In New York, a battle is brewing over a bill called Coverage for All that would use a surplus of federal funds to pay people who are undocumented to enroll in the state’s Essential Plan under the federal Affordable Care Act, potentially granting 250,000 people access to healthcare. Immigrant advocates are rallying for the bill’s inclusion in a two-day special legislative session despite Democratic…
This post was originally published on Latest – Truthout.
A healthcare catastrophe is unfolding across the U.S. as states — now unrestrained by coverage rules enacted early in the coronavirus pandemic — continue to remove people from Medicaid at an alarming clip, mostly for procedural reasons unrelated to their eligibility for the program. The Kaiser Family Foundation (KFF), which has been tracking Medicaid disenrollments since Congress and the Biden…
The United States’ healthcare system is the worst in the developed world, delivering the highest death rates for treatable conditions, the highest infant and maternal mortality rates, and the lowest life expectancy at birth. But a system that is failing patients, often in catastrophic ways, has been a massive boon for the executives who run the few private companies that dominate the nation’s…
This post was originally published on Latest – Truthout.
Hundreds of thousands of poor Floridians have been kicked off Medicaid in recent weeks as their Republican governor, Ron DeSantis, travels the country for his 2024 presidential bid and rakes in campaign cash from big donors. Florida is one of more than a dozen states that have begun unwinding pandemic-era rules barring states from removing people from Medicaid during the public health emergency.
This post was originally published on Latest – Truthout.
Led by Rep. Matt Gaetz and other far-right members of the House GOP, Republican lawmakers are intensifying their push to establish new work requirements for millions of people who receive Medicaid and federal nutrition assistance, an effort that progressives slammed as a cruel attack on the poor.
The Washington Post reported Tuesday that Republicans, including House Speaker Kevin McCarthy (R-Calif.), have rallied around work requirements as a key demand as they use the ongoing debt ceiling standoff as leverage to pursue steep spending cuts and other policy changes.
“The debate in some ways resembles the Republican-led campaign against so-called welfare queens in the 1990s, when a politically resurgent GOP—then under the leadership of House Speaker Newt Gingrich—secured a dramatic restructuring of the government’s social safety net,” the Post noted. “The resulting overhaul, enacted by President Bill Clinton, slashed cash benefits for millions of Americans in ways that GOP leaders now cite as a model.”
In a February letter to President Joe Biden, Gaetz (R-Fla.) and four other House Republicans favorably cited the 1996 welfare reform law—which doubled extreme poverty—as an example of bipartisan cooperation that should be replicated to avert a catastrophic debt default.
During a press conference last month, Gaetz cast his call for tougher work requirements as an attempt to extract a “broader contribution” from “couch potatoes,” which is often how Republicans demean people who receive federal food aid and other benefits—even though most who get such assistance work.
“The legislators that want new work requirements for food stamps and Medicaid are the same ones working to eliminate the estate tax so that billionaire heirs never have to work a day in their lives,” the Patriotic Millionaires, a group that supports tax hikes on the rich, tweeted Tuesday. “It’s not about work, it’s about hurting the poor.”
A recent analysis by the Center on Budget and Policy Priorities estimated that legislation introduced by Rep. Dusty Johnson (R-S.D.) would strip Supplemental Nutrition Assistance Program (SNAP) benefits from more than 10 million people, including 4 million children.
Research has repeatedly shown that SNAP work requirements, which add significant complexity and administrative burdens to the process of obtaining benefits, aren’t effective at boosting employment.
“SNAP recipients who can work, do work,” Rep. Gwen Moore (D-Wis.) said Tuesday. “Yet they do not earn enough to escape poverty. Taking away SNAP doesn’t help anyone find work, it just makes them hungry and ensures the cycle of poverty continues.”
Rep. Mark Pocan (D-Wis.) echoed his colleague, writing on Twitter that “adding draconian hurdles to receive food assistance and benefits makes it harder for people to get back on their feet, not easier.”
“The GOP should call it what it is—a cut to benefits,” he added.
“Republicans still haven’t released a budget, but they’re continuing to make their priorities clear: They want to protect wealthy donors while cutting food assistance and healthcare from families.”
As for Medicaid, state experiments with work requirements have proven disastrous. In Arkansas, a state that briefly imposed work requirements on Medicaid recipients during the Trump era before a judge intervened, more than 18,000 people lost health coverage due to the rules.
Some Republicans, including Gaetz and Rep. Scott Perry (R-Pa.), want to impose work requirements on Medicaid recipients nationwide, a move that would compound massive coverage losses stemming from the recent end of pandemic protections.
In February, Gaetz unveiled the Medicaid Work Requirements Act, which would mandate that adults deemed “able-bodied” work at least 120 hours a month, volunteer for at least 80 hours a month, or take part in a work training program for at least 80 hours a month to remain eligible for Medicaid benefits.
“Republicans still haven’t released a budget, but they’re continuing to make their priorities clear: They want to protect wealthy donors while cutting food assistance and healthcare from families,” tweeted the Senate Budget Committee, which is chaired by Sen. Sheldon Whitehouse (D-R.I.).
In a statement to the Post on Tuesday, White House spokesman Michael Kikukawa indicated that Biden will oppose adding new work requirements to SNAP and Medicaid as part of any deal to raise the debt ceiling.
“The president has been clear that he will oppose policies that push Americans into poverty or cause them to lose healthcare,” said Kikukawa. “That’s why he opposes Republican proposals that would take food assistance and Medicaid away from millions of people by adding burdensome, bureaucratic requirements.”
As the GOP ramps up its assault on SNAP and other critical programs, members of the Senate Democratic caucus are urging the Biden administration to do everything in its power to bolster and expand federal food aid, which was slashed for many families earlier this year when pandemic-related enhancements lapsed.
In a letter to the heads of the U.S. Department of Agriculture (USDA) and Social Security Administration (SSA) earlier this week, a dozen Senate lawmakers called for action to remove “administrative burdens that create barriers to food security” for Supplemental Security Income (SSI) recipients.
“SSI recipients are low-income people at least 65 years old, or blind or disabled adults or children,” the lawmakers wrote. “To help alleviate food insecurity, SSA and USDA must create a seamless path to ensuring that SSI recipients and applicants can obtain SNAP benefits, one with minimal administrative burden. SNAP is the nation’s largest anti-hunger program and SNAP benefits translate to fewer people in poverty and a healthier population.”
This post was originally published on Common Dreams.
Beginning on Saturday, states across the U.S. will start the process of stripping Medicaid coverage from millions of people as pandemic-related protections lapse, part of a broader unraveling of the safety net that was built to help families withstand the public health crisis and resulting economic turmoil. Medicaid’s continuous coverage requirements were enacted early in the COVID-19 pandemic to…
This post was originally published on Latest – Truthout.
Beginning on Saturday, states across the U.S. will start the process of stripping Medicaid coverage from millions of people as pandemic-related protections lapse, part of a broader unraveling of the safety net that was built to help families withstand the public health crisis and resulting economic turmoil.
Medicaid’s continuous coverage requirements were enacted early in the Covid-19 pandemic to help vulnerable people maintain insurance amid the health emergency, resulting in record-high Medicaid enrollment.
But at the end of last year, congressional negotiators agreed on a bipartisan basis to set April 1 as the beginning of the “unwinding” process for the continuous coverage mandates, which prevented states from conducting regular eligibility screenings for Medicaid recipients.
The bipartisan deal gave states 12 months to determine who is still eligible for Medicaid, but some states—including Arkansas and South Dakota—are jumping at the opportunity to quickly remove people from the program. (State timelines for kicking off the unwinding process can be seen here.)
“Tonight at midnight some people in AZ, AR, ID, NH, and SD will lose their Medicaid coverage,” Joan Alker, executive director of the Georgetown Center for Children and Families, tweeted Friday. “South Dakota is especially vexing as expansion kicks in July 1st. The state could structure their renewals to ensure that parents move seamlessly into expansion. But they are erroneously claiming federal rules mean they can’t. Not true.”
Residents of the 10 states that have refused lifesaving Medicaid expansion under the Affordable Care Act (ACA) are likely to be hit hardest by the end of continuous coverage requirements, which the Biden administration estimates could result in 15 million people losing health insurance nationwide—including millions of children.
“Because those states tend to make only the extremely poor eligible for Medicaid, they will have many people who make too much to qualify for the government health insurance but not enough to reach the income needed to get federal subsidies to afford health plans sold on ACA marketplaces—the coverage the administration is counting on as the main fallback,” The Washington Post‘s Amy Goldstein reported earlier this week.
“The toll will be large, too, in 13 states that have not chosen to extend Medicaid benefits to women for a full year after they give birth,” Goldstein added. “Texas falls on both lists.”
Because of the administrative barriers associated with income verification and other eligibility tests, many people are likely to lose Medicaid coverage even though they’re still eligible for the program.
The Health and Human Services (HHS) Department has estimated that nearly 7 million people could be removed from Medicaid despite still being eligible due to “administrative churning.”
The consequences of what one commentator has dubbed “The Great Medicaid Purge” could be disastrous, given the health impacts associated with insurance loss.
As HHS summarized in a recent report:
People who experience churning or coverage disruptions are more likely to delay care, receive less preventive care, refill prescriptions less often, and have more emergency department visits. One study found that unstable Medicaid coverage increased emergency department use, office visits, and hospitalizations between 10% and 36% and decreased use of prescription medications by 19%, compared to individuals with consistent Medicaid coverage. Children with interruptions in coverage also are more likely to have delayed care, unmet medical needs, and unfilled prescriptions.
“I feel sick,” said Adam Gaffney, an ICU doctor at the Cambridge Health Alliance. “Some 15 million people will be purged from Medicaid, including 7 million who actually remain eligible for the program but fail to jump through the bureaucratic hoops! Medicaid is not enough: we need seamless, lifelong universal care now.”
The Medicaid continuous coverage requirements are the latest pandemic-era protections to fall in recent months.
Starting on March 1, enhanced Supplemental Nutrition Assistance Program (SNAP) benefits were cut off in dozens of states, slashing food aid for tens of millions.
Additionally, the boosted Child Tax Credit (CTC) expired in late 2021 due to opposition from Sen. Joe Manchin (D-W.Va.) and congressional Republicans, resulting in a rapid surge in child poverty. Shortly before the expanded CTC lapsed, boosted unemployment benefits that helped millions weather economic chaos ended.
