April 2023

Watch the Full Event Here

Washington, DC – Today, Senator Peter Welch (D-VT) and Representative Jan Schakowsky (D-IL-09), joined Caring Across Generations’ Nicole Jorwic and Protect Our Care for a press conference to discuss the Republicans’ ongoing threats and radical plan to cut Medicaid and take health care away from millions. The House Republicans recently passed the Republican plan which imposes cuts in key programs, including slashing health care and other vital discretionary funding and taking Medicaid away from millions by imposing burdensome paperwork requirements in exchange for not defaulting on the nation’s debt. Read more about how Republicans are demanding health care cuts here. 

A record 92 million Americans are enrolled in Medicaid, which provides affordable care to people from all backgrounds. President Biden and Democrats in Congress are working tirelessly to protect Medicaid from GOP attacks and strengthen the program to ensure everyone has the health care they need. April marks the 5th annual Medicaid Awareness Month.

“Medicaid offers essential health coverage to Vermonters who otherwise couldn’t afford health care,” said Senator Peter Welch (D-VT). “The House GOP’s debt plan to attach work requirements to Medicaid would kick thousands off of their health insurance. It would be absolutely detrimental to those who need access to essential care, including seniors and people living with disabilities. I’m thankful for the advocacy work of Protect our Care and Caring Across Generations, and will continue to stand up and protect Medicaid from these misguided cuts.”

“We’re talking about 92 million Americans right now who are enrolled in Medicaid and this is a lifeline for so many people,” said Representative Jan Schakowsky (D-IL-09). “Cruelty seems to be the point of these work requirements and in what they did yesterday when they decided to hold our economy hostage and cut the most important benefits. We need to protect our care, we need to protect Medicaid. We have to fight back against these terrible cuts. I do believe that when we fight, we win.”

“I’m frankly pretty upset that we have to be here again because one party continues to go to the Medicaid program to get it to pay for things that help the wealthy corporations or gut the ACA while harming people that I love,” said Nicole Jorwic, Chief of Campaigns and Advocacy at Caring Across Generations. “This no good, very bad, ‘Live Grow Save’ bill moves to slash support for Medicaid by over $110 billion dollars by imposing work requirements that are certainly a solution in search of a problem because over 70% of Medicaid beneficiaries are working and the majority of the rest of them are providing care. We shouldn’t have to keep fighting against cuts to these programs at a time when we need to be expanding them.”

“I have been on Medicaid, home and community based services since I was 18,” said Jyll Allen, a patient storyteller from Vermont. “Now Vermont Medicaid and its program called Flexible Choices provide me funding with which to hire my own caregivers. Any cuts to Medicaid really really scare me because the Medicaid home- and community-based waiver has allowed me to be in the community and to access the community as much as I do. I fear that I could lose access to a lot of services that I need and my quality of life would plummet.”

“Republicans should be ashamed that they are more willing to default on the nation’s debt than guarantee affordable health care for families across America,” said Protect Our Care Communications Director Anne Shoup. “Imposing these burdensome paperwork requirements will result in as many as 21 million people losing their health care, throwing patients and hospitals and other providers into chaos as they are forced to pick up the tab. This default bill not only attempts to rip away health care for millions of people who rely on Medicaid, but it also cuts critical health programs by 22 percent. The Republicans have one goal in mind with this legislation: rip away benefits and deny people access to health care.”

New Rules Come As Republicans Passed Bill to Rip Away Medicaid Coverage From 21+ Million Americans

Washington, DC — Today, CMS issued two new rules to strengthen access to care for millions of people who depend on Medicaid and the Children’s Health Insurance Program (CHIP). Together, the two new rules would ensure the 92 million adults and children 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 by establishing national standards for the time patients must wait to see a provider and the distance they must travel. This and other policy changes will expand access to affordable care, address disparities, and ensure value for taxpayer money in the Medicaid program. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“The Biden-Harris administration’s new rules will improve access to care for the 54 percent of children in America who rely on Medicaid and CHIP, and for the 92 million people who depend on Medicaid. The contrast could not be clearer: while Republicans are passing harmful legislation to slash vital programs and throw people off of their health care, President Biden is working to strengthen Medicaid for families across America.” 

