News

Republican-Led States Like Florida and Arkansas See Highest Levels of Coverage Loss

In April, states began the process of unwinding their Medicaid programs, and a recent analysis from the Kaiser Family Foundation shows that more than half a million Americans have already lost their health care. News coverage over the last several weeks makes clear that Republican-led states like Florida and Arkansas are moving far too quickly to throw people off the rolls. Some states are failing to ensure that people know their rights or eligibility for financial assistance under the Affordable Care Act or other health care programs. Instead of doing everything in their power to keep people covered, Republican governors like Ron DeSantis are using this opportunity to slash their Medicaid rolls. 

It’s no surprise that red states are moving to throw people off their coverage given the GOP’s longstanding hostility towards Medicaid and affordable health care. In Florida, nearly 250,000 people have lost their coverage in a state that continues to reject Medicaid expansion, making it harder for families to find affordable coverage options. This comes as Republicans in Congress recently attempted to impose even more paperwork requirements in Medicaid and boot 21 million people off of their health care.

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency, but this provision expired on April 1. Experts fear that as many as 15 million people nationwide could lose their health care due to procedural requirements and bureaucratic red tape, disproportionately impacting people of color, children, and people in rural communities.

KFF Health News: As Medicaid Purge Begins, ‘Staggering Numbers’ of Americans Lose Coverage. “The overwhelming majority of people who have lost coverage in most states were dropped because of technicalities, not because state officials determined they no longer meet Medicaid income limits. Four out of every five people dropped so far either never returned the paperwork or omitted required documents, according to a KFF Health News analysis of data from 11 states that provided details on recent cancellations. Now, lawmakers and advocates are expressing alarm over the volume of people losing coverage and, in some states, calling to pause the process.” [KFF Health News, 6/1/23] 

Politico: 500,000 Dropped From Medicaid — So Far. “That’s the number of people in 11 states who have already been taken off the Medicaid rolls since redetermination started, according to a new analysis from KFF. The total number of people disenrolled varied significantly by state — as did the percentage of total completed renewals affected. Florida tops the charts for both measures, with nearly 250,000 removed from the rolls, equaling about half the number of completed renewals.” [Politico, 6/1/23] 

Washington Post (Opinion): Government Incompetence Is Knocking Eligible Americans Off Medicaid. “Here’s where the numbers get especially infuriating. States are supposed to break out how many people lost coverage because they were reassessed for eligibility and actually determined to no longer qualify (because their income rose, for example, or they aged out of the children’s health insurance program) versus how many people lost coverage for pointless ‘procedural’ reasons (e.g., the state never received documentation needed to reassess eligibility). Based on the states that have publicly released breakdowns so far, the majority of people losing Medicaid are casualties of those paperwork-related reasons.” [Washington Post, 6/1/23] 

New York Times: Hundreds of Thousands Have Lost Medicaid Coverage Since Pandemic Protections Expired. “Hundreds of thousands of low-income Americans have lost Medicaid coverage in recent weeks as part of a sprawling unwinding of a pandemic-era policy that prohibited states from removing people from the program. Early data shows that many people lost coverage for procedural reasons, such as when Medicaid recipients did not return paperwork to verify their eligibility or could not be located. The large number of terminations on procedural grounds suggests that many people may be losing their coverage even though they are still qualified for it. Many of those who have been dropped have been children.” [New York Times, 5/26/23] 

The Hill: Millions Had Medicaid Coverage Tied To The Pandemic. Now They Stand To Lose It. “Many will lose coverage due to no longer being eligible, but others stand to become uninsured due to ‘administrative churn,’ a term federal agencies use to refer to clerical issues that prevent people from receiving services. These obstacles include changes of address, insufficient contact information or enrollees simply struggling with the renewal process. Joan Alker, director of the Center for Children and Families at the Georgetown McCourt School of Public Policy, said she has observed high rates of ‘procedural denials’ in some states, meaning people were denied coverage due to not completing the renewal process, not because they were ineligible.” [The Hill, 5/29/23] 

Tampa Bay Times: Florida Not Doing Enough To Keep Children On Medicaid, Health Advocates Warn. “Health care advocates are sounding the alarm over how Florida is handling last month’s end of emergency Medicaid, which they warn could force thousands of eligible children to lose medical coverage because their parents don’t know they must reapply to the federal program. One reason they don’t know, according to advocates, is that Florida officials haven’t done enough to reach out to families and that some of its messaging is causing confusion.” [Tampa Bay Times, 6/2/23] 

