News

Washington, DC — The Republican Study Committee just released a budget proposal that repeals the Inflation Reduction Act’s Medicare negotiation program, hikes premium costs, and slashes Medicaid. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement:

“Republicans are reigniting their war on American health care. This plan hikes prescription drug prices, raises premiums on families, and slashes Medicaid. They want to drag us back to a time when Big Pharma and insurance companies had unchecked power — all at the expense of patients, and particularly seniors, people with disabilities, people of color, and rural Americans. They want to put people’s lives at risk just so the rich can get richer. Some things never change: Republicans want to raise health costs, ditch critical protections, and put profits over patients’ lives. If they get their way, it would be disastrous for the health and well-being of people across our country.”

Washington, DC — Today, the Fifth Circuit Court of Appeals granted a partial stay pending appeal in Braidwood Management v. Becerra, protecting free preventive care for 150 million Americans as the case moves through the courts. In his initial ruling in the case, Judge O’Connor invalidated critical benefits endorsed by the U.S. Preventive Services Task Force, including lifesaving lung, breast, and colorectal cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, and access to PrEP (pre-exposure prophylaxis), which can reduce the chance of contracting HIV. The court order, approving an agreement reached by the parties, means that, while the ruling stands for the plaintiffs, it will not go into immediate effect nationwide as Judge O’Connor previously ruled. In response, Protect Our Care Communications Director Anne Shoup issued the following statement: 

“This agreement will protect the 150 million people who rely on preventative services while this case works through the courts. While millions of Americans can breathe a sigh of relief knowing they can continue to access free preventive care, these lifesaving services remain at risk. If Judge O’Connor’s ruling stands, free screenings for depression, diabetes, and heart health will no longer be guaranteed, raising costs on families and threatening the health of millions. Without this guarantee, more Americans will be forced to choose between going to the doctor and paying for other essentials like groceries and rent — meaning more Americans will get sick and more will die of entirely preventable causes.”

This week we highlight the inaugural Centers for Medicare and Medicaid Services (CMS) Health Equity Conference and statements affirming LGBTQI+ health equity. As well, LGBTQI+ advocacy groups, the Black Maternal Health Caucus, and the private sector are pushing forward critical initiatives to accelerate progress to reduce health disparities throughout the country. There are persistent challenges to be overcome, and we have highlighted in particular the growing health crisis in the Southern United States this week. From systemic bias in medicine to political polarization actively harming members of our most marginalized communities, the situation in the U.S. south is dire and must be addressed by local and state leaders.

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.

INITIATIVES

National Law Review: CMS Holds First Annual National Health Equity Conference. “CMS hosted its inaugural Health Equity Conference on June 7 and 8. The theme of the conference was “Framing the Future of Equitable Health Care” and, as the name suggests, it was an opportunity for CMS leadership to share foundational information and discuss plans for the future. Leaders throughout CMS provided updates on health equity research, discussed promising practices and innovative solutions, and highlighted the value of collaboration across the agency and with the broader community. To that end, the conference also provided a platform for community partners to discuss multiple programs that incorporate equity-focused initiatives.” [National Law Review, 6/9/23]

Department of Health and Human Services: HHS Statements Reaffirm Support for Promoting Health Equity During and After Pride Month. “Every year, during Pride Month, we honor and celebrate the many ways our family, friends, colleagues, neighbors, and fellow Americans in the LGBTQI+ community contribute to the health and wellbeing of our great nation. Today and every day, the Department works to ensure that every American has access to health care – including gender-affirming care – regardless of their sexual orientation or gender identity. We stand with and support Americans who are targeted because of their gender identity and are committed to protecting them. We also stand with and support their parents, caretakers, and families. We will continue to fight on behalf of all Americans to ensure they have access to the care and support they need… Pride is a reminder that until everyone enjoys the full promise of equity, dignity, protection, and freedom, our work is not finished. I am proud to be part of our Administration-wide effort to protect LGBTQI+ Americans from discrimination in health care, including those who need vital behavioral health support.” [HHS, 6/1/23]

Los Angeles Blade: Gilead to Award $5 Million to the HRC’s HIV and Health Equity Programs. “The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combating stigma in Black and Latino communities. Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges & Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021. The organization said its HIV and Health Equity Program plans to develop a ‘benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches’ while defining ‘best practices, policies, and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.’” [Los Angeles Blade, 5/31/23]

America Magazine: Momnibus Has a Chance to Significantly Reduce the Maternal Mortality Rate. “[T]he Catholic Health Association of the United States is strongly advocating for the passage of the Black Maternal Health Momnibus Act. C.H.A. has joined with more than 45 diverse organizations that represent health care providers, public health professionals, researchers, community-based organizations, nonprofits, health insurance providers, hospitals, maternal and infant health advocates, and other key stakeholders in calling on Congress to pass this legislation to address the maternal mortality crisis and eliminate maternal health inequities. Passing the Momnibus Act would begin to address a number of factors that are responsible for the maternal health crisis and its racial inequities, including issues of systemic racism and social risk factors like housing, transportation and environmental conditions. By advancing the Momnibus Act, Congress can make historic investments in high-quality, culturally appropriate maternity care and robust social support. The reintroduction of the Momnibus Act in May yielded a historic number of congressional co-sponsors, demonstrating the importance of this issue.” [America Magazine, 5/30/23]

