News

Washington, DC — Today, CMS released the finalized 2024 Medicare Advantage & Part D Rate Announcement policies to protect the program for generations to come. Under the plan, Medicare will improve payment accuracy and strengthen the program for millions of seniors. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“The final Rate Announcement demonstrates the Biden-Harris administration’s commitment to protecting Medicare by increasing payments, holding insurance companies accountable by reining in their abuse of the system, and taking steps to make our health system more accessible and more equitable. The CMS plan protects seniors and takes important steps to limit insurance company greed.

“The policies finalized today take on insurance companies who game the system by discriminating against the sickest enrollees or using fraudulent billing practices that abuse taxpayer dollars. Importantly, CMS is aligning Medicare Advantage with the rest of the health system by requiring accuracy in billing and utilizing the most up-to-date diagnosis codes. It’s time for the industry and Republicans to stop their false attacks on the Biden administration and instead provide seniors with the quality care they have earned.”

Washington, DC — Today, the Biden administration issued a notice that it is appealing the devastating ruling in Braidwood Management v. Becerra, which ends a major provision of the Affordable Care Act (ACA) that requires no-cost coverage of lifesaving preventive health care services. Braidwood is the latest effort by ACA opponents and their Republican allies to dismantle American health care. Judge O’Connor’s ruling applies nationwide and ends the benefits covered under the U.S. Preventive Services Task Force, including lifesaving colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, and access to PrEP (pre-exposure prophylaxis), which can substantially reduce the chance of contracting HIV.

In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“President Biden is continuing the fight against the GOP war on our health care. From the very beginning, this lawsuit was politically-driven, brought by longtime foes of the ACA, abortion rights, women’s health, LGBT rights, and affordable health care. Now, the same judge who ruled that the ACA should be overturned entirely is ending life-saving protections under the health care law that 150 million Americans rely on. If Judge O’Connor’s ruling stands, more people will get sick, more people will die, and more people will have to choose between paying for health care and food or rent.”

Braidwood Decision Ends Free Lifesaving Preventive Health Care for 150 Million Americans

Yesterday, U.S. District Judge Reed O’Connor struck down a major provision of the Affordable Care Act (ACA) that requires no-cost coverage of lifesaving preventive health care services.

Braidwood Management v. Becerra is the latest effort by ACA opponents and Republicans to use the courts to dismantle American health care. Judge O’Connor invalidated all of the benefits covered under the U.S. Preventive Services Task Force, including lifesaving colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, and access to PrEP (pre-exposure prophylaxis), which can substantially reduce the chance of contracting HIV. The ruling applies nationwide. 

Patient groups, health care experts, and advocates sounded the alarm that yesterday’s decision to end the ACA’s guaranteed free access to essential preventive services will harm patients and dismantle “bedrock protections” in our health care system. 

American Medical Association Said This “Court Ruling Jeopardizes Access To Vital Preventive Health Services.”  “The AMA is alarmed by today’s deeply flawed court ruling in Texas that jeopardizes access to preventive health services guaranteed under federal health reform, including drugs preventing HIV transmission. A critical section of the Affordable Care Act (ACA) required insurers and health plans to cover dozens of preventive health services with no cost to patients—eliminating copays and deductibles for the early detection of potentially fatal medical conditions, including cancer, hypertension, diabetes, and sexually-transmitted infections. Millions of patients could lose first-dollar coverage for cholesterol treatment, tobacco and alcohol cessation, immunizations, and childhood screenings for lead poisoning, hearing loss, and autism. Care that is critical to reducing maternal mortality would also be jeopardized. These preventive-care requirements that for ten years have enabled millions of Americans to improve their health could just go away as a result of this flawed ruling. Providing insurance coverage for screenings and interventions that prevent disease saves lives—period. Invalidating this provision jeopardizes tools physicians use every day to improve the health of our patients. And the burden of losing this first-dollar coverage will fall disproportionately on low-income and historically marginalized communities that are least able to afford it and are often at high risk of developing preventable medical conditions.”  [AMA, 3/30/23] 

The American Lung Association and 25 Other Patient Groups Released a Joint Statement Highlighting “This Ruling Directly Threatens These Benefits And Would Result In A Return To Financial And Other Barriers Proven To Discourage Americans From Obtaining Lifesaving, Preventive Care.” “Individuals will not immediately lose access to these preventive services because the Court has not yet ruled on the scope of relief or remedy. However, this decision could ultimately allow the reinstatement of financial barriers that in the past discouraged all too many Americans from obtaining preventive care, such as screenings for cancer and hypertension, helping people who smoke quit, and preventive care for pregnant women and babies. Among the Affordable Care Act’s most popular and effective provisions have been the requirement that insurance cover – without cost-sharing – services that help screen for and prevent disease. Access to preventive healthcare can prevent both disease and early death. In recent years, more than 150 million Americans have benefited from expanded access to preventive services under the Affordable Care Act. Studies repeatedly show that high-quality coverage, complete with preventive services, improves the overall health of individuals and our country, lowers overall health spending, and reduces health disparities. This ruling directly threatens these benefits and would result in a return to financial and other barriers proven to discourage Americans from obtaining lifesaving, preventive care. Our organizations are deeply committed to ensuring everyone has access to the care they need, and we will vigorously defend individuals’ rights to access these critical services.” [American Lung Association, 3/30/23]

