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Medicaid Unwinding May Leave Millions Of Children Without Coverage

As we enter the 5th annual Medicaid Awareness Month, millions of children and families are at risk of losing coverage. Protections put into place by Congress to keep people enrolled in Medicaid during the public health emergency will expire on April 1. States have up to a year to complete the “unwinding” process to determine who is still eligible for Medicaid coverage. A record 91.8 million Americans rely on Medicaid or the Children’s Health Insurance Program (CHIP) for their health care, including 34.2 million children – or 54 percent of children in America. It is predicted that approximately 15 million people may lose their coverage due to the unwinding. Children and families in Texas, Florida, and other states that have not expanded Medicaid are particularly vulnerable.

Many of those who could lose coverage are eligible for coverage through the Affordable Care Act (ACA) or traditional Medicaid. States have the responsibility to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, and people with disabilities. The Biden administration is working hard to support states and to demand a fair process. However, to date, many states have not committed to taking common sense measures to keep people covered.

By The Numbers

  • Nearly 7 Million Children Are Expected To Lose Medicaid/CHIP Coverage Due To Unwinding. 15 million enrollees, including as many as 6.7 million children, are expected to lose coverage during unwinding. 
  • More Than 50 Percent Of Children Are Covered By Medicaid/CHIP. Nationally 54 percent of American children are covered by Medicaid/CHIP. 
  • 72 Percent Of Children Will Lose Coverage Largely Due To Procedural Errors. The majority of children who will be disenrolled during the unwinding will still be eligible for Medicaid/CHIP, but will lose coverage due to procedural errors. These barriers include preventable language barriers, lack of support and communication from the state, confusing renewal notices, technology hiccups, and slight income fluctuations.
  • Medicaid Unwinding Disproportionately Impacts Children Of Color And Children In Rural Communities. 68 percent of Black children, 60 percent of Latino children, and nearly 50 percent of American Indian and Alaskan Native and Native Hawaiian and other Pacific Islanders are enrolled in public coverage. Children in rural communities are 24 percent more likely than those in urban areas to rely on Medicaid/CHIP for their health care.
  • Half Of Non-Expansion States Each Have Over 1 Million Children Covered By Medicaid. These states include Texas, Florida, Alabama, South Carolina, Mississippi, Georgia, Wyoming, Wisconsin, Kansas, and Tennessee. Texas and Florida are dealing with large amounts of staff shortages and increased enrollment applications making evaluations challenging and a lengthy process.

Nearly 7 Million Children Are Expected To Lose Medicaid/CHIP Coverage Due To Unwinding. 91.8 million people are enrolled in Medicaid/CHIP as of November 2022. Since February 2020, enrollment has increased by over 20 million people. 15 million people, including as many as 6.7 million children, are expected to lose coverage during unwinding. This is largely due to economic conditions due to the pandemic, Medicaid expansion in Nebraska, Missouri, and Oklahoma, and the federal continuous coverage provision that began in December 2020. Continuous coverage provided a 6.2 percent increase in federal Medicaid match rate to states to keep Americans enrolled without having to re-enroll each period.

More Than 50 Percent Of Children Are Covered By Medicaid/CHIP, Most Are From Marginalized Communities. Nationally 54 percent of American children are covered by Medicaid/CHIP. These children are largely Black or Latino or live in rural areas. Currently, 68 percent of Black children and 60 percent of Latino children are enrolled in public coverage, as well as nearly 50 percent of American Indian and Alaskan Native and Native Hawaiian and other Pacific Islanders. Children in rural communities are 24 percent more likely than those in urban areas to rely on Medicaid/CHIP for their health care. Children of color are more likely to experience churn or gaps in coverage than their white counterparts, due to parents of color being more likely to work low-wage jobs that are less likely to offer coverage.

Millions Are Expected To Lose Coverage Due To Red Tape Barriers During Re-Enrollment. Starting April 1st, states may disenroll ineligible people from Medicaid. Millions of people are expected to lose coverage due to either income increases making them ineligible or red tape barriers in re-enrolling that will prevent people from accessing coverage. These barriers include preventable language barriers, lack of support and communication from the state, confusing renewal notices, technology hiccups, and slight income fluctuations. Children of parents who hold part-time, hourly, or seasonal jobs are more vulnerable due to the slight variations in income throughout the year that could cause changes in their eligibility. The majority of children who will be disenrolled during the unwinding will still be eligible for Medicaid/CHIP, but will lose coverage due to procedural errors.

Texas And Florida Are Among 10 States That Refuse To Expand Medicaid. Half of non-expansion states, Alabama, Mississippi, Florida, Georgia, and South Carolina each have over 1 million children covered by Medicaid. In Texas and Florida specifically, unwinding is going to be challenging with a lack of staffing to review the millions of cases in each state and increase in Medicaid applications. Texas is short 300 eligibility advisors and has seen an increase of nearly 70 percent in enrollment applications compared to 2019. Meanwhile, due to similar staffing shortages and influx of applications, Florida has been taking weeks to review applications, while other states can review an application in as quickly as a day.

This Week in Health Equity

This week we highlight recent anniversary commemorations – the 20th anniversary of the seminal Unequal Treatment report and 13th anniversary of the Affordable Care Act (ACA). Additionally, life changing legislation has been passed in multiple states which will reduce health disparities in kids and increase access to gender affirming care for LGBTQI+ individuals on Medicaid; and maternal health experts released a new roadmap to reverse the maternal health crisis. New research shows how the ACA has significantly reduced racial health disparities. Even with this progress there are continuing areas for growth, most significantly is diversifying the medical and broader health workforce, tackling the rising maternal mortality rates and protecting rural hospitals at risk of collapsing across the nation.

Protect Our Care is dedicated to making high-quality, affordable and equitable health care a right, and not a privilege, for everyone in America. We advocate for policies that lower health care costs and strengthen coverage, which are critical to expanding access to quality health care and, ultimately, achieving better health outcomes, particularly for people of color, rural Americans, LGBTQI+ individuals, people with disabilities, and more. Our strategies are driven by a broader commitment to tackling systemic inequities that persist due to racism and discrimination and the reality that multi-sector policies are needed to address basic conditions that affect health and related outcomes, particularly for marginalized communities.


