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ashoup
In Fact Sheet, Research, News

FACT SHEET: Medicaid Works For Rural Americans

Republicans in 10 States Are Blocking Medicaid Expansion, Jeopardizing Health Care and Increasing Health Care Costs for Rural Americans

This April marks the 7th annual Medicaid Awareness Month. About one in five – 66 million – Americans reside in rural areas across the United States and nearly 14 million are enrolled in Medicaid. Medicaid is a vital source of coverage for people across rural America, who are more likely to lack insurance, experience negative health outcomes, and have more barriers to accessing care. The Affordable Care Act’s (ACA) Medicaid expansion has been a critical part of working towards the goal of closing gaps in health outcomes for rural Americans. Medicaid expansion saves lives, helps keep rural hospitals open, improves families’ financial security, and boosts local economies. The success of Medicaid expansion across the country demonstrates the need for the 10 holdout states to finally expand their Medicaid programs to the 1.6 million people in the coverage gap who have no option for health coverage. 10 percent of rural Americans are uninsured and would benefit from the long awaited expansion. 

However, Republican elected leaders in 10 states refuse to implement Medicaid expansion, blocking 1.6 million from the access to essential health care and financial security Medicaid provides. These holdout states, located in the southern and midwest regions of the U.S. with significant rural populations, are leaving over $13 billion in federal Medicaid funding on the table. In addition to blocking Medicaid expansion in 10 states, MAGA-Republicans want to cut trillions from Medicaid by introducing onerous work reporting requirements and radically restructuring the program through block grants. Donald Trump has promised to follow through on his plan to repeal the ACA, which would end Medicaid expansion and throw the entire health care system into chaos, risking coverage for at least 45 million Americans and ending protections for Americans with preexisting conditions. On the other hand, President Biden and Democrats in Congress have worked to protect and strengthen Medicaid by creating multi-billion dollar incentives for Medicaid expansion, stopping onerous work requirements, pushing for expanded postpartum coverage, and working to minimize the impacts of Medicaid unwinding. 

By The Numbers

  • Millions Of Rural Americans Depend On Medicaid. Nearly 14 million Medicaid enrollees reside in rural areas.
  • Medicaid Strengthens Health In Rural America. Overall, rural residents have worse health outcomes and tend to be older, poorer, and sicker than those in urban areas.
  • Rural States Need Medicaid. Uninsurance rates in rural America are 2 to 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 Keep Rural Hospitals Open. Since 2005, more than 150 rural hospitals have closed, including 20 closures in 2020 alone. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2024, over 400 rural hospitals are at risk of closing in the near future. When hospitals face financial hardship, obstetric services are among the first to be cut. Fewer than half of all rural counties in the United States had hospital-based obstetric care
  • Rural Hospitals Strengthen Local Economies. Hospitals employ ten percent of total county employment. Rural areas with hospital closures experience economic downturns with a 14 percent reduction in country employment. 418 rural hospitals are at risk of closing, and estimated that if those hospitals shut down, over 90,000 health care jobs in rural communities would be lost.

How Medicaid Expansion Helps Rural Americans

Medicaid Expansion Saves Lives. Medicaid expansion has been proven to increase access to care, improve financial security, and save lives. A study published in the Lancet found that Medicaid expansion reduced all-cause of mortality. Mortality rates in rural areas are much higher than in urban areas due to a disparity in health care access and increased prevalence of fatal diseases, suicide, and overdoses. 

Medicaid Expansion Reduces Income Inequality And Medical Debt. Medicaid expansion reduces poverty and income inequality across the board by helping low income families access care without jeopardizing income that they may use for other basic living expenses. A 2019 Health Affairs study found that Medicare, Medicaid, and premium subsidies account for one-third of poverty reduction in households without a disability recipient. Medicaid has also been shown to reduce the prevalence of medical debt with nearly 80 percent of the counties with the highest medical debt being from states that haven’t yet expanded Medicaid. 

Medicaid Expansion Plays A Central Role In Fighting The Opioid Crisis. Rural America largely lacks the ability to treat substance use disorders with 65 percent of rural counties lacking the ability to prescribe buprenorphine, an effective drug used to treat opioid dependency. Starting in 2020, Medicaid began covering all medications, therapies, and counseling services that are approved by the Food and Drug Administration to treat opioid use disorders. Medicaid covers an estimated four in ten people with an opioid use disorder. Medicaid expansion in the remaining 10 states is a necessary foundation to help low-income, rural families dealing with higher rates of substance use disorders. 

Medicaid Expansion Is A Lifeline For Rural Hospitals

In states that haven’t expanded Medicaid, rural hospitals are drowning under financial pressure. Low occupancy rates, high levels of uncompensated care, competition with other hospitals, and struggling local economies create a financial burden that rural hospitals face all over the country. Since 2010, 138 rural hospitals have closed, including 20 closures in 2020 and 8 in 2023. In 2024, over 400 hospitals are at risk of closure.

Medicaid Helps Rural Hospitals Stay Open. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. The two most common types of supplemental Medicaid payments are disproportionate share hospital payments, that pay hospitals for uncompensated care for Medicaid and uninsured patients, and upper limit payments, which supplement the gap between fee-for-service Medicaid base payments and the amount that Medicare covers. Some states are also testing the use of global hospital budgets to increase care and improve health outcomes in rural hospitals.

Closure Of Specialized Care And Obstetrical Services. Some hospitals opt to close specific services or facilities that cause patients in rural areas to have to travel further for specialized care. On average, when a rural hospital closes patients have to travel over 20 miles further to access inpatient or emergency care. A 2021 study found that fewer than half of all rural counties in the United States had hospital-based obstetric care. When hospitals face financial hardship, obstetric services are among the first to be cut. Black and Native American women in rural areas are particularly at risk. Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women.

Medicaid Expansion Boosts State Budgets. Medicaid expansion generates enough savings that it is well worth the initial cost, eventually helping boost states budgets. Expansion allows states to access federally matched funds for some people covered by traditional Medicaid. The American Rescue Plan (ARP) provides states with additional funding from the federal government. From 2022 to 2025, the states that haven’t yet expanded Medicaid would gain $90 billion in federal matching funds in addition to $17.6 billion in ARP bonus payments and $6.6 billion from higher state and local tax revenue.

Rural Hospitals Are Large Employers In Their Communities. For rural areas that often have high unemployment rates, hospitals contribute significantly to local economies by employing large numbers of people with relatively high-paying jobs. Rural hospitals typically account for about 5 percent of a rural county’s total employment. Beyond just being a source of jobs, hospitals tend to pay higher wages than other rural industries. Hospital employees with an associate’s degree are paid an average of 21 percent higher than the rest of the population.

Rural Hospitals Boost Local Economies. Besides hospitals providing higher paying jobs in the health care sector, rural hospitals also stimulate the local economies of other industries. Hospitals purchase goods or services from local private businesses which helps stabilize and reinforces the local economy. In turn, strong private sector employment allows for more tax dollars for public goods, such as education and safety services.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes 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 people of color and rural Americans. Week two 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 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • 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. 
ashoup
In News, Fact Sheet, Research

FACT SHEET: Medicaid Is a Vital Source of Coverage for Communities Of Color

While President Biden and Democrats Fight to Protect and Expand Medicaid, Republicans Return to Some of Their Oldest Schemes to Cut the Program 

This April marks the 7th annual Medicaid Awareness Month, an important time to bring attention to the communities who rely on Medicaid to stay healthy. Generations of structural racism have resulted in people of color experiencing lower rates of health coverage, worse health outcomes, and staggering health inequities. As a result, Medicaid coverage remains a critical source of coverage and financial security, especially for Black, Latino, and Indigenous families in America who experience poverty at a higher rate than white Americans and remain less likely to have access to quality care – an important driver of health. These groups also face higher rates of chronic conditions that make access to affordable health coverage even more essential.

