May 2023

Watch the Event Here.

Washington, DC — Today, National President and CEO of the American Lung Association Harold Wimmer, Associate Executive Director for Public Affairs and Advocacy of the American Public Health Association Susan Polan, and Andrew Pincus joined Protect Our Care for a virtual press conference to discuss the new amicus briefs ahead of the upcoming stay decision from the Fifth Circuit in Braidwood Management v. Becerra. U.S. District Judge Reed O’Connor’s March 30 decision would end ACA’s guaranteed free access to essential preventive services. In 2020 alone, more than 150 million Americans benefited from these preventive services.  

Judge O’Connor invalidated all of the benefits covered under the U.S. Preventive Services Task Force, including lifesaving lung, breast, and colorectal cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, and access to PrEP (pre-exposure prophylaxis), which can reduce the chance of contracting HIV. The ruling applies nationwide. 

“Navigating the health care system is confusing and challenging, and this court case is increasing confusion and uncertainty for patients’ access to preventive services,” said Harold Wimmer, National President and CEO, American Lung Association. “A robust body of research has shown that even modest cost barriers can reduce uptake of preventive services, especially for patients in socioeconomically vulnerable populations. If the lower court’s ruling stands, fewer people will be screened for lung cancer, their cancer will be detected at later stages, and we will lose more people to this devastating disease.” 

“These preventive services help people live longer and healthier lives,” said Susan Polan, Associate Executive Director for Public Affairs and Advocacy, American Public Health Association. “The ACA made highly effective, evidence-based preventive services available more than ever before. Preventive services should be available to everyone. It shouldn’t matter where you live or how you get your health care. The impact of this decision on the public’s health, especially for people of color, will be disastrous. It’s not the time to go backwards.”

“The key issue courts consider in connection with a stay is the ‘balance of the harms.’ The greatest threat here is the harm to patients if a stay is not granted and the ACA’s protection against cost-sharing is eliminated nationwide,” said Andrew Pincus, Visiting Lecturer in Law at Yale Law School and experienced Supreme Court and appellate lawyer. “We know conclusively, from a mountain of data, that if patients have to bear even part of the cost of these preventive services they will not use them – and that will mean diseases won’t be prevented, or won’t be detected at early stages, and more Americans will suffer severe illnesses and deaths. If a stay is granted, companies and insurers will not suffer any increased burden: they just will have to continue to provide the cost-free coverage they’ve been providing for years.  And if the plaintiffs are correct that few companies would even choose to impose cost-sharing, then the burden of continuing the law’s protection is minimal.  Congress determined in the ACA that cost-free access to preventive services significantly enhances public health. The balance of these factors therefore weighs very heavily in favor of the stay.”

“If O’Connor’s decision stands, it will be a tragedy for millions of Americans,” said Leslie Dach, Chair of Protect Our Care. “Free screenings for depression, diabetes, and heart health not only saves families money, but it saves lives. Without this guarantee, more Americans will be forced to choose between going to the doctor and paying for other essentials like groceries and rent — meaning more Americans will get sick and more will die of entirely preventable causes.”

Leading Patient and Provider Groups, Public Health Experts, and Advocates Call for a Stay of Judge O’Connor’s Reckless Ruling to Rip Away Free Preventive Care From Millions

In March 2023, District Judge Reed O’Connor struck down portions of the Affordable Care Act (ACA) that require insurers to cover lifesaving preventive services without cost sharing. The ruling puts millions at the mercy of insurance companies and employers, who could eliminate the benefits entirely or start charging for them, increasing costs for patients by thousands of dollars a year and creating major obstacles to care.

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

The Fifth Circuit Appeals Court is expected to decide on a stay of the ruling shortly. Patient and provider groups, public health experts and organized labor — including the American Medical Association, the American Lung Association, the American Cancer Society, SEIU, the American Public Health Association and 68 academic deans and scholars, and dozens more organizations — overwhelmingly agree that this case is built on an unfounded legal arguments and have submitted briefs affirming that, if Judge Reed O’Connor’s ruling stands, the consequences for patients would be disastrous.