As the pandemic-era safety net crumbles, congressional Republicans are looking to roll back Medicaid, SNAP, and other key programs even further with spending cuts and punitive work requirements.
“Republican calls to cut government funding put everything from child care to opioid treatment and mental health services to nutrition assistance at risk for millions,” Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, warned earlier this week.
This post was originally published on Common Dreams.
Sen. Bernie Sanders warned Monday that without swift congressional action, the $5.8 billion in federal funding relied on each year by community health centers around the United States will expire on September 30, resulting in a devastating “primary care cliff.”
“Congress can and must avoid” such a scenario, says a statement from the Vermont Independent’s office.
Sanders announced that the Senate Health, Education, Labor, and Pensions (HELP) Committee he chairs is scheduled to hold a hearing this Thursday at 10:00 am ET titled, “Community Health Centers: Saving Lives, Saving Money.”
Millions of people in the U.S. currently receive lifesaving services from community health centers in thousands of neighborhoods nationwide.
“In America today, community health centers are providing cost-effective primary medical care, dental care, mental health counseling, and low-cost prescription drugs to 30 million people regardless of a person’s bank account or insurance status,” said Sanders.
“Not only do these health centers save lives and ease human suffering,” Sanders continued. “They save Medicare, Medicaid, and our entire healthcare system billions of dollars each year because they avoid the need to go to expensive emergency rooms and hospitals.”
“In the midst of a broken and dysfunctional healthcare system, I will be doing everything I can to expand community health centers so that every American has access to the primary care that they need and deserve,” he added.
According to the senator’s office:
Nearly 100 million Americans live in a primary care desert, nearly 70 million live in a dental care desert, and some 158 million Americans—nearly half the country’s population—live in a mental healthcare desert. Today, 85 million people are uninsured or under-insured, over 500,000 people go bankrupt each year because of medically related debt, and more than 68,000 people die each year because they cannot afford the healthcare they desperately need. Expanding community health centers will begin to address this urgent crisis.
The following individuals are scheduled to testify at the hearing: Amanda Pears Kelly, chief executive officer of Advocates for Community Health and executive director of the Association of Clinicians for the Underserved; Ben Harvey, chief executive officer of Indiana Primary Health Care Association; Robert Nocon, assistant professor at Kaiser Permanente Bernard J. Tyson School of Medicine; Sue Veer, president and chief executive officer of Carolina Health Centers; and Jessica Farb, managing director at the Government Accountability Office.
This post was originally published on Common Dreams.
Credit scores are far lower on average in the South than they are in northern parts of the contiguous U.S. — and medical debt and state lawmakers’ refusal to expand Medicaid could be to blame, a new analysis by the Washington Post has revealed. The analysis found a gap of roughly 100 points between the lowest average credit scores in the North and South, with the lowest seen most commonly in parts…
This post was originally published on Latest – Truthout.
The right-wing official who served as budget director for the Trump administration is reportedly playing a significant advisory role for House Republicans as they seek to leverage a fast-approaching debt ceiling crisis to enact spending cuts that would disproportionately impact low-income households. According to The Washington Post, former Office of Management and Budget chief Russ Vought “has…
This post was originally published on Latest – Truthout.
The right-wing official who served as budget director for the Trump administration is reportedly playing a significant advisory role for House Republicans as they seek to leverage a fast-approaching debt ceiling crisis to enact spending cuts that would disproportionately impact low-income households.
According to The Washington Post, former Office of Management and Budget chief Russ Vought “has emerged as one of the central voices shaping the looming showdown over federal spending and the national debt.”
“As Republicans struggle to craft a strategy for confronting the Biden administration over the debt ceiling, which limits how much the government can borrow to pay for spending Congress has already approved, Vought has supplied them with a seemingly inexhaustible stream of advice: suggestions for negotiating with the White House, briefings about dealing with the media, a 104-page memo that proposes specific spending levels for every federal agency,” the Post reported Sunday.
More specifically, Vought has suggested that the GOP sideline efforts to cut Social Security and Medicare and instead focus on a “push to obliterate almost all other major forms of federal spending, especially programs that benefit lower-income Americans, and dare Biden to stand in the way.”
Vought’s agenda, the Post noted, proposes $9 trillion in federal spending cuts over the next 10 years, targeting thousands of domestic programs including Medicaid and the Supplemental Nutrition Assistance Program (SNAP).
If adopted, Vought’s proposal would inflict $2 trillion in cuts to Medicaid, potentially compromising coverage for millions across the United States—and compounding the impact of lapsing pandemic protections.
Vought’s proposed cuts to SNAP—a food aid program long attacked by Republicans—would amount to $400 billion. A recent survey found that 64% of respondents said affording food is one of the biggest challenges they’re facing amid elevated inflation.
Tens of millions across the U.S. are currently facing what advocates have dubbed a “hunger cliff” as pandemic-related emergency boosts to SNAP funding expire.
SNAP accounts for a tiny fraction of the federal government’s overall spending.
“At a moment when food distribution centers are seeing increases in demand as American families struggle to feed their children, Republican lawmakers are putting families in their political crossfire by threatening to dramatically decrease spending on essential programs like SNAP. The timing of this could not be worse,” said Ailen Arreaza, executive director of ParentsTogether. “Further cuts to essential policies helping families to keep food on the table would be unconscionable—and those politicians responsible will pay a political price.”
“The only thing more odious than pushing for $3 trillion of unpaid-for tax cuts is pushing for $3 trillion of tax cuts and $3 trillion in cuts to healthcare and nutrition for low- and middle-income families.”
Vought, who is also urging Republicans to cut Labor Department funding in half and slash the Affordable Care Act, presents such austerity as needed to rein in an out-of-control federal bureaucracy. But as the Post notes, Vought “oversaw enormous increases in the national debt as Trump’s director of the Office of Management and Budget,” making clear to critics that his priority is gutting programs that low-income people rely on to meet basic needs.
“The Republican playbook is always to drive more people deeper into poverty, while giving kickbacks and tax breaks to their super-rich friends,” said progressive organizer and former congressional candidate Melanie D’Arrigo.
Last week, more than 70 House Republicans introduced legislation that would make 2017 Trump tax cuts for individuals permanent, a major giveaway to the rich that would cost the federal government around $2.2 trillion in revenue through 2032.
The Biden White House and congressional Democrats have indicated that they would oppose federal spending cuts as part of any deal to raise the debt ceiling and prevent a catastrophic default, which could come as soon as this summer if lawmakers don’t act.
“The only thing more odious than pushing for $3 trillion of unpaid-for tax cuts is pushing for $3 trillion of tax cuts and $3 trillion in cuts to healthcare and nutrition for low- and middle-income families,” tweeted Brendan Duke, a senior adviser to Sen. Michael Bennet (D-Colo.).
This post was originally published on Common Dreams.
Sometimes a little socialism is a very good thing. But don’t tell Mike Pence or the billionaires who bankroll him and his GOP colleagues.
Or, for that matter, the 109 Democrats who were suckered into joining every single Republican in the House of Representatives to vote for a resolution saying that:
“Congress denounces socialism in all its forms, and opposes the implementation of socialist policies in the United States of America.”
The resolution leads up to that conclusion by quoting President Thomas Jefferson wildly out of context. Here’s what the resolution says:
“Whereas the author of the Declaration of Independence, President Thomas Jefferson, wrote, ‘To take from one, because it is thought that his own industry and that of his fathers has acquired too much, in order to spare to others, who, or whose fathers have not exercised equal industry and skill, is to violate arbitrarily the first principle of association, the guarantee to every one of a free exercise of his industry, and the fruits acquired by it.’”
The Republican authors of the resolution, however, neglected to include the context or the next sentence from Jefferson’s May 18, 1816 letter to Joseph Milligan about their combined efforts to translate A Treatise on Political Economy by French economist Destutt de Tracy.
Milligan and Jefferson were discussing Tracy’s call for a national sales tax (like what the GOP proposed last week), which both men opposed. Which is why the next sentence got right to the heart of the matter:
“If the overgrown wealth of an individual be deemed dangerous to the State, the best corrective is the law of equal inheritance to all in equal degree; and the better, as this enforces a law of nature, while extra [sales] taxation violates it.”
Jefferson, in other words, was calling for an inheritance tax — rather than a sales tax — to fix “overgrown wealth” that was “dangerous to the state,” something the Republicans who drafted this resolution would certainly call socialism.
This entire bit of legislative theater, in fact, is preparation for the 2024 election and the GOP’s new plan to end “socialism” in America.
By socialism, of course, they don’t mean subsidies to the fossil fuel industry that made their billionaire donors rich.
They don’t mean the hundreds of billions we shovel at defense contractors every year for unnecessary boondoggles.
Nor do they mean farm supports dear to their rural voters.
They mean Social Security, Medicare, and Medicaid.
Mike Pence drew the battle lines last week around the same time House Republicans were forcing the vote on their anti-socialism screed:
“There are modest reforms in entitlements that can be done without disadvantaging anybody at the point of the need. I think the day could come when we could replace the New Deal with a Better Deal. Literally give younger Americans the ability to take a portion of their Social Security withholdings and put that into a private savings account.”
Republicans have been calling Social Security “socialism” ever since it was put into law on August 14, 1935. In part this is because arguably it is: it’s a form of social insurance.
But the larger reason is that the GOP has been funded by morbidly rich banksters ever since the early 1920s, and those banksters would give nearly anything to have Social Security’s trillions in their banks instead of invested in treasuries.
Social Security isn’t a savings account: it’s insurance against poverty in old age.
And like all insurance policies, some people make out better than others. People who live a long life may take more out of it than they put in; people who die young leave behind much of their working life’s contributions.
That’s how insurance is supposed to work. It’s how your life and health insurance policies work.
But the GOP wants Americans to think of Social Security as a simple savings account, so they can move Social Security’s trillions from government control into the hands of Wall Street.
And that’s just the beginning. Republicans in Congress are still 100% down with the platform on which David Koch ran for vice president back in 1980:
— “We urge the repeal of federal campaign finance laws, and the immediate abolition of the despotic Federal Election Commission.”
— “We favor the abolition of Medicare and Medicaid programs.”
— “We oppose any compulsory insurance or tax-supported plan to provide health services, including those which finance abortion services.”
— “We also favor the deregulation of the medical insurance industry.”
