March 2023

***MEDIA ADVISORY FOR WEDNESDAY, MARCH 22 AT 11 AM ET***

Over 13 Years, Nancy Pelosi Has Championed the Passage, Protection, and Expansion of the ACA, Ensuring Affordable Health Care for Millions of Families Nationwide

Washington, DC – On Wednesday, March 22, 2023, at 11 AM ET, Speaker Emerita Nancy Pelosi will join Protect Our Care and storytellers in an intimate round table discussion to celebrate the 13th anniversary of the Affordable Care Act (ACA). Speakers will reflect on the achievements of the ACA and how they have been personally affected by its passage. 

Speaker Pelosi was instrumental in getting the ACA over the finish line and giving millions peace of mind knowing they can afford the care they need. Not only was Nancy Pelosi central to its passage, but she thwarted Republican efforts to repeal the ACA and its protections for millions of Americans with pre-existing conditions. In the last year alone, she built on the ACA by passing the Inflation Reduction Act to deliver lower health care and prescription drug costs for millions of seniors and families across the nation. This past open enrollment period was the most successful in the history of the ACA with almost 16 million signing up for coverage, proving these policies have touched the lives of nearly every person in the nation, providing patients with lifesaving care.

ROUND TABLE:

WHO:
U.S. Representative Nancy Pelosi (D-CA-12), Speaker Emerita of the House
Leslie Dach, Founder and Chair, Protect Our Care
Adam Hoyer, National Organizing Director, Protect Our Care
Steve Gomez from Phoenix, AZ, Storyteller
Rhena Hicks from Norfolk, VA, Storyteller
Elena Hung, Co-Founder and Executive Director, Little Lobbyists
Amy Raslevich from Pittsburgh, PA, Storyteller

WHAT: ACA Anniversary Round Table Discussion with Speaker Emerita Nancy Pelosi

WHERE: Watch the live stream here 

WHEN:  Wednesday, March 22, 2023, at 11 AM ET

Call Comes as Tri-Caucus Leaders and Civil Rights Organizations Release a Letter Urging for Preservation of Medicaid Coverage as Public Health Emergency Ends

Watch the Full Event Here.

Washington, DC – Today, U.S. Representatives and Tri-Caucus Chairs Nanette Barragán, Judy Chu, and Steven Horsford, joined civil rights leaders and Protect Our Care for a press conference releasing a letter to the Department of Health and Human Services (HHS) calling for state and federal action to keep families in America covered as Medicaid’s continuous coverage requirement ends. The letter stresses the importance of states meeting their obligations to ensure that millions of people in America do not lose critical health care coverage, and calls on HHS to clearly define and enforce states’ legal obligations. The Tri-Caucus letter is supported by Protect Our Care, Asian & Pacific Islander American Health Forum, Coalition on Human Needs, Families USA, Leadership Conference on Civil and Human Rights, NAACP, National Urban League, and UnidosUS.

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision, which has helped secure the lowest level of uninsured Americans ever, is set to expire on April 1. This would potentially result in an estimated 15 million people potentially losing coverage, disproportionately affecting people of color and children. The Biden-Harris administration has committed to expanding access to care and providing guidance to states to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, people with disabilities, and others who rely on the Medicaid program for their health care.

“Millions of Latinos were able to access life-saving health insurance coverage as a result of the Medicaid continuous coverage requirement and these historic gains must not be erased when states resume Medicaid unwinding,” said U.S. Representative and CHC Chair Nanette Barragán (D-CA-44). “As states begin to review Medicaid eligibility, millions of low-income beneficiaries are at risk of becoming uninsured if the program operates as it did in the past. Sixty-four percent of Latinos covered by Medicaid are poised to lose coverage, despite remaining eligible. Secretary Becerra must act boldly and use his new enforcement authority to minimize disparities in coverage rates and affordability of care. I thank my Tri-Caucus colleagues for highlighting the dire need to keep Americans covered as Medicaid’s continuous coverage requirement ends.”

“I am gravely concerned that when states resume the ‘unwinding’ of the Medicaid continuous coverage requirement in April, millions of low-income beneficiaries, including Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and other communities of color, will unnecessarily lose essential health insurance,” said U.S. Representative and CAPAC Chair Judy Chu (D-CA-28). “Once Medicaid terminations resume, nearly one million Asian Americans and Pacific Islanders stand to lose coverage, and one-tenth of all Native Hawaiian and Pacific Islander children will be dropped from the program. Secretary Becerra must use his new enforcement authority to protect health care access for all struggling families and enrolled children, including those belonging to AANHPI communities.”

“We cannot afford to roll back the hard-fought progress we have made on Medicaid, which has helped to narrow racial disparities in health coverage and provide much needed access to life-saving care in communities of color. If Medicaid terminations resume, more than 2 million Black Americans nationwide will lose access to life-saving health care despite their eligibility,” said U.S. Representative and CBC Chair Steven Horsford (D-NV-04). “The Congressional Black Caucus has long prioritized advancing equity in health care in our communities and we join our Tri-Caucus colleagues in calling on HHS Secretary Becerra to take action to preserve beneficiary access to Medicaid coverage and stop eligible Medicaid families from improperly losing health care coverage.”

“Medicaid Unwinding puts millions of families, including one million Asian American, Native Hawaiian, and Pacific Islander individuals, at risk of being uninsured. We know that so many people across federal and state administrations are working hard to preserve and assist these vulnerable individuals, but more needs to be done. Our Asian American, Native Hawaiian, and Pacific Islander communities require support, including more in-language materials, Navigators, and outreach from trusted messengers to ensure no one is left behind,” said Juliet K. Choi, President and CEO, Asian & Pacific Islander American Health Forum.

“The Medicaid redetermination period will be perilous for communities of color without meaningful state efforts and federal oversight,” said Marc Morial, President and CEO, National Urban League. “Forty-seven percent of Black people covered by Medicaid are poised to lose coverage – despite remaining eligible – simply because of red tape. We thank the leadership and members of the Tri Caucus for engaging on this vital civil rights issue.”

“An historic number of Americans, including five million Latinos, are likely to lose their health coverage unless the Biden-Harris Administration acts quickly and boldly to protect Medicaid. Absent immediate intervention, when the continuous coverage requirements expire on April 1, our country faces the loss of health care for millions of families and children and the exacerbation of the health inequities that made the pandemic so deadly for so many communities. For the benefit of all Americans, we must not let this happen. UnidosUS joins with the Congressional Tri-Caucus in urging the Administration to use every tool at its disposal to prevent this potential public health catastrophe,” said Janet Murguía, President and CEO, UnidosUS.