Healthcare Finance: Groups Including the AMA Launch Movement to Promote Health Equity. “On Tuesday, the American Medical Association, the Institute for Healthcare Improvement (IHI) and Race Forward officially launched Rise to Health, a call to action for providers, payers, pharma and professional societies to make health equity a priority. Rise to Health will have enforcement teeth in the form of establishing a set of measures across numerous participants. Rise to Health: A National Coalition for Equity in Health Care has been in the works for about two years. Its ten founders include the AMA, American Hospital Association and AHIP. A unified strategy is the most effective way to create meaningful change, said AMA president Dr. Jack Resneck Jr. Prior efforts have been in siloes, said Mate, who has been working with coalition members around the founding principle that healthcare quality is inseparable from health equity. The coalition has seen dozens of providers, pharma companies and payers add equity to their strategic plans, Mate said. Specific actions defined by the coalition include: a commitment to acting for equity, getting grounded in history and the local context, identifying opportunities for improvement, making equity a strategic priority, taking on initiatives, and aligning, investing and advocating for thriving communities.” [Healthcare Finance, 5/31/23]

CHALLENGES

U.S. News: Southern States Refusing to Expand Medicaid Perpetuates Racism According to Data. “While 40 states have expanded Medicaid, 10 states have not – and most of those are in the South. This refusal to enact Medicaid expansion amounts to a refusal to ease the health care burden of some 3.5 million uninsured adults. People want health insurance, and polling shows 57% of U.S. adults believe the federal government should be tasked with providing health care for all Americans. Of the 10 states that have not expanded Medicaid, seven are in the South: Alabama, Georgia, Florida, Mississippi, South Carolina, Tennessee and Texas. Ironically, Southern states are some of the hardest hit by interrelated issues like poverty, poor health care access and health disparities. Southern states are also home to some of the largest Black populations in the U.S., highlighting how expanding Medicaid in the South is clearly an issue of racial justice. In fact, according to a March analysis from KFF, more than 6 in 10 nonelderly adults who fall into the national coverage gap – meaning they live in a state that has not adopted Medicaid expansion and are not eligible for coverage through the program or for subsidies through the Affordable Care Act’s marketplaces – are people of color. Nearly all nonelderly adults in this coverage gap live in the South. A similar case in point: If Mississippi expanded Medicaid, KFF data has shown Black and Hispanic people accounted for 55% of the uninsured adults who would be newly eligible for coverage, with whites accounting for 42%. This would be crucial for children and adults in the state, which is home to the nation’s highest rate of infant mortality, according to data from the Centers for Disease Control and Prevention.” [U.S. News, 6/7/23]

KFF Health News: There is a Stark Disparity Between Black and White Infant Mortality in the South. “By 2030, the federal government wants infant mortality to fall to 5 or fewer deaths per 1,000 live births. According to annual data compiled by the Centers for Disease Control and Prevention, 16 states have already met or surpassed that goal, including Nevada, New York, and California. But none of those states are in the South, where infant mortality is by far the highest in the country, with Mississippi’s rate of 8.12 deaths per 1,000 live births ranking worst. Even in those few Southern states where infant mortality rates are inching closer to the national average, the gap between death rates of Black and white babies is vast. In Florida and North Carolina, for example, the Black infant mortality rate is more than twice as high as it is for white babies. A new study published in JAMA found that over two decades Black people in the U.S. experienced more than 1.6 million excess deaths and 80 million years of life lost because of increased mortality risk relative to white Americans. The study also found that infants and older Black Americans bear the brunt of excess deaths and years lost. Some experts believe expanding Medicaid coverage to single, working adults who aren’t pregnant and don’t have children — something most Southern states have failed to do — would also help curtail infant deaths. A woman who is healthy when heading into pregnancy is more likely to give birth to a healthy baby because the health of the mother correlates to the health of the infant. Birth outcomes experts agreed that racism and poverty lie at the heart of this difficult problem, which disproportionately threatens Black infants and mothers in the rural South. Research shows that white doctors are often prejudiced against Black patients and minimize their concerns and pain. In South Carolina, the maternal mortality rate increased by nearly 10% from 2018 to 2019, according to the latest data, which found that the risk of pregnancy-related death for Black mothers was 67% higher than for white mothers. Upon review, the state health department determined 80% of those pregnancy-related deaths were preventable.” [KFF Health News, 5/22/23]

AP: Doctors Not Taking Black Women Seriously is a Major Component of Maternal Mortality Racial Disparities. “Black women have the highest maternal mortality rate in the United States — 69.9 per 100,000 live births for 2021, almost three times the rate for white women, according to the Centers for Disease Control and Prevention. Black babies are more likely to die, and also far more likely to be born prematurely, setting the stage for health issues that could follow them through their lives. To be Black anywhere in America is to experience higher rates of chronic ailments like asthma, diabetes, high blood pressure, Alzheimer’s and, most recently, COVID-19. Black Americans have less access to adequate medical care; their life expectancy is shorter. Black Americans’ health issues have long been ascribed to genetics or behavior, when in actuality, an array of circumstances linked to racism — among them, restrictions on where people could live and historical lack of access to care — play major roles. Discrimination and bias in hospital settings have been disastrous. Maternal sepsis is a leading cause of maternal mortality in America. Sepsis in its early stages can mirror common pregnancy symptoms, so it can be hard to diagnose. Due to a lack of training, some medical providers don’t know what to look for. But slow or missed diagnoses are also the result of bias, structural racism in medicine and inattentive care that leads to patients, particularly Black women, not being heard. For decades, frustrated birth advocates and medical professionals have tried to sound an alarm about the ways medicine has failed Black women. Historians trace that maltreatment to racist medical practices that Black people endured amid and after slavery. To fully understand maternal mortality and infant mortality crises for Black women and babies, the nation must first reckon with the dark history of how gynecology began, said Deirdre Cooper Owens, a historian and author.” [AP, 5/23/23]