— “We favor the repeal of the fraudulent, virtually bankrupt, and increasingly oppressive Social Security system. Pending that repeal, participation in Social Security should be made voluntary.”
— “We propose the abolition of the governmental Postal Service.”
— “We oppose all personal and corporate income taxation, including capital gains taxes.”
— “We support the eventual repeal of all taxation.”
— “As an interim measure, all criminal and civil sanctions against tax evasion should be terminated immediately.”
— “We support repeal of all law which impede the ability of any person to find employment, such as minimum wage laws.”
— “We advocate the complete separation of education and State. Government schools lead to the indoctrination of children and interfere with the free choice of individuals. Government ownership, operation, regulation, and subsidy of schools and colleges should be ended.”
— “We condemn compulsory education laws … and we call for the immediate repeal of such laws.”
— “We support the repeal of all taxes on the income or property of private schools, whether profit or non-profit.”
— “We support the abolition of the Environmental Protection Agency.”
— “We support abolition of the Department of Energy.”
— “We call for the dissolution of all government agencies concerned with transportation, including the Department of Transportation.”
— “We demand the return of America’s railroad system to private ownership. We call for the privatization of the public roads and national highway system.”
— “We specifically oppose laws requiring an individual to buy or use so-called “self-protection” equipment such as safety belts, air bags, or crash helmets.”
— “We advocate the abolition of the Federal Aviation Administration.”
— “We advocate the abolition of the Food and Drug Administration.”
— “We support an end to all subsidies for child-bearing built into our present laws, including all welfare plans and the provision of tax-supported services for children.”
— “We oppose all government welfare, relief projects, and ‘aid to the poor’ programs. All these government programs are privacy-invading, paternalistic, demeaning, and inefficient. The proper source of help for such persons is the voluntary efforts of private groups and individuals.”
— “We call for the privatization of the inland waterways, and of the distribution system that brings water to industry, agriculture and households.”
— “We call for the repeal of the Occupational Safety and Health Act.”
— “We call for the abolition of the Consumer Product Safety Commission.”
— “We support the repeal of all state usury laws.”
The real target Republicans are gunning for, in other words, is — as Mike Pence admitted — the New Deal itself.
When FDR came into office in 1933 he began a fundamental transformation of American government from one rooted in Laissez-faire to one rooted in democratic socialism.
It was so successful that Roosevelt was elected President of the United States four times in a row, serving from 1933 to his death in office in 1945.
While the American people loved Roosevelt’s New Deal democratic socialism—and still do—the morbidly rich have always opposed any programs that lift up average working people.
— They don’t want workers empowered to challenge their bosses through unions.
— They don’t want their tax dollars to go to help “moochers” and “takers” who weren’t born wealthy.
— They don’t want wealth broadly distributed across America because it might mean they can’t hoard as much as they want.
Almost as fascinating as Pence and the GOP’s efforts to privatize Social Security and “end socialism” are the media’s response to them.
Two weeks ago the GOP put forward a 30 percent national sales tax (ironically, just like Tracy was proposing in 1816). Last week the former Vice President and unannounced candidate for the White House, Mike Pence, openly called for privatizing Social Security.
But there was no mention of either on any of the Sunday “politics” shows that I saw. Instead, the day was filled with Republicans bashing President Biden for his great economy and failing to shoot down a Chinese spy balloon over populated areas.
Will Republican extremism and hate for the New Deal—programs that have become absolutely essential to our even having a robust middle class—ever become grist for the media mill? Will they actually expose to the American people and discuss these GOP plans?
I’m not holding my breath.
This post was originally published on Common Dreams.
Originally published by The 19th. Planned Parenthood Federation of America and Texas Planned Parenthood affiliates have asked a judge for a ruling in their favor in a lawsuit brought by the state of Texas that accused Planned Parenthood of Medicaid fraud. The suit was filed in January 2022 by Texas Attorney General Ken Paxton, but the situation goes back to 2016, when the state of Texas barred…
In April 2016, government auditors asked a Blue Cross Medicare Advantage health plan in Minnesota to turn over medical records of patients treated by a podiatry practice whose owner had been indicted for fraud. Medicare had paid the Blue Cross plan more than $20,000 to cover the care of 11 patients seen by Aggeus Healthcare, a chain of podiatry clinics, in 2011. Blue Cross said it couldn’t locate…
This post was originally published on Latest – Truthout.
Georgia is set to become the only state to have work requirements for Medicaid coverage.
Republican Gov. Brian Kemp’s reelection — and a surprising Biden administration decision not to appeal a federal court ruling — have freed the state to introduce its plan that would allow for a limited increase in the pool of low-income residents eligible for Medicaid.
Questions remain about the rollout of Kemp’s plan. But it would set up Georgia as a test case for a work provision that has been proposed by several states and struck down in federal courts and by the Biden administration.
Meanwhile, advocacy groups are concerned about barriers to obtaining and maintaining the coverage. They also point out that the Kemp plan would be more expensive per enrollee and cover a fraction of the people who would get Medicaid under a full expansion. The new Georgia eligibility program would require a minimum of 80 hours of work or volunteering a month.
“The best-case scenario is that some uninsured Georgians would get coverage for some amount of time,’’ said Laura Colbert, executive director of the consumer advocacy group Georgians for a Healthy Future. “It’s going to be a big headache for the state and for people who enroll or try to enroll.”
The Trump administration approved Medicaid work requirements for Georgia and 12 other states. Georgia got approval under a “waiver,” or a federal permission that lets states run programs that differ from standard rules on Medicaid, the government insurance that covers the poor and the disabled.
But the Biden White House rejected the Georgia plan.
In August, though, a federal judge in Georgia ruled the Biden administration overstepped its authority, clearing the way for the Kemp plan to proceed. The federal government allowed the 60-day appeal window to lapse without making a move.
The rationale behind the White House decision not to appeal the court decision remains murky. A Centers for Medicare & Medicaid Services spokesperson, Bruce Alexander, said “as a matter of policy, CMS does not comment on matters of litigation.”
CMS’ reluctance to appeal may be connected to where the case would head next, said Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. If appealed, the case would go to a conservative federal court that may be favorable to the lower-court decision — and establish it as a stronger precedent.
“The decision not to appeal may have been based on fear that the result would get confirmed on appeal, since most of the appellate judges in the 11th Circuit are Republican-appointed,” he said.
Biden administration officials could also be waiting for the plan to play out before they step in, said Catherine McKee, a senior attorney with the National Health Law Program, a nonprofit advocacy program. Federal health officials “could let the state go forward and monitor it, and take action in the future,” she said.
Kemp’s office did not respond to KHN’s requests for comment on the status of the plan. But after this article was published, the governor’s office confirmed it is moving forward with the plan, with a goal of it going live by July.
Previously, Kemp celebrated the federal court’s August ruling in a series of tweets: “Despite the Left’s efforts to claw back good policy for partisan politics, this week the judiciary … Ruled the Biden Admin erred in striking down our innovative healthcare waiver which would better serve Georgians than a one-size-fits all Medicaid expansion.”
The Georgia Department of Community Health, which oversees the Medicaid program in the state, declined an interview to answer questions about the work requirement plan.
But the agency recently posted on its website two pages related to the “Georgia Pathways” program: one with information on how to sign up, the other with details on the plan’s requirements. Both pages were taken down after KHN asked the agency about them.
“Pathways is not yet going live so the links were disabled to avoid confusion,” said Fiona Roberts, an agency spokesperson.
Work requirements for Medicaid have a short history of implementation nationally.
The only state to run a full-fledged work requirement program was Arkansas, which launched the rule in 2018. It led to about 18,000 people losing Medicaid coverage. A federal court suspended the requirement the next year.
Kemp’s victory over Democrat Stacey Abrams in this month’s midterm election also stymied — at least for now — Georgia Democrats’ long-standing push for full Medicaid expansion, projected to cover an estimated 450,000, versus about 50,000 under the Kemp plan. On Nov. 8, South Dakota voters approved a ballot measure for full expansion, which would cover more than 40,000 additional people in that state.
Georgia’s per-enrollee cost for the work requirement program is expected to be at least three times higher than it would be under a regular Medicaid expansion, said Colbert.
The federal government would have paid for at least 90% of the costs of insuring hundreds of thousands of Georgians under a full expansion. That compares with the expected 67% matching rate from the feds under the slimmer Kemp plan. And that difference doesn’t account for a Biden administration incentive for expansion that would net Georgia $710 million, according to a KFF estimate.
The administrative barriers to the Kemp work plan would be significant, consumer advocates say. Full-time caregivers, people with mental health conditions or substance use disorders, and people unable to work but who have not yet qualified for disability coverage would find it hard to qualify, Colbert said.
Other challenges could include a lack of transportation that makes it hard for enrollees to get to work and, for potential enrollees, limited access to computers to sign up.
Besides volunteering, other qualifying activities for coverage in the Kemp plan include education and job training.
Many people struggling with homelessness in Georgia would likely not meet the work or volunteer thresholds, said Kathryn Lawler, CEO of Saint Joseph’s Health System, an Atlanta-based nonprofit. Sixty percent of patients at its Mercy Care community health centers are homeless, she said. Coverage through Medicaid expansion would let patients afford health care, address chronic conditions, and relieve the stress of medical bills, she said.
People who need medical care often are too sick to go to work, Lawler said, adding that a single mother with three small children could be deemed ineligible. Full Medicaid expansion, through increased payments to providers, would ultimately allow Mercy Care to serve more people in need, she said.
The decision by CMS not to appeal “was a little surprising,’’ Colbert said, but she added that another unfavorable court ruling could pose a risk to other states’ Medicaid programs, by clearing the way for other work requirements.
The CMS inaction could inspire similar bids for work requirements in other GOP-led states, McKee said.
The Georgia plan, meanwhile, would probably not start until the end of the covid-19 public health emergency, which has provided continuous coverage for many Medicaid enrollees during the pandemic, and looks set to continue into early next year.
This post was originally published on Latest – Truthout.
The Supreme Court heard oral arguments last week on a case disability, eldercare and health care advocates described as “an assault” on the rights of older adults, people with disabilities and their families. Advocates are so concerned over the potential impact of Health and Hospital Corporation of Marion County v. Talevski that they’re still pressing both sides to withdraw or settle before a decision is rendered.
The case could radically alter Medicaid and a host of other government programs by limiting private citizens’ right to sue when those programs aren’t fairly and safely administered.
