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ashoup
In Research, Fact Sheet

“Medicare Autumn” Fact Sheet: American Seniors Will Save As Medicare Negotiates Lower Drug Costs

Protect Our Care launched a new campaign, “Medicare Autumn,” to educate seniors on how Medicare is better than ever. Thanks to the Medicare Drug Price Negotiation Program included in the Inflation Reduction Act, Medicare now has the ability to negotiate drug prices to lower costs for seniors on Medicare. The Biden administration recently announced the first round of high-cost drugs whose prices will come down from negotiation. This includes some of the highest-priced prescription drugs used to treat conditions like diabetes, heart disease, cancer, arthritis, chronic kidney disease, psoriasis, Crohn’s disease, and ulcerative colitis – many of which disproportionately impact women, communities of color, and people in rural areas. 

For too long, Americans have been paying three to four times more than people in other countries for the prescription drugs they depend on, forcing people to choose between filling a prescription or filling their refrigerator. Giving Medicare the power to negotiate with drug companies will help bring the price of medicines in the U.S. more in line with what other countries pay.

The impact of lower prescription drug costs thanks to the Inflation Reduction Act will be felt by people across the country. Negotiating lower prices on certain popular high-cost drugs will help:

  • 3,505,000 Americans who pay an average of $441 out-of-pocket per year for Eliquis, sold by Bristol Myers Squibb, to treat blood clots.
  • 47,000 Americans who pay an average of $921 out-of-pocket per year for Enbrel, sold by Amgen, to treat arthritis and psoriasis. 
  • 521,000 Americans who pay an average of $357 out-of-pocket per year for Entresto, sold by Novartis, to treat heart failure. 
  • 639,000 Americans who pay an average of $260 out-of-pocket per year for Farxiga, sold by AstraZeneca to treat diabetes.
  • 763,000 Americans who pay an average of $121 out-of-pocket per year for Fiasp/NovoLog, sold by Novo Nordisk, to treat diabetes. 
  • 22,000 Americans who pay an average of $5,247 out-of-pocket per year for Imbruvica, sold by AbbVie, to treat blood cancers. 
  • 885,000 Americans who pay an average of $270 out-of-pocket per year for Januvia, sold by Merck, to treat diabetes. 
  • 1,321,000 Americans who pay an average of $290 out-of-pocket per year for Jardiance, sold by Boehringer Ingelheim, to treat diabetes. 
  • 20,000 Americans who pay an average of $2,058 out-of-pocket per year for Stelara, sold by Johnson & Johnson, to treat psoriasis and Crohn’s disease.
  • 1,311,000 Americans who pay an average of $451 out-of-pocket per year for Xarelto, sold by Johnson & Johnson, to treat blood clots.

Drug Price Negotiation Improves Other Medicare Benefits. As a result of Medicare negotiation negotiations, Americans with Medicare will have access to innovative, life-saving treatments at lower prices, translating into lower premiums and out-of-pocket costs for older Americans and producing savings that are being used to improve benefits, including: 

  • a new $35 cap on monthly insulin prescriptions; 
  • free recommended vaccines;
  • a $2,000 annual cap on prescription drug costs taking effect in 2025.

The First 10 Drugs Are Just The Beginning. Negotiations will occur over the coming year and new, lower prices will be announced by September 1, 2024, and take effect in 2026. The first ten drugs that will see lower prices are responsible for about 20% of total Medicare Part D prescription drug costs every year. The companies that market them have made more than $493 billion in revenue from these drugs. Medicare will negotiate lower prices for an additional 15 drugs for prices effective in 2027, and by 2029, Medicare will negotiate lower prices for 20 drugs per year. And President Biden and Democrats in Congress are already working to expand these cost savings to more Americans, no matter what age they are or how they get their health coverage. 

Medicare Drug Price Negotiation Is Overwhelmingly Popular. Negotiating lower prices is overwhelmingly popular across the country, yet big drug companies are suing the federal government to protect their massive profits by halting the program. A recent Hart Research poll shows that 96 percent of Americans agree that lowering drug prices “is an important way to help people afford the cost of living,” and nearly three-quarters of Americans favor Medicare negotiation. Meanwhile, pharmaceutical companies’ arguments against negotiation are overwhelmingly rejected by the American people.

Big Drug Companies Are Threatening To Keep Drug Prices High Through The Courts. Drug company giants including Merck, Bristol Myers Squibb, Johnson & Johnson-owned Janssen Pharmaceuticals, Boehringer Ingelheim, AstraZeneca, and Novartis, as well as mega lobbying groups PhRMA and the US Chamber of Commerce, have sued the federal government in an effort to stop Medicare from negotiating for lower prescription drug prices for Medicare beneficiaries. If the big drug companies get their way patients will pay more so the drug companies can make more money:

  • GONE: Medicare’s power to negotiate lower prices for the most popular and expensive prescription drugs. Under the Inflation Reduction Act, Medicare is set to begin negotiating prices for 10 of the top 50 most expensive Part D drugs in 2026, adding another 15 drugs in 2027 and 2028, and another 20 in 2029 and subsequent years.
  • GONE: $98.6 billion in Medicare savings over the next decade from the drug negotiation program, which translates into savings for patients and taxpayers.
  • GONE: Lower Part D premiums and lower out-of-pocket drug costs for certain Medicare beneficiaries who rely on qualifying drugs.

The plaintiffs assert several sweeping claims, including under the First Amendment, the Fifth Amendment, and the Eighth Amendment across the lawsuits, but experts agree that these meritless arguments are merely an attempt to maintain the status quo where drug companies can protect their massive profits by charging whatever they want at the expense of patients and taxpayers.

ashoup
In Research, Fact Sheet

FACT SHEET: Medicare Open Enrollment Brings New Benefits and Savings for Millions of Seniors

Seniors Will Save in 2024 Thanks to the Inflation Reduction Act: Lower Drug Costs, Monthly Insulin Cost Cap, and Free Vaccines 

Medicare open enrollment began on October 15 and runs through December 7. Millions of seniors will begin selecting their coverage for 2024. It is important that seniors understand the savings available to them as they make decisions about enrolling in a Medicare plan.

As Medicare beneficiaries review plans for 2024, seniors will see new benefits thanks to the Inflation Reduction Act’s measures to drive down drug costs. As they did during the 2023 Medicare open enrollment, seniors will see lower premiums for prescription drug coverage. As of January 1, 2023, critical vaccines are now free, monthly insulin costs are capped at $35 per prescription, and drug companies cannot take advantage of seniors by raising drug prices faster than the rate of inflation. Additionally, in the years ahead, Medicare beneficiaries will see lower drug prices across the board thanks to the Inflation Reduction Act’s provisions to give Medicare the power to negotiate and cap out-of-pocket drug costs at $2,000 a year. This translates to thousands of dollars in savings for millions of seniors and people with disabilities nationwide. 

BY THE NUMBERS: Seniors Will Pay Less for Health Care

The Inflation Reduction Act is drastically reducing the cost of prescription drugs for the more than 50 million Americans enrolled in Medicare’s Part D drug benefit, reducing racial, income, and geographic disparities in health care, and saving lives. Seniors will no longer have to choose between paying for the drugs they need and other essentials like food and housing.

By the Numbers:

  • Over 50 million Medicare beneficiaries no longer face big drug companies’ outrageous price hikes that exceed inflation. 
  • All Medicare Part D beneficiaries have access to covered vaccines, such as shingles and pneumonia, at no cost.
  • No Medicare beneficiary pays more than $35 a month for an insulin copay.
  • Over 50 million Medicare Part D beneficiaries will have out-of-pocket costs for prescription drugs capped at $2,000 per year beginning in 2025. 
  • Lower prices are being negotiated for the first 10 drugs selected for the Negotiation Program, with more drugs to be named each year. The first ten drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/NovoLog.
  • Premiums for the average Medicare Part D plan are decreasing by 1.8 percent in 2024.

