Research Archives — Page 6 of 15

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 News, Report, Press Call, Research

Protect Our Care Unveils New Report During Press Call with Senator Welch Ahead of New Medicare Negotiation Guidance By Biden Administration

Watch the Event Here.

Washington, DC — Today, Protect Our Care announced the release of a new report on five drugs that may be selected for the initial round of negotiations through the Medicare Drug Price Negotiation Program during a press call headlined by U.S. Senator Peter Welch (D-VT). Tahir Amin, Co-Founder and Co-Executive Director of the Initiative for Medicines, Access & Knowledge, Robert Roach, Jr., President of the Alliance for Retired Americans, and Andrea Harris, Director of Policy Programs of Protect Our Care also joined the call to discuss the importance of giving Medicare the power to negotiate lower drug prices.

Big drug companies are now turning to the courts to try to dismantle the Negotiation Program because they didn’t get their way after spending a record $372 million lobbying Congress in 2022. Drug company giants Merck and Bristol Myers Squibb, 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 lower prescription drug prices and giving seniors the breathing room they need. Republican lawmakers have also introduced legislation to repeal the prescription drug provisions of the Inflation Reduction Act in order to line the pockets of drug company executives and raise costs on patients.

“The pricing power of Pharma has been abused, absolutely, from beginning to end,” said U.S. Senator Peter Welch (D-VT). “This question about prescription drugs is really about affordability: things that people need every day, they can’t afford. The price negotiation legislation that President Biden signed is finally going to give a tool to Medicare to do what every other government agency does – stand up for fair prices for prescription drugs. Folks need to be able to afford prescription medications. And we’re not going to let Pharma sue their way out of this achievement that has been long overdue.”

“Prescription drug spending has tripled since 2000 to nearly $400 billion today, and is poised to expand further 50 percent within the next 10 years,” said Tahir Amin, Co-Founder and Co-Executive Director of the Initiative for Medicines. “This increase is fueled mostly by branded drugs which make up just eight percent of prescriptions but account for 84 percent of all drug spending in the United States. We cannot continue to pay these prices, and that’s why the Inflation Reduction Act and the provisions that will curb some of these excesses that the drug companies have been able to develop through patenting games is so important.”

“Our members know when a law truly changes people’s lives,” said Robert Roach, Jr., President of the Alliance for Retired Americans. “And President Biden’s Inflation Reduction Act does that in a number of ways. Because the law penalizes corporations that increase the price of a drug faster than inflation, Americans who take 43 prescription drugs will save between $1 and $499 per average dose. That’s real results.”

“For far too long, big drug companies have exploited their market power, making drugs unaffordable for seniors and costing taxpayers tens of billions of dollars,” said Andrea Harris, Director of Policy Programs of Protect Our Care. “Protect Our Care’s new report shines a light on why the Inflation Reduction Act’s Medicare Drug Price Negotiation Program is so desperately needed to fix this broken system.”

“While the Biden administration is working tirelessly to implement Medicare negotiation and deliver savings to seniors, pharmaceutical companies and their Republican allies are doing everything in their power to protect their outrageous profits,” said Leslie Dach, Chair of Protect Our Care. “Republicans are trying to repeal the Inflation Reduction Act, and major pharmaceutical companies are in court trying to take away Medicare’s power to negotiate lower prices. Fortunately, we have a president who will ensure everyone can afford the medicines they need.”

ashoup In Report, Research, News

NEW REPORT: “Why Medicare Needs the Power to Negotiate for Lower Drug Costs: Outrageous Prices, Greed, and Patent Exploitation”

A Detailed Look At 5 Drugs That Tell The Story

Read the Full Report Here.

