Category: Healthcare

Trump poised to roll back transgender health protections


The Trump administration appears ready to roll back health care protections for transgender people, and advocates are gearing up for a fight.

A proposed rule from the Department of Health and Human Services (HHS) that’s expected in the coming days would make it easier for doctors, hospitals and insurance companies to deny care or coverage to transgender patients, as well as women who have had abortions.

Coming on the heels of the military transgender ban, there are fears the administration could go even further and use the proposal as an opportunity to narrow the definition of gender.

The administration hinted in a recent court filing that new health regulations could be published as soon as next week. The rule is expected to weaken or eliminate an anti-discrimination provision enshrined in ObamaCare.

The provision says patients cannot be turned away because they are transgender, nor can they be denied coverage if they need a service that’s related to their transgender status.

Religious providers say they expect the administration’s rule to reinforce their right not to provide treatment that is against their beliefs.

Advocates, meanwhile, say they are concerned that the proposal could jeopardize the gains made in making sure transgender individuals receive equal access to care.

The proposal is “likely to send an even stronger signal that the administration endorses discrimination in health care against transgender people,” said Harper Jean Tobin, director of policy at the National Center for Transgender Equality.

The rule “won’t mean that overnight transgender people can’t get health care, but it will be a steady drip of allowing more discrimination,” Tobin said.

Chase Strangio, an attorney at the American Civil Liberties Union (ACLU), said access to health care can be a life or death circumstance, and the rule could have “catastrophic effects” if it is finalized.

“To have the government take a stand in favor of discrimination is deeply upsetting, ” Strangio said.

Once the proposal is released, a public comment period will follow. After that, a final rule will be issued.

As for what comes next, Strangio said the ACLU has had two years to prepare for that.

“If the final rule looks like the proposal we are anticipating, we and our partners will file suit as soon as possible,” Strangio said. “We can expect many legal challenges to any final rule.”

President Trump repeatedly pledged support for the LGBTQ community on the campaign trail in 2016. But advocates say the president’s words increasingly ring hollow, and his administration has been steadily eroding protections for transgender individuals.

For example, the military’s transgender ban took effect earlier this month, despite objections from advocacy groups and medical experts. And the Supreme Court on Monday said it would hear arguments this year on three cases concerning whether federal law applies to transgender identity.

Additionally, the Justice Department has argued that the main federal civil rights law doesn’t protect employees from discrimination based on gender identity. Former Attorney General Jeff Sessions in 2017 wrote a memo saying the law “does not encompass discrimination based on gender identity per se.”

The existing health care rule was first issued in 2016, six years after the 2010 Affordable Care Act was signed into law. The rule prohibited providers and insurers who receive federal money from denying treatment or coverage to anyone based on sex, gender identity or termination of pregnancy.

It also required doctors and hospitals to provide “medically necessary” services to transgender individuals, as long as those services were the same ones provided to other patients.

That rule was challenged in court by a group of Christian providers called the Franciscan Alliance. They argued the rule forces insurers to pay for abortions and compels doctors to perform gender transition services, even if they disagree with those services on moral or medical grounds.

A federal judge in Texas agreed with that argument, issuing a nationwide injunction in late 2016 that is still in effect. The ruling said Congress had outlawed discrimination based on “the biological differences between males and females” but not transgender status.

The new proposed rule has been under review at the White House Office of Management and Budget for more than a year, something that experts say is highly unusual.

That delay is causing confusion in the health care industry: ObamaCare’s nondiscrimination statute is the law, even if a rule implementing it has been put on hold.

In a court filing earlier this month, the administration said it would be publishing the proposal soon, a move that would likely affect the lawsuit in Texas.

Luke Goodrich, senior counsel with the Becket Fund for Religious Liberty and a lead attorney for the plaintiffs, said providers would be better served by a ruling from the judge. He said they just want to make sure their religious protections are upheld.

Katie Keith, a health care consultant and professor at Georgetown Law, said, “It’s going to be really hard for people to understand their rights in health care” while the confusion continues.

Tobin, of the National Center for Transgender Equality, said the uncertainty is having a harmful effect.

“At a time when the administration is trying to overturn the entire Affordable Care Act, at a time when the transgender ban in military is taking effect, transgender people are scared for their ability to get the health care they need, and that their providers know they need,” Tobin said.