• Signatory groups:  The AIDS Institute, American Cancer Society Cancer Action Network, American Heart Association, American Kidney Fund, American Lung Association, Arthritis Foundation, Cancer Support Community, Cystic Fibrosis Foundation, Epilepsy Foundation, Hemophilia Federation of America, JDRF , The Leukemia & Lymphoma Society, Lupus Foundation of America, The Mended Hearts, Inc., Muscular Dystrophy Association, National Alliance on Mental Illness (NAMI) , National Coalition for Cancer Survivorship, National Health Council, National Hemophilia Foundation, National Kidney Foundation, National Multiple Sclerosis Society, National Organization for Rare Disorders, National Patient Advocate Foundation, National Psoriasis Foundation, Susan G. Komen, WomenHeart: The National Coalition for Women with Heart Disease

American College of Obstetricians and Gynecologists Said “Allowing Personal Or Political Bias To Interfere With The Practice Of Medicine Will Cause Harm To Our Patients.” “No-copay coverage of critical preventive care like HIV prevention is intended to increase access in order to keep people healthier. Preventive care improves health and saves lives, and it also reduces overall costs to the health care system. An individual’s personal belief does not change the fact that HIV prevention helps people live healthy lives. To improve health outcomes, we should be working toward increased access to and utilization of all preventive care recommended by the U.S. Preventive Services Task Force. Instead, we find ourselves once again defending health care from outside interference and responding to attempts to dismantle our current preventive care system. Today’s decision will leave more people without access to preventive care and will grow health inequities among those who will now find themselves underinsured.” [ACOG, 3/30/23]

Dr. Georges C. Benjamin, Executive Director of the American Public Health Association Said “The Impact Of This Decision Is Disastrous For The Public.” “As a physician, the impact of this decision is disastrous for the public. The Affordable Care Act was designed to move our health system to address prevention and it has been highly successful in doing that. Preventative services are highly effective, and we know that from a medical perspective, this will undermine our ability to protect people and save lives.” [Protect Our Care Event, 3/30/23] 

Margaret A. Murray, CEO of the Association for Community Affiliated Plans, Said “Families Deserve Better Than Having Bedrock Protections Of The Health Reform Law Invalidated With A Two-Page Ruling.” “We call on the Justice Department to appeal this ruling such that this decision can be stayed to give the necessary acts of jurisprudential hygiene time to occur. In the interim, our Safety Net Health Plans will continue to work to equitably improve the health of all their members – regardless of their sexual orientation or their gender identity.” [ACAP, 3/30/23]

The Philadelphia Health Department’s Dr. Kathleen Brady Makes Statement Regarding How This Ruling Will Hurt Local Government Initiatives. “With an ambitious goal of reducing HIV infections by 90% by 2030, Philadelphians need access to PrEP without barriers, financial or otherwise. This ruling hurts the members of our communities who routinely face discrimination and are at increased risk of HIV exposure, particularly Black, Latino, and LGBTQ+ Philadelphians. This decision has been heavily criticized by medical professionals throughout the nation and we add our voice to that chorus. The Health Department is here to ensure that everyone who needs HIV prevention services can get them.” [Philadelphia Health Department, 3/30/23]

Cofounder of United States of Care, Natalie Davis, Said “The Resulting Impacts Of This Decision Will Be Widespread, Starting With The Fact That It Creates Uncertainty For People Seeking Care.” “Free preventive screenings are one of the most popular parts of the health care system across demographics and party lines, with nearly two-thirds of people expressing support for these policies. To put it bluntly, no-cost preventive services save lives. Since these protections went into effect, cancer deaths have dropped by 17%, while new HIV infections have decreased by 73% since the mid-1980’s. Changes to preventive services benefits will have a disproportionate impact on communities of color and communities who are always pushed to the margins of our health care system, exacerbating existing health disparities and erecting additional barriers to services. People need more access to no-cost preventive services, not less.The progress we have made with prevention through access to no cost screenings –  in narrowing health disparities, and increasing access to needed – care is now in jeopardy –  people’s lives are at stake. We can’t go backwards.” [United States of Care, 3/30/23]

The National Coalition of STD Directors: A Joint Statement from the Group Wholly Condemns the Ruling by Judge Reed O’Connor. “Today’s ruling threatens the most powerful tools this nation has to fight the epidemic of sexually transmitted infections (STIs) – guaranteed insurance coverage for basic preventive medical care. We cannot reduce the devastating impact of completely preventable infections like congenital syphilis if people cannot count on their insurance to help them pay for essential routine health services. As our public health systems have buckled under the strain of rising disease rates and falling funding, we have grown increasingly reliant on the routine, privately funded health services that most people use to access services like standard syphilis testing during routine prenatal care or HIV tests in our yearly check-ups. This ruling rips out the backbone of the U.S. health care system, and risks the future health of every single American. STIs impact people of all walks of life and can have devastating consequences when left undetected and untreated. The overreach of one judge should not threaten the health and safety of hundreds of millions of lives. We are calling on the Biden administration to use its full weight to safeguard preventive services coverage for all Americans.” [National Coalition of STD Directors, 3/30/23]

National Partnership For Women And Families:  “This Ruling From Judge O’Connor Is Devastating.”  “This ruling from Judge O’Connor is devastating. Striking down coverage for preventative care hurts all of us but especially folks of color and low-income people who have overwhelmingly benefited from this provision.” [@NPWF, 3/30/23] 