The case centers on the late Gorgi Talevski. In 2019, his daughter Suzie Talevski filed a lawsuit against Health and Hospital Corporation of Marion County, alleging that her father had been abused in his Indiana nursing home run by the state-owned company and funded by Medicaid, which provides health care to over 76 million low-income Americans and is the primary funder of long-term care in the United States.
Among other issues, Talevski alleges that her father was overmedicated to the point of chemical restraint — a practice in which a person is sedated so that they are easier to manage, to the detriment of that person’s own health and well-being.
The question before the Supreme Court was not whether Gorgi Talevski was abused, but whether he and his family had the right to sue the company to seek damages.
“There’s a lot at stake. Depending on how the court rules, if someone is abused in a nursing home and they are harmed, their families might not be able to sue the provider,” said Maria Town, president of the American Association of People with Disabilities. Her organization filed an amicus brief with other disability rights organizations.
For months, national and local advocates have attempted to persuade the parties involved in Health and Hospital Corporation of Marion County v. Talevski to withdraw the case or settle, respectively.
“The fear is that the composition of the Supreme Court is such that they will decide in favor of [the nursing home industry]. But also that the decision could be very broad,” Town said.
A broad decision could also impact a variety of programs beyond long-term care, according to Jasmine Harris, a professor at University of Pennsylvania’s Carey School of Law.
“Everything from Temporary Assistance for Needy Families, the Children’s Health Insurance Program, the Supplemental Nutrition Assistance Program, which was formerly known as food stamps” could be impacted, along with Medicaid and Medicare, Harris told The 19th.
Madiba Dennie, a legal scholar with the Brennan Center for Justice at New York University School of Law, also expressed concern that the case may be an opportunity for “judges to close the doors of justice to ordinary people.” If the court were to limit the right of private citizens to sue government programs, then it would become much more difficult for regular people to protect themselves from harm incurred as a result of those programs.
Town also expressed concern about the lack of recourse outside of the court system that disability advocates and advocates for older adults will have if the court rules in favor of Health and Hospital Corporation of Marion County.
“Our ability to shift policies is more restricted because it’s just harder to get stuff done in Congress. Things have become more polarized,” Town said.
But during oral arguments on Tuesday, some of the court’s conservative justices — whom advocates are most concerned about — expressed skepticism for the arguments made by Health and Hospital Corporation of Marion County.
In particular, Justice Brett Kavanaugh pointed to the text of the statute under discussion, which discusses the legal rights afforded to nursing home patients. Health and Hospital Corporation of Marion County argued that the statute in question, Section 1983, was not specific enough to allow for lawsuits.
Section 1983 is part of the bedrock of civil rights law in the United States. It was originally passed as part of the Ku Klux Klan Act of 1871, and gives private individuals the right to sue state government employees for civil rights violations.
“It’s a very uncomfortable fact for you that the statute says ‘rights’ over and over again,” Kavanaugh said.
More liberal justices were also critical in their questioning.
“It seems to me odd to suggest that we as a court can reinterpret the word ‘law’ [in Section 1983] to carve anything out,” said Justice Ketanji Brown Jackson.
Advocates can and will continue to press both sides to withdraw the case from the Supreme Court. Until a final decision is issued, it is still possible to stop it from proceeding.
Shira Walkshlag, senior director of Legal Advocacy for the Arc of the United States, told The 19th that she “doesn’t do predictions” and therefore the strategy will be to continue to apply pressure. The Arc is one of the largest disability organizations in the United States, and also submitted an amicus briefs.
“Now we have to wait for the decision. But we will also continue to advocate against [Health and Hospital Corporation of Marion County]’s assault on disability rights. The advocacy is to try to get [them] to withdraw the case,” she said.
This post was originally published on Latest – Truthout.
On Wednesday, Kentucky’s Democratic governor announced a plan to expand the state’s Medicaid program to include dental, vision and hearing care for adults.
Gov. Andy Beshear’s plan to expand the services available under Medicaid in Kentucky will impact around 900,000 adults enrolled in the program. New benefits will go into effect on January 1, 2023.
Medicaid is a joint state- and federally-funded program that provides medical coverage to individuals and families with low incomes across the U.S. In Kentucky, a single adult is only eligible for the program if they earn less than $18,075 per year; for families of four, adults are eligible if the household income is below $36,908.
The changes will allow low-income adults in the state to access necessary care that was previously out of reach. (Children in the state are already eligible for dental, vision and hearing care if they receive Medicaid.)
Beshear assured residents that the changes won’t have a major effect on state spending, pointing out that Kentucky already has a healthy Medicaid budget and that federal funding will pay for most of the costs associated with expanding coverage.
Federal dollars will account for 90 percent of the expansion, which will cost an estimated $36 million annually. Kentucky will cover the remaining 10 percent of yearly costs, which amount to around $3.6 million per year — equivalent to approximately 8.5 percent of the state’s total government spending in fiscal year 2022.
“It will have no significant impact on Kentucky’s budget. It will require no changes to our budget in this next session,” Beshear said. “In other words, it is easily affordable, which means we absolutely should do it.”
Beshear touted the changes as being beneficial to workers across Kentucky.
“If you can’t see, it’s really hard to work,” Beshear said. “If you can’t hear the instructions that you’re getting, it’s really hard to work. If you have massive dental problems that are creating major pain or other complications, it’s really hard to work.”
Beshear’s announcement was praised by analysts in the state.
“This is a big deal!” tweeted Dustin Pugel of the Kentucky Center for Economic Policy. “Kentucky Medicaid has long offered vision and dental, but they offered scant services — for example you could get an eye exam, but not glasses. And it has never offered hearing benefits. Good on [the Cabinet for Health and Family Services] for implementing these long-overdue benefits.”
The uninsured rate is at a record low, according to the latest Census data. One major reason: the temporary prohibition on terminating Medicaid coverage for most enrollees during the federally declared public health emergency (PHE). But this “continuous coverage” requirement will phase out when the PHE ends, likely next year. As Congress begins work on end-of-year legislation, policies that protect and bolster health coverage, particularly for low-income people, should be a top priority.
Medicaid’s continuous coverage provision has helped keep people, including millions of children, insured despite the economic and social disruption caused by the COVID-19 pandemic. The continuous coverage requirement helped prevent the churn on and off Medicaid coverage that often happens as people’s income fluctuates, or if they can’t meet paperwork requirements that are often part of eligibility checks. Churn harms Medicaid enrollees, disrupting their access to medications and other needed care, and it’s also administratively burdensome for states, providers, and health plans. Research also shows that paperwork requirements and other administrative burdens often mean that people lose coverage and do not reenroll in Medicaid or other programs they might be eligible for.
Congress should learn important lessons from the last two years and enact policies to help minimize coverage disruptions when the continuous coverage requirement ends. Doing so now could help stem widely anticipated coverage losses and secure widespread coverage for the future, giving more people access to life-saving health care and financial protection. Enacting policies to help retain record low uninsured levels is also key to advancing health equity; the uninsured rate fell to a record low among Black people in 2021. Policymakers should prioritize approaches to maintain these gains.
Congress should include the following policies in year-end legislation to minimize coverage disruptions and loss of coverage, and to help lock in coverage gains:
Extend postpartum coverage to 12 months. Recognizing the importance of uninterrupted coverage after giving birth, the American Rescue Plan gave states the option to extend postpartum coverage for 12 months after childbirth, rather than the 60 days otherwise required by law. To date, 33 states and the District of Columbia have taken up the option or have announced plans to do so. But the American Rescue Plan coverage option is available only through March 2027.
To help reduce the maternal and infant mortality crisis, Congress should permanently increase mandatory pregnancy coverage from 60 days to one year postpartum. Doing so could eliminate the risk of coverage disruptions in all states, but it’s particularly important in the 12 states that have not expanded Medicaid, as postpartum people with very low incomes often lose Medicaid coverage 60 days after giving birth in non-expansion states. Requiring a full year of postpartum coverage in all states could help address maternal health equity; postpartum coverage is especially important for Black people, who are somewhat likelier to experience life-threatening pregnancy complications in the late postpartum period (between six weeks and one year after childbirth) than white people.
Require continuous eligibility for children. Even before the PHE continuous coverage requirement, states had the option to provide “continuous eligibility” to children, meaning that children remain eligible for Medicaid (or the Children’s Health Insurance Program, or CHIP) for a 12-month period regardless of changes in their family’s income. As of January 2022, some 32 states (including D.C.) provided 12 months of continuous eligibility for children under 19 in Medicaid and/or CHIP.
Providing continuous coverage for children increases the share of children accessing preventive care, and reduces the shares experiencing gaps in coverage and with unmet medical needs, research shows. It also reduces administrative burden and administrative costs for states. The evidence is strong, and Congress should require all states to implement continuous eligibility for children. Doing so would help advance health equity by promoting continuity of coverage for children from families with low incomes, who experience disproportionate rates of health disparities.
Congress can help maintain recent health coverage gains through enacting policies including postpartum coverage, continuous eligibility, and funding for Puerto Rico and the territories. As policymakers negotiate the year-end spending bill, they should also consider other policies — such as a permanent reauthorization of CHIP and inclusion of the proposed Medicaid Reentry Act — that also could help people with low incomes gain, retain, or access the coverage they need.
This post was originally published on Latest – Truthout.
Millions of Americans who need hearing aids will be able to purchase them over the counter as soon as this fall under a new Food and Drug Administration (FDA) rule that will likely also lower costs, the Biden administration has announced.
The FDA finalized a rule on Tuesday that would create a new over-the-counter category for hearing aids, which the agency says will largely benefit those who experience mild to moderate hearing impairment. As soon as mid-October, those with hearing loss will be able to purchase aids online or in-store without a prescription or an appointment with a medical professional.
This will make it far easier for people to access hearing aids while also lowering their cost, according to the administration. Costs of hearing aids are often a large barrier to access; hearing aids can cost between $2,000 and $7,000 a pair, with an average of around $4,600. These costs are not covered by Medicare and are often not covered by private health insurance plans. The new rule, which has been praised by public health professionals, could reduce costs by as much as $3,000, President Joe Biden says.
The rule came as a result of an executive order signed by Biden last July, directing the Department of Health and Human Services (HHS), which oversees the FDA, to release new guidance on allowing hearing aids to be sold over the counter to increase access and competition across the pharmaceutical and medical equipment industry.
