News

Greedy Big Pharma Comes For Inflation Reduction Act’s Medicare Negotiations

Washington, D.C. – Today, the pharmaceutical company Merck sued the federal government challenging the constitutionality of the Inflation Reduction Act’s Medicare Prescription Drug Negotiation Program, which allows Medicare to negotiate lower prices for certain drugs. Merck manufactures Januvia, a type 2 diabetes drug that is likely to be eligible for negotiation, and has been on the market without competition for nearly 20 years. In 2021 alone, Medicare spent over $4 billion on the drug. The authority to negotiate lower prices against Big Pharma, making prescription drugs more affordable, is a historic win for American patients who pay up to four times more for the same drugs as patients in other wealthy countries. 

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

“While Americans are cutting pills and skipping doses, Merck is suing the federal government to protect their ability to overcharge seniors and taxpayers to pad their sky-high profits. President Biden and Democrats in Congress delivered a historic win when they fought Big Pharma and enacted legislation to finally allow Medicare to negotiate lower drug prices. Pharma lost that lobbying battle, and now they’re going to court to protect their outrageous profits at the expense of seniors. Big Pharma’s greed knows no bounds.”

Republicans on the Committee on Education & the Workforce Introduce Bills to Promote Junk Plans and Undermine the ACA

Washington, DC — Today, Republicans on the House Committee on Education & the Workforce will mark up legislation that would promote junk plans that lack patient protections under the Affordable Care Act (ACA). Republicans have a long history of promoting junk plans, which can discriminate against people with pre-existing conditions and fail to cover essential services like hospital visits and prescription drugs in order to undermine the Affordable Care Act (ACA). These proposals are particularly harmful for communities of color and other marginalized groups who are more likely to have poorer health and to be living in poverty. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“This is the Republican war on health care at work. After Republicans failed to throw 21 million Americans off of their Medicaid in their debt default negotiations, they have returned to their same old ploy to undermine the ACA and promote junk plans. Republicans want to return to a time when insurance companies made all of the rules and could limit or deny coverage to people for having conditions like asthma, diabetes, and cancer. If passed, these sham bills would only force more families to gamble with their health care, putting them at serious risk of medical debt if they get sick.” 

GOP JUNK PLAN LEGISLATION

• Association Health Plans Act: Introduced by Congressman Tim Walberg, the Associations Health Plans Act will expand access to association health plans (AHPs) and undermine the ACA.
• Self Insurance Protection Act: Introduced by Congressman Bob Good, this legislation will protect access to stop-loss insurance, insurance for employers who self-fund their employee benefit plans, but do not want to assume liability for losses. This promotes use of non-ACA compliant plans such as AHPs and other self funded benefit plans.

BACKGROUND

• Pre-Existing Conditions Affect As Many As 135 Million People. According to an analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition. This includes:

• • 44 million people who have high blood pressure
  • 45 million people who have mental health and substance use disorders
  • 44 million people who have high cholesterol
  • 34 million people who have asthma and chronic lung disease
  • 34 million people who have osteoarthritis and other joint disorders

• AHPs Leave Behind Sick and At-Risk Individuals. AHPs are health plans that are offered to members of trade associations, professional groups, or other organizations. Compared to plans available on state marketplaces, AHPs provide weaker cost and protection coverage and are not required to hold up the same protections that plans under the ACA do. Savings in AHPs come at the expense of sicker and at risk individuals who have higher costs than healthy individuals on these plans.
• AHPs Avoid ACA Regulations. AHPs do not have to participate in the ACA’s single-risk pool rule. The single-risk pool allows premiums to be set based on everyone who has a specific type of insurance. Since AHPs do not have to have one pool, they can set premiums lower for healthier people and higher for those with pre-existing conditions or who are at risk for health issues in the future. This can cause AHPs to lure healthier individuals out of the ACA marketplace pool causing an increase in claim costs and therefore premium increases for ACA-compliant insurers.

• Communities of Color and Other Marginalized Communities Are Exploited By AHPs. Black, Latino, Asian, Indigenous, and LGBTQI+ people in America tend to have poorer health and are more likely to be living in poverty than their White, heterosexual counterparts. Members of these marginalized communities with an AHP for their insurance would likely have higher premiums due to pre-existing conditions, AHP’s not being subject to a single risk pool, and not participating in risk adjustment transfers.

• AHPs Do Not Comply With Essential Health Benefit Requirements. The ACA requires health insurance companies to cover essential health benefits such as prescription drugs, mental health and substance use treatment, and maternity care. AHPs aren’t required to include essential health benefits in their coverage, meaning individuals on these health plans would pay out of pocket for these services.

As we celebrate Pride month, at least 20 million lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI+) American adults are facing threats to health care access. Amidst growing fears of violence and repression, Republicans across the country have launched a crusade against LGBTQI+ rights and affordable health care.

Trump-appointed MAGA judges are setting a dangerous precedent to pull vital medications off the market and eliminate no-cost preventive services that LGBTQI+ people count on to stay healthy — including PrEP, a medicine that is 99 percent effective at preventing the spread of HIV and can cost thousands of dollars annually. This threatens to exacerbate health disparities in queer Black and Hispanic/Latino communities. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for LGBTQI+ people. Meanwhile, state-level Republicans are igniting a war on trans health care, with Florida Republicans banning upwards of 80 percent of all gender-affirming care in the state. Whether it’s barring no-cost screenings or preventive medicine, banning gender-affirming care, or attacking other fundamental LGBTQI+ rights, Republicans’ war on LGBTQI+ health care is only getting worse.

