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HEALTH POLICIES, ANALYSIS, AND RESOURCES

The Health Policy Domain tracks and reports on policies that deal with women’s health, the Affordable Care Act, Head Start, child care and child support services, the Children’s Health Insurance Program, and federal food and drug policy. This domain tracks policies emanating from the White House, the department of Health and Human Services, the US Food and Drug Administration and the Centers for Disease Control (CDC).

Opioid Pharmaceutical Companies Reach 11th Hour Settlement and Avoid Taking Responsibility

Opioid Pharmaceutical Companies Reach 11th Hour Settlement and Avoid Taking Responsibility

The Policy

The morning of what would be a historic opioid trial, four of the biggest U.S. drug manufacturers and distributers reached a $260 million settlement with two Ohio counties, preventing the commencement of the landmark trial.

Distributors AmerisourceBergen, Cardinal Health and McKesson Corp. pledged to pay $215 million, while manufacturer Teva Pharmaceuticals will pay $20 million in cash and an additional $25 million in addiction and overdose treatment drugs. This comes from the co-lead attorney, Paul Farrell Jr., representing the Ohio counties Summit and Cuyahoga. Under this deal, there is no admission of wrongdoing on the companies’ part, but the distributors have agreed to change internal policies to prevent over-distribution in the future.

Monday’s settlement announcement means that only Walgreens remains as one of the original defendants for the Ohio trial, due to most of the defendants, notably, Johnson & Johnson and Mallinckrodt, already reaching settlements with the two counties a week prior. Walgreen’s trial is now postponed until next year, with the potential to be joined by other companies.

Additionally, just hours after the Ohio settlement was announced, a group of bipartisan attorneys general announced that they had reached an agreement with the previously mentioned four companies and Johnson & Johnson in a larger nation-wide lawsuit. This “global resolution” greatly surpasses the Ohio settlement with $22 billion paid in cash over 18 years and $26 billion in anti-addiction and drug treatment medication, totaling a massive payout of $48 billion.

Analysis:

While this settlement halts the federal case out of Ohio, it does not impede any further progress by other lawsuits outside of Summit and Cuyahoga, the two counties in the case. This case was intended on being a landmark case, where it would be used as a glowing example of how to attack the large pharmaceuticals and attribute blame and responsibility for their roles in the opioid crisis. At this stage, it appears as though another case will have to take lead. There are still thousands of counties, cities and towns who have filed cases, this federal one only represented some two thousand across the country.

Although the settlement will provide necessary funding and compensation for the devastation caused by the opioid epidemic, critics would have preferred a trial. By avoiding going to trial, there is no jury to find companies guilty. Notably and most disappointingly, the settlements intentionally did not include admission of wrongdoing or an apology, something people affected by the crisis so desperately want. All companies have maintained that the drugs in question passed intense FDA scrutiny and had labels explaining the risks of addiction.

Engagement Resources:

Photo by unsplash-logoanaluisa gamboa

Healthcare proposals by the 2020 Democratic CandidatesHealthcare proposals by the 2020 Democratic Candidates

Healthcare proposals by the 2020 Democratic CandidatesHealthcare proposals by the 2020 Democratic Candidates

As we reach 56 weeks before the 2020 elections, candidates have detailed their proposals for improving the health of the nation and have discussed them during the recent debates. Voters have understandably placed healthcare in their top concerns when choosing a candidate. The top five candidates rank in the order of Elizabeth Warren, Joe Biden, Bernie Sanders, Kamala Harris, Pete Buttigieg.

  • Elizabeth Warren MA Senator

Warrens stance on healthcare is in defense of the Affordable Care Act and Medicaid from republican attacks. Warren supports Medicare for All, which would provide all Americans with a public health care program.