This Medicaid Awareness Month, Medicaid is under attack by Republicans. The latest GOP scheme slashes trillions from Medicaid through block granting and work reporting requirements and other paperwork and red tape designed to throw people off their coverage. GOP leaders in 10 states have also failed to expand Medicaid under the Affordable Care Act (ACA), blocking 1.6 million people from affordable coverage. Donald Trump has promised to follow through on his plan to repeal the ACA, which would end Medicaid expansion and throw the entire health care system into chaos. The consequences of the GOP war on Medicaid would be particularly devastating for communities of color. President Biden and Democrats, on the other hand, are continuing to fight to address health disparities, expand access to coverage, lower health care costs, and protect Medicaid for years to come.

By The Numbers

  • 1 In 5 Medicaid Enrollees Are Black. As of 2022, Black Americans make up 13.6 percent of the U.S. population, but about 20 percent of Medicaid enrollees. 
  • 1 in 3 Native American And American Indian People Are Enrolled In Medicaid. According to the 2021 census, 4.3 million people identified as Native American and American Indian. Nearly 27 percent of this group is enrolled in Medicaid. 
  • 30 Percent Of Medicaid Enrollees Are Hispanic/Latino. Hispanic/Latino people make up 18.9 percent of the U.S. population, but nearly 30 percent of Medicaid enrollees. 
  • 15 Percent Of Asian Americans Are Enrolled In Medicaid. Roughly 6 percent of the American population identify as Asian American equating to about 21 million people.
  • More Than 30 Percent Of Native Hawaiian And Other Pacific Islanders (NHOPI) Are Covered By Medicaid. That’s about 207,000 out of 690,000 NHOPI people.
  • More Than 1.6 Million People Could Gain Coverage If Holdout States Accepted Expansion. If Republicans did the right thing and expanded Medicaid in the remaining holdout states, more than 1.6 million uninsured adults could gain coverage; people of color make up 61 percent of this group, or roughly 1.3 million people. 

Research Confirms Medicaid Improves Coverage, Health, And Economic Equity

Reduced Racial/Ethnic 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 additional actions to address other social and structural determinants of health can reduce racial/ethnic disparities in the American health care system. The Affordable Care Act (ACA) led to historic reductions in racial/ethnic disparities in access to health care, but gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. 

Closing The Coverage Gap Is Essential For Addressing Health Disparities. Research confirms that Medicaid expansion saves lives and drastically reduces racial/ethnic health coverage disparities. The majority of people in America who would gain coverage if the remaining 10 holdout states expanded Medicaid are people of color. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic/Latino adults. Despite Medicaid expansion’s proven role in reducing racial/ethnic disparities in health care access and improving health outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated 1.5 million uninsured adults are locked out of coverage in the 10 holdout states refusing Medicaid expansion, with people of color comprising 61 percent of those who would gain coverage if these 10 states expanded Medicaid. 

Medicaid Is Essential For Children Now And In The Future. Children of color disproportionately rely on Medicaid coverage, making robust Medicaid access a critical racial/ethnic justice issue for American children. Children of color make up nearly 52 percent of all American children, but nearly 67 percent of the children on Medicaid. This coverage not only provides health coverage in the immediate term, but also provides significant long-term benefits, such as being less likely to be hospitalized and more likely to graduate high school and college.

Medicaid Coverage Is Critical To Improving Maternal Health. The United States is only one of two nations that has reported an increase in maternal mortality since 2000, including increases over the past three years. According to the Centers for Disease Control and Prevention (CDC), more than 80 percent of these deaths are preventable. Women of color consistently experience higher rates of maternal mortality than white women, with the Center on Budget Policy and Priorities finding this to be the result of a combination of factors, including life-long toxic stress resulting from racism and the impacts of structural racism in the health care system. 30 states have expanded postpartum Medicaid coverage to a full year, covering more than 460,000 individuals. In the 10 states that have refused Medicaid expansion, eight had more than 40 percent of births covered by Medicaid. Medicaid covers 65 percent of all births to Black mothers and 65 percent of women of reproductive age living in the coverage gap are women of color. 

Reduced Racial/Ethnic Disparities In Rural Access To Care. 24 percent of rural Americans identify as a person of color. Rural Americans of color face a greater health disparity than their white counterparts due to barriers to health care access, reporting not having primary care providers, forgoing care due to cost, and having fair to poor health status. States that have expanded Medicaid have improved rural hospital financial performance and lower likelihood of hospital closures. When Arkansas and Kentucky accepted Medicaid expansion, adults in those states became more likely to have a personal doctor, obtain care for ongoing conditions, and have a yearly medical check up.

LGBTQI+ People of Color Have Seen Reduced Health Disparities. Due to both systemic factors as well as complex familial dynamics, the LGBTQI+ community is much more at risk of poverty and uninsurance than cisgender heterosexual Americans. Because of this, Medicaid has become a lifeline for the LGBTQI+ community, especially people of color. Around 46 percent of Black LGBTQI+ Americans and 43 percent of Latino LGTBQI+ Americans with incomes below 400 percent of the Federal Poverty Line qualify for Medicaid. As well, Asian American and Pacific Islander (AAPI) LGBTQI+ Americans are over two times as likely to have Medicaid as their primary insurance compared to cisgender heterosexual AAPI individuals.

Medicaid Improves Financial Security For Families. The racial/ethnic wealth gap in America is staggering. According to data from the US Census Bureau, in 2020, the annual median household income for white Americans was nearly $20,000 higher than for Hispanic/Latino households and nearly $30,000 higher compared to Black households. As a result, policies to boost financial well-being undoubtedly help people of color. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. Over the past decade, research has shown the gap in medical debt between Medicaid expansion and holdout states has grown approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states.

Medicaid Reduces Poverty And Inequity. Poverty can produce negative long-term consequences for children and adults alike. 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 people of color. In a nation where Americans are one medical bill away from being pushed into poverty, Medicaid serves as a lifeline not only for health care, but for economic stability. A January 2021 study from Health Affairs found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states.

Medicaid Helps Those Dealing With Behavioral Health Conditions. States that have expanded Medicaid have added behavioral health benefits, including mental health and substance use disorder care, that particularly benefit beneficiaries of color who have disproportionately been affected by these conditions. 28 percent of Black people and 27 percent of Latinos suffer from a mental health or substance use disorder. Medicaid is the single-largest payer for mental health services in America. 40 percent of adults on Medicaid are living with a serious mental health or substance use disorder.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes 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 people of color and rural Americans. Week two 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 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • 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. 
ashoup
In Report, News, Research

NEW REPORT: 85 Million Depend on Medicaid and CHIP, But GOP Doubles Down on Plan to Rip Coverage Away

Medicaid Awareness Month: Republicans Wage War on Medicaid As 85 Million Americans Rely on The Program for Affordable Health Care

Read the Full Report Here.

Washington, D.C. — On the first day of Medicaid Awareness Month, Protect Our Care is releasing a new national report detailing Republican plans to slash Medicaid and rip coverage away from millions of Americans. While Medicaid Awareness Month is a celebration of how this vital health care program has touched millions of families across the nation, it is also an important reminder that Medicaid remains under attack by Republicans. 

“Republican lawmakers are playing a dangerous game as they escalate their attacks against Medicaid and affordable health care,” said Protect Our Care Executive Director Brad Woodhouse. “If MAGA Republicans get their way, Medicaid coverage will be ripped away from kids, seniors, and working people who count on it, reversing all of the progress made by Democrats and the Biden-Harris administration. The consequences of the GOP plans for Medicaid would be devastating, and they are entirely out of step with voters across parties.”

