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FACT SHEET: Medicare Open Enrollment Brings New Benefits and Savings for Millions of Seniors

Seniors Will Save in 2025 Thanks to the Inflation Reduction Act: $2,000 Annual Out-of-Pocket Cap, $35 Monthly Insulin Cost Cap, and Free Vaccines 

Medicare open enrollment begins on October 15 and runs through December 7. Starting October 1, seniors can begin reviewing coverage options for 2025. Seniors will see that   Medicare is better than ever thanks to the Inflation Reduction Act. Seniors will save money on drugs and vaccines, and can expect their premiums to remain stable or even decrease. The cost saving measures in the Inflation Reduction Act were passed in Congress without a single Republican vote and are under attack by Donald Trump and Republican Members of Congress. 

Starting January 1, 2025 people on Medicare will benefit from a $2,000 annual out-of-pocket cap on prescription drug costs. This is in addition to benefits that went into effect on January 1, 2023: recommended vaccines are now free, monthly insulin costs are capped at $35 per prescription, and drug companies cannot take advantage of seniors by raising drug prices faster than the rate of inflation without penalty. Additionally, starting in 2026, Medicare beneficiaries will see lower drug prices across the board thanks to the Inflation Reduction Act’s provisions to give Medicare the power to negotiate lower drug prices, which will save seniors and taxpayers billions of dollars and put downward pressure on premiums.

Seniors Will Pay Less for Health Care 

The Inflation Reduction Act is drastically reducing the cost of prescription drugs for the more than 50 million Americans enrolled in Medicare’s Part D drug benefit, reducing racial, income, and geographic disparities in health care, and saving lives. Seniors will finally have the breathing room they need to pay for other essentials like food and housing, or transportation to visit their grandchildren.

By the Numbers:

  • Over 50 million Medicare Part D beneficiaries will have out-of-pocket costs for prescription drugs capped at $2,000 per year starting January 1, 2025. 
  • Medicare beneficiaries no longer face big drug companies’ outrageous price hikes that exceed inflation. 
  • All Medicare Part D beneficiaries have access to free vaccines, such as shingles and pneumonia, at no cost.
  • No Medicare beneficiary pays more than $35 a month for an insulin copay.
  • Lower prices were negotiated for the first 10 drugs selected for the Negotiation Program, with more drugs to be named each year. Nearly 9 million people on Medicare rely on these drugs and spent $3.4 billion on them in out-of-pocket costs last year alone.
  • Total monthly Part D premiums are expected to decrease by $7.45 (13%) on average from 2024 to 2025.

The Inflation Reduction Act Lowers Prescription Drug Prices

$2,000 Annual Out-of-Pocket Spending Cap. Starting January 1, 2025, no senior on Medicare Part D will spend more than $2,000 a year on prescription drugs. This cap could mean the difference between life and death for the countless seniors relying on high cost drugs for complex conditions such as multiple myeloma. The 3.2 million on Medicare who are expected to reach the cap in 2025 will save an average of $1,500 per year on out-of-pocket costs. By 2029, 4.1 million enrollees, including one in ten seniors in 19 states and DC will benefit from the new annual out-of-pocket limit. 

Medicare Negotiation For Lower Drug Prices. In August, the Biden-Harris administration announced new, lower prices for ten of the most expensive and commonly used drugs among people with Medicare: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/ NovoLog. Nearly 9 million people on Medicare rely on these drugs and spent $3.4 billion on them in out-of-pocket costs last year alone. These prices go into effect in 2026,  and will save seniors $1.5 billion out-of-pocket and save taxpayers an additional $6 billion in the first year alone.  Over 80 percent of Americans support Medicare negotiating lower drug prices — the most popular provision in the Inflation Reduction Act. 

$35 Insulin Cap For Seniors. In 2020, there were more than 3.2 million insulin users with Medicare, with nearly 1.7 million purchasing their insulin without low-income subsidies. On average, seniors with Medicare Part D or B who are not receiving subsidies pay an average of $572 every year for this life-saving medication — an unthinkable sum for many on fixed incomes. Patients who suffer chronic complications can expect to pay upwards of an additional $650 per year. Under the Inflation Reduction Act, monthly insulin copays for people on Medicare are capped at $35 per prescription. A recent study showed that 1.5 million people on Medicare would have saved an average of $500 in 2020 from the $35 insulin copay cap.

Ends Outrageous Price Increases For Seniors. Over the past 20 years, price increases for brand-name drugs in Medicare Part D have risen at more than twice the rate of inflation. The Inflation Reduction Act penalizes drug companies for raising drug prices faster than the rate of inflation starting at the beginning of 2023. Since this provision went into effect, manufacturers of 98 drugs have been penalized, saving at least 770,000 seniors directly on their drug costs, and saving people with Medicare and taxpayers nearly $3 billion. An analysis by KFF showed that half of all drugs covered by Medicare had list price increases exceeding the rate of inflation in 2020. For example, AbbVie has hiked the price of its blockbuster drug Humira 27 times, including in January 2021 when it raised its cost by 7.4 percent

Free Shingles, RSV, and Other Recommended Vaccinations. Thanks to the Inflation Reduction Act, 50.5 million seniors are eligible for no-cost shingles vaccinations. In 2020, nearly 4 million Medicare beneficiaries received the two-part shingles vaccination. With a single shot of Shingrix costing $212, seniors on Medicare Part D are saving over $400 on average on vaccinations in 2023. The high out-of-pocket cost of the shingles vaccine has been a key factor in low vaccination rates, especially among Black and Latino communities. This extends an important affordable preventive service to seniors on Medicare; Americans with private insurance could already typically receive shingles vaccinations at no cost.

These savings and benefits are under attack: 

Republicans want to repeal the Inflation Reduction Act and hike drug costs for seniors. Trump’s Project 2025 makes the GOP’s plans clear: repeal the Inflation Reduction Act, ban Medicare from negotiating drug prices, and line drug companies’ pockets. Every Republican in Congress voted against the Inflation Reduction Act and Republicans in Congress continue to call for its repeal. The GOP’s latest attacks are just another attempt to carry out Trump’s Project 2025, do the bidding of the big drug companies, and repeal the law. 

Big drug companies are charging Americans two to four times more than people in other countries. While Democrats are doing what needs to be done to ensure seniors can afford the care they need without sacrificing groceries, gas, or rent – Republicans are siding with big drug companies and playing partisan games with seniors’ access to medication.

FACT SHEET: President Biden’s Health Care Legacy is a BFD!

As the Democratic National Convention kicks off, Protect Our Care celebrates President Biden’s health care legacy. During his Presidency, Joe Biden has built on the Affordable Care Act (ACA), safeguarding its consumer protections and boosting access to affordable health care for millions of Americans by lowering costs and addressing health inequities. He signed the American Rescue Plan and Inflation Reduction Act, lowering prescription costs and premiums, and he has fought to protect and strengthen Medicare and Medicaid. Protect Our Care Chair Leslie Dach issued the following statement:

“Joe Biden’s health care legacy is a BFD. There would not be an Inflation Reduction Act without Joe Biden – he created it, he fought aggressively for it for months, he refused to give up, and his legislative skills made it happen. As President, he built on the success of the ACA, standing up to greedy drug companies, lowering the cost of drugs and health insurance and expanding affordable health care to millions of people across America. He kept America safe during the pandemic and launched the cancer moonshot program. He has paved the way for a future where every American has the health care they need and where health care is a right, not a privilege.” 

“Joe Biden has always been a health care champion; he sponsored a bill during his first year in the Senate establishing a Medicare drug price negotiation program and he partnered with President Obama to pass the ACA. Every American’s health care is better and more affordable today because of Joe Biden.”

The Inflation Reduction Act and the American Rescue Plan:

  • Protect seniors from prescription drug hikes. Under the Inflation Reduction Act, when drug companies hike prices faster than the rate of inflation, they will have to pay Medicare a rebate. This has not only saved the government billions of dollars, but it has drastically reduced out-of-pocket costs for people on Medicare. In June 2024 alone, the Biden-Harris administration announced that some seniors and people with disabilities will pay less for 64 drugs available through Medicare Part B thanks to the Inflation Reduction Act’s rebate program.
  • Give Medicare the power to negotiate lower drug prices, which will save taxpayers billions of dollars and lower costs for some of the most popular and expensive prescription drugs. By 2030, 80 of the most expensive prescription drugs will have lower prices because of these negotiations. This month, the Biden-Harris administration announced the new, lower prices for 10 of the highest-cost, most popular drugs taken by nearly 9 million people on Medicare who spent $3.9 billion in out-of-pocket costs in 2023. In the first year alone, these newly lowered prices will save seniors $1.5 billion in out-of-pocket costs and will save taxpayers $6 billion, slashing the list prices of the first ten drugs by 38–79 percent. Amidst negotiations, the Biden-Harris administration has also successfully fended off lawsuit after lawsuit from big drug companies and their allies seeking to ban Medicare from negotiating lower drug prices.
  • Cap drug costs for seniors. Under the Inflation Reduction Act, Part D plans are required to cap annual out-of-pocket spending to $2,000 by 2025, giving more than 50 million Americans with Medicare Part D more reassurance and financial stability. According to the Kaiser Family Foundation, this particularly helps seniors with serious conditions like cancer and Multiple Sclerosis. Seniors will also continue to save on insulin and vaccines.
  • Cut insulin costs. The Inflation Reduction Act capped insulin prices at no more than $35 starting January 2023 — saving seniors up to $1,500 annually. In response to calls from President Biden, the three largest insulin manufacturers announced $35 monthly out-of-pocket cost caps, lowering costs of about 90% of the insulin on the market.
  • Provide free vaccines for seniors. Millions of Americans enrolled in Medicare Part D have access to covered vaccines, such as shingles and Tdap, at no cost. HHS found that over 10 million people on Medicare received a free vaccine thanks to the Inflation Reduction Act.
  • Lower health insurance premiums for millions of Americans. The American Rescue plan lowered costs for millions by increasing financial assistance for people who buy coverage on their own and making financial assistance more widely available to middle-class families, ensuring people purchasing coverage through the ACA marketplaces will not pay more than 8.5 percent of their income for coverage. The Inflation Reduction Act carried on those provisions, and families continue to save an average of $2,400 a year on their health insurance premiums.
  • Cap the amount of money families pay for health insurance. The Inflation Reduction Act ensures families pay no more than 8.5 percent of their income towards coverage.
  • Eliminate premiums for low-wage workers. The Inflation Reduction Act and American Rescue Plan ensured no American with an income at or below 150 percent of the federal poverty level buying their coverage on the Marketplace will pay a premium.
  • Provide extra savings for low-income seniors. The Inflation Reduction Act expanded the Medicare Extra Help program, and the Biden-Harris administration announced investments in helping up to 3 million eligible seniors and people with disabilities enroll in the Extra Help program in 2023 to benefit from the program’s lower cost premiums, deductibles, and copayments.
  • Expand coverage and build on public health emergency continuous coverage protections. The American Rescue Plan provided robust financial incentives for the states that have not yet implemented Medicaid expansion. 
  • Create a pathway to coverage for new mothers. The American Rescue Plan called on states to extend postpartum coverage under Medicaid from two months to a full year following pregnancy, when most negative health outcomes occur.