New York Times: North Carolina Officially Expands Medicaid After Republicans Abandon Their Opposition to the Program. “North Carolina on Monday became the 40th state to expand Medicaid under the Affordable Care Act, the latest sign of how Republican opposition to the health measure has weakened more than a decade after President Barack Obama signed it into law. Gov. Roy Cooper, a Democrat, signed legislation expanding the state’s Medicaid program during a sunny afternoon ceremony on the lawn of the Executive Mansion, days after the Republican-controlled legislature gave final approval to the measure. He was surrounded by patients, advocates and some of the same Republican leaders who had previously blocked expansion in the state. The bill will expand Medicaid to adults who make up to 138 percent of the federal poverty level, or about $41,000 for a family of four. State officials say the expansion will cover an estimated 600,000 people. It will take effect when the state adopts a budget, likely by June, Mr. Cooper said in an interview before the signing ceremony. It has been nearly 11 years since the Supreme Court ruled that states did not have to expand Medicaid — the government health insurance program for low-income people — under the Affordable Care Act. Nearly half the states opted out. More recently, progressives have helped to expand Medicaid in seven states — all of them with either Republican-controlled or divided governments — by putting the question directly to voters; in November, South Dakota adopted Medicaid expansion via the ballot box. Monday’s bill signing leaves just 10 states — all with divided or Republican leadership, and most of them in the South — that have yet to expand Medicaid. Advocates say they now have their sights set on Alabama, where Gov. Kay Ivey, a Republican, can expand her state’s program with her own authority. Hospitals, especially struggling rural ones, are eager for the extra revenue that Medicaid reimbursement will bring. The federal government picks up 90 percent of the costs of reimbursement under the expansion, and in North Carolina, hospitals will pay the other 10 percent. The state has revamped its Medicaid program, moving it from a fee-for-service program to one that relies on managed care — a long-sought goal of Republicans.” [New York Times, 3/27/23]

CBS News: The Affordable Care Act Has Reduced Racial Disparities When it Comes to Health Access. “The Affordable Care Act, passed in 2010 under former President Barack Obama, has expanded health insurance coverage across the U.S. and significantly reduced racial and ethnic disparities in access to health care, according to a new report by the Commonwealth Fund. Data shows that prior to the 2013 implementation of the Medicaid expansion — a provision of the ACA that made more families eligible for Medicaid coverage — 40.2% of the Hispanic population, 24.4% of the Black population, and 14.5% of the White population were uninsured in America. However, by 2021, those numbers dropped significantly to 24.5%, 13.5%, and 8.2%, respectively. With more than 5 million people gaining coverage between 2020 and 2022 over the course of the pandemic, the overall uninsured rate in the U.S. dropped to just 8%, a historic low, according to the report. ‘The coverage gap between Black and White adults dropped from 9.9 to 5.3 percentage points, while the gap between Hispanic and White adults dropped from 25.7 to 16.3 points,’ according to the study. Additionally, the report found that adult uninsured rates for Black, Hispanic, and White people all improved during the first two years of the pandemic across all states — whether they had expanded their Medicare coverage or not —  and that Black and Hispanic adults experienced larger gains in insurance coverage than their White counterparts between from 2019 to 2021.” [CBS News, 3/19/23]

The Grio: Anniversary of Affordable Care Act Highlights Gains for Black Americans. “During a White House ceremony commemorating the anniversary on Thursday, President Joe Biden called the signing of ACA an ‘extraordinary achievement’ of Obama’s. When the law was signed in 2010, then-Vice President Biden infamously said to Obama on a hot mic that it was a ‘big f—ing deal.’ Referencing the viral moment, the president added, ‘I stand by the fact that it was a big deal.’ The landmark legislation has steadily reduced the number of uninsured Black Americans over the years. The Department of Health and Human Services said in a report last year that the uninsured rate among Black Americans has decreased 40% since the ACA was implemented. Chiquita Brooks-LaSure, the administrator of the Centers for Medicaid and Medicare Services in the Biden administration, told theGrio that the number of Black Americans enrolled in the ACA this year is about the same as last year, which experienced a record increase of 35%. Brian Smedley, a senior fellow and equity scholar at the Urban Institute, pointed out that the Affordable Care Act also includes civil rights provisions for patients of color who historically experienced inequitable care in America’s health care system. According to the Kaiser Family Foundation, the uninsured rate for Black people was 10.9% as of 2021 compared with 7.2% for white people. Though there is still a gap, it has decreased significantly since 2010. The Kaiser report shows that in 2010 — perhaps shortly before or after Obamacare became the law of the land  —  the percentage of Black Americans who were uninsured was 20% compared with 13% for their white counterparts.The uninsured rate for both groups has dropped dramatically during the Obamacare era. Though millions of Black Americans remain uninsured, Smedley said they are predominantly found in southern states that have refused to expand Medicaid. A 2012 Supreme Court ruling allowed expansion to be optional for states. Since then, many Republican-controlled states have opted out. To date, 10 states have not expanded Medicaid services.” [The Grio, 3/23/23]

Urban Institute: As 20th Anniversary of the Unequal Treatment Report Approaches, New Program to Elevate Health Inequities is Launched. “In 2003, the National Academies Press published a landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, that shocked many policymakers and the medical establishment with its finding that racial and ethnic disparities in the quality of care are “remarkably consistent,” even after controlling for access-related factors, such as income and insurance status. Despite the national attention this report received, the nation has made little progress toward eliminating health care inequities in the 20 years since the report was published. As the 20th anniversary of Unequal Treatment approaches, the Urban Institute is launching a new program of action to elevate health care inequities as a national priority and build momentum for key remedies and structural reforms. To kick-off the initiative, we invite you to join us for a full-day symposium designed to bring together policymakers, researchers, health care administrators and professionals, and other interested parties. The symposium will: make evidence of the causes and consequences of health care inequities more accessible to patients, health care consumers, health care industry leaders, and policymakers; identify the most promising research and policy strategies that have emerged in the 20 years since Unequal Treatment’s publication; allow interested parties to collaborate to develop tools and mechanisms to hold practitioners and policymakers accountable, particularly at the state level, where key opportunities exist to establish equity-focused strategies; and elevate the voices of patients from marginalized communities and a new generation of scholars of color whose perspectives must be centered in identifying research questions and solutions.” [Urban Institute, 3/23/23]