More than one in four Americans are covered through Medicaid or the Children’s Health Insurance Plan (CHIP), and the program serves people from all backgrounds, including children, mothers, people of color, people with disabilities, working families, rural Americans, and seniors. Yet Republicans won’t stop trying to make it harder to access affordable care. The latest GOP budget proposal slashes trillions from Medicaid through block granting and calls for work reporting requirements and other bureaucratic measures designed to throw people off their coverage. GOP leaders in 10 states have failed to expand Medicaid under the Affordable Care Act (ACA), blocking 1.6 million people from lifesaving coverage. Three states under GOP leadership have also failed to expand Medicaid coverage to mothers for 12 months postpartum, refusing to help address the growing maternal mortality rate as one in three pregnancy-related deaths occurs between six weeks and one year after birth. 

On the other hand, President Biden and Democrats in Congress have defended Medicaid from GOP attacks, created multi-billion dollar incentives for Medicaid expansion, stopped onerous work requirements, pushed for expanded postpartum coverage, and worked to minimize the impacts of Medicaid unwinding. The contrast with Republicans could not be clearer. 

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes 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 people of color and rural Americans. Week two 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 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
  • 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.
ashoup
In Fact Sheet, Research

FACT SHEET: Medical Abortion Case Before The Supreme Court Endangers The Health of Millions of Women and Threatens The Entire U.S. Drug Approval Process

SCOTUS Set To Hear Oral Arguments In a Case That Will Decide the Fate of Drugs Relied on by Millions

Tomorrow, extreme anti-abortion activists are scheduled to present arguments before the Supreme Court in FDA v. Alliance for Hippocratic Medicine and Danco v. Alliance for Hippocratic Medicine. This case could dramatically curtail access to mifepristone, a safe and effective medication essential for abortion access that was approved by the FDA 24 years ago. Last year, Republican-appointed judges in Texas and on the Fifth Circuit Court of Appeals ruled in favor of plaintiffs, issuing separate orders severely restricting access to mifepristone, but the Supreme Court stayed this decision. A decision to ban mifepristone would threaten millions of women’s access to safe and legal abortions, but it would also open the door for the politically-motivated removal of other safe and effective drugs from the market — throwing the entire U.S. drug approval process into chaos. 

What Happens Next

  • March 26: The Supreme Court will hear oral arguments on the case.
  • By early July: The Supreme Court will issue a ruling on the case.

Background 

In April 2023, a Trump-appointed federal judge in Texas attempted to revoke authorization for mifepristone, issuing a ban on the medication. His ruling was partially stayed pending appeal, but two MAGA judges on the Fifth Circuit Court of Appeals allowed some restrictions on the drug to remain. The federal government quickly appealed the partial stay to the Supreme Court, which rejected the Fifth Circuit’s restrictions and stayed the ruling in its entirety pending appeal. In August 2023, the Fifth Circuit ruled in favor of anti-abortion advocates, but the ban on mifepristone remains on hold while the Supreme Court weighs an appeal of the ruling.

The anti-abortion advocates, represented by a far-right legal organization, brought this suit with the sweeping aim of achieving a nationwide mifepristone ban. The consequences of this ruling will be most detrimental for women of color, people living in rural areas, and poorer Americans who face the steepest barriers to accessing care.

What the Experts Are Saying

Carrie Flaxman, Senior Advisor at Democracy Forward: “What the lower courts did was utterly fail to defer to the FDA’s scientific judgment that the changes that it made were appropriate and that the drug is safe and effective. In doing so, it is the first time that courts have second-guessed the safety decisions that the FDA has made in approving the drug so there are much broader consequences for the FDA.” [Protecting Our Care in the Courts, 3/12/24]

  • This Case Could Throw Everything Into Chaos and “Open The Floodgate.” “If the Court allows these plaintiffs to go forward, it really could open the door to a floodgate of potential plaintiffs. Any group could create a nonprofit, perhaps in a favorable District, and file a lawsuit without really showing the kind of injury that courts have required.”
  • “A Huge Threat” to Mifepristone And Drug Approvals. “I want to be clear that even if the court orders those [REMS] restrictions reimposed, that that is a huge threat to access to mifepristone. It is also a threat to drug approvals, not just of [mifepristone], but of really everything on the market.”

Jocelyn Frye, President of the National Partnership for Women & Families: “People do rely on the FDA. They rely on science for a number of decisions. They rely on consistency in the law. What Dobbs did is upend that entirely. Many of the factors in traditional ways you would expect the Supreme Court to look at in that case they threw out the window, and arguably because there’s now a conservative wing on that court that has a different agenda in mind.” [Protecting Our Care in the Courts, 3/12/24]

  • “It Should Be An Easy Decision.” “This court is sensitive to the public perception that they are driven by ideology and not by law…[The Supreme Court] should look at precedent, they should look at the law, they should look at the informed judgment of the FDA , and rely on sound science. If they do those things then it should be an easy decision.”
  • Mifepristone Is Widely Used And “Extraordinarily Safe.” “The real test is not necessarily the popularity of mifepristone, but mifepristone is widely used. People have used it; it is extraordinarily safe. And people…have come to rely on that [as an available tool]…The other thing is that it is a tool that as part of the evolution of health care practice it is something that can be used in the context of telemedicine. So as we see health care practices become more accessible to more groups of people, it is troubling to see any reversal that is going to make it harder to access care.”

William Schultz, Partner at Zuckerman Spaeder, and former General Counsel for the Department of Health and Human Services: “One of the reasons why Americans across the country should be concerned about the potential outcome of this case is the overturning of an FDA decision and the effects on the approval process. This can really diminish the confidence that patients, doctors, and health professionals have in drugs approved by the FDA. The inevitable result is it’s going to back up the process. They will require more studies. They will hesitate to approve improvements to drug labels. It will be slower in making these decisions, and the consequences of that are going to be patient lives – you’re talking about life-saving drugs.” [Protecting Our Care in the Courts, 3/12/24]

  • “When The FDA Is Undermined, There’ll Be Less Faith In Approved Drugs.” “When the FDA is undermined, there’ll be less faith in approved drugs. People will be more likely to turn to dietary supplements and alternative remedies, which, if you have a serious treatable disease, is a public health disaster.” 
  • “This Will Chill Investment Into Life-Saving Drugs.” “This will chill investment into life-saving drugs. It costs a lot of money to develop some of the most important drugs we have. PhRMA said in its Amicus brief that affirming the 5th Circuit will add uncertainty about its research, whether it can get drugs approved and if it gets approved whether that approval will be sustained so we will do less research which means less approval of lifesaving drugs. The interest in investment in lifesaving drugs will be diminished.”

What’s At Stake

Access To Safe And Effective Reproductive Care For Millions Of Women Nationwide. The combination of mifepristone and misoprostol, an ulcer medicine, has been found to have a 98 percent efficacy rate, and mifepristone is safer than Tylenol and Viagra. The plaintiffs argue that the FDA’s authorization of the drug over two decades ago was flawed and that the drug which has been used by over 2.5 million women is, in fact, dangerous. Twelve of the nation’s leading medical and scientific organizations have filed an amicus brief demonstrating that the drug is safe and studies and meta-analyses involving tens of thousands of women have shown the same thing. 

  • Outsized Impact On Women Of Color, Rural Populations, and Low-Income Women. An analysis by the Guttmacher Institute found that this decision will have an especially severe impact on people living in states where medication abortion plays a particularly critical role in ensuring access to care, including heavily rural states like Montana, Maine, and Iowa. As is true for all abortion restrictions, people of color, low-income individuals, and those without regular access to a nearby health care provider will be disproportionately harmed by restrictions and uncertainty around medication access. 