Safeguarding and Building on The Affordable Care Act

“This Is A Big F*cking Deal:” Then-Vice President Biden Championed The Affordable Care Act. In 2010, the Obama-Biden administration and Democrats in Congress passed the landmark Patient Protection and Affordable Care Act, transforming the American health care system. The ACA cemented protections for more than 100 million Americans with pre-existing conditions, expanded Medicaid coverage to about 24 million people, and established affordable health care marketplaces now providing quality coverage for over 21.3 million people who buy insurance on their own. Then-Vice President Joe Biden championed the bill, telling then-President Obama, “This is a big f*cking deal.” Not only did President Biden champion the law, but he worked to strengthen it and protect it from Republican attacks: 

  • President Biden opened a Special Enrollment Period, allowing millions of Americans to enroll in affordable coverage. Just days into his presidency, President Biden issued an executive order reopening HealthCare.gov for a special enrollment period to help Americans gain coverage as they continue to suffer from the health and economic impacts of the pandemic. 2.8 million Americans enrolled during the Special Enrollment Period (SEP), with particularly large increases in enrollment for Hispanic, Black, and American Indian and Alaska Native people. 
  • President Biden defended the ACA from lawsuits seeking to dismantle all or part of the law. Less than a month into his Presidency, President Biden defended the Affordable Care Act in California v. Texas, the lawsuit before the Supreme Court to completely dismantle the law. The Biden-Harris administration has also defended a major provision of the ACA that requires no-cost coverage of lifesaving preventive health care services in Braidwood Management v. Becerra.
  • President Biden rolled back the Trump administration’s efforts to undermine the ACA and revoke consumer protections. In his first days in office, President Biden directed federal agencies to re-examine Trump-era policies that undermine the ACA. His administration has since taken steps to revoke Trump administration actions undermining the ACA’s consumer protections. In March, the Biden-Harris administration issued a final rule to protect consumers and limit short-term junk plans that do not need to cover pre-existing conditions, often use deceptive marketing practices, and leave American families with staggering medical bills. In April, the Biden-Harris administration issued a final rule under Section 1557 of the ACA to advance health care protections against discrimination on the basis of race, color, natural origin, sex, age, and disability. That same month, the Biden-Harris administration also reversed a Trump-era regulation allowing insurance companies to sell junk plans known as association health plans.
  • President Biden invested millions in ACA outreach. The Biden-Harris administration made historic investments in outreach, announcing $500 million in grants over the next five years for the Navigators program. The program plays a key role in helping people across the country sign up for health care coverage through ACA marketplace plans.
  • President Biden launched executive actions strengthening building on the ACA by protecting people with pre-existing conditions and making it easier for low-income enrollees. The Biden-Harris administration announced new executive actions to lower health care costs and protect people with pre-existing conditions. The new actions eliminate surprise medical bills and limit junk insurance plans that do not need to cover people with pre-existing conditions like asthma, cancer, and diabetes. In April, the administration also announced new policies to strengthen the ACA, making it easier for low-income Americans to enroll in coverage, increasing access to routine adult dental services, and setting standards for the time and distance people need to travel for appointments for in-network providers. 
  • President Biden expanded affordable health care to DACA recipients under the ACA. In May, the Biden-Harris administration finalized a policy to expand affordable health care to DACA recipients through the ACA. CMS estimates that this rule could lead to 100,000 previously uninsured DACA gaining coverage. 
  • Under President Biden, a record-breaking 21.3 million Americans signed up for affordable health care through ACA marketplaces. Earlier this year, the Biden-Harris administration announced that a record 21.3 million Americans have signed up for health insurance through the Affordable Care Act (ACA) marketplaces – over nine million more than when President Biden took office. 80 percent of enrollees were also able to find a health plan through the Marketplace for $10 or less per month thanks to the Inflation Reduction Act lowering health insurance premiums.
  • President Biden fixed the “family glitch,” expanding ACA marketplace eligibility to over one million Americans. In October 2022, the Biden-Harris administration issued a final rule to fix the “family glitch,” which blocked millions of families from accessing affordable coverage through the ACA marketplaces – expanding coverage and lowering health care costs for more than one million Americans.

Strengthening and Protecting Medicaid and Medicare

President Biden Has Worked To Strengthen and Protect Medicaid and Medicare. Throughout his Presidency, President Biden has made protecting and strengthening Medicaid and Medicare – which cover hundreds of millions of Americans – a cornerstone of his health agenda. During his tenure, President Biden has:

  • Protected Medicaid from budget cuts.
  • Cracked down on Trump’s disastrous paperwork requirements.
  • Pushed to make it easier for millions of eligible people to enroll in Medicaid, reducing red tape and simplifying applications, verifications, enrollment, and renewals for health care coverage through Medicaid and the Children’s Health Insurance Program (CHIP).
  • Signed legislation guaranteeing 12-month continuous coverage for kids on Medicaid and CHIP and announced a rule standardizing enrollment and renewal processes nationwide. The rule also applied consumer protections from the ACA to Medicaid and CHIP enrollees, like banning lifetime limits and waiting periods.
  • Fought to protect people on Medicaid from disenrollment. In September 2023, the Biden-Harris announced that nearly 500,000 children and adults who were improperly disenrolled from Medicaid and CHIP would regain their coverage thanks to their actions. 
  • Established national Medicaid and CHIP standards for patient wait times and travel distance, ensuring that people who rely on Medicaid have meaningful access to health care services including primary care, behavioral health and substance use disorder services, and OB/GYN care. The Biden-Harris administration also announced minimum staffing standards at nursing homes to promote safety and high-quality care for 1.2 million seniors and people with disabilities. 
  • Pushed for prescription drug transparency in Medicaid. 
  • Cracked down on Medicare Advantage plan providers publishing misleading ads.

Lowering Costs and Improving Health Care

President Biden Has Fought To Lower Drug Costs, Including Inhalers. In December 2023, the Biden-Harris administration announced plans to lower prices for certain high-priced medicines by developing a policy for using federal “march-in rights” to license drugs to other manufacturers who could sell them for less in order to stop price gouging and boost competition between drug manufacturers to lower prices for patients. That same month, the Biden-Harris administration announced a new policy to ensure the best value for taxpayers by establishing a fair pricing standard for medical products purchased by the Administration for Strategic Preparedness and Response. In March, President Biden hosted an event to celebrate lower inhaler costs following the FTC’s recent crackdown on drug companies that use improper patents to keep the price of inhalers too high. In response, two drugmakers have capped out-of-pocket costs for some top-selling inhalers at $35 per month. 

President Biden Has Fought To Improve Health Equity and Access to Health Care. President Biden has taken steps during his presidency to address health inequities, issuing several executive orders and new agency rules. On his first day in office, President Biden signed an executive order calling for the federal government to advance an ambitious, whole-of-government equity agenda. In April 2022, he signed another executive order focused on continued efforts to expand access to affordable, quality health coverage, and in February 2023, President Biden signed a new executive order aiming to strengthen and reaffirm the administration’s commitment to deliver equity. In September 2023, the Biden-Harris administration released a historic proposed rule that strengthens prohibitions against discrimination for people with disabilities in any program or activity receiving funding from HHS.

President Biden Has Worked Tirelessly To Address Maternal Health. President Biden has worked to address the maternal mortality crisis and invest in maternal health. In June 2022, the Biden-Harris administration released a whole-of-government blueprint for combating maternal mortality and morbidity. In March, President Biden signed an executive order directing federal agencies to prioritize women’s health research, including studying conditions like menopause, arthritis, and heart disease and in April, the Biden-Harris administration invested $105 million in funding to support more than 100 community-based organizations working to improve maternal and infant health.

President Biden Has Prioritized Reproductive Health Care As MAGA Republicans Rolled Out Abortion Bans and Pushed For Limited Contraception Access. In the wake of the MAGA Supreme Court overturning Roe v. Wade and rolling back nearly 50 years of abortion protections, President Biden has made protecting reproductive health care a top priority. Following the Dobbs v. Jackson decision, President Biden signed an Executive Order seeking to protect access to reproductive health care services and defend women’s fundamental rights. He has issued executive orders strengthening access to affordable contraception and family planning services and rolling back Trump’s gag rule barring family planning providers from mentioning abortion to patients to receive Title X funding. The Biden-Harris administration also recently released new guidance reminding state Medicaid agencies that they must ensure enrollees have access to comprehensive family planning services.

FACT SHEET: Five Things You Should Know About Kamala Harris and Health Care

The Biden-Harris administration has been instrumental in expanding access to quality health care for millions of Americans while also driving down health care costs. Whether it’s lowering the cost of drugs, capping the monthly cost of insulin, or making sure millions of Americans have access to affordable health insurance, this administration has fought for everyday Americans and won. Vice President Harris has battled for better health care her entire time in public office – as California’s Attorney General, as Senator, and as Vice President. At every level of government, Vice President Harris has been a champion for better and more affordable health care for every American.