Professor of Pediatrics at Yale, Meredithe McNamara: Ruling in Braidwood Case is More “Sinister” Than Even Burwell v. Hobby Lobby Stores, Inc. “Per Braidwood, anyone with an objection to LGBTQ identity can claim that providing healthcare for LGBTQ people harms their religious beliefs. In a time when the rights of transgender people are debated in state legislatures throughout the U.S., Braidwood is a clear example of a judicial attack meant to embolden those with prejudice to further harm LGBTQ people.” [Yale Daily News, 3/31/23]

Dr. A. Mark Fendrick of the University of Michigan, One of the Original Drafters of the Preventive Care Mandate, Blasts the Braidwood Ruling. “Requiring patients to pay significant amounts out-of-pocket for high-quality preventive services shouldn’t be a partisan issue. Whether you’re a Democrat or a Republican, it’s just good policy to promote access to services that have been proven to prevent diseases or to detect conditions while they’re still treatable.” [University of Michigan, 3/30/23]

Attorney General Rob Bonta Released a Statement on the Braidwood Ruling. “Preventive healthcare is crucial to saving lives and keeping people healthy and safe. From cancer screenings to pregnancy-related care, to HIV medication, preventive care is a critical aspect of healthcare. I am deeply disappointed in today’s dangerous and short-sighted court ruling in Texas. It puts ordinary Americans’ lives at risk and deprives them of access to the medical care and services they need. We will not let this stand.” [State of California Department of Justice, 3/30/23]

Ben Klein, GLBTQ Legal Advocates & Defenders (GLAD) Senior Director Said “Today’s Order In Braidwood V. Becerra Will Have Direct And Devastating Consequences For Efforts To Combat The HIV Epidemic.” “We have a safe, approved therapy PrEP (Preexposure Prophylaxis), that is nearly 100% effective at preventing transmission of HIV but that remains underutilized, particularly among Black and Latinx communities. Ending the requirement that insurers cover PrEP with no cost-sharing will increase new HIV diagnoses and exacerbate racial health disparities when what we need is to be ensuring more people have access to PrEP. Copays and deductibles deter people from accessing healthcare. Make no mistake, we will see more HIV transmission as a result of this ruling.” [GLAD Legal Advocates and Defenders, 3/30/23]

Watch the Full Event Here.

Washington, DC — Today, American Cancer Society Cancer Action Network President Lisa Lacasse, National Partnership for Women & Families’ Sinsi Hernández-Cancio, American Public Health Association Executive Director Dr. Georges Benjamin, and Andrew Pincus joined Protect Our Care for a virtual press conference discussing U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires no-cost coverage of lifesaving preventive health care services. Today’s decision in Braidwood Management v. Becerra would end ACA’s guaranteed free access to essential preventive services. In 2020 alone, more than 150 million Americans benefited from these preventive services. Read Protect Our Care’s fact sheet here.

Judge O’Connor invalidated all of the benefits covered under the U.S. Preventive Services Task Force, including lifesaving breast cancer screenings, colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, and access to PrEP (pre-exposure prophylaxis), which can reduce the chance of contracting HIV. The ruling applies nationwide. During the call, speakers will make clear that this decision is a tragedy for millions of Americans’ access to lifesaving health care services. 

“This ruling would undoubtedly negatively impact health outcomes and reverse progress,” said Lisa Lacasse, president of the American Cancer Society Cancer Action Network. “We know that any cost barrier can be a deterrent to accessing evidence-based and potentially lifesaving prevention services – including cancer screenings and early detection. If upheld, this ruling could mean reduced cancer screenings, leading to later stage diagnoses, when cancer is more expensive to treat and survival less likely.”

“Judicial extremism is on clear display here,” said Sinsi Hernández-Cancio, Vice President for health justice at National Partnership for Women & Families. “What started as an attack on LGBTQ people is now undermining preventive health care for all of us. This egregious holding harms women’s access to life-saving care and worsens health inequities. From screenings for depression, diabetes, and heart health to essential pregnancy and postpartum care, critical services are no longer guaranteed to be available without copays or cost-sharing. And even though the ACA’s women-specific preventive services such as contraceptive coverage are safe for now, the motives of the plaintiffs are clear, and we must be on high alert that these services, too, could be at risk as this case moves through the courts.”    

“Not only is Judge O’Connor’s decision wrong on the legal merits, it would be highly disruptive to our health care system and roll back health care gains made over the years,” said Andrew Pincus, Visiting Lecturer in Law at Yale Law School and experienced Supreme Court and appellate lawyer. “This ruling would eliminate guaranteed free access to life-saving preventive services for more than 150 million Americans.”

“As a physician, the impact of this decision is disastrous for the public,” said Dr. Georges C. Benjamin, Executive Director of the American Public Health Association “The Affordable Care Act was designed to move our health system to address prevention and it has been highly successful in doing that. Preventative services are highly effective, and we know that from a medical perspective, this will undermine our ability to protect people and save lives.”

“The results of this decision will be that more Americans get sick, more Americans will die, and more Americans will have to make painful choices between their health and paying for other essential needs, like food and shelter,” said Leslie Dach, Chair of Protect Our Care. “This case was brought by long-term opponents of the ACA who have failed over fifty times to repeal the law in Congress and whose policies were rejected by voters in three straight elections.”

Braidwood Case is Latest Effort by ACA Opponents and Republicans to use the Courts To Dismantle American Health Care 

Washington DC — Today, U.S. District Judge Reed O’Connor struck down a major provision of the Affordable Care Act (ACA) that requires no cost coverage of lifesaving preventive health care services. Today’s decision in Braidwood Management v. Becerra 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 breast cancer screenings, colorectal and other cancer screenings, anxiety and depression screenings for children and adults, heart disease screenings, intimate partner violence screenings, and access to PrEP (pre-exposure prophylaxis), which can reduce the chance of contracting HIV. The ruling applies nationwide. 