Federal Government

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

Health Care Organizations and Advocates

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

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

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

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

Physicians and Health Care Experts

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

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

New Navigator polling reveals that voters strongly oppose House Republicans’ plan to take away Medicaid. A striking 85 percent of voters are concerned about the impact of their plan to “take Medicaid away from as many as 21 million people…including kids with disabilities, seniors in assisted living, and pregnant women.” The ‘Default on America Act’ also slashes funding for veterans’ health care, nursing home safety, mental health and substance use services, and more. Not only are these measures widely unpopular, but they threaten the health and well-being of millions of families across the nation. Read more on their disastrous bill here.

When forced to choose the most harmful outcomes for our country, people identify taking away things like Medicaid and cutting veterans benefits as the most harmful with defaulting on the debt coming in second. Compared to both of these alternatives from the GOP, Americans would find “raising the debt ceiling” to be far less problematic. 

This week we highlight a White House proclamation, state actions, studies, conferences, and additional private and public sector efforts focused on reducing inequities in health. These are much-needed interventions in a system plagued by systemic barriers to care, which is only being further exacerbated by the ongoing Republican war on America’s health care.

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 White House: A Proclamation on Asian American, Native Hawaiian, and Pacific Islander Heritage Month. “This year I was proud to launch the first-ever National Strategy to Advance Equity, Justice, and Opportunity for Asian American, Native Hawaiian, and Pacific Islander Communities. This plan reflects my Administration’s commitment to improving the lives of AA and NHPIs — ensuring that the census collects accurate data so they are properly reflected when new policy is made; advancing safety, inclusion, and belonging for AA and NHPI communities; promoting language access and preservation; advancing AA and NHPI representation in the Federal workforce; and striving toward an equitable COVID-19 recovery.” [The White House, 4/28/23]

Metro Weekly: Maryland Governor Signs Trans Health Equity Act. “Maryland Gov. Wes Moore (D) has signed a law requiring Medicaid to cover the costs of medically necessary gender-affirming care for low-income transgender residents. The ‘Trans Health Equity Act’ removes prohibitions on what types of transition-related treatments can be covered by Medicaid, enabling lower-income transgender residents to obtain coverage for medically necessary care. Under the bill, any gender-affirming treatments that have been prescribed to a transgender patient in accordance with current clinical standards of care and have been deemed medically necessary must be covered by Medicaid. The bill stands in direct opposition to actions taken by Republican-led states, whose legislatures or governors have sought to ban gender-affirming treatments for minors, and who have sought to bar Medicaid dollars from being used for any transition-related treatments — even in the case of legal adults who have been recommended to receive such treatments by their primary health care provider.” [Metro Weekly, 5/5/23]

KCRA: Black Health Equity Advocacy Week Established in California. “The California Black Health Network is celebrating its 40th anniversary. The organization is dedicated to advancing health equity for Black and brown communities. In April, Assemblymember Akilah Weber introduced ACR-53, with the support of the California Legislative Black Caucus. According to a news release, the resolution established a statewide focus on the need to address the health disparities gap for Black Californians and declares May 1 to 5, 2023, and every first week of May thereafter, as Black Health Equity Advocacy Week in California. In 2021, CBHN launched the Campaign for Black Health Equity, an initiative that aims to decrease health disparities and improve the life expectancy of Black Californians, according to the news release. The resolution will help amplify CBHN’s campaign efforts across the state, it says.” [5/1/23]

UAMS News: Two-Day Conference Brings Together Organizations Working to Reduce Health Disparities in Arkansas. “The University of Arkansas for Medical Sciences (UAMS) Arkansas Center for Health Disparities (ARCHD) held a two-day conference in North Little Rock for its community partners and individuals from throughout the state. During the opening day of the conference several College of Public Health faculty, staff and students presented final results or updates to research projects funded by the center. Additionally, maternal and child health, violence intervention, chronic diseases and stress management received additional attention as topics of group discussion. ‘The attendees enjoyed learning about how UAMS is partnering with Arkansas’ communities to combat health disparities,’ said Crystal Jones, MS, ARCHD program manager. ‘The event provided an amazing opportunity for researchers to share their findings and collaborate with community leaders and colleagues on strategies to address the state’s health disparities.’” [UAMS News, 5/4/23]