“It’s imperative that states take the necessary steps to ensure that millions of Americans don’t lose their critical health care coverage. Failing to take appropriate action will have devastating impacts on the people who rely on Medicaid for their health care, particularly moms and kids, people of color, rural Americans, and people with disabilities. These risks are particularly acute in states with Republican governors or state legislatures that have refused to expand Medicaid. We support the Tri-Caucus effort and the commitment of the Biden administration to ensure that everyone who is eligible for coverage stays covered,” said Leslie Dach, Founder and Chair, Protect Our Care.

***MEDIA ADVISORY FOR MONDAY, MARCH 20 AT 10:00 AM PT // 1:00 PM EST***

 LAS VEGAS, NV — On Monday, March 20 at 10:00 am, Congresswoman Dina Titus, Congresswoman Susie Lee, Nevada Health Link Chief Operations Officer Janel Davis, and health care advocates will join Protect Our Care Nevada to highlight the 13th anniversary of the Affordable Care Act and discuss how Nevadans have benefitted from the law, which expanded access to quality, affordable health care. The historic legislation eliminated lifetime caps, expanded Medicaid, and secured protections for millions of people living with pre-existing conditions. The Inflation Reduction Act (IRA) built on the strong foundation of the ACA by lowering premiums for middle and working-class families by an average of $2,400 a year. Thanks to the ACA, more than 21 million Americans have gained coverage through Medicaid expansion, and Medicaid has become a pillar of the American health care system, demonstrating the overwhelming need and desire for affordable health coverage. 

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

Speakers will also highlight ongoing attacks on health care, and celebrate the historic investments to secure the future of Nevadans and American health care. Thanks to their vision and determination, Nevadans can now sleep easier at night knowing Congresswoman Titus, Congresswoman Lee, and Nevada’s Democrats in Congress are hard at work to expand health coverage and lower health care and prescription drug costs. 

WHO: Congresswoman Dina Titus, Congresswoman Susie Lee, Nevada Health Link Chief Operations Officer Janel Davis, and health care advocates

WHAT: Virtual Press Conference

WHEN: Monday, March 20 at 10:00 AM PT // 1:00 PM EST

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

***MEDIA ADVISORY FOR MONDAY, MARCH 20 AT 2:00 PM EST // 11 AM PST***

Washington, DC – On Monday, March 20, 2023 at 2 PM EST/11 AM PST, U.S. Representatives and Tri-Caucus Chairs Nanette Barragán, Judy Chu, and Steven Horsford, will join civil rights leaders and Protect Our Care for a press conference to release a letter by the Congressional Tri-Caucus to the Department of Health and Human Services (HHS) calling for state and federal action to keep families in America covered as Medicaid’s continuous coverage requirement ends. The Tri-Caucus letter is supported by Protect Our Care, Asian & Pacific Islander American Health Forum, Coalition on Human Needs, Families USA, Leadership Conference on Civil and Human Rights, NAACP, National Urban League, and UnidosUS.

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision, which has helped secure the lowest level of uninsured Americans ever, is set to expire on April 1. This would potentially result in an estimated 15 million people potentially losing coverage, disproportionately affecting people of color and children. The Biden-Harris administration has committed to expanding access to care and providing guidance to states to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, people with disabilities, and others who rely on the Medicaid program for their health care.

PRESS CALL:

WHO:
U.S. Representative Nanette Barragán (D-CA-44), Chair, Congressional Hispanic Caucus
U.S. Representative Judy Chu (D-CA-28), Chair, Congressional Asian Pacific American Caucus
U.S. Representative Steven Horsford (D-NV-04), Chair, Congressional Black Caucus
Juliet K. Choi, President and CEO, Asian & Pacific Islander American Health Forum
Marc Morial, President and CEO, National Urban League
Janet Murguía, President and CEO, UnidosUS
Leslie Dach, Founder and Chair, Protect Our Care

WHAT: Virtual Press Conference 

WHERE: Register for the Event Here

WHEN: Monday, March 20 at 2 PM EST/11 AM PST

Washington, DC – Today, the Centers for Medicare & Medicaid Services (CMS) released a proposed framework to guide the negotiation of drug prices under Medicare – a key part of the Inflation Reduction Act. CMS announced it will consider the drug’s clinical benefits to patients including whether the drug meets an unmet need and the selected drug’s impact on specific populations, recognize and encourage innovation, look at drugs with common active ingredients, and develop a process for engaging drug manufacturers in a multi-step price negotiation.

Protect Our Care Chair Leslie Dach issued the following statement: 

“The administration has created a thoughtful and comprehensive approach to the Medicare drug negotiation process that will reduce costs for America’s seniors, encourage innovation, and treat drug companies fairly. The Biden administration’s approach to Medicare negotiations will give seniors much-needed breathing room to afford their medicines and other essentials like rent, groceries, and gas, and continue to encourage the development of innovative medications that save lives and keep Americans healthy.”

Washington, DC – Today, President Biden is set to deliver a speech in Las Vegas highlighting new data which shows the current and future savings for people on Medicare. Millions of seniors and people with disabilities will continue to get more breathing room with their monthly health care costs thanks to the Inflation Reduction Act passed by President Biden and Democrats in Congress.

HHS has released new data that shows over 3.4 million seniors and people with disabilities will save an average of $70 per year due to an Inflation Reduction Act provision that allows Medicare beneficiaries to get recommended vaccines for free as of this past January. Previously, Medicare-enrolled recipients may have to pay up to $424 for the shingles vaccine alone.

Additionally, HHS announced the producers of 27 drugs will need to pay rebates to Medicare because the prices of the drugs were raised faster than the rate of inflation because of a provision of the Inflation Reduction Act which creates a critical check on drug companies that try to excessively raise their prices. Some Medicare beneficiaries that take these drugs will save between $2 to $390 per dose of medication starting in April.

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

“Big Pharma has been able to pull the strings and hose the American people for far too long while those on a fixed income have struggled to afford the preventative and life-saving care they need. The Inflation Reduction Act has been a monumental step forward to reining in drug company greed. President Biden and Democrats in Congress have delivered on their promise to lower costs for American families, and because of them, millions of Americans will no longer have to choose between their health care and paying for food or rent. Working people and seniors will pay less for their prescription drugs and vaccinations, so families have a little more breathing room. Now, we must build on this progress and we will not quit until everyone can afford the care they need.” 