National Partnership for Women and Families: A Roadmap to Reversing the Maternal Mortality Crisis. “Our nation’s maternal mortality crisis and the staggering impact on Black and Brown communities are well documented. A new suite of resources, Raising the Bar for Maternal Health Equity and Excellence, authored by the National Partnership for Women & Families, working with a renowned advisory panel and the Alliance of Community Health Plans (ACHP), the Health Care Transformation Task Force (HCTTF) and the National Birth Equity Collaborative (NBEC), offers practical solutions designed for healthcare systems ranging from independent women’s health clinics to large hospital systems. These resources are grounded in a deep understanding that the healthcare sector plays many roles beyond that of provider – as an employer, a community partner, and a policy advocate, each of which shapes maternal health. Jocelyn Frye, president of the National Partnership for Women & Families, hailed the resource as a transformational tool that is urgently needed. Frye said, ‘We know that Black women are three to four times more likely to die from pregnancy-related causes, and we also know the causes are rooted in persistent and systemic biases. By breaking down the different roles and adapting the guidance for institutions of every size, we’re acknowledging not only the depth and complexity of the maternal health crisis but also the breadth of community engagement that will be required to address the crisis successfully.’ Raising the Bar for Maternal Health Equity and Excellence is the second phase of a multi-year Robert Wood Johnson Foundation project. Raising the Bar’s first phase produced a framework that crafted specific principles, roles and actions that healthcare organizations can use to begin or advance their health equity work. Richard Besser, President and CEO, Robert Wood Johnson Foundation (RWJF) said, ‘It is an honor to join the National Partnership for Women & Families in celebrating the application of the important health equity guidelines offered by Raising the Bar to maternal and newborn health. Too many barriers – particularly for Black women – get in the way of providing high quality care. I’m excited to see how Raising the Bar will help us eliminate barriers like bias and discrimination around reproductive healthcare.’ As part of the launch of the guidance report, the National Partnership will host an event that includes remarks from the Honorable Chiquita Brooks-LaSure, Administrator, Centers for Medicare & Medicaid Services, Her remarks will be followed by a panel discussion on innovative approaches to improving maternal health featuring Richard Besser, from RWJF, Betty Chu, MD, Henry Ford Health Systems; Carmen Green, MPH, National Birth Equity Collaborative, Elizabeth Howell, MD, the University of Pennsylvania Health System and Aditi Mallick, MD, Center for Medicaid and CHIP Services.” [National Partnerships for Women and Families, 3/22/23]

Star Tribune: Minnesota Governor Signs Free School Meals Into Law. “School meals will become free for every Minnesota public and charter school student. Gov. Tim Walz signed a bill Friday that makes the change, while surrounded by children who got a firsthand lesson in how legislation becomes law. Until now, Minnesota law required parents to apply for free meals through a federal reimbursement program based on their income. Starting this year, districts could also automatically add a student to the benefit rolls if their family qualified for Medicaid. But Walz and other backers of providing universal free meals said those forms created unnecessary barriers. Minnesota is the third state in the nation to require schools to offer all students free breakfast and lunch, regardless of their family income, behind California and Maine. In Colorado, a similar law allows schools to opt in to a state-funded free meals program. Advocacy group Hunger Solutions estimates that 1 in 6 Minnesota students experience food insecurity, about a quarter of them living in a household that doesn’t qualify for free meals. Sen. Heather Gustafson, DFL-Vadnais Heights, estimates that a family of four living in White Bear Lake would save about $1,900 per school year if their children ate two meals at school. She sponsored the bill in the Senate and called it a ‘lunchbox tax cut,’ at the signing ceremony.” [Star Tribune, 3/17/23]

WMAR Baltimore: Maryland Passes the Trans Health Equity Act Swiftly Through Both Houses. “The LGBTQ+ community is celebrating a huge milestone as law makers officially approved the Trans Health Equity Act, allowing transgender patients to more easily obtain gender-affirming care. The Trans Health Equity Act will expand gender-affirming care through Medicaid so more patients can get the proper treatment. The legislation aims to establish equity by ensuring low-income Marylanders seeking gender-affirming care will receive the same treatment as people with private insurance. Advocates with Baltimore Safe Haven say this allows people in the LGBTQIA+ community to have better access to resources and gain valuable support from medical professionals. Advocates say this bill will truly make a difference in the LGBTQ+ community. Both chambers passed their bill, and now the bills have to go through the opposite chambers before making their way to the Governor’s desk.” [WMAR Baltimore, 3/24/23]


California Health Report: Racism in Academia is Hindering Attempts to Reduce Inequities in Health Care. “Time and time again, scientific reports and surveys cite some version of the following findings: Black people have the worst health outcomes. Black patients have better health outcomes when they see Black doctors. Black patients prefer Black doctors. Black doctors tend to care for higher proportions of Black patients than their White counterparts. Yet 53 percent of Black people in the US say it’s hard to find a Black doctor, which is not surprising. While Black people account for roughly 13 percent of the US population, they make up only 4 percent of the physician workforce and 7.3 percent of medical students. These representational disparities haven’t changed appreciably in decades. We cannot achieve health equity for Black patients without expanding the Black physician workforce, and the nation’s medical institutions are not achieving that goal. When confronted with this problem, academic medicine leaders attribute the plateauing of the Black physician workforce to factors beyond its control — things like disparities in primary education and poverty. Medical institutions have yet to honestly examine and address how they perpetuate the problem of a White-dominated physician training system that unjustly excludes, punishes, and dismisses Black medical students, trainees, and attending physicians. White people must recognize that inclusion is not a zero-sum game, said Camara Jones, MD, MPH, PhD, a Black physician who served as the 2021-2022 UCSF Presidential Chair.” [California Health Report, 3/23/23]