Republicans Are Pulling Medications They Don’t Like From The Market – Setting a Dangerous Precedent for LGBTQI+ Care

A Trump-Appointed Judge Is Working To Curb Access To Safe, Affordable Abortions. In April, another Trump-appointed judge ruled against the FDA in a case seeking to remove a popular medication used to induce abortion from the market. Medication abortions are the most common, least expensive, and most accessible method for people to terminate pregnancy, and the ruling impacts communities that already have difficulty accessing these key services. 

Republicans Want to Pull Medications They Don’t Like Off The Shelves. The case could set a dangerous precedent for any federal judge to pull controversial medications off the market, regardless of the science behind approval decisions or the bureaucratic steps taken to prove safety and efficacy. As Lambda Legal has pointed out, “The trial court’s approach just as easily (or perhaps more easily) could be aimed at HIV-related medications and puberty blockers and hormone treatments, as well as medications for many other health conditions that are specially relevant for our communities.”

Republicans Are Taking Away No-Cost Preventive Care From LGBTQI+ People and Communities of Color

Republicans Are Curbing Access To No-Cost Preventive Services, Disproportionately Impacting LGBTQI+ People and Communities of Color. In March, a Trump-appointed judge decided against the federal government in Braidwood v. Becerra and struck down a major portion of the Affordable Care Act (ACA) requiring no-cost coverage of lifesaving preventive health care services recommended by the U.S. Preventive Services Task Force, including lung and breast cancer screenings, Hepatitis C screenings, HIV screenings, and PrEP medication. These changes have a disproportionate impact on historically marginalized populations like LGBTQI+ people and communities of color — curbing no-cost access to preventive services would create barriers to seeking needed care and exacerbate existing health disparities.

Republicans Are Targeting PrEP, A Key Prevention Strategy For HIV. The Trump-appointed judge’s ruling struck down a portion of the ACA guaranteeing access to pre-exposure prophylaxis (PrEP), a drug proven to substantially reduce the risk of contracting HIV. PrEP has been associated with a significant decrease in the number of new HIV diagnoses. PrEP is shown to lower the risk of infection from sex by more than 90 percent (more than 99 percent effective) and is widely viewed as a key prevention strategy for ending the HIV epidemic in the U.S. Thanks to ACA protections, the percentage of PrEP users has jumped from 3 percent of eligible patients in 2015 to 30 percent of eligible patients prescribed in 2021. 

• Combating HIV Has Been Central To LGBTQI+ Public Health Efforts For Decades, Particularly For Gay and Bisexual Men. Efforts to combat the spread of HIV remain one of the largest public health concerns among LGBTQI+ populations. Gay and bisexual men, as well as Black and Hispanic/Latino Americans, remain disproportionately affected by HIV. The federal government’s 2022-2025 strategy to combat HIV recognized gay and bisexual men—particularly Black, Hispanic/Latino, and Native American men—Black women, and trans women as priority populations. Rural populations, especially gay and bisexual Native American men and Two-Spirit populations, have greater difficulty accessing preventive care for HIV.
• Ending ACA PrEP Protections Disproportionately Harms Black and Hispanic/Latino Gay and Bisexual Men. While 66 percent of eligible white people in America are prescribed PrEP, just 16 percent of eligible Hispanic/Latino Americans and 9 percent of eligible Black Americans are prescribed the lifesaving drug. Academic experts have concluded that Braidwood will disproportionately impact racial and ethnic sociodemographic groups at particularly high risk for HIV infection: “Even in our ‘best-case’ scenario, the predominant burden of new restrictions on access to PrEP will likely fall on Black and Latino gay and bisexual men, as well as transgender women, who already face significant barriers to HIV prevention and care.”

Ending ACA Cost-Sharing Protections Could Increase HIV Transmission By At Least 17 Percent In The First Year Alone. According to academic experts, ending the prohibition of cost sharing for PrEP will increase HIV transmission among men who have sex with men by at least 17 percent in the first year alone. Researchers at Yale have already determined that the Braidwood ruling could see coverage for PrEP drop from 28 percent to only 10 percent, mainly due to the fact that 80 percent of PrEP users are on commercial plans that would now have the ability to refuse to cover PrEP.

• Without ACA Protections, PrEP Could Cost Nearly $4,200 A Year On Average In Addition To Lab Costs and Office Visits. Out-of-pocket costs may be prohibitively high without ACA protections against cost-sharing. A recent study found that PrEP medication costs nearly $350 for a 30-day supply on average. Outside of the cost of obtaining medication, PrEP users incur additional required charges as part of the care regimen like clinical visits and lab costs that can add up to thousands of dollars annually. 
• The Trump-Appointed Judge Who Ruled In Braidwood v. Becerra Has Long Been Hostile To LGBTQI+ Populations. The Texas judge who decided Braidwood has referred to PrEP as a drug that would “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” In the past, he has also said that Obergefell v. Hodges (2015) and Lawrence v. Texas, the 2003 ruling that invalidated all remaining state anti-sodomy laws, “are judicial concoctions, and there is no other source of law that can be invoked to salvage their existence.”

Republicans Are Pushing An Anti-Trans Agenda

10 Republican-Led States Continue To Block Medicaid Expansion, Which Serves Millions Of LGBTQI+ Patients. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for an estimated 1.2 million LGBTQI+ adults, disproportionately trans and non-binary Black, Hispanic/Latino, Pacific Islander, and Native American people. LGB individuals are more likely to qualify for Medicaid based on income, and Medicaid covers about 21 percent of trans and non-binary people in the U.S.

