….

March 28, 2019: Senator Rick Scott tweeted: “Today at the @SenateBudget markup I will be introducing my amendment to protect health care coverage for those with pre-existing conditions.” The tweet included a link to CSPAN.

March 28, 2019: Representative Sean Patrick Maloney (D-New York) posted a press release on his official website titled: “Maloney Introduces Legislation to Ban Use of Taxpayer Dollars for Conversion “Therapy””. From the press release:

Today, in advance of the Transgender Day of Visibility on March 31st, Representative Sean Patrick Maloney (NY-18), a co-chair of the Congressional LGBT Equality Caucus, introduced the Prohibition of Medical Funding for Conversion Therapy Act. The bill would prevent Medicaid funds from being used to pay for conversion “therapy” and crack down on misleading billing tactics, which have allowed taxpayer dollars to fund the discredited practice. The bill is cosponsored by 63 members of Congress.

“Conversion practices are discredited, harmful, and not therapy. Fundamentally, conversion tactics are based on the idea that a person’s gender identity or sexual orientation are diseases to be cured — they have no legitimate medical application and should not be used anywhere,” said Rep. Maloney. “Until we can just ban conversion ‘therapy’ all together, we must ensure taxpayer dollars aren’t funding a fraudulent practice that has been roundly discredited by the medical community. That’s exactly what my bill would do.”

“The Trevor Project hears from youth harmed by the dangerous and discredited practice of conversion therapy every week. By limiting the means by which licensed mental health professionals can be reimbursed for their horrific practice, the Prohibition of Medicaid Funding for Conversion Therapy Act will make clear that conversion therapy is far outside the mainstream,” said Sam Brinton, Head of Advocacy and Government Affairs for The Trevor Project. “More than 21,000 advocates have joined the Trevor Project’s 50 Bills 50 States campaign dedicated to protecting LGBTQ youth from conversion therapy. We look forward to mobilizing them to ensure this critical legislation relieves the attention and support it deserves.”…

…Conversion “therapy” attempts to “cure” the sexual orientation or gender identity of members of the LGBTQ+ community. Despite being discredited by the American Psychiatric Association, American College of Physicians, American Academy of Child Adolescent Psychiatry, and other medical and civil rights organizations, thousands of innocent LGBTQ people are subjected to so-called “conversion” or “reparative therapy” each year. Research has found that the practice can lead to depression, decreases in self-esteem, substance abuse, homelessness, even suicidal behavior. According to the Williams Institute at the UCLA school of Law, hundreds of thousands of LGBTQ young people have been forced to undergo the practice.

States currently decide which services Medicaid can cover and most have failed to ban the use of funding for conversion “therapy”. Because CMS codes do not mention the model of therapy being applied, even illegitimate practices can be performed and billed. The Prohibition of Medicaid Funding for Conversion Therapy Act would take several steps to combat the practice. First, it would legally define “conversion therapy” while ensuring that organizations which provide legitimate support to LGBTQ people are not at risk of losing funding. The bill would also ban the use of Medicaid funding for conversion “therapy” and ensure the practice is not paid for through the use of deceptive billing practices using CMS codes for mental and behavioral health.

The bill has been endorsed by The Trevor Project, Human Rights Campaign (HRC), National Educational Association, PFLAG National, Gay & Lesbian Medical Association (GLMA), National Center for Lesbian Rights (NCLR), Council for Global Equality (CGE), National Center for Transgender Equality (NCTE), Third Way, True Colors Fund, Familia: Trans Queer Liberation Movement, Family Equality Council, AIDS United, Gay Lesbian & Straight Education Network (GLSEN), National Black Justice Coalition, National Gay & Lesbian Chamber of Commerce, National LGBTQ Task Force Action Fund, Equality California.

The bill is cosponsored by Representatives: Ted Lieu, Tulsi Gabbard, Mark Takono, Suzanne Bonamici, Eleanor Holmes Norton, Alan Lowenthal, Charlie Crist, Adriano Espaillat, Eliot Engel, Andre Carson, Raul Grilalva, Steve Cohen, Derek Klimer, Michael Doyle, Debbie Mucarsel-Powell, Jimmy Gomez, Betty McCollum, Chris Pappas, Earl Blumenauer, Eric Swalwell, Paul Tonko, Gregory Meeks, Juan Vargas, Brian Higgins, Lucille Roybal-Allard, Jackie Speier, Mark Pocan, Pramila Jayapal, Alcee Hastings, Seth Moulton, Dina Titus, Norma Torres, James Himes, Bobby Rush, Julia Brownley, Dan Kildee, Adam Smith, James McGovern, John Garamendi, Joseph Kennedy, Nydia Velazquez, Doris Matsui, Mike Quigley, Tim Ryan, David Cicilline, Grace Napolitano, Bill Foster, Angie Craig, Shiela Jackson Lee, Debbie Wasserman Schultz, Scott Peters, Ilhan Omar, Jennifer Wexton, Peter DeFazio, Jerrold Nadler, Rose L. DeLauro, Susan Wild, Denny Heck, Debbie Watson Coleman, Barbara Lee, Jimmy Panetta, Robin L. Kelly, Anthony Brown.

March 28, 2019: H.R.1981 – Prohibition of Medicaid Funding for Conversion Therapy Act was introduced in the U.S. House of Representatives. Here are some key points from the text of the bill:

  • It is to amend title XIX of the Social Security Act to prohibit payments under the Medicaid program for conversion therapy.
  • It adds a new paragraph to XIX of the Social Security Act: “provide that, beginning with the first day of the first quarter that begins on or after the date of enactment of this paragraph, no payment may be made under the plan with respect to conversion therapy (as defined in subsection (qq)) furnished to an individual enrolled under the plan (or a waiver of such plan).”
  • The term ‘conversion therapy’ (A) means any practice or treatment by any person that seeks to change another individual’s sexual orientation or gender identity, including efforts to change behaviors or gender expressions, or to eliminate or reduce sexual or romantic attractions or feelings toward individuals of the same gender, if such person receives monetary compensation in exchange for any such practice or treatment; and
  • (B) does not include any practice or treatment, which does not seek to change sexual orientation or gender identity, that – (i) provides assistance to an individual undergoing a gender transition; or (ii) provides acceptance, support, and understanding of a client or facilitation of client’s coping, social support, and identity exploration and development, including sexual orientation-neutral interventions to prevent or address unlawful conduct or unsafe sexual practices.
  • The term ‘gender identity’ means the gender-related identity; appearance, mannerisms, or other gender-related characteristics of an individual, regardless of the individual’s designated sex at birth.
  • The term ‘person’ means any individual, partnership, corporation, association, or any other entity.
  • The term ‘sexual orientation’ means homosexuality, heterosexuality, or bisexuality.”

March 29, 2019: Planned Parenthood posted a press release titled: “Administration Strips Planned Parenthood FY2019 Title X Funding in Obvious Move to Push Planned Parenthood Out of Program”. From the press release:

The Trump-Pence Administration today announced that it’s stripping Title X funding from several qualified Planned Parenthood affiliates, despite their proven record of providing a high volume of people struggling to make ends meet with birth control, breast cancer and cervical cancer screenings, and STI testing and treatment. The administration’s fiscal year 2019 grants prove, yet again, that the administration will do anything it takes to limit Planned Parenthood’s ability to serve patients through Title X. These cuts to Planned Parenthood’s Title X funding come just after a report that the administration coached an ideologically friendly state health department on how to apply for funds, and only five weeks before Trump’s gage rule is set to take affect, which would put Planned Parenthood out of Title X altogether….

…The four Planned Parenthood affiliates that were stripped of funding in Hawaii, North Carolina, Ohio, Wisconsin, and Virginia serve more than 40,000 patients (Planned Parenthood Southwest Ohio Region, Planned Parenthood of the Great Northwest and the Hawaiian Islands, Planned Parenthood South Atlantic, and Planned Parenthood of Wisconsin). For instance, Wisconsin serves an overwhelmingly majority of the patients in the state and has for nearly 50 years.

In addition to the FY19 grants, the administration is using the gag rule as a tool to push Planned Parenthood out of Title X. It would block patients from care at Planned Parenthood and bar providers from referring patients for safe, legal abortion. The administration’s FY20 budget proposal includes a provision to stop Planned Parenthood from serving patients in Title X – even though Planned Parenthood health centers serve 41 percent of the 4 million patients who depend on Title X health centers..

The press release also includes a statement from Dr. Leana Wen, President, Planned Parenthood Federation of America:

“This lates Trump-Pence administration’s attack on health care affects the ability of 40,000 patients to receive cancer screenings, birth control, STI tests, and other crucial primary and preventative health services. From the beginning, the administration has made it clear it wants to dismantle the Title X program by forcing out trusted health centers that provide evidence-based, comprehensive reproductive health care. Today, they are removing funding form these trusted health centers and providing funding to entities that do not provide evidence-based treatment. This continued attack on Title X will result in dismantling our nation’s program for affordable birth control and reproductive health care, risking access to comprehensive health care for millions of low-income women and families. Planned Parenthood will not let this stand. Just as we are fighting the Trump-Pence administration’s unethical, illegal, and harmful Title X gag rule, we will be fighting through every avenue to protect patients’ rights and every person’s ability to access health care.”