Lowering drug costs, expanding affordable health insurance coverage, and banning health care discrimination is critical to improving access to comprehensive, high-quality health care and – together with other actions – advancing health equity for lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI+) people in America. The Biden-Harris administration has been leading the way in ensuring LGBTQI+ individuals have access to health care, while Republicans continue to undermine LGBTQI+ rights in state legislatures by denying transgender youth access to gender-affirming care, and the ability to use preferred names and pronouns in schools, and banning drag as a form of gender expression. Policies to improve access to care and protect LGBTQI+ individuals from discrimination in health care and other settings are essential for improving the health and well-being of LGBTQI+ people nationwide.

Biden-Harris Administration Helps LGBTQI+ Americans Gain Health Coverage

Expanding Health Coverage For Millions Of Americans. Premium subsidies for people who purchase coverage on their own made available by President Biden’s American Rescue Plan helped nearly 210,000 LGBTQI+ enrollees have access to zero-premium plans. Nationwide, 20 percent of Black LGBTQI+ individuals are uninsured, compared to 15 percent of Black and 9 percent of heterosexual and cisgender individuals. Before the Affordable Care Act (ACA) went into effect in 2013, 34 percent of LGBTQI+ Americans were uninsured. As of June 2020, the uninsurance rate amongst LGBTQI+ individuals dropped to 16 percent. In the 2023 Open Enrollment period, a record-breaking 16.3 million Americans signed up for health insurance through the ACA, more than a 12 percent increase from the previous year.

Reversing Trump Policy Allowing Sexual Orientation Discrimination. In May 2021, Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that sexual orientation would be restored as a protected class under the ACA. In July 2022, HHS put forth a proposed rule implementing Section 1557 of the ACA, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. The proposed rule affirms protections against discrimination on the basis of sex, including sexual orientation and gender identity consistent with recent U.S. Supreme Court decisions. This proposed rule ensures that LGBTQI+ individuals aren’t denied coverage or charged more for care. This Administration’s policy reversal has been especially important with transgender rights being attacked by Republicans.

Closing The Coverage Gap Improves Outcomes For LGBTQI+ Individuals. As of June 2022, 1.2 million LGBTQI+ Americans were covered by Medicaid, and of those nearly 13 percent identified as transgender. According to a Center for American Progress survey, in 2019, the LGBTQI+ uninsured rate was 20 percent in the states refusing to expand Medicaid, compared to 8 percent in states that adopted Medicaid expansion. 29 percent of LGBTQI+ individuals faced difficulty seeking medical care when sick or injured due to cost. LGBTQI+ Americans are twice as likely to be without health insurance. Closing the Medicaid coverage gap is the single most important policy to expand coverage and reduce racial and ethnic inequities in the American health care system, and is an important policy solution for LGBTQI+ people because of the intersectional dimensions of their identities. A 2022 study found that more Black LGBTQI+ adults had Medicaid as their primary insurance compared to their heterosexual and cisgender counterparts. 

Biden-Harris Administration Helps LGBTQI+ Americans Age With Dignity

Millions Of LGBTQI+ Americans Able To Grow Old At Home. Federally provided home- and community-based services funds helped more than 100,000 individuals return to their homes and communities from nursing facilities between 2008 and 2019. Allowing LGBTQI+ seniors to grow old at home helps alleviate the concern older LGBTQ+ adults have about being neglected or abused, or facing discrimination in nursing homes or assisted living facilities. In President Biden’s fiscal year 2024 proposed budget, $150 million is dedicated to investing in Medicaid’s home- and community-based services to ensure more older Americans and people with disabilities have access to care in their own homes and communities. 

The Inflation Reduction Act Supports LGBTQI+ Seniors. The $2,000 cap on prescription drug prices for Medicare enrollees helps LGBTQI+ seniors on Medicare, who typically suffer more from poorer health and poverty. Medication costs are a frequent barrier to managing chronic health issues. 23 percent of the LGBTQI+ community lived in poverty in 2020, compared to 16 percent of their heterosexual counterparts. When looking at further dimensions of intersectionality, members of LGBTQI+ communities of color also disproportionately faced higher rates of poverty than heterosexual members of these communities. A 2021 study found that members of sexual minority communities are more likely than heterosexual individuals to engage in behaviors to reduce the cost of medicine such as skipping doses, trying alternate therapies, or delaying refills.

Biden-Harris Administration Is Defending Transgender Americans

Supporting Gender Affirming Care. On a state-by-state basis, the Center for Medicare and Medicaid Services is approving efforts to expand gender-affirming care under the ACA and other federal programs. HHS has also created a website and resources for LGBTQI+ youth, parents, and providers, on LGBTQI+ health and well-being and gender-affirming care.