KUER 90.1: Bad Paperwork Is Driving Most Of The Turnover On Utah’s Medicaid Rolls. “In Utah, the biggest driver of lost coverage has been procedural reasons, like bad paperwork or missed contacts. Since the protections ended, almost 20,000 Utahns have lost coverage for that reason…On June 5, the department disclosed that a ‘mailing error’ resulted in Medicaid information for an estimated 5,800 Utahns being mistakenly put in incorrect envelopes and sent to the wrong addresses. The agency said new letters would be sent out over the next two weeks.” [KUER, 6/5/23] 

Arkansas Times: Arkansas’s Rush To Prune Medicaid Roster “Not Normal,” Leaves Thousands In Limbo. “Phasing out pandemic-era policies is complicated, and the Biden Administration gave states a year to clean the Medicaid rolls. But thanks to state lawmakers, Arkansas is pruning Medicaid lists in six months instead, forcing tradeoffs between speed and due diligence. The result is that people who are eligible for Medicaid are losing it anyway.” [Arkansas Times, 5/23/23] 

Associated Press: North Dakota Health Officials Urge Return Of Medicaid Renewal Forms As Thousands Lose Coverage. “State Health and Human Services says about 13,000 Medicaid recipients in North Dakota were due for renewal at the end of May, but thousands failed to return their forms, so many lost coverage even though they may still qualify, KFGO reported.” [Associated Press, 6/6/23] 

Vox: Hundreds Of Thousands Of Americans Are Losing Medicaid Every Month. “Policy experts and advocates warned before the eligibility checks began that people who are still eligible for Medicaid could lose their insurance due to administrative problems, such as not receiving mail from the state or not returning documentation to confirm they are still eligible. Now the early evidence suggests that’s exactly what is happening. In Florida, for example, more than 80 percent of people who were dis-enrolled from Medicaid were kicked off for procedural reasons. About the same share of people who lost coverage in Arkansas and Indiana were deemed ineligible because they failed to report information to the state or because the state could not reach them. Only a small percentage of people — about one in seven in Arkansas — were removed because they were no longer eligible (i.e., their income had grown to the point it exceeded Medicaid eligibility limits).” [Vox, 5/19/23]

Politico: The Looming Medicaid Crisis. “Most people currently on Medicaid will still be eligible — if they get through the notification and recertification process. Others will be eligible for heavily-subsidized plans on the Affordable Care Act markets, or may get covered at work. In fact, almost everybody will be eligible for something — except those who fall in the ‘Medicaid gap,’ in the 10 states still resisting Obamacare’s Medicaid expansion. (Two other states have approved expansion although it hasn’t kicked in yet.) But health care is difficult to navigate. Understanding the Medicaid unwinding, figuring out what you are eligible for and then actually getting signed up are three different things, each with its own complexities.” [Politico, 5/22/23]

***MEDIA ADVISORY FOR THURSDAY, JUNE 8 at 10:30 AM MST // 1:30 EDT***

Republicans’ Latest Attack on the ACA Targets Lifesaving Preventive Care for More than 150 Million Americans 

PHOENIX, AZ  — On Thursday, June 8 at 10:30 AM MST // 1:30 EDT, Arizona Attorney General Kris Mayes will join Protect Our Care Arizona to discuss U.S. District Judge Reed O’Connor’s devastating decision to strike down a major provision of the Affordable Care Act (ACA) that requires free coverage of lifesaving preventive health care services. Judge O’Connor’s decision in Braidwood Management v. Becerra would end the ACA’s guaranteed free access to essential preventive services including lifesaving cancer screenings, and more. In 2020 alone, more than 150 million Americans benefited from these preventive services. 

On June 6, the US Court of Appeals for the Fifth Circuit held a hearing to decide if the ACA’s protections should stay in place for everyone other than the plaintiffs while the case works its way through the courts. The plaintiffs have argued that a stay is unnecessary because insurance companies are very unlikely to not drop cost-free coverage. In reality, insurance companies have a proven record of moving quickly to cut costs at the expense of patients. 

Patient and provider groups, public health experts, organized labor, 68 academic deans and scholars, and dozens more organizations overwhelmingly agree that this case is built on unfounded legal arguments and have submitted briefs affirming that, if Judge Reed O’Connor’s ruling stands, the consequences for patients would be disastrous. Speakers will highlight what this decision could mean for Arizonans’ access to lifesaving health care services, and discuss what is to come as the lawsuit moves through the court system. 