Other Focus Areas:

  • Lower the cost of prescription drugs through Affordable Drug Manufacturing Act, allowing the Department of Health and Human Services to manufacture generic drugs to combat drug prices that have spiked due to high demand and limited producers.
  • Prioritize mental health through the Behavioral Health Coverage Transparency Act where insurance companies would be held accountable for providing adequate mental health services and ensure American’s rights are protected as guaranteed by law.
  • Fighting the opioid crisis with the Comprehensive Addiction Resources Emergency (CARE) Act, investing 100 billion in federal funding to fight the epidemic by providing funds for addiction treatment in affected communities.
  • Protecting access to healthcare in rural areas by increasing funding to community health centers, fighting hospital mergers that primarily push rural hospitals out of business, and investing in future healthcare workforces with well-established apprenticeships.

 

  • Joe Biden Former Vice President

Former Vice President Joe Biden has put two areas at the core of his health care platform: Insurance and drug prices.

Biden wants to protect and build on Obamacare/ACA by adding a public option. The key component to his healthcare proposal revolves on Obamacare, not creating drastic structural changes, stating that the ACA was a historical feat. His main additions to the ACA are to give Americans more choice in the form of a public option like Medicare, reducing healthcare cost, and making the healthcare system less complex to navigate through.

Biden vows to stop the abuse of drug companies and to cut drug prices. One key step in fighting the high prices is by repealing the laws that ban Medicare from negotiating lower prices with pharmaceuticals. With such an action, companies will be forced to regulate the drug prices and prevent manufacturers with no competition from placing prices so high. Additionally, Biden proposes allowing consumers to buy lower priced medications from other countries.

  • Bernie Sanders VT Senator

Bernie Sanders is another candidate who has healthcare at their core and also supports Medicare-for-all. While Bernie has been seen as the farthest left-leaning candidate in many cases, many support his approach to ensuring all Americans have access to medical treatment and healthcare.

Sanders also wants to tackle the important issue of drug prices, he proposes lowering prices through negotiating with pharmaceuticals with the Medicare Drug Price Negotiation Act, by allowing low-cost prescription drugs to be bought from Canada and other countries through the Affordable and Safe Prescription Drug Importation Act, and by fixing drug prices to an average based off of five major nations (Canada, UK, France, Germany and Japan) through the Prescription Drug Relief Act.

Sanders is currently taking a step un unchartered territory by proposing to eliminate existing past due medical debt, which currently stands at $81 billion nationally.

  • Kamala Harris CA District Attorney

Harris believes healthcare is a right, not a privilege and wants all Americans to have access to healthcare. The California DA has proposed a version of Medicare for All. This plan expands on the established policy enacted by Obamacare and would eventually transition to a nationwide Medicare system over the next ten years. Both public and private options will be available for all.

Other Focus Areas:

  • Tackling the pharmaceutical companies and lowering prescription drug prices through mandating the Department of Health and Human Services to set a fair price for drugs based on OECD countries. Harris is even willing to take executive action should congress hesitate in ensuring the American people have access to lower prescription medications.
  • Ensure the women’s reproductive rights are protected and extended by nominating Justices that agree with Roe v. Wade, securing Plan Parenthood’s ability to function, and addressing racial disparities in the healthcare system.

 

  • Pete Buttigieg South Bend, Indiana Mayor

Buttigieg’s proposal for healthcare come 2020 centers on “Medicare-for-all who want it”, a memorable phrase from the debate stage. The Medicare for All Who Want It plan will allow everyone to opt in to an affordable, comprehensive public alternative plan, without mandating people to buy in. This affordable public plan will incentivize private insurers to compete on price and bring down costs and would eventually lead to a single-payer health care system.