Goodrich argues that providers won’t turn away patients just because they are transgender, so long as the doctors aren’t giving transition-related care or “being pressured to perform abortions.”

He said the plaintiffs have been treating transgender people for years and “won’t stop doing that, because they provide care for everyone. That’s not what the lawsuit is about in our view.”

Transgender advocates are concerned the administration will use the lawsuit as an excuse to redefine gender.

The New York Times last year reported that HHS proposed in a memo that government agencies adopt a narrower definition of gender in a way that would essentially end federal recognition of transgender individuals.

No rules have been issued, but advocates say administration officials have been telegraphing their views.

The HHS memo is a “blueprint” for discrimination, and the nondiscrimination proposal is a major part of it, Tobin said.

[The Hill]

Trump says GOP senators are working on an Obamacare replacement and it will be ‘spectacular’

President Donald Trump announced Thursday that a team of GOP senators is ready to give health care another shot after nearly a decade of promising and failing to repeal and replace the Affordable Care Act.

But he added the caveat that he’s in no rush to get it done.

Trump resurrected the issue this week after the Justice Department, in a court filing Monday, said it supported the full elimination of President Barack Obama‘s signature legislative achievement. The president’s assertion that Republicans would become “the party of health care” surprised some Republicans, who thought they’d missed their chance to replace the law.

Republicans experienced an embarrassing defeat during Trump’s first year in office when they failed to make good on their campaign promise to end Obamacare. The closest they got to dismantling it was to eliminate the penalty on people who didn’t purchase health care.

Instead, the White House used executive actions to chip away at the law, while 20 governors from red states challenged it in court.

Trump named Sens. John Barrasso of Wyoming, Bill Cassidy of Louisiana and Rick Scottof Florida as the point people on Capitol Hill crafting the legislation.

“They are going to come up with something really spectacular,” Trump told reporters before heading off to a political rally in Michigan.

Trump also claimed that Republicans “will take care of preexisting conditions better than they’re taken care of now.”

The law makes it illegal for health insurers to deny coverage or raise rates on anyone with a preexisting or current illness. Trump did not expand on how it would be improved.

Trump also sounded triumphant about a lawsuit brought by 20 red states to rule Obamacare unconstitutional. A federal judge in Texas ruled in December that the entire law hinged on the fee imposed on people without health insurance. Since Congress eliminated that mandate in its tax bill, the law is no longer constitutional, the judge ruled. An appeal on that case is pending.

According to Trump, those opposed to the ACA are “winning in the courts.”

Democrats campaigned on this issue in November, warning voters that if the courts invalidate the law, then all of its most popular provisions, like protections for people with preexisting conditions, would go down with it.

The law has become increasingly popular with the public, and Democrats credit voters’ concerns about health care for their winning back the House.

Cassidy, one of the three senators Trump named, was also the architect of a replacement bill in 2017 that would have provided block grants to states to allow them to set the guidelines for their insurers. The Senate never voted on it.

All three have been separately working on health care-related legislation, but Trump claims he has asked them to take on the larger endeavor.

Cassidy and Barrasso were both medical doctors. Scott ran a hospital company, which, notably, was fined $1.7 billion for Medicare fraud when he was at the helm.

Trump said he’s not in a rush to get to health care because he’s waiting to see what the courts will decide. Democrats, who are elated to be talking about health care, argue the exact opposite, and say there should be a replacement in place if the ACA is dismantled because otherwise people lose the consumer protections in the law.

[Chicago Tribune]

President Trump again blasts John McCain, says he was ‘never a fan’ and ‘never will be’

President Donald Trump again criticized the late Sen. John McCain Tuesday, pointing specifically to his vote against repealing Obamacare and saying was “never a fan” and “never will be.”

“I’m very unhappy that he didn’t repeal and replace Obamacare, as you know. He campaigned on repealing and replacing Obamacare for years and then they got to a vote and he said thumbs down,” Trump said. “Plus there were other things. I was never a fan of John McCain and I never will be.”

The president’s comments came during an Oval Office meeting with the president of Brazil and after a series of weekend tweets in which Trump blasted the senator, who passed away battling brain cancer in last August.

Trump accused him of “spreading the fake and totally discredited dossier” and of sending it to the FBI and the media “hoping to have it printed BEFORE the Election.” But the president’s claim is not accurate. McCain wasn’t made aware of the dossier until after the election when he passed it on to the FBI.