The Science-Based FDA Drug Approval Process That Has Served America Well Since 1938. The Justice Department warned in an earlier brief that this lawsuit has the potential to undermine the country’s process for regulating pharmaceuticals. If the courts ultimately side with the plaintiffs, it will be an unprecedented situation. Professor Greer Donley of the University of Pittsburgh Law School says, “We’re talking about a judge who is a non-scientist overriding an agency full of experts about the safety and efficacy of a drug. That, to my knowledge, has never happened before.” Lawrence O. Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University called the ruling, “A frontal assault on the legitimacy of the F.D.A. and their discretion to make science-based decisions and gold standard approval processes.” 

Safe And Legal Medications Targeted For Political Purposes. A ruling affirming plaintiffs’ claims would open the door to any third party with a political agenda to challenge a medication that they object to. Ameet Sarpatwari, an expert on pharmaceutical policy and law at Harvard Medical School, said the ruling is likely to encourage a spate of additional challenges. “This opens the door to the courts’ second-guessing any FDA approval — especially for drugs for controversial areas like gender-affirming care, or PrEP for HIV prevention.” He argued it would also instill uncertainty in the pharmaceutical industry. “This should worry every manufacturer out there,” he said. “They are now not assured of a uniform market for their drug based on FDA approval.” Other experts have echoed this fear that a wide range of approved medicines could be targeted including mRNA vaccines, COVID-19 vaccines, HIV medications, hormone therapies, drugs that are derived from stem cells, or any class of medicines that may be politically unpopular. 

Access To Life-Saving Drugs That Patients Count On Every Day. An earlier amicus brief filed by 19 leading scholars of food and drug law states, “We are not aware of any case in which a court has removed a drug from the market over FDA’s objection. The effects could extend far beyond mifepristone. No drug is without risk, and a ruling for Plaintiffs could lead to challenges to the FDA’s benefit-risk determinations for drugs it has approved to treat other diseases and conditions. Patients who rely on life-saving medications could see their drugs removed from the market with little notice.” 

Innovation And Investment In New Drug Development. Pharmaceutical companies must plan years in advance which diseases and therapies to invest in. Injecting a huge dose of political uncertainty into the process could make investors and companies more hesitant to pursue innovative new treatments. Law Professor Rachel Sachs and Professor Donley recently explained that “[o]btaining approval for a new drug is expensive, time-consuming and risky. It typically involves years or decades of research and can cost hundreds of millions, or even billions, of dollars. Most drugs that enter the research and development process fail, never making it to market. The prize at the end of this ordeal is the FDA’s approval to sell the product.” Therefore, “[i]t could chill innovation nationwide if political actors could circumvent the agency’s data-driven process by engaging the courts. Manufacturers might become wary of investing time and money into products for a wide range of conditions which may — decades down the line — be the subject of nuisance litigation.” 

Chaos In The Established Regulatory System. Following the initial ruling, R. Alta Charo, a professor emerita of law and bioethics at the University of Wisconsin said, “The biggest threat that a decision like this brings is the threat of creating chaos.” Charo also told the New York Times that a decision to invalidate an F.D.A. drug approval could have ripple effects for other federal agencies with technical expertise, including those that oversee regulations related to the environment, energy, and digital communications. “Imagine what you could do when you’ve got commercial interests that are upset about a whole slew of” issues, he said, adding, “There’s just no end to this really.”

Who Is Behind It 

An “Alliance” Of Right-Wing Medical Groups Is The Lead Plaintiff In The Case. The plaintiffs in this case are led by the Alliance for Hippocratic Medicine, a group seemingly created for the sole purpose of filing this lawsuit. The Alliance was only incorporated in August of 2022 and the group’s sparse website is even newer than that. 

The Other Plaintiffs Include Peddlers Of Anti-Choice Misinformation And Anti-LGBTQI+ Extremist Groups. The other plaintiffs include the American Association of Pro-Life Obstetricians and Gynecologists, the American College of Pediatricians, and the Christian Medical & Dental Associations. The American College of Pediatricians is a fringe extremist group that trades on its name similar to the premiere U.S. Association of Pediatricians to push anti-LGBTQI+ junk science via the far-right media and filing amicus briefs in cases related to abortion or LGBTQI+ rights. The American Association of Pro-Life Obstetricians and Gynecologists and the Christian Medical and Dental Associations are other far-right groups that use their members’ medical certifications to push false information regarding abortion and birth control. Including the dangerous pseudoscience of “abortion reversal.” 

The Plaintiffs Are Represented By The Alliance Defending Freedom, An SPLC-Designated Hate Group. The legal team for the plaintiffs is the Alliance Defending Freedom (ADF), one of the most prolific extremist advocacy groups in the country. Designated a hate group by the Southern Poverty Law Center, the ADF has advocated both in the U.S. and abroad for forced sterilization of trans people, criminalization of same-sex relationships, and strict restrictions on abortions. ADF receives tens of millions of dollars in dark money annually, coming often from the same sources that led the right-wing attacks on the Affordable Care Act, Social Security, and Medicare. 

Nearly 150 Congressional Republicans Have Filed An Amicus Brief Supporting The Extreme Case. 145 Republican Members of Congress, including 26 Senators and 119 Representatives, have filed an amicus brief in support of the plaintiffs. In the brief, they argue that the 23-year-old FDA approval of mifepristone was an “unlawful deregulation of chemical abortion drugs” that “has endangered patient health and safety,” despite presenting no evidence that the drug is anything but safe and effective.

More Than 20 Republican Attorneys General Have Filed An Amicus Brief Supporting The Suit. Twenty-two GOP attorneys general led by Mississippi have filed an amicus brief in support of the plaintiffs. In the brief, they argue that the 24-year-old FDA approval of mifepristone represents an “elective-abortion policy that Congress could never pass.” This brief argues that federal agencies themselves “erode the separation of powers,” “imperil federalism,” and “seize power,” and pushes the Supreme Court to subject the FDA’s actions to “searching review.” 

Three Republican Attorneys General For Missouri, Idaho, and Kansas Filed A Separate Amicus Brief Supporting The Suit. Three Republican Attorneys General representing Missouri, Idaho, and Kansas – who all signed onto the 22-state amicus brief led by Mississippi – have filed a separate amicus brief in support of the plaintiffs, arguing that the FDA’s 24-year-old approval of mifepristone “has imposed increased costs to state-funded medical insurance and public hospitals.” If accepted, this dangerous legal argument, which claims that the drug’s approval created “sovereign harms that radically interfere with the ability of the States to set policy,” opens the door for challenges to any drug that increases costs to state-funded public health programs.

Why The Plaintiffs’ Legal Arguments Are Wrong

The plaintiffs assert several different claims:

  • They contend that the FDA’s approval of mifepristone in 2000 should be invalidated because (a) the agency cited regulations governing drugs that “treat serious or life-threatening illnesses” and, plaintiffs contend, mifepristone does not fall within that category, and (b) the conditions for use specified by the agency were inadequate.
  • When the agency approved the drug in 2000, it used its “risk evaluation and mitigation strategy” (REMS) authority to impose restrictions designed to ensure the drug is distributed and prescribed safely. In 2016, the FDA loosened those restrictions, allowing the drug to be used later in a woman’s pregnancy (up to 70 gestational days), prescribed after only one in-person clinic visit and by a broader set of healthcare providers, and taken by the woman at home rather than in a doctor’s office. The plaintiffs assert that these changes were not supported by the data relied upon by the FDA and ask the court to restore the original, more stringent restrictions.
  • The plaintiffs also invoke the Comstock Act, a criminal law prohibiting the “knowing[]” mailing of “obscene or crime-inciting matter” that includes in its long list of items “article[s] or thing[s] designed, adapted, or intended for producing abortion.” They claim that this law required the FDA to prohibit the distribution of mifepristone by mail or common carrier.