March 29, 2019: Planned Parenthood posted a press release titled: “Georgia Third State This Year to Pass Six-Week Abortion Ban, Headed to Gov. Kemp.” From the press release:

Politicians in Georgia passed this bill despite mass opposition to the ban. Support for Roe v Wade is at its highest level on record — 73% of Americans say they do not want to see Roe overturned. More than 300 Georgia business leaders spoke out publicly against the ban. The Georgia film and entertainment industry published letters, threatening to boycott work in Atlanta if the ban passes. Yet, the bill passed with little regard for the constituents these legislators claim to represent…

Today, Georgia became the third state this year after Kentucky and Mississippi, to pass a ban on abortion before many people know they are pregnant. The bill passed by one vote. This is part of an alarming national trend of abortion bans. Just this week, Planned Parenthood and Guttmacher Institute released a 2019 State Abortion Restriction Snapshot that shows nearly half of abortion restrictions introduced in state legislatures are bans of one type or another — and in fact, there has been a 63% spike in six-week abortion bans, like the one in Georgia, compared to this time last year. Georgia is just one of 32 states to introduce abortion bans this year as part of a national strategy to outlaw safe, legal abortion.

…The sustained and coordinated effort to ban abortion in states has also triggered a counter-movement of reproductive health champions who are introducing bills that would protect and expand abortion access. In more than half the states, champions are pushing for bills that codify abortion rights in to state law, repeal harmful policies that create barriers to care, and would treat abortion as health care, not a crime. New York was the first state this year to codify abortion rights into law. Other states like Illinois, Vermont, Massachusetts, Maine, and Rhode Island are aggressively pursuing similar laws.

The press release included a statement by Dr. Leana Wen, President, Planned Parenthood Action Fund:

“Georgia’s six-week ban is a dangerous policy designed to block abortion access before many women even know they’re pregnant. Almost weekly now, we are seeing bans on abortion care like this one. These restrictions go beyond rhetoric, they will only roll back gains to public health and harm women’s health and the health of families across Georgia. Planned Parenthood will not back down from this fight. Planned Parenthood’s patients in Georgia and across the country deserves the right to control their own body, life, and future, no matter where they live or how much money they make. As health care providers and advocates, everyone must work together with our elected champions to pass policies that will protect the right to safe, legal abortion. There are few options left and time is running out for women everywhere. With Kavanaugh on the Supreme Court and Trump in the White House, access is on the line.”

March 29, 2019: Senator Diane Feinstein tweeted: “If Republicans successfully overturn the Affordable Care Act, California would lose $22.4 billion in federal funding that currently provides health care for vulnerable children and families. We must not let Republicans put millions of families in jeopardy.”

March 31, 2019: Larry Levitt, Senior VP at Kaiser Family Foundation, tweeted: “The president’s budget on March 11 proposed replacing the ACA with an approach molded after the Graham-Cassidy bill, providing “relief” from “many” of the ACA’s insurance rules. The original Graham-Cassidy bill allowed unlimited premiums on people with pre-existing conditions.”

March 31, 2019: Larry Levitt, Senior VP at Kaiser Family Foundation tweeted: “Now that we seem to be talking about pre-existing conditions again, a reminder of what it takes to truly protect people: Guaranteed access to insurance. A limit on premiums charged to sick people. Required benefits. A cap on out-of-pocket costs. No lifetime or annual limits.”

April 1, 2019: The American Medical Association, posted a press release titled: “AMA, physician groups defend ACA gains in new Texas v. filing”. From the press release:

In defense of significant coverage gains and key patient protection provisions of the Affordable Care Act (ACA), the American Medical Association (AMA) and other leading physician organizations today filed an amicus brief on the case of Texas v United States. Additional organizations joining the AMA include the American College of Physicians (ACP), American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP) and the American Psychiatric Association (APA).

“The district court ruling that the individual mandate is unconstitutional and inseparable from the remainder of the ACA would wreak havoc on the entire health care system, destabilize health insurance coverage, and roll back federal health policy to 2009,” said AMA President Barbara L. McAneny, M.D. “The ACA has dramatically boosted insurance coverage, and key provisions of the law enjoy widespread public support. The district court’s decision to invalidate the entire ACA should be reversed.”

If the district court ruling is upheld, it would adversely impact every single American, rendering the following ACA provisions null and void:

  • Patients would no longer have protections for pre-existing health conditions
  • Children would no longer have coverage under their parents’ health plans until age 26
  • Insurers would no longer be held to the 85% medical loss ratio, meaning they could generate higher profits at the expense of coverage and payments for services
  • 100 percent coverage for certain preventative services would cease
  • Individual marketplace and subsidies based on income would be eliminated
  • Federal funding for Medicaid expansion would end, as would Medicaid eligibility expansion
  • Annual and life-time dollar limits could be reinstated, leading to more bankruptcies due to health care costs….

April 1, 2019: Reuters posted an article titled: “Two Republican attorneys general urge court to uphold Obamacare”. It was written by Brendan Pierson. From the article:

Two Republican state attorneys general on Monday urged a federal appeals court to uphold the Obamacare federal healthcare law, saying that striking it down would be disruptive for patients, doctors, insurers and employers.

The attorneys general of Ohio and Montana submitted “friend of the court” briefs to the 5th U.S. Circuit Court of Appeals, which is expected to review a December ruling by U.S. District Judge Reed O’Connor in Fort Worth, Texas, striking down the Affordable Care Act, popularly known as Obamacare.

Dozens of patient and healthcare industry groups, including the American Medical Association, American Hospital Association, American Cancer Society and seniors advocacy group AARP also filed briefs in support of the law.

The briefs come less than a week after the U.S. Department of Justice, in an unexpected legal maneuver, said the entire healthcare law should be invalidated. Previously, President Donald Trump’s administration had said portions of Obamacare should be struck down and others should survive, including a state-led expansion of the Medicaid health insurance program for the poor…

April 1, 2019: The AARP and AARP Foundation posted a press release titled: “AARP and AARP Foundation Submit Amicus Brief in Support of ACA and the Security It Provides Older Americans”. From the press release:

AARP and AARP Foundation filed an amicus brief today with the United States Court of Appeals for the Fifth Circuit supporting the constitutionality of the Patient Protection and Affordable Care Act (ACA) and asking it to reverse the trial court’s December 2018 ruling in Texas v. United States. The brief argues that if the ACA is invalidated, millions of older Americans will be harmed, many will lose their health coverage, and the nation’s health system will be thrown into turmoil.

“AARP vigorously opposes any attempt to dismantle the ACA, which will undoubtedly threaten the health and financial stability of millions of Americans, including older adults, that the law has provided for nearly a decade,” said Nancy LeaMond, AARP Executive Vice President and Chief Advocacy & Engagement Officer. “Undermining the ACA will increase out-of-pocket expenses for older Americans by reopening the Part D ‘doughnut hole’ and taking away key consumer protections, including preventing insurers from charging an age tax and guaranteeing coverage for people with preexisting health conditions.”

According to the brief:

“The ACA is a lifeline for millions of Americans, including older adults, who rely on it for their health and financial stability. More than nine years after its enactment, the ACA has become an integral part of the nation’s health care system. Among other things, it expands access to quality affordable care, guarantees coverage for people with preexisting conditions, and limits how much more insurers can charge older adults. It strengthens the financial viability of Medicare, lowers Medicare prescription drug costs, and expands Medicaid eligibility.”

“If this Court find the ACA is invalid, millions of older adults will lose the health care coverage and consumer protections they have relied on for years. It will also throw the Medicare and Medicaid programs into fiscal and administrative chaos, which will disrupt the nation’s health care system and economy. It will plunge the more than 100 million people with preexisting conditions into an abyss of uncertainty about whether they can obtain coverage. Finally, it will destroy hard-fought gains, including protections for nursing facility residents and the lowest income seniors who rely on Medicare.”

“When Congress reduced the tax penalty for not complying with the minimum coverage provision, it did not intend to dismantle the ACA. It also did not intend for that reduction to affect any other ACA provision, including those that protect people with preexisting conditions and limit age rating. Instead, Congress limited its actions in the Tax Cuts and Jobs Act of 2017 to reducing the tax penalty for not complying with the minimum coverage provision to $0.”

The amicus brief includes AARP and AARP Foundation, Center for Medicare Advocacy, and Justice in Aging.

April 1, 2019: Center for Medicare Advocacy posted a press release titled: “Center for Medicare Advocacy Files Amicus Brief in Support of the Affordable Care Act”. From the press release:

Today the Center for Medicare Advocacy joined AARP and Justice in Aging in filing an amicus brief in Texas v. United States, urging the Fifth Circuit Court of Appeals to reverse the trial court’s December 2018 ruling that would nullify the entire Affordable Care Act (ACA). The three organizations highlight the ACA’s critical protections for older adults and the disastrous ramifications that would ensue if the law were to be struck down. The amicus brief was filed in support of the appellant states, which are led by California. Last week, the U.S. Department of Justice announced a new, more extreme position in the case, maintaining that the entire law must be invalidated.

The brief explains that the ACA is a lifeline for older adults, who rely on it for their health and financial stability. For “pre-Medicare” individuals, age 50-64, the law guarantees coverage of preexisting conditions and limits how much more insurers can charge based on age. For Medicare beneficiaries, the ACA lowers medical costs by, among other things, closing the “doughnut hole” in the Medicare Part D prescription drug benefit. That provision alone has save more than 11.8 million Medicare beneficiaries over $26.8 billion. The law eliminated out-of-pocket costs for numerous preventative services. The ACA also helps nursing facility residents by protecting against fraud and abuse. Finally, the ACA strengthens the financial solvency of the Medicare program, having extended the life of the Medicare Trust Fund by approximately eight years.

