News

The GOP Debt Ceiling Plan Includes 22 Percent in Discretionary Funding Cuts 

The House Republican default plan not only rips away health care for millions of people who rely on Medicaid, but it also cuts critical health programs by 22 percent. From funding for veterans’ health care to nursing home safety to mental health, these cuts will take desperately-needed health care away from families across the nation. As a result, more people in America will get sick and more will die. Here’s what the GOP is trying to take away from people:

1. Veterans Health Care: The GOP plan would severely cut health services for veterans delivered by the Veterans Health Administration, including inpatient, outpatient, mental health and suicide prevention, and long-term care services.
2. NIH and the Cancer Moon Shot: The GOP plan would cut NIH’s essential investments in biomedical innovation to advance cures and treatments, including the Cancer Moonshot program, Alzheimer’s disease research, research related to opioids and pain management, and a universal flu vaccine. 
3. Mental Health and Substance Use Disorder: The GOP plan would cut key programs for mental health services, including mental health resources for children. It would also cut services for substance use and prevention services, including funding aimed at combating the opioid and overdose crisis and helping pregnant and postpartum women. Additionally, the GOP plan would cut funding for the new 988 National Suicide Prevention Lifeline.
4. Community Health Centers: The GOP plan would cut discretionary funding for the Health Centers program, which provides primary and preventive care, including mental health and contraceptive care, to rural areas and other underserved people. It would also cut funding for programs that treat people living with HIV/AIDS as well as the Title X Family Planning Program.
5. Inspecting Nursing Homes: The plan would cut funding for programs that protect the Medicare Trust Fund from fraud and abuse, and inspect nursing home facilities for health and safety.
6. Addressing Shortages of Health Care Providers: The GOP plan would cut health care provider training programs for primary care physicians, nurses, behavioral health providers, and other providers that are essential for addressing our workforce shortages.
7. Addressing the Maternal Health Crisis: The GOP plan would cut the Maternal and Child Health Services Block Grant Program that serves low-income mothers and babies, as well as funding for programs that address the maternal health crisis like Maternal Mortality Review Committees. 
8. Preparing for the Next Pandemic: The GOP plan would cut programs that prepare us for the next public health emergency, including funds for vaccines and treatments, hospital preparedness, and the CDC’s funding to modernize public health data and other critical public health infrastructure needs and provide support to states and other jurisdictions.

Washington DC — Today, House Speaker Kevin McCarthy delivered a speech promoting the GOP plan to take health care away from millions of people on Medicaid and lower needed health care funding. A record 92 million people in America are covered by Medicaid, mostly seniors, children, and people with disabilities, but the GOP is seeking serious cuts to Medicaid and other vital health care programs. In his speech, McCarthy proposed bureaucratic reporting requirements, which will only result in millions losing coverage. Read more about how Republicans are demanding health care cuts here. In response, Protect Our Care Chair Leslie Dach issued a statement:

“House Republicans are intent on slashing vital health care programs, even if that means threatening the entire U.S. economy. McCarthy made it clear once again in his speech that the GOP plan is to rip away the coverage that people need to stay healthy and thrive. Their plan takes special aim at Medicaid, which 92 million Americans rely on, including people with disabilities, people with mental health and substance use disorders, children, pregnant women, seniors in nursing homes, rural Americans, and people of color. If Republicans truly cared about the state of the economy for working families, they wouldn’t put support for continued tax cuts for the wealthy before America’s health care.”

Republicans Want To Kick Millions Off Medicaid Through Bogus Work Requirements

• Across States, Expanded Medicaid Work Requirements Cut Enrollment And Increased Costs. In the handful of states that attached work requirements to Medicaid benefits, costs skyrocketed and large portions of participants lost coverage. In 2018, Kentucky withdrew a planned rollout of work requirements for Medicaid after the new restrictions were estimated to cost $271 million to implement. New Hampshire put work requirements on hold in 2019 after 40 percent of affected Medicaid enrollees almost lost coverage. In 2020, a Michigan court halted Medicaid work requirements that would have threatened 80,000 participants’ coverage. Most recently, new Medicaid work requirements in Georgia are estimated to cost up to $270 million annually—three times more than Medicaid expansion would have cost the state.
• In Arkansas, Work Requirements Failed Miserably, Causing 1 In 4 Medicaid Enrollees To Lose Coverage. In Arkansas, work requirements caused more than 18,000 people — nearly 1 in 4 of those subject to work requirements — to lose Medicaid coverage over the course of just seven months. The uninsured rate rose nearly 4% in less than a year, and a state court halted the requirements after less than two years. A group of public health experts later declared that the policy “failed to achieve its stated goal of boosting employment,” instead “harm[ing] health care coverage and access.”
• Expanded Medicaid Work Requirements Make It Harder For People To Meet Basic Needs. 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 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.”