Republicans Are Waging War On Trans People and Their Health Care. Across the country, Republicans have escalated their war on trans people and health. As of May 2023, 16 Republican-led states have enacted new anti-trans health care laws and 22 states have passed anti-trans health care bills in at least one Republican-held legislative chamber. Republicans have re-centered their culture wars around trans people, with new legislation prohibiting drag shows from public property alongside bans on gender-affirming care. Anti-trans laws contribute to negative health impacts, including an increased risk of suicidality and substance use among trans and non-binary youths. Equitable access to health care services has always been a challenge for LGBTQI+ people. A 2018 survey found that 75 percent of people seeking gender-identity-based care have had negative experiences during physician visits. The fight to get insurers to cover basic care for trans patients—let alone gender-affirming care—has been a grueling, decades-long process even with ACA protections and federal and state-level enforcement. New bans threaten to undo decades of work to provide trans people with access to affordable, gender-affirming care.

Florida Republicans Have Effectively Banned 80 Percent of All Trans Health Care Providers In The State. In the past year alone, Florida Republicans have passed a slate of anti-trans laws banning health care for minors and adults alike. In April 2022, the Florida GOP passed legislation that requires trans adults seeking gender-affirming care to receive approval from the Florida Board of Medicine at least 24 hours in advance and has banned insurance providers from covering gender-affirming care for young adults. Just a few weeks ago, Florida Governor Ron DeSantis signed yet another law that bars up to 80 percent of all gender-affirming care providers in the state from practicing, including all nurse practitioners, physician assistants, and telehealth visits, drastically reducing the number of providers available for trans adults seeking care.

Republicans’ Anti-Trans Efforts Are Prompting “Mass Migration” Of LGBTQI+ People. In addition to direct attacks on trans health care, Republicans have ramped up their efforts to make LGBTQI+ social integration part of the broader culture wars. For example, Florida Republicans, led by Governor Ron DeSantis, have also enacted a ban on all topics surrounding gender identity and sexual orientation—including sex education and LGBTQI+ health—prompting many Florida-based Pride groups to cancel Pride celebrations amid a “mass migration” of LGBTQI+ people out of the state. In March, Tennessee Republicans adopted a strict ban on gender-affirming health care, while Texas Republicans have ordered state agencies to start investigating parents seeking gender-affirming care for their trans kids for criminal penalties.

Big Pharma Is Telling Investors on Wall Street Everything Is Fine While Telling Lawmakers Medicare Negotiation Will Destroy Innovation

Read the Full Report Here.

Washington, DC — Protect Our Care is releasing a new national report exposing pharmaceutical companies’ latest ploy to protect their sky-high profits at the expense of patients. Thanks to the Inflation Reduction Act, the Biden administration is now putting in place the Medicare Drug Price Negotiation Program that will finally give Medicare the authority to negotiate lower prices, making prescription drugs more affordable. Big Pharma is continuing its false claims to lawmakers that this program will undermine innovation and discourage the development of new medications, while telling Wall Street that they are enthusiastic about U.S. pharmaceutical innovation and research and development opportunities.

Key Points:

• American patients pay up to 4 times more for the same drugs as patients in other wealthy countries.
• Despite blaming the  negotiations for terminating new drug development, many drug companies are telling investors they are bullish on innovation and continue to invest  in research and development following the passage of the Inflation Reduction Act.
• The nonpartisan Congressional Budget Office estimates just a 1% decrease in the development of new drugs over the next 30 years as a result of the Medicare Drug Price Negotiation Program. 
• Even when the negotiation program is fully implemented, the United States will remain the most generous payer in the world for drugs.

“Big Pharma’s greed knows no bounds telling the public one thing and investors another,” said Protect Our Care Chair Leslie Dach. “Our nation’s seniors are depending on the savings from the Inflation Reduction Act, and Big Pharma is trying to roll back the law simply to protect their profits. Big Pharma’s claims are bogus and should be rejected.”

Hearing on June 6 Will Determine if Judge O’Connor’s Disastrous Ruling Takes Immediate Effect Nationwide

In March, District Judge Reed O’Connor in Braidwood Management v. Becerra struck down a provision of the Affordable Care Act (ACA) that requires insurers to cover lifesaving preventive services without cost sharing.  Braidwood is a politically-driven effort to dismantle the ACA, brought by longtime foes of abortion rights, women’s health, LGBTQI+ rights, and affordable health care. Now, the same judge who ruled that the ACA should be overturned entirely is ending lifesaving protections under the health care law that 150 million Americans rely on. 

Judge O’Connor applied his order to every company nationwide, refusing to limit it to the two companies and six individuals that are the plaintiffs that brought the case. The US Court of Appeals for the Fifth Circuit is holding a hearing June 6 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 ruling puts millions at the mercy of insurance companies and employers, who could eliminate the benefits entirely or start charging for them, increasing costs for patients and creating major obstacles to care. 

Eliminating costs for these lifesaving screenings and services has transformed how preventive care is delivered, saved countless lives, improved health outcomes, reduced disparities in care, and cut consumer health care costs for more than 150 million people. Guaranteed no-cost coverage of preventive services, including screenings for chronic disease, is critical to ensuring everyone has access to the same quality health care, no matter where they live or the color of their skin. 

Patient and provider groups, public health experts, and organized labor — including the American Medical Association, the American Lung Association, the American Cancer Society, SEIU, the American Public Health Association and 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.