“If the ACA is struck down,” said Judith Stein, Executive Director for the Center for Medicare Advocacy, “millions of older adults and people with disabilities will lose the health care coverage and consumer protections they have relied on for almost a decade.” Because the ACA contains around 165 provisions that impact Medicare, it will also throw the Medicare program into fiscal and administrative turmoil, which will disrupt the nation’s health care system and economy. It will plunge more than 100 million people with preexisting conditions into uncertainty about whether they can obtain coverage.

As the brief states:

The ACA is deeply rooted into the nation’s health care system and economy. Millions of Americans depend on the ACT for their health, protection, and well-being. Their lives now hang in the balance… The ACA is the law of the land.

April 1, 2019: The American Academy of Family Physicians (AAFP) posted news on their website titled: “AAFP Joins Objection to Administration’s Move Against ACA”. From the news:

During the heated campaigning of last fall’s midterm elections, the White House and officials from both parties pledged that people with preexisting health conditions would not lose the safeguards afforded by the Patient Protection and Affordable Care Act (ACA).

This month, the Academy and five peer medical organizations charged in a March 27 statement that the administration had broken that promise.

The Group of Six spoke out in response to a March 25 letter from the Department of Justice (DOJ) to the U.S. Court of Appeals for the Fifth Circuit. In that two-sentence letter, the administration – which last year said it would cease defending the ACA in court – announced that it now plans to argue against the law.

Referring to a judgement issued in December by U.S. District Judge Reed O’Connor in Texas et al. v. United States et. al., that the ACA has become unconstitutional, the letter read, in full: “The Department of Justice has determined that the district court’s judgement should be affirmed. Because the United States is not urging that any portion of the district court’s judgement should be reversed, the government intends to file a brief on the appellee’s schedule.”

O’Connor’s ruling in the case, which was brought by 20 state attorneys general seeking to strike down the ACA, said the law became unconstitutional once Congress eliminated the tax penalty imposed on people who do not obtain health insurance — the ACA’s “individual mandate.”

The AAFP voiced strong disagreement with that decision.

This latest reversal, the Group of Six said in its statement, “would endanger not only essential protections for persons with preexisting conditions, but other programs that millions of Americans depend on to ensure their access to affordable health care.” Among these crucial items now in jeopardy: federal funding for Medicaid expansion, premium subsidies to make coverage affordable in the individual market, and the ACA’s ban on annual and lifetime coverage limits…

April 1, 2019: Donald J. Trump tweeted: “Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high – Really bad HealthCare! Even the Dems want to replace it, but with Medicare for All, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans…”

April 1, 2019: Donald J. Trump tweeted: “…are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win…”

April 1, 2019: Donald J. Trump tweeted: “…back the House. It will be truly great HealthCare the will work for America. Also, Republicans will always support Pre-Existing Conditions. The Republican Party will be known as the Party of Great HealtCare. Meantime, the USA is doing better than ever & is respected again!”

April 1, 2019: Senator Susan Collins (Republican – Maine) sent a letter to U.S. Attorney General William P. Barr regarding Texas v. United States. From the letter:

I am writing to express my profound disagreement with the Department’s court filing on March 25, 2019, indicating that it will not defend any portion of the Affordable Care Act (ACA) in the ongoing litigation before the United States Court of Appeals for the Fifth Circuit. This surprising decision goes well beyond the position taken by the Department last June, and puts at risk not only critical consumer provisions such as those protecting individuals suffering from pre-existing conditions, but also other important provisions of that law, such as the Medicaid expansion, dependent coverage for young adults to age 26, coverage for preventative services, and the regulatory pathway for FDA approval of biosimilars.

Last June, then-Attorney General Sessions argued that the ACA’s provisions protecting people with pre-existing conditions are inseparable from the individual mandate, and cannot survive if that provision is struck down as unconstitutional. In a letter to Attorney General Sessions at the time, which I will attach for your convenience, I noted my opposition to the individual mandate as the penalty for violating it was highly regressive. Nevertheless, I disagreed that eliminating this regressive penalty would require striking the ACA’s pre-existing conditions and other critical consumer protections. Now, however, the Department has gone even further by arguing that all remaining provisions of the ACA should be ruled invalid….

…As I explained in my letter to Attorney General Sessions, sever ability shouldn’t be measured solely by Congress’s intent in 2010, when the Affordable Care Act became law, but rather by Congress’s intent in 2017, when Congress amended it through the Tax Cuts and Jobs Act. It is implausible that Congress intended protections for those with preexisting conditions to stand or fall together with the individual mandate, when Congress affirmatively eliminated the penalty while leaving these and other critical consumer protections in place. If Congress had intended to eliminate these consumer protections along with the individual mandate, it could have done so. It chose not to do so.

Rather than seeking to have the courts invalidate the ACA, the proper route for the Administration to pursue would be to propose changes to the ACA or to once again seek its repeal. The Administration should not attempt to use the courts to bypass Congress.

I continue to believe that the individual mandate should be treated as severable. The Administration should reconsider its decision and defend the remainder of the ACA.

April 1, 2019: The Tampa Bay Times posted an editorial titled: “Why the Affordable Care Act should be saved, not killed.” From the editorial:

The Affordable Care Act has been the law of the land for nine years and touches the lives of nearly every American. It ensures no one can be denied coverage because of a pre-existing condition. It also ensures no one can be bankrupted by medical bills, because it bans lifetime limits on insurance coverage. The law has saved countless lives, and it is supported by far more Americans than oppose it. Yet the Trump administration has irresponsibly announced it wants to overturn the entire law by agreeing with a Texas judge who ruled that it is unconstitutional. Never mind that neither the president nor congressional Republicans have an alternative ready to replace the Affordable Care Act. The case is now before a federal appeals court. Here’s a reminder of 15 facts and what is at stake:

21 million Americans could lose their health insurance if the Affordable Care Act is overturned.

102 million Americans have a pre-existing medical condition that could raise their premiums or deny them coverage altogether if they sought insurance without the protection of the Affordable Care Act, according to a study by Avalere, a health care consulting firm. That’s half of Americans enrolled in coverage outside Medicare or Medicaid.

About 8 million Floridians have pre-existing conditions, including 2.1 million Floridians who have individual coverage.

1.8 million Floridians signed up for health insurance in the federal exchange under the Affordable Care Act for 2019.

#1 Florida’s rank among the 39 states that use the federal health care exchange.

Florida is one of the states that are plaintiffs in the Texas lawsuit where the federal judge ruled the Affordable Care Act is unconstitutional.

55% of American voters support improving, not replacing, the nation’s health care system, according to a Quinnipiac poll released last week…

April 2, 2019: The Hill posted an article titled: “McConnell to Trump: We’re not repealing and replacing ObamaCare”. It was written by Alexander Bolton. From the article:

Senate Majority Leader Mitch McConnell (R-Ky.) told President Trump in a conversation Monday that the Senate will not be moving comprehensive health care legislation before the 2020 election, despite the president asking Senate Republicans to do that in a meeting last week.

McConnell said he made it clear to the president that Senate Republicans will work on bills to keep down the cost of health care, but that they will not work on a comprehensive package to replace the Affordable Care Act, which the Trump administration is trying to strike down in court…

…After getting the message from McConnell, Trump tweeted Monday night that he no longer expected Congress to pass legislation to replace ObamaCare and still protect people with pre-existing medical conditions, the herculean task he laid before Senate Republicans at a lunch meeting last week…

…Trump blindsided GOP senators when he told them at last week’s lunch meeting that he wanted Republicans to craft legislation to replace the 2010 Affordable Care Act.

The only heads-up they got was a tweet from Trump shortly before the meeting saying, “The Republican Party will become The Party of Healthcare!”…

April 2, 2019: The Hill posted an article titled: “Democrats rally at Supreme Court ahead of ObamaCare vote”. It was written by Jessie Hellmann. From the article:

House and Senate Democrats rallied on the steps of the Supreme Court Tuesday ahead of a vote on a resolution asking the Department of Justice (DOJ) to reverse its decision to side with a lower court ruling ObamaCare unconstitutional.

The symbolic resolution will likely pass the Democratic-controlled House Wednesday, but it won’t get a vote in the Senate, where Republicans are in the majority.

But it gives Democrats another chance to highlight the Trump administration’s efforts to repeal ObamaCare, which they see as a winning issue ahead of the 2020 elections…

April 2, 2019: The Speaker of the House website posted news titled: “Pelosi Remarks at Press Event on Supreme Court Steps Calling on Trump Administration to Halt Assault on American’s Health Care in the Courts”. From the news:

Speaker Nancy Pelosi joined House and Senate Democrats on the steps of the Supreme Court for a press event to highlight House and Senate resolutions and calling on the Trump Administration to halt its assault on Americans’ health care in the courts. Below are the Speaker’s remarks:

…We are here to condemn what the President did. Last week, the Trump Administration radically expanded its war on the Affordable Care Act – on America’s health care – asking the court to strike down every last provision of the ACA.

The distinguished Leader went through some of the concerns. Some bear repeating.

Imagine that he would say, after the Republicans misrepresented their position on pre-existing conditions – remember during the campaign they said, ‘Oh we’re for the benefit of not having pre-existing conditions be a barrier to your access to health care’. They said that, in spite of the fact that over and over again they have voted to eliminate that benefit.

And now, the President is acting in a way to not only eliminate that benefit, which is so important, also to eliminate a companion benefit that goes with the pre-existing condition – to eliminate the ban on lifetime limits and annual limits on people who need health care. This is terrible.

Being a woman is no longer a pre-existing condition under the ACA. You can be on your parent’s policy. Lengthening the stability and solvency of Medicare – they don’t care. They think Medicare should wither on the vine. That is the Republican mantra.