The Inflation Reduction Act Lowers Prescription Drug Prices

Medicare Negotiation For Lower Drug Prices. The Biden administration is implementing the Medicare Drug Price Negotiation Program which is supported by over 80 percent of Americans — the most popular provision in the Inflation Reduction Act. In August, the first round of high-cost drugs that will be negotiated was announced: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp/ NovoLog. These high-cost drugs treat conditions like cancer, diabetes, and blood clots. The first ten drugs selected for negotiation are taken by nearly 9 million people on Medicare, who spent $3.4 billion in out-of-pocket costs last year alone.  The negotiated prices will be effective starting in 2026. 

Game-Changer For Insulin-Dependent Seniors. In 2020, there were more than 3.2 million insulin users with Medicare, with nearly 1.7 million purchasing their insulin without low-income subsidies. On average, seniors with Medicare Part D or B who are not receiving subsidies pay an average of $572 every year for this life-saving medication — an unthinkable sum for many on fixed incomes. Patients who suffer chronic complications can expect to pay upwards of an additional $650 per year. Under the Inflation Reduction Act, insulin copays for people on Medicare are capped at $35 per prescription each month. A recent study showed that 1.5 million people on Medicare would have saved an average of $500 in 2020 from the $35 insulin copay cap.

Ends Outrageous Price Increases For Seniors. The Inflation Reduction Act penalized drug companies for raising drug prices faster than the rate of inflation starting at the beginning of 2023. An analysis by KFF showed that half of all drugs covered by Medicare had list price increases exceeding the rate of inflation in 2020. For example, Humira, a medication commonly used to treat rheumatoid arthritis, is one of the nation’s highest revenue-generating drugs, raking in $21 billion in sales in 2019. AbbVie, Humira’s manufacturer, has hiked the price of Humira 27 times, including in January 2021 when it raised its cost by 7.4 percent. Over the past 20 years, price increases for brand-name drugs in Medicare Part D have risen at more than twice the rate of inflation. 

Free Shingles Vaccinations. Thanks to the Inflation Reduction Act, 50.5 million seniors are eligible for no-cost shingles vaccinations. In 2020, nearly 4 million Medicare beneficiaries received the two-part shingles vaccination. With a single shot of Shingrix costing $212, seniors on Medicare Part D are saving over $400 on average on vaccinations in 2023. The high out-of-pocket cost of the shingles vaccine has been a key factor in low vaccination rates, especially among Black and Latino communities. This extends an important affordable preventive service to seniors on Medicare; Americans with private insurance could already typically receive shingles vaccinations at no cost.

ashoup
In Fact Sheet, Research

FACT SHEET: GOP Legislation to Promote HSAs Gives a Boost to the Wealthy While Undermining Affordable Coverage

As Republicans are on the verge of forcing a reckless government shutdown, they are once again considering legislation to promote the use of health savings accounts (HSA), which overwhelmingly benefit high-income people. This legislation incentivizes the expansion of HSAs through tax breaks, rewarding the highest-paid workers while worsening racial and ethnic inequities in health care. This comes as Republicans are working to repeal the Inflation Reduction Act, raise prescription drug prices, and throw millions off of Medicaid. Once again, Republicans prove they are dead set on prioritizing tax breaks for the wealthy over helping people get the health care they need. 

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 upfront. 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.

ashoup
In Fact Sheet, Research

FACT SHEET: How Medicare’s New Drug Price Negotiation Power Will Advance Health Equity

On August 29, the Biden administration announced the first round of high-cost drugs whose prices will come down as Medicare negotiates with the drug companies – a new power they have under the Inflation Reduction Act. This new program will lower prices for some of the highest-priced prescription drugs on the market used to treat conditions like diabetes, heart failure, blood clots, and autoimmune disorders – conditions that disproportionately impact women, communities of color, and people in rural areas. The Inflation Reduction Act was championed by President Biden and Democrats in Congress to lower health care costs for people across the nation. 

The first ten drugs selected for negotiation are taken by nearly 9 million people on Medicare and account for about 20 percent of annual Medicare Part D spending. CMS will negotiate lower prices with manufacturers of these drugs, and those prices will take effect in 2026. The drugs are:

  1. Eliquis which is manufactured by Bristol Myers Squibb and Pfizer to treat blood clots
  2. Enbrel which is manufactured by Amgen to treat rheumatoid arthritis, psoriasis, and psoriatic arthritis
  3. Entresto which is manufactured by Novartis to treat heart failure 
  4. Farxiga which is manufactured by AstraZeneca to treat diabetes, heart failure, and kidney disease
  5. Fiasp, also known as NovoLog, which is manufactured by Novo Nordisk to treat diabetes
  6. Imbruvica which is manufactured by AbbVie and Johnson & Johnson to treat leukemia and lymphoma 
  7. Januvia which is manufactured by Merck to treat diabetes
  8. Jardiance which is manufactured by Boehringer Ingelheim and Eli Lilly to treat diabetes
  9. Stelara which is manufactured by Johnson & Johnson to treat psoriasis, psoriatic arthritis, Crohn’s disease, and ulcerative colitis
  10. Xarelto which is manufactured by Johnson & Johnson’s Janssen Pharmaceuticals and Bayer to treat blood clots

The Medicare Drug Price Negotiation Program advances health equity in two key ways: 

First, the Negotiation Program will lower drug prices for certain high-cost drugs, which will reduce out-of-pocket costs for Medicare enrollees. Since Black, Latino, women, LGBTQI+, and disabled people on Medicare are more likely to have lower incomes and less savings, reducing prescription drug costs will be especially impactful for their financial security and access to care. Lowering prices through negotiation is one of several ways the law reduces prescription drug costs for Medicare enrollees. Others include: capping monthly copays for insulin at $35, providing vaccines at no cost, limiting annual out-of-pocket spending in Part D to $2,000, which will save seniors with high drug costs over $400 per year, and making the Medicare Extra Help program available to more low-income seniors, reducing their premiums and copays for medication. 

Second, negotiating lower prices for the selected drugs will make drugs that are disproportionately needed by historically marginalized communities more affordable and accessible. The ten drugs selected by Medicare for lower negotiated prices treat a number of conditions that disproportionately impact people of color, and Medicare enrollees of color are more likely than the general Medicare population to take six of the ten selected drugs. Of the ten drugs selected by Medicare, eight treat conditions that disproportionately impact people of color including diabetes, heart failure, chronic kidney disease, blood clots, arthritis, and blood cancer (see Table 1). Additionally, six of the ten drugs are taken by a disproportionate number of Black, Latino, Asian, and/or American Indian/Alaska Native Medicare enrollees relative to the Medicare population as a whole (see Table 2), including

  • Enbrel is taken by a higher percentage of Latino enrollees and American Indian/Alaska Native enrollees than their proportion of the Medicare population. 
  • Entresto is taken by a higher percentage of Black enrollees than their proportion of the Medicare population. 
  • Farxiga is taken by a higher percentage of Black enrollees, Latino enrollees, and Asian American enrollees than their proportion of the Medicare population.
  • Fiasp/NovoLog is taken by a higher percentage of Black enrollees, Latino enrollees, and American Indian/Alaskan Native enrollees than their proportion of the Medicare population.
  • Januvia is taken by a higher percentage of Black enrollees, Latino enrollees, and Asian American enrollees than their proportion of the Medicare population. 
  • Jardiance is taken by a higher percentage of Black enrollees, Latino enrollees, Asian American enrollees, and American Indian/Alaskan Native enrollees than their proportion of the Medicare population.