Washington, DC — House Republicans just passed their extreme “Default on America Act” which rips away health care from as many as 21 million people who count on it. Sixty percent of children with disabilities and 30% of adults with disabilities get their coverage from Medicaid. 3.2 million Americans count on Medicaid for their long-term care bills, including six in 10 nursing home residents.

From funding for veterans’ health care to nursing home safety to mental health and substance use, these cuts will take desperately needed health care away from families across the nation. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“This is the most extreme attack on American health care that we’ve seen in years. These MAGA Republicans are trying to force their plan to take away Medicaid from people who count on it. The Republican plan to impose so-called work requirements alone will result in as many as 21 million people losing their health care, creating chaos for patients and for hospitals, other providers, and states who will be forced to pick up the tab. It’s shameful that the GOP would rather default on our nation’s debt than ensure that families across America have access to the affordable care they deserve.”

Washington, DC — Yesterday, the White House released a new analysis showing that 21 million Americans are at risk of losing their health care under the latest Republican plan to impose so-called work requirements for millions of people on Medicaid. Research shows the vast majority of people with Medicaid coverage who can work are already working and that applying this type of restriction only serves to throw people off the rolls due to bureaucratic hurdles and paperwork requirements. Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“The GOP debt default proposal is nothing more than a ploy to cut vital programs like Medicaid. Kevin McCarthy and Republicans in Congress have eyed cuts to Medicaid for decades, and so-called work requirements are just their latest method for kicking people off the rolls. If this draconian proposal passes, as many as 21 million people will lose their Medicaid coverage, creating chaos for families and for hospitals and states who have to pick up the tab. This plan will impose severe harm on people with disabilities, parents, rural Americans, and others who fall victim to MAGA Republicans’ ongoing war on American health care. This is an absolute non-starter.” 

• The GOP Plan Could Make It Harder For People To Meet Basic Needs. Work reporting requirements could put over 21 million Medicaid beneficiaries—nearly 1 in 3 Medicaid enrollees in expansion states—at risk of losing coverage. Millions of people in America would lose coverage if all states were required to implement Medicaid work requirements, and research suggests that work requirements could have “particular adverse effects on certain Medicaid populations, such as women, people with HIV, and adults with disabilities including those age 50 to 64.”
• Medicaid Work Reporting Requirements Have A History Of Significantly Reducing Enrollment. Restricting access to Medicaid for adults reduces coverage for children who are still eligible, and requiring people on Medicaid to prove they are working adds an administrative burden that is hardest on low-income enrollees. The industries that employ the most Medicaid enrollees tend to have extremely volatile hours, threatening loss of coverage under expanded work requirements: “The two industries that employ the most Medicaid enrollees potentially subject to work requirements are restaurants/food services and construction; many enrollees also work at grocery stores, department stores, and discount stores or provide home health or child care services. These industries generally have above-average rates of involuntary part-time work, where employees want full-time work but can’t get it.”

Last week, House Speaker Kevin McCarthy released a plan to change the rules and take away Medicaid coverage from millions of people who currently qualify if they fail to comply with bureaucratic work requirements. The evidence shows the vast majority of people with Medicaid coverage who can work are working, and that applying this type of restriction to non-employment programs, including Medicaid, has significant adverse impacts on health and well-being. 

Millions of people in this country count on Medicaid, especially people with disabilities, people with mental health and substance use disorders, children, pregnant women, seniors in nursing homes, rural Americans, and people of color. This latest Republican scheme would take Medicaid coverage away from those people who count on it the most and make it harder for hospitals, doctors, and other providers in rural and difficult-to-serve areas to stay afloat and stay open. Read more about how Republicans are fighting for health care cuts during Medicaid Awareness Month here.