Ms Magazine: Medical Racism Has a Large Role in the Spike of Maternal Mortality. “The coronavirus exacerbated the effects of medical racism already baked into the United States healthcare system, leading to a spike in Black maternal mortality rates between 2020 and 2021, new data from the Centers for Disease Control and Prevention reveals. The recent statistics, though bleak, come as no surprise to maternal health experts, who say the disparities have persisted for decades. In 2021, more than 360 Black women died of maternal health causes across the country, according to the CDC, up from just over 290 in 2020 and more than 240 the year prior. The spike amid the coronavirus pandemic is likely due to a combination of factors, ranging from infection by the virus itself to medical racism.  As women’s age increased, so did the maternal mortality rate. For Black women over 40, the rate was over 300 per 100,000 births, compared to 42 per 100,000 for those under 25.  Despite advancements in medicine and technology over the years, the racial gap in who is suffering the most severe consequences of childbirth is growing, and most Black maternal and child health experts point to systematic racism as the root cause. Inequities in access to quality healthcare before, during and after pregnancy, as well as provider bias during labor and delivery, contribute to the dismal outcomes. And, the “weathering” effect that exposure to discrimination has on Black people’s bodies over a lifetime, which can break down a mother’s body prematurely, is also linked to the high death rates. The spread of COVID-19 decreased the quality of maternal healthcare for everyone across the country, said Mahdi, so for those who already had issues accessing high quality care, the impact of that care being further reduced had a significant effect.” [Ms Magazine, 3/20/23]

NY Daily News: The U.S. Must Begin Tackling the Growing Maternal Mortality Crisis. “New CDC numbers reveal that 1,205 women died of pregnancy-related causes in 2021, compared with 861 in 2020 and 754 in 2019. That represented a one-year jump of 38% and a two-year jump of 64%, to the highest maternal mortality rate on record since 1965. America’s overall rate was and still is far higher than its peer countries, and remains high by international standards whether you’re white, Latina or Black. Our maternal mortality is 54% higher than Russia’s; nearly double Canada’s; more than double the U.K.’s, France’s and Italy’s, and five times Japan’s and Germany’s. Second, race-based disparities here are especially egregious, and stubborn. Black women are 2.6 and 2.5 times likelier to die of maternity-related causes than white or Hispanic women. Research suggests economic disadvantages, discrimination by health-care providers and chronic stress all add up to take their toll. And the problem is inextricable from the fact that, even after the passage of Obamacare, too many Black Americans lack affordable access to quality medical treatment. The Biden administration last year laid out a thoughtful blueprint to save mothers’ lives; passage of sweeping federal legislation, a dozen bills collectively nicknamed the Momnibus, would go further. Waste no time. American women are dying in numbers far too large. As long as they do, American values remain on life support.” [NY Daily News, 3/20/23]

Idaho Capital Sun: Only Hospital for 9,000 Residents in Idaho Ends Its Obstetrical Services. “Idaho’s Bonner General Health, the only hospital in Sandpoint, announced Friday afternoon that it will no longer provide obstetrical services to the city of more than 9,000 people, meaning patients will have to drive 46 miles for labor and delivery care moving forward. Sandpoint Women’s Health will not accept new obstetrics patients effective immediately and offered a referral list for patients to use for their care. The hospital said it would make every attempt to continue deliveries through May 19, but said it will depend on staffing. The release also said highly respected, talented physicians are leaving the state, and recruiting replacements will be ‘extraordinarily difficult.’ Idaho has one of the most restrictive abortion bans in the country, with affirmative defenses in court only for documented instances of rape, incest or to save the pregnant person’s life. Physicians are subject to felony charges and the revocation of their medical license for violating the statute, which the Idaho Supreme Court determined is constitutional in January. Dr. Amelia Huntsberger, an obstetrician-gynecologist at Bonner General Health, said in an email to States Newsroom that she will soon leave the hospital and the state because of the abortion laws as well as the Idaho Legislature’s decision not to continue the state’s maternal mortality review committee. Linda Larson, who has lived in Sandpoint for 36 years and delivered her first child at Bonner General Health, said the community relies on Bonner General Health for much of its health care services, including physical therapy and routine blood work.” [Idaho Capital Sun, 3/17/23]

IN THE NEWS: Big Health Insurance Companies Continue “Lobbying Frenzy” to Protect Massive Medicare Advantage Profits

Over the past several months, the insurance industry has been running a massive advertising campaign to scare seniors into believing the Biden administration is cutting Medicare. Republicans in Congress are echoing these claims to protect insurance company profits. In reality, the Biden administration is proposing to increase spending on Medicare Advantage by approximately $4 billion while protecting the program from overpayments, fraud, and abuse by big insurance companies. Recent coverage makes clear that health insurance companies are working overtime to “exaggerate the stakes” in order to protect their massive profits at the expense of seniors. 

Read Protect Our Care’s fact sheet about how big insurers are spreading falsehoods about Medicare Advantage here


STAT: Wary Of Changes To Medicare Advantage, Health Insurers Put Up A Fight — And Exaggerate The Stakes. “For the past two months, the health insurance industry has attempted to scare older adults and the public into thinking the federal government is slashing Medicare benefits next year… Since any changes to Medicare are politically unpopular, health insurers are hoping the pressure will force the Biden administration to retreat from its February proposals that would specifically change how Medicare Advantage plans are paid. Final regulations are due to come out April 3. But insurance companies, as well as some doctors’ groups, are distorting the reality of the proposals in an effort to protect the sizable and growing profits they earn from Medicare Advantage. If anything, the government’s proposals are relatively tame, according to researchers and experts who have no ties to the industry. And they say officials could do more to combat the most egregious coding practices, which increase costs.” [STAT, 3/27/23]