Here are some of the highlights from her extensive track record on health care:

  1. Vice President Harris cast the tie-breaking vote which allowed the Inflation Reduction Act to pass the Senate and become law. As Vice President, Kamala Harris has cast the most tie-breaking votes in history including for the seminal pieces of legislation of the Biden-Harris administration, the American Rescue Plan and the Inflation Reduction Act. Now two years after the passage of the Inflation Reduction Act, around 19.7 million Americans are saving on average $700 a month on health insurance, nearly 82 million Americans have access to no-cost vaccines and preventive care through Medicaid and CHIP, 10 million seniors received free vaccinations in 2023 alone, and Medicare is currently negotiating the price of 10 drugs taken by over 9 million seniors. On top of this, the Inflation Reduction Act capped monthly insulin costs at $35 for 3.3 million seniors on Medicare Part D. Surveys show around 1.5 million seniors would have seen cumulative savings of about $734 million in Part D and $27 million in Part B if this cap were in effect in 2020. Without her deciding vote, millions of Americans would be paying more for health care, with some not having any access at all. Now Vice President Harris is fighting to expand the savings from provisions like the $35 insulin cap to all Americans, including those with private coverage. 
  2. Kamala Harris filed 10 amicus briefs defending the Affordable Care Act as California Attorney General, and as Senator co-sponsored 14 pieces of legislation protecting and expanding on the ACA, including legislation expanding preventive care requirements for private and public health insurance. Kamala Harris has a long and consistent history of fighting to defend and expand the ACA. Whether she was defending the constitutionality of the ACA in court, to arguing for the protection of contraception mandates, to ensuring that Republican plans to flood the ACA marketplace with junk plans could not come to fruition, at every turn Harris has stood up for the American people against interest groups wanting to increase their health care costs. Her history on health care is clear, Kamala Harris wants Americans to have lower costs and better care. 
  3. Kamala Harris has always fought for reproductive freedom. During her time in the Senate, Kamala Harris co-sponsored 14 pieces of legislation that would expand and protect the reproductive rights of Americans. From supporting the Women’s Health Protection Act to protecting access to birth control to fighting for the expansion and protection of insurance coverage for abortions, Kamala Harris has a remarkably consistent record when it comes to ensuring Americans have access to quality and affordable reproductive health care. She has fought against the GOP war on reproductive rights since she was California’s AG filing amicus briefs arguing against the dystopian restrictions on abortion access in states like Texas and helping the California Congress create legislation ensuring equal access to reproductive health services to all people within the state. As Vice President, Harris has been a leader standing up for reproductive freedom working to protect access to abortion care and affordable high-quality contraception. 
  4. Kamala Harris has prioritized maternal health and increasing health care equity. Maternal mortality in the U.S. is highest in the industrialized world, with around one-third of maternal deaths occurring during the postpartum period. Studies show that at least a factor of the incredibly high rate of perinatal maternal mortality is due to coverage disruptions during the first year after pregnancy, something which disproportionately affects people of color. As Vice President, Harris has challenged states to extend postpartum Medicaid coverage from only two months to a full year. This policy would allow for over 720,000 people annually to see expanded coverage who wouldn’t have been able to access it otherwise. Now, thanks to these efforts, 46 states and Washington DC have adopted full extended postpartum coverage.Black women are three times more likely to die from pregnancy-related complications than white women in the United States and maternal mortality rates — already higher than any other developed country — are still dramatically increasing. Even so, an estimated 80 percent of these deaths are preventable, making the passage of legislation addressing this crisis even more critical. As a Senator, Kamala Harris was involved with creation and proposing of the first Black Maternal Health Momnibus Act to address this crisis in maternal health. The “Momnibus” would direct HHS to establish task forces to address social determinants of health and award grants to innovations in maternity care and maternal mortality tracking. It also would expand federal nutrition programs through increasing the postpartum and breastfeeding periods and reduce specific state funding to jurisdictions which have no laws restricting constraints on incarcerated pregnant people. Every year since 2020, the Momnibus Act has been reintroduced in the Senate. It is perhaps the most essential central piece of legislation existing to address maternal mortality rates and health equity.
  5. As the California Attorney General, Kamala Harris was a part of cases which fined pharmaceutical companies nearly $7.2 billion for deceptive marketing, inflating prices, and harming American consumers. Then-Attorney General Harris broke records throughout her term when it came to settlements holding pharmaceutical companies accountable for deceptive and illegal practices. She was involved in the second largest recovery from a pharmaceutical company and the largest consumer protection settlement reached with a pharmaceutical company. Of the billions she was able to recover due to inflated drug prices and illegal marketing practices, $2.2 billion came from Johnson and Johnson, whose drugs Xarelto, Stelara, Imbruvica are currently up for Medicare price negotiation, $71 million came from Amgen, whose drug Enbrel is currently up for Medicare price negotiation, $68.5 million came from AstraZeneca, whose drug Farxiga is currently up for Medicare price negotiation, and $19.5 million came from Bristol-Myers Squibb, whose drug Eliquis is currently up for Medicare price negotiation.

FACT SHEET: The State of LGBTQI+ Health Care in America

Despite Progress Made By President Biden, the GOP is Putting LBGTQI+ Rights At Risk

Lowering drug costs, expanding affordable health insurance coverage, and banning health care discrimination are critical to improving access to comprehensive, high-quality health care and – together with other actions – advancing health equity for lesbian, gay, bisexual, transgender, queer, and 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 sabotage LGBTQI+ rights in state legislatures by denying transgender youth access to gender-affirming care, and the ability to use chosen 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.

However, 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.

The Biden-Harris Administration Is Helping Millions of 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 heterosexual and cisgender individuals and 9 percent of non-LGBTQI+ individuals overall. 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 21.3 million Americans signed up for health insurance through the ACA, a 17 percent increase from 2022.

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 rule affirms protections against discrimination on the basis of sex, including sexual orientation and gender identity consistent with recent U.S. Supreme Court decisions. In April 2024, this rule became finalized and 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. These new protections are already under attack with the state of Florida suing the administration to overturn the rule.

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. In February 2024, the Biden-Harris Administration dedicated $5.1 million to fund family counseling and support for LGBTQI+ youth and their families. The goal of this grant is to prevent health risks including suicide, depression, homelessness, and drug use, while also promoting wellness.

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.  

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 2023, 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 2023, a Trump-appointed judge decided against the federal government in Braidwood v. Becerra and struck down a major portion of the 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. 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. 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. 

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.

FACT SHEET: Medicaid Is A Lifeline For People With Disabilities

April marks the 7th annual Medicaid Awareness Month. Medicaid is a vital source of care for people with disabilities across the country and helps ensure they can access quality care. Up to 1 in 4 Americans have some type of disability. The program also provides half of all long-term care in the United States, which includes essential home- and community-based services for people with disabilities. Protecting access to Medicaid is essential for ensuring that people with disabilities get the care they need. 

Medicaid is a popular, lifesaving program, but Republicans want to cut it and rip coverage away from millions of hardworking families. Voters agree that it is important to prevent harmful cuts to Medicaid that would reduce health care access. Yet the latest GOP scheme slashes trillions from Medicaid and would throw millions of people off their coverage through block granting and burdensome work reporting requirements. These requirements are especially cruel for Americans with disabilities who may not be able to work long hours or secure a health-related exemption from the requirement. Republicans also won’t quit their mission to repeal the Affordable Care Act (ACA) and Medicaid expansion, putting health care for millions of people in jeopardy.  

By The Numbers 

  • 1 In 3 Medicaid Enrollees Have A Disability. One-third of Medicaid enrollees report having a disability, and 11 percent of enrollees qualified for Medicaid based on a disability determination.
  • Up To 1 In 4 U.S. Adults Have A Disability. Up to 27 percent of American adults have some type of disability. Medicaid covers 43 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illnesses.
  • Over 10 Million Non-Elderly Adults Are Enrolled in Medicaid Due To At Least One Disability. More than 10 million people under age 65 enrolled in Medicaid qualified as a result of a disability determination. Other individuals with disabilities may qualify for Medicaid due to age, pregnancy, or income.
  • Medicaid Covers Half Of All Long-Term Care. The Medicaid program provides half of all long-term care in the United States, which includes essential home- and community-based services for people with disabilities.
  • Millions Lose Medicaid Coverage In Unwinding Post-Pandemic. As Medicaid transitions back to its pre-pandemic eligibility and enrollment rules, too many people are losing coverage because of the carelessness and callousness of certain Republican governors who are terminating coverage for people who may still be eligible. Americans with disabilities are at an increased risk of losing Medicaid coverage due to the renewal process barrier, regardless of whether individuals remain eligible.

Americans with disabilities have faced barriers to achieving and maintaining optimal health. They are 1.4x more likely to have obesity, 2x more likely to smoke, 2x more likely to have diabetes, and 2.8x more likely to have heart disease. Yet 1 in 4 report having an unmet health care need because of cost in the past year and the same proportion report not having a usual health care provider. Medicaid enrollees with disabilities have access to regular preventive care and treatment for chronic illnesses and conditions. States are also required to provide key services for adults, such as hospital stays, physician, lab, and x-ray services, and nursing home care.

In 2010, the ACA opened the door for states to expand Medicaid, and the results are piling in: Medicaid expansion works. In addition to providing coverage for about 24 million people, expansion has resulted in healthier people, communities, and economies. Study after study shows that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes for people with disabilities. 

People With Disabilities Rely On Medicaid Expansion For Coverage. More than six in 10 nonelderly Medicaid adults with disabilities do not receive SSI, meaning that they qualify for Medicaid on another basis (such as income, or as parents in non-expansion states). Medicaid is a significant source of health care coverage for these adults, providing critical access to care for serious health conditions and supporting those in the workforce.

Medicaid Expansion Helps Adults With Disabilities Gain Access To Affordable Care Without Having To Wait. Medicaid expansion helps adults with disabilities gain quicker access to coverage without waiting for a disability determination, which can take years. Thanks to the Affordable Care Act (ACA), Medicaid expansion has allowed people gain coverage who previously were not eligible for coverage and otherwise would have been uninsured. Many uninsured individuals with pre-existing conditions who would not have qualified for Social Security Disability Insurance yet are also eligible for coverage under Medicaid expansion.

Medicaid Expansion Has Improved Health Care Services For People With Disabilities. According to the same 2021 study, Medicaid expansion often improves the services provided to people with disabilities, as states have been able to provide better coverage of critical services including specialized treatments and coverage for behavioral health concerns and other chronic conditions.