Negotiating lower prices remains overwhelmingly popular among voters of all parties across the country. Unfortunately, big drug companies are suing the federal government to halt the program and protect their massive profits, and Republicans are attempting to repeal the Inflation Reduction Act in its entirety, placing these equity-advancing improvements at risk.

Table 1: Demographic Impact of Conditions Treated by Drugs Selected for Negotiation

Race/Ethnicity Conditions Selected Drugs
Black Non-Latino When compared to White non-Latinos, Black non-Latinos are:

  • 60 percent more likely to be diagnosed with diabetes and twice as likely to die from diabetes.
  • 2.5 times more likely to be hospitalized with diabetes and associated long-term complications than White Americans.
  • 3.2 times more likely to be diagnosed with end-stage renal disease.
  • 30 percent more likely to die from heart disease.
  • 30 percent more likely to have high blood pressure, and less likely to have their blood pressure under control.
  • 30% to 100% more likely to experience blood clots.
 Eliquis (blood clots)
Entresto (heart failure)
Farxiga (diabetes; heart failure; chronic kidney disease)
Fiasp/ NovoLog (diabetes)
Januvia (diabetes)
Jardiance (diabetes; heart failure)
Xarelto (blood clots)
Latino When compared to White non-Latinos, Latinos are:

  • 70 percent more likely to be diagnosed with diabetes and 1.3 times more likely to die from diabetes.
  • Twice as likely to be hospitalized for treatment of end-stage renal disease related to diabetes.
  • More likely to have higher levels of disability-related diabetes (3.2%) and hypertension (2.7%).
  • Among the most likely to have activity limitations due to arthritis of any racial group other than American Indian/Alaska Natives.
 Enbrel (rheumatoid arthritis; psoriasis; psoriatic arthritis)
Farxiga (diabetes; heart failure; chronic kidney disease)
Fiasp/ NovoLog (diabetes)
Januvia (diabetes)
Jardiance (diabetes; heart failure)
Asian American When compared to White non-Latinos, Asian Americans are:

  • 40 percent more likely to be diagnosed with diabetes.
  • 60 percent more likely to be diagnosed with end-stage renal disease.
 Farxiga (diabetes; heart failure; chronic kidney disease)
Fiasp/ NovoLog (diabetes)
Januvia (diabetes)
Jardiance (diabetes; heart failure)
American Indian / Alaska Native When compared to White non-Latinos, American Indian/Alaska Natives are:

  • Nearly three times more likely to be diagnosed with diabetes and 2.3 times more likely to die from diabetes.
  • Twice as likely to be diagnosed with end-stage renal disease.
  • 50 percent more likely to be diagnosed with coronary heart disease.
  • Most likely to have activity limitations due to arthritis of any racial group.
 Enbrel (rheumatoid arthritis; psoriasis; psoriatic arthritis)
Entresto (heart failure)
Farxiga (diabetes; heart failure; chronic kidney disease)
Fiasp/ NovoLog (diabetes)
Januvia (diabetes)
Jardiance (diabetes; heart failure)

Table 2: Drugs Selected for Negotiation Disproportionately Taken by Medicare Enrollees of Color

Race/Ethnicity Medicare Part D Pop. Jardiance Januvia Farxiga  Entresto Enbrel Fiasp/ NovoLog*
Black Non-Latino 10.7% 14% 16% 16% 18% 11% 17%
Latino 10.1% 13% 16% 14% 9% 14% 11%
Asian American 3.7% 6% 7% 6% 3% 3% 3%
American Indian/Alaska Native 0.3% 1% >0% >0% >0% 1% 1%

*the full drug name is Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; NovoLog PenFill

Click here for a PDF of the tables and links.

ashoup
In Research, Fact Sheet

FACT SHEET: Republicans’ Latest Proposals Raise Health Care Costs, Take Away Coverage From Millions, And Starve Vital Health Programs

GOP War on Health Care Alive and Well

Republicans are at it again – attacking health care on multiple fronts. They want to hike costs and rip away care from millions of Americans in their latest budget proposal, including taking away Medicare’s power to negotiate lower drug prices for seniors. They are threatening a reckless government shutdown that would only make matters worse, and proposed a continuing resolution that would compound the growing health crises as it seeks to cut 8 percent of almost all federal spending. And the legislation they are championing in the House would send us back to the days when insurance companies could make the rules and weaken protections for preexisting conditions. If the GOP gets their way, they would throw millions of people off of Medicaid, reverse prescription drug savings for seniors under the Inflation Reduction Act, and make health care coverage more expensive for families purchasing coverage on their own through the Affordable Care Act. 

Here’s a closer look at what the GOP is proposing;

The Budget Details 

What The Republican Budget Proposal Means for Americans: 

  • GONE: Medicare’s power to negotiate lower prices for the most expensive prescription drugs.
  • GONE: Premium savings for 14.3 million Americans who buy insurance on their own — averaging $2,400 per family.
  • GONE: Medicaid for millions of Americans including people with disabilities, new mothers, and children who can’t meet the bureaucratic paperwork burdens imposed by a work requirement. 
  • GONE: Nearly $4 billion in funding for research on cancer, Alzheimers, and long COVID.
  • GONE: Over $500 million in savings under the Affordable Care Act.

Medicare’s Price Negotiation Power Will Be Stripped Away by Republicans. Currently, negotiations are underway for ten drugs that make up around 20 percent of all Medicare Part D spending. Americans currently pay two to four times more for prescriptions than people in other countries and if Republicans have their way it will stay like that. The Arrington budget would slash Medicare’s power to negotiate and make sure prices stay high for Americans and federal spending is needlessly inflated.

Republicans Want to Make Health Care More Expensive For Millions By Repealing The Inflation Reduction Act’s Premium Subsidies. House Budget Chair Jodey Arrington’s budget proposal would scrap the Inflation Reduction Act’s premium subsidies, which has helped save over 13 million Americans an average of $2,400 per year on health care. It also ensures that no individuals making under $20,000 or families making around $41,000 will have to pay health care premiums at all. These subsidies have led a record breaking 14.3 million people to enroll in affordable health plans. The Republican plan will cause over 3 million people to lose coverage entirely. 

Medicaid Work Requirements Would Kick Millions of Americans, Including Mothers and Children, Off of Rolls. Despite all evidence and case studies showing that implementing work requirements on Medicaid kicks off people who do meet the work requirement but can’t jump through the additional bureaucratic reporting hoops and increases the program’s total costs due to increased administrative oversight, Republicans have proposed an 80 hour a month work requirement for Medicaid. Over 60 percent of Medicaid enrollees already work, so an additional work requirement will likely only kick off the 11 percent not able to work due to illness or disabilities, 13 percent not able to work due to caregiving, and 6 percent not able to work due to school attendance. This program will leave disabled Americans, those caring for families, the children of parents who have lost coverage, and those seeking education to better their job opportunities in the future without care.

Critical Research into Cancer, Alzheimers, Long COVID, and Other Diseases Will Be Halted. Republicans plan to cut over $3.8 billion in funding to the National Institute of Health and eliminate funding entirely for the Agency for Healthcare Research and Quality. With NIH funding accounting for 99.4 percent of all FDA approved drugs from 2010-2019, these cuts will significantly undermine novel pharmaceutical innovation and development.

Repealing Bans on Physician Self-Referral Will Increase Health Care Costs and Jeopardize Communities’ Access to Care. In the FY 2024 budget, House Republicans have proposed ending the Stark Law, which would allow physicians to self-refer patients to facilities and services in which they have a financial stake. Importantly, these controversial physician-owned hospitals provide limited or no emergency services, cherry pick the most potentially profitable patients, and incur significantly higher costs on the Medicare program. According to the HHS, up to one-third of these hospitals may violate Medicare requirements by relying on publicly funded services to stabilize patients while still charging the patients exorbitantly. The Affordable Care Act’s closing of the “whole hospital” exception loophole in the Stark Law reduced the federal deficit by half a billion dollars over ten years; Republicans repealing it will cost the federal government and the American people millions of dollars annually.