HEADLINES:

USA Today: President Biden Touts Drug Savings For Medicare Beneficiaries As Changes Roll Out. “Seniors could save an average of $70 a year on vaccines under Medicare changes President Joe Biden is touting Wednesday to argue his efforts to reduce health care costs are working. Medicare recipients may also pay less for medicines administered at the doctor’s office if receiving one of 27 drugs whose prices have risen faster than inflation. The administration also announced Wednesday how it will select ten drugs for price negotiations with manufacturers, and how those negotiations will happen. The chosen drugs will be announced in September. ‘We’re going to now be able to begin the historic process of negotiating to get lower competitive prescription drug prices,’ said HHS Secretary Xavier Becerra. ‘We’re taking on powerful interest to bring down health care costs so Americans can sleep better at night.’ The Medicare changes are part of a massive bill passed last year to address health costs, make historic investments in clean energy and raise taxes on corporations. Biden, who is expected to travel the country this year to promote his legislative accomplishments, will speak about the Medicare prescription drug savings at the University of Nevada in Las Vegas.” [USA Today, 3/15/23]

Washington Times: White House Outlines Steps To Slash Drug Costs Under Signature Biden Law. “The Biden administration on Wednesday outlined its effort to implement signature legislation that allows Medicare to negotiate the price of drugs for the first time and slashes costs of other drugs that seniors rely on. White House officials said the Inflation Reduction Act that President Biden and Democrats muscled to passage last year will reduce out-of-pocket costs for more than two dozen drugs under Medicare and make certain vaccines free for 3.4 million Americans. ‘Those folks, they paid about $234 million in out-of-pocket costs for those vaccines back in 2021,’ Health and Human Services Secretary Xavier Becerra said. ‘Today, they would pay zero dollars as a result of the president’s new lower prescription drug law.’ Mr. Becerra’s agency also will release guidance on how it plans to implement a marquee part of the law that allows Medicare to negotiate down the cost of certain medicines in Part D, the prescription-drug benefit. Medicare will announce the first 10 drugs selected for negotiation in September. The administration outlined new and pending benefits for seniors as Mr. Biden leans into the health care debate ahead of the 2024 election cycle.” [Washington Times, 3/15/23]

AP News: Biden Drawing Contrast To Republicans On Lower Drug Costs. “President Joe Biden will highlight the stark differences in how Democrats are tackling skyrocketing drug prices compared to their Republican counterparts as he gears up for an expected reelection announcement. In a speech on Wednesday in Las Vegas that could serve as a preview of the campaign ahead, Biden planned to put the issue of lowering drug costs at the center of his policy and political agenda. The White House thinks it has a winning message in showcasing legislation passed last year that is expected to save taxpayers billions of dollars and lower the cost of drugs for the roughly 84 million Americans who rely on Medicare. […] The federal government expects to see significant savings from those negotiations and to make money from a rule that requires drugmakers to send Medicare a check when they raise drug prices higher than inflation. That’ll help shore up the social safety net for older Americans, Biden told Democratic donors on Monday in Rancho Santa Fe, California. ‘Not only is it the right thing to do for people, it cuts the deficit by $160 billion,’ he said. Already, the legislation caps the price of insulin at $35 for disabled and older Americans who rely on Medicare.” [AP News, 3/15/23]

NBC News: Biden To Highlight Lower Prescription Drug Costs. “President Joe Biden on Wednesday is set to announce fines on drugmakers for raising prices on some drugs faster than inflation for people on Medicare, a move that will lower people’s coinsurance payments. Ahead of Biden’s remarks, in Las Vegas, administration officials previewed the actions that the president and his health care team have taken to lower drug costs in a call with reporters Tuesday night. The Inflation Reduction Act, which the president signed into law last year, includes prescription drug provisions that penalize pharmaceutical companies for raising prices for certain drugs faster than the rate of inflation for Medicare beneficiaries, the officials noted. Starting next month, some Medicare beneficiaries will see lower out-of-pocket prices for 27 prescription drugs whose prices rose faster than inflation in the last quarter of 2022, the Department of Health and Human Services announced. Companies that violated the provision of the law will be required to pay Medicare a rebate to cover the difference in pricing.” [NBC News, 3/15/23]

The Hill: Biden Administration Names First Round Of Drugs To Face Medicare Rebate Penalties. “The Biden administration has released its first list of nearly 30 drugs covered by Medicare that will be subject to the penalties included in the Inflation Reduction Act, because their prices increased faster than the rate of inflation. Under the act, drug manufacturers are required to pay rebates to the federal government if the price of medications covered by Medicare Part B and Part D increase at a rate that exceeds inflation. This measure was included as a way of limiting drug costs, along with price caps that were included in the legislation for seniors. The Department of Health Human Services released a list of 27 drugs on Wednesday that will be subject to the rebate penalty. Medications on the list included the arthritis treatment Humira as well as cancer treatments like Rybrevant, which is indicated for certain cases of non-small cell lung cancer and was first approved in 2021. ‘Seniors may see their out-of-pocket costs for these drugs decrease by $2 to as high as $390 per average dose starting April 1st,’ the White House said in a statement.” [The Hill, 3/15/23]

Wall Street Journal: First Drugs Facing Medicare Price Penalty Are Named. “U.S. health officials released the first list of drugs paid for by the government’s Medicare insurance program whose prices went up more than the rate of inflation and will face a penalty under a new federal law. The Centers for Medicare and Medicaid Services on Wednesday named 27 drugs that had the large price increases, including  rheumatoid-arthritis treatment Humira from AbbVie Inc. and Yescarta lymphoma therapy from Gilead Sciences Inc., and will face the price-increase penalty in the form of a rebate. The federal government will start billing the pharmaceutical companies that sell the medicines for the rebates in 2025, according to the health officials. Companies that don’t pay could face a penalty that is 125% of the rebate amount. Starting in April, some Medicare beneficiaries will also pay less out of pocket for any of the 27 prescription drugs they take. The beneficiaries could save $2 to $390 per average dose on their out-of-pocket cost, health officials said. The rebate program ‘is a critical way to address long-term price increases by drug companies while improving access and affordability for the millions of people with Medicare coverage,’ said CMS Administrator Chiquita Brooks-LaSure.” [Wall Street Journal, 3/15/23]

Bloomberg Law: Drug Price Law to Launch New Era in Medicare, Top Official Says. “Jonathan Blum was a Senate staffer early in his career when Congress developed the original Medicare Part D prescription drug program. More than 20 years later, he holds a position at the Centers for Medicare & Medicaid Services that gives him huge influence over the next major iteration of drug pricing policy. Blum returned to the federal government in 2021 in the middle of the Covid-19 pandemic with a goal of expanding the reach of CMS programs after working in the commercial insurance world. ‘What I saw during the last three years with the Covid pandemic’ was ‘a health-care system that largely failed many people,’ Blum, 53, said in an interview. ‘To come back and really take the lessons from the past three years or so, and have CMS better positioned going forward to build more resilient health-care systems, more resilient health-care communities, really focusing on programs for how we help people going forward, that to me is a huge opportunity for us.’ He’ll consider the agency’s work a success if it results in ‘lower costs to beneficiaries and better clinical measures’ as a result of more patients better able to afford needed therapies, he said.” [Bloomberg Law, 3/15/23]

Read the Report Here.