This is a meritless lawsuit that should have been thrown out of court – for multiple reasons.

  • The plaintiffs lack “standing” to sue. To file a lawsuit in federal court, a plaintiff must assert an “actual” or “certainly impending” real-world injury. These plaintiffs are not regulated by the FDA and do not prescribe mifepristone. Their claim – that patients will come to them for help after taking the drug, which will require them to divert attention from other patients, inflicting costs and risking potential liability and emotional distress – is indistinguishable from standing arguments that have been repeatedly rejected by the Supreme Court because they “depend[] on the unfettered choices made by independent actors not before the courts and whose exercise of broad and legitimate discretion the courts cannot presume either to control or to predict.”
  • Most of the claims are, in addition, barred by the statute of limitations and/or failure to raise the arguments before the FDA. Federal law provides that a party seeking to challenge a decision by an administrative agency must file suit no later than six years after the decision. The challenge to the FDA’s approval of the drug in 2000 is therefore untimely. (The plaintiffs try to rely on their 2002 petition to the FDA challenging that approval, but that petition was denied in 2016, more than six years before the filing of this lawsuit.) The plaintiffs filed a separate petition urging the FDA to withdraw its 2016 decision loosening the REMS standards applying to mifepristone, which the agency denied in 2021 – making the challenge to the REMS standards timely; but the plaintiffs did not challenge the 2000 approval in that petition and their claim that the petition implicitly “reopened” the approval decision is contrary to basic principles of administrative law. Also, the plaintiffs have never raised their Comstock Act argument before the FDA. Finally, even the challenge to the 2016 REMS standards is not properly before the court because it has been superseded by the FDA’s 2023 action further revising those standards: the 2016 decision, therefore, is no longer operative.
  • The plaintiffs are wrong on the merits. As the Justice Department and a company that manufactures the drug explain in detail: there is no basis for overturning the FDA’s expert determination in 2016 regarding the proper REMS standard for this drug, which was fully supported by the data cited by the agency; FDA properly rested its approval of mifepristone on its authority over drugs treating serious illnesses, because pregnancy can be, many times is, accompanied by complications posing serious risks to a woman’s health; and FDA’s 2000 approval and accompanying standards were a proper exercise of the agency’s expertise. The REMS and approval decisions are subject to deferential review and may be set aside only if found to be “arbitrary and capricious” – a high standard that the plaintiffs do not come close to satisfying. Concerning the Comstock Act, the government explained that, by 1960, “federal courts of appeals settled upon a consensus view that the Comstock Act did not prohibit the mailing or other conveyance of contraceptives or items designed to produce abortions where the sender does not intend them to be used unlawfully.” (A Justice Department opinion explains in detail the basis for this conclusion.) Therefore, “even if FDA were required to consider the Comstock Act, because the Comstock Act does not prohibit the mailing or other conveyance of abortion-inducing drugs where the sender does not intend them to be used unlawfully, and given that these drugs may be used lawfully, neither FDA’s decisions related to in-person dispensing nor the absence of a prior FDA affirmative prohibition on distribution by mail was inconsistent with the Comstock Act.”
  • The plaintiffs are not suffering, or threatened with, irreparable injury. A party is entitled to an injunction only if it can show that, without the injunction, it will suffer irreparable injury. Here, for the same reasons they lack standing, their speculative arguments about harm cannot satisfy the irreparable injury requirement. And plaintiffs’ delay in filing suit – more than two decades after the drug was first approved and nearly a year after the FDA denied their petition regarding the REMS standards – further supports that conclusion.
  • The balance of harms weighs sharply against the plaintiffs. Even when a plaintiff can demonstrate irreparable injury, a court may not grant injunctive relief if the harm to the plaintiff is outweighed by the harm that would be suffered by other parties and the harm to the public interest. Eliminating the availability of a drug that millions of women have used over two decades will inflict serious harm on Americans across the country who rely on the drug for safe and effective reproductive care. (Plaintiffs’ claims that mifepristone is unsafe are wrong: a mountain of evidence demonstrates the drug’s safety.) As the government explains, “[r]emoving access to mifepristone would cause worse health outcomes for patients who rely on the availability of mifepristone to safely and effectively terminate their pregnancies.” It would interfere with Congress’s decision to entrust the FDA with technical decisions regarding the safety and efficacy of drugs. It would also create a legal precedent that could disrupt the new drug approval system that has produced myriad life-saving treatments that benefit tens of millions of Americans.
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In Fact Sheet, Research

FACT SHEET: The Affordable Care Act Has Expanded Affordable Coverage to Tens of Millions of Americans

Over the last 14 years, the Affordable Care Act (ACA) has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA has survived countless repeal attempts, and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

Over the next five days, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

The ACA’s marketplace has been a vital lifeline for millions of Americans. President Biden delivered on his promise to build upon the successes of the ACA with advanced premium tax credits, which has led to nearly 14.8 million people signing up for affordable health insurance seeing lower costs for their health plans. Over 21 million Americans have signed up for affordable health insurance for 2023. 

Among the many benefits of the ACA, it also expanded Medicaid coverage. As of March 2024, 40 states have expanded their Medicaid programs, covering approximately 24 million Americans. Its implementation in states has saved tens of thousands of lives, provided people with health services that they otherwise would not be able to afford, and has advanced the goal of ending ethnic and racial inequities in health care. However, in the 10 states that refuse to expand Medicaid, approximately 1.5 million Americans do not have access to the life-saving coverage provided through Medicaid because of Republican efforts to block expansion.

By the Numbers:

  • Approximately 45 million people have health coverage thanks to the ACA.
  • Nearly 5 million Americans have newly signed up for a Marketplace plan for 2024. 
  • Since the ACA was enacted, the uninsured rate has dropped from 17.8% in 2010 to 9.6% in 2022.
  • The uninsured rate for low-income adults dropped from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid.
  • Around one in four non-elderly Americans living in rural areas have health coverage through Medicaid thanks to the ACA’s Medicaid expansion.
  • Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017 while 15,600 older adults died prematurely as a result of their state’s decision not to expand the program.
  • Medicaid expansion reduced mortality in non-elderly adults by nearly four percent. 
  • Around 710,000 children gained public coverage as a result of their parents enrolling in Medicaid between 2013 and 2015.

More Than 21.3 Million People Signed Up For Coverage They Can Afford Through The Marketplace. In 2024, a record-breaking 21.3 million people who buy insurance on their own signed up for health coverage through the ACA Marketplace. This is the highest number of Americans to ever enroll during an Open Enrollment Period and it is thanks to policies that lowered premiums in President Biden’s American Rescue Plan and Inflation Reduction Act. Families are now saving an average of $2,400 a year on their health insurance premiums.

Lower Health Costs Have Improved Access To Care And Financial Security. Between 2010 and 2018, the share of non-elderly adults with a problem paying a medical bill fell by 17 percent, the share who didn’t fill a prescription fell by 27 percent, the share who skipped a test or treatment fell by 24 percent, and the share who didn’t visit a provider when needing care fell by 19 percent.

Medicaid Expansion Saves Lives. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time,15,600 older adults died prematurely as a result of their states’ decision not to expand the program. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent.

Americans With Pre-Existing Conditions Are Able To Access Affordable Coverage. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge more because of a pre-existing condition. Half of all Americans have a pre-existing health condition. As well, insurers can no longer put annual or lifetime limits on the care one receives. Over 179 million Americans with employer-based coverage are protected from these lifetime limits, in addition to the millions with ACA Marketplace coverage.

Expanding Health Services. Marketplace coverage and Medicaid expansion have helped patients access preventative care, including colon cancer screenings. Expansion also increased patient access to kidney transplants and made diabetes medication more affordable for low-income patients. The program was also tied to earlier diagnosis of colorectal cancer and reducing diabetes-related amputations.