Georgetown University Health Policy Institute: Medicaid Work Requirement Would Have Damaging Impact. “The Medicaid work reporting requirement provisions contained in Section 321 of House Speaker McCarthy’s draft debt ceiling bill released yesterday are a radical attempt to cut federal funds for Medicaid and will threaten coverage for millions of low-income people — not because people aren’t working but because they fail to jump over a whole new set of bureaucratic hurdles. The vast majority of those who can work do — 93% according to the Kaiser Family Foundation in the Medicaid expansion group are either workers, caregivers, students, or unable to work due to illness. The Speaker’s bill has it backwards – having Medicaid actually support people’s ability to work when they can get their health conditions addressed. Taking it away will only make it harder for them to work.” [Georgetown University, 4/20/23]

Over 30 Patient Groups Including the American Lung Association: This Legislation is a Clear Attack on Quality and Affordable Healthcare. “To be clear: these requirements are not about work, they are about paperwork, and otherwise-eligible patients will lose coverage when they get caught up in this bureaucratic red tape. Additionally, exemption processes inherently create opportunities for administrative errors that jeopardize patients’ access to care. By eliminating the federal match for individuals not in compliance, the legislation leaves no doubt that states would take away coverage from millions of individuals and result in significantly worsened health outcomes.” [4/24/23]

Nearly 230 Medicaid Organizations Sign Letter Opposing McCarthy’s Work Requirement Plan. “Medicaid is a lifeline to 91 million Americans, providing insurance coverage for millions of children, veterans, and people who own and work at small businesses. The program is a critical source of coverage to people who have historically been egregiously underserved by our health care system including people of color, particularly in Black, Latino, Asian American, Native Hawaiian and Pacific Islander, and Indigenous communities, and people living in rural communities. The evidence is clear that when people have a reliable source of high-quality health coverage, they can access critical health services, including preventive care and behavioral health services; experience improved health outcomes and better overall health; and are protected against unexpected medical expenses. These ideas are not new: they were resoundingly rejected by people across the country when they were proposed as part of efforts to repeal the ACA in 2017. Unsurprisingly, the American public continues to strongly oppose them – new polling shows that 71 percent of Americans say it is important to prevent Medicaid cuts. [C]uts to the Medicaid program are unacceptable.” [4/19/23]

Doctors’ Organizations Representing Over 550,000 Physicians 2017 Statement Condemning Work Requirements. “Imposing work requirements, lock-outs, premiums, and other out-of-pocket costs will limit access to preventive and primary care services and inhibit Medicaid beneficiaries from seeking care that helps them avoid costlier health conditions and maintain wellness. Studies show 8 out of 10 Medicaid enrollees are in working families and 59% are working themselves.” [12/8/17]

Statement of ACAP CEO Margaret A. Murray on McCarthy’s Work Requirements Bill. “Nearly two-thirds of adults enrolled in Medicaid already work. Medicaid helps people who work stay on the job. In fact, a survey of people covered by Medicaid in Michigan found that people who had Medicaid coverage were better able to get a job—and keep it. We are also concerned that work requirements will exacerbate ‘churn,’ where people who meet the eligibility requirements for Medicaid are disenrolled owing to paperwork and administrative burdens. Reducing or eliminating health care coverage would impose financial stress on families, limit access to the care they need, and run the risk of denying coverage to people who are Medicaid-eligible.” [4/19/23]

Watch the Ads Here.

Washington, DC — Today, Protect Our Care is launching new digital ads in 10 key districts calling out Republicans’ radical plan to rip health care away from millions of Americans. Last week, House Speaker Kevin McCarthy released the Republican plan to slash vital health care funding by 22 percent and throw people off of Medicaid by imposing burdensome paperwork requirements. Read more about the disastrous GOP health care plan here.

The new ads will run on digital platforms in the following districts: David Valadao (CA-22), Mike Garcia (CA-27), Young Kim (CA-40), Michelle Steel (CA-45), Nicholas Lalota (NY-01), George Santos (NY-03), Mike Lawler (NY-17), Marcus Molinaro (NY-19), Brandon Williams (NY-22) and Anthony D’Esposito (NY-04). 

