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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]

Over the past several months, the insurance industry has been running a massive advertising campaign to scare seniors into believing the Biden administration is cutting Medicare. Republicans in Congress are echoing these claims to protect insurance company profits. In reality, the Biden administration is proposing to increase spending on Medicare Advantage by approximately $4 billion while protecting the program from overpayments, fraud, and abuse by big insurance companies. Recent coverage makes clear that health insurance companies are working overtime to “exaggerate the stakes” in order to protect their massive profits at the expense of seniors. 

Read Protect Our Care’s fact sheet about how big insurers are spreading falsehoods about Medicare Advantage here. 

HEADLINES

STAT: Wary Of Changes To Medicare Advantage, Health Insurers Put Up A Fight — And Exaggerate The Stakes. “For the past two months, the health insurance industry has attempted to scare older adults and the public into thinking the federal government is slashing Medicare benefits next year… Since any changes to Medicare are politically unpopular, health insurers are hoping the pressure will force the Biden administration to retreat from its February proposals that would specifically change how Medicare Advantage plans are paid. Final regulations are due to come out April 3. But insurance companies, as well as some doctors’ groups, are distorting the reality of the proposals in an effort to protect the sizable and growing profits they earn from Medicare Advantage. If anything, the government’s proposals are relatively tame, according to researchers and experts who have no ties to the industry. And they say officials could do more to combat the most egregious coding practices, which increase costs.” [STAT, 3/27/23]

The New York Times: Biden Plan To Cut Billions In Medicare Fraud Ignites Lobbying Frenzy. “The change in payment formulas is an effort, Biden administration officials say, to tackle widespread abuses and fraud in the increasingly popular private program… Without reforms, taxpayers will spend about $25 billion next year in “excess” payments to the private plans, according to the Medicare Payment Advisory Commission, a nonpartisan research group that advises Congress. The proposed changes have unleashed an extensive and noisy opposition front, with lobbyists and insurance executives flooding Capitol Hill to engage in their fiercest fight in years.” [The New York Times, 3/22/23]

Axios: The Quiet Privatization Of Government Health Insurance Programs. “The insurers that administer Medicare benefits and their allies are running an enormous lobbying blitz against proposed regulations by the Biden administration that they say will cut their government funding and, in turn, harm enrollees. Supporters of the cuts say that the proposal corrects overpayment, which plans obtain by manipulating the billing system. The potency of the lobbying is a sign of just how ingrained Medicare Advantage has become among seniors over the years — and how important it is to some insurers’ business mix.” [Axios, 3/28/23] 

Stat: Denied By AI: How Medicare Advantage Plans Use Algorithms To Cut Off Care For Seniors In Need. “Behind the scenes, insurers are using unregulated predictive algorithms, under the guise of scientific rigor, to pinpoint the precise moment when they can plausibly cut off payment for an older patient’s treatment. The denials that follow are setting off heated disputes between doctors and insurers, often delaying treatment of seriously ill patients who are neither aware of the algorithms, nor able to question their calculations. Older people who spent their lives paying into Medicare, and are now facing amputation, fast-spreading cancers, and other devastating diagnoses, are left to either pay for their care themselves or get by without it. If they disagree, they can file an appeal, and spend months trying to recover their costs, even if they don’t recover from their illnesses.” [Stat, 3/13/23] 

Medicare Rights Center: New Campaign Urges Commonsense Medicare Advantage Reforms. “A new national survey shows current and future Medicare beneficiaries agree—they overwhelmingly support addressing MA payment flaws, including as outlined in the 2024 AN:

• 90% favor reforms to reduce MA overpayments.
• 70% want policymakers to prevent fraudulent MA plan billing practices.
• 65% say MA plans should be held accountable for providing value to beneficiaries and taxpayers.” [Medicare Rights Center, 3/23/23]

Health Affairs: Born On Third Base: Medicare Advantage Thrives On Subsidies, Not Better Care. “Over the past seven years, Medicare Advantage’s (MA’s) enrollment has almost doubled, adding 10 percent to its market share , now at 49 percent… The Medicare Advantage industry’s explanation of its success is grounded in claims about MA’s ability to deliver Medicare Part A and B benefits for much less than TM. These savings are, in theory, the basis for the rebates, the incremental revenue CMS pays to plans that fund the improved benefits and lower premiums as compared to TM, which in turn help attract members to MA plans… However, a close examination of the bid process reveals that most of these savings are artifacts of the process and not due to better or more efficient care. They result from including “induced utilization costs” from Medicare supplemental insurance, legislated increases in the benchmarks, and risk score gaming.” [Health Affairs, 3/27/23]