Washington, DC — Today, Protect Our Care is releasing a report detailing the disastrous implications of the medical abortion lawsuit in Texas aiming to ban the abortion medication mifepristone. A decision to ban mifepristone would threaten millions of women’s access to safe and legal abortions and open the door for the politically-motivated destruction of the entire drug approval process.

Since the Supreme Court’s elimination of the constitutional right to an abortion, anti-abortion activists have ramped up their attacks on remaining protections. This attack in Texas comes at a huge cost, not only to the access to safe abortion care but to the entire U.S. drug approval process. Protect Our Care’s new report outlines the dire consequences of Judge Matthew Kacsmaryk’s potential ruling.  

Protect Our Care Founder Leslie Dach issued the following statement: 

“The medical abortion case being argued today in Texas endangers the health of millions of women and also threatens the entire drug approval process in the United States. If the judge decides to overturn the FDA approval of mifepristone, it would open the door to other politically motivated lawsuits that could result in the banning of critical life-saving drugs relied on by millions. The result would be chaos in our drug approval system and the arbitrary banning of drugs that keep so many of us alive and healthy.”

This week we highlight President Biden’s budget, two new steps taken in health equity, and new research on health crises and the acute impact of these challenges on marginalized groups. Leading the charge in the battle to combat rural inequities, a new federal initiative will act as a lifeline to rural communities that are often left without adequate access to quality health care. A new bill in Minnesota seeks to expand access to testing methods that will likely lead to drastically reduced inequities in medical care to systematically marginalized communities throughout the state. New research reports show that health crises across the board, from infant mortality to obesity rates, are on the rise after the COVID-19 pandemic and disproportionately affecting already overlooked marginalized groups.

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

INITIATIVES

The San Diego Voice and Viewpoint: President Biden’s Proposed Budget Will Advance Health Equity. “President Joe Biden unveiled a $6.8 trillion budget plan that includes aiding several social programs, raising taxes on the wealthy, and decreasing the country’s debt by $3 trillion over the next decade. The Budget includes $471 million to support implementation of the White House Blueprint for Addressing the Maternal Health Crisis to reduce maternal mortality and morbidity rates and address persistent disparities; expand maternal health initiatives in rural communities; implement implicit bias training for healthcare providers; create pregnancy medical home demonstration projects; and address the highest rates of perinatal health disparities, including by supporting the perinatal health workforce. In addition, the Budget requires all States to provide continuous Medicaid coverage for 12 months postpartum, eliminating gaps in health insurance at a critical time. The budget expands access to quality, affordable health care by investing $150 billion over 10 years to improve and expand Medicaid home and community-based services, such as personal care services. To bolster the health care workforce, the budget provides a total of $966 million in 2024 to expand the National Health Service Corps, which provides loan repayment and scholarships to healthcare professionals in exchange for practicing in underserved areas, and a total of $350 million to expand programs that train and support the nursing workforce. The administration said every child with a disability should have access to the high-quality early intervention, special education services, and personnel needed to thrive in school and graduate ready for college or a career. The budget invests $16.8 billion in Individuals with Disabilities Education Act (IDEA) grants to support special education and related services for more than seven million students with disabilities in grades Pre-K through 12, an increase of $2.1 billion above the 2023 enacted level.” [The San Diego Voice and Viewpoint, 3/13/23]

Kaiser Health News: Rural Hospitals Begin Signing Up for New Federal Lifeline. “Just off the historic U.S. Route 66 in eastern New Mexico, a 10-bed hospital has for decades provided emergency care for a steady flow of people injured in car crashes and ranching accidents. It’s the only hospital for the more than 4,500 people living on a swath of 3,000 square miles of high plains and lakes east of Albuquerque. But even with a tax levy to help support the medical outpost, the facility lost more than $1 million in the past six months, [Christine] Campos [administrator of Guadalupe County Hospital] said. Guadalupe is one of the nation’s first to start the process of converting into a Rural Emergency Hospital. The designation was created as part of the first new federal payment program launched by the Centers for Medicare & Medicaid Services for rural providers in 25 years. More than 140 rural hospitals have closed nationwide since 2010, and health policy watchers aren’t sure how many of the more than 1,700 rural facilities eligible for the new designation will apply. CMS officials said late last month that seven have already filed applications. Facilities that convert will get a 5% increase in Medicare payments as well as an average annual facility fee payment of about $3.2 million in exchange for giving up their expensive inpatient beds and focusing solely on emergency and outpatient care. Rural hospitals with no more than 50 beds that closed after the law passed on Dec. 27, 2020, are eligible to apply for the new payment model if they reopen.” [Kaiser Health News, 3/6/23]

MinnPost: Improved Medical Treatment and Health Equity Around the Corner With New Testing Method. “On a recent Friday, Emily Myatt of the American Cancer Society Cancer Action Network (ACS CAN) and [Aleta Steevens] delivered a newly drafted bill to remove barriers to biomarker testing in Minnesota to the Chief Clerk’s office in the State Capitol building, and it was introduced during the legislative session this week. Biomarker testing is the analysis of a patient’s tissue or blood sample for the presence of a molecular signature that can guide a physician’s treatment plan and assess risk for conditions such as cancer, arthritis, autoimmune diseases, and mental illness, among others. According to Dr. Douglas Yee, the director of the Masonic Cancer Center, testing for alterations in the BRCA gene changed the treatment outlook for breast cancer, in part by predicting which class of drugs may be most effective. The application of biomarker testing to determine who will respond to specific drugs and/or who will have adverse effects is essential to avoiding inappropriate or ineffective treatment.  In the case of cancer, this can greatly impact a person’s quality and length of life. Currently, Minnesotans have unequal access to biomarker testing based on where they live (rural versus the metro area), insurance coverage, and socioeconomic status. People of color – particularly, the Black community – do not benefit from biomarker testing at the same rates as white people. This is particularly concerning, as rates of breast cancer mortality are highest in Black women, and Black men are at a higher risk of mortality from colon and prostate cancer than their white counterparts. No one should have to worry about out-of-pocket costs for this important test.  Expanding biomarker testing access will improve justice and health equity. There are few, if any, drawbacks to this bill. The results of biomarker testing are confidential.  Federal legislation, the Genetic Information Nondiscrimination Act (GINA), prohibits health insurers from discriminating against enrollees based on their genetic information. An actuarial analysis found that the increase in health insurance premiums to cover comprehensive biomarker testing would be just cents (between $.05 and $.51) per member per month.” [MinnPost, 3/13/23]