Medicaid Expansion Reduces Income Inequality. A January 2021 study found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. Over the past decade research also has shown the gap in medical debt between Medicaid expansion and holdout states has grown approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states. 

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In Fact Sheet, Research

FACT SHEET: The Affordable Care Act Has Expanded Access to Care for People of Color

Over the last 14 years, the Affordable Care Act (ACA) has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA has survived countless repeal attempts and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

There is overwhelming evidence that the ACA has made a historic contribution to improving health care for communities of color. In addition to increasing coverage and improving health outcomes, the health care law has helped narrow racial disparities in maternal health, cancer care, and more. Even as the ACA is more popular than ever, Republicans are still trying to repeal and sabotage the health care law.  Meanwhile, Democrats continue their work to lower costs and expand affordable coverage. Democrats’ policies to lower costs are an essential step in reducing ethnic and racial inequities in health care, as research shows better access to care as well as a more diverse health care workforce – two goals advanced by the ACA – improve health outcomes.

By the Numbers:

  • The uninsured rate among nonelderly Black and Hispanic/Latino young adults between 2010 and 2022 was cut in half from 19.9 percent to 10 percent and 32.6 percent to 18 percent respectively.
  • American Indians and Alaskan Natives saw both private and public health insurance enrollment increase by 1.2 percent and 3.2 percent respectively after the implementation of the ACA with an additional 6.3 percent increase in public insurance enrollment in Medicaid expansion states.
  • Medicaid expansion has reduced racial disparities in timely treatment with one study showing its introduction in states completely erases disparities in timely cancer care.
  • Although less directly researched, the ACA has also empirically benefited first-generation immigrants with one study showing post-ACA that the rates of insurance increase for Latino and Asian immigrants by 14.3 percent and 9.9 percent respectively in just the state of California.
  • Black and Hispanic individuals are 59.2 percent more likely to have gained health coverage due directly to the expanded premium subsidies than White individuals in non-expansion states.

Lowering the Uninsured Rate. Before the passage of the ACA, more than 16 percent of the nearly 50 million Americans lacking health insurance were African Americans. According to the Kaiser Family Foundation, the ACA helped lower the uninsured rate for nonelderly African Americans by nearly half between 2010 and 2022 from 19.9 percent to 10 percent. The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the health care law were overturned. Research also shows the ACA cut uninsurance rates among Asian Americans by more than half–from nearly 20 percent to just under 8 percent — eliminating coverage disparities with white Americans.

Reductions in Racial Disparities In Health Outcomes. Access to preventive care starts with access to affordable coverage. 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. The ACA significantly reduced racial disparities in the share of people who went without care because of cost. Positive medical outcomes have also increased significantly with one study showing Black heart transplant recipients had a 8 percent increase in post-surgery survival after the passage of the ACA.

Improvements To Infant And Maternal Health. Whether coverage comes from Medicaid expansion or increased access to affordable coverage on the ACA Marketplace, coverage improves infant and maternal mortality outcomes. One study found that reductions in maternal mortality in expansion states were concentrated among Black mothers, “suggesting that expansion could be contributing to decreasing racial disparities in maternal mortality.” Expansion has also been tied to improving health outcomes for Black babies, significantly reducing racial disparities in low birth weight and premature birth. 

Preventive Care Leads To Improvements In Disease-Specific Diagnosis And Treatment. A 2017 study called preventive care “one of the most important health care strategies to facilitate early diagnosis and treatment, improve quality of life, and prevent premature death.” Access to preventive care through Medicaid expansion reduced racial disparities in cancer care and resulted in earlier diagnosis and treatment for Black patients. According to the Center for American Progress, Black women were more likely to receive care because of the ACA.

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In Fact Sheet, Research

FACT SHEET: Republicans Propose Budget That Will Raise Health Care Costs and Rip Coverage Away from Millions of Americans

In MAGA Republicans’ latest attack on American health care, the Republican Study Committee (RSC) released a disastrous budget proposal for FY2025. The plan would increase prescription drugs prices by repealing the Inflation Reduction Act, hike annual premiums by thousands of dollars, expand junk plans that don’t cover basic benefits like prescription drugs or maternity care, strip away protections for people with pre-existing conditions, and put Medicaid coverage for millions in jeopardy. 

While President Biden and Democrats in Congress are hard at work bringing down the cost of health care in order to keep food on the table and a roof over the heads of millions of people, MAGA Republicans are working to rip away protections, raise health care costs, and throw the health care system into chaos. Here’s just a few of the catastrophic changes Republicans want: 

Kill the Inflation Reduction Act’s Drug Pricing Savings. The RSC budget proposal would fully repeal the Inflation Reduction Act, which is saving Americans thousands of dollars on health care by holding big pharmaceutical companies accountable and bringing down the cost of prescription drugs, making health care plans more affordable with premium tax credit subsidies, and capping the price of insulin at $35 per month for Medicare Part D beneficiaries. Here are just a few of the impacts this disastrous plan would have on American health care:

  • GONE: Insulin co-pays will no longer be capped at $35 per month for 4 million Americans on Medicare who use insulin.
  • GONE: 52 million Medicare beneficiaries will no longer be able to receive the shingles vaccination and other recommended vaccinations free of cost.
  • GONE: Seniors on Medicare will no longer be protected from drug company price hikes through inflation rebates.
  • GONE: Medicare will be banned from negotiating drug prices. Nearly 9 million people take the first ten drugs that were selected for Medicare negotiation, which account for 20 percent of the annual Medicare Part D spending. Negotiated prices will take effect in 2026.
  • GONE: 400,000 low-income seniors will no longer receive more help affording prescription drugs through the Medicare Part D Extra Help program.
  • GONE: Medicaid and CHIP beneficiaries will no longer have access to recommended vaccinations free of cost.
  • GONE: Seniors with the highest brand-name drug costs will no longer have their out-of-pocket costs capped at $3,250 for the year and $2,000 in 2025, which would save nearly 19 million Americans an average of $400 each year

Strike Premium Tax Credits, Raising Premiums By Thousands of Dollars. The RSC budget proposal would rescind temporary enhancements to premium tax credits originally enacted in the American Rescue Plan and extended by the Inflation Reduction Act until 2025. These enhanced tax credits have reduced ACA Marketplace enrollees’ premiums by an average of $800 per year.

  • GONE: Premium tax credits that make premiums affordable for 80 percent of people who purchase health care on the Marketplace, saving millions of Americans an average $527.
  • GONE: Annual health insurance premiums will increase by an average $7,676 for a family of four making $125,000 a year if premium tax credit enhancements are rescinded.

Expand Junk Plans. The RSC proposal would codify rules put forth by the Trump administration that expanded health insurance plans known as association health plans (AHPs). These plans are not required to cover the essential health benefits put in place by the Affordable Care Act and are allowed to charge people more based on their age, health status, and gender. AHPs have a long history of fraud and unpaid claims and provide weaker cost and protection coverage. The proposal also applauds efforts by the Trump administration to expand short-term limited-duration plans, which engage in predatory marketing practices, fail to protect people with pre-existing conditions, and put patients at risk of bankruptcy when they get sick. The Trump administration’s decision to expand access to these plans exposed consumers to scams and reduced transparency about coverage limits and hidden fees. 

Rip Away the ACA’s Protections For Pre-Existing Conditions. The RSC proposal would remove many protections for the over 100 million Americans with pre-existing conditions made possible through the Affordable Care Act, and would allow insurers to deny coverage, except for people who have had continuous coverage through an employer or the individual market.