WHO:
Arizona Attorney General Kris Mayes
Will Humble, Executive Director, Arizona Public Health Association
Brian Hummell, Government Relations Director, American Cancer Society Cancer Action Network

WHAT: Virtual Press Conference

WHEN: Thursday, June 8 at 10:30 AM MST // 1:30 EDT

WHERE: Register to join the Zoom event (Registration required)

Congressional Ways and Means Committee Bills Are a Broad Attack on Health Coverage

Washington, D.C. – Today, the House Ways and Means Committee is considering legislation to promote the use of health savings accounts (HSA) and undermine the protections under the Affordable Care Act (ACA). HSAs overwhelmingly benefit high-income people; these bills incentivize the expansion of HSAs through tax breaks which would reward the highest-paid workers while worsening racial and ethnic inequities in health care. While Republicans are considering bills to help the wealthy and raise costs on middle class Americans, they are failing to prioritize legislation that would lower drug prices, make insurance more affordable, and make the health care system fairer for families. 

In response, Protect Our Care’s Executive Director Brad Woodhouse issued a statement:

“These Republican bills are more about giving tax breaks for the wealthy than about helping people get the health care they need. Instead of expanding access to health care and fighting health disparities, these bills would allow health plans to get around anti-discrimination bills. Time and again, Republicans prove they are not for protecting health care, they are for side-stepping ACA protections of health care.”

BACKGROUND

• HSAs Make Health Care Less Accessible And Affordable. Republican efforts to promote the use of HSAs directly undermines the ACA’s goals to make quality health care more accessible and affordable for all Americans. The promotion of employer-sponsored high deductible health plans that use HSAs increases the cost of health care for employees and continues the difficult decisions low income working families have to make between putting food on the table or paying for medical care. 
• HSAs Benefit The Wealthy. HSAs largely benefit high-income individuals. Contributions to HSAs are not taxed, which helps wealthy people decrease their taxable income and avoid paying their fair share. These contributions can also be invested in stocks and bonds to accrue tax-free earnings that carry over year to year — further exacerbating the wealth gap.
• HSAs Do Not Make Care More Affordable for Low-Income Individuals. HSAs do not benefit low-income individuals as they often do not have the ability to contribute to HSAs and need to use their available income to pay for medical bills and care up front. Nearly 70 percent of adults under 200 percent of the poverty line would not have been able to pay a $1,000 medical bill within 30 days in 2022, let alone contribute to a HSA. Low-income individuals also do not benefit as much from tax-free earnings as high-income individuals due to the lower amount of tax deductions from being in a lower income tax bracket. Employers who offer high deductible health plans, where HSAs are necessary, typically contribute little to nothing to their employees’ HSAs. 
• HSAs Exacerbate Racial And Ethnic Inequities In Health Care. Black and Latino people with private insurance are half as likely to have HSAs as white and Asian people. Per the Center on Budget and Policy Priorities: “Against a backdrop of long-standing racial disparities in wealth — a typical white family in 2019 had eight times the wealth of a typical Black family and five times the wealth of a typical Latino family — HSAs provide preferential tax treatment that is disproportionately out of reach for people of color.”
• HSAs Cost The Government Billions. HSAs will cost the government $182 billion between 2023 and 2032. Meanwhile, the cost of President Biden’s plan for permanently closing the Medicaid coverage gap or permanently extending marketplace coverage premium tax credits over the next 10 years would cost roughly the same amount at $200 billion and $183 billion respectively. Unlike the bills to expand HSAs, Medicaid expansion and marketplace premium tax credits would allow millions of uninsured individuals to gain quality coverage.

Greedy Big Pharma Comes For Inflation Reduction Act’s Medicare Negotiations

Washington, D.C. – Today, the pharmaceutical company Merck sued the federal government challenging the constitutionality of the Inflation Reduction Act’s Medicare Prescription Drug Negotiation Program, which allows Medicare to negotiate lower prices for certain drugs. Merck manufactures Januvia, a type 2 diabetes drug that is likely to be eligible for negotiation, and has been on the market without competition for nearly 20 years. In 2021 alone, Medicare spent over $4 billion on the drug. The authority to negotiate lower prices against Big Pharma, making prescription drugs more affordable, is a historic win for American patients who pay up to four times more for the same drugs as patients in other wealthy countries. 

In response, Protect Our Care’s Executive Director Brad Woodhouse issued a statement:

“While Americans are cutting pills and skipping doses, Merck is suing the federal government to protect their ability to overcharge seniors and taxpayers to pad their sky-high profits. President Biden and Democrats in Congress delivered a historic win when they fought Big Pharma and enacted legislation to finally allow Medicare to negotiate lower drug prices. Pharma lost that lobbying battle, and now they’re going to court to protect their outrageous profits at the expense of seniors. Big Pharma’s greed knows no bounds.”