If Republicans Shut Down the Government Or Fail To Reauthorize Critical Health Programs

If Republicans don’t get their way to cut Medicaid, the Affordable Care Act, and the Inflation Reduction Act, it is more and more likely that they will shut down the entire federal government. Along with crucial federal programs not being funded during a shutdown, there are a range of other health initiatives that need to be reauthorized before the end of fiscal year 2023 on September 30, which Republicans are also neglecting to prioritize. Instead of governing, it seems the Republican party seeks to hold the entire American health care system hostage.

Over 300 Community Health Centers Will Be At Risk. The Community Health Center Fund provides around 70 percent of federal funding to over 300 grantees across the country running vital health centers which integrate local health equity efforts into broader health care. The funding for this program expires September 30th, and without additional resources the lapse in funding could cause a collapse in employment in these centers.

Federal Funding That Offsets Uncompensated Care Hospitals Provide Will Dry Up. In a letter sent by America’s Essential Hospitals, the group warned that the $8 billion cut to DSH payments, which would go into effect on October 1, could dramatically undermine America’s health and safety. As well without this funding, access to life-saving services could disappear for many low-income or otherwise marginalized Americans.

The Global Fight Against HIV/AIDS Will be Undermined. A government shutdown could cause The President’s Emergency Plan for AIDS Relief (PEPFAR) to not be reauthorized. This will sunset seven provisions at the end of fiscal year 2023 which involve how to allocate spending and U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Funding the Fight Against the Opioid Epidemic Would Dry Up. Without reauthorization, many programs launched in 2018 aimed at tackling the growing opioid crisis would lapse.

Pandemic Preparedness Would Collapse and Drug Shortages Continue. Due to an ongoing fight in the House, Republicans have held up reauthorizing the Pandemic and All Hazards Preparedness Act (PAHPA). Democrats have fought to address the growing drug shortages using the PAHPA, but Republicans have delayed the reauthorization, now causing it to potentially lapse out entirely due to a Republican shutdown.

The Republican Continuing Resolution Would Only Make Matters Worse

A Short Term CR Offered By Some Republicans Would Slash Federal Spending And Undermine Critical Research And Public Health Programs. Instead of shutting down the government, some Republicans have offered up a short-term funding bill which will keep the federal government running until October 31st. This continuing resolution will only compound the growing health crises as it seeks to cut 8 percent of almost all federal spending. Not only will these cuts increase wait times, slash public spending on disaster initiatives, and undermine critical pharmaceutical research, but it will also drastically decrease access to vital public health services as tens of thousands of Americans face obstacles in maintaining stable social determinants of health.

Republican Legislation Would Weaken Protections For Millions Of Americans With Pre-Existing Conditions

Legislation Offered By Republicans This Summer Would Promote “Junk” Insurance Plans And Undermine the ACA. The Association Health Plans Act and Self Insurance Protection Act passed by the Education & Workforce Committee this summer would expand access to association health plans (AHPs) and other non-ACA compliant health care plans, weakening protections for the over 135 million Americans with pre-existing conditions. 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. AHPs do not have to participate in the ACA’s single-risk pool rule and 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.

ashoup
In Research, Fact Sheet

FACT SHEET: Republicans Continue To Promote Junk Plans That Have a History of Fraud & Are Dangerous For Patients

Republicans Promoting Junk Plans are Putting Big Insurance Company Profits Before Patients Once Again

This month, President Biden announced plans to rein in junk plans like short-term, limited-duration insurance (STLDI) plans that were previously expanded and promoted by the Trump administration. The fact of the matter is simple: junk plans engage in predatory marketing practices, fail to protect people with pre-existing conditions, and put patients at risk of bankruptcy when they get sick.

In 2018, the Trump administration changed the rules to allow these plans to be sold like regular insurance and gutted funding for advertising Affordable Care Act (ACA) marketplace plans — to disastrous effect. Far from promoting “consumer protection” and “consumer choice,” the Trump administration exposed consumers to scams and reduced transparency about coverage limits and hidden fees. These plans 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. 

While some conservative voices claim that ending these rules could leave some uninsured, the Biden administration and Democrats in Congress have expanded access to no- or low-cost ACA coverage and funded outreach and enrollment so people are more likely to enroll in coverage that protects pre-existing conditions and less likely to get ripped off. Nearly 16.4 million people are enrolled in Marketplace coverage, including plans costing as little as $0 and $10/month. As the Biden administration works to lower health care costs and regulate these junk plans, Congressional Republicans are passing legislation to weaken protections for millions of people with pre-existing conditions and boost health insurance plans that aren’t required to cover prescription drugs or hospital care.

The Trump Administration Expanded Junk Plans and Gutted Funding For Advertising ACA Plans, Putting Consumers At Risk

The Trump Administration Cut Critical ACA Health Subsidies & Enabled Greater Access To Short-Term, Limited Duration Insurance (STLDI) Plans That Did Not Meet ACA Requirements. In late 2017, after Congressional Republicans’ efforts to repeal and replace the Affordable Care Act (ACA) failed to advance, then-President Trump ordered sweeping changes to health insurance with a pair of executive actions. He first announced that the sale of certain cheap policies with few benefits or protections – known as short-term, limited-duration insurance (STLDI) – would be allowed to be sold for up to 364 days with renewals for up to three years instead of three months, then announced cuts to critical health subsidies helping pay out-of-pocket costs for low-income people in America. In response, many patient and physicians groups raised concerns that junk plans would “cause significant economic harm to women and older, sicker Americans who stand to face higher-cost and fewer insurance options,” and “draw younger and healthier people away from the exchanges and drive additional plans out of the market.” The changes were solidified in August 2018 as a final rule allowing STLDI plans to be considered a form of individual health insurance coverage that would meet the ACA’s individual mandate.

Junk Plans Enabled By The Trump Administration Have Left Patients Without Protections For Pre-existing Conditions Afforded By the ACA. “Because they tend to look less expensive up front, short-term plans continue to find buyers, and they have been championed by the Trump administration (which has loosened restrictions on them) as an alternative for consumers. […] Consumer advocates have long sounded alarm bells about short-term plans and others that don’t comply with the Affordable Care Act rules — rules that require plans to provide comprehensive benefits to all comers, regardless of their health. The ACA also prohibits annual or lifetime dollar limits on coverage for any plan sold on the federal or state health insurance exchanges.” [NPR, 12/3/20]

Patient Advocacy Groups, Health Policy Experts, and Insurance Insiders Alike Have Warned Against Junk Plans’ Lack of Transparency and Coverage. Patient advocacy groups and health policy experts have long warned about the fraud risks that come with STLDI and other non-ACA-compliant plans. In January 2019, the Georgetown University Health Policy Institute found that consumers searching online for ACA-compliant plans were often directed, instead, to “junk plans.” Another study sponsored by the Leukemia and Lymphoma Society found that junk plans often rely on misleading marketing, are often misunderstood by consumers who purchase them with no right to appeal plan decisions, drive up patients’ out-of-pocket costs, and “threaten prices across the insurance market.” In March 2021, 30 patient organizations published a report pushing for greater regulation of dozens of different types of “junk insurance,” including STLDI plans. Even health insurance industry insiders have warned that the “very profitable” plans are inadequate, and state insurance regulators have expressed concerns that STLDI plan administrators have been misleading and taking advantage of consumers while offering substandard coverage.

Ever Since The Trump Administration’s Rule Change, Junk Plans Have Attracted Fraud. Following the Trump administration’s rule change, health insurance companies across the country began offering STLDI plans to consumers. Shortly after the rule took effect, federal officials shut down numerous “ruinous” health insurance plans that falsely claimed to provide comprehensive health insurance, with one commissioner describing them as a “classic bait-and-switch scheme designed to trick consumers.” 