Other Focus Areas:

  • Improving mental health and combatting addiction by reaching a mental health parity, where mental health and substance abuse disorders are treated with the same priority as physical conditions. Buttigieg would see that health plans providers and insurance companies will face fines and penalties should they violate meeting these standards. Regarding addiction, Buttigieg pledges a $100 million grant for affected communities, to hold companies that exacerbated the opioid crisis accountable, and to expand naloxone programs to all 50 states.
  • Focus on healthcare in rural states by reducing care shortages in rural areas by training homegrown healthcare workers, invest heavily in telehealth, and expand transportation services to Americans in need.
  • Make medicine affordable by cutting out of pocket spending for seniors, capping monthly prescription spending under the proposed healthcare policy to $250, and reduce the cost of life saving drugs like naloxone and insulin.

 

Engagement Resources

Photo by unsplash-logoNatasha Spencer

Purdue Pharmaceuticals Turbulent Dealings with the Opioid Crisis

Purdue Pharmaceuticals Turbulent Dealings with the Opioid Crisis

The Case
The multiple lawsuits against arguably the biggest contributors to the opioid crisis, Purdue Pharma and the company’s founders the Sackler family, claim that both entities participated in massive false advertising. (Other companies targeted in the lawsuit include companies Johnson & Johnson, Teva. )Purdue should have known  that their products weren’t safe or effective, yet they advertised their drugs were both. With this knowledge, company executives pushed addictive and ineffective drugs to the masses and therefore caused the current crisis the US finds itself in today.

This behavior by Purdue is not new, in 2007, Purdue and three of its top executives paid more than $630 million in federal fines for misleading marketing, and three executives were criminally convicted, each sentenced to three years of probation and 400 hours of community service. Nevertheless, it is being argued Purdue has continued their false advertising and this new case is requesting more fu8nds from the pharmaceutical giant for those harmfully affected by its products.

Settlement
Purdue Pharma has negotiated a new billion-dollar settlement with the state of Oklahoma  to prevent it from going going to court in a large federal case next month. This conglomerate lawsuit is comprised of thousands of cities, states and communities who have been negatively impacted by the opioid crisis and are seeking to hold Purdue accountable. The tentative deal would relaunch the Purdue company under non-Sackler ownership, where the family entirely removes themselves. The newly formed company will be managed by a group of trustees and while the company will still exist, all Oxycontin profits will be used towards the settlement.

Though Purdue Pharma’s tentative settlement would bring some relief to communities, a growing number of state attorneys general are lining up against the deal. They want the Sackler family to pay far more out of their personal fortune, roughly $13 billion.

{UPDATE} Sep 16

On September 16th, Purdue Pharma filed for Chapter 11 bankruptcy. This filling also includes a restructuring of the company into a for-profit “public benefit trust”. This trust would include more than $4 billion in treatment drugs to help members of the affected communities treat their addiction by weaning them off of opiates and reaching a life after opiates. The trust is intended to last for ten years. The anticipated bankruptcy filing, which could be worth up to $12 billion over time, occurred to avoid the onslaught of court cases that was on the horizon for Purdue. The sum of the $12 billion bankruptcy filing comes from the settlements paid by Purdue and the Sackler family to the communities and individuals filing suit, the larger the payout, the more money thousands of communities get to repair.

Analysis
Even with this bankruptcy filing, Purdue may not be off the hook, there are still current trials pending, in addition to the possibility that proposed settlements can be rejected. Federal Bankruptcy Judge Robert Drain (NY) will have discretion over the case, specifically on whether or not the multiple states that do not agree with the settlement can continue with their lawsuits. Purdue announced that the bankruptcy filing is intended to “facilitate an orderly and equitable resolution of all claims against Purdue, while preserving the value of Purdue’s assets for the benefit of those impacted by the opioid crisis”.

Opponents of the filing and deal point to the findings by experts that the pay out would not reach the goal of $13 billion and that the company avoids true accountability by avoiding liability charges by a judge or jury. New York Attorney General Letitia James said the settlement shows the Sacklers’ “attempting to evade responsibility and lowball millions of victims of the opioids crisis.” There have been over 700,000 drug overdose deaths in the US since 1999. Officials are fighting for what they believe pays for those deaths and restores their communities to the healthy state before Purdue Pharma wreaked havoc. At this time, the fate of the company and the crisis-stricken communities, are still developing.