CHALLENGES

Washington Post: Rise in Infant Mortality Hitting Black Families the Hardest. “A new federal study highlights a striking racial disparity in infant deaths: Black babies experienced the highest rate of sudden unexpected deaths in 2020, dying at almost three times the rate of White infants. The findings were part of research released Monday by the Centers for Disease Control and Prevention, which also found a 15 percent increase in sudden infant deaths among babies of all races from 2019 to 2020, making SIDS the third leading cause of infant death in the United States after congenital abnormalities and the complications of premature birth. Before the pandemic, overall infant mortality — including diseases, accidents and injuries, and unexplained deaths — had been on a downward trend in the United States. Some of that drop can be attributed to the enormously successful campaign launched in the 1990s to encourage putting babies to sleep on their backs, as opposed to facedown when they may re-breathe the carbon dioxide they exhaled or suffocate in soft bedding. On average, about 3,400 U.S. babies die suddenly and unexpectedly each year, according to CDC data. In 2020, the SUID rate was highest among Black infants (at 214 deaths per 100,000 live births), followed by American Indian or Alaskan Native infants (at 205 deaths per 100,000 live births), and nearly three times the rate for White infants (75.6 deaths per 100,000 live births). Understanding the causes of those deaths, many of which are unobserved, is key to preventing them.” [Washington Post, 3/13/23]

The Root: Inequities in Black Maternal Health Remain Even After Increasing Wealth and Education Access. “One of the Biden Administration’s top healthcare officials is sounding the alarm about persistent maternal health disparities for Black women, which they say don’t wane even as income and education levels rise. Black women have long experienced higher rates of complications from pregnancy and childbirth, including miscarriage and stillbirth, than the population at large. Those disparities are known to be heavily concentrated among mothers with lower incomes, who are likely to be uninsured or live in communities with low concentrations of medical facilities. But many people assume that those challenges dissipate at least somewhat for Black women as they climb the income and education ladders and obtain college degrees and middle-to-upper income status. Unfortunately, those problems don’t decrease even as more money comes in… In a report issued last June, the Biden White House laid out what it deemed a ‘maternal health crisis facing the United States,’ in which overall maternal death rates are double in the United States than they are among other Western nations. As bad as that sounds, the numbers are startlingly worse for Black women, who suffer pregnancy-related deaths at a rate more than triple that of white women per 100,000 live births, according to the report, which also echoed Brooks-LaSure’s comments. Translation: Black women are dying at a high and unnecessary rate largely because doctors aren’t listening to them.” [The Root, 3/7/23]

Idaho Capital-Sun: On National Women’s Day, Groups Say U.S. Anti-Abortion Laws Violate Human Rights. “Ahead of International Women’s Day, hundreds of U.S. and global human rights groups, doctors and attorneys have asked the United Nations to intervene on behalf of the millions of women in the U.S. who have been left without access to legal abortion and vital forms of reproductive health care in the wake of last summer’s monumental U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization. The more than 50-page letter – dense with devastating anecdotes from news articles and studies and doctor interviews – argues that the effects of Dobbs and the resulting state and local anti-abortion policies have compromised Americans’ rights to life, health, privacy and liberty. The letter authors argue that the U.S. is violating various human rights treaties it has signed. They ask the U.N. officials to make an official visit to the U.S. to witness these harms, to convene a virtual stakeholder meeting with U.S. civil society, and to call for private companies to take action to protect reproductive rights. They also call on the U.N. to ask the U.S. to comply with its obligations under international law. They write that the U.N. Human Rights Committee has already established that denial of abortion in other countries can cause suffering and amount to torture. And they stress that in the U.S., racial minorities and marginalized groups disproportionately face health and legal harms because of the policies enacted after the Supreme Court overturned Roe v. Wade.” [Idaho Capital-Sun, 3/8/23]

NBC News: Systemic Barriers Persist for Black Diabetes Patients Even After Eli Lilly Price Cap. “The news last week that the drugmaker Eli Lilly will cap out-of-pocket costs for its insulin at $35 per month brought relief to some. But what remains are systemic problems with insurance coverage and misdiagnosis that continue to challenge many with diabetes. The price cap by Eli Lilly, the country’s largest manufacturer of insulin, will have an outsize effect on Black people, who are not only more prone to diabetes but are also more likely to struggle to pay for the drug. Without the caps, most people with diabetes who are uninsured or under-insurered can spend upward of $1,000 per month or more on insulin out-of-pocket.  But beyond the cost of insulin, larger structural inequities contribute to poorer health outcomes for Black Americans as a whole, especially those with diabetes. [Otis Kirksey] said that Black people are more likely to live in food deserts and have fewer healthy food options, which means their chances of ‘developing diabetes are significantly higher.’ Black people may experience an overdiagnosis for prediabetes or Type 2 diabetes, according to a March 2021 report by the Centers for Disease Control and Prevention. Data from 2019 found that Black people were twice as likely than white people to die from diabetes and were 2.5 times more likely to be hospitalized with diabetes and experience long-term complications, according to the U.S. Department of Health and Human Services’ Office of Minority Health. Close to 1 in 5 adults in the U.S. with diabetes skipped, delayed or used less insulin to save money, a 2021 report by Annals of Internal Medicine found. It also said that insulin rationing was more common among Black Americans.” [NBC News, 3/8/23]