“Kevin McCarthy has made clear that Republicans are united in their plan to risk a default on our debt in order to force cuts to health care for millions of Americans,” said Protect Our Care Executive Director Brad Woodhouse. “These new ads make clear that the GOP proposal is an attack on veterans, people with disabilities and substance use disorders, seniors, caregivers, children, and more. If Republicans were serious they would throw out this reckless, ultra-MAGA plan and prioritize lowering health care costs, not gutting the programs that people across the nation depend on.” 

Example (CA-23) Ad Script: 

The Republicans’ default crisis means they won’t pay the bills and could default on the debt with American families paying the price.

Their plan could kick more than 10 million Americans off Medicaid including seniors, moms, and kids.

It cuts veterans’ health care by 22%.

Why are Republicans doing it?

So they can give more tax breaks to the wealthiest Americans.

Call Rep. David Valadao: Tell him to STOP the MAGA Default crisis and attacks on our health care.

This week we highlight new rules from the HHS supporting state actions to increase access to care for those leaving incarceration, an important tool to reduce disparities for this population who are disproportionately people of color. Multiple new reports from entities and organizations like the World Health Organization and the Robert Wood Johnson Foundation highlight both new data in health disparities as well as policy solutions refocusing health efforts towards community-based models that promote health equity. Finally, a groundbreaking new piece of research has shown that access to Black physicians is directly correlated to a marked increase in Black life expectancy within that community, whether or not people attend that physician’s practice. Other studies featured in this edition underscore the importance of policy implementation to maximize the likely equity impact.

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

World Health Organization: WHO Releases Largest Global Collection of Health Inequality Data. “The repository allows for tracking health inequalities across population groups and over time, by breaking down data according to group characteristics, ranging from education level to ethnicity. The data from the repository show that, in just a decade, the rich-poor gap in health service coverage among women, newborns and children in low- and middle-income countries has nearly halved. They also reveal that, in these countries, eliminating wealth-related inequality in under-five mortality could help save the lives of 1.8 million children. The Health Inequality Data Repository (HIDR) includes nearly 11 million data points and consists of 59 datasets from over 15 sources. The data include measurements of over 2000 indicators broken down by 22 dimensions of inequality, including demographic, socioeconomic and geographical factors. Though limited, the available disaggregated data reveal important inequality patterns. In high-income countries, hypertension is more common among men than women and obesity rates are similar among men and women. By contrast, in low-income countries, hypertension rates are similar among women and men, but obesity rates are higher among women than men. The repository also reveals inequalities in national COVID-19 responses. In 2021, in more than a third of the 90 countries with data, COVID-19 vaccination coverage among the most educated was at least 15 percentage points higher than among the least educated.” [WHO, 4/20/23]

Department of Health and Human Services: HHS Releases New Guidance to Support States Increasing Health Care for Those Leaving Incarceration. “The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is announcing a new opportunity for states to help increase care for individuals who are incarcerated in the period immediately prior to their release to help them succeed and thrive during reentry. The new Medicaid Reentry Section 1115 Demonstration Opportunity would allow state Medicaid programs to cover services that address various health concerns, including substance use disorders and other chronic health conditions. In January, California became the first state to cover certain health care services for individuals transitioning back to the community. The Medicaid Reentry Section 1115 Demonstration Opportunity will allow states to cover a package of pre-release services for up to 90 days prior to the individual’s expected release date that could not otherwise be covered by Medicaid due to a longstanding statutory exclusion that prohibits Medicaid payment for most services provided to most people in the care of a state or county carceral facility. According to the U.S. Department of Justice, from 2011 to 2012, approximately 37 percent of people in state/federal prisons and 44 percent of people who were incarcerated overall had a history of mental illness. The National Institute on Drug Abuse (NIDA) estimates that the rate of substance use disorders for people who are incarcerated may be as high as 65 percent. The NIDA report also says that, without treatment, individuals formerly incarcerated are at increased risk of overdose within the first few weeks of reentry.” [HHS, 4/17/23]