  • 2022: A Florida-Based Health Insurance Company That Scammed Patients was Forced To Refund $100 Million After An FTC Investigation. One company, Health Insurance Innovations Inc. (later known as Benefytt Technologies), began using junk plans to scam consumers into paying exorbitant fees, often without their permission, for little coverage using deceptive websites such as “Obamacareplans.com.” In 2022, the Federal Trade Commission ordered the company to pay $100 million in refunds to customers who fell victim to the scam.

The Biden Administration Has Worked To Promote Informed Consumer Choice By Expanding Access To ACA Marketplace Plans And Launching Outreach Campaigns

The Biden Administration Has Expanded Critical Health Subsidies Allowing Millions of People To Access No- or Low-Cost ACA Plans. “Low-income Americans who missed signing up for 2022 Affordable Care Act coverage can now enroll in plans with $0 premiums through the federal exchange’s website. Those with incomes less than 150% of the federal poverty level – $19,320 for an individual and $39,750 for a family of four – can select policies on healthcare.gov through a special enrollment period, the Centers for Medicare and Medicaid Services told CNN exclusively on Monday. Most people will be able to select plans with no premiums, while others may have to pay a few dollars. 

The Biden Administration Has Promoted Informed Consumer Choice By Launching Advertising and Outreach Campaigns About Expanded ACA Access. “The agency is launching advertising and outreach campaigns to spread the word about the new special enrollment period, which lasts for the rest of the year. The effort will also target those experiencing certain life changes, such as losing job-based coverage, getting divorced or aging out of a parent’s policy, which have always allowed them to sign up for Obamacare policies during the year.” [CNN, 3/21/22]

While The Biden Administration Works To Lower Costs, Congressional Republicans Are Passing Legislation To Boost Junk Plans

The Biden Administration Is Working To Close Trump-Era Loopholes That Have Propped-Up Junk Plans. The Biden administration has worked to lower health care costs and crack down on “junk plans” like STLDI, proposing new rules closing Trump-era loopholes allowing health insurance companies to mislead patients and sell plans that provide very limited coverage. Under the new rules, STLDI plans will be limited to a maximum of 3 months – instead of 3 years as was allowed under the Trump administration – and will be required to disclose benefit limits as well as potential exposure to exorbitant surprise fees that disproportionately impact lower-income households and people of color.

…Meanwhile, Congressional Republicans Are Passing Legislation To Weaken Protections For Millions of People with Pre-Existing Conditions and Boost Health Insurance Plans That Fail To Cover Key Prescriptions & Hospital Care. In June 2023, Republicans held a markup on multiple pieces of legislation promoting “junk plans” that 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 ACA. One of these bills would expand access to association health plans (AHPs), a type of junk plan that leaves behind sick and at-risk individuals and undermines the ACA. Another would promote the use of non-ACA-compliant plans and other self-funded benefit plans. Further, these types of plans exploit communities of color and other marginalized communities, making Black, Latino, Asian, Indigenous, and LGBTQI+ people in America – who are more likely to be living in poverty than their White, heterosexual counterparts – more likely to face higher premiums.

ashoup
In Fact Sheet, Research

NEW: State-By-State Fact Sheets Show How Americans Are Saving Big on Health Care Thanks to Biden Administration’s Lower Cost, Better Care Agenda

Read the Fact Sheets Here. 

Washington, DC — Today, Protect Our Care is releasing 50 state-by-state fact sheets outlining how the Inflation Reduction Act reduces health care costs for the American people — with even more savings on the way as the law’s provisions to give Medicare the power to negotiate and cap seniors’ prescription drug costs take effect. The fact sheets use new United States Department of Health and Human Services (HHS) data showing just how impactful the law has become for people across the nation.

“This data shows how much money Americans will save on their prescription drug and health care costs because of the leadership of President Biden and Congressional Democrats,” said Protect Our Care Chair Leslie Dach. “At a time when people are worried about the cost of living and rising health care costs, the Biden administration is working tirelessly to expand access to affordable health care. Meanwhile, big drug companies and their Republican allies in Congress are doing everything in their power to roll back this progress and hike costs for the American people. It’s a shame that Republicans continue to prioritize drug company profits over the health and financial well-being of hard-working people.” 

For example, here are the key numbers for Wisconsin:

BY THE NUMBERS

  • 298,750 Wisconsinites will save an average $474.91 thanks to the Inflation Reduction Act’s $2,000 annual out-of-pocket cost cap, effective in 2025. Last year, 788,856 Wisconsinites spent an average of $453 out-of-pocket on prescription drugs. 
  • 31,935 Wisconsinites on Medicare who use insulin are now charged no more than $35 per month for an insulin prescription.
  • 181,848 Wisconsinites are saving an average of $531 on monthly health insurance premiums.
  • 935,961 of Wisconsin’s seniors are able to receive the shingles vaccination and other recommended vaccinations free of cost.
  • 1,439,080 of Wisconsin’s Medicaid beneficiaries will have access to expanded vaccine coverage.
  • 19 million people with Medicare will save an average of $400 thanks to the Inflation Reduction Act’s $2,000 annual cost caps alone.

The new reports come as new polling shows that the health care measures in the Inflation Reduction Act are the most popular in the entire bill. From Maine to Hawaii, seniors are benefitting from the law’s monthly insulin cap and no-cost vaccinations. Families purchasing insurance on their own are saving hundreds of dollars a month on their premiums. The Inflation Reduction Act has also taken immediate action to stop drug companies from raising Medicare drug prices faster than the rate of inflation, protecting people on Medicare from exorbitant price increases. Soon, Medicare will have the power to negotiate lower prices for some of the costliest medications on the market. 

ashoup
In Fact Sheet, Research

FACT SHEET: The Biden-Harris Administration Is A Champion For LGBTQI+ Health

Lowering drug costs, expanding affordable health insurance coverage, and banning health care discrimination is critical to improving access to comprehensive, high-quality health care and – together with other actions – advancing health equity for lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI+) people in America. The Biden-Harris administration has been leading the way in ensuring LGBTQI+ individuals have access to health care, while Republicans continue to undermine LGBTQI+ rights in state legislatures by denying transgender youth access to gender-affirming care, and the ability to use preferred names and pronouns in schools, and banning drag as a form of gender expression. Policies to improve access to care and protect LGBTQI+ individuals from discrimination in health care and other settings are essential for improving the health and well-being of LGBTQI+ people nationwide.

Biden-Harris Administration Helps LGBTQI+ Americans Gain Health Coverage

Expanding Health Coverage For Millions Of Americans. Premium subsidies for people who purchase coverage on their own made available by President Biden’s American Rescue Plan helped nearly 210,000 LGBTQI+ enrollees have access to zero-premium plans. Nationwide, 20 percent of Black LGBTQI+ individuals are uninsured, compared to 15 percent of Black and 9 percent of heterosexual and cisgender individuals. Before the Affordable Care Act (ACA) went into effect in 2013, 34 percent of LGBTQI+ Americans were uninsured. As of June 2020, the uninsurance rate amongst LGBTQI+ individuals dropped to 16 percent. In the 2023 Open Enrollment period, a record-breaking 16.3 million Americans signed up for health insurance through the ACA, more than a 12 percent increase from the previous year.

Reversing Trump Policy Allowing Sexual Orientation Discrimination. In May 2021, Department of Health and Human Services (HHS) Secretary Xavier Becerra announced that sexual orientation would be restored as a protected class under the ACA. In July 2022, HHS put forth a proposed rule implementing Section 1557 of the ACA, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. The proposed rule affirms protections against discrimination on the basis of sex, including sexual orientation and gender identity consistent with recent U.S. Supreme Court decisions. This proposed rule ensures that LGBTQI+ individuals aren’t denied coverage or charged more for care. This Administration’s policy reversal has been especially important with transgender rights being attacked by Republicans.