Threaten Coverage For People With High-Risk Medical Conditions, Leaving Millions of Americans At The Mercy of State Coverage Pools. The RSC proposal would funnel people with high-risk medical conditions into state-run coverage pools, leaving states with the final say on how insurers can determine premiums based on health risks. These high risk coverage pools often impose high premiums and deductibles, with premiums as much as 200 percent higher than average and deductibles substantially greater than allowed under the ACA – all at a higher cost to American taxpayers. Numerous studies have shown that high risk coverage pools often provide worse care, with many having exclusions for pre-existing conditions, limited benefits, lifetime and annual limits on coverage, waiting periods, and often result in delayed or forgone care.

Loosen Restrictions For Hospitals Providing Worse Care At Higher Costs For Patients. The RSC proposal would eliminate the ban on physician-owned hospitals, which 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.

Jeopardize Medicaid Coverage For Millions Through Block Grants. MAGA Republicans want to radically restructure Medicaid by changing it into five block grants. Block grants would shift costs to states and inevitably result in deep cuts to Medicaid programs by capping the amount of federal Medicaid funding states receive. As CBPP found in 2017, a block grant would force states to make deep cuts to their Medicaid programs to compensate for the federal funding cuts.

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In Fact Sheet, Research

FACT SHEET: The Affordable Care Act Has Lowered Costs and Protected Patients With Pre-Existing Conditions From Being Denied Coverage

Over the last 14 years, the ACA has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage by an average of $2,400 a year per family.

The ACA has survived countless repeal attempts and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. Additionally, Republican allies in the courts are attacking access to free preventive services under the ACA, jeopardizing lifesaving care for millions. Read more about the case here. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

Prior to the passage of the ACA, people with pre-existing conditions could be charged more, denied coverage, or denied certain benefits simply for having a diagnosis ranging from specific conditions like cancer, diabetes, or pediatric asthma, or simply for being a woman. Without the ACA, a change in life circumstances, such as changing jobs, getting divorced, or retiring could mean losing access to lifesaving health care for the over 100 million Americans with pre-existing conditions.

Republicans in Congress are working to dismantle protections for pre-existing conditions. Under the guise of offering cheaper insurance, MAGA-Trump Republicans want to expand the availability of short-term “junk plans” and association health plans that don’t cover basic benefits like prescription drugs or maternity care and can drop and deny coverage for people with pre-existing conditions. The GOP also wants to cut funding for Medicaid and kick people off the program by imposing burdensome paperwork requirements. All of these actions would be devastating for the tens of millions of Americans who rely on the ACA’s protections to access affordable health care. 

A Closer Look:

  • Over 100 million people with pre-existing conditions are protected from being charged more for, dropped from, or denied health coverage. 
  • 179 million Americans with employer coverage are protected from lifetime and annual limits, in addition to over 20 million with ACA Marketplace coverage. 
  • Insurers can no longer charge women more than men for the same coverage and are required to cover important health benefits like maternity care.
  • Health insurance companies can not discriminate by charging more or denying coverage based on sexual orientation or gender identity. 

Thanks to the ACA:

Over 100 Million Americans With Pre-Existing Conditions Are Protected. Because of the ACA, insurers in the individual market can no longer drop or deny coverage, or charge more because of a pre-existing condition. Over 100 million Americans have a pre-existing health condition, including nearly 30 million Americans with diabetes, 26 million with asthma, and millions more with cancer, arthritis, and heart disease.

The ACA Guarantees Comprehensive Coverage. Because of the ACA, insurers have to cover what are known as “essential health benefits,” such as maternity care, prescription drugs, and substance and mental health. Before the ACA, individual market plans often failed to cover these basic, and oftentimes preventive, health services. 

The ACA Ended Annual And Lifetime Limits, Including For People With Employer-Based Coverage. Thanks to the ACA, insurers can no longer put annual or lifetime limits on the care you receive. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million, functionally locking people with complex medical needs out of coverage. 179 million Americans with employer coverage are protected from lifetime limits, in addition to the millions with ACA Marketplace coverage. 

Women Can No Longer Be Charged More Than Men. Because of the ACA, insurers can no longer charge women more than men for the same coverage, and insurers are now required to cover important health benefits like maternity care. Before the ACA, only 12 percent of individual market plans offered maternity care. The ACA established maternity coverage as one of the ten essential health benefits required on all new individual and small group policies. President Biden’s American Rescue Plan expanded on this by creating an incentive for states to offer a full year of Medicaid coverage postpartum instead of the required 60 days, and 46 states and DC have done so. 

LGBTQI+ Americans Are Protected From Discrimination By Health Insurance Companies. Republicans have worked to sabotage the Biden administration’s efforts to require health insurance plans offered through the ACA to include sexual orientation and gender identity as protected characteristics. LGBTQI+ Americans are more likely to be without health insurance than straight individuals. According to a Center for American Progress survey, in 2019, the LGBTQI+ uninsured rate was 20 percent in holdout states, compared to 8 percent in states that adopted Medicaid expansion. Access to affordable, quality health care plans under the ACA help combat the number of LGBTQI+ Americans who are uninsured. Premium subsidies made available by the American Rescue Plan and extended by the Inflation Reduction Act have helped nearly 210,000 LGBTQI+ enrollees have access to zero-premium plans.

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In Fact Sheet, Research

FACT SHEET: The Affordable Care Act Has Lowered Costs and Improved Health Care for Children and Young People

Protect Our Care Is Marking the 14th Anniversary of the Affordable Care Act With 5 Days Celebrating the Growing Success of the Health Care Law Under President Biden

Over the last 14 years, the Affordable Care Act (ACA) has become an essential pillar of the American health care system and has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care by expanding the ACA, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. The Inflation Reduction Act lowered premiums for people who buy their own coverage. Four out of five individuals can find coverage on the Marketplace for under $10 per month.

The ACA has survived countless repeal attempts, and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for children and young adults. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating these threats, Republicans in Congress and their allies are working overtime to dismantle access to reproductive care and vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. Additionally, Republican allies in the courts are attacking access to free preventive services under the ACA, jeopardizing lifesaving care for millions. Read more about the case here. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation: 

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

Before the passage of the ACA, young Americans could be thrown off their parent’s health insurance the moment they turned 18. Many young adults were left uninsured after graduating college and were forced to navigate adulthood with entry-level or part-time jobs that didn’t offer employer-sponsored health care. An estimated 3 million young adults had coverage between 2010 and 2016 because of the ACA’s dependent coverage requirement. This coverage policy was responsible for a rapid 14 percent reduction in the number of uninsured young adults immediately after the passage of the ACA. Uninsurance rates for young adults continued to decrease, by 8.7 percent, in the following years, except during the Trump administration. Research has overwhelmingly shown that young adults have had dramatically improved self-reported physical and mental health, increased early-stage cancer diagnosis, reduced poor birth outcomes, and are less likely to die of opioid overdose following the passage and expansions of the ACA. President Biden and Democrats in Congress are working to further lower costs so everyone can afford the health care they need. 

By The Numbers:

  • More than 28 million children and young adults with pre-existing conditions gained protection.
  • Uninsurance in young adults fell by about 14 percent in the years following the passage of the ACA thanks to Medicaid expansion and ACA provisions.
  • 710,000 children gained coverage through Medicaid expansion when their parents enrolled. 
  • In 2023, more than one in four, or 4.1 million of those enrolled in Marketplace coverage were between the ages of 18 and 34.

Thanks To The ACA

Expanded Medicaid. Uninsurance rates among young adults fell by nearly half as a result of the ACA’s Medicaid expansion, improving access to care. Research confirms expanding access to Medicaid for parents has had ripple effects on their children. In states that expanded Medicaid, more children gained health coverage and were more likely to have regular access to health care. Children in states that have not expanded Medicaid are almost twice as likely to be uninsured — and that gap is growing. 