Experts Submit Briefs Calling For Stay of Braidwood v. Becerra Ruling Warning Of The Dangers Of Putting Life-Saving Care At Risk 

Federal Government

Department of Justice: “The Public and the United States Will Face Significant Harm” Unless the Ruling Is Stayed. “[T]he public and the United States will face significant harm if the broad and universal relief ordered is not stayed during the pendency of this appeal. […] Collectively, the vacated and enjoined coverage requirements have ensured that more than 150 million Americans can benefit from the above-listed and other preventive services without cost sharing. ROA.2170. Absent a stay, those people will lose the federally-backed protection that their health plans must include that coverage, or the ability to have those services covered without cost sharing. Available data suggests that more than a third of group health plans (which, in 2020, covered approximately 14 million participants) may begin new plan years before January 1, 2024. That includes more than 20% of group health plans (which, in 2020, covered approximately 6.3 million participants) that may start a new plan year prior to July 1, 2023. ROA.2179. Many additional plans will begin new plan years in January 2024. If the nationwide vacatur and injunction ordered by the district court remain in effect pending appeal, many of these plans could either eliminate coverage of the relevant preventive services or impose cost sharing for those services.” [Department of Justice, Motion For A Partial Stay Of Final Judgment Pending Appeal, 4/27/23]

Health Care Organizations and Advocates

American Hospital Association et al. Fifth Circuit Amicus Brief: Preventive Care Is Essential to Population Health And A Stay Is In The Public Interest. A coalition comprising 12 top public health organizations—the American Hospital Association, Federation of American Hospitals, the Catholic Health Association of the United States, America’s Essential Hospitals, and the Association of American Medical Colleges—filed an amicus brief in support of an appeal to Judge Reed O’Connor’s ruling: “Evidence-based preventive-care services free from political influence are essential to patient wellbeing and population health and lead to lower health care costs over the long term. Upending coverage of preventive-care services will increase the risk that acute illnesses or chronic diseases will not be timely detected or treated. […] Estimates show that an increased uptake of recommended preventive services could save over 100,000 additional lives every year. […] In addition to providing vital screenings, the ACA’s preventive-care coverage requirement ensures access to life-saving medications. […] Without zero-cost-sharing access to PrEP, many at-risk populations—particularly Black and Hispanic adults—will face an increased chance of contracting HIV. […] The ACA’s preventive-care coverage requirement saves lives and improves population health, saving the public costs in the long term. Maintaining these benefits pending appeal is therefore in the public interest.” [American Hospital Association et al. Brief, 5/4/23]

American Medical Association et al. Fifth Circuit Amicus Brief: Ruling Threatens to Reverse Recent Public Health Advancements Must Be Stayed. A coalition comprising 12 top public health organizations—the American Medical Association, American College Of Obstetricians And Gynecologists, Society For Maternal-Fetal Medicine, American Academy Of Pediatrics, American Medical Women’s Association, American Academy Of Family Physicians, National Medical Association, Infectious Diseases Society Of America, American College Of Chest Physicians, American Thoracic Society, National Hispanic Medical Association, and American Society Of Clinical Oncology—filed an amicus brief in support of a motion to stay Judge Reed O’Connor’s ruling: “As professional organizations representing physicians across the country, Amici know that no-cost preventive care saves lives, saves money, improves health outcomes, and enables healthier lifestyles. Ensuring that patients can receive these services is of the utmost importance to public health. The district court’s unprecedented decision imperils access to these services nationwide. Amici file this brief to inform this Court of the repercussions that decision could have on preventive care access. […] 151.6 million individuals currently have private health coverage that covers preventive services with zero cost-sharing,” including “approximately 58 million women, 57 million men, and 37 million children.” The Task Force requirements can also apply to Medicaid expansion enrollees, adding another 20 million adults,10 and to Medicare enrollees, if HHS has determined that a given service is appropriate for inclusion in the program, adding 61.5 million individuals more.11 In other words, approximately 233 million individuals are currently enrolled in plans that must cover preventive services without cost-sharing. […] Finally, the availability of no-cost preventive care has improved utilization and health outcomes among populations that have historically faced difficulty accessing health care. In particular, a recent study concluded that “[g]iven the large differences in the share of uninsured and the use of clinical preventive services among Black and Hispanic adults relative to White adults pre-ACA, the ACA does appear to have reduced the differences between minority adults and White adults.” Eliminating coverage requirements would impose further barriers, making it even harder to ensure that patients receive the requisite care.” [American Medical Association et al. Brief, 4/28/23]

American Lung Association et al. Fifth Circuit Amicus Brief: Ruling Could Hold Hazardous Consequences for Public Health Unless Stayed. A coalition comprising eight primarily public health-oriented non-profit organizations—the American Lung Association, Adult Vaccine Access Coalition, American Heart Association, Campaign for Tobacco-Free Kids, GO2 for Lung Cancer, LUNGevity Foundation, Public Citizen, and Truth Initiative—filed an amicus brief in support of a motion to stay Judge Reed O’Connor’s ruling: “The provisions of the Affordable Care Act (ACA) that require insurers to provide coverage for certain preventive services without cost to patients reflect Congress’s recognition that barrier-free access to preventive care is critical for safeguarding Americans’ health. The district court’s judgment upends Congress’s careful policy choices and creates the risk that insurers will reinstate cost-sharing for vital preventive services or even exclude them from coverage entirely. To avoid the hazardous consequences the district court’s judgment could hold for public health, this Court should stay the judgment pending appeal. […] If preventive care costs increase even for “just” a few million Americans, the health consequences could be serious…If insurers now respond to the district court’s judgment by imposing cost-sharing requirements for patients to receive these life-saving medications, research suggests that patients could discontinue use despite the risks to their health…More broadly, according to a recent survey, 40 percent of American adults would be unable or unwilling to pay out of pocket for the majority of the evidence-based preventive services affected by the district court’s judgment.” [American Lung Association et al. Brief, 4/27/23]