Closing The Coverage Gap Improves Outcomes For LGBTQI+ Individuals. As of June 2022, 1.2 million LGBTQI+ Americans were covered by Medicaid, and of those nearly 13 percent identified as transgender. According to a Center for American Progress survey, in 2019, the LGBTQI+ uninsured rate was 20 percent in the states refusing to expand Medicaid, compared to 8 percent in states that adopted Medicaid expansion. 29 percent of LGBTQI+ individuals faced difficulty seeking medical care when sick or injured due to cost. LGBTQI+ Americans are twice as likely to be without health insurance. Closing the Medicaid coverage gap is the single most important policy to expand coverage and reduce racial and ethnic inequities in the American health care system, and is an important policy solution for LGBTQI+ people because of the intersectional dimensions of their identities. A 2022 study found that more Black LGBTQI+ adults had Medicaid as their primary insurance compared to their heterosexual and cisgender counterparts. 

Biden-Harris Administration Helps LGBTQI+ Americans Age With Dignity

Millions Of LGBTQI+ Americans Able To Grow Old At Home. Federally provided home- and community-based services funds helped more than 100,000 individuals return to their homes and communities from nursing facilities between 2008 and 2019. Allowing LGBTQI+ seniors to grow old at home helps alleviate the concern older LGBTQ+ adults have about being neglected or abused, or facing discrimination in nursing homes or assisted living facilities. In President Biden’s fiscal year 2024 proposed budget, $150 million is dedicated to investing in Medicaid’s home- and community-based services to ensure more older Americans and people with disabilities have access to care in their own homes and communities. 

The Inflation Reduction Act Supports LGBTQI+ Seniors. The $2,000 cap on prescription drug prices for Medicare enrollees helps LGBTQI+ seniors on Medicare, who typically suffer more from poorer health and poverty. Medication costs are a frequent barrier to managing chronic health issues. 23 percent of the LGBTQI+ community lived in poverty in 2020, compared to 16 percent of their heterosexual counterparts. When looking at further dimensions of intersectionality, members of LGBTQI+ communities of color also disproportionately faced higher rates of poverty than heterosexual members of these communities. A 2021 study found that members of sexual minority communities are more likely than heterosexual individuals to engage in behaviors to reduce the cost of medicine such as skipping doses, trying alternate therapies, or delaying refills.

Biden-Harris Administration Is Defending Transgender Americans

Supporting Gender Affirming Care. On a state-by-state basis, the Center for Medicare and Medicaid Services is approving efforts to expand gender-affirming care under the ACA and other federal programs. HHS has also created a website and resources for LGBTQI+ youth, parents, and providers, on LGBTQI+ health and well-being and gender-affirming care.

Protecting Transgender Youth Mental Health. The Biden Administration is focusing on providing mental health support, creating a more welcoming environment in public schools, and acknowledging the positive impacts of gender-affirming care. President Biden signed the Executive Order on Advancing Equality LGBTQI+ Individuals in June 2022 to defend the rights and safety of LGBTQI+ individuals by directing relevant agencies to discredit conversion therapy, ensuring that federal benefit programs can be equitably accessed by LGBTQI+ households, and increasing federal support for family counseling to reduce the risk of family rejection of LGBTQI+ youth. The Substance Abuse and Mental Health Services Administration is also piloting additional dedicated services for LGBTQI+ youth in the national 988 Suicide and Crisis Lifeline. 

Stepping In When States Fail. In honor of Transgender Visibility Day in March 2022, the Justice Department issued a letter to all state attorneys general reinforcing federal transgender youth protections against discrimination and obtaining gender-affirming care. Due to the increase in anti-trans state legislation, the Department of Justice has also filed statements of interest and amicus briefs supporting legal action against state laws that restrict the rights of transgender youth.

ashoup
In Fact Sheet, Research

FACT SHEET: Republicans Are Waging War On LGBTQI+ Health Care

As we celebrate Pride month, at least 20 million lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI+) American adults are facing threats to health care access. Amidst growing fears of violence and repression, Republicans across the country have launched a crusade against LGBTQI+ rights and affordable health care.

Trump-appointed MAGA judges are setting a dangerous precedent to pull vital medications off the market and eliminate no-cost preventive services that LGBTQI+ people count on to stay healthy — including PrEP, a medicine that is 99 percent effective at preventing the spread of HIV and can cost thousands of dollars annually. This threatens to exacerbate health disparities in queer Black and Hispanic/Latino communities. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for LGBTQI+ people. Meanwhile, state-level Republicans are igniting a war on trans health care, with Florida Republicans banning upwards of 80 percent of all gender-affirming care in the state. Whether it’s barring no-cost screenings or preventive medicine, banning gender-affirming care, or attacking other fundamental LGBTQI+ rights, Republicans’ war on LGBTQI+ health care is only getting worse.

Republicans Are Pulling Medications They Don’t Like From The Market – Setting a Dangerous Precedent for LGBTQI+ Care

A Trump-Appointed Judge Is Working To Curb Access To Safe, Affordable Abortions. In April, another Trump-appointed judge ruled against the FDA in a case seeking to remove a popular medication used to induce abortion from the market. Medication abortions are the most common, least expensive, and most accessible method for people to terminate pregnancy, and the ruling impacts communities that already have difficulty accessing these key services. 

Republicans Want to Pull Medications They Don’t Like Off The Shelves. The case could set a dangerous precedent for any federal judge to pull controversial medications off the market, regardless of the science behind approval decisions or the bureaucratic steps taken to prove safety and efficacy. As Lambda Legal has pointed out, “The trial court’s approach just as easily (or perhaps more easily) could be aimed at HIV-related medications and puberty blockers and hormone treatments, as well as medications for many other health conditions that are specially relevant for our communities.”

Republicans Are Taking Away No-Cost Preventive Care From LGBTQI+ People and Communities of Color

Republicans Are Curbing Access To No-Cost Preventive Services, Disproportionately Impacting LGBTQI+ People and Communities of Color. In March, a Trump-appointed judge decided against the federal government in Braidwood v. Becerra and struck down a major portion of the Affordable Care Act (ACA) requiring no-cost coverage of lifesaving preventive health care services recommended by the U.S. Preventive Services Task Force, including lung and breast cancer screenings, Hepatitis C screenings, HIV screenings, and PrEP medication. These changes have a disproportionate impact on historically marginalized populations like LGBTQI+ people and communities of color — curbing no-cost access to preventive services would create barriers to seeking needed care and exacerbate existing health disparities.

Republicans Are Targeting PrEP, A Key Prevention Strategy For HIV. The Trump-appointed judge’s ruling struck down a portion of the ACA guaranteeing access to pre-exposure prophylaxis (PrEP), a drug proven to substantially reduce the risk of contracting HIV. PrEP has been associated with a significant decrease in the number of new HIV diagnoses. PrEP is shown to lower the risk of infection from sex by more than 90 percent (more than 99 percent effective) and is widely viewed as a key prevention strategy for ending the HIV epidemic in the U.S. Thanks to ACA protections, the percentage of PrEP users has jumped from 3 percent of eligible patients in 2015 to 30 percent of eligible patients prescribed in 2021. 