Protect Our Care Chair Leslie Dach issued the following statement: 

“Judge O’Connor’s decision will increase costs and hurt millions of families across the country who depend on free preventive care to stay healthy. From the start, this was a politically-driven lawsuit, financially supported by people with extreme views, and placed in front of a judge with a proven record of attempting to dismantle the ACA. As a result of this devastating ruling, Americans will again be at the mercy of insurance companies who could increase costs for cancer screenings, prenatal care, mental health screenings, and more. This ruling will upend how Americans receive preventive care in this country, and more Americans will die because their cancers will be detected too late or they won’t receive the mental health or prenatal care they need. The courts must stay this ruling pending appeal. The health and financial security of millions of Americans is now at grave risk.”

Washington, D.C. – Beginning Saturday, April will mark the fifth annual Medicaid Awareness Month, and there has never been a better time to raise awareness about Medicaid’s importance for communities across the nation. A record 92 million Americans are enrolled in Medicaid, providing affordable, quality health care to people from all backgrounds, including children, mothers, people of color, people with disabilities, rural Americans, and seniors. 

Medicaid Awareness Month comes as Republicans in Congress are seeking serious cuts to the program and proposing bureaucratic work reporting requirements while GOP leaders in 10 states have failed to expand Medicaid under the Affordable Care Act, blocking millions of families from affordable coverage. President Biden and Democrats in Congress, on the other hand, are working to strengthen Medicaid for years to come. 

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could lose their coverage during the public health emergency. This provision, which has helped secure the lowest level of uninsured Americans ever, is set to expire on April 1. As states begin to redetermine who is eligible for Medicaid, an estimated 15 million people are vulnerable to losing coverage, disproportionately affecting people of color and children. 

Throughout the month of April, Protect Our Care will release reports, publish fact sheets, and host events nationwide with elected officials, storytellers, and health care advocates. These activities will highlight Medicaid’s critical role in America, underscore what needs to be done to expand and strengthen the program, and make clear the dire consequences of Republican threats. 

To mark the start of Medicaid Awareness Month, Protect Our Care Executive Director Brad Woodhouse released the following statement: 

“This month is a critical reminder that Medicaid is working for people in America. Regardless of who you are or where you live, you or someone you love has almost certainly benefited from Medicaid. And with more Americans relying on Medicaid coverage than ever before, it is essential that lawmakers fight to protect people with Medicaid coverage from Republican attacks. As they continue to block Medicaid expansion in 10 remaining states and pursue reckless cuts to Medicaid, Republicans continue to play politics with people’s lives.”

The month will include the following themes each week:

• Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
• Week 2: Medicaid helps women and kids. Week two will bring attention to the vital role of Medicaid for mothers and children across the country. 
• Week 3: Medicaid helps people of color and rural Americans. Week three will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier.
• Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care.

BACKGROUND:

Over 2 Million People Are Stuck In The Medicaid Coverage Gap. Prior to North Carolina voting to expand Medicaid earlier this month, 2.1 million people were stuck in the Medicaid coverage gap. These people are too poor to qualify for the Affordable Care Act marketplace subsidies but are ineligible for Medicaid due to their state’s failure to expand the program. North Carolina’s expansion allowed nearly 180,000 people to gain coverage and no longer be stuck in the gap.

Almost Half Of Births Are Covered By Medicaid. Medicaid covers nearly 20,000,000 women of reproductive age, giving them access to reproductive health care services such as birth control, cancer screenings, and maternity care without cost-sharing. Over 40 percent of births in the United States were covered by Medicaid in 2022. Thanks to the American Rescue Plan, states were given the option to extend coverage to new mothers for one year postpartum, which improves maternal health outcomes. Congress subsequently made this option permanent as part of end-of-year legislation signed into law at the end of 2022. So far, 29 states have elected to extend postpartum coverage.

Over 50 Percent Of American Children Are Enrolled In Medicaid And CHIP. Over 40 million children in the United States are enrolled in Medicaid or CHIP. Medicaid eligibility during childhood lowers the high school dropout rate, raises college enrollment, and increases four-year college attainment. Medicaid for children also has a positive impact on employment opportunities later in life. For each additional year of Medicaid eligibility as a child, adults by age 28 had higher earnings and made $533 additional cumulative tax payments due to their higher incomes.

Reduced Racial Disparities In Coverage. Increasing Medicaid access is the single most important action available to expand coverage and address access to quality care as a driver of health. This together with other actions to address other social and structural determinants of health can reduce racial disparities in the American health care system. The majority of Americans who would gain coverage if the remaining 10 holdout states expanded Medicaid are people of color. 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 an Black adults after expansion, and a 45 percent reduction between white and Hispanic adults. 

Millions Of Rural Americans Depend On Medicaid. Nearly 14 million Medicaid enrollees reside in rural areas. Uninsurance rates in rural America are 2-3 percentage points higher than in urban areas. States that expanded Medicaid experienced a 7 point increase in insured rates after the passage of the Affordable Care Act.

Medicaid Helps Seniors And Older Americans Stay Retired And Out Of Poverty. Many seniors and older Americans survive off of low incomes or have chronic health conditions that prohibit them from working. Medicaid allows these individuals living on fixed incomes and often have chronic diseases to continue getting the care they need by filling in the gaps in their Medicare coverage without having to worry about choosing between food and housing or their health. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for seniors and older adults.