American Cancer Society et al. Amicus Brief: Ruling Substantially Harms Our Patients and Must Be Stayed. A coalition comprising 15 public health organizations—the American Cancer Society (ACS), American Cancer Society Cancer Action Network (ACS CAN), American Kidney Fund (AKF), Arthritis Foundation, CancerCare, Cancer Support Community (CSC), Cystic Fibrosis Foundation, Epilepsy Foundation, Hemophilia Federation of America, Leukemia and Lymphoma Society (LLS), National Minority Quality Forum (NMQF), National Multiple Sclerosis Society, National Patient Advocate Foundation, The AIDS Institute, and WomenHeart—filed an amicus brief in support of a motion to stay Judge Reed O’Connor’s ruling: “All Americans use or will use health care services, and the lifetime risk that individual Americans will contract one of the diseases or conditions towards which amici direct our efforts is high. Preventive services can aid in prevention, early detection and treatment of many diseases, which increases patients’ chances of survival and extends life expectancies. Preventive care also helps control patients’ costs of treating these diseases and conditions. […] A review of 65 papers published from 2000-2017 found that “even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services.”…two out of five respondents stated that they would not pay out of pocket for eleven out of twelve preventive services included in the survey. […] The U.S. District Court’s March 30 decision threatens to imminently and drastically reduce insurance coverage of preventive services, deter utilization of those services, and worsen patient outcomes. Without a stay, the District Court’s order will substantially harm the patients amici serve and support.” [American Cancer Society et al. Brief, 4/28/23]

Physicians and Health Care Experts

American Public Health Association & Public Health Deans and Scholars Fifth Circuit Amicus Brief: Ruling Could Cause Irreparable Harm By Limiting Access to Life-Saving Services and Must Be Stayed. A group of 68 distinguished academic deans and scholars of public health, alongside the American Public Health Association, filed an amicus brief in support of a motion to stay Judge Reed O’Connor’s ruling: “To protect Americans’ health, the ACA requires virtually all private insurance plans to cover critical preventive services cost-free. And the statute relies on a body of medical experts to identify the services that qualify for that coverage. The district court’s nationwide order eliminates this requirement for dozens of life-saving services. If it is not stayed, some companies and insurers will re-impose cost-sharing—indeed, some plans could impose cost-sharing with just sixty days’ notice. As a result, many Americans will not use these services: studies consistently demonstrate that when people are required to pay part of the cost of preventive care, they often do not obtain it. That will lead to more serious illnesses and even deaths among the individuals deprived of coverage. It also will affect Americans more broadly, because many of the covered services prevent and treat illnesses that, if not detected and treated, can be spread among the population generally. […] A stay will maintain the status quo for the more than 150 million Americans who rely on cost-free coverage for preventive services. By contrast, the district court’s order will inflict irreparable harm by causing many Americans to suffer serious and life-threatening conditions and illnesses that otherwise would have been avoided. That harm is not outweighed by the temporary exclusion of non-parties from the relief granted by the district court.” [American Public Health Association and Public Health Deans and Scholars Brief, 4/28/23]

Service Employees International Union (SEIU) Fifth Circuit Amicus Brief: Ruling Will Threaten The Healthcare of More Than 130 Million Employees Unless Stayed. “SEIU respectfully urges the Court to grant Defendants-Appellants’ (“Defendants”) motion for a partial stay of the district court’s nationwide judgment. That judgment threatens the healthcare of the more than 130 million employees and families with private employment-based insurance plans by enjoining Defendants from taking any action to enforce or implement the requirement that preventive care services recommended by the Preventive Services Task Force (“Task Force”) be provided at no cost. As borne out by the experiences of SEIU’s physician members, the mandate to make preventive care available at no cost has saved lives, and the district court’s decision, by reducing access to that care, will negatively affect millions of Americans’ health. Yet the district court, in flagrant disregard of the governing legal standards, failed even to address or acknowledge the significant negative effects its judgment will have on millions of non-parties. The district court’s judgment also interferes with the statutory and due process rights of non-party employees and their families. […] Many of those affected workers are SEIU members. Yet the interests of employees and their families in retaining access to preventative care services are not adequately represented in this case by the agency Defendants-Appellants.” [SEIU Brief, 4/28/23]

Insurance Companies Most Recent Move Shows They Will Be Quick to Drop Coverage 

In March, District Judge Reed O’Connor in Braidwood Management v. Becerra struck down a provision of the Affordable Care Act (ACA) that requires insurers to cover lifesaving preventive services without cost sharing. Judge O’Connor applied his order to every company nationwide, refusing to limit it to the two companies and six individuals that are the plaintiffs that brought the case. The US Court of Appeals for the Fifth Circuit is holding a hearing June 6 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. 

Just last month, the requirement for insurance companies to cover at home COVID-19 tests ended, and insurers have already started removing this coverage. Some Blue Cross affiliates, including CareFirst and Blue Cross Blue Shield of Massachusetts, have informed customers that they “will no longer reimburse members for tests purchased on or after May 12, 2023.” And customers looking for guidance from CVS, one of the nation’s largest retailers of COVID-19 tests, are being told that they must “check your plan to see if you’re covered” for reimbursement for tests. This has caused confusion to patients who don’t know if their plans will cover tests, and is the likely harbinger of more to come. 