National Institute of Health: Anti-Poverty Policies May Reduce Disparities in Brain Development and Mental Health Symptoms for Children. “States that provide stronger social safety nets have lower socioeconomic disparities in the brain development and mental health of children 9 to 11 years old, according to research supported by the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. The disparity in brain structure between children from high- versus low-income households was more than a third lower in states with greater cash assistance than in those offering less, and the disparity in mental health symptoms was reduced by nearly a half. Emerging evidence has shown that children from families with lower income relative to children from families with higher income exhibit smaller hippocampal volume. The hippocampus plays a critical role in memory and emotional learning. As hypothesized, differences in hippocampal volume between children from high- and low-income families were greater in states with a higher cost of living. However, the availability and benefit value of monetary assistance programs in higher cost-of-living states reduced this disparity by 34%, and similarly, in states with Medicaid expansion, the disparity was reduced by 43%. Overall, more expensive cost-of-living states with anti-poverty programs in more expensive states had narrower gaps in income-associated differences in brain structure. Similar levels were observed in states with the lowest cost of living.” [National Institute of Health, 5/2/23]

The Bakersfield Californian: AAFA Announces New Health Equity Program Sites. “[O]n World Asthma Day, the Asthma and Allergy Foundation of America (AAFA) [announced] the second round of awardees to be supported through AAFA’s Health Equity Advancement and Leadership (HEAL) program. This initiative bolsters AAFA’s commitment to drastically reduce health disparities in communities with the heaviest asthma and allergy burden. AAFA’s HEAL program identifies and funds community-based health interventions tailored to at-risk populations most impacted by asthma and allergic diseases. Now in its second year, AAFA has selected two new programs in New York and Alabama to be funded through HEAL. The first program to be confirmed… will be implemented in New York City… will develop a unique asthma care intervention targeted toward the Hispanic population in the Bronx and surrounding areas. In high-poverty neighborhoods of the South Bronx, Hispanic communities comprise the largest racial and ethnic group that bears the highest burden of asthma-related morbidity. In addition to New York City, the new round of HEAL funding will support a new program in Alabama using a virtual model to complete asthma management home visits and provide asthma health education. The program will build a community health worker network to address the rural health disparity needs through collaborations with schools, local and state departments of health, and other state-based organizations and partners.” [The Bakersfield Californian, 5/2/23]

CHALLENGES

Axios: Immigrants Make Up a Disproportionate Number of Uninsured People in the United States. “Immigrant adults and children under the age of 65, including those who are undocumented, account for 8% of the U.S. population but make up nearly 32% of the uninsured population in the country, according to a new report from the Urban Institute and the Robert Wood Johnson Foundation. Despite tax credits being available for Marketplace coverage through 2024, the majority of immigrants who are uninsured still won’t be able to access coverage ‘solely because of their immigration status,’ the report says. Researchers estimate that after Medicaid redeterminations take place this year, 8.6 million of the 27 million people who will be uninsured will be noncitizens. California, New York, Colorado and Washington state have proposed or are expanding health coverage for nonresidents either through Medicaid parity programs or their Affordable Care Act Marketplaces. Despite these state options, just 16.5% of uninsured noncitizens are eligible for Medicaid or Marketplace coverage, the report found.” [Axios, 5/5/23]

Medical Economics: New Report Emphasizes Need to Reduce Racial Health Disparities. “In March, the Kaiser Family Foundation published an annual update to its Key Data on Health and Health Care by Race and Ethnicity. The analysis examines how people of color in the U.S. fare when compared to White people across a broad range of measures of health, health care and social determinants of health (SDOH). The update reveals that Black, Hispanic, and American Indian and Alaskan Native (AIAN) adults fared significantly worse than White adults across most of the more than 30 measures examined. Something that continues to cause grave concern is the mortality rate among both mothers and infants, particularly among minority patients. We know that Black infants were more than two times as likely to die as White infants, with 10.4 deaths per 1,000 births versus 4.4 deaths per 1,000 births. And the AIAN infants were nearly twice as likely to die as White infants with 7.7 deaths per 1,000 births. Black and AIAN women also had the highest rates of pregnancy-related mortality. Another finding… is that adults of color were more likely than White adults to report not having a usual doctor or provider and to have to choose to go without care because of the cost. Approximately one-third of Hispanic adults, (a) quarter of AIAN adults and nearly 1 in 5 of Asian and Black adults reported not having a personal health care provider, compared (with) 16% of White adults.” [Medical Economics, 4/27/23]