As we enter the 5th annual Medicaid Awareness Month, millions of children and families are at risk of losing coverage. Protections put into place by Congress to keep people enrolled in Medicaid during the public health emergency will expire on April 1. States have up to a year to complete the “unwinding” process to determine who is still eligible for Medicaid coverage. A record 91.8 million Americans rely on Medicaid or the Children’s Health Insurance Program (CHIP) for their health care, including 34.2 million children – or 54 percent of children in America. It is predicted that approximately 15 million people may lose their coverage due to the unwinding. Children and families in Texas, Florida, and other states that have not expanded Medicaid are particularly vulnerable.

Many of those who could lose coverage are eligible for coverage through the Affordable Care Act (ACA) or traditional Medicaid. States have the responsibility to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, and people with disabilities. The Biden administration is working hard to support states and to demand a fair process. However, to date, many states have not committed to taking common sense measures to keep people covered.

By The Numbers

• Nearly 7 Million Children Are Expected To Lose Medicaid/CHIP Coverage Due To Unwinding. 15 million enrollees, including as many as 6.7 million children, are expected to lose coverage during unwinding. 
• More Than 50 Percent Of Children Are Covered By Medicaid/CHIP. Nationally 54 percent of American children are covered by Medicaid/CHIP. 
• 72 Percent Of Children Will Lose Coverage Largely Due To Procedural Errors. The majority of children who will be disenrolled during the unwinding will still be eligible for Medicaid/CHIP, but will lose coverage due to procedural errors. These barriers include preventable language barriers, lack of support and communication from the state, confusing renewal notices, technology hiccups, and slight income fluctuations.
• Medicaid Unwinding Disproportionately Impacts Children Of Color And Children In Rural Communities. 68 percent of Black children, 60 percent of Latino children, and nearly 50 percent of American Indian and Alaskan Native and Native Hawaiian and other Pacific Islanders are enrolled in public coverage. Children in rural communities are 24 percent more likely than those in urban areas to rely on Medicaid/CHIP for their health care.
• Half Of Non-Expansion States Each Have Over 1 Million Children Covered By Medicaid. These states include Texas, Florida, Alabama, South Carolina, Mississippi, Georgia, Wyoming, Wisconsin, Kansas, and Tennessee. Texas and Florida are dealing with large amounts of staff shortages and increased enrollment applications making evaluations challenging and a lengthy process.

Nearly 7 Million Children Are Expected To Lose Medicaid/CHIP Coverage Due To Unwinding. 91.8 million people are enrolled in Medicaid/CHIP as of November 2022. Since February 2020, enrollment has increased by over 20 million people. 15 million people, including as many as 6.7 million children, are expected to lose coverage during unwinding. This is largely due to economic conditions due to the pandemic, Medicaid expansion in Nebraska, Missouri, and Oklahoma, and the federal continuous coverage provision that began in December 2020. Continuous coverage provided a 6.2 percent increase in federal Medicaid match rate to states to keep Americans enrolled without having to re-enroll each period.

More Than 50 Percent Of Children Are Covered By Medicaid/CHIP, Most Are From Marginalized Communities. Nationally 54 percent of American children are covered by Medicaid/CHIP. These children are largely Black or Latino or live in rural areas. Currently, 68 percent of Black children and 60 percent of Latino children are enrolled in public coverage, as well as nearly 50 percent of American Indian and Alaskan Native and Native Hawaiian and other Pacific Islanders. Children in rural communities are 24 percent more likely than those in urban areas to rely on Medicaid/CHIP for their health care. Children of color are more likely to experience churn or gaps in coverage than their white counterparts, due to parents of color being more likely to work low-wage jobs that are less likely to offer coverage.

Millions Are Expected To Lose Coverage Due To Red Tape Barriers During Re-Enrollment. Starting April 1st, states may disenroll ineligible people from Medicaid. Millions of people are expected to lose coverage due to either income increases making them ineligible or red tape barriers in re-enrolling that will prevent people from accessing coverage. These barriers include preventable language barriers, lack of support and communication from the state, confusing renewal notices, technology hiccups, and slight income fluctuations. Children of parents who hold part-time, hourly, or seasonal jobs are more vulnerable due to the slight variations in income throughout the year that could cause changes in their eligibility. The majority of children who will be disenrolled during the unwinding will still be eligible for Medicaid/CHIP, but will lose coverage due to procedural errors.

Texas And Florida Are Among 10 States That Refuse To Expand Medicaid. Half of non-expansion states, Alabama, Mississippi, Florida, Georgia, and South Carolina each have over 1 million children covered by Medicaid. In Texas and Florida specifically, unwinding is going to be challenging with a lack of staffing to review the millions of cases in each state and increase in Medicaid applications. Texas is short 300 eligibility advisors and has seen an increase of nearly 70 percent in enrollment applications compared to 2019. Meanwhile, due to similar staffing shortages and influx of applications, Florida has been taking weeks to review applications, while other states can review an application in as quickly as a day.

This week we highlight recent anniversary commemorations – the 20th anniversary of the seminal Unequal Treatment report and 13th anniversary of the Affordable Care Act (ACA). Additionally, life changing legislation has been passed in multiple states which will reduce health disparities in kids and increase access to gender affirming care for LGBTQI+ individuals on Medicaid; and maternal health experts released a new roadmap to reverse the maternal health crisis. New research shows how the ACA has significantly reduced racial health disparities. Even with this progress there are continuing areas for growth, most significantly is diversifying the medical and broader health workforce, tackling the rising maternal mortality rates and protecting rural hospitals at risk of collapsing across the nation.