Stat: Key Senators Blast Medicare Advantage Insurers For ‘Exorbitant Salaries,’ ‘Massive Payouts’ To Execs. “Sens. Elizabeth Warren (D-Mass.) and Jeff Merkley (D-Ore.) slammed seven different Medicare Advantage insurers for lobbying against proposed rate cuts to the program while their executives still collected ‘exorbitant salaries’ and gave ‘massive payouts’ to their shareholders. The strong language came in a series of letters from the two key Senate Democrats to Humana, Centene, UnitedHealthcare, Aetna CVS Health, Molina Health, Elevance Health and Cigna — which collectively account for 70% of the market for Medicare Advantage, a private alternative to traditional Medicare. Nearly all of those companies, along with the insurance industry’s major trade group, America’s Health Insurance Plans, have been pushing back against a Biden administration proposal that would cut baseline payments to the plans by 2.3% in 2024.” [Stat, 3/23/23]

Washington DC — Today, GOP Speaker Kevin McCarthy outlined the Republican agenda for an upcoming debt ceiling bill. Republicans are seeking broad and devastating cuts to health care programs, including so-called work requirements and other draconian policies that would raise costs and rip away coverage from millions of Americans. These policies are especially harmful to children, rural Americans, people of color, and older adults. In response, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“Kevin McCarthy’s latest stunt confirms that Republicans are fighting to hold our economy hostage so they can slash vital health care programs. More Americans are covered under the Affordable Care Act and Medicaid than ever before, but Republicans want to roll back this progress and throw moms and kids off the rolls with burdensome paperwork requirements — all so they can preserve tax breaks for the wealthiest Americans. Republicans are once again showing us who they truly are by proposing deep and devastating cuts to health care, completely disregarding what the American people want and need to stay healthy. If Republicans truly cared about the state of the economy for working families, they would try to tackle rising health care costs instead of ripping away coverage from millions.”

Medicaid Coverage Requirement is Set to Expire April 1, Threatening Health Care for Millions of Families

Watch the Full Event Here.

Washington, DC – Today, U.S. Representatives Kathy Castor and Colin Allred joined Protect Our Care for a press conference calling governors across the country to protect coverage for families as the requirement to keep people on Medicaid ends April 1. The speakers will talk about the responsibility governors have to use their authority and resources to ensure children and families counting on Medicaid do not lose coverage due to burdensome paperwork and bureaucratic red tape. 

Congress passed legislation at the beginning of the COVID-19 pandemic to protect access to Medicaid by ensuring no one could be disenrolled during the public health emergency. This provision has helped secure the lowest level of uninsured Americans ever. When the requirement ends, an estimated 15 million people could potentially lose coverage, disproportionately affecting people of color and children. It is especially important to keep families covered in all the states where leaders continue to reject Medicaid expansion, including Florida and Texas. The Biden-Harris administration has committed to expanding access to care and providing guidance to states to assess eligibility in a way that will minimize coverage losses, particularly for children, people of color, people with disabilities, and others who rely on the Medicaid program for their health care. 

“Medicaid has been a lifeline to our neighbors for the past three years, thanks to the swift congressional action at the beginning of the COVID-19 pandemic. Having continuous coverage has brought a sense of financial and health security to many throughout the pandemic, particularly our nation’s children and new parents,” said U.S. Representative Kathy Castor. “Governor DeSantis and his colleagues across the country must take all available steps to ensure that individuals who are renewing their Medicaid coverage are provided every opportunity to stay enrolled in Medicaid if they are eligible, or to be given help enrolling in other affordable coverage options, like the Affordable Care Act marketplace.”

“Governor Abbott has a responsibility to make sure that Texans who qualify for Medicaid don’t get bogged down in red tape and paperwork – especially the 1.4 million kids and 300,000 Texas moms who are at risk of losing coverage,” said U.S. Representative Colin Allred. “I worry that our state is not prepared for the amount of processing it will take to ensure that there’s no lapse in coverage for these families. That’s why it’s so important that we do all we can to get these families the resources and information they need to keep their family healthy.”

“It is the responsibility of every state and every governor to be sure that those who qualify for Medicaid stay covered. This means helping everyone to understand their coverage options and giving them the help they need to re-enroll so that no one loses their health care because they fail to submit the right paperwork or simply because they were not communicated in the language most appropriate for them,” said Leslie Dach, Chair of Protect Our Care. “It is critical to understand what’s at risk here – the families, people who are working hard every day, people with disabilities, children, moms who rely on Medicaid could lose access to basic health care. Every state elected official must think of their own families and what it would be like if health care was ripped away from them for no reason.”