The New York Times: Biden Plan To Cut Billions In Medicare Fraud Ignites Lobbying Frenzy. “The change in payment formulas is an effort, Biden administration officials say, to tackle widespread abuses and fraud in the increasingly popular private program… Without reforms, taxpayers will spend about $25 billion next year in “excess” payments to the private plans, according to the Medicare Payment Advisory Commission, a nonpartisan research group that advises Congress. The proposed changes have unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years.” [The New York Times, 3/22/23]

Axios: The Quiet Privatization Of Government Health Insurance Programs. “The insurers that administer Medicare benefits and their allies are running an enormous lobbying blitz against proposed regulations by the Biden administration that they say will cut their government funding and, in turn, harm enrollees. Supporters of the cuts say that the proposal corrects overpayment, which plans obtain by manipulating the billing system. The potency of the lobbying is a sign of just how ingrained Medicare Advantage has become among seniors over the years — and how important it is to some insurers’ business mix.” [Axios, 3/28/23

Stat: Denied By AI: How Medicare Advantage Plans Use Algorithms To Cut Off Care For Seniors In Need. “Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations. Older people who spent their lives paying into Medicare, and are now facing amputation, fast-spreading cancers, and other devastating diagnoses, are left to either pay for their care themselves or get by without it. If they disagree, they can file an appeal, and spend months trying to recover their costs, even if they don’t recover from their illnesses.” [Stat, 3/13/23

Medicare Rights Center: New Campaign Urges Commonsense Medicare Advantage Reforms. “A new national survey shows current and future Medicare beneficiaries agree—they overwhelmingly support addressing MA payment flaws, including as outlined in the 2024 AN:

  • 90% favor reforms to reduce MA overpayments.
  • 70% want policymakers to prevent fraudulent MA plan billing practices.
  • 65% say MA plans should be held accountable for providing value to beneficiaries and taxpayers.” [Medicare Rights Center, 3/23/23]

Health Affairs: Born On Third Base: Medicare Advantage Thrives On Subsidies, Not Better Care. “Over the past seven years, Medicare Advantage’s (MA’s) enrollment has almost doubled, adding 10 percent to its market share , now at 49 percent… The Medicare Advantage industry’s explanation of its success is grounded in claims about MA’s ability to deliver Medicare Part A and B benefits for much less than TM. These savings are, in theory, the basis for the rebates, the incremental revenue CMS pays to plans that fund the improved benefits and lower premiums as compared to TM, which in turn help attract members to MA plans… However, a close examination of the bid process reveals that most of these savings are artifacts of the process and not due to better or more efficient care. They result from including “induced utilization costs” from Medicare supplemental insurance, legislated increases in the benchmarks, and risk score gaming.” [Health Affairs, 3/27/23]

Stat: Key Senators Blast Medicare Advantage Insurers For ‘Exorbitant Salaries,’ ‘Massive Payouts’ To Execs. “Sens. Elizabeth Warren (D-Mass.) and Jeff Merkley (D-Ore.) slammed seven different Medicare Advantage insurers for lobbying against proposed rate cuts to the program while their executives still collected ‘exorbitant salaries’ and gave ‘massive payouts’ to their shareholders. The strong language came in a series of letters from the two key Senate Democrats to Humana, Centene, UnitedHealthcare, Aetna CVS Health, Molina Health, Elevance Health and Cigna — which collectively account for 70% of the market for Medicare Advantage, a private alternative to traditional Medicare. Nearly all of those companies, along with the insurance industry’s major trade group, America’s Health Insurance Plans, have been pushing back against a Biden administration proposal that would cut baseline payments to the plans by 2.3% in 2024.” [Stat, 3/23/23]

McCarthy’s Letter Says It All: Republicans Want Deep and Dangerous Cuts to American Health Care While Protecting Tax Breaks for Wealthy Americans

Washington DC — Today, GOP Speaker Kevin McCarthy outlined the Republican agenda for an upcoming debt ceiling bill. Republicans are seeking broad and devastating cuts to health care programs, including so-called work requirements and other draconian policies that would raise costs and rip away coverage from millions of Americans. These policies are especially harmful to children, rural Americans, people of color, and older adults. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“Kevin McCarthy’s latest stunt confirms that Republicans are fighting to hold our economy hostage so they can slash vital health care programs. More Americans are covered under the Affordable Care Act and Medicaid than ever before, but Republicans want to roll back this progress and throw moms and kids off the rolls with burdensome paperwork requirements — all so they can preserve tax breaks for the wealthiest Americans. Republicans are once again showing us who they truly are by proposing deep and devastating cuts to health care, completely disregarding what the American people want and need to stay healthy. If Republicans truly cared about the state of the economy for working families, they would try to tackle rising health care costs instead of ripping away coverage from millions.”

U.S Representatives Kathy Castor and Colin Allred Call on Governors to Protect Medicaid Coverage for Children and Families

Medicaid Coverage Requirement is Set to Expire April 1, Threatening Health Care for Millions of Families

Watch the Full Event Here.

Washington, DC – Today, U.S. Representatives Kathy Castor and Colin Allred joined Protect Our Care for a press conference calling governors across the country to protect coverage for families as the requirement to keep people on Medicaid ends April 1. The speakers will talk about the responsibility governors have to use their authority and resources to ensure children and families counting on Medicaid do not lose coverage due to burdensome paperwork and bureaucratic red tape. 

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision has helped secure the lowest level of uninsured Americans ever. When the requirement ends, an estimated 15 million people could potentially lose coverage, disproportionately affecting people of color and children. It is especially important to keep families covered in all the states where leaders continue to reject Medicaid expansion, including Florida and Texas. The Biden-Harris administration has committed to expanding access to care and providing guidance to states to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, people with disabilities, and others who rely on the Medicaid program for their health care. 

“Medicaid has been a lifeline to our neighbors for the past three years, thanks to the swift congressional action at the beginning of the COVID-19 pandemic. Having continuous coverage has brought a sense of financial and health security to many throughout the pandemic, particularly our nation’s children and new parents,” said U.S. Representative Kathy Castor. “Governor DeSantis and his colleagues across the country must take all available steps to ensure that individuals who are renewing their Medicaid coverage are provided every opportunity to stay enrolled in Medicaid if they are eligible, or to be given help enrolling in other affordable coverage options, like the Affordable Care Act marketplace.”