Research cited by the FDA finds that nearly 30 million Americans benefit from using hearing aids or could benefit given the opportunity. People who experience hearing loss say that they frequently feel depressed, anxious or isolated because of the condition and that going to an audiologist to have hearing aids prescribed is a time-consuming and often expensive process.
But hearing aids are still inaccessible to many people. Only about 1 in 5 people who could benefit from hearing aids use one.
“For millions of Americans, hearing aids and the doctor’s visit to get them prescribed are too expensive,” Biden said in a statement. “This action makes good on my commitment to lower costs for American families, delivering nearly $3,000 in savings to American families for a pair of hearing aids and giving people more choices to improve their health and wellbeing.”
Biden also emphasized that the new ruling will increase competition in the market. Currently, five large hearing aid manufacturers dominate about 90 percent of the market.
HHS Secretary Xavier Becerra said that the rule is a “significant milestone” in making hearing aids more accessible. “Reducing health care costs in America has been a priority of mine since Day One and this rule is expected to help us achieve quality, affordable health care access for millions of Americans in need,” Becerra said.
Progressive lawmakers have also praised the rule. “Even mild hearing loss among older people can increase social isolation and, studies show, double dementia risk,” wrote the Congressional Progressive Caucus on Twitter. “This is such an important move that will change lives.”
People with severe hearing loss or who are under 18 will still have to obtain hearing aids through a prescription.
Despite established links between hearing loss and depression, dementia, and more, many people with hearing loss don’t purchase hearing aids, a recent poll found. This is in part due to cost and stigma, but also because hearing health is poorly understood.
These deficiencies may be linked to the fact that Medicare doesn’t cover hearing, forcing people to seek out care out of pocket or through private insurance, which many can’t afford.
As a result, some progressive advocates have called for Medicare and Medicaid expansion to ensure that seniors and other populations with Medicare, like those with disabilities, can access hearing care. Advocates for those with hearing loss have emphasized that, though the rule expands access for many people, some people with hearing loss still need consultation with an audiologist in order to fully understand the condition and get fitted for a hearing aid.
Meanwhile, according to a report released in June by Senators Elizabeth Warren (D-Washington) and Chuck Grassley (R-Iowa), hearing aid makers had waged a fierce campaign to lobby the FDA against the rule. They sent hundreds of what appeared to be form letters to lawmakers and submitted hundreds of comments during the rule’s public comment period, amounting to nearly 40 percent of all publicly available comments on the rule.
South Dakotans on Tuesday resoundingly defeated a Republican-authored constitutional amendment that would have raised the threshold for passage of most ballot initiatives from a simple majority to 60%, an effort motivated by GOP lawmakers’ desire to head off a Medicaid expansion vote set for November.
Voters rejected the proposal, known as Amendment C, by a margin of 67.4% to 32.6%, dealing a decisive blow to state-level Republicans’ latest attempt to weaken the ballot initiative process.
“The people of South Dakota have preserved their right to use direct democracy,” said Kelly Hall, executive director of the Fairness Project, a national group that worked to defeat the South Dakota amendment. “This victory will benefit tens of thousands of South Dakotans who will choose to use the ballot measure process to increase access to healthcare for their families and neighbors, raise wages, and more policies that improve lives.”
“We look forward to what’s next in South Dakota: an aggressive campaign to expand Medicaid in the state,” Hall added.
If passed, Amendment C would have required a 60% supermajority to approve any voter-initiated referendum that would “increase taxes or fees or that would require the state to appropriate $10 million or more in the first five fiscal years.” The proposal was endorsed by South Dakota’s Republican Gov. Kristi Noem and the powerful Koch network, which spent big on pro-Amendment C ads and mailers.
“Amendment C is a political ploy that would empower special interests, lobbyists, and politicians at the expense of South Dakota voters,” South Dakotans for Fair Elections said ahead of Tuesday’s vote. “If you care about secure and fair elections, vote no on C.”
Republican sponsors and supporters of the amendment readily admitted that their expedited campaign to get Amendment C on the primary election ballot was fueled at least in part by opposition to the Medicaid referendum, which would make South Dakota the seventh state since 2017 to approve an expansion of the healthcare program through the voter initiative process.
Only Idaho’s 2018 Medicaid expansion initiative received more than 60% of the vote, an indication that Amendment C would likely have spelled doom for the South Dakota referendum.
As Daniel Nichanian of Bolts noted late Tuesday, “GOP lawmakers in South Dakota were not able to increase the threshold of passage for initiatives on their own, without consulting voters, since the change would have affected the state constitution.”
“And South Dakotans’ refusal to go along with this stands out as reaffirming the state’s historical legacy,” Nichanian observed. “South Dakota was the first in the nation to adopt a process for citizens to initiate ballot measures. In 1898, voters approved a constitutional amendment to that effect that was pushed by local populist leaders — a legacy that voters reaffirmed on Tuesday.”
This post was originally published on Latest – Truthout.
Despite efforts in recent weeks by the federal government to address the ongoing infant formula shortage, parents are still struggling to find formula.
The Food and Drug Administration announced this week that nearly two million cans of infant formula from a United Kingdom-based company would arrive in the United States in the coming days. Abbott Laboratories — the Illinois-based company whose alleged unsanitary conditions led to a voluntary recall of baby formula, the deaths of two infants, and the closure of a large formula manufacturing plant in Michigan, sparking the crisis — announced it will release about 300,000 cans of EleCare infant formula that will undergo extensive testing before being distributed nationwide, according to the FDA.
The U.S. formula shortage has been blamed on pandemic-related supply chain disruptions and a market with limited competition, exclusive contracts, and few big suppliers. Earlier this month, producers of infant formula were allowed to speed up the manufacturing process, and the Biden administration called on state attorney generals to crack down on price gouging of formula, according to a White House statement.
In response to the formula shortage, some pundits advised mothers to breastfeed instead. But that advice, however well-intentioned, ignores not only medical realities but structural barriers to breastfeeding. Those barriers are particularly high in the Black community and in Southern states, where breastfeeding rates are lower.
“Breastfeeding is a reproductive choice issue,” said Kimarie Bugg, the founder and CEO of Reaching Our Sisters Everywhere (ROSE) a national organization based in Georgia that aims to decrease racial disparities in breastfeeding. “We know there are long-term health benefits to a mother, a child, a family, and society if a woman is successful breastfeeding.”
Black people have the lowest rates of breastfeeding initiation among all racial groups in the U.S., according to a 2015 study. People who breastfeed less are usually young, low-income, Black, unmarried, and beneficiaries of the Supplemental Nutritional Program for Women, Infants, and Children (WIC). Andrea Freeman, author of the 2019 book “Skimmed: Breastfeeding, Race, and Injustice,” says another factor behind the racial disparity is a cultural stigma attached to breastfeeding that’s rooted in enslavement, coupled with a concerted push to market baby formula to Black people during the mid-20th century.
There’s also a geographic disparity, as Southern states overall have a lower rate of breastfeeding than the nation as a whole. According to the CDC’s latest breastfeeding report card from 2020, 84.1% of U.S. infants born in 2017 were ever breastfed, compared to just 76.2% of infants in Southern states. Nationwide the rate is lowest in Louisiana at just 66.2%. Among the Southern states, only Texas and Virginia had breastfeeding initiation rates above the national average.
A Centers for Disease Control and Prevention report published in 2019 found that better maternal health care, along with increased work and family support, could narrow the racial and geographic breastfeeding gaps. Sociocultural norms, concerns about milk supply, income, and lack of accurate information are among the factors that affect a person’s decision to breastfeed, according to the CDC.
The American Academy of Pediatrics recommends breastfeeding exclusively for the first six months of an infant’s life, noting that it leads to better health outcomes for both the parent and the infant. Maternal benefits include decreased risk of diabetes and hypertension, while infant benefits include better dental health and neurodevelopmental outcomes, the AAP said. It advises against breastfeeding only for people with HIV infections and infants with classic galactosemia, a rare genetic disorder.
Facing South spoke with Bugg and other experts about what could be done to increase breastfeeding rates in the South.
Expanding Medicaid coverage to include lactation services — think breastfeeding classes or lactation consultants — could be one solution to the racial and geographic disparities in breastfeeding rates.
Nationwide, only one-third of state Medicaid programs cover breastfeeding education or lactation consultation services, according to a Kaiser Family Foundation report released this month. Nine states nationwide don’t cover any of those services under Medicaid, and seven are in the South: Arkansas, Florida, Kentucky, Louisiana, Mississippi, Tennessee, and Texas.
In the South, the states with the highest breastfeeding initiation rates are Georgia, South Carolina, North Carolina, Texas, and Virginia, according to federal data. Four of those states — Georgia, North Carolina, South Carolina, and Virginia — cover certain forms of lactation care through Medicaid. Generally, parents can get free breast pumps in Southern states through WIC or Medicaid.
Greater racial diversity in the lactation consultant field could be a solution to the racial disparities in breastfeeding, according to Bugg, an early pioneer in lactation advocacy among Black communities. “Here in the state of Georgia, we want to make sure mothers are comfortable and the care they’re getting is culturally appropriate,” she said. “We do a lot of referring, depending on what their specific needs are.”
ROSE holds support groups addressing the complexities in breastfeeding in Black communities. The group also sued Georgia over a 2016 requirement that those who want to teach women how to breastfeed obtain the equivalent of an advanced degree; in March of this year the courts ruled the requirement to be unconstitutional. Bugg said the legal victory ensured that lactation consultants would be available to rural parents and not just those concentrated in the Atlanta metropolitan area.
While South Carolina Medicaid does not pay for breast pumps, the state Department of Health and Environmental Control notes that the WIC program has lactation counselors on staff, support groups, and food packages for people who breastfeed exclusively, according to the DHEC website. WIC offices in all states also have lactation consultants on staff.
But more could be done in South Carolina as well as other states, according to Tisha Felder, a behavioral scientist at the University of South Carolina’s College of Nursing. Felder co-founded Mocha Mama’s Milk, a virtual breastfeeding support group for South Carolinians that launched this spring.
“If we want to see some changes, we need to invest in these maternal child health policies,” including paid family leave and WIC’s breastfeeding program, Felder said.
This post was originally published on Latest – Truthout.
When it comes to reproductive care, Mississippi has a dual distinction. The state spawned the law that likely will lead to the Supreme Court striking down Roe v. Wade. It is also unique among Deep South states for doing the least to provide health care coverage to low-income people who have given birth.