Washington, DC — Ahead of the release of the final guidance for the Medicare Drug Price Negotiation Program from the Biden-Harris administration, Protect Our Care is releasing a new report that provides a detailed look at five drugs that will likely qualify for the first round of negotiations, demonstrating the importance of finally allowing Medicare to negotiate lower drug prices. The five drugs are:

Enbrel which is sold by Amgen to treat arthritis and plaque psoriasis. Enbrel has seen a 346% price increase since 2008.
Ibrance which is sold by Pfizer to treat breast cancer. It cost $181,663 for an annual supply of Ibrance in 2022.
Imbruvica which is sold by AbbVie to treat Leukemia and Lymphoma. The average annual out-of-pocket cost for Imbruvica was $7,118 in 2020.
Januvia which is sold by Merck to treat Type 2 Diabetes. Januvia made $49.9 billion in global revenue.
Xarelto which is sold by Johnson & Johnson to treat blood clots. Medicare has spent $25 billion on Xarelto since its launch.

Together, the Medicare program incurred total spending of $16.69 billion in 2021 alone for these five drugs. These drugs have high list prices and list price increases over time that far exceed inflation. Imbruvica has an annual list price tag of $197,486; Ibrance is priced at $181,663 per year. Enbrel’s price is $82,001 per year, which has grown by 346% since 2008. These prices translate into billions in sales for drugmakers. For example, Medicare has spent nearly $28 billion on Januvia since 2010 and $15.4 billion on Enbrel since 2010.

Big drug companies protect their profits by exploiting the patent system to extend the length of time their drugs are on the market without generic or biosimilar competitors. AbbVie, for example, has filed 195 patent applications for Imbruvica to thwart competition, extending its patent protection for an additional 5.3 years and yielding $13.8 billion in revenue. Amgen has extended patent protections for Enbrel by 13.6 years, protecting $55 billion in revenue.

After voting against lowering drug prices, reducing health care premiums, capping insulin costs, and improving care for seniors and people with disabilities in the Inflation Reduction Act, it is no surprise that Republicans and big drug companies are now attacking it in Congress and the courts. Pharmaceutical giants Merck and Bristol Myers Squibb, as well as mega lobbying groups, PhRMA and the US Chamber of Commerce, are filing meritless lawsuits to protect their profits and stop the administration from negotiating lower drug prices. MAGA Republicans in Congress have introduced legislation to repeal the Inflation Reduction Act’s prescription drug provisions and revoke the savings for millions.

“For far too long, Big Pharma has held unchecked power to charge whatever they wanted for prescription drugs, and patients have been forced to skip doses and choose between their health and putting food on the table,” said Leslie Dach, Chair, Protect Our Care. “Patients deserve affordable care and the Inflation Reduction Act keeps that promise. Thankfully, President Biden and Democrats are committed to lowering drug costs and delivering savings to those who need it most.”

“These five drugs tell the story of Big Pharma’s greed at the expense of seniors and taxpayers,” said Andrea Harris, Director of Policy Programs, Protect Our Care. “They lost the lobbying battle against reducing drug prices for seniors by negotiating lower prices, and now they are doing everything in their power to stop the law from helping patients who are cutting pills and skipping doses. The Medicare Drug Price Negotiation Program is finally ending the age of Big Pharma’s unchecked power to charge whatever they want for drugs.”

ashoup In Research, Fact Sheet

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 Research, Fact Sheet

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.

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NEW REPORT: “Big Pharma’s Big Doubletalk” Details Industry’s Latest Scheme to Protect Their Sky-High Profits and Hike Drug Prices

Big Pharma Is Telling Investors on Wall Street Everything Is Fine While Telling Lawmakers Medicare Negotiation Will Destroy Innovation

Read the Full Report Here.

Washington, DC — Protect Our Care is releasing a new national report exposing pharmaceutical companies’ latest ploy to protect their sky-high profits at the expense of patients. Thanks to the Inflation Reduction Act, the Biden administration is now putting in place the Medicare Drug Price Negotiation Program that will finally give Medicare the authority to negotiate lower prices, making prescription drugs more affordable. Big Pharma is continuing its false claims to lawmakers that this program will undermine innovation and discourage the development of new medications, while telling Wall Street that they are enthusiastic about U.S. pharmaceutical innovation and research and development opportunities.