Protecting Transgender Youth Mental Health. The Biden Administration is focusing on providing mental health support, creating a more welcoming environment in public schools, and acknowledging the positive impacts of gender-affirming care. President Biden signed the Executive Order on Advancing Equality LGBTQI+ Individuals in June 2022 to defend the rights and safety of LGBTQI+ individuals by directing relevant agencies to discredit conversion therapy, ensuring that federal benefit programs can be equitably accessed by LGBTQI+ households, and increasing federal support for family counseling to reduce the risk of family rejection of LGBTQI+ youth. The Substance Abuse and Mental Health Services Administration is also piloting additional dedicated services for LGBTQI+ youth in the national 988 Suicide and Crisis Lifeline. 

Stepping In When States Fail. In honor of Transgender Visibility Day in March 2022, the Justice Department issued a letter to all state attorneys general reinforcing federal transgender youth protections against discrimination and obtaining gender-affirming care. Due to the increase in anti-trans state legislation, the Department of Justice has also filed statements of interest and amicus briefs supporting legal action against state laws that restrict the rights of transgender youth.

 Biden Administration Announced Lower Out-of-Pocket Costs for 43 Drugs Subject to Penalties 

Washington, DC — Today, the Biden administration announced that the number of drugs subject to the Inflation Reduction Act’s inflation penalties has doubled. This means that 43 prescription drugs had price hikes outpacing the annual rate of inflation last quarter, and now these drug manufacturers must pay Medicare a rebate and Medicare beneficiaries will see lower coinsurance costs. According to CMS, beneficiaries could save up to $449 per dose on these drugs. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“This announcement is an important reminder that the Inflation Reduction Act is working for the American people. Drug companies are finally being held accountable when they jack up the price of prescription drugs in order to pad their profits. For years, seniors from all backgrounds have faced prescription drug prices that rise so fast they can’t keep up, and too many have been forced to choose between buying food or prescription drugs that keep them alive. Now, seniors purchasing some of the most expensive medications can breathe a sigh of relief knowing that greedy drug companies are being held accountable by the Biden administration.”

Washington, D.C. — Today, the Supreme Court of the United States issued a ruling to protect over 90 million Americans who receive their health care through Medicaid. Health and Hospital Corporation of Marion County v. Talevski, which was described as “one of the most consequential health care cases in [the Supreme Court’s] history,” concerns whether individuals have the right to enforce provisions of the Medicaid law in court. The Court upheld individual’s right to sue, supporting decades of precedent and protecting patients’ access to critical health care coverage. An adverse ruling in this case would have also implicated the rights of beneficiaries across a broad range of state-administered public programs, including Supplemental Nutrition Assistance Program, child welfare, and federal public housing benefits. In response, Protect Our Care’s Policy and Health Equity Senior Advisor Anne Morris Reid issued the following statement:

“A negative ruling in this case would have been devastating  for the tens of millions of Americans who rely on Medicaid for their health coverage – with particularly severe consequences for the pregnant women, children, people of color, people with disabilities and other low-income Americans this program serves. The Supreme Court rejected the defendants’ goal to strip patients of their rights to seek targeted and rapid relief when they lose or are denied health coverage. At a time when Republicans are playing politics with Medicaid as part of their ongoing war on health care, it is a relief that the Court’s decision protected the most powerful tools beneficiaries have to hold state officials or health providers accountable.”

Republican-Led States Like Florida and Arkansas See Highest Levels of Coverage Loss

In April, states began the process of unwinding their Medicaid programs, and a recent analysis from the Kaiser Family Foundation shows that more than half a million Americans have already lost their health care. News coverage over the last several weeks makes clear that Republican-led states like Florida and Arkansas are moving far too quickly to throw people off the rolls. Some states are failing to ensure that people know their rights or eligibility for financial assistance under the Affordable Care Act or other health care programs. Instead of doing everything in their power to keep people covered, Republican governors like Ron DeSantis are using this opportunity to slash their Medicaid rolls. 

It’s no surprise that red states are moving to throw people off their coverage given the GOP’s longstanding hostility towards Medicaid and affordable health care. In Florida, nearly 250,000 people have lost their coverage in a state that continues to reject Medicaid expansion, making it harder for families to find affordable coverage options. This comes as Republicans in Congress recently attempted to impose even more paperwork requirements in Medicaid and boot 21 million people off of their health care.

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, but this provision expired on April 1. Experts fear that as many as 15 million people nationwide could lose their health care due to procedural requirements and bureaucratic red tape, disproportionately impacting people of color, children, and people in rural communities.

KFF Health News: As Medicaid Purge Begins, ‘Staggering Numbers’ of Americans Lose Coverage. “The overwhelming majority of people who have lost coverage in most states were dropped because of technicalities, not because state officials determined they no longer meet Medicaid income limits. Four out of every five people dropped so far either never returned the paperwork or omitted required documents, according to a KFF Health News analysis of data from 11 states that provided details on recent cancellations. Now, lawmakers and advocates are expressing alarm over the volume of people losing coverage and, in some states, calling to pause the process.” [KFF Health News, 6/1/23] 

Politico: 500,000 Dropped From Medicaid — So Far. “That’s the number of people in 11 states who have already been taken off the Medicaid rolls since redetermination started, according to a new analysis from KFF. The total number of people disenrolled varied significantly by state — as did the percentage of total completed renewals affected. Florida tops the charts for both measures, with nearly 250,000 removed from the rolls, equaling about half the number of completed renewals.” [Politico, 6/1/23] 