Without a stay in Braidwood, this type of action by insurers would be catastrophic for access to critical preventive services. Insurance companies would once again be able to charge patients for lifesaving care, like cancer screenings, anxiety and depression screenings for children and adults, screenings for hepatitis and other diseases, and access to critical medicines like statins and PrEP. Read more about what’s at risk in the case here. 

Experts Warned Of A Confusing “Hodgepodge” Of Coverage For COVID Testing After The Expiration Of The Public Health Emergency. From 2021 to May 11, 2023 the federal government required all private insurers to cover up to eight at home COVID-19 tests per month. When that requirement ended on May 11, some private insurers opted to continue coverage, but there is no longer a nationwide rule.  Christona Silcox of the Duke Margolis Center for Health Policy warned that, “What we will see is a hodgepodge of approaches by different insurance companies, which is going to make it difficult for individuals to know what they’re going to be paying.” 

Details About What Plans Will Cover Are Scarce And Each Insurance Company Can Make Its Own Decisions About What To Cover And How Much Customers Will Have To Pay.  After the expiration of the PHE, the federal government has encouraged insurers to continue coverage, but each company can ultimately make their own decision. On May 1 CNN reported that, “So far, details on those plans are scarce.” The Blue Cross Blue Shield Association told CNN that its coverage may include “reasonable limits” on tests. Aetna, Cigna, Humana and UnitedHealthcare did not provide any details on what their plans will or will not cover going forward. Some Blue Cross affiliates, including CareFirst and Blue Cross Blue Shield of Massachusetts have already informed customers that they “will no longer reimburse members for tests purchased on or after May 12, 2023.” 

Major Retailers Refer Customers To “Check Your Plan” To See If Covid Tests Are Still Covered. Customers looking for guidance from CVS, one of the nation’s largest retailers of COVID-19 tests, are told that they must “check your plan to see if you’re covered” for reimbursement for tests. 

Democrats Saved Health Care For 21 Million Americans From Republican Plans to Slash Medicaid and Destroy Our Economy

Washington, DC — Today, President Biden will sign legislation protecting millions of Americans’ health care, avoiding default on our nation’s debt. This victory was achieved for the American people despite Republicans’ best effort to rip Medicaid away from 21 million Americans with burdensome paperwork requirements after trying to hold the economy hostage in order to get their way. President Biden, with the support of Democrats in Congress, held the line insisting he wouldn’t agree to any deal that took health care coverage away from Americans, and the agreement protects Medicaid from any Republican cuts. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“President Biden and Democratic lawmakers saved Medicaid from the latest installment of Republicans’ war on health care. Not only did the Biden-Harris Administration save the economy from a Republican default, but 21 million Americans can rest easier knowing that their health care is secure.

“The American people have repeatedly rejected Republican attacks on health care, but there is no doubt Republicans in Congress will continue trying to rip away Medicaid from millions, hike drug and health insurance prices, and remove protections for pre-existing conditions. As we speak, Republicans and their allies are in court fighting to take away no cost preventive services, dismantle the Affordable Care Act, revoke reproductive rights, and upend the FDA’s drug approval process. Thankfully, we have a president who is standing up for families and will stop at nothing to protect health care.”  

Washington, DC — Over the weekend, President Biden reached a deal to avoid default and protect millions of Americans’ health care. Republicans in Congress wanted to rip Medicaid away from 21 million Americans by imposing burdensome paperwork requirements, and they were threatening to default on our debt if they didn’t get their way. President Biden, with the support of Democrats in Congress, held the line insisting they wouldn’t agree to any deal that took health care coverage away from Americans, and the agreement protects Medicaid from any changes whatsoever. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“President Biden drew a line in the sand and vowed to protect health care coverage in default negotiations, and he did. President Biden and Democratic lawmakers should be commended for protecting the economy from the devastating consequences of a Republican default and stopping the latest GOP plan to slash Medicaid. It should now be clear that Medicaid, like Social Security and Medicare, has the overwhelming support of the American people. 

“Unfortunately, the Republican war on health care continues, and there is no doubt they will continue trying to rip away Medicaid from millions, hike drug and health insurance prices, and remove protections for pre-existing conditions. Republicans and their allies are also in court fighting to take away no cost preventive services, dismantle the Affordable Care Act, revoke reproductive rights, and upend the FDA’s drug approval process. The American people have repeatedly rejected Republican attacks on health care, but sadly, the threats are only growing. 

“While Medicaid was protected in this deal, we must ensure that as lawmakers navigate the appropriations process, vital programs like food assistance and those that promote the health and well-being of people across America are protected as well.”

This week we highlight two federal agencies and their programs to increase health equity by modernizing rules for blood donations and increasing incentives for health providers to ensure that needed care is accessible to all people as well as newly reintroduced, comprehensive federal legislation to address the Black maternal health crisis. Private sector initiatives are complementing  federal and state efforts, with the most recent Asembia Summit explicitly addressing the need for gender equity in care and Black legacy civil rights organizations joining with Biden-Harris Administration officials and calling on health insurers and health associations to take meaningful action to prevent coverage losses and strengthen care quality and affordability. Local programs, the front lines of promoting health equity, often go without recognition, but a Chicago-based group is making a splash now that it is expanding beyond the Chicago area to provide free counseling and classes to cancer patients across the country. Among other research highlighting stark and persistent health disparities, a seminal study funded by the National Institutes of Health (NIH) calculated the staggering economic burden of health disparities for five racial and ethnic minority groups and additional research quantified lives lost and the societal price for failing to achieve health equity.