The dossier, compiled by former British intelligence officer Christopher Steele, alleged links between the Trump campaign and Russian officials. Along with other explosive allegations, it alleged that Russians held compromising information about Trump that could be used to blackmail him.

On ABC’s “The View” on Monday, McCain’s daughter Meghan fired back at Trump, saying he “spends his weekend obsessing over great men” because “he will never be a great man” like her father.

[ABC News]

Trump falsely claims ‘we actually got rid of Obamacare except for one vote’

President Donald Trump claimed on Thursday that he had abolished President Barack Obama’s health care reform law.

According to BuzzFeed correspondent David Mack, Trump made the remarks during a cabinet meeting on Thursday.

“We actually got rid of Obamacare except for one vote,” the president reportedly said.

In fact, the Affordable Care Act has not been repealed, but Republicans have undermined it by striking the law’s individual mandate.

[Raw Story]

Trump Celebrates ‘Record’ Sales of Nonexistent Health Insurance Policies

As usual, President Donald Trump is either ignorant or lying about his own policies. This time, it’s so ridiculously obvious that correcting the record might sound fake.

During an event Thursday at Northeast Iowa Community College in Peosta, Trump was very excited to report that “incredible” numbers of people were signing up for association health plans, a form of coverage his administration is making easier to buy. He’s right about one thing: That truly is incredible, in that it’s the opposite of credible.

Trump didn’t use the term ”association health plans” in his remarks, but he did repeatedly praise Alexander Acosta, the secretary of labor, whose department published the regulations governing these policies last month, so it’s clear what Trump is referring to.

“I hear it’s like record business that they’re doing,” Trump said. “We just opened about two months ago, and I’m hearing that the numbers are incredible. Numbers of people that are getting really, really good health care instead of Obamacare, which is a disaster.”

To recap: zero people have actually enrolled in this insurance because it is literally impossible to do so until Sept. 1 at the earliest. And as for Obamacare being a “disaster,” its current problems have a lot to do with Trump himself.

Association health plans are policies that allow small companies in the same industry to band together to buy health benefits for their employees. These already existed before Trump, and before the Affordable Care Act became law in 2010.

President Barack Obama’s administration made them comply with the Affordable Care Act’s rules requiring health plans to provide a minimum, basic set of benefits (things like prescription drugs and maternity care) and limited how insurers could set prices based on the health status of the workers.

The Trump administration is changing that. These association health plans could evade the benefit rules and also charge premiums based on workers ages, occupations and places of business.

Association health plans may save some employees and employers money because they offer skimpier benefits, although those savings could be negated if an employee needs care not covered by her plan and has to pay out of pocket.

And these plans are designed to attract healthy consumers, so the more of them that leave the Affordable Care Act exchanges to join association health plans, the more costly the exchange customer base becomes and the higher premiums for those customers will be.

[Huffington Post]

Trump slashes funding that helps people sign up for Obamacare

The Trump administration is once again slashing funding for a program that helps Americans sign up for Obamacare.

The Centers for Medicare & Medicaid Services announced Tuesday that it would provide only $10 million for the navigator program for this fall’s open enrollment season. The move is the latest effort by the Trump administration to undermine the Affordable Care Act.

This past year, navigators only received $36 million in funding, down from $63 million in 2016. The reduction was paired with a 90% cut in Obamacare’s advertising budget.
The agency once again defended the decrease by saying that navigators, which usually hail from non-profit and community organizations, are not effective. They enrolled less than 1% of consumers who signed up for 2018 coverage in 34 states using the federal exchange, according to CMS.

Navigators say they don’t get credit for all the consumers they help guide through the process but don’t actually sign up. Also, navigators assist people with enrolling in Medicaid, which is not reflected in the numbers.

The Trump administration broadened the opportunity for private sector agents and brokers to assist consumers in signing up last fall. They assisted 42% of enrollees, the agency said.

Navigators applying for funding will also be encouraged to show how they will educate people about the newly expanded alternatives to Obamacare, such as association health plans and short-term plans. The Trump administration is making it easier for Americans to sign up for these policies, which many experts say will weaken Obamacare by siphoning off younger and healthier enrollees. These alternative plans don’t have to provide all of the Affordable Care Act’s consumer protections.