Washington Post (Opinion): Government Incompetence Is Knocking Eligible Americans Off Medicaid. “Here’s where the numbers get especially infuriating. States are supposed to break out how many people lost coverage because they were reassessed for eligibility and actually determined to no longer qualify (because their income rose, for example, or they aged out of the children’s health insurance program) versus how many people lost coverage for pointless ‘procedural’ reasons (e.g., the state never received documentation needed to reassess eligibility). Based on the states that have publicly released breakdowns so far, the majority of people losing Medicaid are casualties of those paperwork-related reasons.” [Washington Post, 6/1/23] 

New York Times: Hundreds of Thousands Have Lost Medicaid Coverage Since Pandemic Protections Expired. “Hundreds of thousands of low-income Americans have lost Medicaid coverage in recent weeks as part of a sprawling unwinding of a pandemic-era policy that prohibited states from removing people from the program. Early data shows that many people lost coverage for procedural reasons, such as when Medicaid recipients did not return paperwork to verify their eligibility or could not be located. The large number of terminations on procedural grounds suggests that many people may be losing their coverage even though they are still qualified for it. Many of those who have been dropped have been children.” [New York Times, 5/26/23] 

The Hill: Millions Had Medicaid Coverage Tied To The Pandemic. Now They Stand To Lose It. “Many will lose coverage due to no longer being eligible, but others stand to become uninsured due to ‘administrative churn,’ a term federal agencies use to refer to clerical issues that prevent people from receiving services. These obstacles include changes of address, insufficient contact information or enrollees simply struggling with the renewal process. Joan Alker, director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, said she has observed high rates of ‘procedural denials’ in some states, meaning people were denied coverage due to not completing the renewal process, not because they were ineligible.” [The Hill, 5/29/23] 

Tampa Bay Times: Florida Not Doing Enough To Keep Children On Medicaid, Health Advocates Warn. “Health care advocates are sounding the alarm over how Florida is handling last month’s end of emergency Medicaid, which they warn could force thousands of eligible children to lose medical coverage because their parents don’t know they must reapply to the federal program. One reason they don’t know, according to advocates, is that Florida officials haven’t done enough to reach out to families and that some of its messaging is causing confusion.” [Tampa Bay Times, 6/2/23] 

KUER 90.1: Bad Paperwork Is Driving Most Of The Turnover On Utah’s Medicaid Rolls. “In Utah, the biggest driver of lost coverage has been procedural reasons, like bad paperwork or missed contacts. Since the protections ended, almost 20,000 Utahns have lost coverage for that reason…On June 5, the department disclosed that a ‘mailing error’ resulted in Medicaid information for an estimated 5,800 Utahns being mistakenly put in incorrect envelopes and sent to the wrong addresses. The agency said new letters would be sent out over the next two weeks.” [KUER, 6/5/23] 

Arkansas Times: Arkansas’s Rush To Prune Medicaid Roster “Not Normal,” Leaves Thousands In Limbo. “Phasing out pandemic-era policies is complicated, and the Biden Administration gave states a year to clean the Medicaid rolls. But thanks to state lawmakers, Arkansas is pruning Medicaid lists in six months instead, forcing tradeoffs between speed and due diligence. The result is that people who are eligible for Medicaid are losing it anyway.” [Arkansas Times, 5/23/23] 

Associated Press: North Dakota Health Officials Urge Return Of Medicaid Renewal Forms As Thousands Lose Coverage. “State Health and Human Services says about 13,000 Medicaid recipients in North Dakota were due for renewal at the end of May, but thousands failed to return their forms, so many lost coverage even though they may still qualify, KFGO reported.” [Associated Press, 6/6/23] 

Vox: Hundreds Of Thousands Of Americans Are Losing Medicaid Every Month. “Policy experts and advocates warned before the eligibility checks began that people who are still eligible for Medicaid could lose their insurance due to administrative problems, such as not receiving mail from the state or not returning documentation to confirm they are still eligible. Now the early evidence suggests that’s exactly what is happening. In Florida, for example, more than 80 percent of people who were dis-enrolled from Medicaid were kicked off for procedural reasons. About the same share of people who lost coverage in Arkansas and Indiana were deemed ineligible because they failed to report information to the state or because the state could not reach them. Only a small percentage of people — about one in seven in Arkansas — were removed because they were no longer eligible (i.e., their income had grown to the point it exceeded Medicaid eligibility limits).” [Vox, 5/19/23]

Politico: The Looming Medicaid Crisis. “Most people currently on Medicaid will still be eligible — if they get through the notification and recertification process. Others will be eligible for heavily-subsidized plans on the Affordable Care Act markets, or may get covered at work. In fact, almost everybody will be eligible for something — except those who fall in the ‘Medicaid gap,’ in the 10 states still resisting Obamacare’s Medicaid expansion. (Two other states have approved expansion although it hasn’t kicked in yet.) But health care is difficult to navigate. Understanding the Medicaid unwinding, figuring out what you are eligible for and then actually getting signed up are three different things, each with its own complexities.” [Politico, 5/22/23]

***MEDIA ADVISORY FOR THURSDAY, JUNE 8 at 10:30 AM MST // 1:30 EDT***

Republicans’ Latest Attack on the ACA Targets Lifesaving Preventive Care for More than 150 Million Americans 

PHOENIX, AZ  — On Thursday, June 8 at 10:30 AM MST // 1:30 EDT, Arizona Attorney General Kris Mayes will join Protect Our Care Arizona to discuss U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires free coverage of lifesaving preventive health care services. Judge O’Connor’s decision in Braidwood Management v. Becerra would end the ACA’s guaranteed free access to essential preventive services including lifesaving cancer screenings, and more. In 2020 alone, more than 150 million Americans benefited from these preventive services. 