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

Fierce Healthcare: Momnibus Act Reintroduced to Congress as Lawmakers Call for Protection of Black Mothers. “Senator Cory Booker and Representatives Lauren Underwood and Alma Adams have reintroduced the bicameral Black Maternal Health Momnibus Act. The Momnibus is comprised of thirteen bills backed by the Black Maternal Health Caucus members. Bills within the act would combat rising maternal mortality rates directly through healthcare reform and indirectly through addressing social determinants of health. Data collected in 2021 showed that maternal mortality rates have reached a nearly 60 year high. If Congress were to pass the act, further funding for improving maternal healthcare for veterans and incarcerated mothers would be unlocked, programs to improve data collection on the crisis would be launched and education programs on maternal vaccinations would expand. Other parts of the bill would convene a task force to address the maternal health crisis. Said task force would direct the investment of funds into programs tackling social determinants of health. Environmental factors leading to poor maternal health outcomes would be addressed through extending eligibility for the special Supplemental Nutrition Program for Women, Infants and Children (WIC) to the postpartum and breastfeeding periods and triggering investment in digital tools to improve maternal health in underserved areas.” [Fierce Healthcare, 5/16/23]

Politico: FDA Relaxes Blood Donation Restrictions on Gay and Bisexual Men. “The FDA on Thursday finalized a long-awaited plan to loosen restrictions on blood donation by men who have sex with men. Currently, men who have sex with men must abstain from sex for three months before giving blood. The new policy still limits people who have certain risk factors — such as a history of non-prescription injection drug use, those who have exchanged sex for money or drugs, or those who previously tested HIV-positive from donating. The final guidelines are consistent with the draft policy issued in January, which proposed to ease restrictions on blood donation from certain men who have sex with men. The FDA says blood donation establishments “may now implement” the new policy, but it is unclear how long it will take for donation centers to revise questionnaires and procedures. The agency did not set a deadline for implementing the revised policy.” [Politico, 5/11/23]

Health Affairs: Looking Back One Year Out From CMS’s New Health Equity Initiative. “In the past year, three revised models and one new model have been announced, all of which have a prominent focus on addressing health equity. One revised model is the Medicare Advantage (MA) Value-Based Insurance Design Model, which builds upon the statutory authority permitting CMS to waive the uniformity requirements with respect to supplemental benefits provided to chronically ill enrollees. Participating plans can provide targeted supplemental benefits such as food, transportation, and housing assistance; reduced copayments; and rewards and incentives in connection with participation in activities that focus on promoting improved health, preventing injuries and illness, and promoting efficient use of health care resources. Beginning in July 2023, [CMS] will collect detailed information from participating plans about the supplemental benefits provided, so that we can assess their use and effectiveness in improving care and outcomes. The second revised model is the ACO Realizing Equity, Access, and Community Health (ACO REACH) Model, which is a revamped and renamed version of the former Global and Professional Direct Contracting Model. [T]he ACO REACH Model is testing a novel “health equity benchmark adjustment,” to remove the disincentive for providers serving disproportionate numbers of underserved beneficiaries to participate in the model. [CMS] also revised the Maryland Primary Care Program, a component of the third model, the Maryland Total Cost of Care Model. In January 2022, the Maryland Primary Care Program began to offer a “Health Equity Advancement Resource and Transformation (HEART)” payment to provide additional support to primary care participants and federally qualified health centers (FQHCs) furnishing enhanced care management services to socioeconomically disadvantaged and complex patients with high clinical risk in counties with high ADI relative to other counties in the state.” [Health Affairs, 5/11/23]

American Journal of Managed Care: Talking About Women’s Health is the First Step to Improving Health Equity. “Panelists at the 2023 Asembia Specialty Pharmacy Summit discussed the myriad of challenges that women face when they encounter the health care system and how these issues can be addressed to provide female patients more agency. Joanne Armstrong, MD, vice president and chief medical officer of women’s health and genomics at CVS/Aetna, began with championing digital tools, saying that although women are the dominant users of digital solutions but only 5% are targeted towards them. She also emphasized the role gender biases play in health disparities, especially for women of color, and why topics predominately experienced by women, such as menstruation, should not be considered taboo. Additionally, discussion around women’s health should extend beyond talking about menstruation and pregnancy to include all aspects of health, including mental health and conditions that predominately impact women, such as lupus and multiple sclerosis. Stephanie Sassman, portfolio leader of women’s health at Genentech, recommended that clinics and government agencies need to establish more partnerships to address major gaps in care for women and normalize discussions around women’s health equity.” [American Journal of Managed Care, 5/9/23]

NBC Chicago: Suburban Group is Beginning Expansion of Cancer Health Equity Initiatives. “Bringing cancer support programs to everyone, regardless of where they live or receive treatment, is Maigenete Mengesha’s mission. Through a partnership with the University of Illinois Cancer Center and the UI Health Mile Square Health Center, Wellness House is offering dozens of programs at the Mile Square location at 1220 S. Wood Street in Chicago. Two-time breast cancer survivor Jeanette Carter lives in Hyde Park and learned about the Wellness House support programs, that are offered completely free of charge, through her doctor, Deborah Manst. Manst urged Carter to try a Mediterranean diet, but Carter wasn’t sure what that meant. She began taking nutrition classes through Wellness House at Mile Square Health Center. In addition to nutrition and exercise classes, Wellness House also offers counseling. They now have a new designation that allows a Wellness House facilitator to expand online counseling sessions beyond the Chicago area, to cancer patients and their families in other states.” [NBC Chicago, 5/17/23]