  • Combating HIV Has Been Central To LGBTQI+ Public Health Efforts For Decades, Particularly For Gay and Bisexual Men. Efforts to combat the spread of HIV remain one of the largest public health concerns among LGBTQI+ populations. Gay and bisexual men, as well as Black and Hispanic/Latino Americans, remain disproportionately affected by HIV. The federal government’s 2022-2025 strategy to combat HIV recognized gay and bisexual men—particularly Black, Hispanic/Latino, and Native American men—Black women, and trans women as priority populations. Rural populations, especially gay and bisexual Native American men and Two-Spirit populations, have greater difficulty accessing preventive care for HIV.
  • Ending ACA PrEP Protections Disproportionately Harms Black and Hispanic/Latino Gay and Bisexual Men. While 66 percent of eligible white people in America are prescribed PrEP, just 16 percent of eligible Hispanic/Latino Americans and 9 percent of eligible Black Americans are prescribed the lifesaving drug. Academic experts have concluded that Braidwood will disproportionately impact racial and ethnic sociodemographic groups at particularly high risk for HIV infection: “Even in our ‘best-case’ scenario, the predominant burden of new restrictions on access to PrEP will likely fall on Black and Latino gay and bisexual men, as well as transgender women, who already face significant barriers to HIV prevention and care.”

Ending ACA Cost-Sharing Protections Could Increase HIV Transmission By At Least 17 Percent In The First Year Alone. According to academic experts, ending the prohibition of cost sharing for PrEP will increase HIV transmission among men who have sex with men by at least 17 percent in the first year alone. Researchers at Yale have already determined that the Braidwood ruling could see coverage for PrEP drop from 28 percent to only 10 percent, mainly due to the fact that 80 percent of PrEP users are on commercial plans that would now have the ability to refuse to cover PrEP.

  • Without ACA Protections, PrEP Could Cost Nearly $4,200 A Year On Average In Addition To Lab Costs and Office Visits. Out-of-pocket costs may be prohibitively high without ACA protections against cost-sharing. A recent study found that PrEP medication costs nearly $350 for a 30-day supply on average. Outside of the cost of obtaining medication, PrEP users incur additional required charges as part of the care regimen like clinical visits and lab costs that can add up to thousands of dollars annually. 
  • The Trump-Appointed Judge Who Ruled In Braidwood v. Becerra Has Long Been Hostile To LGBTQI+ Populations. The Texas judge who decided Braidwood has referred to PrEP as a drug that would “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” In the past, he has also said that Obergefell v. Hodges (2015) and Lawrence v. Texas, the 2003 ruling that invalidated all remaining state anti-sodomy laws, “are judicial concoctions, and there is no other source of law that can be invoked to salvage their existence.”

Republicans Are Pushing An Anti-Trans Agenda

10 Republican-Led States Continue To Block Medicaid Expansion, Which Serves Millions Of LGBTQI+ Patients. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for an estimated 1.2 million LGBTQI+ adults, disproportionately trans and non-binary Black, Hispanic/Latino, Pacific Islander, and Native American people. LGB individuals are more likely to qualify for Medicaid based on income, and Medicaid covers about 21 percent of trans and non-binary people in the U.S.

Republicans Are Waging War On Trans People and Their Health Care. Across the country, Republicans have escalated their war on trans people and health. As of May 2023, 16 Republican-led states have enacted new anti-trans health care laws and 22 states have passed anti-trans health care bills in at least one Republican-held legislative chamber. Republicans have re-centered their culture wars around trans people, with new legislation prohibiting drag shows from public property alongside bans on gender-affirming care. Anti-trans laws contribute to negative health impacts, including an increased risk of suicidality and substance use among trans and non-binary youths. Equitable access to health care services has always been a challenge for LGBTQI+ people. A 2018 survey found that 75 percent of people seeking gender-identity-based care have had negative experiences during physician visits. The fight to get insurers to cover basic care for trans patients—let alone gender-affirming care—has been a grueling, decades-long process even with ACA protections and federal and state-level enforcement. New bans threaten to undo decades of work to provide trans people with access to affordable, gender-affirming care.

Florida Republicans Have Effectively Banned 80 Percent of All Trans Health Care Providers In The State. In the past year alone, Florida Republicans have passed a slate of anti-trans laws banning health care for minors and adults alike. In April 2022, the Florida GOP passed legislation that requires trans adults seeking gender-affirming care to receive approval from the Florida Board of Medicine at least 24 hours in advance and has banned insurance providers from covering gender-affirming care for young adults. Just a few weeks ago, Florida Governor Ron DeSantis signed yet another law that bars up to 80 percent of all gender-affirming care providers in the state from practicing, including all nurse practitioners, physician assistants, and telehealth visits, drastically reducing the number of providers available for trans adults seeking care.

Republicans’ Anti-Trans Efforts Are Prompting “Mass Migration” Of LGBTQI+ People. In addition to direct attacks on trans health care, Republicans have ramped up their efforts to make LGBTQI+ social integration part of the broader culture wars. For example, Florida Republicans, led by Governor Ron DeSantis, have also enacted a ban on all topics surrounding gender identity and sexual orientation—including sex education and LGBTQI+ health—prompting many Florida-based Pride groups to cancel Pride celebrations amid a “mass migration” of LGBTQI+ people out of the state. In March, Tennessee Republicans adopted a strict ban on gender-affirming health care, while Texas Republicans have ordered state agencies to start investigating parents seeking gender-affirming care for their trans kids for criminal penalties.

ashoup
In Fact Sheet, Research

FACT SHEET: Ron DeSantis is Bad News for Health Care

Ron DeSantis

Ron DeSantis has long been an antagonist towards affordable health care. His record is clear: as Florida Governor, DeSantis has refused to expand Medicaid under the Affordable Care Act (ACA), preventing hundreds of thousands of Floridians from receiving free, comprehensive care and leaving the state with one of the highest rates of uninsured residents in the country. When he served in Congress, DeSantis tried to repeal the ACA six times and even opposed Trump’s hallmark “replacement” because it didn’t go far enough to slash coverage for millions of Americans with pre-existing conditions. He has tried to slash Medicaid, which seniors, communities of color, and people with disabilities count on, and even campaigned on a far-right plan to cut and privatize Medicare.

If Ron DeSantis got his way:

  • Health care coverage for nearly 30 million people would be repealed
  • Tens of thousands of older adults’ lives would be threatened
  • People with pre-existing conditions could again be denied coverage or charged higher prices
  • Health insurance premiums could be 20 percent higher
  • 65 million seniors who rely on Medicare would face significantly higher health care costs
  • ….and so much more.

THE DETAILS: Governor Ron DeSantis Has Held Back Care From Hundreds of Thousands of Florida Residents 

As Governor, Ron DeSantis Has Prevented Hundreds of Thousands of Florida Residents — Disproportionately People of Color — From Receiving Coverage By Refusing The Expand Medicaid. Florida Republicans, led by Ron DeSantis since 2019, have been blocking Medicaid expansion under the Affordable Care Act, preventing up to 726,000 Floridians from obtaining Medicaid coverage, remaining a “hard no” on expanding Medicaid even as millions of residents faced hardship during the COVID-19 pandemic. Of the hundreds of thousands of currently uninsured residents that would become eligible for the program if DeSantis expanded Medicaid under the ACA, around 57 percent are people of color, with Black residents disproportionately shut out of coverage, comprising 28 percent of those in the coverage gap despite forming just 17 percent of Florida overall.