On June 6, the US Court of Appeals for the Fifth Circuit held a hearing to decide if the ACA’s protections should stay in place for everyone other than the plaintiffs while the case works its way through the courts. The plaintiffs have argued that a stay is unnecessary because insurance companies are very unlikely to not drop cost-free coverage. In reality, insurance companies have a proven record of moving quickly to cut costs at the expense of patients. 

Patient and provider groups, public health experts, organized labor, 68 academic deans and scholars, and dozens more organizations overwhelmingly agree that this case is built on unfounded legal arguments and have submitted briefs affirming that, if Judge Reed O’Connor’s ruling stands, the consequences for patients would be disastrous. Speakers will highlight what this decision could mean for Arizonans’ access to lifesaving health care services, and discuss what is to come as the lawsuit moves through the court system. 

WHO:
Arizona Attorney General Kris Mayes
Will Humble, Executive Director, Arizona Public Health Association
Brian Hummell, Government Relations Director, American Cancer Society Cancer Action Network

WHAT: Virtual Press Conference

WHEN: Thursday, June 8 at 10:30 AM MST // 1:30 EDT

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

Washington, D.C. – Drug company giant Merck sued the federal government yesterday to try and stop Medicare from negotiating lower prescription drug prices, a key part of the recently approved Inflation Reduction Act. Merck manufactures Januvia, an expensive type 2 diabetes drug that is likely to be eligible for negotiation, and has been on the market without competition for nearly 20 years. The authority to negotiate lower prices against Big Pharma, making prescription drugs more affordable for millions of seniors, is a historic win for American patients who pay up to four times more for the same drugs as patients in other wealthy countries. President Biden and Democrats in Congress delivered on their promise to lower costs for American families by passing the Inflation Reduction Act, and now seniors are depending on those savings while Big Pharma is desperately trying to protect their profits.

Members of Congress

Senator Patty Murray (D-WA): Big Pharma Continues Protecting Profits At The Expense of Patients’ Health. “This lawsuit could prevent millions of Americans on Medicare from benefiting from lower prescription drug prices. People are sick and tired of big pharma protecting their profits at the expense of patients’ health.” [Twitter, 6/6/23]

Senator Ron Wyden (D-OR): “No Surprise” Big Pharma Wants To Stop Medicare From Negotiating Lower Drug Prices. “It’s no surprise that Big Pharma wants to stop Medicare from negotiating lower drug prices on behalf of American seniors. I expect the Biden administration to vigorously defend Medicare’s bargaining power so seniors will see the lower drug prices they expect.” [Washington Post, 6/6/23]

Senator Bernie Sanders (I-VT): Merck Wants To Keep U.S. Drug Prices High. “Merck wants to end Medicare’s ability to negotiate some drug prices. Here’s why. Its diabetes drug, Januvia, costs $6,600 a year in the US, but just $192 in France. Its cancer drug, Keytruda, costs $187,000 in the US, but just $87,000 in Germany.” [Twitter, 6/6/23]

Senator Sherrod Brown (D-OH): Big Pharma Will Stop At Nothing To Raise Prices. “For years we fought Big Pharma to allow Medicare to negotiate lower drug prices. Last year, we won. But of course these corporations never give up. Big Pharma will stop at nothing to raise prices on Ohio seniors.” [Twitter, 6/6/23]

Rep. Frank Pallone Jr. (D-NJ): Merck’s “Outrageous” Lawsuit Seeks To Block Medicare Price Negotiation & Rip-Off The American People.“This lawsuit is outrageous. Empowering Medicare to negotiate fair prescription drug prices for seniors is not only plainly constitutional, but it’s also necessary if life-saving drugs are to continue to be available to all Americans. People just can’t afford their medications and increasingly go without them. The only rights that are being violated here are those of the American people who have been getting ripped off by Big Pharma companies like Merck for years. Thankfully, Big Pharma’s ability to extort seniors on drug prices is coming to an end. I’m incredibly proud of our work to stand up for consumers by passing drug price negotiation and I’m confident the law will withstand this ridiculous lawsuit by Merck.” [Energy and Commerce Committee Ranking Member Frank Pallone, Jr. Press Release, 6/6/23]

Rep. Adam Schiff (D-CA): Merck’s Lawsuit Is “Profit Over Patients.” “Corporate greed threatens seniors’ access to affordable medications. Merck’s lawsuit against Medicare drug price negotiation is an egregious prioritization of profit over patients. We must safeguard the needs of our people, not Big Pharma’s bottom line.” [Twitter, 6/6/23]

Rep. Pramila Jayapal (D-WA): Merck Wants To Force Patients To Pay More. “Merck claims that the fair price negotiation provisions Democrats passed last year will prevent development of new drugs, so they’re suing to block them & force patients to pay more. Yet big pharma spent $577B on stock buybacks & dividends from 2016-2020. Make it make sense.” [Twitter, 6/6/23]