Legal Defense Fund: Civil Rights Leaders Urge Action as the PHE Ends and Millions are at Risk of Jeopardized Care. “Yesterday, on the final day of the COVID-19 public health emergency designation, civil rights leaders convened at the White House for a joint meeting with the Office of Public Engagement, the Administrator for the Centers for Medicare and Medicaid Services (CMS), senior Biden administration officials, and representatives of health insurers and health associations to discuss concerns related to Medicaid unwinding, the end of the COVID-19 public health emergency, budget negotiations surrounding Medicaid work requirements, changes in Medicare Advantage Plans, and public awareness around cost-savings tied to the Inflation Reduction Act. Following the meeting, the civil rights leaders released a letter outlining key actions for insurers to consider, highlighting the urgent need for unified action. The leaders stated, ‘The lives of millions of vulnerable individuals, particularly Black people and other people of color, rely on the actions and commitments of health insurers and health associations. It is imperative that we work together, raise awareness, and take meaningful action to prevent individuals from being unjustly deprived of healthcare coverage and to ensure that families remain protected and healthcare remains affordable for everyone. We are urging insurers to commit to achieving health access, equity, and affordability for all.’” [Legal Defense Fund, 5/12/23]

CHALLENGES

National Institutes of Health: New Study Shows the Economic Burden of Health Disparities Remains High. “The study, funded by the National Institute on Minority Health and Health Disparities (NIMHD), part of the National Institutes of Health,  revealed that in 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, a 41% increase from the previous estimate of $320 billion in 2014. The study also finds that the total burden of education-related health disparities for persons with less than a college degree in 2018 reached $978 billion, about two times greater than the annual growth rate of the U.S. economy in 2018. This study is the first to estimate the total economic burden of health disparities for five racial and ethnic minority groups nationally and for all 50 states and the District of Columbia using a health equity approach. The health equity approach set aspirational health goals that all populations can strive for derived from the Healthy People 2030 goals. It establishes a single standard that can be applied to the nation and each state, and for all racial, ethnic, and education groups. It is also the first study to estimate the economic burden of health disparities by educational levels as a marker of socioeconomic status.” [National Institutes of Health, 5/16/23]

Washington Post: New Study Find Black Communities Faced Waves of Excess Deaths. “America’s Black communities experienced an excess 1.6 million deaths compared with the White population during the past two decades, a staggering loss that comes at a cost of hundreds of billions of dollars, according to two new studies that build on a generation of research into health disparities and inequity. In one study, researchers conclude that the gap in health outcomes translated into 80 million years of potential life lost — years of life that could have been preserved if the gap between Black and White mortality rates had been eliminated. The second report determined the price society pays for failing to achieve health equity and allowing Black people to die prematurely: $238 billion in 2018 alone. The reasons for the excess deaths and resulting economic toll are many, including mass incarceration, but the root is the same, according to the reports published Tuesday in the influential medical journal JAMA: the unequal nature of how American society is structured. That includes access to quality schools, jobs with a living wage, housing in safe neighborhoods, health insurance and medical care — all of which affect health and well-being. Expanding their analysis to a broader population, the researchers concluded that the failure to achieve health equity in 2018 cost the nation $1.03 trillion. That price tag includes the burden experienced by American adults older than 25 who do not have a college degree and by Native American, Asian, Black, Latino and Pacific Islander people.” [Washington Post, 5/16/23]

WAMC: Coalition of Public Health Experts Say Ending the PHE Will Lead to More Dangerous Outcomes for the Most Vulnerable. “Berkshire Health Systems, the county’s largest healthcare provider, is dropping many of its COVID-19 precautions in line with the state. Visitation policies have been expanded, pre-procedure testing will be discontinued, and testing centers in North Adams, Pittsfield, and Great Barrington will close at the end of the month. Even one of the most effective means of limiting the spread of the respiratory illness that has killed millions worldwide is being halted. But not all public health professionals think the concept of returning to normal is possible. A Massachusetts resident, Christine Mitchell, who received her doctorate from the Harvard T.H. Chan School of Public Health, signed on to an open letter from the Massachusetts Coalition for Health Equity calling on the commonwealth to maintain masking requirements for health care institutions. Given how disproportionately the pandemic impacted the most vulnerable at its height, Mitchell says this new chapter of public health policy underscores already deadly themes of ableism and discrimination against people with disabilities. ‘Only 29% of the Massachusetts population have gotten a COVID booster shot,’ said Dr. Lara Jirmanus. ‘And when you take a look at who’s gotten it, you actually find that there are huge inequities in terms of people of color, people according to levels of education. People with lower levels of education have also been less likely to get the vaccine, people with lower income. And that suggests to me that this is also an access issue. It’s about people who are unable to take the day off work to recover from the vaccine.’” [WAMC, 5/11/23]

The Post and Courier: Death Rate of Infants Born to Black Mothers in South Carolina Increased Over 40 Percent from 2017 to 2021. “Although the regional hospital in the city of Orangeburg delivers babies, the birth outcomes in the county are awful by any standard. In 2021, nearly 3 percent of all Black infants in Orangeburg County died before their 1st birthday. Nationally, the average is about 1 percent for Black infants and less than 0.5 percent for White infants. 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. A new study published in the Journal of the American Medical Association found that, over 20 years, 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 compared with White Americans. The study also found that infants and older Black Americans bear the brunt of excess deaths and years lost. [A] report published by the state Department of Health and Environmental Control in April shows the rate for non-Hispanic Black babies — who died at a rate nearly 2½ times that of non-Hispanic White infants in South Carolina in 2021 — is growing worse. The death rate among infants born to Black mothers in the state increased by nearly 40 percent from 2017 to 2021.” [The Post and Courier, 5/21/23]