Washington Post: Diabetes and Obesity Rising in Young Americans. “Diabetes and obesity are rising among young adults in the United States, an alarming development that puts them at higher risk for heart disease, according to a study of 13,000 people between 20 and 44 years old. And Black and Hispanic people, particularly Mexican Americans, would bear the brunt. Deaths from heart attacks and other effects of cardiovascular illnesses had been declining in the United States because of medical advances in prevention and treatment. That progress stagnated during the past decade. Young Black adults face the greatest risk. Hypertension is twice as prevalent among them as it is in other racial and ethnic groups. Diabetes and obesity are also more common. The study’s authors pinpointed structural racial inequities in American society as a driver of the gaps. Hypertension is rising among Hispanic people, a trend not evident among other groups. They emphasized that it transcends lifestyle choices. When people struggle to pay the bills, they often turn to cheaper, unhealthier food. Fresh produce is harder to come by in areas with few grocery stores. Here are some ways the study’s authors proposed addressing the disparities: [e]xpanding large-scale efforts to screen and treat young Black adults for hypertension, [s]creening people for diabetes earlier in life because current guidelines often apply to people 35 and older [s]tarting a public health campaign addressing the rise in diabetes among Mexican American adults that is culturally competent and shaped by community leaders, [and c]reating more green spaces in communities that encourage exercise to counter sedentary lifestyles contributing to the rise in obesity.” [Washington Post, 3/5/23]

Afro: Black Women are Some of the Most Affected by Diabetes and Access to Treatment. “Over 30 million people in the United States have been diagnosed with both Type 1 and Type 2 diabetes—including nearly 13 percent of all non-Hispanic Black people. According to the Office of Minority Health at the Department of Health and Human Services, African Americans are 80 percent more likely to be diagnosed with diabetes and the majority of them are women. African Americans are more likely to develop Type 2 diabetes and unfortunately suffer fatalities from Type 2 diabetes at twice the rate of their White counterparts. Black people are overwhelmingly more likely to suffer from debilitating complications caused by diabetes such as amputations, blindness and kidney failure more than their white counterparts. Due to lack of health resources in predominately African American communities, black people receive poorer quality care and get care later when the disease has progressed. The risk for getting Type 2 diabetes increases with age with the highest incidence occurring between 65-75. This is precisely the point in life when income decreases. African-American women are especially affected. They are likely to be caregivers and spend their hard-earned money on ensuring family members are healthy making access to insulin a greater challenge. Instead of focusing on lowering drug costs for all Americans, some lawmakers continue to attack the Affordable Care Act and its health care protections for those that have pre-existing conditions. While they do this, as many as one in four people skips insulin doses or ration prescriptions because of the rising cost. Sadly, some of these people are dying as a result—and many black women are specifically at risk.” [Afro, 3/13/23]

US News: Primary Care Visits Are Shorter and More Prone to Error for Non-White Patients. “[A] new study that found Black and Hispanic patients — as well as patients with public health insurance like Medicaid or Medicare — tend to get the short end of the stick when it comes to the length of office visits. In some cases, shorter visits can potentially lead to dangerous consequences, investigators found, upping the risk for poor prescribing practices involving antibiotics, painkillers and/or sedatives. On one hand, Neprash and her team noted that the average primary care visit lasts about 18 minutes. On the other hand, they point to prior research suggesting that a primary care doctor would actually need 27 hours to fully convey all the critical information required to prevent chronic disease, while also addressing all of a patient’s specific issues. The huge gap between need and reality seems to please nobody, with surveys indicating that both patients and doctors wish they had less rushed experiences. But the team also found that a patient’s race/ethnicity and insurance status seemed to play a role, ‘with shorter visits observed among patients of color and patients with public insurance coverage, [such as] Medicaid and Medicare, rather than commercial insurance,’ she said. Younger patients also tended to have shorter visits. To explore how shorter visits might translate into worse care, Neprash and her colleagues focused on three subsets of patients: the roughly 223,000 visits that involved an upper respiratory tract infection diagnosis; the approximately 1.6 million visits that resulted in a pain-related diagnosis, and more than 2.75 million visits involving seniors. They found that more than half (nearly 56%) of visits involving an upper respiratory tract infection resulted in an inappropriate antibiotic prescription. They also found that 3.4% of pain-related visits resulted in the potentially lethal co-prescribing of both an opioid painkiller and a benzodiazepine sedative (such as Valium or Xanax). Taking both types of medications together ups the risk for an overdose, as both cause breathing suppression and sedation. Just over 1% of visits involving seniors involved the prescribing of medications that do not adhere to public health guidelines. And the chance that inappropriate prescribing of antibiotics, painkillers or sedatives might occur rose as the duration of the doctor visit got shorter, Neprash’s group noted.” [US News, 3/13/23]

Washington, DC — Today, President Biden proposed a budget that will protect and strengthen Medicare, cut drug prices, and crack down on wasteful spending by Big Pharma. The proposal caps insulin at $35 for those on private insurance, provides affordable coverage in states that have failed to expand Medicaid, broadens Medicare’s power to negotiate lower drug prices, extends coverage to women for a full year after they’ve had a baby, extends Medicare solvency, and makes enhanced ACA subsidies permanent. The policies outlined are in direct opposition to the Republican threats to defund Medicare and Medicaid and to repeal the Affordable Care Act and the Inflation Reduction Act. Biden’s budget is estimated to save billions in the long run and expand lower costs for millions of Americans.

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

“This budget is a reminder that President Biden is laser-focused on delivering lower cost, better health care to hard-working Americans. By building on the success of the Inflation Reduction Act, President Biden is making sure working people and seniors will have lower costs for coverage and prescription drugs, so families have a little breathing room.

“On the other hand, Republicans refuse to give up on their radical effort to raise costs and rip away health care from millions of Americans. Their proposal of massive cuts to the Affordable Care Act, Medicaid, and Medicare would be disastrous for the American people, disproportionately impacting children, rural Americans, people with disabilities, and people of color. President Biden made it clear in his proposed budget that he will not let Republicans hold our economy and the American people hostage.”