Mississippians on Medicaid, the government health insurance program for the poor, lose coverage a mere 60 days after childbirth. That’s often well before the onset of postpartum depression or life-threatening, birth-related infections: A 2020 study found that people racked up 81% of their postpartum expenses between 60 days and a year after delivery. And Mississippi’s own Maternal Mortality Review Committee found that 37% of pregnancy-related deaths between 2013 and 2016 occurred more than six weeks postpartum.
Every other state in the Deep South has extended or is in the process of extending Medicaid coverage to 12 months postpartum. Wyoming and South Dakota are the only other states where trigger laws will outlaw nearly all abortions if Roe falls and where lawmakers haven’t expanded Medicaid or extended postpartum coverage.
“It’s hypocrisy to say that we are pro-life on one end, that we want to protect the baby, but yet you don’t want to pass this kind of legislation that will protect that mom who has to bear the responsibility of that child,” said Cassandra Welchlin, executive director of the MS Black Women’s Roundtable, a nonprofit that works at the intersection of race, gender and economic justice.
Efforts to extend coverage past 60 days have repeatedly failed in Mississippi — where 60% of births are covered by Medicaid — despite support from major medical associations and legislators on both sides of the aisle.
Mississippi House Speaker Philip Gunn, a Republican, said shortly after he killed the most recent bill that would’ve extended postpartum coverage that he’s against expanding any form of Medicaid. “We need to look for ways to keep people off, not put them on,” he told The Associated Press in March. When asked about the issue during a May 8 interview on CNN, Mississippi Gov. Tate Reeves said, “When you talk about these young ladies, the best thing we can do for them is to provide and improve educational opportunities for them.” (Neither Gunn nor Reeves responded to requests for comment.)
During the pandemic, a change in federal rules prevented states from cutting off Medicaid recipients, which has allowed people in Mississippi and elsewhere to retain postpartum coverage beyond 60 days. But at the end of the federal public health emergency declaration — which is set to expire in July 2022 — states will revert to their prior policies. “What we are afraid of is that when that does end, it will go back to what we knew was pre-pandemic health care,” Welchlin said.
We discussed the implications of Mississippi’s post-Roe reality with Welchlin and two other experts in the field: Alina Salganicoff, the Kaiser Family Foundation’s director for women’s health policy, and Andrea Miller, president of the National Institute for Reproductive Health. Their answers have been lightly edited for length and clarity.
What services does Medicaid provide postpartum?
Alina Salganicoff: Typically, everything from assistance if the person is having problems breastfeeding to screening for depression services.
Cassandra Welchlin: We know the struggles of so many who have had life threatening illnesses such as heart conditions and hypertension. We know of course that Medicaid helps in that.
What have you seen in terms of postpartum needs in Mississippi?
Welchlin: One of the stories that really touched me over the course of this pandemic was that of a mom who already had a child, and she needed access to child care so she could get back and forth to the doctor. During this particular pregnancy she had a severe heart disorder where she couldn’t breathe, and she had to get rushed to the hospital. Because she was so connected to doulas and a supportive care organization like us, she was able to get admitted and sure enough that’s when they diagnosed her with that heart condition. And she was a mom on Medicaid.
What happens when mothers lose Medicaid coverage postpartum?
Andrea Miller: Only giving someone two months postpartum doesn’t allow for the kind of continuation of care that you need. If there are indications of problems in the postpartum period, they don’t all necessarily show up within the first two months. And we certainly know that the ability to have a healthy infant and keep an infant healthy is also related to whether you have coverage. The extension to 12 months really allows for that kind of continuum of care.
Welchlin: We know in the state of Mississippi, women die at higher rates, and of course it’s higher for Black women. And so, when women don’t have that coverage, what happens is they die.
What does it mean to not extend postpartum Medicaid coverage if Roe falls?
Miller: These bans on abortion are going to be layered on top of an already-unconscionable maternal and infant health crisis that most particularly impacts those who are struggling to make ends meet. It particularly impacts Black women and other communities of color…. A state like Mississippi that is so clearly wanting to ban abortions — the fact that they refuse to extend basic health care benefits that will help during pregnancy and postpartum just clearly indicates that they are not interested in the health and well-being of women and families and children, that they are purely on an ideological crusade.
Anything else that you wanted to add?
Salganicoff: We’re very focused on that first year of life. But if you’re speaking about a woman who is not going to be able to get an abortion that she seeks and ends up carrying the pregnancy, the supports that she’s going to need and her child is going to need go far beyond the first year of life.
Miller: You can’t have a conversation about legality or soon-to-be illegality of abortion in these states and not have a conversation simultaneously about the existing crisis around maternal and infant health. These things are all interconnected, and that’s why it is so deeply disturbing that the states trying to ban abortion are the same states that are refusing to expand Medicaid under the ACA, that are failing to take advantage of the ability to extend postpartum [coverage] by 12 months, that don’t invest in child care, that don’t invest in education — these are all part of the same conversation.
Welchlin: Audre Lorde said, “There is no such thing as a single-issue struggle because we do not live single-issue lives.” So, abortion access, reproductive justice, voting rights, racial justice, gender equity — these are not separate issues, they are intersecting issues that collectively determine the quality of our lives.
This post was originally published on Latest – Truthout.
The movement for abortion rights has made missteps. But anti-abortion advocates wouldn’t have had such a lonely battle with such imperfect choices had anyone else inserted themselves into the fray.
This post was originally published on Dissent MagazineDissent Magazine.
Washington, D.C., resident Michael Tyree wasn’t sure about getting the coronavirus vaccine at first.
“I thought about it for a little over a month,” said the 70-year-old retiree, who relies on Medicaid for health care.
But his sister insisted that he get vaccinated before visiting her. So he walked into a CVS for his shot last year.
Many of his fellow Medicaid patients are still on the fence. People insured by Medicaid — the joint federal-state program that provides health care coverage to more than 78 million people with low incomes or disabilities — are less likely to be vaccinated against the coronavirus than those with private insurance, according to a report by the National Academy of State Health Policy.
Though complete national data is scarce, California reported last month that 57% of Medicaid recipients in the state had gotten at least one dose of the vaccine, compared to 84% of all residents. Other states have reported similar gaps.
Most Medicaid enrollees are people of color, and the pandemic hit some of those communities hardest. It has also taken a particular toll on people with disabilities, who are eligible for Medicaid. But along with common reasons for vaccine hesitancy — such as lack of trust in government or the health care system — Medicaid patients may also have more difficulty taking time away from low-paying jobs to get a shot, experts say.
“It’s very important that we are making sure that vaccines are available to all populations of people,” said Dr. Michelle Fiscus, a public health consultant with NASHP who helped author the report, “especially those who have already experienced disproportionate burdens from COVID-19.”
The report recommended that state Medicaid programs improve their data systems so that they know how many of their patients have received coronavirus vaccines. It also recommended they pay doctors for their time counseling patients on vaccination, even if the patients don’t end up accepting the shot. The Biden administration moved in December to require states to cover this type of counseling for children’s coronavirus vaccines. Doctors have pushed the administration to do the same for adults.
“That is a disincentive to health care providers to take the time to have that talk if they can’t be paid for that time,” Fiscus said. “So it’s really important that medical providers be appropriately compensated.”
The pandemic has highlighted states’ poor record in inoculating Medicaid patients against preventable disease. Adults insured by Medicaid are less likely than those with private insurance to have gotten all commonly recommended vaccines, such as influenza and tetanus, said a March report from the Medicaid and CHIP Payment and Access Commission.
But state Medicaid agencies have a lot on their plate besides vaccinations: The Biden administration is expected to end the public health emergency for the coronavirus in coming months, and that would also mean an end to the mandate that states keep current Medicaid patients on their rolls. Agencies will have to reevaluate recipients’ eligibility when that happens; millions of people may lose their Medicaid coverage.
This post was originally published on Latest – Truthout.
President Joe Biden’s 2023 budget proposal was released March 28, sans a 40-year-old restrictive clause known as the Hyde Amendment. This is the second year Biden has excluded the controversial amendment that denies insurance coverage of abortion for people enrolled in Medicaid. Public support for ending Hyde is at an all-time high, with nearly six in 10 Americans supporting health insurance coverage for abortion, whether public or private. Abortion rights advocates hope the budget will be passed without Hyde and that legislators will not reintroduce the amendment to appease conservative lawmakers, like during the 2022 spending bill negotiations.
“We applaud the Biden administration for its recommitment to ending the Hyde Amendment by removing this decades-old policy, which disproportionately harms people of color working to make ends meet, from its budget,” said Morgan Hopkins, the interim executive director of campaigns and strategies at All* Above All. “It’s a significant step forward to ending a decades-old policy.”
The Hyde Amendment has been included in annual spending bills since 1976, three years after the Supreme Court ruled in favor of abortion rights in 1973’s Roe v. Wade. Since legislators could no longer ban abortions outright, former Republican Rep. Henry Hyde introduced the Hyde Amendment as a rider to the budget. When the amendment passed, he was straightforward with his intention and was quoted saying that the amendment was the best vehicle for restricting abortion access. Since then, the amendment has been included every year and prohibits federal funds from being used to cover abortions for people enrolled in Medicaid, Medicare, and the Children’s Health Insurance Program.
“We often say that [Hyde] is the original abortion ban,” Hopkins said. “We really need to see bold action from all of our elected officials to end this harmful policy.”
The people most impacted by Hyde have historically been communities of color. According to the Guttmacher Institute, people of color who are at reproductive age are disproportionately likely to have low incomes and to be insured through Medicaid. Twenty-nine percent of Black women aged 15 to 49, and 25% of Latinx women were enrolled in Medicaid between 2016 and 2019. Half of all women in the same age group with incomes below the poverty line were insured through Medicaid, and 62% of Black women with incomes below the poverty line were insured through Medicaid.
“Systemic racism, economic insecurity, and immigration status multiply the barriers to abortion care,” Hopkins said. “Folks who are enrolled in Medicaid are disproportionately people of color because of the way that capitalism and systemic racism work. Abortion care is an economic justice issue and a racial justice issue.”