Stat: New Research Shows in Counties With More Black Doctors Correlate to an Increase in Black Life Expectancy. “The study, published Friday in JAMA Network Open, is the first to link a higher prevalence of Black doctors to longer life expectancy and lower mortality in Black populations. The new study found that Black residents in counties with more Black physicians — whether or not they actually see those doctors — had lower mortality from all causes, and showed that these counties had lower disparities in mortality rates between Black and white residents. The finding of longer life expectancy persisted even in counties with a single Black physician. Lisa Cooper, a primary care physician who directs the Johns Hopkins Center for Health Equity and has written widely on factors that may explain why Black patients fare better under the care of Black doctors, called the study ‘groundbreaking’ and ‘particularly timely given the declining life expectancy and increasing health disparities in the U.S. in recent years.’ The team found life expectancy increased by about one month for every 10% increase in Black primary care physicians. While extending life by a few months may not sound like much given that the life expectancy gap between Black and white Americans nationally is nearly six years, picking up such a signal on a population level is significant, the authors said. The study found that every 10% increase in Black primary care physicians was associated with a 1.2% lower disparity between Black and white individuals in all-cause mortality.” [Stat, 4/14/23]

Yahoo News: Decreasing Black Maternal Mortality Rates Means Supporting Community-Health Models. “The crisis of maternal mortality in the United States continues to escalate. After rising steadily over time, annual death rates skyrocketed by a shocking 40% in 2021 alone, according to the Centers for Disease Control and Prevention. What’s more, Black women are 2.6 times more likely to die of maternity-related causes than white women. Such outcomes transcend class—in the highest-income groups, twice as many Black women die within a year after childbirth. The same holds true for their babies. Our work has convinced us that conversations about maternal mortality tend to underplay one of the most powerful tools at our disposal: community-based models that respect nuances of culture and language. That said, there are evidence-based alternatives that actually work. Midwives, who are far more common outside the U.S., can provide a host of prenatal and delivery services while staying vigilant to the possible need for interventionist obstetrical care. Community health workers, doulas, and other providers skilled at integrating family and social supports with appropriate healthcare also belong in the prenatal to post-partum continuum. Often, they have local roots, come from backgrounds similar to the populations they tend to, and respect the need to provide continuous, family-centered support. To take fuller advantage of their background and skill set, we believe the federal government should finance efforts to increase the number of licensed midwives and other local providers. States should develop credentialing and scope-of-practice standards so that perinatal community-based providers can use the full breadth of their knowledge. Guided by a commitment to quality and equity, hospitals should make referrals to external resources and prioritize less acute services, even if that reduces their revenue. Employers and public and private insurers should also guarantee coverage for appropriate maternal care outside the hospital. None of this will adequately reduce the toll of maternal mortality unless it is accompanied by affordable insurance that covers community-based services, guarantees continuity of care, and addresses the chronic medical and social conditions that often cause the greatest harms.” [Yahoo News, 4/13/23]

Robert Wood Johnson Foundation: New Report on How to Achieve Healthy Births for All. “Far too frequently, a Black person’s pain or suffering is dismissed because of discrimination or implicit bias in our healthcare system. It cannot go on that way. For Black women and their infants to thrive, it’s crucial that doctors, nurses, and other medical professionals value and respect every birthing person’s experiences. Access to the best possible care is a fundamental right. Offering it can be an act of social justice. That means access to care at every stage of our lives. Women’s health during pregnancy is deeply connected to their health before and in between pregnancies. If you live in a community with limited access to medical care and are unable to see a doctor regularly, you are entering into pregnancy with increased risk. Women need comprehensive reproductive healthcare, from primary care through postpartum support, for healthy outcomes. We deserve to receive this care from providers who understand our needs. We deserve to enter pregnancy with anticipation, not trepidation. America is the most dangerous place to give birth in the developed world—and pregnancy-related deaths are on the rise. The toll is not equally distributed: Black women are three times more likely to die of pregnancy-related causes than White women. Birth justice-focused organizations are advancing policies and practices that address the impact of structural racism on maternal and infant health outcomes. Communities on the front lines of this crisis are advocating to increase the number of birth support people demonstrated to improve birth outcomes—and expand insurance coverage to include their care. These efforts are vital to reducing disparities. Lastly, our policymakers must invest in making birth equity a reality in our country. Medicaid expansion, on the rise in some states, is associated with reduced rates of maternal death, particularly for Black women. In order to address the Black maternal health crisis, however, we must not only expand and enhance Medicaid coverage, but also ensure that providers receive adequate payment. Without both expanded Medicaid and fair reimbursement, Black women will not be able to access the healthcare they need.” [Robert Wood Johnson Foundation, 3/23/23]