When Medicare was passed, they said it would lead to a socialist dictatorship. They do not believe in a public role. They are anti-governance.

So, this is not an issues fight or a legislative fight; it’s a values fight for our country. That we value the health and well-being of the American people and we recognize that their financial stability is related to their health stability.

The Medicaid expansion, as the distinguished Leader said, this isn’t just about the 20 million people who now have access to quality, affordable, health care. It’s about over 150 million American families who have better care, better benefits. Again, no lifetime limits, no pre-existing conditions ban and some of the other provisions that I mentioned.

Better benefits, lowering the increase in costs, improving the health – not just the health care, but the good health of Americans. It’s about prevention. It’s about nutrition.

Its about so many things that perhaps they don’t understand, but what we do understand is that they do not believe in public policy that affects the good health of the American people. And that is why we’re going to have this resolution debated on the floor today, voted tomorrow. From day one, Congressman Colin Allred led the way. House Democrats voted to throw the full legal weight of the Democrats in the House of Representatives and we hope that some of the Republicans will join us against the Texas lawsuit, he’s from Texas.

But more than 190 Republicans voted to be fully complicit in everything this monstrous proposal puts forth.

So, because of the President’s actions, which are to be condemned, that lawsuit is even more dangerous than it was in January, and that is why we are bringing forth that Allred resolution this week.

The American people deserve to know exactly where their representatives stand on the Trump Administration’s vicious campaign to take way their health care. This is so interesting because the President has been trying to do away with the Affordable Care Act from day one. We know that. And the way it was protected was not just by our inside maneuvering, it was because of the outside mobilization of so many groups. Many of whom are present today…

April 2, 2019: Speaker Nancy Pelosi tweeted: “During the 2019 election, Republicans claimed they supported protections for Americans with pre-existing conditions. Their support for Texas v U.S. – which would destroy protections for people w/ pre-existing conditions – is yet another sign of their true colors. #ProtectOurCare”

April 2, 2019: Speaker Nancy Pelosi tweeted: “The American people deserve to know “exactly” where their representatives stand on the Trump Admin’s vicious attacks on American’s health care. #ProtectOurCare”.

April 2, 2019: Senator Chuck Schumer tweeted: “We know what the GOP health plan would look like: gut protections for pre-existing conditions & massive losses of coverage. Today, Senate & House Democrats introduced resolutions telling the Trump DOJ to reverse its position to take away coverage for nearly 20 million Americans.”

The tweet includes a photo of Senator Chuck Schumer standing a a podium in front of the Supreme Court. The podium has a sign that says #ProtectOurCare. He is surrounded by other Democrats.

April 2, 2019: PBS News Hour posted an article titled: “House GOP tries to force vote about infants surviving attempted abortions”. It was written by Alan Fram. From the article:

Republicans started a long-shot drive Tuesday to force a House vote on a measure that could imprison doctors for five years if they don’t try saving the life of infants born during attempted abortions.

Their effort seems likely to fail in the Democratic-controlled House, where Speaker Nancy Pelosi, D-Calif., has refused to allow a vote on the bill. But Republicans hope it will be politically damaging for Democrats from moderate districts who oppose the GOP move, and see it as a way to energize conservative anti-abortion voters…

…Opponents say such births are extremely rare, generally occurring when doctors determine that a child won’t survive and parents opt to spend time with it before death.

Republicans have been pushing the issue since it arose earlier this year in Virginia and New York….

…House Republicans are utilizing a seldom used procedure that forces a vote on a measure once 218 lawmakers, a majority, sign a petition. Aides say all 197 Republicans are expected to sign. A few Democrats will probably join, but not the 21 Democrats that Republican will need to succeed.

Senate Democrats blocked a GOP effort in February to force debate on a similar bill.

April 2, 2019: Planned Parenthood posted a press release titled: “Planned Parenthood Condemns GOP House Petition to Criminalize Doctors”. From the press release:

Today, Reps. Scalise (R-LA) and Wagner (R-MO) tried to force a vote on an act to criminalize doctors – the same bill which failed in the Senate in February. This bill is not based in science or reality, but is yet another part of the Trump-Pence administration and Republican leadership’s attacks on health care. This legislation is overwhelmingly opposed by the medical community.

Politicians in Congress are trying to shame patients and criminalize doctors for a practice that doesn’t exist – while giving political cover to politicians at the state level to pass bans that outlaw abortion before many women know they’re pregnant. In fact, new data shows proposed six-week abortion bans – like the ban passed in Georgia last week – have increased an alarming 63 percent compared to last year…


The claims regarding this legislation are completely false and offensive, and are not based in science or medicine. It’s important to remember that the people spreading this misinformation have one motive in mind — to ban safe, legal abortion in this country. About one in four women in this country will have an abortion in her lifetime. Undermining access to safe, legal abortion is widely out of touch with the majority of Americans – 73 percent of Americans do not want women to lose their access to safe, legal abortion.

This bill represents overreach into the practice of medicine, and is opposed by medical groups. The American Congress of Obstetricians and Gynecologists strongly opposed this legislation calling it a “gross interference in the practice of medicine”.

States across the country are chipping away at the ability to access abortion safely and legally. More than 420 abortion restrictions have gone into effect since 2011 – the constitutional right to safe, legal abortion in our country has been eroded to the point that millions of women across the US do not have access to abortion.

April 3, 2019: The U.S. House of Representatives voted on H.Res.271 “Condemning the Trump Administration’s Legal Campaign to Take Away Americans’ Health Care”.

H.Res 271 was sponsored by Colin Z. Allred, (D-Texas).

It had 104 co-sponsors:

  • Tom O’Halleran (D-Arizona)
  • Donald Norcross (D-New Jersey)
  • Joaquin Castro (D-Texas)
  • Debbie Dingell (D-Michigan)
  • Henry C. “Hank” Johnson Jr. (D-Georgia)
  • Robin L. Kelly (D-Illinois)
  • Adriano Espaillat (D-New York)
  • Alan Lowenthal (D-California)
  • Donna E. Shalala (D-Florida)
  • Gilbert Ray Cisneros Jr. (D-California)
  • Debbie Wasserman Schultz (D-Florida)
  • Jim Cooper (D-Tennessee)
  • Diana DeGette (D-Colorado)
  • Katie Porter (D-California)
  • Abigail Davis Spanberger (D-Virginia)
  • John B. Larson (D-Connecticut)
  • Steven Horsford (D-Nevada)
  • Gerald E. Connolly (D-Virginia)
  • Terri A. Sewell (D-Alabama)
  • Mark Takano (D-California)
  • Bonnie Coleman Watson (D-New Jersey)
  • Jimmy Panetta (D-California)
  • Jerrold Nadler (D-New York)
  • Eleanor Holmes Norton (D-DC At Large)
  • Donald A. McEachin (D-Virginia)
  • David Cicilline (D-Rhode Island)
  • Ted Lieu (D-California)
  • Barbara Lee (D-California)
  • Bobby L. Rush (D-Illinois)
  • Michael F. Doyle (D-Pennsylvania)
  • Bradley Scott Schneider (D-Illinois)
  • Darren Soto (D-Florida)
  • Paul Tonko (D-New York)
  • David E. Price (D-North Carolina)
  • Rosa L. DeLauro (D-Connecticut)
  • Janice Schakowsky (D-Illinois)
  • Adam Schiff (D-California)
  • Tony Cardenas (D-California)
  • Chris Pappas (D-New Hampshire)
  • Norma J. Torres (D-California)
  • Katherine M. Clark (D-Massachusetts)
  • Filemon Vela (D-Texas)
  • Angie Craig (D-Texas)
  • Ruben Gallego (D-Arizona)
  • Kathy Castor (D-Florida)
  • David J. Trone (D-Maryland)
  • Gwen Moore (D-Wisconsin)
  • Gregorio Killi Cammacho Sabian (D-MP- At Large)
  • Suzanne Bonamici (D-Oregon)
  • Doris Matsui (D-California)
  • Salud O. Carbajal (D-California)
  • TJ Cox (D-California)
  • Jefferson Van Drew (D-New Jersey)
  • Anthony G. Brown (D-Maryland)
  • Pramila Jayapal (D-Washington)
  • Abby Finkenauer (D-Iowa)
  • Marcy Kaptur (D-Ohio)
  • Andy Kim (D-New Jersey)
  • Brian Higgins (D-New York)
  • Lori Trahan (D-Massachusetts)
  • Peter A. DeFazio (D-Oregon)
  • Linda T. Sanchez (D-California)
  • Mikie Sherrill (D-New Jersey)
  • Albio Sires (D-New Jersey)
  • Bill Foster (D- Illinois)
  • Jamie Raskin (D-Maryland)
  • Steve Cohen (D-Tennessee)
  • Cheri Bustos (D-Illinois)
  • Eddie Bernice Johnson (D-Texas)
  • Jennifer Wexton (D-Virginia)
  • Thomas R. Suozzi (D-New York)
  • Jim Costa (D-California)
  • Joe Neguse (D-Colorado)
  • Mary Gay Scanlon (D-Pennsylvania)
  • Matt Cartright (D-Pennsylvania)
  • Andy Levin (D-Michigan)
  • Sylvia R. Garcia (D-Texas)
  • Lizzie Fletcher (D-Texas)
  • Brendan F. Boyle (D-Pennsylvania)
  • Raja Krishnamoothi (D-Illinois)
  • Greg Stanton (D-Arizona)
  • William R. Keating (D-Massachusetts)
  • Jimmy Gomez (D-California)
  • Susan Wild (D-Pennsylvania)
  • Jahana Hayes (D-Connecticut)
  • Lisa Blunt Rochester (D- Delaware AtLarge)
  • Bill Pascrell Jr. (D-New Jersey)
  • Kim Schrier (D-Washington)
  • John Garamendi (D-California)
  • Dina Titus (D-Nevada)
  • Eliot L. Engel (D-New York)
  • Joyce Beatty (D-Ohio)
  • Jerry McNerney (D-California)
  • John A. Yarmuth (D-Kentucky)
  • Karen Bass (D-California)
  • James R. Langevin (D-Rhode Island)
  • Julia Brownley (D-California)
  • Madeline Dean (D-Pennsylvania)
  • Al Lawson Jr. (D-Florida)
  • Kendra S. Horn (D-Oklahoma)
  • Rashida Tlaib (D-Michigan)

The text of H.Res 271 is relatively short.