In a testimony given to We Testify, an organization that amplifies abortion experiences, Brittany Mostiller, a 35-year-old woman from Illinois, said she had to figure out how to pay $900 out of pocket — more money than she made in a month — for an abortion because Medicaid would not cover the procedure. She was 22 years old at the time, a mother to three daughters, working a part-time job at a grocery store, and she knew she could not afford another child “physically, emotionally, or financially,” she said in her testimony.
“The decision to have an abortion was the easy part — but I couldn’t afford it,” Mostiller said in her testimony.
It took Mostiller several weeks to save up for the procedure in Illinois, which meant she had to wait until further in her pregnancy before she could afford the $900.
“This was a really challenging and disheartening experience,” Mostiller said. “Millions of people live in states that are hostile to abortion. I experienced firsthand the panic and worry of not being sure of whether I’d be able to get the abortions I wanted because I couldn’t afford them. Medicaid insurance has been a health care lifeline for me and my family — including when I chose to become a parent. We need to make sure that everyone on Medicaid is able to decide if, when, and how to grow their families without fear of that decision being taken away from them simply because insurance won’t cover it.”
Since Mostiller’s abortion, Illinois has become one of the 16 states that allows people enrolled in Medicaid to have abortion coverage. People in the other 34 states and the District of Columbia have to pay for the procedure themselves or access abortion funds to pay for the costs of abortion, which could include the procedure, medication, transportation, and lodging if they need to travel.
“There is a web of barriers to abortion care that would also have to be addressed for people to truly be able to access care,” Hopkins said. “That includes making sure that clinics can stay open and making sure that if people have to travel, they can move freely. Ideally, people wouldn’t have to travel far for abortion care. So it’s one step forward, and we know that there’s larger changes that would still have to happen for people to fully be able to access abortion care.”
As the fate of abortion rights hangs in the balance with the upcoming Supreme Court decision on abortion in June, and conservative states passing abortion bans at an alarming rate, abortion rights advocates see the removal of the Hyde Amendment as a win to guarantee and expand abortion access but hope that Congress and the Senate will support the momentum. House Majority Leader Steny H. Hoyer hopes to pass the 2023 appropriations bill through the House of Representatives by the end of June.
“With states like Texas, Idaho, Florida, and many others pushing abortion care out of reach, this critical moment we are in demands bold action from all of our elected officials,” Hopkins said. “We now look to Congress to carry this momentum and pass federal spending bills without Hyde and coverage bans. Abortion justice can’t wait.”
Prism is an independent and nonprofit newsroom led by journalists of color. We report from the ground up and at the intersections of injustice.
This post was originally published on Latest – Truthout.
Two prominent Democratic senators have requested a Government Accountability Office study of why covid vaccination rates remain far lower among Medicaid enrollees than the general population and what barriers are impeding state efforts to increase immunizations among program beneficiaries, low-income people who have been disproportionately affected by the virus.
Sens. Robert Casey Jr. of Pennsylvania and Ron Wyden of Oregon asked for the inquiry, citing recent stories by KHN and Roll Call that have highlighted the problem and states’ ongoing struggle to raise vaccination rates, according to a letter to the GAO that was provided to KHN. A KHN article published in February reported data from several states — Utah, Washington, Virginia, and California — which showed that vaccination rates of the Medicaid population were well below overall state rates. For example, in California, 54% of Medicaid enrollees 5 and older had been at least partly vaccinated, compared with 81% of state residents in that age group.
State and Medicaid health plan officials told KHN that part of the problem was that plans don’t have current addresses or phone numbers for many members, which has made contacting them difficult. In a KHN story published in August, state officials said they were also hampered by a lack of access to data about which members are immunized.
The problems reflect the decentralized nature of Medicaid, which gets the majority of its funding from the federal government but is managed by the states.
“Barriers to vaccinating Medicaid enrollees are particularly troubling given the program’s importance for persons of color and low-wage workers,” the senators wrote in the letter to the GAO.
“We are concerned that these data barriers may be impeding efforts to increase COVID-19 vaccination rates and address persistent health inequities exacerbated by the pandemic, particularly among communities of color and people with limited incomes who have been disproportionately affected by this disease.”
Casey chairs the Senate Special Committee on Aging, and Wyden chairs the Senate Committee on Finance, which oversees Medicare and Medicaid spending.
“We want to ensure every effort is made to ease vaccine access to these beneficiaries,” the senators wrote. “A lack of good data hurts our ability to get shots in arms, which can prolong the pandemic and put high-risk groups in even greater danger.’’
The letter also cited a report by Duke University researchers that says there’s a 15% to 20% difference in vaccination rates between Medicaid beneficiaries and people with other forms of health coverage.
The vaccination lag is especially important because 5 million enrollees are front-line workers in the health industry and other critical services, the senators said, citing a report from the Center on Budget and Policy Priorities.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
This post was originally published on Latest – Truthout.
Since the start of the pandemic, Medicaid, the federal and state program to provide health insurance to low income Americans, has been far more generous than in the past. Enrollment is higher than ever, at 77.8 million.
This isn’t because of some nationwide change of heart in state governments; it’s because states were paid to stop cutting people from their Medicaid rolls. Under the Families First Coronavirus Response Act, the first coronavirus relief bill passed in March 2020, states received a 6.2 percent boost in federal Medicaid funding in exchange for halting disenrollments.
The usual process of conducting “redeterminations,” in which states redetermine whether a beneficiary’s income levels or other factors still qualify them for Medicaid, has been paused for almost two years.
The post The Coming Medicaid Purge appeared first on PopularResistance.Org.
This post was originally published on PopularResistance.Org.
Sacramento, California — This was supposed to be the year that low-income Californians could hire a doula to guide them through pregnancy and advocate for them in the hospital.
But the new benefit for people enrolled in Medi-Cal, the state’s Medicaid health insurance program, has been delayed twice as the state and doulas — nonmedical workers who help parents before, during, and after birth — haggle over how much they should get paid.
The state initially proposed a flat rate of $450 per birth, covering all prenatal and postnatal visits, on-call time during the pregnancy, and labor and delivery — which often lasts 12 or more hours.
Doulas say that amount is too low, and far less than their clients would pay out-of-pocket. It’s also below what doulas receive from Medicaid programs in most other states that offer the benefit.
The only state that pays less is Oregon, where doulas receive up to $350 per birth. The reimbursement rates of other states that offer doula services through Medicaid are usually between $770 and $900. When Rhode Island implements its benefit in July, it will be the highest-paying state, offering doulas up to $1,500.
In most states that offer a doula benefit, the rate Medicaid programs pay is a maximum, which doulas receive if the patient attends every prenatal and postnatal visit. Unlike obstetricians, who see many patients in a day, most doulas accept only a few clients a month.
“We’re talking six to nine months of face time, screen time, texting time, research, resources, and dollars. $450? That’s wild,” said Chantel Runnels, a doula in Riverside County, California, who usually charges clients about $1,000.
“It feels limiting,” Runnels said. “Like there is no value on our time.”
Doulas do not deliver babies. They provide resources to navigate the health care system, information on sleep or nutrition, and postpartum coaching and lactation support. They also support mothers during birth to make sure their wishes are being respected by the hospital.
Doulas are unregulated, and most of their work is for patients who pay out-of-pocket. Most private insurance does not cover doulas, said Cassondra Marshall, an assistant professor at the University of California-Berkeley School of Public Health who has conducted research on doulas in the Bay Area. Tricare, the health insurance program for active-duty members of the military, began covering doulas this year, paying them about $970 for labor support and six visits.
The structure of California’s benefit is still being determined. Doulas and the state aren’t in sync on credentialing and training — in addition to pay, said Anthony Cava, a spokesperson for the California Department of Health Care Services, which administers Medi-Cal. Doulas also told the state they want to bill separately for labor and prenatal and postnatal visits, instead of receiving a bundled flat rate.
The state “recognizes rates must be adequate” to attract enough providers and reduce health disparities, Cava said in a statement. “We are considering input received from the doula stakeholders, and are also reviewing other states’ doula programs and their payment structures and associated rates for similar services,” Cava said.
Cava said the state’s $450 proposal was modeled after the rates in other states, including Oregon, which was one of the first states to include doula benefits in its Medicaid package, in 2014.
But Oregon’s $350 maximum payment is too low to attract enough doulas, said Amy Chen, a senior attorney with the National Health Law Program who studies doula Medicaid benefits across states. “One of the big challenges is that the reimbursement rate is so low that doulas just can’t do it,” Chen said.
From 2018 through 2021, Oregon paid for doulas in 310 births, about 0.39% of the births to Medicaid enrollees during that period, according to state officials.
It’s a “lower uptake” than the state had hoped for, Oregon Health Authority spokesperson Aria Seligmann said in a statement. We’re “currently reevaluating the reimbursement rate to ensure doulas’ services are appropriately valued,” Seligmann said.
Doulas in Oregon must spend about 100 hours learning how to charge Medicaid and must upgrade their software, phones, and medical record systems to comply with privacy laws — all on their own dime, said Raeben Nolan, vice president of the Oregon Doula Association. “Very few people are willing to go through the hoops,” Nolan said.
Five Medicaid programs offer a doula benefit, and six more (including California’s) are implementing one soon.
Offering a doula benefit in Medi-Cal is one of the as-yet-unfulfilled promises of the “Momnibus” Act that was signed by Gov. Gavin Newsom last year. Lawmakers and advocates hope that by providing doulas to the state’s poorest and most vulnerable women, California will help address racial disparities, improve birth outcomes, and diversify and expand its health care workforce. The benefit was originally supposed to kick in Jan. 1 but is now slated to start in January 2023 — if doulas and the state can come to an agreement.
California is embarking on a massive transformation of its Medicaid program that will expand benefits beyond health care and into the realm of social services. As part of this transformation, the state plans to bring several types of nontraditional health care workers into the Medi-Cal workforce, including promotores, peer mental health counselors, and doulas.
The maternal mortality rate is rising nationally, and the rate for Black mothers is nearly three times that of white mothers. Studies have associated doula care with a range of better birth outcomes, such as lower rates of cesarean sections, fewer babies with low birth weights, and more breastfeeding.
Since 2019, at least 10 pilot programs around California have provided doula services to Black parents or Medi-Cal enrollees, funded by a mix of public funds, grants, and private insurance. The services were free to patients, and participating doulas were paid a maximum of $1,000 per birth in Riverside County to $3,000 in Alameda County.