Medicaid Expansion Reduces Out-Of-Pocket Health Care Spending, Which Is Especially Important For People With Disabilities Who Often Have Limited Incomes. A majority, or nearly 85 percent, of adults with disabilities who have Medicaid coverage earn annual incomes of less than 200 percent of the FPL, $12,060 for an individual, making access to affordable health care even more essential. In 2022, CMS adopted rules to lower maximum out-of-pocket costs by $400.

Medicaid Is One Of The Most Effective Anti-Poverty Programs, Particularly For People With Disabilities. Medicaid reduces poverty by limiting out-of-pocket spending and expanding state-level Medicaid programs.  The average out-of-pocket spending decreased in states that expanded Medicaid. The poverty-reducing effects were greatest for adults with disabilities, elderly, children, and racial/ethnic minorities.

Medicaid Expansion Has Increased Employment For People With Disabilities. According to a 2021 study, individuals with disabilities living in Medicaid expansion states are more likely to be employed than those living in non-expansion states. In expansion states, people with disabilities have seen increased health coverage and employment rates compared to non-expansion states. On the other hand, Republican-backed work reporting requirements reduce employment and can jeopardize health care for people with disabilities because definitions are outdated and don’t accommodate many types of disabilities that affect peoples’ ability to work. 

Hundreds of Thousands of Americans With Disabilities Are Stuck Without Coverage In States That Have Refused to Expand Medicaid. 10 states have refused to expand Medicaid under the Affordable Care Act (ACA), stranding many adults with low incomes in the Medicaid coverage gap. As a result, over 265,000 Americans with disabilities with incomes below the federal poverty level are ineligible for Medicaid or ACA marketplace assistance in these states. Over half of these individuals reside in Texas or Florida, and adults with disabilities form at least 20 percent of those in the Medicaid coverage gap in Alabama, South Carolina, Kansas, Tennessee, and Wyoming. 

 

Medicaid Helps People With Disabilities Access Comprehensive, Consistent Long-Term Care. Medicaid beneficiaries with disabilities comprised 95 percent of the fees for service of long-term care services while making up less than 25 percent of people who are enrolled in the program. 

  • Medicaid Provides Half Of Long-Term Care In The U.S. Medicaid provides half the nation’s long-term care – a broad category encompassing a critical array of services available for people with prolonged illnesses, disabilities, and other chronic conditions. Medicaid providers and consumers have worked to broaden access to care in at-home and community-based settings, where many seniors and people with disabilities would prefer to live.

Increased Medicaid Funding For Caregivers Benefits People With Disabilities. The Biden-Harris administration recently finalized new rules that require Medicaid to provide increased funding for home care services, a critical component of care for millions of people with disabilities who rely on care workers to meet their basic needs while living in their homes and communities.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

  • Week 1: Republican threats to Medicaid. In the first week of Medicaid Awareness Month, Protect Our Care focused on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
  • Week 2: Medicaid helps people of color and rural Americans. In week two, Protect Our Care highlighted how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
  • Week 3: Medicaid helps women and kids. For week three, Protect Our Care brought attention to the vital role of Medicaid for mothers and children across the country.
  • Week 4: Medicaid helps seniors and people with disabilities. The final week focuses on how Medicaid helps seniors and people with disabilities access lifesaving care. 

FACT SHEET: Medicaid is Essential For Seniors & Older Adults’ Coverage

Medicaid Is the Largest Funder of Long-Term Care For Seniors and Without It, Millions Would Be Without Care

This April marks the 7th annual Medicaid Awareness Month. Medicaid remains a critical source of coverage as Americans age, with Medicaid serving as a primary funder for long-term care and filling many of the gaps in Medicare coverage, such as premium costs, transportation to medical appointments, and medical equipment. 18.2 million Americans aged 50 and up rely on Medicaid coverage. Without Medicaid, millions of seniors would be forced to go without lifesaving care. These benefits often go unnoticed but are essential to the health and well-being of seniors nationwide.  

Medicaid is a popular, lifesaving program, but Republicans want to cut it and rip coverage away from millions of hardworking families. Over 66 percent of Americans, including 55 percent of Republicans, have a favorable opinion of Medicaid. Voters agree that it is important to prevent harmful cuts to Medicaid that would reduce health care access. Yet the latest GOP scheme slashes trillions from Medicaid and would throw millions of people off their coverage through block granting and burdensome work reporting requirements. Republicans also won’t quit their mission to repeal the Affordable Care Act (ACA) and Medicaid expansion, putting health care for millions of women and families in jeopardy. 

By The Numbers

  • Millions of Seniors & Older Americans Rely On Medicaid Coverage. 7.2 million Americans over 65 are enrolled in Medicaid and more than 11 million Americans ages 50 to 64 have health coverage through Medicaid – many thanks to the Affordable Care Act’s Medicaid expansion.
  • Nearly 6 Million Older Adults Live Below The Federal Poverty Level. For millions of seniors and older Americans on fixed incomes, Medicaid is a lifeline.
  • Medicaid Funds Nearly Half Of Long-Term Care Nationwide. As seniors age, long-term care services become more essential, serving about 70 percent of seniors who will need some form of long-term care in their lives.
  • 1.5 Million People Would Gain Coverage If Remaining States Expanded Medicaid. 1.5 million people would gain Medicaid coverage if the remaining states implemented expansion, roughly 270,000 of the uninsured in the coverage gap are aged 55-64.
  • Medicaid Pays For 62 Percent Of Long-Term Care Residents In Nursing Homes. Medicaid covers nursing home bills for over 60 percent of residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room cost over $100,000 yearly in 2024.
  • 12 Million Medicare Beneficiaries Also Have Medicaid Coverage. Nearly 8 million of the dual eligible Medicare-Medicaid beneficiaries are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare.

Seniors And Older Adults Depend On Medicaid For Affordable, Comprehensive Care. As of 2021, 3.6 million older adults are going without coverage. Older Americans often have more complex health issues, requiring additional medical attention that is costly, pushing care out of reach. For seniors on Medicare, Medicaid helps fill many of the gaps in Medicare coverage, such as transportation to medical appointments and medical equipment. 

Medicaid Supplements Medicare Coverage For Millions Of Seniors. 12 million seniors are eligible Medicare-Medicaid dual beneficiaries. Nearly 8 million are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare. Nearly half of dual enrollees are seniors of color and over half of dual enrollees suffer from long-term disabilities. 

Medicaid Helps Seniors And Older Americans Stay Retired And Out Of Poverty. Many seniors and older Americans survive off of low incomes or have chronic health conditions that prohibit them from working. Medicaid allows these individuals living on fixed incomes and often have chronic diseases to continue getting the care they need by filling in the gaps in their Medicare coverage without having to worry about choosing between food and housing or their health. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for seniors and older adults. In a nation where out-of-pocket health care spending forced more than 10 million Americans into poverty in 2016 alone, Medicaid serves as a lifeline not only for health care, but for economic stability as Americans age. A January 2021 study from Health Affairs found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states.

Low-Income Seniors With Medicare Depend On Medicaid For Long-Term Care. It is estimated that 70 percent of seniors will need long-term care at some point and 62 percent of nursing facility residents utilize Medicaid to receive their care. Medicaid is a critical provider of home- and community-based care that are essential to keep loved ones at home with their families and neighbors. Without Medicaid, many seniors would not be able to afford these needed services with Medicare alone. 84 percent of individuals in nursing facilities covered by Medicaid in 2019 were dually eligible, with Medicaid covering costs once Medicare benefits have been depleted. 

Increased Medicaid Funding For Caregivers Benefits People With Disabilities. The Biden-Harris administration recently announced renewed efforts to increase Medicaid funding for caregivers, a critical contingent of care for millions of people with disabilities who rely on these types of providers to meet their basic needs.

Hundreds of Thousands of Seniors Are Stuck In The Medicaid Coverage Gap. 10 states have refused to expand Medicaid under the Affordable Care Act (ACA), stranding many seniors with low incomes in the Medicaid coverage gap. As a result, over 407,000 older Americans with incomes below the federal poverty level are ineligible for Medicaid or ACA marketplace assistance in these states. Over half of these individuals reside in Texas or Florida, and seniors from at least 25 percent of those in the Medicaid coverage gap in Tennessee, Alabama, Georgia, South Carolina, and Florida.

  • Over 10,000 Older Americans Died Prematurely Due To States’ Decisions Not To Expand Medicaid. Due to states’ decisions not to expand Medicaid under the ACA, 10,444 older Americans died prematurely between 2014 and 2017 alone in the 10 states that have refused to expand the program.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

  • Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
  • Week 2: Medicaid helps people of color and rural Americans. Week two will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
  • Week 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care.

FACT SHEET: Medicaid Works For Women & Children

April marks the 7th annual Medicaid Awareness Month. Medicaid is an essential source of coverage for women and children. More than 18 million, or nearly 1 in 5, adult women are enrolled in Medicaid. Approximately 40 million, or half of all children in the U.S., are enrolled in Medicaid or the Children’s Health Insurance Program. Medicaid coverage brings affordable care and financial security to women and families, and it helps narrow racial and rural disparities in health care. As the nation faces an unacceptably high and worsening rate of pregnancy-related death, Medicaid coverage is more important than ever to help pregnant women and new moms access the health care they need. 

Medicaid is a popular, lifesaving program, but Republicans want to cut it and rip coverage away from millions of hardworking families. Over 66 percent of Americans, including 55 percent of Republicans, have a favorable opinion of Medicaid. Voters agree that it is important to prevent harmful cuts to Medicaid that would reduce health care access. Yet the latest GOP scheme slashes trillions from Medicaid and would throw millions of people off their coverage through block granting and burdensome work reporting requirements. And as Medicaid transitions back to its pre-pandemic eligibility and enrollment rules, too many people, especially children are losing coverage because of the carelessness and callousness of certain Republican governors who are terminating coverage for people who may still be eligible. Republicans also won’t quit their mission to repeal the Affordable Care Act (ACA) and Medicaid expansion, putting health care for millions of women and families in jeopardy.  