Republicans Want To Take Health Care Away From Millions by Cutting Funding

• Tens of Millions of Americans are at Risk of Losing Vital Parts of Their Health Care if Cuts to Medicaid Are Pushed Through. Over 92 million Americans are currently enrolled in Medicaid. Cuts to Medicaid would surely see considerable reductions in coverage leaving millions potentially uninsured with no pathway to get health coverage.
• More Than 50 Percent Of Children Could See Significant Reductions in Their Health Coverage If Medicaid Funding Is Slashed. Nationally, 54 percent of American children are covered by Medicaid/CHIP. Slashing Medicaid funding would see many of these children become ineligible for low-cost health insurance with no pathway to finding affordable health care.
• Marginalized Groups Are Disproportionately Harmed by Republican Attacks. Increasing Medicaid access is the single most important action available to expand coverage and reduce racial inequities in the American health care system. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion and a 45 percent reduction between white and Hispanic adults. Cutting Medicaid and repealing the ACA’s Medicaid Expansion would result in coverage loss, and therefore inflame these disparities.
• Rural Americans Relying on Medicaid Could be Left Behind by Republicans. Nearly 14 million Medicaid enrollees reside in rural areas. Medicaid helps fund rural hospitals, which employ six percent of all employees in rural counties that report having any hospital employment. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2023, over 600 rural hospitals are at risk of closing in the near future.
• Nearly 45 Percent Of Adults With Disabilities Could See Reduced Health Coverage or Lose Coverage Entirely. Medicaid covers 45 percent of non-elderly adults with disabilities, including adults with physical disabilities, developmental disabilities, and brain injuries. Republican plans could leave many of these people and their families with little support and sometimes even no health coverage at all.
• Medicaid’s Assistance for Those With Substance Use Disorders Could Substantially Diminish. Nationally, around 12 percent of Medicaid enrollees over 18 have some kind of substance use disorder (SUD) and Medicaid is crucial to building a system of comprehensive substance use care. These interventions have been vital and life-saving, with one study finding that around 10,000 lives were saved from fatal opioid overdoses as a direct result of Medicaid expansion alone. Cutting Medicaid, put simply, would increase overdoses and decrease treatment options for thousands of Americans.
• Funding For Nearly Two-Thirds of Long-Term Residents in Nursing Homes Could Dry Up. Medicaid covers nursing home bills for over 60 percent of residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room can cost over $100,000 annually. Medicaid caps or cuts would see more seniors without the financial resources to afford long-term care.
• Births Currently Covered by Medicaid Could be at Risk. Medicaid covers over 40 percent of births in the United States and Congress recently offered permanent federal funding to states that opt to expand Medicaid coverage to mothers for one year postpartum. All of these gains would be rolled back under Republican plans and maternal mortality, already a dire crisis in this country especially for Black and Indigenous mothers, would only be worsened.
• Over a Quarter of Americans Living With a Serious Mental Health Condition Could See Their Coverage Cut Back. Medicaid is the single-largest payer for mental health services in America, serving 26 percent of all adults living with a serious mental health condition. Expanding Medicaid services, such as behavioral health benefits, also has led to improved access and better outcomes for low-income individuals. Simply having access to Medicaid has shown in some studies to reduce depression rates by over 3 percent among those with chronic health conditions. Capping or cutting Medicaid spending could see these achievements in mental health care rolled back.

A federal judge in Texas issued a ruling revoking authorization for mifepristone, a safe and effective medication essential for reproductive care that was approved by the FDA more than 20 years ago. Not only does this ruling risk barring the use of mifepristone for safe and legal abortions for millions of American women, but it lays the groundwork for any judge to be able to overrule the evidence-based and scientific FDA medication approval process, throwing the  entire system into chaos. Low-income individuals, women of color, and those without regular access to a nearby health care provider will be disproportionately harmed by these restrictions.  

The Supreme Court is expected to decide on a stay on the decision this week. Watch Protect Our Care’s event with legal and public health experts discussing the dangers of Judge Kacsmaryk’s ruling here.

Health care and legal experts overwhelmingly agree that this case is built on an unfounded legal arguments and, if Judge Matthew Kacsmaryk’s ruling stands, the consequences for patients would be disastrous. 

Physicians, Former FDA Officials, and Pharmaceutical Companies

American Medical Association: This Ruling Flies in the Face of Science. “Today’s court decision from a federal district court in Texas staying longstanding approval of mifepristone… threatens to upend access to a safe and effective drug that has been used by millions of people for more than 20 years. Additionally, this decision introduces the extraordinary, unprecedented danger of courts upending longstanding drug regulatory decisions by the U.S. Food and Drug Administration (FDA). Doing so goes against the established scientific process that leads to those decisions and puts other drugs at risk of being subject to similar efforts. Substituting the opinions of individual judges and courts in place of extensive, evidence-based, scientific review of efficacy and safety through well-established FDA processes is reckless and dangerous.” [American Medical Association, 4/7/23]