Analysts

Washington Post: Several Legal Experts Are “Skeptical” Of Merck’s “Pretty Weak” Lawsuit. “Some legal analysts say to expect more lawsuits from drugmakers who allege the policy will thwart the development of innovative new therapies. And several said they’re skeptical [of] the lawsuit, which Merck vowed to take all the way to the Supreme Court if needed, will survive. But the move has strategic merit for the company, even though the case is ‘pretty weak,’ said Ameet Sarpatwari, an assistant professor of medicine at Harvard Medical School.” [The Washington Post, 6/7/23]

Bloomberg (Opinion): “Merck’s Lawsuit Against Drug Price Controls Is Doomed.” “The pharmaceutical company says provisions in the Inflation Reduction Act violate the Constitution, but no judge is likely to agree. Merck’s lawsuit seeking to prevent enforcement of the drug pricing provisions adopted last year as part of the Inflation Reduction Act makes lots of good arguments against the legislation. But despite oodles of colorful language, the complaint doesn’t seem likely to win the company the injunction it’s hoping for.” [Bloomberg (Opinion), 6/7/23]

Truthout: Merck’s Lawsuit Comes Even As The Government Has “Already” Been Allowed To Negotiate Drug Prices “For Decades.” “Crucially, this is one of the only recent steps taken by lawmakers to lower prescription drugs at the federal level. Prescription drugs cost more in the U.S. than anywhere else in the world, due in large part to the pharmaceutical industry’s strong grip over lawmakers. This is a major factor in U.S. residents having worse health outcomes than residents of any other wealthy country. The government is already allowed to negotiate drug prices. For decades, the Department of Veterans Affairs has negotiated drug prices with manufacturers, allowing the agency to pay roughly half the amount for certain top drugs than Medicare does. Merck has garnered sharp criticism for the lawsuit, which critics said is motivated by a desire to profit off the health and survival of Americans. Indeed, records show that Merck’s revenue grew a whopping 22 percent in 2022.” [Truthout, 6/6/23] 

The Pharma Letter: Merck’s Lawsuit Has “Mixed Prospects.” “The judicial response to industry lawsuits on drug pricing regulations have been mixed in the past. Previously, the Pharmaceutical Research and Manufacturers of America (PhRMA) brought a similar claim on First Amendment grounds against California, alleging that requirements for public notification and explanation of drug price increases violated free expression. However, the US District Judge sided with the state and dismissed the lawsuit. Should the judge in this case take a similar approach – which is not guaranteed, given that District Court judgements are not binding precedent – the First Amendment claim is likely to fail.” [The Pharma Letter, 6/7/23]

Physicians and Health Care Experts

​​Zachary Baron and Andrew Twinamatsiko, associate directors of the O’Neill Institute for National and Global Health Law at the Georgetown University Law Center:  “That lawsuits are ultimately brought says nothing about any actual legal infirmity with the IRA or the Medicare Drug Negotiation program. In fact, as discussed briefly below, a number of the potential claims that the pharmaceutical industry and their allies may pursue largely track other unsuccessful industry challenges and would likely face substantial legal headwinds. If successful, such lawsuits would have broader implications beyond just Medicare or prescription drugs. Rather, the success of these challenges could result in new legal doctrines that would severely restrict federal regulatory authority in the health care arena.” [Health Affairs Forefront, 6/7/23]

Nicholas Bagley, Professor at the University of Michigan School of Law: “Merck doesn’t have a constitutional right to sell its drugs to the government at the price that it sets. That’d be nuts. […] both of these claims look very, very weak. […] That’s not an unconstitutional condition. That’s just bargaining.” [Twitter (Thread), 6/6/23]

Ameet Sarpatwari, Assistant Professor of Medicine at Harvard Medical School:  “What Merck argues is ‘coercion’ is actually the establishment of a freer, more rational marketplace [that will address a crucial root cause of high drug prices].” [New York Times, 6/6/23]

Erik Gordon, Clinical Professor at the University of Michigan’s Ross School of Business: “[There are] better odds that Elizabeth Holmes wins Medtech Innovator of the Year than that Merck wins its lawsuit.” [STAT, 6/6/23]

Jonathan Reiner, Professor Of Medicine & Surgery at the George Washington University School of Medicine & Health Services: “Merck made $14.5 billion in profits last year.” [Twitter, 6/7/23]

Health Care Organizations and Advocates

Bill Sweeney, Senior Vice President at AARP: “Seniors and taxpayers are tired of being the piggy bank for the profits of big drug companies. Lawsuits like this are simply an attempt to keep high profits by gouging America’s seniors.” [CNBC, 6/6/23]

Tricia Neuman, Senior Vice President at the Kaiser Family Foundation: “It’s no surprise that drug companies have been gearing up to challenge #Medicare price negotiations in the courts, but a little surprising to see a lawsuit before CMS announces the names of the 10 drugs included on the list.” [Twitter, 6/6/23]

Robert Weissman, President of Public Citizen: “Merck is claiming the U.S. Constitution requires the U.S. government and people to be suckers. That’s not true. This lawsuit is a desperate attempt by the industry to beat back popular legislation that would curtail Big Pharma’s ability to price gouge Medicare and secure monopoly profits. Full stop. While Big Pharma’s litigation gambit plays out, it is critical that the federal government continue its preparation for price negotiations. Delay in the commencement of long-overdue negotiations will result in billions of dollars in excess costs for taxpayers and consumers” [Public Citizen Press Release, 6/6/23]