Stat: Study Shows One in Three Black Americans Live in a “Cardiology Desert.” “About 16.8 million Black Americans — roughly 1 in 3 — live in counties with little or no access to heart specialists, according to a report from GoodRx, a digital health company that provides drug discounts and also researches health trends. When zooming in on counties that have sizable Black populations, the analysts found that 72% of these counties are ‘cardiology deserts,’ most of them concentrated in southeastern states. The findings illustrate the barriers to accessing care for a population that already faces a disproportionate burden from cardiovascular disease. It’s the leading cause of death in the U.S., and Black Americans face a 30% higher risk of death from heart disease than white people. [A]reas where heart specialists are most difficult to reach are also where specialists may be most needed.” [Stat, 5/2/23]

RevCycle Intelligence: Preventable Heart Failure Admissions Driven by Inequities in Health Care Access Costing Medicare Over $60 Million Annually. “The South is considered the ‘Heart Failure Belt,’ with heart failure mortality being 69 percent higher than the national average at 31.0 per 100,000 in rates in Alabama, Arkansas, Mississippi, Oklahoma, Louisiana, and Georgia. What’s more, Black Americans have the highest incidence of heart failure among all racial and ethnic groups in the US, with the disparity being especially noticeable in the US South. Uneven access to primary care, failure to deliver guideline-based care, and lack of care coordination all contribute to excess hospital admissions, especially among Black patients. Some 16.8 million Black Americans live in areas with suboptimal specialty care access, including cardiology care deserts. Stopping closures and opening new pharmacies in underserved areas could help Black, Hispanic, and other racial and ethnic minorities get access to life-saving, self-management medications, researchers said. Additionally, European models in which some drugs are made available through non-pharmacy settings could also increase access for certain patient populations.” [RevCycle Intelligence, 5/3/23]

Axios: More Than One in Five Americans Skip Health Care Due to Barriers in Transportation. “While telehealth may have reduced transportation barriers for mental health, primary care and some other services, it’s not accessible to all and can’t substitute for in-person care for some medical needs, the Urban Institute researchers wrote. The findings point to gaps that could be filled by Medicaid coverage of nonemergency medical transportation, which varies by state, or expanded access to telehealth where public transit options are limited, they said.  21% of adults without access to a vehicle or public transit went without needed medical care last year. About 5% of nonelderly adults didn’t get needed care in the past year because of difficulty finding transportation, an experience more common among individuals from low-income families, people with disabilities and those on public health programs. Though 91% of adults said they had access to a vehicle, the figure was substantially lower Black adults (81%), those with low family incomes (78%) or a disability (83%) and for individuals with public health insurance (79%) or no coverage (83%). Research suggests as much as 40% of a person’s health can be attributed to socioeconomic factors like education, employment and the availability of transportation.” [Axios, 4/28/23]

Washington, D.C. — Today, the House Ways and Means Health Subcommittee is holding a hearing on “Examining Policies that Inhibit Innovation and Patient Access.” What House Republicans are not including in their hearing agenda is an examination of the anti-innovation “Default on America Act” they just passed. Their legislation risks health care for 21 million Americans, slashes care for veterans, and cuts vital health care funding by 22 percent. This translates to over $10 billion in annual funding cuts to the National Institutes of Health (NIH), which would drastically reduce funding for innovative cures. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“If Republicans want to talk about policies that actually stifle innovation, look no further than their Default on America Act. Republicans’ Default on America Act slashes NIH funding that we know leads to innovative new drug discoveries. At a time when families are struggling to get by and afford the medications they depend on, Republicans want to cut NIH funding by billions of dollars in order to protect tax breaks for the wealthiest Americans and corporations. Not only do Republicans want to cut funding for the NIH, but they also want to slash funding for mental health and substance use treatment, veterans’ care, and more. They are also seeking to throw millions of people off of their Medicaid coverage, which will only make it harder for people to get the medications they need to stay healthy.” 