“Governor Abbott has a responsibility to make sure that Texans who qualify for Medicaid don’t get bogged down in red tape and paperwork – especially the 1.4 million kids and 300,000 Texas moms who are at risk of losing coverage,” said U.S. Representative Colin Allred. “I worry that our state is not prepared for the amount of processing it will take to ensure that there’s no lapse in coverage for these families. That’s why it’s so important that we do all we can to get these families the resources and information they need to keep their family healthy.”

“It is the responsibility of every state and every governor to be sure that those who qualify for Medicaid stay covered. This means helping everyone to understand their coverage options and giving them the help they need to re-enroll so that no one loses their health care because they fail to submit the right paperwork or simply because they were not communicated in the language most appropriate for them,” said Leslie Dach, Chair of Protect Our Care. “It is critical to understand what’s at risk here – the families, people who are working hard every day, people with disabilities, children, moms who rely on Medicaid could lose access to basic health care. Every state elected official must think of their own families and what it would be like if health care was ripped away from them for no reason.”

PRESS CALL: U.S Representatives Castor, Allred to Call on Governors to Protect Children and Families as Medicaid Continuous Coverage Requirement Ends


Washington, DC – On Monday, March 27, 2023, at 10 AM ET, U.S. Representatives Kathy Castor and Colin Allred will join Protect Our Care for a press conference to call on governors across the country to keep families in America covered as the requirement to keep people on Medicaid ends April 1. The speakers will talk about the responsibility governors have to use their authority and resources to ensure children and families counting on Medicaid do not lose coverage due to burdensome paperwork and bureaucratic red tape. 

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision has helped secure the lowest level of uninsured Americans ever. An estimated 15 million people could potentially lose coverage, disproportionately affecting people of color and children. It is especially important to keep families covered in all the states where leaders continue to reject Medicaid expansion, including Florida and Texas. The Biden-Harris administration has committed to expanding access to care and providing guidance to states to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, people with disabilities, and others who rely on the Medicaid program for their health care.


U.S. Representative Kathy Castor (D-FL-14)
U.S. Representative Colin Allred (D-TX-32)
Leslie Dach, Founder and Chair, Protect Our Care

WHAT: Virtual Press Conference 

WHERE: Register for the Event Here.

WHEN: Monday, March 27 at 10 AM ET

HEADLINES: President Biden Celebrates 13th Affordable Care Act Anniversary

Washington, DC – Today, President Biden celebrated the 13th anniversary of the Affordable Care Act (ACA) at the White House. President Biden was introduced by Teresa Acosta, whose family, including her son with Type 1 diabetes, relies on the ACA for affordable coverage.  During the speech, President Biden emphasized his administration’s commitment to building on the ACA, a stark contrast to the GOP agenda of repealing the ACA and the Inflation Reduction Act and hiking costs for millions of seniors and families.

Thanks to the ACA, health outcomes have improved across all age groups, medical debt has decreased, and financial security is stronger for families. We’ve also seen stark inequities in care narrow – both for rural Americans and communities of color who have traditionally faced serious barriers to health care. When paired with policies to address other social and structural determinants of health, expanding access to care improves the health and well-being of every American. Read Protect Our Care’s ACA anniversary fact sheet here

Thanks to the tireless work of President Biden and Democrats in Congress, the 2023 open enrollment period was the most successful in history — with almost 16 million Americans signing up for coverage. Coupled with the health law’s expansion of Medicaid, protections for people with preexisting conditions and cost-saving measures, the ACA has touched the lives of nearly every person in the nation. 


Washington Post: President Biden Calls Out Republicans Seeking to Repeal the Affordable Care Act. “Today, before heading to Ottawa to meet with Canadian Prime Minister Justin Trudeau, President Biden used an event marking the 13th anniversary of the Affordable Care Act to criticize congressional Republicans for wanting to repeal the now-popular program enacted under President Barack Obama — saying that would have ‘a devastating impact on the American people.’ Biden said the ACA moved the country in the direction of ‘the fundamental principle that we hold as Democrats and Americans that health care is a right, not a privilege.’” [Washington Post, 3/23/23]

Fox News: President Biden Says Saving Lives “Doesn’t Mean Much to Our Republican Friends.” “Biden criticized ‘MAGA Republicans’ for their opposition to the ACA at the White House event, which had former Speaker Nancy Pelosi; Vice President Kamala Harris and many other top-level Democrats in attendance. ‘The Affordable Care Act has been law for 13 years. It has developed deep roots in this country,’ Biden said. ‘It has become a critical part of our healthcare and saving lives.’ Biden added that ‘MAGA Republicans’ are intent on repealing the ACA, despite Biden’s claims that it would have a ‘devastating impact’ on Americans.” [Fox News, 3/23/23]

WSAZ: Biden Celebrates 13th Anniversary of the Affordable Care Act. “President Joe Biden on Thursday marked the 13th anniversary of the signing of the Affordable Care Act, also known as Obamacare. Biden gave remarks from the White House on the key accomplishments of the landmark bill. He highlighted how the law has resulted in quality health care for more than 40 million Americans and lowered costs for families. Biden also mentioned steps he has taken as president to boost the legislation, including capping out-of-pocket drug costs for seniors on Medicare. The president slammed House Republican proposals the White House dubbed a ‘five-alarm fire.’ Biden called out the House Freedom Caucus’ proposed budget, which he says will increase health care costs and push the biggest cut to Medicare in decades.” [WSAZ, 3/23/23]