Republicans on the Committee on Education & the Workforce Introduce Bills to Promote Junk Plans and Undermine the ACA

Washington, DC — Today, Republicans on the House Committee on Education & the Workforce will mark up legislation that would promote junk plans that lack patient protections under the Affordable Care Act (ACA). Republicans have a long history of promoting junk plans, which can discriminate against people with pre-existing conditions and fail to cover essential services like hospital visits and prescription drugs in order to undermine the Affordable Care Act (ACA). These proposals are particularly harmful for communities of color and other marginalized groups who are more likely to have poorer health and to be living in poverty. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“This is the Republican war on health care at work. After Republicans failed to throw 21 million Americans off of their Medicaid in their debt default negotiations, they have returned to their same old ploy to undermine the ACA and promote junk plans. Republicans want to return to a time when insurance companies made all of the rules and could limit or deny coverage to people for having conditions like asthma, diabetes, and cancer. If passed, these sham bills would only force more families to gamble with their health care, putting them at serious risk of medical debt if they get sick.” 

GOP JUNK PLAN LEGISLATION

• Association Health Plans Act: Introduced by Congressman Tim Walberg, the Associations Health Plans Act will expand access to association health plans (AHPs) and undermine the ACA.
• Self Insurance Protection Act: Introduced by Congressman Bob Good, this legislation will protect access to stop-loss insurance, insurance for employers who self-fund their employee benefit plans, but do not want to assume liability for losses. This promotes use of non-ACA compliant plans such as AHPs and other self funded benefit plans.

BACKGROUND

• Pre-Existing Conditions Affect As Many As 135 Million People. According to an analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition. This includes:

• • 44 million people who have high blood pressure
  • 45 million people who have mental health and substance use disorders
  • 44 million people who have high cholesterol
  • 34 million people who have asthma and chronic lung disease
  • 34 million people who have osteoarthritis and other joint disorders

• AHPs Leave Behind Sick and At-Risk Individuals. AHPs are health plans that are offered to members of trade associations, professional groups, or other organizations. Compared to plans available on state marketplaces, AHPs provide weaker cost and protection coverage and are not required to hold up the same protections that plans under the ACA do. Savings in AHPs come at the expense of sicker and at risk individuals who have higher costs than healthy individuals on these plans.
• AHPs Avoid ACA Regulations. AHPs do not have to participate in the ACA’s single-risk pool rule. The single-risk pool allows premiums to be set based on everyone who has a specific type of insurance. Since AHPs do not have to have one pool, they can set premiums lower for healthier people and higher for those with pre-existing conditions or who are at risk for health issues in the future. This can cause AHPs to lure healthier individuals out of the ACA marketplace pool causing an increase in claim costs and therefore premium increases for ACA-compliant insurers.

• Communities of Color and Other Marginalized Communities Are Exploited By AHPs. Black, Latino, Asian, Indigenous, and LGBTQI+ people in America tend to have poorer health and are more likely to be living in poverty than their White, heterosexual counterparts. Members of these marginalized communities with an AHP for their insurance would likely have higher premiums due to pre-existing conditions, AHP’s not being subject to a single risk pool, and not participating in risk adjustment transfers.

• AHPs Do Not Comply With Essential Health Benefit Requirements. The ACA requires health insurance companies to cover essential health benefits such as prescription drugs, mental health and substance use treatment, and maternity care. AHPs aren’t required to include essential health benefits in their coverage, meaning individuals on these health plans would pay out of pocket for these services.

Hearing on June 6 Will Determine if Judge O’Connor’s Disastrous Ruling Takes Immediate Effect Nationwide

In March, District Judge Reed O’Connor in Braidwood Management v. Becerra struck down a provision of the Affordable Care Act (ACA) that requires insurers to cover lifesaving preventive services without cost sharing.  Braidwood is a politically-driven effort to dismantle the ACA, brought by longtime foes of abortion rights, women’s health, LGBTQI+ rights, and affordable health care. Now, the same judge who ruled that the ACA should be overturned entirely is ending lifesaving protections under the health care law that 150 million Americans rely on. 

Judge O’Connor applied his order to every company nationwide, refusing to limit it to the two companies and six individuals that are the plaintiffs that brought the case. The US Court of Appeals for the Fifth Circuit is holding a hearing June 6 to decide if the ACA’s protections should stay in place for everyone other than the plaintiffs while the case works its way through the courts. 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 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. 

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 unfounded legal arguments and have submitted briefs affirming that, if Judge Reed O’Connor’s ruling stands, the consequences for patients would be disastrous.