Consumer groups decried the move.

[CNN]

Trump challenges Native Americans’ historical standing

The Trump administration says Native Americans might need to get a job if they want to keep their health care — a policy that tribal leaders say will threaten access to care and reverse centuries-old protections.

Tribal leaders want an exemption from new Medicaid work rules being introduced in several states, and they say there are precedents for health care exceptions. Native Americans don’t have to pay penalties for not having health coverage under Obamacare’s individual mandate, for instance.

But the Trump administration contends the tribes are a race rather than separate governments, and exempting them from Medicaid work rules — which have been approved in three states and are being sought by at least 10 others — would be illegal preferential treatment. “HHS believes that such an exemption would raise constitutional and federal civil rights law concerns,” according to a review by administration lawyers.

The Health and Human Services Department confirmed it rebuffed the tribes’ request on the Medicaid rules several times. Seema Verma, administrator of the Centers for Medicare & Medicaid Services, conveyed the decision in January, and officials communicated it most recently at a meeting with the tribes this month. HHS’ ruling was driven by political appointees in the general counsel and civil rights offices, say three individuals with knowledge of the decision.

Senior HHS officials “have made it clear that HHS is open to considering other suggestions that tribes may have with respect to Medicaid community engagement demonstration projects,” spokeswoman Caitlin Oakley said, using the administration’s term for work requirements that can also be fulfilled with job training, education and similar activities.

The tribes insist that any claim of “racial preference” is moot because they’re constitutionally protected as separate governments, dating back to treaties hammered out by President George Washington and reaffirmed in recent decades under Republican and Democratic presidents alike, including the Clinton, George W. Bush and Obama administrations.

“The United States has a legal responsibility to provide health care to Native Americans,” said Mary Smith, who was acting head of the Indian Health Service during the Obama administration and is a member of the Cherokee Nation. “It’s the largest prepaid health system in the world — they’ve paid through land and massacres — and now you’re going to take away health care and add a work requirement?”

Tribal leaders and public health advocates also worry that Medicaid work rules are just the start; President Donald Trump is eyeing similar changes across the nation’s welfare programs, which many of the nearly 3 million Native Americans rely on.

“It’s very troublesome,” said Caitrin McCarron Shuy of the National Indian Health Board, noting that Native Americans suffer from the nation’s highest drug overdose death rates, among other health concerns. “There’s high unemployment in Indian country, and it’s going to create a barrier to accessing necessary Medicaid services.”

Native Americans’ unemployment rate of 12 percent in 2016 was nearly three times the U.S. average, partly because jobs are scarce on reservations. Low federal spending on the Indian Health Service has also left tribes dependent on Medicaid to fill coverage gaps.

“Without supplemental Medicaid resources, the Indian health system will not survive,” W. Ron Allen — a tribal leader who chairs CMS’ Tribal Technical Advisory Group — warned Verma in a Feb. 14 letter.

The Trump administration has allowed three states — Arkansas, Kentucky and Indiana — to begin instituting Medicaid work requirements, and at least 10 other states have submitted or are preparing applications. More than 620,000 Native Americans live in those 13 states, according to 2014 Census data. And more states could move in that direction, heightening the impact.

Some states, like Arizona, are asking HHS for permission to exempt Native Americans from their proposed work requirements. But officials at the National Indian Health Board say that may be moot, as federal officials can reject state requests.

Tribal officials say their planning process has been complicated by HHS’ refusal to produce the actual documents detailing why Native Americans can’t be exempted from Medicaid work requirements. “The agency’s official response was that they couldn’t provide that [documentation] because of ongoing, unspecified litigation,” said Devin Delrow of the National Indian Health Board. HHS did not respond to a question about why those documents have not been made available.

While the tribes say they hope to avoid a legal fight, their go-to law firm — Hobbs, Straus, Dean & Walker LLP — in February submitted a 33-page memo to the Trump administration, sternly warning officials that the health agency was violating its responsibilities.

“CMS has a duty to ensure that [Native Americans] are not subjected to state-imposed work requirements that would present a barrier to their participation in the Medicaid program,” the memo concludes. “CMS not only has ample legal authority to make such accommodations, it has a duty to require them.”