Condemning the Trump Administration’s Legal Campaign to Take Away Americans’ Health Care.

Whereas on February 26, 2018, 18 State attorneys and 2 Governors filed a lawsuit in the United States District Court for the Northern District of Texas, Texas v. United States … (in this preamble referred to as “Texas v. United States), arguing that the requirement of the Patient Protection and Affordable Health Care Act… (in this preamble referred to as “ACA”) to maintain minimum essential coverage is unconstitutional and, as a result, the court should invalidate the law.

Whereas in a June 7, 2018, letter to Congress, then Attorney General Jefferson Davis Sessions announced that the Department of Justice –

(1) would not defend the constitutionality of the minimum essential coverage provision; and

(2) would argue that provisions protecting individuals with pre-existing conditions (specifically the provisions commonly known as “community rating” and “guaranteed issue”) are inseparable from the minimum essential coverage provision and should be invalidated;

Whereas in the June 7, 2018, letter to Congress, Attorney General Sessions also advised Congress that “the Department will continue to argue that Section 5000A(a) is severable from the remaining provisions of the ACA”, indicating a difference from plaintiffs’ position in Texas v. United States;

Whereas on December 14, 2018, the United States District Court for the Northern District of Texas issued an order that declared the requirement to maintain minimum essential coverage unconstitutional and struck down the ACA in its entirety, including protections for individuals with pre-existing conditions;

Whereas the decision of the United States District Court for the Northern District of Texas was stayed and is pending appeal before the United States Court of Appeals for the Fifth Circuit;

Whereas on March, 25, 2019, the Department of Justice, in a letter to the United States Court of Appeals for the Fifth Circuit, changed its position and announced that the entire ruling of the United States District Court for the Northern District of Texas should be upheld and the entire ACA should be declared unconstitutional;

Whereas prior to 2014, individuals with pre-existing conditions were routinely denied health insurance coverage, subject to coverage exclusions, charged unaffordable premium rates, exposed to unaffordable out-of-pocket costs, and subject to lifetime and annual limits on health insurance coverage;

Whereas as many as 133,000,000 nonelderly people in the United States –

(1) have a pre-existing condition and could have been denied coverage, only offered coverage at an exorbitant price had they needed individual market health insurance prior to 2014, or had coverage for their pre-existing condition excluded prior to 2014; and

(2) will lose protections for pre-existing conditions if the ruling of the United States District Court for the Northern District of Texas is upheld in Texas v. United States;

Whereas contrary to President Trump’s public claims that he supports protections for people with pre-existing conditions, he has ordered his Department of Justice to actively pursue the destruction of these protections in Federal court;

Whereas employer-provided health plans cannot place lifetime or annual limits on health coverage, and if the Trump Administration succeeds in its argument before court, more than 100,000,000 people in the United States who receive health insurance through their employer could once again face lifetime annual coverage limits;

Whereas if the Trump Administration succeeds in its argument before the court, insurers would be allowed to impose an unlimited “age tax” on the health insurance premiums of older Americans;

Whereas prior to 2010, Medicare enrollees faced massive out-of-pocket prescription drug costs once they reached a certain threshold known as the Medicare “donut hole”, and since the donut hole began closing in 2010, millions of Medicare beneficiaries have saved billions of dollars on prescription drugs;

Whereas at a time when 3 in 10 adults report not taking prescribed medicines because of the cost, if the Trump Administration succeeds in its argument before the court, seniors enrolled in Medicare would face billions of dollars in new prescription drug costs;

Whereas as of March 2019, 37 States, including the District of Columbia, have expanded or are in the process of expanding Medicaid to individuals with incomes up to 138 percent of the Federal poverty level, providing health coverage for more than 12,000,000 newly eligible people;

Whereas if the Trump Administration succeeds in its argument before the court, the millions of individuals and families who receive coverage from Medicaid could lose eligibility and no longer have access to health care;

Whereas as of March 2019, many people who buy individual health insurance are provided tax credits to reduce the cost of premiums and assistance to reduce out-of-pocket costs such as copays and deductibles, which has made individual health insurance coverage affordable for millions of people in the United States for the first time;

Whereas if the Trump Administration succeeds in its argument before the court, the health insurance individual exchanges would be eliminated and millions of people in the United States who buy health insurance on the individual marketplaces could lose coverage and would see premium expenses for individual health insurance increase exorbitantly;

Whereas if the Trump Administration succeeds in its argument before the court, people in the United States would lose numerous consumer protections in their coverage, including the requirements that –

(1) plans offer preventative care without cost-sharing;

(2) young adults have the option to remain on a parent’s plan until age 26; and

(3) many health insurance plans offer a comprehensive set of essential benefits such as maternity care, addiction treatment, and prescription drug coverage;

Whereas pursuant to section 516 of title 28, United States Code, the conduct of litigation in which the United States is a party is reserved to the Department of Justice;

Whereas public report suggests that the President and his political advisors directed this course of action in direct contravention of the Department of Justice’s longstanding policy to defend Acts of Congress and duty to advance reasonable analysis of legal questions, for example –

(1) when the Department of Justice changed its litigating position on June 7, 2018, in the Texas v. United States case to ask the court to strike down the ACA’s guaranteed issue and community rating requirements, thereby eliminating protections for people with pre-existing conditions and reinstating legal discrimination based on health status, that position was found to be so legally indefensible that three of the four career attorneys representing the Government refused to sign the relevant briefs and removed themselves from the case; and

(2) when the Department of Justice changed its litigating position on March 25, 2019, in the appeal of Texas v. United States to seek the invalidation of every provision of the ACA, it was reported that the decision was made over objections of both the Department of Justice as well as the Department of Health and Human Services; and

Whereas the Trump Administration has proceeded in the Texas v. United States lawsuit with total disregard for the consequences of its actions for the lives of millions of Americans; Now, therefore, be it.

Resolved, That it is the sense of the House of Representatives that –

(1) the actions taken by the Trump Administration seeking the invalidation of the ACA’s protections for people with pre-existing conditions, and later the invalidation of the entire ACA, are an unacceptable assault on the health care of the American people; and

(2) the Department of Justice should –

(A) protect individuals with pre-existing conditions, seniors struggling with high prescription drug costs, and the millions of people in the United States who newly gained health insurance coverage since 2014;

(B) cease any and all effort to destroy Americans’ access to affordable health care; and

(C) reverse its position in Texas v. United States, No 19-10011 (5th Cir.).

The vote on H.Res 271 was 240 YEAS to 186 NAYS (and with one person voting “Present” and five people not voting).

232 Democrats voted YEA.

8 Republicans voted YEA. They were:

  • Brian Fitzpatrick (R-Pennsylvania)
  • John Katko, (R-New York)
  • Tom Reed (R- New York)
  • Denver Riggleman (R-Virginia)
  • Chris Smith (R-New Jersey)
  • Pete Stauber (R-Minnesota)
  • Elise Stefanik (R-New York)
  • Fred Upton (R- Michigan)

185 Republicans voted NAY.

1 Democrat voted NAY – Collin Peterson (D-Minnesota)

Representative Anthony Gonzales (R – Ohio) voted “Present”.

5 Representatives did not vote at all:

  • Donald McEachin (D-Virginia)
  • Tom Rooney (R-Florida)
  • John Rutherford (R-Florida)
  • Tim Ryan (D-Ohio)
  • Steve Stivers (R-Ohio)

April 3, 2019: CNBC posted an article titled: “House condemns Trump’s support for tossing out Obamacare as Democrats put 2020 pressure on GOP”. It was written by Jacob Pramuk. From the article:

The Democratic-held House voted Wednesday to condemn the Trump administration’s support for a lawsuit that aims to toss out the Affordable Care Act.

The resolution will have little practical effect and likely will not get a vote in the GOP-held Senate. But by approving the measure, Democrats aim to put pressure on House Republicans ahead of a 2020 election that the party again wants to frame as a referendum on GOP attempts to scrap the health-care law.

It passed the House by a 240-186-1 vote, as one Republican member voted “present”. Eight GOP lawmakers – many of whom could face tough reelection bids next year – supported the measure. Only one Democrat – Rep. Collin Peterson, an Obamacare skeptic whose Minnesota district overwhelmingly backed President Donald Trump in 2016 – voted against the resolution…

April 3, 2019: Donald J. Trump tweeted: “I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party. It will be on full display during the Election as a much better & less expensive alternative to ObamaCare…”

April 3, 2019: Donald J, Trump tweeted: “…This will be a great campaign issue. I never asked Mitch McConnell for a vote before the Election as has been incorrectly reported (as usual) in the @nytimes, but only after the Election when we take back the House, Etc. Republicans will always support pre-existing conditions!