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

New York Times: North Carolina Officially Expands Medicaid After Republicans Abandon Their Opposition to the Program. “North Carolina on Monday became the 40th state to expand Medicaid under the Affordable Care Act, the latest sign of how Republican opposition to the health measure has weakened more than a decade after President Barack Obama signed it into law. Gov. Roy Cooper, a Democrat, signed legislation expanding the state’s Medicaid program during a sunny afternoon ceremony on the lawn of the Executive Mansion, days after the Republican-controlled legislature gave final approval to the measure. He was surrounded by patients, advocates and some of the same Republican leaders who had previously blocked expansion in the state. The bill will expand Medicaid to adults who make up to 138 percent of the federal poverty level, or about $41,000 for a family of four. State officials say the expansion will cover an estimated 600,000 people. It will take effect when the state adopts a budget, likely by June, Mr. Cooper said in an interview before the signing ceremony. It has been nearly 11 years since the Supreme Court ruled that states did not have to expand Medicaid — the government health insurance program for low-income people — under the Affordable Care Act. Nearly half the states opted out. More recently, progressives have helped to expand Medicaid in seven states — all of them with either Republican-controlled or divided governments — by putting the question directly to voters; in November, South Dakota adopted Medicaid expansion via the ballot box. Monday’s bill signing leaves just 10 states — all with divided or Republican leadership, and most of them in the South — that have yet to expand Medicaid. Advocates say they now have their sights set on Alabama, where Gov. Kay Ivey, a Republican, can expand her state’s program with her own authority. Hospitals, especially struggling rural ones, are eager for the extra revenue that Medicaid reimbursement will bring. The federal government picks up 90 percent of the costs of reimbursement under the expansion, and in North Carolina, hospitals will pay the other 10 percent. The state has revamped its Medicaid program, moving it from a fee-for-service program to one that relies on managed care — a long-sought goal of Republicans.” [New York Times, 3/27/23]

CBS News: The Affordable Care Act Has Reduced Racial Disparities When it Comes to Health Access. “The Affordable Care Act, passed in 2010 under former President Barack Obama, has expanded health insurance coverage across the U.S. and significantly reduced racial and ethnic disparities in access to health care, according to a new report by the Commonwealth Fund. Data shows that prior to the 2013 implementation of the Medicaid expansion — a provision of the ACA that made more families eligible for Medicaid coverage — 40.2% of the Hispanic population, 24.4% of the Black population, and 14.5% of the White population were uninsured in America. However, by 2021, those numbers dropped significantly to 24.5%, 13.5%, and 8.2%, respectively. With more than 5 million people gaining coverage between 2020 and 2022 over the course of the pandemic, the overall uninsured rate in the U.S. dropped to just 8%, a historic low, according to the report. ‘The coverage gap between Black and White adults dropped from 9.9 to 5.3 percentage points, while the gap between Hispanic and White adults dropped from 25.7 to 16.3 points,’ according to the study. Additionally, the report found that adult uninsured rates for Black, Hispanic, and White people all improved during the first two years of the pandemic across all states — whether they had expanded their Medicare coverage or not —  and that Black and Hispanic adults experienced larger gains in insurance coverage than their White counterparts between from 2019 to 2021.” [CBS News, 3/19/23]

The Grio: Anniversary of Affordable Care Act Highlights Gains for Black Americans. “During a White House ceremony commemorating the anniversary on Thursday, President Joe Biden called the signing of ACA an ‘extraordinary achievement’ of Obama’s. When the law was signed in 2010, then-Vice President Biden infamously said to Obama on a hot mic that it was a ‘big f—ing deal.’ Referencing the viral moment, the president added, ‘I stand by the fact that it was a big deal.’ The landmark legislation has steadily reduced the number of uninsured Black Americans over the years. The Department of Health and Human Services said in a report last year that the uninsured rate among Black Americans has decreased 40% since the ACA was implemented. Chiquita Brooks-LaSure, the administrator of the Centers for Medicaid and Medicare Services in the Biden administration, told theGrio that the number of Black Americans enrolled in the ACA this year is about the same as last year, which experienced a record increase of 35%. Brian Smedley, a senior fellow and equity scholar at the Urban Institute, pointed out that the Affordable Care Act also includes civil rights provisions for patients of color who historically experienced inequitable care in America’s health care system. According to the Kaiser Family Foundation, the uninsured rate for Black people was 10.9% as of 2021 compared with 7.2% for white people. Though there is still a gap, it has decreased significantly since 2010. The Kaiser report shows that in 2010 — perhaps shortly before or after Obamacare became the law of the land  —  the percentage of Black Americans who were uninsured was 20% compared with 13% for their white counterparts.The uninsured rate for both groups has dropped dramatically during the Obamacare era. Though millions of Black Americans remain uninsured, Smedley said they are predominantly found in southern states that have refused to expand Medicaid. A 2012 Supreme Court ruling allowed expansion to be optional for states. Since then, many Republican-controlled states have opted out. To date, 10 states have not expanded Medicaid services.” [The Grio, 3/23/23]