Young Adults Can Stay On Their Parents’ Plan Until Age 26. People younger than 26 years old are eligible to be on their parents’ insurance even if they are married, a parent, don’t live with their parents, attend school, are not financially dependent on their parents, or are eligible to enroll in their employers’ plan. In 2023, more than one in four, or 4.1 million of those enrolled in Marketplace coverage were between the ages of 18 and 34.

More Than 28 Million Children & Young Adults With Pre-Existing Conditions Gained Protections. Thanks to the ACA, children with pre-existing conditions like asthma and diabetes cannot be charged more or denied coverage by their insurers. Nationwide, over 100 million Americans have a pre-existing condition, including more than 17 million people under the age of 18 and 11.3 million people aged 18 to 24.

Free Preventive Services And Annual Check-Ups. The ACA guarantees well-child visits with no cost-sharing for patients. These visits help prevent the development of chronic conditions and increase vaccinations among children. Plans sold on the ACA Marketplace must also cover preventive pediatric health benefits, including oral health and vision services. More than 36 million children with private insurance are also guaranteed free preventive care and are protected from lifetime and annual limits. However, these free preventive health services are now at risk of being overturned in the courts in the Braidwood Management v. Becerra case. 

Ended annual and lifetime limits. Because of the ACA, insurers can no longer put annual or lifetime limits on the care you receive, which is critical for children with complex medical needs. According to First Focus, without these protections, “children with cancer and other pediatric conditions, or babies that were born prematurely and spent the first weeks or months of their lives in the neonatal intensive care unit, could exhaust their annual and lifetime limits in a short time.” 

Improvements To CHIP & Medicaid Coverage. The ACA improved children’s coverage by increasing the federal matching rate for the Children’s Health Insurance Program (CHIP) and standardizing–and in many states, expanding–Medicaid eligibility for children. The ACA also ensures that states provide Medicaid coverage to children in foster care up to age 26. 

Contraception Use Covered Under The ACA Has Led To A Sharp Decrease In Unintended Pregnancies. Among young adults, the contraception mandate under the ACA has led to increased use of contraception, increased use of more effective contraceptives, and decreased risk of unintended pregnancy. The racial disparity between Black and white women using contraceptives has also reduced by an incredible 70.5 percent when analyzing contraceptive use pre- and post-passage of the ACA. 

Mental Health And Substance Abuse Treatment Are More Accessible Than Ever. Over 62 million Americans gained expanded benefits for mental health and substance use disorder because of the ACA. With over one-third of young Americans aged 18-25 living with mental illness, this coverage has been life-changing for many. Additionally, the ACA provided increased access to services for the 5.1 million young adults living with substance use disorder. Particularly, the ACA’s Medicaid expansion has played a direct role in reducing opioid-related mortality by 3.6 percent by expanding access to services for rural Americans, racial and ethnic minorities, and impoverished communities most affected by the opioid epidemic.

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In Fact Sheet, Research

FACT SHEET: The Affordable Care Act Has Improved Health Care for Seniors

Over the last 14 years, the ACA has helped tens of millions of Americans gain access to affordable health coverage. Thanks to President Biden’s efforts to lower the cost of health care, a record-breaking 21.3 million Americans signed up for coverage through the Marketplaces for 2024. President Biden built upon the ACA by further lowering premium and prescription drug costs through the Inflation Reduction Act. The new law has lowered annual premiums for people who buy their own coverage by an average of $2,400 per family and has saved the average 60-year-old couple with a household income of $75,000 approximately $1,900 in monthly premiums for Marketplace coverage. Building on the ACA’s closure of the prescription drug donut hole, President Biden’s Inflation Reduction Act reduces out-of-pocket drug costs for Medicare enrollees by capping monthly insulin costs at $35, providing recommended vaccines at no cost, introducing a new annual out-of-pocket spending cap, and negotiating lower drug prices. 

The ACA has survived countless repeal attempts and now it’s stronger than ever. Yet Republicans still want to destroy the ACA and all of its protections for over 100 million people with pre-existing conditions. Donald Trump has fully reignited his calls to repeal the ACA. As Trump is escalating his threat, Republicans in Congress and their allies are working overtime to dismantle reproductive care and access to vital preventive care, hike premiums, slash Medicare and Medicaid, reverse recent coverage gains, and raise prescription drug costs for the American people. 

This week, Protect Our Care is highlighting five key ways the ACA is working across the nation:

Monday, March 18: How the ACA helps women
Tuesday, March 19: How the ACA helps seniors & young people
Wednesday, March 20: How the ACA helps people with pre-existing conditions
Thursday, March 21: How the ACA helps people of color
Friday, March 22: How the ACA expanded affordable coverage to tens of millions of Americans

Background:

Among the many benefits of the ACA, the health care law ensures that the more than 50 million people enrolled in Part D coverage who may have otherwise fallen into a prescription drug coverage gap “donut hole” have their vital medications covered. The ACA guarantees no-cost coverage of preventive services, which has led to an increase in utilization among seniors and a decrease in catastrophic health costs. The ACA also laid a strong foundation for the Inflation Reduction Act’s measures to lower drug prices, including the new out-of-pocket cap on drug costs that went into effect in January 2024 and drops to $2,000 out-of-pocket cap in 2025, which will save nearly 19 million seniors about $400 per year. These benefits, along with the expansion of Medicaid, have improved the health of seniors across the country.

By the Numbers:

  • Over 50 million seniors are protected from the Medicare ‘donut hole’ coverage gap. 
  • Lifesaving free preventive care has led to an increase in utilization with one study showing that implementation of the ACA led to a 9 percent increase in colonoscopies among seniors.
  • The Balancing Incentives Program under the ACA has led to a 3.2 percent increase in daily home caregiving and better quality care for seniors.
  • Spillover effects from ACA coverage have resulted in a 17.4 percent increase in SNAP enrollment, leading to better health outcomes among low-income seniors.
  • The ACA’s 2014 Medicaid expansion led to seniors being 4 percent more likely to have dual Medicare and Medicaid coverage, allowing for more affordable health care and better health outcomes.
  • Through Medicaid expansion, 7.2 million Americans over 65 are enrolled in Medicaid and more than 8.5 million Americans ages 50 to 64 have health coverage.

People Over The Age Of 50 Save Thousands On Premiums. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to AARP. People who buy insurance on their own, especially early retirees, have been able to save thousands on health insurance thanks to the enhanced premium subsidies passed in the ARP and extended in the IRA.

Seniors Are Guaranteed Free Preventive Services And Annual Check-Ups. Around 61 million people with Medicare have access to free preventive services because of the Affordable Care Act. Additionally, Medicare beneficiaries likely see lower premiums thanks to the cost-saving measures implemented under the ACA.

Millions of Medicare Beneficiaries Are Benefiting From Higher Quality, More Coordinated Care. Provisions in the ACA encouraged groups of doctors, hospitals, and other health care providers to come together to provide coordinated high-quality care to the Medicare patients they serve, affecting nearly 9 million seniors.

32 Million Older Adults With Pre-Existing Conditions Gained Protections. Thanks to the ACA, people with pre-existing conditions like asthma and diabetes cannot be charged more or denied coverage by their insurers. Nationwide, half of all Americans have a pre-existing condition, including 32 million people aged 55-64. And now, millions of Americans who have contracted the coronavirus are also protected from discrimination by their insurance companies. 

A Closer Look At How The Affordable Care Act Is Working For Seniors Across The Country:

Seniors Saved Thousands On Prescription Drug Costs Thanks To The ACA. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

The ACA’s Medicaid Expansion Saved The Lives Of At Least 19,200 Older Adults. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time,15,600 older adults died prematurely as a result of their state’s decision not to expand the program.

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