Engagement Resources:

 

Photo by unsplash-logoDan Meyers

The Administration Joins Others in Concern Regarding E-Cigarettes and Vaping

The Administration Joins Others in Concern Regarding E-Cigarettes and Vaping

The Policy
The Trump Administration announced a proposal banning flavored e-cigarettes and products amid cries for stricter regulation after the death of 12 people and a mysterious pulmonary sickness that has affected over 800, as of Sept 27, 2019. New York has already announced an “emergency executive action” to ban flavored E–cigs in the state, following Michigan. In Massachusetts Governor Charlie Baker is instituting a state-wide sale ban tentatively lasting 4 months halting the sale of products and devices within and to the state. Attorneys general in multiple states, like Illinois, are investigating whether Juul , a leading e-cigarette manufacturer, violated consumer protection laws by marketing its products to teenagers under 18. Recently, the Food and Drug Administration (FDA) slammed the makers of Juul for allegedly actively advertising to children and teens and for claiming e-cigs were safer than traditional cigarettes. The sleek and discrete styleon their products appeals to teens and young adults as both stylish and easy to disguise. The FDA has issued a warning and is ordering the company to correct its marketing, threatening fines and seizure of products.

Vaping has become increasingly popular and available, specifically with teens and young people. The purpose of vaping – also called Juuling after a top seller, Juul – and e-cigarette use is to act as a steppingstone on the path to quitting entirely. However, these devices have been used to go down the opposite path. Teens and young adults can start their “smoking” habit with these devices, though few proceed to actual cigarettes. Additionally, vaping is seen as a better choice to smoking cigarettes due to the removal of additives and chemicals found in traditional cigarettes. However,vape devices have an array of chemicals in their liquid concentrates, in addition to some containing THC. Vaping rates among high schoolers have increased by almost double from 2017 to 2018, translating to 3 million high schoolers using these devices.

Analysis
This proposed policy comes on the heels of multiple deaths and mysterious illnesses, but while nothing has been done federally, states are taking it upon themselves to stop this issue before it gets out of control. Supporters of holding e-cigarette makers accountable comes from the fact that teens and young people have been the demographic negatively affected by the products. The fear of children contracting an illness related to these devices has resulted in cries for tighter regulation, overhauling of marketing practices, and extensive research.

The issue with the marketing strategy of vape manufacturers stems from critics accusing Juul of intentionally targeting youth and young adults by producing and marketing flavors including mango, cucumber, and mint. Additionally, the products were marketed as a healthier alternative to traditional cigarettes, when e-cigarettes contain substantial levels of addictive nicotine, compounded with the chemicals found in the vapor and liquids. Due to their newness, there is little known about the devices’ safety and prolonged effects.

Stricter regulation is supported by the fact that while the legal age to buy cigarettes is 18, or 21 in some states. However, the devices and products are widely available online and occasionally do not require proof of age. Moreover, there is little regulation on products outside of the big sellers, resulting in less knowledge about the contents of such products.

In response to the Trump Administration crackdown on vaping, Juul CEO will be stepping down after accepting a proposal to ban flavored products and stop all US advertising. There is an expectation that many more cases will develop in the coming months. There are supporters for the move by law makers to halt production and use of Juul products, but such a move is also met with criticism over the swift action of something that is seen as a minor issue, compared to the inaction of larger crisis like gun violence or the opioid epidemic.