  • Hundreds Of Thousands More Floridians Who Would Be Eligible For Expanded Medicaid Have Been Forced To Pay Higher Premiums and Copays On ACA Marketplace Plans. “Florida’s rate of uninsured people under 65 is 15.1%, according to the latest data from 2021, the third highest rate after Oklahoma and Texas. That is an improvement since 2010, the year Obamacare was signed, when the rate was 26%. The state has led the nation in signing people up for private subsidized insurance through the Obamacare exchange, largely through the efforts of private brokers and federal recruitment programs. But many of these cheaper Obamacare plans are less desirable than Medicaid for the low-income people who qualify because they often come with high deductibles. And the world around Florida has shifted. California, where 21% of people under 65 were uninsured before Obamacare, got that number down to 8.1% by 2021. […] [T]he federal government covers 90% of Medicaid expansion costs for American citizens and residents, meaning most states bear a much smaller burden. And President Biden signed a law in 2021 providing an extra incentive for states to sign onto expansion — covering an additional 5% of the costs for the first two years, one of several measures designed to bolster the nation’s insurance rolls. That new money has not swayed DeSantis…” [Los Angeles Times, 5/22/23]

Florida Has One Of The Highest Rates Of Uninsured Residents Thanks To Governor Ron DeSantis. Thanks to Ron DeSantis, Florida has one of the highest rates of uninsured residents in the U.S. with 15.1 percent under 65 uninsured—nearly 2.6 million people as of 2021. By allowing high rates of uninsurance to persist, DeSantis has neglected the health and well-being of his own constituents: “Floridians without insurance suffer because when they can’t pay for their medical care, they end up in debt or go without needed treatment or both. The state suffers, too, because it ends up with a sicker, less productive workforce as well as a higher charity care load for its hospitals, clinics, and other pieces of the medical safety net. DeSantis could do something about this. He has refused. In fact, as of this moment, his administration is embarking on a plan that some analysts worry could make the problem worse. […] Childless adults in the Sunshine State can’t get Medicaid unless they fall into a special eligibility category, like having a disability. And even adults with kids have a hard time getting onto the program because the standard income guidelines are so low ― about 30% of the poverty line, which last year worked out to less than $7,000 for a family of three. That’s not enough to cover rent, food, and other essentials, let alone buy a health insurance policy.”

Florida Families Experiencing Extreme Poverty Are Not Covered By Medicaid Thanks To Governor Ron DeSantis. Under DeSantis, Florida has become “one of the hardest places in the country for poor adults to obtain health insurance. By refusing to allow Florida to expand Medicaid under the Affordable Care Act, DeSantis has forced millions of Florida families to depend on a ‘patchwork of services that often drive up costs to taxpayers and leave patients with crippling debt, undertreated illnesses or both.’ […] Adults without young children in Florida don’t qualify for the program and even a family of four would have to earn less than $8,400 a year.” [Los Angeles Times, 5/22/23]

Ron DeSantis Signed A Bill Allowing Health Care Providers and Insurers To Discriminate Against LGBTQI+ Patients Into Law. “Acting at the behest of the administration of Florida Governor Ron DeSantis, the Florida Board of Medicine and the Board of Osteopathic Medicine also adopted a politically motivated and discriminatory rule that denies age-appropriate gender-affirming care to Florida’s transgender youth. The rule (64B8-9.019) was filed with the Florida Department of State on February 24, 2023 and became effective on March 16, 2023.” [Human Rights Campaign, 5/11/23]

Ron DeSantis Opposes The ACA And Its Protections For As Many As 133 Million People With Pre-Existing Conditions

While Serving In Congress, Ron DeSantis Voted Six Times To Repeal The Affordable Care Act. As a member of Congress, Ron DeSantis voted six times to repeal the Affordable Care Act (ACA) and strip millions of lifesaving, affordable health coverage. ACA protections safeguard care for as many as 1 in 2 non-elderly Americans, 50 to 13 million people. 

  • 2017: Ron DeSantis Voted For Trump’s ACA Repeal. DeSantis voted for passage of the American Health Care Act, which would have reduced health coverage nationwide. 23 million people would have lost coverage under this bill by 2026, and millions of people with pre-existing conditions would have lost protections for coverage. The nonpartisan Congressional Budget Office found that the American Health Care Act would have raised premiums by 20 percent. The negative economic impact of the American Health Care Act would have caused about 1.8 million people to lose their jobs by 2022.
  • DeSantis Initially Opposed the AHCA Because It Didn’t Go Far Enough. According to the Los Angeles Times, DeSantis made his reputation in Congress clear as an “avid opponent of Obamacare” who initially “opposed a Republican plan to end the law because it did not go far enough, leaving, he said, ‘the core architecture of Obamacare in place.’” In fact, DeSantis was part of a conservative faction that resisted early proposals until Republicans expanded the ACHA to allow insurers in some states to “raise prices for people with pre-existing conditions whose coverage lapsed,” reportedly arguing that early proposals “didn’t undo enough of the law’s protections for people with pre-existing conditions.”
  • 2015: Ron DeSantis Voted For A Total Repeal Of The ACA. DeSantis voted for HR 596, an act “to repeal the Patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation Act of 2010.” The bill also ordered House committees to develop a replacement that would “provide people with pre-existing conditions access to affordable health coverage,” but provided no specifics. 

Ron DeSantis Has Tried to Slash Medicaid and Privatize Medicare

During His Congressional Career, Ron DeSantis Voted To Slash Medicaid and Embraced Slashing and Privatizing Medicare. Ron DeSantis was well-known for supporting measures to slash and privatize key retirement programs including Medicare. 

  • 2017: Rep. Ron DeSantis Voted To Cut $880 Billion From Medicaid. While serving in Congress, DeSantis voted for AHCA, which included $880 billion in cuts to Medicaid. Vox called the AHCA a “sneaky” reversal of the ACA’s Medicaid expansion: “Medicaid, a government program that simply compensates health care providers at stingy rates, is much cheaper than private insurance. So the ACA’s authors chose to expand it to cover all families with incomes below 138 percent of the poverty line, rather than shelling out the money it would have cost to have the government pay for them to buy private insurance. The AHCA reverses this expansion. But to avoid the criticism that the law throws poor children off their health insurance, it reverses it in a somewhat sneaky way. Rather than taking Medicaid away from families who have it, it simply caps new enrollments in Medicaid so no new poor families can sign up. But the way this cap works, you can’t get back on Medicaid if you go off of it. So a poor family that gets a raise and becomes non-poor for a year will lose access to Medicaid permanently.”
  • 2014: Rep. Ron DeSantis Voted To Slash and Privatize Medicare. In April 2014, DeSantis voted for a budget amendment that would have raised the retirement age for Medicare to 70, cutting lifetime Medicare benefits and expenditures substantially, and “changed Medicare from a program that guarantees access to health insurance into one that would have provided a stipend payment that would not, over time, have necessarily kept pace with the actual cost to buy health insurance. 
  • 2013: Rep. Ron DeSantis Voted For A “Fringe Proposal” To Slash and Privatize Medicare. In March 2013, DeSantis voted for a budget amendment described as a “once-fringe proposal” that would have raised the retirement age for Medicare to 70, cutting lifetime Medicare benefits and expenditures substantially, and “changed Medicare from a program that guarantees access to health insurance into one that would have provided a stipend payment that would not, over time, have necessarily kept pace with the actual cost to buy health insurance. 
  • 2012: Ron DeSantis Campaigned For Congress On Privatizing Medicare. “Florida Gov. Ron DeSantis expressed support for privatizing Medicare and Social Security during his first campaign for Congress in 2012. […] A CNN KFile review of comments from DeSantis’ 2012 congressional campaign found he repeatedly said he supported plans to replace Medicare with a system in which the government paid for partial costs of private plans or a traditional Medicare plan. In one interview with a local newspaper, DeSantis said he supported ‘the same thing’ for Social Security, citing the need for ‘market forces’ to restructure the program. […] Under the proposals, the government would subsidize seniors by partially paying for private plans or a traditional Medicare plan. ‘I would embrace proposals like [Rep.] Paul Ryan offered, and other people have offered, that are going to provide some market forces in there, more consumer choice, and make it so that it’s not just basically a system that’s just going to be bankrupt when you have new people coming into it,’ DeSantis told the St. Augustine Record in a video that was posted on YouTube at the time.” [CNN, 2/9/23]
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