Letter from Over 300 Current and Former Pharmaceutical Industry Executives: This Decision Flies in the Face of Scientific and Legal Precedent. “On Friday, April 7, a federal judge with no scientific training fundamentally undermined the bipartisan authority granted by Congress to the Food and Drug Administration to approve and regulate safe, effective medicines for every American.  Judge Kacsmaryk’s act of judicial interference has set a precedent for diminishing FDA’s authority over drug approvals, and in so doing, creates uncertainty for the entire biopharma industry. As an industry we count on the FDA’s autonomy and authority to bring new medicines to patients under a reliable regulatory process for drug evaluation and approval. Adding regulatory uncertainty to the already inherently risky work of discovering and developing new medicines will likely have the effect of reducing incentives for investment, endangering the innovation that characterizes our industry. Judicial activism will not stop here. If courts can overturn drug approvals without regard for science or evidence, or for the complexity required to fully vet the safety and efficacy of new drugs, any medicine is at risk for the same outcome as mifepristone.” [Letter In Support of the FDA’s Authority to Regulate Medicines, accessed 4/18/23]

Statement from Jim Stansel, Executive Vice President of the Pharmaceutical Research and Manufacturers of America: The FDA is the Gold Standard for Determining Whether a Medicine is Safe and Effective. “PhRMA has serious concerns with any court substituting its opinion for the FDA’s expert approval decision-making. Patients and their doctors rely on the FDA to serve as an expert and trusted arbiter of what medicines are safe for use so they can make the most informed health care decisions. Moreover, undermining the FDA’s longstanding authority given to them by Congress to approve drugs would have a chilling effect on the research and development ecosystem. Biopharmaceutical researchers and scientists need certainty that FDA approvals will be upheld so they can make the long-term investments required to develop new medicines and ultimately get them approved for use by patients. At a time when medical innovation has never been more promising, it is vital we have a legal and policy environment that fosters the development of new treatments and cures and protects patients’ access to the medicines they need.” [Phrma, 4/12/23]

Pharmaceutical Companies 5th Circuit Amicus Brief: Texas Ruling Will Shatter the FDA’s Gold Standard Approvals Method. ““[T]he opinion identified no errors in FDA’s scientific judgment or calculations. Instead, the court proffered its own, competing analysis, which lacked any evidence that could support the type of rigorous scientific decision-making with which FDA is tasked. The court cast aside not only the voluminous scientific evidence FDA considered at the time of approval, but also nearly a quarter century of subsequent data showing safe and effective use of the drug. In its place, the court relied on personal stories told by plaintiffs and cherry-picked, unreliable publications—many of which were not even submitted to FDA. The court then ruled that FDA was required to refuse to approve the NDA based on the court’s own non-scientific assessment of this alternative, incomplete record.” [Pharmaceutical Companies, Executives, And Investors Brief, 4/11/23]

Former FDA Officials 5th Circuit Amicus Brief: This Ruling Puts the Country on a Dangerous Path Towards a Piecemeal Regulatory Scheme Congress Already Rejected in 1938. “Courts lack the expertise to step into FDA’s shoes by second-guessing FDA’s experts on the safety and efficacy of drugs. Assuming that role would require in expert judges to learn how to do what FDA’s expert pharmacologists, toxicologists, chemists, epidemiologists, physicians, and data scientists have spent lifetimes training to do. Getting it wrong can lead to catastrophic consequences—measured not in dollars, but in human lives— and deprive patients of life-saving medication they depend upon. FDA’s modern authority over drug approvals evolved in response to a series of public health crises that occurred over the last century. In response to these crises, Congress steadily expanded and centralized FDA’s authority over drug approvals to give FDA more discretion to protect public health. Congress codified FDA’s accelerated approval authority in 2012, when it passed the Food and Drug Administration Safety and Innovation Act.” [Brief of Former FDA Officials, 4/17/23]

Legal Scholars

Opinion of Dr. Jamie Rowen, Associate Professor of Legal Studies and Political Science, and Dr. Tami S. Rowen, Associate Professor of Obstetrics, Gynecology and Gynecologic Surgery: Ruling Heightens All the Risks Associated with Abortion. “In this case, and using the doctors’ own theory of harm, there are actually numerous benefits that the plaintiff doctors receive from having mifepristone available to pregnant people in Texas. Those who cannot access mifepristone will have to either use less effective medication regimens or will be forced to get surgical abortions at later gestational ages. Delays means the fetus continues to grow, a fact about abortion access restrictions that deeply troubled Justice Kennedy. Studies have also shown mifepristone to be helpful with labor induction, increasing the safety of the delivery process for someone who does continue with a pregnancy. Ongoing research into other applications for mifepristone may be interrupted by these judges’ decisions that limit the ways the drug can be used. [I]t is difficult to see how the FDA’s approvals of other medications are not vulnerable. For example, COVID-19 vaccines do not require an in-person doctor’s visit. Doctors who have been vocally opposed to the COVID-19 vaccine can easily find information to support arguments that they will have to care for vaccine injuries.” [PennLive, 4/17/23]