Meanwhile, tribal leaders say the Trump administration has signaled it may be seeking to renegotiate other aspects of the government’s relationship with Native Americans’ health care, pointing to a series of interactions they say break from tradition.

“This doesn’t seem to be isolated to the work requirements,” said McCarron Shuy of the National Indian Health Board.

The Trump administration also targeted the Indian Health Service for significant cuts in last year’s budget, though Congress ignored those cuts in its omnibus funding package last month, H.R. 1625 (115). The White House budget this year proposed eliminating popular initiatives like the decades-old community health representative program — even though tribal health officials say it is essential.

Tribal officials noted that both HHS Secretary Alex Azar and Deputy Secretary Eric Hargan skipped HHS’ annual budget consultation with tribal leaders in Washington, D.C., last month. The secretary’s attendance is customary; then-HHS Secretary Tom Price joined last year. However, Azar canceled at the last minute. His scheduled replacement, Hargan, fell ill, so Associate Deputy Secretary Laura Caliguri participated in his place. That aggravated tribal leaders who were already concerned about the Trump administration’s policies.

Another point of contention for the tribes is that HHS’ civil rights office — while rejecting Native Americans’ Medicaid request on grounds that they’re seeking an illegal preference — simultaneously announced new protections sought by conservative religious groups.

HHS further stressed that the administration remains committed to Native Americans’ health.

“Secretary Azar, HHS, and the Trump administration have taken aggressive action and will continue to do so to improve the health and well-being for all American Indians and Alaska Natives,” according Oakley, of HHS.

But tribal leaders and public health experts say the administration’s record hasn’t matched its rhetoric. “Work requirements will be devastating,” said Smith, the former Indian Health Service acting director. “I don’t know how you would implement it. There are not jobs to be had on the reservation.”

[Politico]

With Vice President Pence breaking tie, Senate passes anti-Planned Parenthood bill

Vice President Pence cast a tie-breaking Senate vote Thursday to pass legislation that will allow states to withhold federal funds from Planned Parenthood and other health care providers that perform abortions.

The measure, which now goes to President Trump for his signature, dismisses an Obama-era rule banning states from denying federal funds to such organizations.

Pence’s vote was needed to break a 50-50 tie. Republicans Susan Collins of Maine and Lisa Murkowski of Alaska broke with their party, voting against the measure.

Republicans have said the Obama rule should be overturned to allow states the right to steer funds away from abortion providers, if they choose.

Sen. Joni Ernst, R-Iowa, said the measure reverses a rule that “attempted to empower federal bureaucrats in Washington and silence our states.”

Democrats condemned the measure throughout the day, with Senate Minority Leader Chuck Schumer of New York calling it “another example of the Republican war on women.”

“It would let states treat women as second-class citizens who don’t deserve the same access to health care as men,” he said.

The House in February had voted 230-188 largely along party lines to reject the rule under the Congressional Review Act, which allows Congress to overturn recently enacted regulations.

The rule prohibits states from withholding family-planning funding from providers for reasons other than their ability to offer family-planning services. It took effect Jan. 18, two days before President Obama left office.

Since 2011, 13 states have restricted access to such grants, disrupting or reducing services in several instances.

[USA Today]

Trump order targets wide swath of public assistance programs

The Trump administration is seeking to completely revamp the country’s social safety net, targeting recipients of Medicaid, food stamps and housing assistance.

Trump is doing so through a sweeping executive order that was quietly issued earlier this week – and that largely flew under the radar.

It calls on the Departments of Health and Human Services, Housing and Urban Development, Agriculture and other agencies across the federal government to craft new rules requiring that beneficiaries of a host of programs work or lose their benefits.

Trump argued with the order, which has been in the works since last year, that the programs have grown too large while failing to move needy people out of government help.

“Since its inception, the welfare system has grown into a large bureaucracy that might be susceptible to measuring success by how many people are enrolled in a program rather than by how many have moved from poverty into financial independence,” it states.

The order is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households or families that have low incomes.”

Democrats have blasted the effort, arguing the order blends the issues of welfare and broader public assistance programs in a deliberate way they say is intended to lower support for popular initiatives.

“Welfare” has historically been used to describe cash assistance programs like Temporary Assistance for Needy Families. Democrats and liberal activists say the Trump administration is seeking to expand the definition of welfare to mean food stamps, Medicaid and other programs as a way to demonize them.