TaNefer Camara is a maternal health strategist in Oakland, where she charges $3,000 for doula work. She became a doula to help other women of color but said she couldn’t take on many Medi-Cal patients at what she called the “laughable” rate of $450. “You don’t need to go into poverty to try and fix a situation such as maternal health care,” she said.
Marshall, of UC-Berkeley, found that doulas who were paid a flat rate for all their services often had to work multiple jobs to make ends meet. “The flat rate lump sums aren’t nearly enough for all that they’re doing,” Marshall said.
Minnesota has been offering a doula benefit since 2014. But the state found that a maximum reimbursement rate of $411 was too low, and the legislature increased it in 2019 to $770.
California’s proposed rate is off base, said Ashley Kidd-Tatge, a doula and the doula coordinator at Everyday Miracles, a nonprofit organization that matches Medicaid beneficiaries with doulas in the Twin Cities. Most doulas in her area charge non-Medicaid patients $800 to $1,500 per birth.
“$450 is incredibly low,” Kidd-Tatge said. “I don’t know too many folks, even in the Twin Cities, who would entertain that rate.”
This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
This post was originally published on Latest – Truthout.
Despite the fact that we are in the midst of an unprecedented and deadly pandemic with no signs of abating, the right-wing majority on the Supreme Court appears unlikely to stop the carnage. The reactionary “justices” seem more inclined to shield corporate profits and red states’ rights than to protect the health and safety of the people.
Scientists have achieved near unanimity that vaccines and masking are effective in preventing COVID infections. Nevertheless, the high court is being asked to block Biden administration rules that would mandate vaccines and/or masking and testing. On January 7, the court heard arguments in two sets of cases that will have widespread impact on the health of millions of people in the United States.
The high court is not considering whether to strike down the mandates but rather whether to stop them from going into effect while the lower courts consider their constitutionality, which could take several months. Meanwhile, untold numbers of people are getting sick and dying.
Stephen Breyer noted that the day before the arguments, there were three-quarters of a million new COVID cases. “Can you ask us to say it’s in the public interest in this situation to stop this vaccination rule? … To me, I would find that unbelievable,” Breyer remarked to Scott Keller, attorney for the business associations challenging Biden’s vaccine-or-mask mandate.
The first set of cases the court heard are subsumed under the name National Federation of Independent Business v. OSHA. Twenty-six business associations and attorneys general from 27 (mostly red) states are suing to stop the Occupational Safety and Health Administration (OSHA) from mandating that companies with more than 100 employees require their workers to get vaccinated or wear masks and submit to weekly COVID tests. As Sonia Sotomayor noted, this is not a vaccine mandate, since it presents a choice between vaccines and masking/testing. OSHA estimated that 40 percent of employers would opt for the mask-and-test policy.
Attorney Keller argued that the vaccine-or-mask mandate was “not a necessary, indispensable use of OSHA’s extraordinary emergency power.” Elena Kagan retorted, “It’s an extraordinary use of emergency power occurring in an extraordinary circumstance, a circumstance that this country has never faced before.”
Keller predicted that leaving the mandate in effect would cause “a massive economic shift” leading to “billions upon billions of non-recoverable costs” for businesses. He said Congress should have clearly given OSHA the authority to promulgate rules to combat COVID.
Pursuant to its authority under the Occupational Health and Safety Act, OSHA issued an “emergency temporary standard” to protect workers from viruses that pose “a grave danger.”
OSHA predicts that the rule would affect 84 million workers and would cause approximately 22 million people to get vaccinated. Estimates project that its implementation would prevent 250,000 people from being hospitalized. There is an exception for workers with religious objections and those who do not come into close contact with other people at their jobs or work substantially outdoors.
U.S. Solicitor General Elizabeth Prelogar told the court, “Workers are getting sick and dying every day because of their exposure to the virus at work. OSHA amassed substantial evidence of widespread workplace outbreaks across industries.” She said unvaccinated workers have a 1-in-14 chance of being hospitalized and a 1-in-200 chance of dying.
During argument, all six right-wing members of the court seemed inclined to side with the corporations and the red states. Conservatives suggested that OSHA exceeded its authority under the statute and the vaccine and/or masking requirements are more properly within the purview of Congress or the states (even though it was Congress that enacted the statute giving OSHA such power). They thought the rule was too broad as COVID is not a distinctly “occupational” danger.
By contrast, Sotomayor, Kagan and Breyer clearly favored protecting workers from the public health crisis caused by COVID. Kagan said, “I would think that workplace risk is about the greatest, least controllable risk with respect to COVID that any person has.” She added, “You have to be there. You have to be there for eight hours a day. You have to be there in the exact environment that the workplace is set up with. And you have to be there with a bunch of people you don’t know and who might be completely irresponsible.”
Kagan queried, “Why isn’t this necessary to abate a grave risk? This is a pandemic in which nearly a million people have died. It is by far the greatest public health danger that this country has faced in the last century. More and more people are dying every day. More and more people are getting sick every day.” Kagan noted that nearly a million people have died from COVID. “We know that the best way to prevent spread is for people to get vaccinated,” she stated, “and to prevent dangerous illness and death is for people to get vaccinated. That is by far the best. The second best is to wear masks.”
Indeed, the Centers for Disease Control and Prevention (CDC) found that unvaccinated people have a much higher risk of death than those who are fully vaccinated.
Sotomayor noted that some states are forbidding employers from requiring vaccines and certain states are stopping employers from requiring their employees to wear masks.
Breyer made clear he would allow the mandates to continue during the litigation, citing statistics for high rates of infections and deaths from COVID.
Chief Justice John Roberts said Congress did not specifically give OSHA power to impose a vaccine or test mandate and that OSHA had never before mandated vaccines.
Neil Gorsuch and Brett Kavanaugh — notorious opponents of deference to agencies that protect people — said the OSHA statute didn’t clearly authorize the agency to impose the mandate, considering the economic ramifications.
Gorsuch, the only member of the court present during arguments without a mask, said “the flu kills people every year,” and OSHA doesn’t regulate in that area. He erroneously stated that the flu killed hundreds of thousands of people annually. In fact, the flu kills between 12,000 and 52,000 Americans each year, according to the CDC.
Samuel Alito, who, like all of his colleagues on the court, is fully vaccinated, pointed out that there are “risks [of … adverse consequences” from the vaccines. “Serious side effects that could cause a long-term health problem are extremely unusual following any vaccination, including COVID-19 vaccination,” the CDC says, however. “The benefits of COVID-19 vaccination outweigh the known and potential risks.”
Alito derisively described OSHA’s interpretation as “squeezing an elephant into a mousehole,” strongly indicating he would refuse to allow the protective rule to go into effect.
Amy Coney Barrett thought that OSHA should have adopted a more targeted rule, saying this rule was too broad as it covered both dental employees and landscapers.
Clarence Thomas was not convinced that the mandate was “necessary.”
The second bloc of cases the court considered is Biden v. Missouri and Becerra v. Louisiana. They involve the fate of a directive promulgated by the secretary of the Department of Health and Human Services (HHS), which requires vaccinations for more than 17 million health care workers in facilities that accept Medicare and Medicaid. The rule contains an exemption for medical and religious reasons.
In these cases, a right-wing majority of the court may well strike down the mandate which would affect nearly half the country. But the votes are not as predictable as they are in the OSHA case.
Lawyers for the states challenging the rule argued that requiring vaccinations would cause health workers to resign from their jobs. “Rural America will face an imminent crisis,” stated Jesus Osete, Missouri’s deputy attorney general.
But Kagan responded that HHS had considered that eventuality before issuing the mandate. “I don’t know very much about the rural market,” Kagan acknowledged. “But the secretary” of Health and Human Services, “that’s his job.” Kagan added that many workers would feel safer coming to work if their coworkers were vaccinated. She noted that some people aren’t going to the hospital for mammograms and colonoscopies for fear of contracting COVID.
“The one thing you can’t do is to kill your patients. So you have to get vaccinated so that you’re not transmitting the disease that can kill elderly Medicare patients, that can kill sick Medicaid patients,” Kagan said. She called the elderly on Medicare and the poor who receive Medicaid “the most vulnerable patients there are,” adding, “Poverty has a great deal to do with medical outcome.”
Sotomayor noted that this rule was promulgated under the Spending Clause, affording the government wide latitude to impose conditions on the monies it disburses. Roberts appeared persuaded by this argument.
In a likely attempt to appear fair and balanced to protect the legitimacy of the Roberts Court, the chief justice seemed prepared to uphold the Medicare-Medicaid health care mandate. He maintained that it is closely related to COVID’s threat to health so it could be justified in an emergency.
Gorsuch appeared unmoved in his intention to strike down the mandate aimed at protecting Medicare and Medicaid patients. He echoed the states’ argument that the regulation “effectively controls the employment of individuals at these healthcare facilities in a way that Congress specifically prohibited.” Gorsuch characterized this use of money “as a weapon to control these things,” and suggested that it “should be left to the states to regulate.”
Kavanaugh also leaned toward blocking the rule, although he wondered aloud why “the people who are regulated are not here complaining about the regulation, — the hospitals and healthcare organizations. A very unusual situation. They, in fact, overwhelmingly appear to support the … regulation.”
Barrett objected that this was an “omnibus” rule covering ambulatory surgical centers as well as skilled nursing facilities. But she may have been swayed by the argument that Congress explicitly made provisions that the courts found objectionable severable, so those sections could be struck down without dooming the entire mandate. As Sotomayor pointed out, “the vast majority of the regulations across all facilities relate to health and safety.”
Thomas expressed worry about whether the vaccine “could have significant health consequences” and was troubled that the rule could preempt the issue in some states. Alito was concerned about prior notice to the states about the mandate.
Although Thomas and Alito seemed unsympathetic to the mandate, they questioned whether the states of Missouri and Louisiana had “standing” to sue on behalf of their citizens.
It is essential that the Biden administration’s mandates become operable to protect millions of people in the United States from illness and death. The response to the pandemic has fallen largely along political lines, so we cannot rely on the states to safeguard their residents.
Seven of the 10 states that have the highest number of deaths per 100,000 residents as a result of COVID are led by Republican governors.
Unvaccinated people tend to focus on their personal choice and not on the good of the whole. “But the point is that it’s not the risk to the individual that’s at question; it’s that risk plus the risk to others,” Sotomayor noted. “When you remain unmasked or unvaccinated, you put yourself at risk, but you put others” at risk as well.
This post was originally published on Latest – Truthout.