CHALLENGES

Axios: Communities of Color Saw Disproportionately Higher COVID Deaths in Young Adults. “Communities of color experienced significantly higher premature death rates than white people during the pandemic and accounted for 59% of the years of life lost during the health crisis, according to a KFF analysis released on Monday. Although individuals 75 and older had the highest risk of becoming seriously ill and dying from COVID-19, younger adults who had their lives cut short by the illness offer a window into racial disparities that the pandemic laid bare. Between March 2020 and the end of 2022, the U.S. experienced nearly 1.7 million excess deaths, defined as fatalities beyond what would have been expected in a typical year that can be due directly or indirectly to COVID-19. The increase in the premature death rate for Hispanic people (33%) was over twice that of white people (14%) from 2019 to 2022. White people experienced an average of 12.5 years of life lost from premature deaths while Hispanics experienced 19.9 years of life lost and American Indian-Alaska Natives had 22 years of life lost before age 75. AIAN people made up 3% of total years of life lost but just 1% of the population. Black people made up 26% of the total years of life lost but just 13% of the population, and Hispanic people accounted for 27% of years of life lost in contrast to 19% of the population. Some groups of color also have higher rates of underlying conditions that may have increased the risk of severe illness and death.” [Axios, 4/25/23]

New York Times: Black Pregnant Women Are More Likely to be Suspected and Tested for Drug Use. “Hospitals are more likely to give drug tests to Black women delivering babies than white women, regardless of the mother’s history of substance use, suggests a new study of a health system in Pennsylvania. And such excessive testing was unwarranted, the study found: Black women were less likely than white women to test positive for drugs. The authors of the new study urged hospitals to examine their drug testing practices in order to address racial biases. It’s not clear what led to greater drug testing of Black women at the Pennsylvania health system. All patients entering the labor and delivery department were screened verbally for substance use, with questions adapted from the National Institute on Drug Abuse’s quick verbal screening test. The policy called for running urine toxicology tests on patients with a positive result from the screening test, a history of substance use in the year before delivery, few prenatal visits or a poor birth outcome without a clear medical explanation. But substance use history couldn’t fully explain the results. And the researchers found no racial differences in the number of prenatal care visits or the rate of stillbirths.” [New York Times, 4/14/23]

Axios: Medicaid Redeterminations Disproportionately Leave Pacific Islanders Vulnerable. “Thousands of Pacific Islanders who went years without promised Medicaid coverage before Congress made amends during the pandemic could lose those benefits this spring in the first wave of eligibility redeterminations. States are culling their Medicaid rolls with the end of the COVID-19 emergency, removing guarantees of continuous coverage that reduced health inequities in ways obvious and not-so-obvious. Consider the 94,000 individuals from the Marshall Islands, Palau and the Federated States of Micronesia now living in the U.S. While non-citizens, they’re guaranteed Medicaid and CHIP benefits under a Reagan-era agreement that gave the U.S. exclusive use and control of sites in those islands for military activity. Congress erroneously stripped the group’s Medicaid benefits when drafting welfare reform legislation in 1996. That left communities exposed to the ravages of COVID-19 more than other groups before Congress restored the benefits in a year-end spending package in 2020. Now, some of those same individuals could be forced out of the safety net program as states redetermine eligibility requirements. They include the Marshallese from islands that were the site of Cold War U.S. nuclear tests that left residents suffering from cancers, birth defects and forced relocations. After 25 years without Medicaid benefits, some Pacific Islanders could fall through the cracks again unless states and health groups come up with workarounds, new processes and outreach.” [Axios, 4/21/23]