April 3, 2019: NYTimes Communications tweeted: “We stand by our reporting:… President Trump’s own budget includes his health care proposal:”

The tweet included a link to a New York Times article from March 11, 2019. (Scroll back for more details on the article.)

April 3, 2019: Action News 2 WBAY posted an article titled: “UPDATE: Federal court lets Wisconsin out of both ‘Obamacare’ lawsuits”. From the article:

A federal judge has granted Wisconsin’s request to withdraw from a multi-state lawsuit seeking repeal of the federal health care law popularly known as Obamacare.

The judge on Tuesday granted the request made by Democratic Attorney General Josh Kaul at the order of Democratic Gov. Tony Evers.

The judge also allows Wisconsin to withdraw in a second case also related to the health care law on sex discrimination….

April 3, 2019: CBS News posted an article titled: “Georgia “heartbeat” abortion bill could join the legal fight to overturn Roe v. Wade”. It was written by Kate Smith. From the article:

Gov. Brian Kemp is poised to sign the Georgia “heartbeat” abortion bill, one of the most restrictive pieces of anti-abortion access legislation in the country. But the bill could have implications beyond the state and ultimately affect women nationwide by providing legal bait to challenge Roe v. Wade.

If approved, the bill will prohibit abortions after a heartbeat is detected – typically five to six weeks in a woman’s pregnancy, when most women don’t know they’re pregnant.

The controversial bill, however, has little chance of being successfully implemented in the state. Similar legislation across the country has been temporarily blocked or struck down by federal judges who say they violate Roe v. Wade – the 1973 Supreme Court decision that guarantees a woman’s right to abortion up until a fetus is viable. The American Civil Liberties Union in conjunction with the Center for Reproductive Rights have promised to file a lawsuit against the Georgia law the moment it’s signed into law.

But Elizabeth Nash, a senior state issues manager at the Guttmacher Institute in Washington, D.C. said the goal of the bill probably isn’t Georgia anyway. It’s Washington.

“The whole point of this is that it’s aimed at the U.S. Supreme Court,” she said. “It could have a much bigger impact because it would impact access across the country.”

In this regard, the bill isn’t unique. States have started introducing and passing more anti-abortion access legislation than ever before, hoping it may lead to the Supreme Court reconsidering Roe v. Wade, Nash said in a telephone interview with CBS News on Tuesday. States see an opportunity for a possible challenge to the 1973 ruling with the arrival of Justice Brett Kavanaugh….

…If Governor Kemp signs Georgia’s six-week abortion ban, the legislation won’t go into effect until January 2020…

April 8, 2019: The Trump administration filed a motion to expedite oral argument to the United States District Court for the Northern District of Texas. From the motion:

Plaintiffs-Appellees are: State of Texas; State of Wisconsin; State of Alabama; State of Arizona; State of Florida; State of Georgia; State of Indiana; State of Kansas; State of Louisiana; State of Mississippi, by and through Governor Phil Bryant; State of Missouri; State of Nebraska; State of North Dakota; State of South Carolina; State of South Dakota; State of Tennessee; State of Utah; State of West Virginia; State of Arkansas; Neill Hurley; John Nantz

Defendants-Appellants are: United States of America; United States Department of Health & Human Services; Alex Azar, II, Secretary of U.S. Department of Health and Human Services; United States Department of Internal Revenue; Charles P. Rettig, in his Official Capacity as Commissioner of Internal Revenue

Intervenor Defendants-Appellants are: State of California, State of Connecticut; District of Columbia; State of Delaware; State of Hawaii; State of Illinois; State of Kentucky; State of Massachusetts; State of New Jersey; State of New York; State of North Carolina; State of Oregon; State of Rhode Island; State of Vermont; State of Virginia; State of Washington; State of Minnesota

The Motion to Expedite Oral Argument says:

The United States hereby moves to expedite the oral argument and, in particular, respectfully requests that the Court schedule oral argument during its scheduled sitting in July 2019. This motion is unopposed.

In this case, plaintiffs challenge the constitutionality of the requirement, contained in the Patient Protection and Affordable Care Act, that certain individuals purchase health insurance. Plaintiffs further argue that the mandate is not severable from the remainder of the Act. A group of States have intervened to defend the constitutionality of the statute and to urge that even if the individual mandate is unconstitutional, it is severable from the rest of the Act. The House of Representatives has also intervened on appeal, and agrees that the individual mandate is constitutional and is severable regardless.

In district court, the United States took the position that the mandate is unconstitutional and that it is not severable from the so-called guaranteed-issue and community-rating provisions of the Act, but that the remaining provisions of the Act are severable. After further consideration, the United States has informed this Court of its new position that it agrees with the district court that the mandate is unconstitutional and not severable with the remained of the Act, and that it therefore intends to file a brief on the appellee’s schedule.

The opening briefs for the intervenor appellants were filed on March 25, 2019. Appellees’ brief and the brief for the United States are due on March 1, 2019.

The United States respectfully requests that the case be calendared for oral argument in the sitting scheduled for the week of July 8. Prompt resolution of this case will help reduce uncertainty in the healthcare sector, and other areas affected by the Affordable Care Act. The importance of doing so is underscored by the change in the alignment of the parties on appeal. We are not asking the Court to shorten the period for the filing of reply briefs, which would be due under the rules on May 22, 2019.

We have conferred with counsel for the other parties. The House consents to the relief requested by this motion: expedited scheduling of oral argument in the case for the Court’s regularly scheduled argument session in July 2019. The intervenor states and the plaintiff do not oppose this motion.

Things to Know:

  • The House of Representatives referred to in the motion was in the 115th Congress, when the Republicans had the majority the House. This case predates the beginning of the 116th Congress, where the Democrats have the majority in the House.
  • This motion was made after the U.S. Department of Justice announced that it would not defend the Affordable Care Act.
  • The United States District Court for the Northern District of Texas has two choices: it can approve the motion, or it can deny the motion.

April 9, 2019: Representative Jerrold Nadler (Democrat – New York) posted a press release on his official website titled: “House Chairs Seek Documents from Trump Administration on Sudden Decision to Stop Defending Health Care Law”. From the press release:

Five House Committee Chairs sent letters to the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the White House requesting documents and information regarding the involvement of White House officials in the Administration’s troubling decision to not defend the constitutionality of the Affordable Care Act (ACA).

The letters were signed by Committee on Oversight and Reform Chairman Elijah E. Cummings, Committee on Energy and Commerce Chairman Frank Pallone, Jr., Committee on Ways and Means Chairman Richard E. Neal, Committee on Education and Labor Chairman Bobby Scott, and Committee on the Judiciary Chairman Jerrold Nadler.

The chairs wrote in their letter to HHS and the White House:

“If the Administration’s new legal position prevails and the entire ACA is struck down, there would be catastrophic implications for millions of American consumers and the United States health care system.”

The chairs wrote in their letter to the DOJ:

“This refusal appears to be violating longstanding policies to defend and enforce Acts of Congress; will have a significant negative impact on the accessibility of healthcare for Americans; and appears to be driven by political considerations rather than considered legal arguments. The Department owes Congress and the public an explanation as to why it refuses to enforce the law and we request that you provide previously requested information to us and make certain individuals available for questioning.”

April 9, 2019: NARAL Pro-Choice America posted a press release titled: “Senate Judiciary Committee holds hearing on unconstitutional abortion ban”. From the press release:

As the Senate Judiciary Committee holds a hearing on an unconstitutional abortion ban, which would have grave consequences for women’s rights and lives, NARAL Pro-Choice America President Ilyse Hogue issued the following statement:

“The GOP is engaged in a coordinated attack on reproductive freedom, aimed at overturning Roe v. Wade and punishing women. From introducing a patchwork of legislation this year in over a dozen states to criminalize abortion, to launching a full-blown misinformation campaign aimed at vilifying women and families, the GOP’s agenda has reached new heights of cruelty. We look to members of the Senate Judiciary Committee to stand against this relentless campaign of political overreach to control women’s lives, bodies, and futures.”

Republicans in Congress have tried several times to advance unconstitutional abortion bans. This proposed legislation from Senator Lindsey Graham (R-S.C.) would criminalize abortion after 20 weeks of pregnancy, harming women and families who face some the most medically complex situations imaginable.

Meanwhile, bills that would effectively outlaw abortion have been introduced in more than a dozen statehouses across the country – Alabama, Kentucky, Mississippi, Georgia, Missouri, Ohio, Tennessee, Florida, Illinois, Maryland, Minnesota, New York, South Carolina and West Virginia. This session, Kentucky Governor Matt Bevin signed into a law a bill to ban abortion before many women know they are pregnant.

April 9, 2019: CBS News posted an article titled: “Lindsey Graham introduces bill which would ban abortions after 20 weeks.” It was written by Grace Segers. From the article:

Sen. Lindsey Graham, Republican from South Carolina, is once again introducing the Pain-Capable Unborn Child Protection Act, which would ban abortions after 20 weeks. Graham has sponsored this bill every year since 2013 only to have it defeated again and again in Congress.