Urban Institute: As 20th Anniversary of the Unequal Treatment Report Approaches, New Program to Elevate Health Inequities is Launched. “In 2003, the National Academies Press published a landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, that shocked many policymakers and the medical establishment with its finding that racial and ethnic disparities in the quality of care are “remarkably consistent,” even after controlling for access-related factors, such as income and insurance status. Despite the national attention this report received, the nation has made little progress toward eliminating health care inequities in the 20 years since the report was published. As the 20th anniversary of Unequal Treatment approaches, the Urban Institute is launching a new program of action to elevate health care inequities as a national priority and build momentum for key remedies and structural reforms. To kick-off the initiative, we invite you to join us for a full-day symposium designed to bring together policymakers, researchers, health care administrators and professionals, and other interested parties. The symposium will: make evidence of the causes and consequences of health care inequities more accessible to patients, health care consumers, health care industry leaders, and policymakers; identify the most promising research and policy strategies that have emerged in the 20 years since Unequal Treatment’s publication; allow interested parties to collaborate to develop tools and mechanisms to hold practitioners and policymakers accountable, particularly at the state level, where key opportunities exist to establish equity-focused strategies; and elevate the voices of patients from marginalized communities and a new generation of scholars of color whose perspectives must be centered in identifying research questions and solutions.” [Urban Institute, 3/23/23]

National Partnership for Women and Families: A Roadmap to Reversing the Maternal Mortality Crisis. “Our nation’s maternal mortality crisis and the staggering impact on Black and Brown communities are well documented. A new suite of resources, Raising the Bar for Maternal Health Equity and Excellence, authored by the National Partnership for Women & Families, working with a renowned advisory panel and the Alliance of Community Health Plans (ACHP), the Health Care Transformation Task Force (HCTTF) and the National Birth Equity Collaborative (NBEC), offers practical solutions designed for healthcare systems ranging from independent women’s health clinics to large hospital systems. These resources are grounded in a deep understanding that the healthcare sector plays many roles beyond that of provider – as an employer, a community partner, and a policy advocate, each of which shapes maternal health. Jocelyn Frye, president of the National Partnership for Women & Families, hailed the resource as a transformational tool that is urgently needed. Frye said, ‘We know that Black women are three to four times more likely to die from pregnancy-related causes, and we also know the causes are rooted in persistent and systemic biases. By breaking down the different roles and adapting the guidance for institutions of every size, we’re acknowledging not only the depth and complexity of the maternal health crisis but also the breadth of community engagement that will be required to address the crisis successfully.’ Raising the Bar for Maternal Health Equity and Excellence is the second phase of a multi-year Robert Wood Johnson Foundation project. Raising the Bar’s first phase produced a framework that crafted specific principles, roles and actions that healthcare organizations can use to begin or advance their health equity work. Richard Besser, President and CEO, Robert Wood Johnson Foundation (RWJF) said, ‘It is an honor to join the National Partnership for Women & Families in celebrating the application of the important health equity guidelines offered by Raising the Bar to maternal and newborn health. Too many barriers – particularly for Black women – get in the way of providing high quality care. I’m excited to see how Raising the Bar will help us eliminate barriers like bias and discrimination around reproductive healthcare.’ As part of the launch of the guidance report, the National Partnership will host an event that includes remarks from the Honorable Chiquita Brooks-LaSure, Administrator, Centers for Medicare & Medicaid Services, Her remarks will be followed by a panel discussion on innovative approaches to improving maternal health featuring Richard Besser, from RWJF, Betty Chu, MD, Henry Ford Health Systems; Carmen Green, MPH, National Birth Equity Collaborative, Elizabeth Howell, MD, the University of Pennsylvania Health System and Aditi Mallick, MD, Center for Medicaid and CHIP Services.” [National Partnerships for Women and Families, 3/22/23]

Star Tribune: Minnesota Governor Signs Free School Meals Into Law. “School meals will become free for every Minnesota public and charter school student. Gov. Tim Walz signed a bill Friday that makes the change, while surrounded by children who got a firsthand lesson in how legislation becomes law. Until now, Minnesota law required parents to apply for free meals through a federal reimbursement program based on their income. Starting this year, districts could also automatically add a student to the benefit rolls if their family qualified for Medicaid. But Walz and other backers of providing universal free meals said those forms created unnecessary barriers. Minnesota is the third state in the nation to require schools to offer all students free breakfast and lunch, regardless of their family income, behind California and Maine. In Colorado, a similar law allows schools to opt in to a state-funded free meals program. Advocacy group Hunger Solutions estimates that 1 in 6 Minnesota students experience food insecurity, about a quarter of them living in a household that doesn’t qualify for free meals. Sen. Heather Gustafson, DFL-Vadnais Heights, estimates that a family of four living in White Bear Lake would save about $1,900 per school year if their children ate two meals at school. She sponsored the bill in the Senate and called it a ‘lunchbox tax cut,’ at the signing ceremony.” [Star Tribune, 3/17/23]

WMAR Baltimore: Maryland Passes the Trans Health Equity Act Swiftly Through Both Houses. “The LGBTQ+ community is celebrating a huge milestone as law makers officially approved the Trans Health Equity Act, allowing transgender patients to more easily obtain gender-affirming care. The Trans Health Equity Act will expand gender-affirming care through Medicaid so more patients can get the proper treatment. The legislation aims to establish equity by ensuring low-income Marylanders seeking gender-affirming care will receive the same treatment as people with private insurance. Advocates with Baltimore Safe Haven say this allows people in the LGBTQIA+ community to have better access to resources and gain valuable support from medical professionals. Advocates say this bill will truly make a difference in the LGBTQ+ community. Both chambers passed their bill, and now the bills have to go through the opposite chambers before making their way to the Governor’s desk.” [WMAR Baltimore, 3/24/23]