By The Numbers

  • Medicaid Covers Nearly 18.5 Million Women Nationwide. 18.44 million adult women ages 19-64 rely on Medicaid for coverage.
  • Most Women On Medicaid Are Working Or Have Caregiving Responsibilities. According to the Kaiser Family Foundation, the vast majority of women enrolled in Medicaid work, including mothers on Medicaid. In 2020, 93 percent of women enrolled in Medicaid were either working, going to school, at home caring for young children or relatives, or experiencing an illness or disability that does not permit them to work. 
  • Medicaid Is A Major Source Of Coverage For Women Of Color. Due to systemic inequality that results in fewer women of color having access to employer-provided coverage, women of color are disproportionately likely to enroll in Medicaid. 31 percent of Black women and 27 percent of Hispanic or Latina women rely on Medicaid, compared with just over 16 percent of white individuals. Women of color experience higher rates of poverty than white women and remain less likely to have access to quality care.
  • Medicaid Covers Nearly Half Of Women With Disabilities. Medicaid covers more than 44 percent of nonelderly women with mental and physical disabilities. As of 2019, Medicaid was the source of health coverage for one in four American women with mental illness.
  • Over 50 Percent Of Children Are Enrolled In Medicaid And CHIP. Approximately 40 million children in the United States are enrolled in Medicaid or CHIP. 
  • 1.6 Million People Would Gain Coverage If Remaining States Expanded Medicaid. Estimates from the Center on Budget and Policy Priorities found that roughly 1.6 million people, including children, would enroll in Medicaid and CHIP if the remaining 10 states implemented expansion. These states are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming, and Wisconsin. 
  • The Children’s Uninsured Rate In Medicaid Holdout States Is Double The Rate In Expansion States. In 2021, the child uninsured rate was 7.1 percent in holdout states, compared to 4 percent in states that adopted expansion. If holdout states expanded Medicaid, the number of uninsured children would drop by 7.3 percent
  • Almost Half Of Births Are Covered By Medicaid. Medicaid covers over 40 percent of births in the United States. Thanks to the American Rescue Plan, states were given the option to extend coverage to new mothers for one year postpartum, which improves maternal health outcomes. Congress subsequently made this option permanent as part of end-of-year legislation signed into law at the end of 2022. 45 states, the District of Columbia, and the United States Virgin Islands have extended postpartum Medicaid coverage for a full year, and Nevada and Idaho are planning to do so. Arkansas, Iowa, and Wisconsin have not extended postpartum coverage. 

Medicaid Coverage Benefits Mothers And Women Of All Ages

Medicaid Is The Largest Payer Of Reproductive Health Care Coverage. Medicaid covers nearly 17 million women of reproductive age, giving them access to reproductive health care services such as birth control, cancer screenings, and maternity care without cost-sharing. Medicaid’s reproductive health coverage is especially important in states that have further restricted access to abortion in the wake of the Supreme Court overturning Roe v. Wade.

  • Expanding Access To Care At Every Stage. There is an urgent need for quality, affordable health coverage prior to, during, and after giving birth. The United States continues to experience the highest rates of maternal mortality among wealthy nations, deaths that Centers for Disease Control and Prevention (CDC) data show are largely preventable. While 48 percent of maternal deaths occur during pregnancy and delivery, more than half, 52 percent, occur in the year following the birth of a child. Recent CDC data show that 4 in 5 of maternal deaths are preventable. 12 percent of maternal deaths are deemed “late,” occurring between six weeks and one year following delivery, demonstrating the immense need for continuous health access and coverage for a minimum of one year following the birth of a child. The Biden-Harris Administration has established a pathway to coverage, providing states the opportunity to extend postpartum coverage under Medicaid from 60 days to 12 months following birth. Currently, 47 states have elected to extend Medicaid coverage for a full year postpartum.
  • More Than Four In 10 Births Are Covered By Medicaid. More than 4 in 10 births were financed by Medicaid in 2022. Rates varied across the nation, with 61 percent of births financed by Medicaid in Louisiana, and 22 percent in Utah. Medicaid covers 65 percent of all births to Black mothers and 59 percent of all births to Latina mothers.
  • Expanding Medicaid & Closing The Coverage Gap Is Critical To Improving Maternal Health. Women of color consistently experience higher rates of maternal mortality than white women, largely due to the intersection of health with race, gender, poverty, geography, and other social factors.
  • Medicaid Helps Keep Families Out Of Debt. 41 percent of Americans reported having debt due to medical costs or bills. Since Medicaid was expanded by the ACA, the program has covered the medical expenses of millions more poor and near-poor adults than it did previously, helping prevent households from becoming poor because of medical spending.

Medicaid Improves Access To Care For Women. Women with Medicaid are far more likely to receive care than uninsured women. According to the Kaiser Family Foundation, women with Medicaid coverage are less likely than women with private insurance to report delaying or forgoing care due to cost. Women with Medicaid coverage receive preventive care such as cancer screenings and well-women services at roughly the same rates as women with private coverage and at a higher rate than women without insurance. 

Medicaid Helps Pay For Long-Term Care, Relied On By Elderly Women. Medicaid pays for roughly half of the nation’s long-term services and supports. In 2019, women accounted for 59 percent of the 12.3 million dual-eligibles, or people who rely on both Medicare and Medicaid for coverage. Most dual-eligibles are elderly, and many need Medicaid coverage for their long-term care needs.

Medicaid Creates Jobs In The Health Industry, Which Is Overwhelmingly Female. Kaiser Family Foundation estimates that there are 15.5 million frontline health care workers — 77 percent of which are women — establishing Medicaid as a major job creator for women. 

Medicaid Coverage Has Long-Term Benefits For Children 

Research Shows Medicaid Prevents Child Deaths. A 2020 study found that children who received health insurance through Medicaid were less likely to die young, be employed in their adult life, and less likely to develop a disability as an adult. 

Medicaid Helps Children Stay Healthy, Leads To Long-Term Benefits For Children When They Grow Up. Medicaid eligibility during childhood lowers the high school dropout rate, raises college enrollment, and increases four-year college attainment. Medicaid for children also has a positive impact on employment opportunities later in life. For each additional year of Medicaid eligibility as a child, adults by age 28 had higher earnings and made $533 additional cumulative tax payments due to their higher incomes.

Thanks To Medicaid, Students Have Access To The Resources They Need To Focus In School. Medicaid’s Early Periodic Screening Diagnostic and Treatment benefit gives children under 21 years old access to comprehensive and preventive health services, such as yearly physicals, hearing, vision, and dental screenings, and physical, mental, and developmental disability treatments. The benefit also helps students gain access to medical supplies, such as hearing aids, glasses, and assistive technology, to help them succeed in school. 

The ACA’s Medicaid Expansion Helps Children Gain Access To Care

After the ACA expanded access to Medicaid, the children’s uninsured rate fell to an all-time low. Research confirms expanding access to Medicaid for parents has had ripple effects for their children. At the same time, the 10 states that continue to reject expansion are limiting children’s health care access: 

Medicaid Expansion Led To Gains In Coverage For Children As Well As Parents. Parents enrolled in Medicaid are more likely to access the support they need to be a healthy and effective parent. When parents gain coverage they are more likely to enroll the whole family, so the family will be protected from the economic strains of medical debt and lay the groundwork for optimal child development. Children of parents who are enrolled in Medicaid are more likely themselves to have coverage, due to parents having a more straightforward experience adding their children than if they have never signed up for coverage before. Medicaid for children will save families an estimated $1,222 per year per child when states implement 12-month continuous Medicaid and CHIP eligibility.

The Children’s Uninsured Rate In States That Have Rejected Expansion Is Twice The Rate In States That Expanded The Program — And That Gap Is Growing. The rate of uninsured children in states that have not expanded their Medicaid coverage grew at nearly three times the rate than that of states that have expanded Medicaid coverage. Texas and Florida, two non-expansion states, were responsible for 41 percent of coverage losses for children in a three-year period. 

When Parents Have Health Insurance, Children Are More Likely To Have Coverage. When parents are covered, their children are more likely to have access to health care and have long term benefits from that coverage. Adults who had health insurance as a child were more likely to have better health as adults, including fewer hospitalizations and emergency visits. Medicaid eligibility during childhood is also more linked to a higher likelihood of graduating from high school and college, as well as having higher wages in adulthood.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

  • Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
  • Week 2: Medicaid helps people of color and rural Americans. Week two will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
  • Week 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care. 

FACT SHEET: Medicaid Works For Rural Americans

Republicans in 10 States Are Blocking Medicaid Expansion, Jeopardizing Health Care and Increasing Health Care Costs for Rural Americans

This April marks the 7th annual Medicaid Awareness Month. About one in five – 66 million – Americans reside in rural areas across the United States and nearly 14 million are enrolled in Medicaid. Medicaid is a vital source of coverage for people across rural America, who are more likely to lack insurance, experience negative health outcomes, and have more barriers to accessing care. The Affordable Care Act’s (ACA) Medicaid expansion has been a critical part of working towards the goal of closing gaps in health outcomes for rural Americans. Medicaid expansion saves lives, helps keep rural hospitals open, improves families’ financial security, and boosts local economies. The success of Medicaid expansion across the country demonstrates the need for the 10 holdout states to finally expand their Medicaid programs to the 1.6 million people in the coverage gap who have no option for health coverage. 10 percent of rural Americans are uninsured and would benefit from the long awaited expansion. 

However, Republican elected leaders in 10 states refuse to implement Medicaid expansion, blocking 1.6 million from the access to essential health care and financial security Medicaid provides. These holdout states, located in the southern and midwest regions of the U.S. with significant rural populations, are leaving over $13 billion in federal Medicaid funding on the table. In addition to blocking Medicaid expansion in 10 states, MAGA-Republicans want to cut trillions from Medicaid by introducing onerous work reporting requirements and radically restructuring the program through block grants. Donald Trump has promised to follow through on his plan to repeal the ACA, which would end Medicaid expansion and throw the entire health care system into chaos, risking coverage for at least 45 million Americans and ending protections for Americans with preexisting conditions. On the other hand, President Biden and Democrats in Congress have worked to protect and strengthen Medicaid by creating multi-billion dollar incentives for Medicaid expansion, stopping onerous work requirements, pushing for expanded postpartum coverage, and working to minimize the impacts of Medicaid unwinding. 