HEADLINES:

STAT: Biden Makes Drug Pricing A Central Part Of His Deficit Reduction Plans. “Another Medicare pilot program to make an appearance in the president’s budget, though not by name, is a plan to limit Medicare Part D cost-sharing to $2 on generic drugs for chronic conditions, such as hypertension and high cholesterol. It’s not clear whether the policy is a copy of the pilot program or a way of skipping that experiment and moving straight to a national policy. A separate budget policy proposes to extend Medicaid drug rebates to states’ Children’s Health Insurance Programs, for an estimated savings of $2.3 billion over 10 years. The budget also calls for extending Medicare’s $35 monthly cap on insulin out-of-pocket costs to people with private insurance. The measure is popular with voters in both parties, but Republicans blocked legislation from Democrats last year that would have made that cap law. More than 1 in 5 insulin users with private insurance pay more than $35 a month for the medicine, according to the Kaiser Family Foundation.” [STAT News, 3/9/23]

Wall Street Journal: Biden Budget to Propose Saving Hundreds of Billions by Cutting Drug Prices, Fraud. “The White House said the budget will outline a plan requiring that insurance companies that run Medicaid Managed Care programs pay back Medicaid if companies charge more than the cost of patient care. In managed care, the state contracts with private insurance companies to provide the benefits on behalf of the state. States pay the managed-care company generally a set amount each month. The proposal would save $20 billion over 10 years, the White House said, and is similar to what is already required of Medicare Managed Care plans. More than 70% of Medicaid enrollees are in managed-care plans, and the numbers are expected to increase. A series of new prescription drug-related proposals would save more than $200 billion over a decade by imposing new rules on the pharmaceutical industry, according to the White House. The budget plan would allow Medicare to negotiate prices for more drugs and bring them into negotiation sooner after they launch. This proposal has been criticized by PhRMA, the trade group for the pharmaceutical industry, which says it will mean less revenue for research and development of new drugs.” [Wall Street Journal, 3/9/23]

Axios: Biden’s “Finish The Job” Budget: $35 Insulin Cap At Center Of Plan. “President Biden will use the release of his FY2024 budget Thursday to pressure Republicans to cap the cost of insulin at $35 a month for all Americans, according to administration officials. Why it matters: By putting Biden’s insulin cap at the center of his budget rollout, the White House is previewing the populist tone that will course throughout his expected re-election campaign. White House budgets are always political documents, but Biden is leaning into making this year’s proposal a virtual campaign manifesto. He also wants to lay potential traps for the new — and thin — GOP House majority as both sides position themselves for a big summer showdown on how to raise the debt ceiling and whether to cut any spending. […] What they’re saying: ‘The President, like 7 in 10 Americans, thinks it is unacceptable that Congressional Republicans continue to block common-sense legislation to cap the cost for all Americans in need of insulin,’ White House press secretary Karine Jean-Pierre told Axios. ‘If the MAGA Republicans get their way, seniors will pay higher out-of-pocket costs on prescription drugs and insulin, the deficit will be bigger, and Medicare will be weaker,’ Biden wrote in the New York Times op-ed on Tuesday.” [Axios, 3/9/23]

The Epoch Times: Republicans Denounce Biden’s Budget, but Haven’t Provided an Alternative of Their Own. “While Republicans are united in their opposition to the Biden budget, they remain a house divided in drafting a plan of their own. Republicans are reportedly preparing three budget proposals, one each from the House Budget Committee, the Republican Study Committee, and the Freedom Caucus. Emmer alluded to the division in the Republicans’ press conference on Mar. 8, which was intended as a call for bipartisanship in the wake of a joint briefing with House Democrats by the Congressional Budget Office. ‘You can’t make a difference on your own. You got to do it with other people, and Kevin McCarthy has literally started to bring both sides of this—all side—because it’s not that easy anymore. It’s not just both sides,’ Emer said in an apparent reference to factions within the Republican caucus. Biden said he believes the Republican objective to reduct [sic] the deficit without increasing taxes or cutting Social Security, Medicare, or defense spending is unachievable. ‘How are they going to make the math work?’ Biden asked. ‘What are they going to cut?’ He suggest [sic] that Republicans cannot make their vision work without cutting social programs that many Americans depend on. The president acknowledged that he and the Republicans have a different vision for the economy, but said he is willing to work together to reconcile their proposals. ‘I’m ready to meet with the speaker anytime, tomorrow if he has a budget,’ the president said. He proposed to compare their positions line-by-line and come to an agreement.” [The Epoch Times, 3/9/23]

Bloomberg Law: Biden Puts Drug Pricing at Front of Medicare Spending Debate. “President Joe Biden is doubling down on efforts to curb what Medicare and Medicaid pay for medicines, a proposal that would allow reductions in Medicare spending without changing benefits or physician pay. Biden’s fiscal 2024 budget request, released Thursday, called for extending the Inflation Reduction Act (Public Law 117-169) inflation rebates to the commercial market and expanding the number and scope of drugs that will soon face government negotiations. Currently, the law allows only Medicare to collect rebates from drug manufacturers that raise prices on products faster than the rate of inflation, and focuses negotiation only on older medicines. The budget also requests higher spending for the Department of Health and Human Services to extend certain health programs. Presidential budgets are largely symbolic documents, pointing to policies that administrations want to focus on. The administration’s proposal for health programs has a major focus on curbing drug spending.” [Bloomberg Law, 3/9/23] 

Modern Healthcare: Biden Budget Plan Outlines Health Priorities. “The federal government would save $20 billion over 10 years by constraining payments to Medicaid insurers, according to the White House. The budget proposal also expands on Biden’s previously announced behavioral health agenda by calling for reduced out-of-pocket costs for Medicare enrollees, mental health workforce development and parity for mental health coverage under private health insurance. Other highlights from Biden’s fiscal 2024 budget plan include: Health insurance exchanges: The White House would permanently extend enhanced subsidies for health insurance exchange users. Medicaid: Biden’s budget calls for the creation of a federally funded ‘Medicaid-like’ coverage plan to provide benefits to low-income adults in states that have not expanded Medicaid under the Affordable Care Act. The plan also would expand home- and community-based services for Medicaid beneficiaries. […] Prescription drug prices: Biden proposes expanding on the Inflation Reduction Act by allowing the federal government to set prices on a broader array of medicines, cap cost-sharing for some generic pharmaceuticals under Medicare Part D at $2, beef up Medicaid and Children’s Health Insurance Program drug rebates, and require drugmakers to refund private customers when they increase prices at a rate that exceeds inflation.” [Modern Health, 3/9/23]

Endpoints News: Biden Budget Wants To More Than Double Number Of Negotiated Drugs Under Medicare, And Eliminate Hepatitis C. “President Joe Biden on Thursday unveiled his 2024 budget, which is packed with lofty goals that may never see the light of day because Congress controls the federal purse strings and Republicans control the House. Even still, the wide-ranging budget looks to immediately build off the Inflation Reduction Act by rapidly expanding the number of drugs that will be negotiated and decreasing the amount of time that small and large molecule drugs will go without negotiations, from 10 years for small molecules and 13 years for biologics to just five years for both small and large molecule drugs. The shift would have a much more significant impact on biopharma R&D than the original IRA, which the Congressional Budget Office projected would cut only about 10 drugs over 30 years.” [Endpoints News, 3/9/23]