Photo by unsplash-logoAmritanshu Sikdar

Landmark Decision in Opioid Epidemic Case

Landmark Decision in Opioid Epidemic Case

The Case
Amid cries to hold pharmaceutical companies accountable for their role in the nation-wide opioid epidemic that killed 47,000 Americans in 2017 alone, an Oklahoma court has done just that. Judge Thad Balkman ordered Johnson & Johnson to pay $572 million, upon finding the company guilty in its role in fueling the state’s opioid crisis. Oklahoma originally sought $17.5 billion to be paid by the defendant over the next 30 years to repair the damages done by the crisis. The facts of the case found that the defendants, Johnson & Johnson, “engaged in false and misleading marketing of both their drugs and opioids generally, and the law makes it clear that such conduct is more than enough to serve as the act or omission necessary to establish the first element of Oklahoma’s public nuisance law,” according to the Judge. Johnson & Johnson’s defense centralized over the claim that the company could not be held liable for supplying legal products and ingredients that were highly regulated by the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), and state authorities. Additionally, Johnson & Johnson disputed the claim that neither the company (J&J) or its subsidiaries, participated in a misinformation campaign where healthcare professionals understated the dangers of the drugs, nor did they conduct sales calls to doctors that lead to over prescribing or the drug crisis. Nevertheless, the company was found guilty of these charges and claims.

Analysis
Oklahoma is one of dozens of states suing drug makers, with this being the first to go to trial as many companies have settled out of court . This historic case is the first to hold pharmaceuticals responsible for the opioid epidemic which started in 1999 and has reportedly taken over 6,000 lives in Oklahoma since 2000, in addition to the more than 400,000 people have died of overdoses nationwide since 1999. A federal trial, made up of nearly 2,000 cases involving cities, counties, communities and tribal lands, is set for this October, in Ohio. Attorneys for this federal case, have been watching Oklahoma’s proceedings closely, hoping to find similar success.

Johnson & Johnson has announced that they plan to appeal the ruling, which the company attorney called flawed and stated it was a misapplication of the public nuisance law that has been rejected by other, out of state judges. Should the appeal fail, Johnson and Johnson will fund millions to ease the epidemic in Oklahoma, where money will be diverted to addition treatment and prevention programs in the state. This case, as it is already proving to be, will likely be the first of many court cases holding companies and even individuals accountable. However, success in other states is still questionable due to varying state laws.

The Johnson& Johnson case is likely to be the first in a series of cases that seek to hold big pharma companies accountable to the tragic consequence of opioid misuse. With drug maker’s now being held accountable, USRN will be covering the numerous events coming soonJoin our mailing list to be the first to know when the next pharmaceutical is prosecuted

Fig 1. Oklahoma Opioid Use – National Institute on Drug Abuse

Fig 2. US Drug Overdose NCHS Data Brief No. 329 – CDC

Photo by kgrkz

Trump Administration Threatens to Make Big Changes to SNAP Benefits

Trump Administration Threatens to Make Big Changes to SNAP Benefits

Policy
The Trump Administration has proposed a change that will affect the way in which states determine who qualifies for the Supplemental Nutrition Assistant Program, known as SNAP and food stamps. The proposal tightens restrictions and closes a “loophole” that allows states to continue to give benefits when a family’s gross income exceeds a certain level. Another “loophole” closure is ending the automatic eligibility of SNAP for residents who already qualify for Temporary Assistance for Needy Families (TANF). This change would require families who receive TNAF to go through a secondary review of assets and income to determine future SNAP eligibility. The most devastating component of the proposal affects children’s free lunches. With this change, school children would have to apply separately to continue to receive free lunches, in comparison to the current policy which automatically qualifies children in families receiving SNAP.  There are currently 36 million people who receive monthly SNAP benefits and 265,000 school children.

Analysis
This change specifically affects lower income families that are receiving SNAP benefits that exceed poverty guidelines or $33,475 for a family of four. According to the U.S. Department of Agriculture an estimated 3 million  people could lose food stamp benefits under this proposal. In addition to the lower income families that will be affected, the proposal will also negatively impact many seniors and individuals with disabilities should their assets exceed $3,500.