Background

• The “Default On America Act” would cut NIH funding by 22%, which is over $10 billion of NIH’s $47.5 billion FY 2023 Budget.  
• Research shows that a 10% increase in NIH disease-specific research yields a 4.5% increase in new drugs, so a 22% cut can be expected to yield a 9.9% reduction in new products. This is a far more significant impact than the estimated 1% reduction in new drug approvals resulting from the prescription drug price negotiation program, which Republicans falsely claim is anti-innovation. 
• NIH funding totaling $230 billion contributed to research associated with all 356 new drugs approved by the FDA from 2010 to 2019. Every $10 million in NIH funding yields 2.7 commercial sector patents, so the Republicans’ cuts would result in 2,700 fewer commercial patents, far more harmful to innovation than prescription drug negotiation. The stock market has valued new patents at about $11.2 million per patent, so this is an economic loss of over $30 billion.
• Wall Street analysts estimate the Inflation Reduction Act will decrease Big Pharma’s revenue by $40 billion over the next 10 years, yet research shows Big Pharma could lose $1 trillion and still be the most profitable industry in the U.S.

Washington, D.C. — Yesterday, Arkansas posted an update on its Medicaid redeterminations, commonly known as the Medicaid unwinding, showing that 45,000 people have already lost their health care coverage. Of those who lost their Medicaid, 40 percent are newborns or children. And, according to Arkansas officials, 72 percent have lost their coverage because of procedural issues. 

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 expired on April 1, and an estimated 15 million people nationwide are at risk of losing coverage, disproportionately impacting rural Americans, people with disabilities, people of color, and children. States are working to re-evaluate their Medicaid rolls, but Republican-led states like Arkansas are often moving too quickly to throw people off of Medicaid without ensuring that they know their rights or eligibility for financial assistance under the Affordable Care Act or other health care programs. 

For additional background: Protect Our Care recently hosted events with Reps. Kathy Castor and Colin Allred, Tri-Caucus Chairs Nanette Barragán, Judy Chu, and Steven Horsford, and Senator Bob Casey and Rep. Debbie Dingell to discuss the urgent need for governors to do the right thing and protect health care coverage.

“It’s clear that Arkansas has one goal in mind: rip away health care from as many people as possible as quickly as possible,” said Protect Our Care Chair Leslie Dach. “People should not lose their health care  because they didn’t quickly meet paperwork requirements or because they didn’t receive information about staying enrolled. Governors need to do the right thing and do everything in their power to keep people enrolled. Unfortunately, this seems to be just the latest salvo in the ongoing Republican war on America’s health care.” 

COVERAGE

Politico: Arkansas’ Tale On Medicaid Unwinding. “New data from Arkansas shows Medicaid unwinding is going how state officials had hoped — and many consumer advocates had feared. Nearly 45,000 Arkansans who had remained on Medicaid because of pandemic protections had their coverage terminated in April. Eighty-five percent lost their insurance for procedural reasons — because they failed to return their renewal forms or other requested information, or because the state couldn’t locate them — according to data published by the state Department of Human Services.” [Politico, 5/9/23]

Arkansas Democrat Gazette: Nearly 73,000 Medicaid Beneficiaries In Arkansas Lose Coverage In April. “The cases of 72,802 Medicaid beneficiaries in Arkansas were closed at the end of April because they are either no longer eligible for Medicaid or didn’t return requested information necessary to determine their eligibility, the Arkansas Department of Human Services reported Monday. The closed cases include 44,667 Medicaid beneficiaries whose coverage had been previously extended because of special eligibility rules during the federal public public health emergency and 28,135 other Medicaid beneficiaries whose coverage was closed as part of normal operations…” [Arkansas Democrat Gazette, 5/8/23]

Protect Our Care Hosts Events with California Attorney General Rob Bonta, Nevada Attorney General Aaron Ford, U.S. Representative Bobby Scott (D-VA-03), Jimmy Gomez (D-CA-34), and more.

Protect Our Care held virtual events around the country to discuss U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires free coverage of lifesaving preventive health care services. Judge O’Connor’s decision in Braidwood Management v. Becerra would end the ACA’s guaranteed free access to essential preventive services including lifesaving breast cancer screenings, colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, and access to PrEP (pre-exposure prophylaxis), which can reduce the chance of contracting HIV.