By The Numbers

  • Millions Of Rural Americans Depend On Medicaid. Nearly 14 million Medicaid enrollees reside in rural areas.
  • Medicaid Strengthens Health In Rural America. Overall, rural residents have worse health outcomes and tend to be older, poorer, and sicker than those in urban areas.
  • Rural States Need Medicaid. Uninsurance rates in rural America are 2 to 3 percentage points higher than in urban areas. States that expanded Medicaid experienced a 7 point increase in insured rates after the passage of the Affordable Care Act.
  • Medicaid Helps Keep Rural Hospitals Open. Since 2005, more than 150 rural hospitals have closed, including 20 closures in 2020 alone. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2024, over 400 rural hospitals are at risk of closing in the near future. When hospitals face financial hardship, obstetric services are among the first to be cut. Fewer than half of all rural counties in the United States had hospital-based obstetric care
  • Rural Hospitals Strengthen Local Economies. Hospitals employ ten percent of total county employment. Rural areas with hospital closures experience economic downturns with a 14 percent reduction in country employment. 418 rural hospitals are at risk of closing, and estimated that if those hospitals shut down, over 90,000 health care jobs in rural communities would be lost.

How Medicaid Expansion Helps Rural Americans

Medicaid Expansion Saves Lives. Medicaid expansion has been proven to increase access to care, improve financial security, and save lives. A study published in the Lancet found that Medicaid expansion reduced all-cause of mortality. Mortality rates in rural areas are much higher than in urban areas due to a disparity in health care access and increased prevalence of fatal diseases, suicide, and overdoses. 

Medicaid Expansion Reduces Income Inequality And Medical Debt. Medicaid expansion reduces poverty and income inequality across the board by helping low income families access care without jeopardizing income that they may use for other basic living expenses. A 2019 Health Affairs study found that Medicare, Medicaid, and premium subsidies account for one-third of poverty reduction in households without a disability recipient. Medicaid has also been shown to reduce the prevalence of medical debt with nearly 80 percent of the counties with the highest medical debt being from states that haven’t yet expanded Medicaid. 

Medicaid Expansion Plays A Central Role In Fighting The Opioid Crisis. Rural America largely lacks the ability to treat substance use disorders with 65 percent of rural counties lacking the ability to prescribe buprenorphine, an effective drug used to treat opioid dependency. Starting in 2020, Medicaid began covering all medications, therapies, and counseling services that are approved by the Food and Drug Administration to treat opioid use disorders. Medicaid covers an estimated four in ten people with an opioid use disorder. Medicaid expansion in the remaining 10 states is a necessary foundation to help low-income, rural families dealing with higher rates of substance use disorders. 

Medicaid Expansion Is A Lifeline For Rural Hospitals

In states that haven’t expanded Medicaid, rural hospitals are drowning under financial pressure. Low occupancy rates, high levels of uncompensated care, competition with other hospitals, and struggling local economies create a financial burden that rural hospitals face all over the country. Since 2010, 138 rural hospitals have closed, including 20 closures in 2020 and 8 in 2023. In 2024, over 400 hospitals are at risk of closure.

Medicaid Helps Rural Hospitals Stay Open. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. The two most common types of supplemental Medicaid payments are disproportionate share hospital payments, that pay hospitals for uncompensated care for Medicaid and uninsured patients, and upper limit payments, which supplement the gap between fee-for-service Medicaid base payments and the amount that Medicare covers. Some states are also testing the use of global hospital budgets to increase care and improve health outcomes in rural hospitals.

Closure Of Specialized Care And Obstetrical Services. Some hospitals opt to close specific services or facilities that cause patients in rural areas to have to travel further for specialized care. On average, when a rural hospital closes patients have to travel over 20 miles further to access inpatient or emergency care. A 2021 study found that fewer than half of all rural counties in the United States had hospital-based obstetric care. When hospitals face financial hardship, obstetric services are among the first to be cut. Black and Native American women in rural areas are particularly at risk. Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women.

Medicaid Expansion Boosts State Budgets. Medicaid expansion generates enough savings that it is well worth the initial cost, eventually helping boost states budgets. Expansion allows states to access federally matched funds for some people covered by traditional Medicaid. The American Rescue Plan (ARP) provides states with additional funding from the federal government. From 2022 to 2025, the states that haven’t yet expanded Medicaid would gain $90 billion in federal matching funds in addition to $17.6 billion in ARP bonus payments and $6.6 billion from higher state and local tax revenue.

Rural Hospitals Are Large Employers In Their Communities. For rural areas that often have high unemployment rates, hospitals contribute significantly to local economies by employing large numbers of people with relatively high-paying jobs. Rural hospitals typically account for about 5 percent of a rural county’s total employment. Beyond just being a source of jobs, hospitals tend to pay higher wages than other rural industries. Hospital employees with an associate’s degree are paid an average of 21 percent higher than the rest of the population.

Rural Hospitals Boost Local Economies. Besides hospitals providing higher paying jobs in the health care sector, rural hospitals also stimulate the local economies of other industries. Hospitals purchase goods or services from local private businesses which helps stabilize and reinforces the local economy. In turn, strong private sector employment allows for more tax dollars for public goods, such as education and safety services.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

  • Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
  • Week 2: Medicaid helps people of color and rural Americans. Week two will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
  • Week 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care. 

FACT SHEET: Medicaid Is a Vital Source of Coverage for Communities Of Color

While President Biden and Democrats Fight to Protect and Expand Medicaid, Republicans Return to Some of Their Oldest Schemes to Cut the Program 

This April marks the 7th annual Medicaid Awareness Month, an important time to bring attention to the communities who rely on Medicaid to stay healthy. Generations of structural racism have resulted in people of color experiencing lower rates of health coverage, worse health outcomes, and staggering health inequities. As a result, Medicaid coverage remains a critical source of coverage and financial security, especially for Black, Latino, and Indigenous families in America who experience poverty at a higher rate than white Americans and remain less likely to have access to quality care – an important driver of health. These groups also face higher rates of chronic conditions that make access to affordable health coverage even more essential.

This Medicaid Awareness Month, Medicaid is under attack by Republicans. The latest GOP scheme slashes trillions from Medicaid through block granting and work reporting requirements and other paperwork and red tape designed to throw people off their coverage. GOP leaders in 10 states have also failed to expand Medicaid under the Affordable Care Act (ACA), blocking 1.6 million people from affordable coverage. Donald Trump has promised to follow through on his plan to repeal the ACA, which would end Medicaid expansion and throw the entire health care system into chaos. The consequences of the GOP war on Medicaid would be particularly devastating for communities of color. President Biden and Democrats, on the other hand, are continuing to fight to address health disparities, expand access to coverage, lower health care costs, and protect Medicaid for years to come.

By The Numbers

  • 1 In 5 Medicaid Enrollees Are Black. As of 2022, Black Americans make up 13.6 percent of the U.S. population, but about 20 percent of Medicaid enrollees. 
  • 1 in 3 Native American And American Indian People Are Enrolled In Medicaid. According to the 2021 census, 4.3 million people identified as Native American and American Indian. Nearly 27 percent of this group is enrolled in Medicaid. 
  • 30 Percent Of Medicaid Enrollees Are Hispanic/Latino. Hispanic/Latino people make up 18.9 percent of the U.S. population, but nearly 30 percent of Medicaid enrollees. 
  • 15 Percent Of Asian Americans Are Enrolled In Medicaid. Roughly 6 percent of the American population identify as Asian American equating to about 21 million people.
  • More Than 30 Percent Of Native Hawaiian And Other Pacific Islanders (NHOPI) Are Covered By Medicaid. That’s about 207,000 out of 690,000 NHOPI people.
  • More Than 1.6 Million People Could Gain Coverage If Holdout States Accepted Expansion. If Republicans did the right thing and expanded Medicaid in the remaining holdout states, more than 1.6 million uninsured adults could gain coverage; people of color make up 61 percent of this group, or roughly 1.3 million people. 

Research Confirms Medicaid Improves Coverage, Health, And Economic Equity

Reduced Racial/Ethnic Disparities In Coverage. Increasing Medicaid access is the single most important action available to expand coverage and address access to quality care as a driver of health. This together with additional actions to address other social and structural determinants of health can reduce racial/ethnic disparities in the American health care system. The Affordable Care Act (ACA) led to historic reductions in racial/ethnic disparities in access to health care, but gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. 

Closing The Coverage Gap Is Essential For Addressing Health Disparities. Research confirms that Medicaid expansion saves lives and drastically reduces racial/ethnic health coverage disparities. The majority of people in America who would gain coverage if the remaining 10 holdout states expanded Medicaid are people of color. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic/Latino adults. Despite Medicaid expansion’s proven role in reducing racial/ethnic disparities in health care access and improving health outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated 1.5 million uninsured adults are locked out of coverage in the 10 holdout states refusing Medicaid expansion, with people of color comprising 61 percent of those who would gain coverage if these 10 states expanded Medicaid. 

Medicaid Is Essential For Children Now And In The Future. Children of color disproportionately rely on Medicaid coverage, making robust Medicaid access a critical racial/ethnic justice issue for American children. Children of color make up nearly 52 percent of all American children, but nearly 67 percent of the children on Medicaid. This coverage not only provides health coverage in the immediate term, but also provides significant long-term benefits, such as being less likely to be hospitalized and more likely to graduate high school and college.

Medicaid Coverage Is Critical To Improving Maternal Health. The United States is only one of two nations that has reported an increase in maternal mortality since 2000, including increases over the past three years. According to the Centers for Disease Control and Prevention (CDC), more than 80 percent of these deaths are preventable. Women of color consistently experience higher rates of maternal mortality than white women, with the Center on Budget Policy and Priorities finding this to be the result of a combination of factors, including life-long toxic stress resulting from racism and the impacts of structural racism in the health care system. 30 states have expanded postpartum Medicaid coverage to a full year, covering more than 460,000 individuals. In the 10 states that have refused Medicaid expansion, eight had more than 40 percent of births covered by Medicaid. Medicaid covers 65 percent of all births to Black mothers and 65 percent of women of reproductive age living in the coverage gap are women of color. 

Reduced Racial/Ethnic Disparities In Rural Access To Care. 24 percent of rural Americans identify as a person of color. Rural Americans of color face a greater health disparity than their white counterparts due to barriers to health care access, reporting not having primary care providers, forgoing care due to cost, and having fair to poor health status. States that have expanded Medicaid have improved rural hospital financial performance and lower likelihood of hospital closures. When Arkansas and Kentucky accepted Medicaid expansion, adults in those states became more likely to have a personal doctor, obtain care for ongoing conditions, and have a yearly medical check up.