Statement from Holly Fernandez Lynch, Assistant Professor of Medical Ethics and Law: Texas Ruling is a Truly Unprecedented Decision. “What has happened in this case from the Northern District of Texas is that we have a single federal judge who has inserted himself, standing in for the agency to say FDA should have never approved mifepristone because they did not have adequate data to determine that it was safe. There was no new evidence that was presented to the court that would change FDA’s determination about whether this product meets the statutory standard for approval. What changed in this case was that ultimately the litigants were able to get their arguments in front of a federal judge.” [NPR, 4/11/23]

Statement from Khiara M. Bridge, Professor of Law: Ruling Creates Risk of Judges Reversing Other FDA Approvals. “We had accepted that federal law would preempt state law, that it would be preposterous that one federal judge in one district in Texas—or in any other state—would be able to affect the availability of a drug that had had FDA approval for 20 years. Now the things that we thought we knew about the relationship between federal law and state law, and the FDA’s ability to regulate, have been called into question. How many folks claim to have been injured by vaccines or have been injured by [being] allergic to penicillin? How many people can say they have been injured by drugs and could use those numbers as a reason to doubt the legitimacy of the approval process? We’re in really shaky territory when it comes to certainty about things that are available today.” [Wired, 4/13/23]

NAACP Legal Defense Fund 5th Circuit Amicus Brief: Texas Ruling Directly Undermines the Supreme Court and the Public Interest. “Because the district court’s opinion will impact the availability of mifepristone in all 50 states, it is contrary to the minimal assurances provided for in Dobbs. Justice Kavanaugh’s concurrence emphasized that the Dobbs decision ‘does not prevent the numerous States that readily allow abortion from continuing to readily allow abortion’ and that all states ‘may evaluate the competing interests and decide how to address this consequential issue.’ Rather than leave it to individual states to ‘readily allow abortion,’ as encouraged by Justice Kavanaugh, the district court’s order disallows the two-step medication abortion option entirely. The Supreme Court opined thirty years ago that ‘[t]he ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives.’ Increased abortion access has had a demonstrably positive economic impact on women, and on Black women, in particular. A review of the data from 2020 among states that report racial and ethnic data on abortion patients indicates 39 percent identify as non-Hispanic Black, and among those aged 15-44 there were 24.4 abortions per 1,000 non-Hispanic Black women. When people can decide if, when, and how many children to have, they are able to make conscious determinations about other aspects of their lives.” [NAACP Legal Defense And Educational Fund Brief 4/11/23]

Insider: Washington District Judge Thomas O. Rice. Contradicts Texas Ruling, Forbidding Mifepristone Bans. “[J]ust minutes after the Texas ruling was made public, Washington State Judge Thomas O. Rice issued his own ruling on mifepristone, arguing the exact opposite of Kacsmaryk, and prohibiting the FDA from pulling the drug from the market. Rice said a nationwide injunction on the pill would be ‘inappropriate.’ The Texas lawsuit was filed by the Alliance Defending Freedom, representing a coalition of medical groups and doctors who oppose abortion. The group alleged that mifepristone is dangerous and rallied against the FDA’s initial approval of it more than 20 years ago. Meanwhile, in Washington State, several Democratic attorneys general filed a lawsuit against the FDA accusing the agency of excessively regulating the pill. The judge in the case responded by prohibiting the FDA from taking ‘any action’ that would cause the drug to ‘become less available.’” [Insider, 4/7/23]

Provider Groups

American College of Obstetricians and Gynecologists 5th Circuit Amicus Brief: The District Court Relied on Biased and Flawed Studies to Justify Ruling. “Without any form of the evidentiary hearing and in complete disregard to the overwhelming body of evidence proving that mifepristone is safe, the District Court’s order (the “Order”) purports to suspend the use of treatment essential to amici’s patients, in order to further its own ideological agenda and that of Appellees. The decision is rife with medically inappropriate assumptions and terminology. It disregards decades of unambiguous analysis supporting the use of mifepristone in miscarriage and abortion care. It relies on pseudoscience and on speculation, and adopts wholesale and without appropriate judicial inquiry the assertions of a small group of declarants who are ideologically opposed to abortion care and at odds with the overwhelming majority of the medical community and the FDA.” [Medical and Public Health Societies Brief, 4/11/23]

Doctors for America 5th Circuit Amicus Brief: Banning the Use of Mifepristone Would Endanger the Health of Patients. “An injunction reversing the approval of mifepristone would remove the availability of an evidence-based treatment that is the safest and best option for many patients. As physicians describe… the removal of mifepristone would undermine their ability to provide safe and effective management of early pregnancy loss.” [Doctors for America Brief,  2/13/23]