The Hill: What We Have Gained 13 Years Later From the Affordable Care Act. “A reported 13.6 million Americans got insurance in 2021 alone via that ACA marketplaces. Closing the prescription drug “donut hole” saved millions of Medicare recipients billions of dollars, and 2022 surveys by the Kaiser Family Foundation and Morning Consult found that a majority of Americans approve of the ACA. Staunch Republican opposition is shrinking. It turns out that public opinion is even more striking when you ask folks about specific ACA provisions. For example: 90 percent of Americans support prohibiting health insurance companies from denying coverage for people with preexisting conditions; 89 percent support requiring health insurance companies to cover the cost for most preventive services; 88 percent support prohibiting health insurance companies from denying coverage to pregnant women; 87 percent support prohibiting health insurance companies from charging sick people more, and the same percentage support giving states the option to expand Medicaid; 85 percent support providing financial help to low- and moderate-income Americans to purchase coverage; and 78 percent support allowing young adults to stay on their parents’ insurance plans until age 26. More than 35 million Americans have health insurance today because of the ACA — men, women and children who are benefiting from lower cost and higher quality health care coverage. They can thank the vision and courage of leaders such as former House Speaker Nancy Pelosi (D-Calif.), former Majority Leader Steny Hoyer (D-Md.) and former Majority Whip Jim Clyburn (D-S.C.), who socialized the issue and worked to secure the history-making votes in Congress.” [The Hill, 3/23/23]

MSNBC: The Affordable Care Act Has Never Been Stronger Than Today. “After the Affordable Care Act became law 13 years ago today, there were plenty of points at which its future appeared to be in doubt. Legal challenges put the ACA in jeopardy — including three separate cases that went to the U.S. Supreme Court. After Donald Trump’s 2016 election, the fate of Obamacare appeared sealed. All the while, Republicans made all kinds of predictions about the ACA’s imminent failure and disastrous consequences. Obamacare, the GOP insisted, would create ‘armageddon.’ Thirteen years later, it’s now obvious that Republicans were wrong and the ACA’s proponents were right. In fact, thanks entirely to the reform law, the nation’s uninsured rate has never been lower. Just as important is the fact that health insurance has never been more affordable than it is now: Democrats included generous new ACA subsidies in the party’s American Rescue Plan in 2021, with some consumers seeing their premiums fall to nearly or literally zero, thanks entirely to the investments in the Democrats’ relief package. Those benefits were extended last year — though many congressional Republicans are eager to roll back the benefits and force premiums higher. The ACA is working; it’s popular; it’s affordable; it’s advancing; it’s withstood far too many legal challenges; and it no longer has a Republican-imposed target on its back. Thirteen years ago today, this dynamic was hard to predict, but to the benefit of tens of millions of American families, it’s the truth.” [MSNBC, 3/23/23]

On the 13th Anniversary of the ACA, North Carolina Becomes the 40th State to Expand Medicaid After Years of Republican Obstruction

North Carolina Expands Medicaid, Giving 600,000 Residents Access to Affordable Health Care

Washington DC — Today, on the 13th anniversary of the Affordable Care Act (ACA) being signed into law, North Carolina became the 40th state to expand Medicaid, extending affordable health care to 600,000 North Carolinians. This move will especially help low-income workers, moms and children, people with disabilities, and Black, Brown, Indigenous, and rural residents. 

Before today, North Carolina was just one of 11 states that have refused Medicaid expansion. Democratic Governor Roy Cooper has fought tirelessly for Medicaid expansion, making it one of his central priorities since taking office in 2017. Already, about 3.5 million North Carolinians rely on Medicaid and the ACA for health coverage, or 33 percent of the state population. In addition to securing coverage for those who need it, this measure will strengthen the economy, boost support for rural hospitals and other safety net providers, relieve hardships for families living in poverty, and — together with policies that focus on other social and structural determinants of health — reduce gaps where people can’t get the health care they need to thrive if they live in certain places or are of certain backgrounds.

In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“Governor Cooper, Democratic lawmakers, and advocates fought tirelessly for North Carolina’s Medicaid expansion for years — and now, on the 13th anniversary of the ACA being signed into law, they got it over the finish line. This is a victory for North Carolinians and a victory for the 600,000 individuals and their families who will now have access to lifesaving care. Medicaid expansion is especially significant for moms and kids, people of color, folks living in rural areas, people with disabilities, and other communities who face extreme barriers to accessing care and suffer worse health outcomes. This is a critical step to increase coverage and make health care more affordable.

“Even as Republicans in Washington try to gut the Affordable Care Act and Medicaid, this bipartisan action shows what can happen in the states after years of gridlock because the people demanded it.”


More North Carolinians’ Lives Will Be Saved. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent. Medicaid expansion will insure over 365,000 North Carolinians, saving them millions of dollars and increasing access to quality and affordable health care.

North Carolinians Will Receive Expanded Services. Medicaid expansion has helped patients access preventive care, including colon cancer screenings. Expansion also increased patient access to kidney transplants and made diabetes medication more affordable for low-income patients. The program was also tied to earlier diagnoses of colorectal cancer and reducing diabetes-related amputations.

North Carolina Will See Reduced Racial Disparities in Health Care. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion and a 45 percent reduction between white and Hispanic adults. There is evidence already that North Carolina’s adoption of Medicaid Expansion will not just follow these trends, but secondarily increase economic activity throughout the state and reduce economic inequities as well.

North Carolina’s 4.6 Million Rural Residents Will Secure Better Care. The uninsured rate for low-income adults dropped from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid. Investigations into North Carolina have found areas in the western part of the state will see uninsurance rates drop by over 8 percent, with that number being even higher for those without a high school education. Research also confirms that rural hospitals in Medicaid expansion states are 62 percent less likely to close, and 75 percent of vulnerable rural hospitals are in non-expansion states.

U.S. Representatives, Governor Evers, and Health Care Advocates to Join Protect Our Care in Michigan, Wisconsin, California, and Arizona to Mark 13-Year Anniversary of the Affordable Care Act


U.S. Representatives Elissa Slotkin (MI-07), Judy Chu (D-CA-28), and Jimmy Gomez (D-CA-34), Wisconsin Governor Tony Evers, and Health Care Advocates Join Protect Our Care to Discuss How Democrats Have Fought to Strengthen the ACA

On Thursday, March 23, U.S. Representatives Elissa Slotkin (MI-07), Judy Chu (D-CA-28), and Jimmy Gomez (D-CA-34), Wisconsin Governor Tony Evers, and health care advocates will join Protect Our Care in Michigan, Wisconsin, California, and Arizona to highlight the 13th anniversary of the Affordable Care Act and discuss how people across the country have benefitted from the law, which expanded access to quality, affordable health care. The historic legislation eliminated lifetime caps, expanded Medicaid, and secured protections for millions of people living with pre-existing conditions. The Inflation Reduction Act built on the strong foundation of the ACA by lowering premiums for middle- and working-class families by an average of $2,400 a year. Thanks to the ACA, more than 21 million Americans have gained coverage through Medicaid expansion, and Medicaid has become a pillar of the American health care system, demonstrating the overwhelming need and desire for affordable health coverage.