Experts Submit Briefs Calling For Stay of Braidwood v. Becerra Ruling Warning Of The Dangers Of Putting Life-Saving Care At Risk 

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]

Insurance Companies Most Recent Move Shows They Will Be Quick to Drop Coverage 

In March, District Judge Reed O’Connor in Braidwood Management v. Becerra struck down a provision of the Affordable Care Act (ACA) that requires insurers to cover lifesaving preventive services without cost sharing. Judge O’Connor applied his order to every company nationwide, refusing to limit it to the two companies and six individuals that are the plaintiffs that brought the case. The US Court of Appeals for the Fifth Circuit is holding a hearing June 6 to decide if the ACA’s protections should stay in place for everyone other than the plaintiffs while the case works its way through the courts. The plaintiffs have argued that a stay is unnecessary because insurance companies are very unlikely to not drop cost-free coverage. In reality, insurance companies have a proven record of moving quickly to cut costs at the expense of patients. 

Just last month, the requirement for insurance companies to cover at home COVID-19 tests ended, and insurers have already started removing this coverage. Some Blue Cross affiliates, including CareFirst and Blue Cross Blue Shield of Massachusetts, have informed customers that they “will no longer reimburse members for tests purchased on or after May 12, 2023.” And customers looking for guidance from CVS, one of the nation’s largest retailers of COVID-19 tests, are being told that they must “check your plan to see if you’re covered” for reimbursement for tests. This has caused confusion to patients who don’t know if their plans will cover tests, and is the likely harbinger of more to come. 

Without a stay in Braidwood, this type of action by insurers would be catastrophic for access to critical preventive services. Insurance companies would once again be able to charge patients for lifesaving care, like cancer screenings, anxiety and depression screenings for children and adults, screenings for hepatitis and other diseases, and access to critical medicines like statins and PrEP. Read more about what’s at risk in the case here. 

Experts Warned Of A Confusing “Hodgepodge” Of Coverage For COVID Testing After The Expiration Of The Public Health Emergency. From 2021 to May 11, 2023 the federal government required all private insurers to cover up to eight at home COVID-19 tests per month. When that requirement ended on May 11, some private insurers opted to continue coverage, but there is no longer a nationwide rule.  Christona Silcox of the Duke Margolis Center for Health Policy warned that, “What we will see is a hodgepodge of approaches by different insurance companies, which is going to make it difficult for individuals to know what they’re going to be paying.” 

Details About What Plans Will Cover Are Scarce And Each Insurance Company Can Make Its Own Decisions About What To Cover And How Much Customers Will Have To Pay.  After the expiration of the PHE, the federal government has encouraged insurers to continue coverage, but each company can ultimately make their own decision. On May 1 CNN reported that, “So far, details on those plans are scarce.” The Blue Cross Blue Shield Association told CNN that its coverage may include “reasonable limits” on tests. Aetna, Cigna, Humana and UnitedHealthcare did not provide any details on what their plans will or will not cover going forward. Some Blue Cross affiliates, including CareFirst and Blue Cross Blue Shield of Massachusetts have already informed customers that they “will no longer reimburse members for tests purchased on or after May 12, 2023.” 

Major Retailers Refer Customers To “Check Your Plan” To See If Covid Tests Are Still Covered. Customers looking for guidance from CVS, one of the nation’s largest retailers of COVID-19 tests, are told that they must “check your plan to see if you’re covered” for reimbursement for tests. 

Democrats Saved Health Care For 21 Million Americans From Republican Plans to Slash Medicaid and Destroy Our Economy

Washington, DC — Today, President Biden will sign legislation protecting millions of Americans’ health care, avoiding default on our nation’s debt. This victory was achieved for the American people despite Republicans’ best effort to rip Medicaid away from 21 million Americans with burdensome paperwork requirements after trying to hold the economy hostage in order to get their way. President Biden, with the support of Democrats in Congress, held the line insisting he wouldn’t agree to any deal that took health care coverage away from Americans, and the agreement protects Medicaid from any Republican cuts. In response, Protect Our Care Chair Leslie Dach issued the following statement: 

“President Biden and Democratic lawmakers saved Medicaid from the latest installment of Republicans’ war on health care. Not only did the Biden-Harris Administration save the economy from a Republican default, but 21 million Americans can rest easier knowing that their health care is secure.

“The American people have repeatedly rejected Republican attacks on health care, but there is no doubt Republicans in Congress will continue trying to rip away Medicaid from millions, hike drug and health insurance prices, and remove protections for pre-existing conditions. As we speak, Republicans and their allies are in court fighting to take away no cost preventive services, dismantle the Affordable Care Act, revoke reproductive rights, and upend the FDA’s drug approval process. Thankfully, we have a president who is standing up for families and will stop at nothing to protect health care.”