Over 200 Reproductive Health, Rights, and Justice Organizations 5th Circuit Amicus Brief: The District Court effectively Substituted Itself for the Agency as the Expert Evaluator of Drug Safety. “Despite the fact that the challenged approval has been in effect for over twenty years, the court—citing nothing more than plaintiffs’ assertions in their brief—declared that medication abortion causes ‘physical and emotional trauma,’ ‘mental and monetary costs,’ and death. Rather than stay this erroneous decision in its entirety, the Fifth Circuit compounded the problem. In its 2016 approval, the FDA relied on no fewer than 12 independent clinical studies, collectively representing “well over 30,000 patients,” and conclusively showing ‘serious adverse events’ at rates ‘generally far below 1.0%.’ Hundreds of additional high-quality studies conducted since mifepristone’s 2000 approval show the same.” [Brief Of Over 200 Reproductive Health, Rights, And Justice Organizations, 4/14/23]

Statement from Nancy Northup, President and CEO of the Center for Reproductive Rights: This Ruling Is Wrong on the Facts and Law. “The appellate court order repeats serious errors in Judge Kascmaryk ruling [sic]. Again, it is wrong on the facts and the law, resulting in an unprecedented override of the FDA’s scientific judgment. The court rightly found that some claims were filed too late, but that should not distract from the radical assault on the FDA’s decision-making authority and the fact that it will wreak havoc on the provision of medication abortion if it stands.” [Center for Reproductive Rights Press Release, 4/13/23]

McCarthy Addresses the New York Stock Exchange to Assure Wall Street He Has Their Back While Promising to Rip Health Care Away From Americans Who Count On It

Washington, DC — Today, House Speaker Kevin McCarthy delivered a speech promoting the GOP plan to raise costs for working families and throw people off of their health care. A record 92 million Americans are covered by Medicaid, but Kevin McCarthy confirmed that Republicans in Congress are seeking to ‘limit federal spending,’ which translates to serious cuts to Medicaid and other vital health care programs. In recent weeks, Republicans have proposed bureaucratic work reporting requirements in Medicaid, threatening to throw millions off of their coverage. Read more about how Republicans are fighting for health care cuts during Medicaid Awareness Month here. 

Protect Our Care Communications Director Anne Shoup issued the following statement: 

“Kevin McCarthy’s speech confirms that Republicans are fighting to hold our economy hostage so they can slash vital health care programs. 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. If Republicans truly cared about the state of the economy for working families, they would try to tackle rising health care costs instead of pandering to Wall Street executives and trying to rip away coverage from millions.”

Mifepristone Case Threatens Health and Safety of Millions of Patients and to Disrupt Entire Drug Approval Process  

Washington, DC — Today, Justice Samuel Alito issued an administrative stay of Judge Matthew Kacsmaryk’s ruling invalidating the FDA’s approval of mifepristone. This will allow the plaintiffs time to respond to the Justice Department’s request for a full stay of the ruling and for the court to make its decision on the stay request. Not only does the case threaten safe and legal abortion access, but it lays the groundwork for any judge to be able to overrule the evidence-based and scientific FDA medication approval process. The consequences of Judge Kacsmaryk’s ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care. 

Watch Protect Our Care’s event with legal and public health experts discussing the dangers of Judge Kacsmaryk’s ruling here. In response, Protect Our Care Communications Director Anne Shoup issued the following statement: 

“This case is one of the single greatest threats to American health care today. Not only does it seek to undermine patients’ access to safe and legal abortions, but it threatens to throw the entire U.S. drug approval process into chaos. It opens the door to politically-motivated lawsuits seeking to remove or greatly restrict the availability of other safe and effective drugs. If the ruling stands, millions of patients will suffer, and the Supreme Court must issue a full stay of the district court’s decision.”

Watch the Event Here.

Washington, DC — Today, U.S. Representatives and Co-Chairs of the Medicaid Expansion Caucus joined Protect Our Care for a press conference discussing the urgency for the remaining 10 non-expansion states to follow North Carolina’s lead and finish the job to extend coverage to the estimated 1.9 million Americans in the coverage gap. During the call, the speakers discussed how expansion has never been more important as states face threats of major coverage losses due to the ongoing Medicaid unwinding.

“Every day we don’t expand Medicaid in Georgia is a day we lose out on millions in federal investments to our state but more importantly thousands of Georgians who lose out on life-saving, affordable health care,” said U.S. Representative Hank Johnson (D-GA-04). “It’s really tragic that some Georgians actually lose their lives because they don’t have access to the health care system. Our legislature needs to expand Medicaid in our state. It’ll help about 650,000 Georgians access the health care system.” 

“We have over 100,000 Tennesseans who are not getting Medicaid who could get it and Tennessee would receive $900 million over two years from the federal government,” said U.S. Representative Steve Cohen (D-TN-09). “This would not only be good for the health of Tennesseans but the health of poor Tennesseans who otherwise don’t get treated and for our rural hospitals, many of which have closed.”

“I’m really glad to see that we’re on a positive pathway towards expanding Medicaid in North Carolina. And now as a voice in Congress, I will continue to fight for all Americans that remain trapped by their states in the Medicaid coverage gap,” said U.S. Representative Don Davis (D-NC-01). “We must incentivize other non-expansion states to move forward and provide life-saving health care coverage to nearly 2 million Americans in need.”