Key Points:

American patients pay up to 4 times more for the same drugs as patients in other wealthy countries.
Despite blaming the negotiations for terminating new drug development, many drug companies are telling investors they are bullish on innovation and continue to invest in research and development following the passage of the Inflation Reduction Act.
The nonpartisan Congressional Budget Office estimates just a 1% decrease in the development of new drugs over the next 30 years as a result of the Medicare Drug Price Negotiation Program.
Even when the negotiation program is fully implemented, the United States will remain the most generous payer in the world for drugs.

“Big Pharma’s greed knows no bounds telling the public one thing and investors another,” said Protect Our Care Chair Leslie Dach. “Our nation’s seniors are depending on the savings from the Inflation Reduction Act, and Big Pharma is trying to roll back the law simply to protect their profits. Big Pharma’s claims are bogus and should be rejected.”

ashoup In Fact Sheet, Research

FACT SHEET: Ron DeSantis is Bad News for Health Care

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]

ashoup In News, Report, Press Call, Research

PRESS CALL: Congressman Pat Ryan, New York Veterans to Discuss New Report on How the Republican Default Plan Threatens Veterans’ Health Care

FOR PLANNING PURPOSES:
Contact: [email protected], 646-359-4422

House Republicans Continue To Double Down on Their Efforts to Rip Away Lifesaving Care

New York, NY — Today, at 11:30 AM EST, U.S. Representative Pat Ryan (NY-18) will join Protect Our Care New York and executive director of The Hudson Valley National Center for Veteran Reintegration Kevin Keaveny to discuss House Republicans’ “Default on America Act,” legislation, and its impact on health care for millions of veterans across the country.

Today, Protect Our Care unveiled a new report detailing exactly how veteran’s health care would be impacted if the Republican Default on America Act were to become law. The report found that under the GOP bill, millions of veterans, including the 225,400 who receive their health care services in New York, would face:

An over-22 percent slash to health care funding
30 million fewer outpatient visits
81,000 jobs lost across the Veterans Health Administration
A backlog of 134,000 claims
$565 million in cuts earmarked for major construction projects, including critical upgrades to clinics and hospitals

Speakers will discuss the report, and how the Republican plan would gut resources for the Veterans Administration and disproportionately harm veterans of color, disabled veterans, low-income veterans, and veterans facing homelessness in New York and across the United States.

Speakers will also discuss proposed cuts to Medicaid and other vital services, including mental health and substance use treatment, maternal care, cancer research and more.

PRESS CALL:

WHO:
U.S. Representative Pat Ryan (NY-18)
Kevin Keaveny, Hudson Valley National Center for Reintegration
Nate Jackson, Protect Our Care New York

WHAT: Virtual Press Conference

WHEN: Thursday, May 18 at 11:30 AM EST

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

ashoup In News, Report, Research

NEW REPORT: Inside Republicans’ Radical Plan To Slash Health Care For Millions Of Veterans

Read the Full Report Here.

Washington, D.C. — Ahead of President Biden’s meeting with congressional Republicans on default negotiations, Protect Our Care is releasing a new national report exposing the dire consequences of Republicans’ proposed cuts to veterans’ health care. The GOP’s ‘Default on America’ Act slashes veterans’ health care funding by 22 percent, threatening to rip health care away from millions of veterans. Under the GOP bill, veterans would face:

30 million fewer outpatient visits
81,000 jobs lost across the Veterans Health Administration
A backlog of 134,000 claims
$565 million in cuts earmarked for major construction projects, including critical upgrades to clinics and hospitals

The Republican bill also seeks unprecedented cuts to Medicaid and other vital services, including for mental health and substance use, maternal care, cancer research and more.

“Not only does the House Republican default bill threaten to rip away health care from 21 million people who rely on Medicaid, but it also cuts veterans’ health care by 22 percent,” said Protect Our Care Chair Leslie Dach. “The cuts to veterans’ care would be disastrous and an insult to those who risked their lives to keep us safe, threatening millions of patients’ access to care. As always, the GOP has one goal in mind: rip away benefits and deny people access to health care in order to support the wealthiest Americans.”

Protect Our Care also released fact sheets in the following states:

Arizona
Nevada
Virginia
Michigan
New York
California
Pennsylvania
Wisconsin
Georgia

Research