This year might be different, thanks to a conservative majority in the Supreme Court and several restrictive abortion measures being passed in Republican-controlled states across the country. But the bill would still need 60 votes to bypass a filibuster and pass the Senate, an extremely unlikely outcome given that Republicans control only 54 seats in the chamber. And it would also need to pass the House, which now has a substantial Democratic majority…

…The legislation has never been able to clear the hurdle of invoking cloture, a procedural vote which allows legislation to advance to the Senate floor for a full vote…

…Democrats argue that such a bill would restrict a woman’s right to choose what happens in her body and violate Roe v. Wade, the landmark 1973 Supreme Court decision that legalized abortion nationwide…

…Supreme Court Chief Justice John Roberts sided with the court’s four liberal justices to block a restrictive abortion law in Louisiana from going into effect in February. Court watchers say Roberts, a Republican appointee and former official in the Reagan administration, may still be hesitant to overturn judicial precedent on the matter.

April 10, 2019: Planned Parenthood posted a press release titled: “Ohio To Become Sixth State to Ban Abortion Before Many People Know They’re Pregnant”. From the press release:

Today, admit large protests at the statehouse the Ohio General Assembly passed Senate Bill 23, the dangerous six-week abortion ban. Once it is signed by Governor MikeDeWine, Ohio will be the sixth state to ban abortion before many people know they’re pregnant. The law has no exceptions for cases rape or incest and threatens felony charges to doctors who provide care to patients. This becomes the 22nd restriction to reproductive health care in Ohio that has been enacted since 2011. Ohio is one of 16 states to pursue a six-week-ban, revealing a 63% uptick in these types of abortion bans this year.

This attack comes two weeks after the Sixth Court of Appeals upheld a law the bars Planned Parenthood from funding programs that provide essential health services and education and after a temporary injunction was placed on the bill that seeks to ban the dilation and evacuation procedure, which is the most common second trimester abortion procedure, to prevent it from being enforced. It’s clear that politicians will stop at nothing to ban abortion in Ohio.

The press release includes a statement from Dr. Leana Wen, President of Planned Parenthood Federation of America:

“Ohio’s six-week ban is a dangerous policy designed to block abortion access before many women know they’re pregnant. This is yet another attack we are seeing on the health and well-being of the residents of Ohio. Just two weeks ago, the Sixth Circuit Court of Appeals upheld a law that bans Planned Parenthood form programs that provide life-saving services including STD and HIV tests, breast and cervical cancer screenings, and domestic violence education, as well as the Healthy Moms, Healthy Babies program aimed at reducing maternal and infant mortality. These actions will roll back gains to public health and harm women’s health and the health of families across Ohio. Planned Parenthood will not back down from this flight. Our parents in Ohio and across the country deserve the right to control their own body, life, future, no matter where they live or how much money they make.”

April 10, 2019: NBC News posted an article titled: “Texas abortion bill proposes death penalty for women, physicians”. It was written by Dartunorro Clark. From the article:

Texas lawmakers are considering a bill that would ban abortion in the state and charge women who have abortions with homicide, which can carry the death penalty in the state.

Rep. Tony Tinderholt, a Republican, introduced the “Abolition of Abortion in Texas Act”, or House Bill 896, in January to “protect the rights of an unborn child” but was granted his first committee hearing on Monday and Tuesday.

Nearly 500 people testified, with 54 testifying against the bill, according to The Washington Post…

…Tinderholt introduced a similar bill in 2017, bit it failed to leave committee. He was placed under state protection because of death threats he received after proposing the bill, according to The Texas Tribune…

…The bill would ban abortion at any stage of pregnancy and would criminalize women who have abortions and the physicians who perform them, even in cases of rape, human trafficking or incest. The bill directly conflicts with the landmark Roe v. Wade decision, which outlawed criminalizing abortion…

April 10, 2019: NARAL Pro-Choice Ohio posted a press release titled: “NARAL Pro-Choice Ohio statement on Ohio’s six-week abortion ban”. From the press release:

The Ohio General Assembly has passed Senate Bill 23, which will effectively end access to all abortion care in Ohio if enacted.

NARAL Pro-Choice Ohio Executive Director Kellie Copeland said: “Today, the GOP majorities in the Ohio House and Senate voted to virtually outlaw abortion and drag us into a dystopian nightmare where people are forced to continue pregnancies regardless of the harm that may come to them or their family. We will stand in support of Ohio’s abortion providers as they challenge this attack on the public health in court. We will stand with Ohioans as they seek the abortion care they need.

“The passage of this six-week ban on safe, legal, accessible and affordable abortion is not the will of the majority. It is the act of the minority which abused their power to gerrymander Ohio’s legislative districts to give them the power to force their out-of-touch ideology on our state. We will work day and night to upend this attack on democracy to ensure that Ohio will once again have fair elections that result in elected officials that share our values and support reproductive freedom.”

In a media event held before the House vote, pro-choice advocates were joined by members of the Ohio House Democratic Caucus in speaking against the bill.

Ashley Underwood represented NARAL Pro-Choice Ohio at the event: “Those of us born with wombs are not voiceless vessels. We are not incubators. We are not the concubines of movements whose moral compass instructs them to deny us our autonomy. Our bodies should not be treated as the sole piece of incriminating evidence when conception is the result of violation and violence. And yet, each time the Ohio legislature further restricts abortion access for the thousands of constituents who need it, the state of Ohio treats us as such,

“Abortion is healthcare. Abortion is a life saving procedure. Abortion is moral. And good people have abortions”.

April 10, 2019: Senator Chuck Grassley (Republican – Iowa) posted a news release on his official website titled: “Grassley, Senators Introduce Bill to Protect Pre-Existing Conditions Coverage.” From the news release:

Senate Republicans believe in patient-centered health care that delivers the choices they want, the affordability and protections they need, and the quality care they deserve. That’s why U.S. Sen. Chuck Grassley of Iowa today joined Sen. Thom Tillis of North Carolina and 16 other senators in introducing the Protect Act, legislation that would protect Americans with pre-existing conditions and ensure that Americans have the peace of mind knowing that they and their loved ones will never be denied health insurance coverage or be charged more because of a pre-existing condition…

…Joining Grassley and Tillis as co-sponsors as the Protect Act are Sens. Lamar Alexander of Tennessee, Bill Cassidy of Louisiana, Rob Portman of Ohio, David Perdue of Georgia, Joni Ernst of Iowa, John Cornyn of Texas, Kevin Cramer of North Dakota, Johnny Isakson of Georgia, Roger Wicker of Mississippi, Shelley Moore Capito of West Virginia, John Barasso of Wyoming, Rick Scott of Florida, John Kennedy of Louisiana, Todd Young of Indiana, Tom Cotton of Arkansas, and Richard Burr of North Carolina.

The Protect Act amends the Health Insurance Portability and Act (HIPPA) to:

Guarantee the availability of health insurance coverage in the individual or group market, regardless of pre-existing conditions;

Prohibit discrimination against patients based on health status – including prohibiting increased premiums for patients due to pre-existing conditions;

Prohibit insurance companies from excluding coverage of treatments for a beneficiary’s pre-existing condition.

There was no further information about the Protect Act on Senator Grassley’s website. Senator Thom Tillis has a link on his website that leads to what looks like a pamphlet about The Protect Act. It is very vague.

Here are some key points from that pamphlet:

  • The three fundamental principles of the Protect Act are: Protection, Affordability, and Choices.
  • Protection: The Protect Act guarantees coverage for pre-existing conditions and prohibits insurance companies from excluding coverage of treatments for a patient’s pre-existing condition.
  • Affordability: The Protect Act prohibits insurance companies from charging you higher premiums due to pre-existing conditions.
  • Choices: The Protect Act guarantees the availability of health insurance coverage in the employer or individual markets for you and your loved ones regardless of whether or not you have a pre-existing conditions.
  • Does the Protect Act repeal or replace Obamacare? No. The Protect Act does not strike down, weaken, or change a single provision from Obamacare, nor is it designed to be a replacement for Obamacare.
  • Why isn’t the Protect Act a more comprehensive health care bill? This billl demonstrates the commitment of Republicans to protect Americans with pre-existing conditions, regardless of the future of Obamacare. The senators who introduced the bill have made it clear that they are wiling to work with anyone – Republican and Democrat alike – who want to reform our broken health care system and ensure Americans have access to quality and affordable health care.
  • The second page of the two page pamphlet is propaganda. It tries to convince people that the Republican’s idea version of health care is “patient-centered reform”.
  • It also tries to convince people that “government-run health care” is bad. This part is mostly using the same, old, Republican talking points that have been used since before Obamacare was signed into law. It includes scare tactics like:
  • “While the government can’t even run your local DMV properly, there are politicians in Washington who are proposing a total government takeover of your health care. That means if you like your current health insurance, you won’t be able to keep it, because the private plans that over 180 million Americans rely on would become illegal. In addition to paying higher taxes, it would also mean fewer choices for you and your family. With government bureaucrats in charge, you won’t be able to get the health care you want, when you need it. That means you and your loved ones could wait months or longer to get the treatment you need.”
  • This scare tactic is designed to subtly convince Americans that Obamacare is bad. It is also designed to frighten Americans away from voting for politicians who want single-payer health care, Medicare for All, or Universal Health care. Plenty of other countries have universal health care plans (UK, Canada, Australia – to name a few), and their systems work much better, are less expensive, and is more patient focused than anything the United States has.
  • In short, Obamacare already protects Americans by prohibiting insurance companies from excluding or dropping people because of their pre-existing conditions, from refusing to cover the care for pre-existing conditions, or from charging people with pre-existing conditions more for their coverage. Universal health care would provide those same protections because it means every American is covered and can access care for a very affordable cost.
  • The Protect Act is a talking point that Republicans are going to use as we head towards the 2020 election. It is an empty idea that doesn’t offer anything we don’t already have in Obamacare. It was created so Republicans have something to point at when Americans, rightly, point out the many times Republicans have tried to pass health care bills that would entirely exclude coverage for pre-existing conditions (or price that coverage too high for most Americans to afford).