“It is long past time that Republicans stop threatening cuts to Medicaid,” said Protect Our Care Executive Director Brad Woodhouse. “People desperately need health care. It shouldn’t be a partisan issue. It shouldn’t have been a partisan issue all these years. It’s simply just time to get it done.”

Washington, DC — Last night, the Fifth Circuit issued a partial stay of Judge Matthew Kacsmaryk’s ruling invalidating the FDA’s approval of mifepristone.The Justice Department announced today that it would ask the U.S. Supreme Court for a full stay of the ruling. While the court’s decision does not entirely bar access to mifepristone, it dramatically restricts access to the drug. This case lays the groundwork for any judge to be able to overrule the evidence-based and scientific FDA medication approval process. The consequences of this ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care. Watch Protect Our Care’s event with legal and public health experts discussing the dangers of Judge Kacsmaryk’s ruling here. In response, Protect Our Care Communications Director Anne Shoup issued the following statement: 

“Despite issuing a partial stay, the 5th Circuit is still undermining patients’ access to safe and legal abortions and threatening to throw the entire U.S. drug approval process into chaos. It not only puts at risk the use of mifepristone, but it opens the door to politically-motivated lawsuits seeking to remove or greatly restrict the availability of other safe and effective drugs. If the ruling stands, millions of patients will suffer, and the Supreme Court should issue a full stay of the district court’s decision.”

This week we highlight the upcoming Black Maternal Mortality Week of action, new Centers for Medicare and Medicaid (CMS) rules on Medicare Advantage focusing on improving health equity, the 75th anniversary of the World Health Organization as well as its heightened focus on reducing health disparities, and new private ventures aimed at addressing underserved rural communities in the South where Republican legislators often exacerbate inequities through their apathy towards state action. While progress is continuing to be made, there is also mounting evidence that the radical Republican agenda in state legislatures, the Courts, and within Big Pharma is undermining measures and policies which have saved countless lives and empirically reduced health disparities across the board.

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 Black Maternal Mortality Week. “Studies show that Black women are often dismissed or ignored in hospitals and other health care settings, even as they suffer from severe injuries and pregnancy complications and ask for help. Systemic inequities are also to blame. When mothers do not have access to safe and stable housing before and after childbirth, they are at greater risk of falling ill. When women face barriers traveling to the hospital for prenatal and postpartum checkups, they are less likely to remain healthy. Air pollution, water pollution, and lead pipes can have dangerous consequences for pregnant women and newborns. And when families cannot afford nutritious foods, they face worse health outcomes. Vice President Kamala Harris has been a leader on the issue of maternal mortality for years and led the charge to improve maternal health outcomes, including by issuing a call to action to address disparities in maternal care. She continues to elevate the issue nationally, convening State legislators, medical professionals, and others so all mothers can access the care they need before, during, and after childbirth. This week, as we continue our work to make pregnancy and childbirth safe, dignified, and joyful for all, let us remember that health care should be a right and not a privilege. Let us give thanks to the extraordinary maternal health care workforce, which serves its patients and their families every day. And let us join in common cause to end the tragedy of maternal mortality once and for all.” [The White House, 4/10/23]

The Ford Foundation: Dom Kelly’s A New Disabled South is Working on Increasing Equity and Access in the Southern U.S. “New Disabled South is a coalition of disability justice activists, advocates and organizations working across the South. The South is home to one third of all disabled people in the United States. Because people with disabilities live at the intersection of all systems of inequality, they are impacted by the problems that plague the South—from high poverty levels to an incredibly harsh criminal justice system—all the more. Today, New Disabled South is working across 14 states to lift our people out of poverty, remove barriers that disabled people face when voting, end the criminalization of Black disabled people, and more. Of the millions of disabled people living in poverty, the majority of the population in the South are BIPOC. We know that 8 out of the 12 states that have yet to expand Medicaid are in the South, and that means that hundreds of thousands if not millions of disabled people are without access to affordable health care. Fifty percent of people killed by law enforcement in the U.S. are disabled, and more than half of disabled Black men have been arrested by the time they turn 28—double the risk in comparison to their white disabled counterparts.” [The Ford Foundation, 4/3/23]

The World Health Organization: WHO Celebrates 75th Anniversary and Calls for Increased Focus on Health Equity. “WHO is urging countries to take urgent action to protect, support and expand the health workforce as a strategic priority. Investments in education, skills and decent jobs for health need to be prioritized to meet the rapidly growing demand for health and avert a projected shortage of 10 million health workers by 2030; primarily in low- and middle-income countries. A global education programme on basic emergency care targeting 25% of nurses and midwives from 25 low- and middle-income countries by the end of 2025 was also recently announced by WHO. In the shadow of the COVID-19 pandemic, WHO’s roadmap to recovery includes an urgent paradigm shift towards promoting health and well-being and preventing disease by addressing its root causes and creating the conditions for health to thrive. WHO is urging countries to provide health by prioritizing primary health care as the foundation of universal health coverage.” [The World Health Organization, 4/3/23] 