NATIONAL

Thursday, March 30 – American Cancer Society Action Network, American Public Health Association, Legal Experts and Health Advocates Join Protect Our Care to Discuss Disastrous Impacts on ACA Protections in Braidwood Decision: Protect Our Care was joined by American Cancer Society Cancer Action Network President Lisa Lacasse, National Partnership for Women & Families’ Sinsi Hernández-Cancio, American Public Health Association Executive Director Dr. Georges Benjamin, and Andrew Pincus for a virtual press conference discussing U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires no-cost coverage of lifesaving preventive health care services. “Not only is Judge O’Connor’s decision wrong on the legal merits, it would be highly disruptive to our health care system and roll back health care gains made over the years,” said Andrew Pincus, experienced Supreme Court and appellate lawyer. “This ruling would eliminate guaranteed free access to life-saving preventive services for more than 150 million Americans.” You can watch the event here.

Coverage:

• Washington Post: Texas Judge Invalidates Aca Promise of Free Preventive Health Services
• Bloomberg Law: US Appeals Decision Striking Free Access to Key Health Services
• STAT: Texas Judge Strikes Down Major Obamacare Provision Protecting Preventive Care
• Gizmodo: Zero-Cost Cancer Screenings and Birth Control ‘On the Line’ as Judge Strikes Down ACA Provision
• Dogwood: 150 Million Americans Are at Risk of Losing Free Preventive Healthcare. What Does That Mean for You?

Protect Our Care Hosted Two Press Calls Last Year: Chairman Bobby Scott, Legal Experts, Health Care Advocates Join Protect Our Care to Discuss Devastating Impacts of Kelley v. Becerra Lawsuit. You can watch the event here. Experts, Advocates Join Protect Our Care to Discuss Disastrous Impacts of New Lawsuit Threatening ACA Protections. You can watch the event here.

ARIZONA

Monday, May 1 – Arizona Copper Courier Op-Ed by Ali Farrell on the Braidwood Decision and the Threat to Preventative Care: Protect Our Care Arizona placed an opinion piece in the Arizona Copper Courier by Ali Farrell, a small business owner who receives health coverage through the ACA. In the piece, Farrell highlights the importance of the no-cost coverage of preventative care under the ACA, and how the Braidwood decision adversely impacts Arizonans. She writes, “The decision made in Braidwood Management v. Becerra means more people won’t be able to access preventative care, and for people like me with an extensive family history of breast cancer, staying on top of those services can be lifesaving. Living with a family history of breast cancer is terrifying. As a woman in my early forties, there is a feeling of existential dread looming in the back of my mind every single day. I live in constant worry that it is not if, it is when I get sick. Fortunately for me and for so many others living with this fear, we are able to have some peace of mind because we are proactive about making the most of any preventative measures available to us.” You can read the full op-ed here.

CALIFORNIA

Thursday, April 6 – Braidwood Accountability Event with U.S. Rep. Jimmy Gomez (CA-34), California Attorney General Rob Bonta: California Attorney General Rob Bonta and US Rep. Jimmy Gomez joined Protect Our Care California to discuss U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires free coverage of lifesaving preventive health care services. US Rep. Jimmy Gomez said, “Early detection for a lot of diseases is the difference between life and death . . . Since I’ve been in Congress, and my entire life, I’ve been fighting for affordable, accessible, and of course quality health care.” California Attorney General Rob Bonta said, “When patients have access to blood pressure checks, flu shots, cancer screenings, pregnancy care, dental and vision screenings for infants and children, HIV medication, and many other critical preventive services, the burden on state and local public health systems is lessened. Preventive care keeps more people healthy. This ruling is dangerous, it’s short sighted, and worst of all, it puts countless lives at risk. We won’t let this stand.” You can watch the event here.

Coverage:

• KSWB (San Diego Fox): Attorney General Bonta Speaks Up Against Braidwood Decision

MICHIGAN

Tuesday, April 25 – Braidwood Accountability Event with State Representative Julie Rogers with Michigan Health Care Leaders: State Rep. Julie Rogers, D-Kalamazoo, Anita Fox, Michigan Department of Insurance and Financial Services (DIFS) director, and Nicole Wells Stallworth, Planned Parenthood Advocates of Michigan executive director, joined Protect Our Care Michigan to discuss U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires free coverage of lifesaving preventive health care services. “The disastrous Braidwood ruling in Texas only further increases health care disparities in underserved communities across Michigan and around the country,” said state Rep. Julie Rogers, D-Kalamazoo, chair of the House Health Policy Committee. “That’s why my colleagues and I are introducing legislation that would enshrine important elements of the federal Affordable Care Act in Michigan law, including coverage for preventative services. We cannot afford to make preventative health care an afterthought in Michigan, or anywhere across the country for that matter.” You can watch the event here.