Thanks to the ACA, health plans are also required to cover preventive care services without cost-sharing. Access to preventive care has improved health outcomes and reduced economic inequity. The ACA has helped reduce longstanding disparities in coverage rates, improving health care access for children, rural Americans, people with disabilities, and people of color across the nation.

Speakers will also highlight ongoing Republican attacks on health care, and celebrate how  President Biden and Democrats in Congress have made historic investments to secure the future of American health care. Thanks to their vision and determination, people can now sleep easier at night knowing President Biden and Democrats in Congress are hard at work to expand health coverage and lower health care and prescription drug costs.

U.S. Representative Elissa Slotkin
Laura Appel of the Michigan Health & Hospital Association
Laura Bonnell, Bonnell Foundation director
Sarah Stark, diabetic and Michigan resident

WHEN: Thursday, March 23 at 11:00 AM ET

WHERE: Register to join the Zoom event (Registration required)

Wisconsin Governor Tony Evers
Kat, marketplace consumer from Milwaukee
Chad, marketplace consumer from Central Wisconsin
Mary, retired nurse from SE Wisconsin

WHEN: Thursday, March 23 at 11:30 AM CT

WHERE: Register to join the Zoom event (Registration required)

U.S. Representative Judy Chu
U.S. Representative Jimmy Gomez
Michael Lawson, President, Los Angeles Urban League
Susan Meyer, California Alliance for Retired Americans 

WHEN: Thursday, March 23 at 10:00 AM PT

WHERE: Register to join the Zoom event (Registration required)

Matt Jewett, Children’s Action Alliance
Alison Farrell, Arizona mother and entrepreneur
Ron Barber, Former Arizona Congressman 

WHEN: Thursday, March 23 at 2:00 PM MST

WHERE: Register to join the Zoom event (Registration required)

Thirteen Years Later, the Affordable Care Act Is Only Getting Stronger

ACA Anniversary Comes As Republicans Reignite War on Health Care

Washington DC — Thirteen years ago today, President Barack Obama signed the Affordable Care Act (ACA) into law, and millions of Americans gained quality health care as a result. In the years since, Democrats have stopped Republican efforts to repeal the ACA, and they have built on the health care law by passing the Inflation Reduction Act to deliver lower health care and prescription drug costs for millions of seniors and families across the nation. 

Over the past 13 years, we’ve seen health outcomes improve across all age groups, medical debt decrease, and stronger financial security for families. We’ve also seen stark inequities in care narrow – both for rural Americans and communities of color who have traditionally faced serious barriers to health care. When coupled with policies to address other social and structural determinants of health, expanding access to care improves the health and well-being of every American.  

Thanks to the tireless work of President Biden and Democrats in Congress, the 2023 open enrollment period was the most successful in history — with almost 16 million Americans signing up for coverage. Coupled with the health law’s expansion of Medicaid, protections for people with preexisting conditions and cost-saving measures, the ACA has touched the lives of nearly every person in the nation. Read Protect Our Care’s ACA anniversary fact sheet here

“The ACA is a pillar of our health care system,” said Protect Our Care Chair Leslie Dach. “Thanks to the ACA, millions of people with pre-existing conditions like diabetes or asthma are protected, people who buy insurance on their own can afford their premiums, more than 21 million people are covered through Medicaid expansion, and over 150 millions patients have access to free cancer screenings and other preventive care. Thirteen years in, the law is now built into the fabric of America and is only getting stronger.”

“On the ACA’s 13th anniversary, it’s important not to lose sight of Republicans’ war on health care,” said Protect Our Care Executive Director Brad Woodhouse. “They want to raise costs on families, they want to go back to a time where people with pre-existing conditions paid more, and they want to keep siding with Big Pharma and insurance companies. While President Biden and Democrats in Congress have worked tirelessly to build on the ACA and ensure affordable, quality health care for every American, the GOP is still fighting to cut the ACA, reject Medicaid expansion, and undermine the law’s protections in the courts. Some things never change: Republicans want to raise health costs, ditch critical protections, and put profits over patients.” 


Republicans Want To Gut The ACA

Thirteen years after the passage of the ACA, Republicans’ threat of repeal is as real as ever. Republicans are consulting with Russ Vought, Trump’s former Office of Management and Budget Chief, to navigate debt ceiling negotiations. Vought’s plan would cut $2 trillion from Medicaid alone, disproportionately impacting children, rural Americans, and people of color. Vought is also advocating for $600 billion in cuts to the ACA, which would rip coverage from 20 million Americans and raise premiums for nearly 15 million more.   Meanwhile the House Freedom Caucus has proposed draconian budget cuts and onerous work requirements designed to strip Medicaid coverage from millions of Americans who rely on it. 

If Republicans get their way and the Affordable Care Act is repealed:

  • GONE: Protections for 135 million Americans with pre-existing conditions, including 54 million people with a pre-existing condition that would make them completely uninsurable.
  • GONE: Medicaid expansion, which covers more than 21 million people. 
  • GONE: 49 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
  • GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
  • GONE: Insurance companies will be able to charge women more than men.
  • GONE: Premium tax credits that help 80 percent of people who purchase health care on the marketplace.
  • GONE: Key support for rural hospitals. 
  • GONE: Ban on insurance companies having lifetime caps on coverage.
  • GONE: Requirements that insurance companies cover prescription drugs and maternity care.
  • GONE: 61.5 million Medicare beneficiaries will face higher costs and disruptions to their medical care.