Modern Healthcare: CMS Announces Final Rule on Medicare Advantage. “The Centers for Medicare and Medicaid Services’ Medicare Advantage and Medicare Part D final rule for 2024 aims to further the agency’s efforts to strengthen federal oversight of health insurance companies. CMS published the regulation Wednesday, which includes major changes to the standards for quality metrics, prior authorizations, marketing and health equity. CMS received nearly 40,000 marketing misconduct complaints from beneficiaries in 2021, a 157% increase over the prior year, the agency previously reported. Based on this evidence of growing problems, the final rule imposes new restrictions on marketing by health insurers, brokers and others. CMS will replace the reward factor with a health equity index and reduce the weight of patient experience and complaints on quality scores. The health equity provisions and other aspects of the regulation are intended to reward health insurance companies for ensuring people from underserved communities receive quality care. Insurers must halve the length of time they take to respond to prior authorization requests and extend approvals through the full course of a patient’s treatments, and may no longer require preapproval for emergency behavioral healthcare. In addition to including a health equity metric in the Star Ratings program, the final rule requires Medicare Advantage insurers to provide access to healthcare in a “culturally competent manner” by including the languages providers speak in network directories, offering digital health education and addressing health disparities in quality improvement programs. The regulation also implements prescription drug pricing provisions from the Inflation Reduction Act of 2022.” [Modern Healthcare, 4/5/23]

CHALLENGES

The New Republic: The ACA Requires Insurers to Not Deny Coverage for Contraceptives, Insurers are Doing it Anyways. “The Affordable Care Act, or ACA, was signed into law 13 years ago, but some provisions of the landmark health care legislation regarding contraceptive care are still unenforced. Although the ACA requires that health plans cover contraceptive care without cost-sharing, several million patients still face hurdles to accessing certain products, with companies using outdated federal guidance to justify the lack of coverage. That’s according to a letter signed by 91 Democratic members of the House of Representatives that was sent to the Biden administration on Monday, including a two-pronged request for cracking down on health plan noncompliance. The letter, led by Democratic Women’s Caucus chair Lois Frankel and first obtained by The New Republic, asks for new guidance clarifying that insurers must cover all prescribed contraceptive products without therapeutic equivalents, as well as the out-of-pocket costs for certain over-the-counter products. Despite updated guidance and enforcement from the Departments of Health and Human Services, Treasury, and Labor—or the tri-agencies, as they are known—the letter says that ‘unlawful barriers’ remain to accessing contraceptive care… citing an October report by the House Committee on Oversight and Reform… That report found that at least 34 contraceptive products face coverage exclusions or cost-sharing; for 12 of those products, there is no therapeutic equivalent. The October report also found that an average of 40 percent of exception requests were denied by insurers and pharmacy benefit managers between 2015 and 2021. The letter argues that if insurers haven’t changed their practice over the past decade or so, they aren’t going to start now if they’re left to their own devices.” [The New Republic, 3/28/23]

The Washington Post: Syphilis Cases are Increasing in Infants Across the Country. “A decade ago, the United States stood on the brink of eliminating the scourge of babies born with syphilis. Now, cases are surging, a phenomenon that is underscoring deep inequities in the nation’s health-care system and reviving concerns about a disease easily controlled with routine antibiotics. The spike, driven in part by the nation’s drug and homelessness crisis, is especially apparent across the Sun Belt, according to public health experts and data from the Centers for Disease Control and Prevention. The rate of syphilis is five times higher for babies born to Black mothers than to White mothers, reflecting racial disparities in access to maternal health care. While the overall number of infected infants seems low — nearly 2,700 nationally in 2021, or 74 of every 100,000 live births — public health officials say no baby in developed nations should be born with syphilis because most cases are preventable with testing and penicillin treatment of the mother. The fact that cases have climbed, experts say, is an indictment of the U.S. health-care system. Oman, Cuba and Sri Lanka are among the countries that have virtually eliminated mother-to-child transmission of syphilis in recent years, according to the World Health Organization. After steadily declining since World War II, congenital syphilis roared back in the United States to about 4,000 cases a year in the early 1990s as syphilis surged in adults. The number of infected infants dwindled to several hundred a year in the 2000s, then started climbing again in 2013. To reverse the trends, public health authorities are striving to reach women at highest risk for passing syphilis to their babies — those who are homeless, exchange sex for money, or use drugs are more likely to be exposed to the disease and less likely to seek prenatal care.” [The Washington Post, 4/1/23]

Yale Daily News: Researchers Predict Rapid Increase in HIV Infections Due Directly to Braidwood Ruling. “In a recent study led by the Yale School of Public Health, researchers found that the Sept. 2022 Texas ruling in Braidwood Management v. Becerra could potentially result in more than 2,000 predictable cases of human immunodeficiency virus in the U.S. in the coming year. In the study, the researchers tried to estimate how many new HIV infections would result from the outcome of this court ruling, focusing on men who have sex with men… In addition, the researchers estimated that coverage would drop from 28 percent to 10 percent after the Braidwood Management v. Becerra decision… However, according to Paltiel, this number is almost certainly an underestimate.” [Yale Daily News, 3/31/23]