David Mitchell, Founder of Patients For Affordable Drugs Now: “Merck’s bogus lawsuit bemoans Medicare’s negotiation authority as ‘tantamount to extortion’ – but the truth is, Big Pharma companies like Merck are the ones who have been extorting patients for years, forcing them to pay unjustified prices or sacrifice their health. […] We believe that courts will see Merck’s lawsuit for what it is: a meritless attempt to maintain its ability to unilaterally set prices that are untethered to quality at the expense of patients. The truth is, implementation of Medicare negotiation is a desperately needed, long-awaited rebalancing of our drug price system that will help millions of patients obtain the medications they need at prices they can afford while ensuring continued innovation.” [Patients For Affordable Drugs Now Press Release, 6/6/23]

Margarida Jorge, Head of Lower Drug Prices Now: “This is nothing but a political stunt motivated by the same shameless greed that we’re used to seeing from drug corporations that have made decades of inflated profits at the expense of patients’ health and taxpayers’ hard-earned money. […] It’s time for big drug corporations like Merck to give up their monopoly control over prices and negotiate fair prices for the medicines we need.” [Lower Drug Prices Now Press Release, 6/6/23]

Max Richtman, President & CEO of the National Committee to Preserve Social Security and Medicare: “Merck’s decision to sue the federal government today demonstrates that there is no bottom to Big Pharma’s greed and the corporate culture of putting profits before people. With its lawsuit, Merck has made it clear that one of the nation’s most profitable drugmakers wants seniors to continue paying sky-high prices for their vital medications. (Merck made $14.5 billion in profits last year.) […] Merck’s constitutional arguments are spurious at best; the Veterans Administration has been successfully negotiating prices with Big Pharma for years. Drugmakers can still remain profitable while abiding by the Inflation Reduction Act, which was a long-awaited and landmark piece of legislation to protect seniors from industry price gouging.” [National Committee to Preserve Social Security and Medicare Press Release, 6/6/23]

Richard Fiesta, Executive Director of the Alliance for Retired Americans: “Merck’s ridiculous lawsuit is the equivalent of a toddler throwing a temper tantrum. Americans pay the highest prices in the world for prescription drugs and too many seniors must choose between putting food on the table and paying for their medicine. That is because corporations like Merck have been allowed to charge taxpayers whatever they want for their drugs.” [The Alliance for Retired Americans Press Release, 6/6/23]

Congressional Ways and Means Committee Bills Are a Broad Attack on Health Coverage

Washington, D.C. – Today, the House Ways and Means Committee is considering legislation to promote the use of health savings accounts (HSA) and undermine the protections under the Affordable Care Act (ACA). HSAs overwhelmingly benefit high-income people; these bills incentivize the expansion of HSAs through tax breaks which would reward the highest-paid workers while worsening racial and ethnic inequities in health care. While Republicans are considering bills to help the wealthy and raise costs on middle class Americans, they are failing to prioritize legislation that would lower drug prices, make insurance more affordable, and make the health care system fairer for families. 

In response, Protect Our Care’s Executive Director Brad Woodhouse issued a statement:

“These Republican bills are more about giving tax breaks for the wealthy than about helping people get the health care they need. Instead of expanding access to health care and fighting health disparities, these bills would allow health plans to get around anti-discrimination bills. Time and again, Republicans prove they are not for protecting health care, they are for side-stepping ACA protections of health care.”

BACKGROUND

• HSAs Make Health Care Less Accessible And Affordable. Republican efforts to promote the use of HSAs directly undermines the ACA’s goals to make quality health care more accessible and affordable for all Americans. The promotion of employer-sponsored high deductible health plans that use HSAs increases the cost of health care for employees and continues the difficult decisions low income working families have to make between putting food on the table or paying for medical care. 
• HSAs Benefit The Wealthy. HSAs largely benefit high-income individuals. Contributions to HSAs are not taxed, which helps wealthy people decrease their taxable income and avoid paying their fair share. These contributions can also be invested in stocks and bonds to accrue tax-free earnings that carry over year to year — further exacerbating the wealth gap.
• HSAs Do Not Make Care More Affordable for Low-Income Individuals. HSAs do not benefit low-income individuals as they often do not have the ability to contribute to HSAs and need to use their available income to pay for medical bills and care up front. Nearly 70 percent of adults under 200 percent of the poverty line would not have been able to pay a $1,000 medical bill within 30 days in 2022, let alone contribute to a HSA. Low-income individuals also do not benefit as much from tax-free earnings as high-income individuals due to the lower amount of tax deductions from being in a lower income tax bracket. Employers who offer high deductible health plans, where HSAs are necessary, typically contribute little to nothing to their employees’ HSAs. 
• HSAs Exacerbate Racial And Ethnic Inequities In Health Care. Black and Latino people with private insurance are half as likely to have HSAs as white and Asian people. Per the Center on Budget and Policy Priorities: “Against a backdrop of long-standing racial disparities in wealth — a typical white family in 2019 had eight times the wealth of a typical Black family and five times the wealth of a typical Latino family — HSAs provide preferential tax treatment that is disproportionately out of reach for people of color.”
• HSAs Cost The Government Billions. HSAs will cost the government $182 billion between 2023 and 2032. Meanwhile, the cost of President Biden’s plan for permanently closing the Medicaid coverage gap or permanently extending marketplace coverage premium tax credits over the next 10 years would cost roughly the same amount at $200 billion and $183 billion respectively. Unlike the bills to expand HSAs, Medicaid expansion and marketplace premium tax credits would allow millions of uninsured individuals to gain quality coverage.