Coverage:

• Michigan Advance: Health care advocates say ACA ruling has ‘disastrous’ impact on Michiganders
• WTVB: Rep. Julie Rogers, DIFS Director, health care advocates discuss impacts on ACA protections for Michiganders in Braidwood decision
• Gongwer: DIFS Director, Other Officials Stress Importance Of Preventative Care
• MIRS: Bill To Put Preventative Health Care In ACA Coming
• WKZO AM: Rep. Julie Rogers, DIFS Director, health care advocates discuss impacts on ACA protections for Michiganders in Braidwood decision
• Lansing City Pulse: Health care advocates say ACA ruling has ‘disastrous’ impact on Michiganders
• WNWN-FM (Battle Creek, MI): Rep. Julie Rogers, DIFS Director, health care advocates discuss impacts on ACA protections for Michiganders in Braidwood decision

Thursday, May 4 – Oakwood Press Op-Ed by Laura Bonnell on Protecting the ACA from Repeal: Protect Our Care Michigan placed an opinion piece in the Oakland Press by Laura Bonnell, CEO of the Bonnell Foundation, a nonprofit that provides financial assistance and emotional support to parents whose children have cystic fibrosis. In the piece, Bonnell makes the case that repealing the ACA would be disastrous for families like hers. Bonnell writes, “The impact of the ACA in the cystic fibrosis community cannot be overstated, including expanded Medicaid that has provided coverage for tens of thousands of families nationwide.” You can read the full op-ed here.

NEVADA

Monday, May 8 – Attorney General Ford, Health Care Advocates to Discuss Efforts to Protect Nevadans’ Access to Lifesaving Preventive Care and Necessary Reproductive Health Care: Protect Our Care Nevada is joined by Attorney General Aaron Ford, Lindsey Harmon, Executive Director of Planned Parenthood Votes Nevada, and For Our Future Nevada Health Care Advocate Jarrett Clark to discuss efforts to fight for the medical rights of Nevadans regarding recent attacks on American health care, including U.S. District Judge Reed O’Connor’s devastating decision to strike down a major coverage provision of the Affordable Care Act (ACA) and Judge Matthew Kacsmaryk’s ruling to invalidate the FDA’s approval of mifepristone.

Tuesday, April 18 – Reno Gazette-Journal Op-ed by Jarrett Clark on Protecting the ACA From Republican Attacks: Protect Our Care Nevada placed an opinion piece in the Reno Gazette-Journal by Jarrett Clark, a longtime Nevada resident and advocate for policies that benefit Nevada workers and their families. In the piece, Clark highlights how the Affordable Care Act saved his life after he was diagnosed with a rare genetic blood disorder. He also highlights the importance of protecting the ACA from Republican attacks, citing Braidwood Management v. Becerra. He writes, “Judge O’Connor’s decision in Braidwood Management v. Becerra would end the ACA’s guaranteed free access to essential preventive services including lifesaving breast cancer screenings, colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, preventive HIV treatments and more.” You can read the full op-ed here.

NEW YORK

Thursday, April 6 – Braidwood Accountability Event with NYC Council Member Erik Bottcher and LGBTQ Health Care Advocates: New York City Council Member Erik Bottcher and New York-based LGBTQ and health care advocacy organizations including GMHC, Housing Works, Callen-Lorde Community Health Center, Stonewall Community Development Corporation, and Equality New York joined Protect Our Care New York to discuss U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires free coverage of lifesaving preventive health care services. “It’s truly shameful that after all these years, after the programs provided by the Affordable Care Act have proven to be some of the most popular in decades for Americans, the Republicans are putting politics over people’s lives by continuing to attack it and attempt to dismantle it for political reasons. One of the  worst parts about this ruling is that it targets preventative care. That is an area that the US lags in badly. There are far too many people in our country who go to the emergency room for their primary health care. There is nothing more expensive. So when Republicans claim this is about costs they are being totally disingenuous,” said New York City Councilman Erik Bottcher. You can watch the event here. 