LGBTQI+ People of Color Have Seen Reduced Health Disparities. Due to both systemic factors as well as complex familial dynamics, the LGBTQI+ community is much more at risk of poverty and uninsurance than cisgender heterosexual Americans. Because of this, Medicaid has become a lifeline for the LGBTQI+ community, especially people of color. Around 46 percent of Black LGBTQI+ Americans and 43 percent of Latino LGTBQI+ Americans with incomes below 400 percent of the Federal Poverty Line qualify for Medicaid. As well, Asian American and Pacific Islander (AAPI) LGBTQI+ Americans are over two times as likely to have Medicaid as their primary insurance compared to cisgender heterosexual AAPI individuals.

Medicaid Improves Financial Security For Families. The racial/ethnic wealth gap in America is staggering. According to data from the US Census Bureau, in 2020, the annual median household income for white Americans was nearly $20,000 higher than for Hispanic/Latino households and nearly $30,000 higher compared to Black households. As a result, policies to boost financial well-being undoubtedly help people of color. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. Over the past decade, research has shown the gap in medical debt between Medicaid expansion and holdout states has grown approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states.

Medicaid Reduces Poverty And Inequity. Poverty can produce negative long-term consequences for children and adults alike. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for people of color. In a nation where Americans are one medical bill away from being pushed into poverty, Medicaid serves as a lifeline not only for health care, but for economic stability. A January 2021 study from Health Affairs found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states.

Medicaid Helps Those Dealing With Behavioral Health Conditions. States that have expanded Medicaid have added behavioral health benefits, including mental health and substance use disorder care, that particularly benefit beneficiaries of color who have disproportionately been affected by these conditions. 28 percent of Black people and 27 percent of Latinos suffer from a mental health or substance use disorder. Medicaid is the single-largest payer for mental health services in America. 40 percent of adults on Medicaid are living with a serious mental health or substance use disorder.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

  • Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
  • Week 2: Medicaid helps people of color and rural Americans. Week two will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
  • Week 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care. 

FACT SHEET: Medical Abortion Case Before The Supreme Court Endangers The Health of Millions of Women and Threatens The Entire U.S. Drug Approval Process

SCOTUS Set To Hear Oral Arguments In a Case That Will Decide the Fate of Drugs Relied on by Millions

Tomorrow, extreme anti-abortion activists are scheduled to present arguments before the Supreme Court in FDA v. Alliance for Hippocratic Medicine and Danco v. Alliance for Hippocratic Medicine. This case could dramatically curtail access to mifepristone, a safe and effective medication essential for abortion access that was approved by the FDA 24 years ago. Last year, Republican-appointed judges in Texas and on the Fifth Circuit Court of Appeals ruled in favor of plaintiffs, issuing separate orders severely restricting access to mifepristone, but the Supreme Court stayed this decision. A decision to ban mifepristone would threaten millions of women’s access to safe and legal abortions, but it would also open the door for the politically-motivated removal of other safe and effective drugs from the market — throwing the entire U.S. drug approval process into chaos. 

What Happens Next

  • March 26: The Supreme Court will hear oral arguments on the case.
  • By early July: The Supreme Court will issue a ruling on the case.

Background 

In April 2023, a Trump-appointed federal judge in Texas attempted to revoke authorization for mifepristone, issuing a ban on the medication. His ruling was partially stayed pending appeal, but two MAGA judges on the Fifth Circuit Court of Appeals allowed some restrictions on the drug to remain. The federal government quickly appealed the partial stay to the Supreme Court, which rejected the Fifth Circuit’s restrictions and stayed the ruling in its entirety pending appeal. In August 2023, the Fifth Circuit ruled in favor of anti-abortion advocates, but the ban on mifepristone remains on hold while the Supreme Court weighs an appeal of the ruling.

The anti-abortion advocates, represented by a far-right legal organization, brought this suit with the sweeping aim of achieving a nationwide mifepristone ban. The consequences of this ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care.

What the Experts Are Saying

Carrie Flaxman, Senior Advisor at Democracy Forward: “What the lower courts did was utterly fail to defer to the FDA’s scientific judgment that the changes that it made were appropriate and that the drug is safe and effective. In doing so, it is the first time that courts have second-guessed the safety decisions that the FDA has made in approving the drug so there are much broader consequences for the FDA.” [Protecting Our Care in the Courts, 3/12/24]

  • This Case Could Throw Everything Into Chaos and “Open The Floodgate.” “If the Court allows these plaintiffs to go forward, it really could open the door to a floodgate of potential plaintiffs. Any group could create a nonprofit, perhaps in a favorable District, and file a lawsuit without really showing the kind of injury that courts have required.”
  • “A Huge Threat” to Mifepristone And Drug Approvals. “I want to be clear that even if the court orders those [REMS] restrictions reimposed, that that is a huge threat to access to mifepristone. It is also a threat to drug approvals, not just of [mifepristone], but of really everything on the market.”

Jocelyn Frye, President of the National Partnership for Women & Families: “People do rely on the FDA. They rely on science for a number of decisions. They rely on consistency in the law. What Dobbs did is upend that entirely. Many of the factors in traditional ways you would expect the Supreme Court to look at in that case they threw out the window, and arguably because there’s now a conservative wing on that court that has a different agenda in mind.” [Protecting Our Care in the Courts, 3/12/24]

  • “It Should Be An Easy Decision.” This court is sensitive to the public perception that they are driven by ideology and not by law…[The Supreme Court] should look at precedent, they should look at the law, they should look at the informed judgment of the FDA , and rely on sound science. If they do those things then it should be an easy decision.”
  • Mifepristone Is Widely Used And “Extraordinarily Safe.” The real test is not necessarily the popularity of mifepristone, but mifepristone is widely used. People have used it; it is extraordinarily safe. And people…have come to rely on that [as an available tool]…The other thing is that it is a tool that as part of the evolution of health care practice it is something that can be used in the context of telemedicine. So as we see health care practices become more accessible to more groups of people, it is troubling to see any reversal that is going to make it harder to access care.”

William Schultz, Partner at Zuckerman Spaeder, and former General Counsel for the Department of Health and Human Services: “One of the reasons why Americans across the country should be concerned about the potential outcome of this case is the overturning of an FDA decision and the effects on the approval process. This can really diminish the confidence that patients, doctors, and health professionals have in drugs approved by the FDA. The inevitable result is it’s going to back up the process. They will require more studies. They will hesitate to approve improvements to drug labels. It will be slower in making these decisions, and the consequences of that are going to be patient lives – you’re talking about life-saving drugs.” [Protecting Our Care in the Courts, 3/12/24]

  • “When The FDA Is Undermined, There’ll Be Less Faith In Approved Drugs.” “When the FDA is undermined, there’ll be less faith in approved drugs. People will be more likely to turn to dietary supplements and alternative remedies, which, if you have a serious treatable disease, is a public health disaster.” 
  • “This Will Chill Investment Into Life-Saving Drugs.” “This will chill investment into life-saving drugs. It costs a lot of money to develop some of the most important drugs we have. PhRMA said in its Amicus brief that affirming the 5th Circuit will add uncertainty about its research, whether it can get drugs approved and if it gets approved whether that approval will be sustained so we will do less research which means less approval of lifesaving drugs. The interest in investment in lifesaving drugs will be diminished.”

What’s At Stake

Access To Safe And Effective Reproductive Care For Millions Of Women Nationwide. The combination of mifepristone and misoprostol, an ulcer medicine, has been found to have a 98 percent efficacy rate, and mifepristone is safer than Tylenol and Viagra. The plaintiffs argue that the FDA’s authorization of the drug over two decades ago was flawed and that the drug which has been used by over 2.5 million women is, in fact, dangerous. Twelve of the nation’s leading medical and scientific organizations have filed an amicus brief demonstrating that the drug is safe and studies and meta-analyses involving tens of thousands of women have shown the same thing. 

  • Outsized Impact On Women Of Color, Rural Populations, and Low-Income Women. An analysis by the Guttmacher Institute found that this decision will have an especially severe impact on people living in states where medication abortion plays a particularly critical role in ensuring access to care, including heavily rural states like Montana, Maine, and Iowa. As is true for all abortion restrictions, people of color, low-income individuals, and those without regular access to a nearby health care provider will be disproportionately harmed by restrictions and uncertainty around medication access. 

The Science-Based FDA Drug Approval Process That Has Served America Well Since 1938. The Justice Department warned in an earlier brief that this lawsuit has the potential to undermine the country’s process for regulating pharmaceuticals. If the courts ultimately side with the plaintiffs, it will be an unprecedented situation. Professor Greer Donley of the University of Pittsburgh Law School says, “We’re talking about a judge who is a non-scientist overriding an agency full of experts about the safety and efficacy of a drug. That, to my knowledge, has never happened before.” Lawrence O. Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University called the ruling, “A frontal assault on the legitimacy of the F.D.A. and their discretion to make science-based decisions and gold standard approval processes.” 

Safe And Legal Medications Targeted For Political Purposes. A ruling affirming plaintiffs’ claims would open the door to any third party with a political agenda to challenge a medication that they object to. Ameet Sarpatwari, an expert on pharmaceutical policy and law at Harvard Medical School, said the ruling is likely to encourage a spate of additional challenges. “This opens the door to the courts’ second-guessing any FDA approval — especially for drugs for controversial areas like gender-affirming care, or PrEP for HIV prevention.” He argued it would also instill uncertainty in the pharmaceutical industry. “This should worry every manufacturer out there,” he said. “They are now not assured of a uniform market for their drug based on FDA approval.” Other experts have echoed this fear that a wide range of approved medicines could be targeted including mRNA vaccines, COVID-19 vaccines, HIV medications, hormone therapies, drugs that are derived from stem cells, or any class of medicines that may be politically unpopular. 

Access To Life-Saving Drugs That Patients Count On Every Day. An earlier amicus brief filed by 19 leading scholars of food and drug law states, “We are not aware of any case in which a court has removed a drug from the market over FDA’s objection. The effects could extend far beyond mifepristone. No drug is without risk, and a ruling for Plaintiffs could lead to challenges to the FDA’s benefit-risk determinations for drugs it has approved to treat other diseases and conditions. Patients who rely on life-saving medications could see their drugs removed from the market with little notice.” 