“This executive order perpetuates false and racist stereotypes about certain groups supposedly taking advantage of government assistance,” House Democratic Whip Steny Hoyer (Md.) and Rep. Barbara Lee (D-Calif.) said in a joint statement reacting to the order.

President Trump “is trying to erect a smokescreen in the shape of Reagan’s ‘welfare queen’ so people don’t see he’s coming after the entire middle and working class,” said Rebecca Vallas, managing director of the Center for American Progress’s Poverty to Prosperity Program.

Welfare reform has long been a goal of GOP lawmakers, and there’s broad support in the Republican conference for changing the federal safety net to impose stricter work requirements and block grant state funding for programs like Medicaid and food stamps.

While noting that he hadn’t seen the specific text of the executive order, Rep. Tom Cole (R-Okla.) said he supports the concept.

“For able-bodied, single adults, I certainly favor work requirements,” Cole said.

With Republicans in total control of the government, conservatives have been hoping for a major legislative push to overhaul federal assistance programs.

Speaker Paul Ryan (R-Wis.) late last year said he wanted Republicans to work on entitlement reform, with a focus on promoting work and career-based education.

“We want to smooth the path from welfare to work, pull people out of poverty, pull people out of welfare,” Ryan said in December.

Robert Rector, a senior research fellow at the Heritage Institute, said the executive order is meant to signal support to congressional Republicans.

“[Administration officials] have been talking to Congress, and the executive order is designed to set the table for them,” Rector said. “Do what they can in the executive branch, and give support to similar efforts on the Hill.”

But a short legislative calendar and a slim Republican majority in the Senate mean the administration may be largely on its own.

Agencies are limited in what changes they can make to their programs, so comprehensive welfare reform may be off the table without major legislation.

Republicans have already acknowledged they won’t be able to cut spending on entitlement programs like Medicare, Medicaid and Social Security.

“I think it’s very tough to get this thing through the Senate when it requires 60 votes. I certainly don’t have any problem with the president taking initiative,” Cole said.

The executive order doesn’t set any new policy, but Center for American Progress’s Vallas said the order is important as a messaging document, and it shows that Trump is willing to act without Congress.

“This is more of President Trump not being content to wait for Congress to dismantle these programs. This is him wanting to take matters into his own hands,” Vallas said.

The order follows policy shifts already underway at various agencies.

Health and Human Services officials have encouraged states to pursue work requirements for Medicaid beneficiaries. Arkansas, Indiana and Kentucky have already been granted such waivers, and several other states have waivers pending with the administration.

Earlier this year, the Agriculture Department sought input on “innovative ideas to promote work and self-sufficiency among able-bodied adults” participating in the food stamp program.

In Congress, House Republicans unveiled a provision in the 2018 farm bill to expand mandatory work requirements in the food stamp program. The broader legislation will be marked up later this month, but it faces a long uphill battle.

The administration’s effort could also face legal challenges. Medicaid advocates in Kentucky have already sued over the work requirements, and additional safety net changes could provoke even more lawsuits.

[The Hill]

Trump approves Arkansas Medicaid work requirements

Arkansas on Monday became the third state to get the Trump administration’s permission to impose work requirements on Medicaid beneficiaries.

The Centers for Medicare and Medicaid Services approved a Medicaid waiver that included a requirement for recipients to work, or participate in job training or job search activities for 80 hours a month.

State officials said they will begin implementing the work requirements June 1, making them the first state to do so. If a person fails to meet the requirements for three months, he or she will lose coverage for the rest of that calendar year.

However, the state did not get approval to roll back the eligibility level for Medicaid beneficiaries. If that provision had been approved, an estimated 60,000 people would have lost coverage.

Arkansas expanded Medicaid under ObamaCare to people earning up to 138 percent of the federal poverty level, and receives federal funding to pay for those new enrollees. But Gov. Asa Hutchinson (R) sought to restrict the program so that only people who are at the federal poverty level would be eligible.

The so-called “partial expansion” was a key test of the limits of the Trump administration’s power on how far states could go to limit Medicaid enrollment. Arkansas officials sought to reduce eligibility, while still getting the same level of federal funding.

[The Hill]

Reality

Work requirements don’t make more people work, because most recipients already work, they just throw them off benefits.

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