CHALLENGES

California Health Report: Racism in Academia is Hindering Attempts to Reduce Inequities in Health Care. “Time and time again, scientific reports and surveys cite some version of the following findings: Black people have the worst health outcomes. Black patients have better health outcomes when they see Black doctors. Black patients prefer Black doctors. Black doctors tend to care for higher proportions of Black patients than their White counterparts. Yet 53 percent of Black people in the US say it’s hard to find a Black doctor, which is not surprising. While Black people account for roughly 13 percent of the US population, they make up only 4 percent of the physician workforce and 7.3 percent of medical students. These representational disparities haven’t changed appreciably in decades. We cannot achieve health equity for Black patients without expanding the Black physician workforce, and the nation’s medical institutions are not achieving that goal. When confronted with this problem, academic medicine leaders attribute the plateauing of the Black physician workforce to factors beyond its control — things like disparities in primary education and poverty. Medical institutions have yet to honestly examine and address how they perpetuate the problem of a White-dominated physician training system that unjustly excludes, punishes, and dismisses Black medical students, trainees, and attending physicians. White people must recognize that inclusion is not a zero-sum game, said Camara Jones, MD, MPH, PhD, a Black physician who served as the 2021-2022 UCSF Presidential Chair.” [California Health Report, 3/23/23]

Ms Magazine: Medical Racism Has a Large Role in the Spike of Maternal Mortality. “The coronavirus exacerbated the effects of medical racism already baked into the United States healthcare system, leading to a spike in Black maternal mortality rates between 2020 and 2021, new data from the Centers for Disease Control and Prevention reveals. The recent statistics, though bleak, come as no surprise to maternal health experts, who say the disparities have persisted for decades. In 2021, more than 360 Black women died of maternal health causes across the country, according to the CDC, up from just over 290 in 2020 and more than 240 the year prior. The spike amid the coronavirus pandemic is likely due to a combination of factors, ranging from infection by the virus itself to medical racism.  As women’s age increased, so did the maternal mortality rate. For Black women over 40, the rate was over 300 per 100,000 births, compared to 42 per 100,000 for those under 25.  Despite advancements in medicine and technology over the years, the racial gap in who is suffering the most severe consequences of childbirth is growing, and most Black maternal and child health experts point to systematic racism as the root cause. Inequities in access to quality healthcare before, during and after pregnancy, as well as provider bias during labor and delivery, contribute to the dismal outcomes. And, the “weathering” effect that exposure to discrimination has on Black people’s bodies over a lifetime, which can break down a mother’s body prematurely, is also linked to the high death rates. The spread of COVID-19 decreased the quality of maternal healthcare for everyone across the country, said Mahdi, so for those who already had issues accessing high quality care, the impact of that care being further reduced had a significant effect.” [Ms Magazine, 3/20/23]

NY Daily News: The U.S. Must Begin Tackling the Growing Maternal Mortality Crisis. “New CDC numbers reveal that 1,205 women died of pregnancy-related causes in 2021, compared with 861 in 2020 and 754 in 2019. That represented a one-year jump of 38% and a two-year jump of 64%, to the highest maternal mortality rate on record since 1965. America’s overall rate was and still is far higher than its peer countries, and remains high by international standards whether you’re white, Latina or Black. Our maternal mortality is 54% higher than Russia’s; nearly double Canada’s; more than double the U.K.’s, France’s and Italy’s, and five times Japan’s and Germany’s. Second, race-based disparities here are especially egregious, and stubborn. Black women are 2.6 and 2.5 times likelier to die of maternity-related causes than white or Hispanic women. Research suggests economic disadvantages, discrimination by health-care providers and chronic stress all add up to take their toll. And the problem is inextricable from the fact that, even after the passage of Obamacare, too many Black Americans lack affordable access to quality medical treatment. The Biden administration last year laid out a thoughtful blueprint to save mothers’ lives; passage of sweeping federal legislation, a dozen bills collectively nicknamed the Momnibus, would go further. Waste no time. American women are dying in numbers far too large. As long as they do, American values remain on life support.” [NY Daily News, 3/20/23]

Idaho Capital Sun: Only Hospital for 9,000 Residents in Idaho Ends Its Obstetrical Services. “Idaho’s Bonner General Health, the only hospital in Sandpoint, announced Friday afternoon that it will no longer provide obstetrical services to the city of more than 9,000 people, meaning patients will have to drive 46 miles for labor and delivery care moving forward. Sandpoint Women’s Health will not accept new obstetrics patients effective immediately and offered a referral list for patients to use for their care. The hospital said it would make every attempt to continue deliveries through May 19, but said it will depend on staffing. The release also said highly respected, talented physicians are leaving the state, and recruiting replacements will be ‘extraordinarily difficult.’ Idaho has one of the most restrictive abortion bans in the country, with affirmative defenses in court only for documented instances of rape, incest or to save the pregnant person’s life. Physicians are subject to felony charges and the revocation of their medical license for violating the statute, which the Idaho Supreme Court determined is constitutional in January. Dr. Amelia Huntsberger, an obstetrician-gynecologist at Bonner General Health, said in an email to States Newsroom that she will soon leave the hospital and the state because of the abortion laws as well as the Idaho Legislature’s decision not to continue the state’s maternal mortality review committee. Linda Larson, who has lived in Sandpoint for 36 years and delivered her first child at Bonner General Health, said the community relies on Bonner General Health for much of its health care services, including physical therapy and routine blood work.” [Idaho Capital Sun, 3/17/23]