Coverage:

• NEWS12 The Bronx: Elected Officials and LGBTQ Advocacy Groups Rally In Response to Braidwood Ruling
• NEWS12 Brooklyn: Elected Officials and LGBTQ Advocacy Groups Discuss Impacts of Braidwood Ruling 
• WNYC Radio: Local Elected Officials and Health Care Leaders Discuss Braidwood Ruling
• Gay City News: New York leaders warn ACA preventive care ruling threatens access to care
• Gothamist: NYC health providers warn ‘HIV cases will go up’ if Texas ruling curbs access to PrEP

Monday, April 24 – amNY Op-ed by Jason Cionciatto on How the Braidwood Ruling Threatens Access to PrEP: Protect Our Care New York placed an opinion piece in amNY by Jason Cionciatto, Vice President of Communications and Policy at GMHC, the world’s first and leading provider of HIV and AIDS prevention, care, and advocacy. In the piece, Cionciatto highlights how the Braidwood ruling threatens access to PrEP, a lifesaving HIV prevention drug. He writes, “The Braidwood decision, if it is allowed to stand, would be a disaster for HIV prevention, enabling individual insurers to deny access to pre-exposure prophylaxis (PrEP), medications that, according to the CDC, reduce the risk of contracting HIV from sex by 99%. PrEP is a cornerstone of federal and state plans to end the HIV epidemic, and it has been instrumental in reducing new HIV infections nationwide.” You can read the full op-ed here.

Manufacturers of Top Selling Drugs in U.S. Reported Nearly $128 Billion in Revenue for the First Three Months of 2023

Despite decreased COVID-19 drug sales, pharmaceutical companies, among the most profitable firms in the country, reported approximately $128 billion in revenue for the first quarter of 2023. During this period, Eli Lilly spent $750 billion on stock buybacks. Meanwhile, more than a third of Americans report not filling a prescription they need because they can’t afford it.

For too long, drug companies have been able to charge whatever they want, gouge whoever they want and profit as much as they can. President Biden and Democrats passed a plan to give Medicare the power to negotiate lower drug prices, which takes effect in 2026. Congress should build on this and expand Medicare’s ability to negotiate lower drug prices.

A Closer Look at Big Pharma’s Q1 2023 Earnings

• AbbVie reported quarterly revenue of $12.2 billion. 
• Amgen reported quarterly revenue of $6.1 billion. 
• AstraZeneca reported quarterly revenue of $10.9 billion, driven by a 15 percent increase in non-COVID revenues.
• Bristol-Myers Squibb reported quarterly revenue of $11.3 billion in the first three months of 2023 and told investors they expect to earn more this year than previously expected.
• Eli Lilly reported nearly $7 billion in revenue following 10 percent growth in non-COVID drug sales. The company informed investors that they are on track to make nearly $1 billion more than their expected annual revenue. Eli Lilly rewarded investors by spending $750 million on stock buybacks.
• Gilead reported nearly $6.4 billion in revenue, despite significantly lower remdesivir sales.
• Johnson and Johnson reported $24.7 billion in revenue. The company spent nearly all of its quarterly net profits on its talc powder-related lawsuits.
• Merck reported revenue of nearly $14.5 billion for the first quarter of 2023.
• Novartis reported $13.2 billion in revenue.
• Pfizer reported revenue of nearly $18.3 billion for the first quarter of 2023.
• Regeneron reported quarterly revenue of $3.2 billion.

Pharma Executives Brag About Strong Performance

“In Q1 2023…we returned just over $1 billion to shareholders in dividends and repurchased $700 million in stock.” [Eli Lilly Q1 Earnings Call, Anat Ashkenazi, 4/27/23]

“This performance is really quite remarkable when you consider that a 15% growth in revenue from our ex-COVID medicines. Core earnings per share grew 6% compared to the first quarter of 2022.” [AstraZeneca Q1 Earnings Call, Pascal Soriot, 4/27/23]

“We’re off to an excellent start in 2023 with each of our five key therapeutic areas meeting or exceeding our first quarter expectations…Total net revenues were $12.2 billion, approximately $400 million ahead of our expectations.” [AbbVie Q1 Earnings Call, Rob Michael, 4/27/23]