News

Washington, DC — Today, House Speaker Kevin McCarthy told reporters that work reporting requirements are a red line in debt ceiling negotiations. Already, House Republicans have passed a radical bill to cut Medicaid and rip coverage away from 21 million Americans — disproportionately impacting people of color, rural Americans, and people with disabilities. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“President Biden did the right thing taking Medicaid cuts off the table in debt negotiations. Adding paperwork requirements may be a red line for McCarthy, but it means cutting off a vital lifeline for 21 million people who count on Medicaid — which is the exact result MAGA Republicans want. There is no room for work reporting requirements in Medicaid, SNAP, or TANF. 

“For Republicans who have mounted a decades-long war on American health care, these so-called work requirements serve the same purpose as the GOP ongoing efforts to repeal or sabotage the ACA — deny people the health coverage they need in order to protect tax breaks for billionaires. The American people have repeatedly rejected Republican efforts to slash American health care, and President Biden and congressional Democrats must stand firm against the GOP’s latest scheme to deny care to millions of Americans.” 

Less than a month ago, 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 did this ruling risk barring the use of mifepristone for safe and legal abortions for millions of American women, disproportionately harming low-income individuals, women of color, and those without regular access to a nearby health care provider – it also laid 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. 

The Supreme Court has stayed Judge Matthew Kacsmaryk’s ruling for now, allowing mifepristone to remain on the market for now, but the case is still in motion. The Fifth Circuit Court of Appeals is poised to rule on the merits of the case shortly. Read Protect Our Care’s statement on the SCOTUS order here.

23 states and 253 members of Congress – joined by physicians, health care experts, and legal experts – overwhelmingly agree that this case is built on unfounded legal arguments supported by anecdotes and cherry-picked studies. If Judge Matthew Kacsmaryk’s ruling stands, the consequences for patients would be disastrous. 

Fifth Circuit Appeal

Former FDA Officials 5th Circuit Amicus Brief: The Texas Ruling Threatens Patients’ Access to Critical Drugs That Prevent Suffering and Save Lives. A group of six former FDA officials, including David Kessler, Jane Henney, Margaret Hamburg, Michael A Friedman, Joshua Shafstein, Stephen Ostroff, and Norman “Ned” Sharpless, filed an amicus brief in support of the FDAt “In reviewing an administrative agency’s action based on the agency’s evaluation of scientific evidence, such as FDA drug approval decisions, courts have emphasized that they will uphold the action as long as it is within a zone of reasonableness and meets the standard of rationality required by the Administrative Procedure Act. In this case, instead of reviewing FDA’s approval of mifepristone and subsequent modifications to its conditions of use under this firmly established standard, the district court substituted its own opinions about FDA’s evaluation of the scientific data for the expert judgments of FDA clinicians and scientists, and on that basis overturned FDA’s approval of mifepristone. This unprecedented order turns Congress’s desired regulatory scheme on its head and opens the door to constant legal challenges of drug approvals. If allowed to stand, the district court’s order would threaten the incentives for drug companies to undertake the time- consuming and costly investment required to develop new drugs and provide patients access to critical remedies that prevent suffering and save lives.” [Former FDA Officials Brief, 5/2/23]

Amicus Brief By 23 States And The District Of Columbia: Overturning FDA Approval Has Devastating Consequences For The Industry And The Public. A coalition of 23 states—including New York, Arizona, California, Colorado, Connecticut, Delaware, Hawai‘i, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and Wisconsin—and the District of Columbia filed an amicus brief in support of an appeal: “In this case, allowing the district court to unilaterally substitute its judgment for the FDA’s determinations—in defiance of the scientific evidence and in a manner that unduly burdens rather than assures safe access—contravenes the mandate of the FDA and undermines the integrity of the FDA-approval process, with devastating consequences for the industry and the public. Providers and patients in amici States rely on the availability of thousands of FDA-approved drugs to treat or manage a range of medical conditions experienced by their residents, including asthma, HIV, infertility, heart disease, diabetes, and more. […] These harmful outcomes would cause ripple effects across the entire health system. In many amici States, the same facilities providing abortion also offer other critical services, such as pre- and post-natal care, family planning, cancer screening, and other critical forms of preventative health care. Delays resulting from increased demand for abortion procedures (in lieu of medication abortions) will obstruct access to all care offered at those facilities, inevitably resulting in higher rates of unintended pregnancy and sexually transmitted infections, barriers to early detection and treatment for breast, ovarian, and testicular cancers and chronic diseases, and worsened overall health outcomes. Underserved groups, including women of color, low-income women, people with disabilities, and LGBTQ individuals, will be hardest hit. And increasingly poor overall health outcomes will impose substantial costs on amici States and local governments. By contrast, in amici States’ experience, the alleged strains on the health care system purportedly caused by the FDA’s regulatory decisions, which the district court accepted as fact, have simply never materialized.” [New York et al. Brief, 5/1/23]