If you would like more information about Universal Health Care, I recommend you check out my blog post titled: “America Needs Universal Health Care“. My blog has way more information about universal health care, and more specific details about various plans for it, than the Republicans Protect Act does.

April 11, 2019: The American Civil Liberties Union of Ohio (ACLU) posted a press release titled: “ACLU of Ohio to Challenge Total Abortion Ban”. From the press release:

The ACLU of Ohio announced today that it will file a lawsuit challenging Senate Bill 23, legislation that would ban all abortions in the State of Ohio. Governor Mike DeWine is expected to sign the bills in the coming days. The named plaintiff in the lawsuit will be Northeast Ohio based abortion care provider, Preterm-Cleveland. Additional plaintiffs will include Planned Parenthood of Greater Ohio, Planned Parenthood of Southwest Ohio, and the Women’s Med Center of Dayton.

The ACLU will argue that the banning of abortion at six weeks, or with the detection of a fetal heartbeat, is a direct violation of the Constitution and a complete undermining of Roe v. Wade. Similar lawsuits have been filed against so-called “heartbeat bills” in four other states (Iowa, Kentucky, Arkansas and North Dakota) and the courts have struck all of the abortion bans down as unconstitutional…

April 11, 2019: TIME posted an article titled: “Ohio Governor Signs Bill Banning Abortion After First Heartbeat”. From the article:

A bill imposing one of the most stringent abortion restrictions in the nation was signed into law in Ohio.

Republican Gov. Mike DeWine signed the heartbeat bill Thursday, breaking with his predecessor, Republican John Kasich, who had vetoed the measure twice.

Ohio’s closely divided politics had slowed the progress of the bill as it has caught momentum elsewhere, forcing years of debate in the state where the bill originated…

…DeWine’s action came a day after the latest version of the bill, which outlaws abortions once a fetal heartbeat is detected, cleared the Republican-controlled Legislature. Doctors say a fetal heartbeat can be detected using transvaginal ultrasound technology as early as five weeks into pregnancy, before many women know they are pregnant.

Even before the bill was signed, the ACLU of Ohio said it was preparing a constitutional challenge to the law on behalf of Pre-Term Cleveland and three other Ohio abortion clinics.

The legal challenge is what bill’s backers have always wanted. They hoped to provoke a legal challenge with the potential to overturn the U.S. Supreme Court’s 1973 Roe v. Wade ruling that legalized abortion up until viability, usually at 22 to 24 weeks…

…The law makes no exceptions for pregnancies resulting from rape or incest…

…The latest version of the bill passed out of an Ohio House committee Tuesday. The Full House approved it Wednesday and, that same day, the Senate agreed to House changes and sent it to DeWine…

April 11, 2019: NARAL Pro-Choice Ohio posted a press release titled: “DeWine Abortion Ban Attacks Woman”. From the press release:

In response to the signing of an unconstitutional attack on the right to safe and legal abortion, NARAL Pro-Choice Ohio Executive Director Kellie Copeland released the following statement:

“Today and everyday, we will not accept barriers places on abortion access by politicians or judges. We refuse to be intimidated by shame and stigma. No one should be forced to carry a pregnancy against their will. None of us will have reproductive freedom until all of us do.

“Governor DeWine, we’ll see you in court.”

All seven surgical abortion clinics, and two providers offering medication abortion services, will be open tomorrow serve patients.

April 11, 2019: Des Moines Register posted an article titled: “Chuck Grassley: Supreme Court unlikely to overturn Obamacare, so no need to create replacement”. It was written by Tony Leys. From the article:

U.S. Senator Chuck Grassley said Thursday he doubts a Republican lawsuit will succeed in getting the Affordable Care Act overturned.

“I don’t believe the courts are going to strike it down,” the Iowa Republican said in a phone interview with the Des Moines Register…

…Like other Republicans, he has been critical of the Affordable Care Act. The wide-ranging law is also known as Obamacare, because then-President Barack Obama, a Democrat, signed it in 2010…

…Trump told reporters last month, “The Republican Party will soon be known as the party of health care – you watch.”

But Grassley said Thursday there is no pressing need for Republicans to create a comprehensive plan to replace Obamacare. “We don’t have to work on a replacement, because it’s unclear what the courts are going to do,” he said.

Grassley said he expects the Supreme Court to uphold the Affordable Care Act, as it did in a 2012 decision, in which Chief Justice John Roberts was the deciding vote. “I would be very doubtful… that he’s going to be changing his mind,” Grassley said.

He touted a bill he co-sponsored this week that would bar insurers from discriminating against people with pre-existing health problems. But he said the bill would not be debated unless the Affordable Care Act is struck down, because that law already protects Americans with pre-existing conditions.

He acknowledged this week’s bill doesn’t address related issues, such as the use of current Obamacare subsidies to help moderate-income Americans buy health insurance before they become ill. Without such measures, insurers could decide to stop selling health policies on the individual market, where people turn for coverage if they aren’t eligible for insurance from employers or from Medicaid or Medicare…

April 11, 2019: National Law Journal posted an article titled: “DOJ’s Brett Shumate, Key Civil Division Lawyer, Just Announced He’s Leaving”. It was written by C. Ryan Barber. From the article:

Brett Shumate, a top political appointee in the U.S. Justice Department’s Civil Division, is stepping down after a two-year stint crisscrossing the country in defense of the Trump administration’s policies…

…Shumate did not respond to a request for comment. A person close to Shumate noted that two-year tenures are standard for political appointees and said he plans to spend time with his family before taking the next career step. He has not selected or committed to any law firm, the person said.

Shumate was among the leading lawyers on the Justice Department that abandoned the defense of the Affordable Care Act in the U.S. Court of Appeals for the Fifth Circuit, which is weighing the constitutionality of the Obama administration’s signature health care law. In a reversal, the Justice Department said last month it will now endorse the Texas trial lawyer’s decision declaring the entirety of the Affordable Care Act unlawful.

The government this week asked the court to set an expedited argument schedule and to hear the case by July. Main Justice has not yet announced who will argue for the government. The government’s abrupt refusal last year to defend part of Obamacare spurred several career Justice Department lawyers to withdraw their appearances in the case…

April 15, 2019: Kaiser Family Foundation (KFF) posted information titled: “Uninsured Adults in States that Did Not Expand Who Would Become Eligible for Medicaid under Expansion”. From the information:

Prior to the Affordable Care Act, Medicaid eligibility was limited to specific low-income groups, such as elderly, people with disabilities, children, pregnant women, and some parents. The ACA expanded Medicaid coverage to nearly all adults with incomes up to 138% of the Federal Poverty Level ($17,236 for an individual in 2019). As of April 2019, 14 states have not adopted the ACA Medicaid expansion. Across all non-expansion states, 4.4 million uninsured non elderly adults would become eligible for Medicaid if all opted to expand their programs. The two-page fact sheets provide a snapshot with key data for those who would become eligible for Medicaid under expansion in non-expansion states.

The following states did not expand Medicaid. Here is a list of information from KFF about Medicaid in those states:

  • Wisconsin: Covers adults up to 100% FPL in Medicaid, but did not adopt the ACA expansion.
  • South Dakota: If South Dakota were to expand its Medicaid program 29,000 uninsured non-elderly adults would become eligible for coverage, 45% of the state’s uninsured non-elderly.
  • Wyoming: If Wyoming were to expand its Medicaid program 20,000 uninsured non-elderly adults would become eligible for coverage 37% of the state’s uninsured non-elderly.
  • Kansas: If Kansas were to expand its Medicaid program 80,000 uninsured non-elderly adults would become eligible for coverage, 40% of the state’s uninsured non-elderly.
  • Missouri: If Missouri were to expand its Medicaid program 219,000 uninsured non-elderly adults would become eligible for coverage, 47% of the state’s uninsured non-elderly.
  • Oklahoma: If Oklahoma were to expand its Medicaid program 196,000 uninsured non-elderly adults would become eligible for coverage, 43% of the state’s uninsured non-elderly.
  • Texas: If Texas were to expand its Medicaid program 1.4 million uninsured non-elderly adults would become eligible for coverage 36% of the state’s uninsured non-elderly.
  • Mississippi: If Mississippi were to expand its Medicaid program 163,000 uninsured non-elderly adults would become eligible for coverage 53% of the state’s uninsured non-elderly.
  • Alabama: If Alabama were to expand its Medicaid program 223,000 uninsured non-elderly adults would become eligible for coverage, 54% of the state’s uninsured non-elderly.
  • Tennessee: If Tennessee were to expand its Medicaid program 207,000 uninsured non-elderly adults would become eligible coverage, 38% of the state’s uninsured non-elderly.
  • North Carolina: If North Carolina were to expand its Medicaid program 379,000 uninsured non-elderly adults would become eligible for coverage, 40% of the state’s uninsured non-elderly.
  • Georgia: If Georgia were to expand its Medicaid program 457,000 uninsured non-elderly adults would become eligible for coverage, 40% of the state’s uninsured non-elderly.
  • South Carolina: If South Carolina were to expand its Medicaid program 211,000 uninsured non elderly adults would become eligible for coverage, 44% of the state’s uninsured non-elderly.
  • Florida: If Florida were to expand its Medicaid program 837,000 uninsured non-elderly adults would become eligible for coverage, 36% of the state’s uninsured non-elderly.


A Timeline of the GOP’s Attempts to Destroy Obamacare – Part Three 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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