Healthcare Dive: Biden’s Proposed HHS Budget Aims To Make Pandemic-Era Subsidies Permanent. “President Biden’s proposed fiscal year 2024 budget for the HHS targets healthcare access for underserved populations and aims to make premium Affordable Care Act subsidies permanent. Released Thursday, the budget also proposes to extend Medicare solvency and give the federal government more power to negotiate prescription drug prices. It allocates $144.3 billion in discretionary funding to the agency, up from $127.3 billion in 2023, and aims to reduce the federal deficit by nearly $3 trillion over the next decade. The HHS proposes to allocate $183 billion over the next 10 years to make enhanced tax credits, enacted originally under the American Rescue Plan and extended into 2025 by the Inflation Reduction Act, permanent. With the subsidies, enrollment in Marketplace plans soared during the coronavirus pandemic, contributing to a record-low rate of uninsured Americans and a record-high number of ACA plan enrollees. Last month, the CMS announced a record 16.3 million people had signed up during the 2023 open enrollment session.” [Healthcare Dive, 3/9/23]

Read the Fact Sheets Here.

Washington DC — Today, Protect Our Care is releasing state-by-state fact sheets to underscore Republicans’ radical plan to raise costs and rip away health care from millions of Americans. Republicans in Congress have set their sights on making massive cuts to the Affordable Care Act (ACA), Medicaid, and Medicare. They are working to throw out protections for pre-existing conditions, repeal the Inflation Reduction Act’s measures to reduce the cost of drugs, make coverage more affordable for nearly 15 million Americans, and gut Medicaid expansion, which covers 20 million people. These cuts would be disastrous for the American people, disproportionately impacting children, rural Americans, people with disabilities, and people of color.

Protect Our Care’s new fact sheets outline the consequences of Republicans’ plans to repeal the ACA and Medicaid expansion. Republicans refuse to give up on this decade-long effort despite the ACA and Medicaid expansion being extremely popular with voters.

These attacks come as more and more Americans rely on the ACA and Medicaid for their health care. President Biden and Democrats in Congress passed the Inflation Reduction Act, which expanded tax credits to help make premiums more affordable for people purchasing coverage on their own. President Biden also made record investments in the Navigator program and eliminated the family glitch, which previously blocked millions of families from receiving coverage under the ACA. As a result, the uninsured rate has reached an all-time low, and a record 16.3 million people have signed up for health care coverage for 2023. 

Protect Our Care Founder Leslie Dach issued the following statement: 

“Republicans have promised to gut the Affordable Care Act and Medicaid. They want to rip away protections for people with pre-existing conditions, raise premiums, and take health insurance away from millions of Americans. If they get their way, health care costs would go through the roof and millions would have nowhere to turn.”

What the Congressional Republican Agenda Means for Americans

Speaker McCarthy and MAGA Congressional Republicans have committed to balance the budget while adding $3 trillion or more to the deficit through tax cuts skewed toward the wealthy and large corporations. As a matter of simple math, that requires trillions in program cuts. Congressional Republicans have yet to disclose to the American people where these cuts will come from. But past Republican legislation, budgets, and litigation, along with recent statements, proposals, and budget plans, provide clear evidence that health care will be on the chopping block for severe cuts. 

Virtually every Republican budget or fiscal plan over the last decade has included repeal of the Affordable Care Act (ACA) and deep cuts to Medicaid. That would mean: higher health care costs for American families; ending critical protections for people with pre-existing conditions; and threats to health care for seniors and people with disabilities, including growing home care waiting lists and worse nursing home care. 

Americans deserve to see congressional Republicans’ full and detailed budget plan, including what it cuts from the ACA and Medicaid, Social Security and Medicare, and other critical programs, and should have the chance to compare it with the President’s budget plan, which he will release March 9. 

ACA repeal would reverse The United States’ progress in getting more Americans health insurance. Since the passage of the Affordable Care Act, monthly enrollment rates for Medicaid have increased by over 59 percentage points—coverage gains that would surely be lost if the ACA and Medicaid expansion is eliminated. 

More than 106 million Americans—about 32 percent of the country—rely on Medicaid and the Affordable Care Act for health coverage. 

In total, over 37 million Americans’ health insurance coverage will be at risk from ACA repeal. This includes over 16,306,448 who have signed up for ACA marketplace coverage for 2023, and over 21,339,037 enrolled in Medicaid expansion coverage available due to the ACA. 

Nearly 54 million Americans with pre-existing health conditions could lose critical protections. Before the ACA, at least 53,883,000 Americans with pre-existing health conditions could be denied coverage or charged more if they tried to buy individual market health insurance. Republican repeal proposals either eliminate these protections outright or find other ways to gut them. 

Over 25 million Americans could lose protection against catastrophic medical bills. Before the ACA, insurance plans were not required to limit enrollees’ total costs, and almost one in five people with employer coverage had no limit on out-of-pocket costs, meaning they were exposed to tens of thousands of dollars in medical bills if they became seriously ill. 

About 68 million Americans with Medicaid could lose critical services, or could even lose coverage altogether, including over 44,223,975 children. Slashing federal funding for Medicaid will force states to make Medicaid eligibility changes that would make it harder to qualify for, and enroll in, Medicaid coverage. States would also likely consider capping or limiting enrollment.

Medicaid funding could be slashed. Republican budget plans would eliminate the minimum federal Medicaid matching rate (FMAP) for states. Under current law, states with lower relative average per-capita income receive higher matching rates than states with the highest average per-capita income, and no state receives a FMAP that is lower than 50 percent. If the 50 percent floor were eliminated, according to some older estimates, states could see their FMAP fall to as low as 15 percent, forcing Americans to pick up a far greater share of the cost of their Medicaid programs or make substantial cuts to their Medicaid programs. 

Almost 10 million seniors and people with disabilities could receive worse home care, with ballooning wait lists for those still in need. Under a block grant or per-capita cap, there would be fewer dollars available for home care services, an optional benefit in Medicaid. Faced with large federal funding cuts, states would almost certainly ration care. The United States already has over 655,596 people on its home care wait lists so any additional cuts in federal funding will likely cause the state’s existing waitlist to skyrocket. 

Hundreds of thousands of nursing home residents would be at risk of lower-quality care. Over 60 percent of nursing home residents are covered by Medicaid. With large cuts in federal funding, states would be forced to cut nursing home rates to manage their costs, as many states have done during recessions. Research shows that when nursing homes are paid less, residents get worse care.