Amicus Brief By 253 Members of Congress: The Texas Ruling Poses A Serious Health Risk & Would Erect Additional Barriers To Health Care. “[T]he district court’s stay of the U.S. Food and Drug Administration’s September 28, 2000 Approval of mifepristone and other challenged agency actions has no basis in law, threatens the Congressionally mandated drug approval process, and poses a serious health risk to pregnant individuals by making abortion more difficult to access […] [T]he district court’s order not only misapplies the law but also threatens to harm members of the public, many of whom rely on the availability of mifepristone for reproductive care—and many more of whom rely on the integrity of FDA’s drug approval process for continued access to life-improving and lifesaving drugs. Congress intended to—and did—vest authority in FDA to evaluate and ensure the safety and efficacy of drugs in the United States, and amici call on this Court to give due weight to that intent.  […] By curtailing access to the most common method of medication abortion, the district court’s order would erect additional barriers to health care for vulnerable populations. Reduced abortion access is also associated with higher rates of poverty, and lower educational attainment for both children and parents. The unavailability of mifepristone will have an especially acute impact on Black maternal health. In 2020, maternal death rates were 62 percent higher in abortion-restriction states than in abortion access states.” [253 Members of Congress Brief, 5/1/23]

Former DOJ Officials Amicus Brief in Alliance for Hippocratic Medicine v. FDA. “In this brief, former high-ranking officials from both major parties, who hold opposing views on the moral and jurisprudential aspects of abortion, argue the District Court wrongly assumed that the FDA has the authority under the Food, Drug & Cosmetic Act to consider unrelated laws when it reviews applications for approval of new drugs. FDA’s role is to determine the safety and efficacy of drugs based on scientific evidence and not to purport to enforce laws over which they do not have enforcement authority. Amici also demonstrate how the court’s interpretation of the Comstock Laws from 1873—federal anti-vice law that criminalizes the mailing of abortion drugs when intended for use in unlawful abortions—was wrong and its rejection of DOJ’s interpretation of those laws misplaced.” [Former DOJ Officials Brief, 4/13/23]

Motion To Stay

Amicus Brief By 240 Members of Congress: Texas Ruling Second-Guessed Scientific Determinations with Cherry-Picked Anecdotes To Upend the Status Quo. “The district court appears to have second-guessed FDA’s scientific determinations with cherry-picked anecdotes and studies, and on that basis, imposed a remedy that could significantly upend the status quo. […] the district court’s misguided stay under Section 705 of the Administrative Procedure Act will reduce access to abortion, exacerbating an already significant reproductive health crisis,” write the lawmakers, adding: “The consequences of the district court’s remedy could extend far beyond mifepristone, for it undermines the science-based, expert-driven process that Congress designed for determining whether drugs are safe and effective. […] Its perilous consequences reach far beyond mifepristone. Providers and patients rely on the availability of thousands of FDA-approved drugs to treat or manage a range of medical conditions, including asthma, HIV, infertility, heart disease, diabetes, and more.” [240 Members of Congress Brief, 4/11/23]

Former FDA Officials Supreme Court 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.” [Former FDA Officials SCOTUS Brief, 4/17/23]

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]

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]

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]

Washington, DC — Today, Representative Lauren Underwood (D-IL-14) introduced the Black Maternal Health Momnibus Act of 2023, which is a package of 13 bills to address critical drivers of maternal mortality. Black women are three times more likely to die from pregnancy-related complications than White women in the United States. Maternal mortality in the United States is higher than in any high-income nation. An estimated 80 percent of these deaths are preventable, and the problem is getting worse: recent CDC data show a 40 percent increase in maternal deaths between 2020 and 2021, making passing the Momnibus legislation and requiring Medicaid to provide 12 months of postpartum coverage more urgent than ever before. In response, Protect Our Care Chair Leslie Dach released the following statement:

“It is unacceptable that the United States loses more moms to preventable pregnancy-related deaths than any other high-income country, and this problem has only worsened over the past 30 years. This tragedy disproportionately befalls Black, Indigenous, and rural families. The Black Maternal Health Momnibus Act is essential legislation that addresses the leading causes of poor maternal health outcomes, and it will save lives and help end the maternal health crisis. Protect Our Care commends Representatives Underwood and Adams and Senator Booker for their tireless leadership to improve the pregnancy, birthing, and postpartum experience in America. Congress should pass this legislation without delay.” 

White House Confirms President “Will Not Accept Proposals that Take Away People’s Health Coverage”

Washington, DC — Over the weekend, President Biden committed to protecting health care for millions of Americans as Republicans are seeking to rip away coverage for as many as 21 million people who rely on Medicaid through their extreme “Default on America Act.” 

President Biden told reporters Medicaid is off the table while the White House confirmed “he will not accept proposals that take away peoples’ health coverage.” The President reinforced this commitment today. 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 22 percent cuts to research for cancer cures, veterans health care, and other vital health care programs. Republicans have 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 the following statement:

“President Biden made it very clear that he is not going to let Republicans hold our economy and the American people hostage in exchange for millions of people losing their health care. If the GOP gets their way, 21 million Americans risk  losing their health care coverage because of bureaucratic barriers and red tape. This would disproportionately harm people with disabilities or behavioral health disorders, caregivers, people of color, and rural Americans.  By standing up to GOP health care sabotage, President Biden is standing up for the American people. If Republicans truly cared about working families, they wouldn’t continue to put support for tax cuts for the wealthy before ensuring every American has affordable health care.”

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.