Innovation And Investment In New Drug Development. Pharmaceutical companies must plan years in advance which diseases and therapies to invest in. Injecting a huge dose of political uncertainty into the process could make investors and companies more hesitant to pursue innovative new treatments. Law Professor Rachel Sachs and Professor Donley recently explained that “[o]btaining approval for a new drug is expensive, time-consuming and risky. It typically involves years or decades of research and can cost hundreds of millions, or even billions, of dollars. Most drugs that enter the research and development process fail, never making it to market. The prize at the end of this ordeal is the FDA’s approval to sell the product.” Therefore, “[i]t could chill innovation nationwide if political actors could circumvent the agency’s data-driven process by engaging the courts. Manufacturers might become wary of investing time and money into products for a wide range of conditions which may — decades down the line — be the subject of nuisance litigation.” 

Chaos In The Established Regulatory System. Following the initial ruling, R. Alta Charo, a professor emerita of law and bioethics at the University of Wisconsin said, “The biggest threat that a decision like this brings is the threat of creating chaos.” Charo also told the New York Times that a decision to invalidate an F.D.A. drug approval could have ripple effects for other federal agencies with technical expertise, including those that oversee regulations related to the environment, energy, and digital communications. “Imagine what you could do when you’ve got commercial interests that are upset about a whole slew of” issues, he said, adding, “There’s just no end to this really.”

Who Is Behind It 

An “Alliance” Of Right-Wing Medical Groups Is The Lead Plaintiff In The Case. The plaintiffs in this case are led by the Alliance for Hippocratic Medicine, a group seemingly created for the sole purpose of filing this lawsuit. The Alliance was only incorporated in August of 2022 and the group’s sparse website is even newer than that. 

The Other Plaintiffs Include Peddlers Of Anti-Choice Misinformation And Anti-LGBTQI+ Extremist Groups. The other plaintiffs include the American Association of Pro-Life Obstetricians and Gynecologists, the American College of Pediatricians, and the Christian Medical & Dental Associations. The American College of Pediatricians is a fringe extremist group that trades on its name similar to the premiere U.S. Association of Pediatricians to push anti-LGBTQI+ junk science via the far-right media and filing amicus briefs in cases related to abortion or LGBTQI+ rights. The American Association of Pro-Life Obstetricians and Gynecologists and the Christian Medical and Dental Associations are other far-right groups that use their members’ medical certifications to push false information regarding abortion and birth control. Including the dangerous pseudoscience of “abortion reversal.” 

The Plaintiffs Are Represented By The Alliance Defending Freedom, An SPLC-Designated Hate Group. The legal team for the plaintiffs is the Alliance Defending Freedom (ADF), one of the most prolific extremist advocacy groups in the country. Designated a hate group by the Southern Poverty Law Center, the ADF has advocated both in the U.S. and abroad for forced sterilization of trans people, criminalization of same-sex relationships, and strict restrictions on abortions. ADF receives tens of millions of dollars in dark money annually, coming often from the same sources that led the right-wing attacks on the Affordable Care Act, Social Security, and Medicare. 

Nearly 150 Congressional Republicans Have Filed An Amicus Brief Supporting The Extreme Case. 145 Republican Members of Congress, including 26 Senators and 119 Representatives, have filed an amicus brief in support of the plaintiffs. In the brief, they argue that the 23-year-old FDA approval of mifepristone was an “unlawful deregulation of chemical abortion drugs” that “has endangered patient health and safety,” despite presenting no evidence that the drug is anything but safe and effective.

More Than 20 Republican Attorneys General Have Filed An Amicus Brief Supporting The Suit. Twenty-two GOP attorneys general led by Mississippi have filed an amicus brief in support of the plaintiffs. In the brief, they argue that the 24-year-old FDA approval of mifepristone represents an “elective-abortion policy that Congress could never pass.” This brief argues that federal agencies themselves “erode the separation of powers,” “imperil federalism,” and “seize power,” and pushes the Supreme Court to subject the FDA’s actions to “searching review.” 

Three Republican Attorneys General For Missouri, Idaho, and Kansas Filed A Separate Amicus Brief Supporting The Suit. Three Republican Attorneys General representing Missouri, Idaho, and Kansas – who all signed onto the 22-state amicus brief led by Mississippi – have filed a separate amicus brief in support of the plaintiffs, arguing that the FDA’s 24-year-old approval of mifepristone “has imposed increased costs to state-funded medical insurance and public hospitals.” If accepted, this dangerous legal argument, which claims that the drug’s approval created “sovereign harms that radically interfere with the ability of the States to set policy,” opens the door for challenges to any drug that increases costs to state-funded public health programs.

Why The Plaintiffs’ Legal Arguments Are Wrong

The plaintiffs assert several different claims:

  • They contend that the FDA’s approval of mifepristone in 2000 should be invalidated because (a) the agency cited regulations governing drugs that “treat serious or life-threatening illnesses” and, plaintiffs contend, mifepristone does not fall within that category, and (b) the conditions for use specified by the agency were inadequate.
  • When the agency approved the drug in 2000, it used its “risk evaluation and mitigation strategy” (REMS) authority to impose restrictions designed to ensure the drug is distributed and prescribed safely. In 2016, the FDA loosened those restrictions, allowing the drug to be used later in a woman’s pregnancy (up to 70 gestational days), prescribed after only one in-person clinic visit and by a broader set of healthcare providers, and taken by the woman at home rather than in a doctor’s office. The plaintiffs assert that these changes were not supported by the data relied upon by the FDA and ask the court to restore the original, more stringent restrictions.
  • The plaintiffs also invoke the Comstock Act, a criminal law prohibiting the “knowing[]” mailing of “obscene or crime-inciting matter” that includes in its long list of items “article[s] or thing[s] designed, adapted, or intended for producing abortion.” They claim that this law required the FDA to prohibit the distribution of mifepristone by mail or common carrier.

This is a meritless lawsuit that should have been thrown out of court – for multiple reasons.

  • The plaintiffs lack “standing” to sue. To file a lawsuit in federal court, a plaintiff must assert an “actual” or “certainly impending” real-world injury. These plaintiffs are not regulated by the FDA and do not prescribe mifepristone. Their claim – that patients will come to them for help after taking the drug, which will require them to divert attention from other patients, inflicting costs and risking potential liability and emotional distress – is indistinguishable from standing arguments that have been repeatedly rejected by the Supreme Court because they “depend[] on the unfettered choices made by independent actors not before the courts and whose exercise of broad and legitimate discretion the courts cannot presume either to control or to predict.”
  • Most of the claims are, in addition, barred by the statute of limitations and/or failure to raise the arguments before the FDA. Federal law provides that a party seeking to challenge a decision by an administrative agency must file suit no later than six years after the decision. The challenge to the FDA’s approval of the drug in 2000 is therefore untimely. (The plaintiffs try to rely on their 2002 petition to the FDA challenging that approval, but that petition was denied in 2016, more than six years before the filing of this lawsuit.) The plaintiffs filed a separate petition urging the FDA to withdraw its 2016 decision loosening the REMS standards applying to mifepristone, which the agency denied in 2021 – making the challenge to the REMS standards timely; but the plaintiffs did not challenge the 2000 approval in that petition and their claim that the petition implicitly “reopened” the approval decision is contrary to basic principles of administrative law. Also, the plaintiffs have never raised their Comstock Act argument before the FDA. Finally, even the challenge to the 2016 REMS standards is not properly before the court because it has been superseded by the FDA’s 2023 action further revising those standards: the 2016 decision, therefore, is no longer operative.
  • The plaintiffs are wrong on the merits. As the Justice Department and a company that manufactures the drug explain in detail: there is no basis for overturning the FDA’s expert determination in 2016 regarding the proper REMS standard for this drug, which was fully supported by the data cited by the agency; FDA properly rested its approval of mifepristone on its authority over drugs treating serious illnesses, because pregnancy can be, many times is, accompanied by complications posing serious risks to a woman’s health; and FDA’s 2000 approval and accompanying standards were a proper exercise of the agency’s expertise. The REMS and approval decisions are subject to deferential review and may be set aside only if found to be “arbitrary and capricious” – a high standard that the plaintiffs do not come close to satisfying. Concerning the Comstock Act, the government explained that, by 1960, “federal courts of appeals settled upon a consensus view that the Comstock Act did not prohibit the mailing or other conveyance of contraceptives or items designed to produce abortions where the sender does not intend them to be used unlawfully.” (A Justice Department opinion explains in detail the basis for this conclusion.) Therefore, “even if FDA were required to consider the Comstock Act, because the Comstock Act does not prohibit the mailing or other conveyance of abortion-inducing drugs where the sender does not intend them to be used unlawfully, and given that these drugs may be used lawfully, neither FDA’s decisions related to in-person dispensing nor the absence of a prior FDA affirmative prohibition on distribution by mail was inconsistent with the Comstock Act.”
  • The plaintiffs are not suffering, or threatened with, irreparable injury. A party is entitled to an injunction only if it can show that, without the injunction, it will suffer irreparable injury. Here, for the same reasons they lack standing, their speculative arguments about harm cannot satisfy the irreparable injury requirement. And plaintiffs’ delay in filing suit – more than two decades after the drug was first approved and nearly a year after the FDA denied their petition regarding the REMS standards – further supports that conclusion.
  • The balance of harms weighs sharply against the plaintiffs. Even when a plaintiff can demonstrate irreparable injury, a court may not grant injunctive relief if the harm to the plaintiff is outweighed by the harm that would be suffered by other parties and the harm to the public interest. Eliminating the availability of a drug that millions of women have used over two decades will inflict serious harm on Americans across the country who rely on the drug for safe and effective reproductive care. (Plaintiffs’ claims that mifepristone is unsafe are wrong: a mountain of evidence demonstrates the drug’s safety.) As the government explains, “[r]emoving access to mifepristone would cause worse health outcomes for patients who rely on the availability of mifepristone to safely and effectively terminate their pregnancies.” It would interfere with Congress’s decision to entrust the FDA with technical decisions regarding the safety and efficacy of drugs. It would also create a legal precedent that could disrupt the new drug approval system that has produced myriad life-saving treatments that benefit tens of millions of Americans.