Axios: The COVID-19 Pandemic Has Increased Maternal Mortality Rates. “The U.S. maternal mortality rate increased during the COVID-19 pandemic, disproportionately impacting Black women, with far higher odds of severe complications among pregnant patients with COVID infection at delivery, a new analysis published in JAMA Network Open found. The JAMA analysis, led by researchers from the University of Southern California, Los Angeles, found the mortality risk of pregnant patients with COVID-19 at delivery between March 2020 and December 2020 was 14 times higher than those without the virus. Previous studies have found contributors to the high maternal mortality rate during the pandemic have included a lag in COVID-19 vaccination in pregnant people due to concerns over the potential effects of the vaccine that may persist despite studies showing they are safe. The CDC estimates that as of April 1, approximately 71% of pregnant people have completed the primary vaccination series (below the vaccination rate for those over the age of 18), and only about 23% of pregnant people have received an updated booster dose. The pandemic also exacerbated existing social determinants of health, and as a result disproportionately impacted women of color, who were often on the frontlines working ‘essential’ jobs and getting sick.” [Axios, 4/10/23]

The Washington Post: Two Pregnant Women Were Denied Care After Florida Banned Abortion, One Almost Died. “[Anya Cook] was about to deliver her baby alone in the bathroom of a hair salon. On this Thursday afternoon in mid-December, about five months before her due date, she knew the baby would not be born alive. Over the course of the day, according to medical records, Cook would lose roughly half the blood in her body. She had intended to deliver the fetus in a hospital, a doctor by her side. When her water broke the night before — at least six weeks ahead of when a fetus could survive on its own — she drove straight to the emergency room, where she said the doctor explained that she was experiencing pre-viability preterm prelabor rupture of the membranes (PPROM), which occurs in less than 1 percent of pregnancies. The condition can cause significant complications, including infection and hemorrhage, that can threaten the health or life of the mother, according to multiple studies. At the hospital in Coral Springs, Fla., Cook received antibiotics, records show. Then she was sent home to wait. Cook’s experience reflects a new reality playing out in hospitals in antiabortion states across the country — where because of newly enacted abortion bans, people with potentially life-threatening pregnancy complications are being denied care that was readily available before the Supreme Court overturned Roe v. Wade in June. When abortion was legal across the country, doctors in all states would typically offer to induce or perform a surgical procedure to end the pregnancy when faced with a pre-viability PPROM case. But in the 18 states where abortion is now banned before fetal viability, many hospitals have been turning away pre-viability PPROM patients as doctors and administrators fear the legal risk that could come with terminating even a pregnancy that could jeopardize the mother’s well-being, according to 12 physicians practicing in antiabortion states. The medical exceptions to protect the life of the mother that are included in abortion bans are often described in vague language that does not appear to cover pre-viability PPROM, doctors said. A 2022 study on the impact of Texas’s six-week abortion ban found that 57 percent of pre-viability PPROM patients in Texas who were not given the option to end their pregnancies experienced ‘a serious maternal morbidity,’ such as infection or hemorrhage, compared with 33 percent of PPROM patients who chose to terminate in states without abortion bans.” [The Washington Post, 4/10/23]

***MEDIA ADVISORY FOR WEDNESDAY, APRIL 12 AT 11:00 AM AZ TIME // 2PM ET***

Congress is Fighting to Finish the Job of the Inflation Reduction Act by Extending the Insulin Copay Cap to all Diabetics

Phoenix, AZ — On Wednesday, April 12 at 11:00 AM AZ TIME, Rep. Ruben Gallego (AZ-03) will join Protect Our Care Arizona to discuss the ongoing efforts to expand the Inflation Reduction Act’s insulin savings to every Arizonan. The event will showcase the Inflation Reduction Act’s insulin cap that benefits more than three million seniors nationwide, including 63,185 Arizonans. Lowering insulin costs is especially important for people of color, who disproportionately suffer from diabetes and are more likely to skip, ration, or completely forgo insulin as a result of outrageous costs. Read more about how the lifesaving policy is helping Arizonans here. 

Now, Congress is fighting to extend these savings to all Arizonans and people across the country. This would be a key step to ensuring access to the medicine an estimated 21 million patients need to thrive.

WHO:
U.S. Representative Ruben Gallego, (AZ-03)
Dora Vasquez, Executive Director, Arizona Alliance for Retired Americans
Mary Lynn Kasunic, President & CEO, Area Agency on Aging
Valle del Sol Community Health Center
Protect Our Care Arizona

WHAT: Press Conference

WHERE: Valle del Sol Community Health Center, 3807 N. 7th St., Phoenix, AZ 85014
Watch the livestream here.

WHEN: Wednesday, April 12 at 11:00 AM AZ TIME // 2PM ET