Supporters of the current system highlight the discretion the current policy gives to states and how it is instrumental in allowing working low-income families continue to receive benefits through their transition into a higher income bracket. Additionally, cries for protecting children, people with disabilities, and the elderly have gained support as advocates push for continued access to the benefits to our most vulnerable populations. The Trump Administration’s continuous goal is to cut cost where possible. This change is expected to save $2.5 billion a year by removing people from SNAP. This proposal has a 60-day public commenting period after it is officially introduced, before it makes it way to lawmakers. Such a proposal will only result in the worsening of hunger and food insecurity across the nation.

Engagement Resources

  • Children’s Defense Fund : A national children’s advocacy group committed to ensuring the protection of children and promoting their growth & development.
  • CLASP : A national, nonpartisan, anti-poverty nonprofit advancing policy solutions for low-income people.
  • Feeding America : A national organization whose goal is to provide food access to millions through food banks and food panties.

Photo by unsplash-logoHush Naidoo

The Trump Administration Defunds UNFPA for a Third Consecutive Year

The Trump Administration Defunds UNFPA for a Third Consecutive Year

Policy
For the third year in a row, the Trump administration is withholding funding to the UN Population Fund (UNFPA). The UN Population Fund is an agency that deploys into war zones and natural disaster-wrecked areas providing health services to the vulnerable. The agency focuses on ensuring that pregnant women and girls get health care, can deliver babies safely, and are protected from gender-based violence. State Department Secretary Mike Pompeo made the announcement that the United States would be withholding $32.5 million in funding from the UN agency. A State Department spokesman cited Pompeo’s decision based on his determination that the UN Agency “supports or participates in the management or a program of coercive abortion or involuntary sterilization” in China. The United Nations Population Fund, lawmakers, and advocates refute this claim, saying that it is not true. Such a stance threatens women’s health and safety, and is a reflection of national policy from the Trump Administration.

Analysis
The UNFPA is a key player in ensuring women and girls in poor developing countries receive reproductive healthcare and protections. With the United States being one of the largest donors to the fund, blocking these funds will directly impart the central functions and goals of addressing gender-based violence, child marriage, female genital mutilation, maternal death, and threats to reproductive rights. As the Administration targets organizations that go against the conservative views of reproductive rights, UNFPA has fallen victim to defunding. With claims that the Fund supports coercive abortion and sterilization, specifically in China, the Administration has announced that such actions violate the Kemp-Kasten Amendment, first enacted in 1985, which blocks US aid to “any organization the US determines is involved in coercive abortion or involuntary sterilization”. .

In China UNFPA works only on policy guidance, with the goal of changing Chinese practices such as sex-selective abortions, contrary to the assumption that the office is persuading or administering abortions. It is worth noting that  no member of the Trump Administration has visited or inspected the facility to see its true purpose, raising concern and confusion on the basis of Pompeo’s decision.

This regretful Trump administration decision will drastically impede UNFPA’s crucial work in protecting the lives and health of hundreds of millions of women and girls. Funding currently supports emergency humanitarian operations in current conflict zones like Syria and Venezuela. Critics and lawmakers state that the State Department’s decision, which is not based on evidence, will hurt vulnerable women and children around the globe.

Engagement Resources:

Photo by NeONBRAND

States Have a Mixed Response in Dealing with a Nation-wide Measles Outbreak

States Have a Mixed Response in Dealing with a Nation-wide Measles Outbreak

Policy
New York Governor Andrew Cuomo ended religious exemptions by amending the provision in NY A02371, to combat rising anti-vaccination communities. Since January 1st of this year, there have been 1,077 cases of measles in 28 states, an increase from 372 from 2018, after the disease was declared eliminated from the US in 2000. The largest outbreaks were found in New York were found in Orthodox Jewish communities who are believed to have traveled to Israel where a current outbreak is occurring, in addition to Butte County, CA, and Portland Oregon. The majority of those infected were individuals who had yet to be vaccinated, either due to being younger than the CDC recommended vaccination age of 12 -15 months old or were not given vaccinations by the requests of their parents or guardians. New York joins Washington, Maine and California in setting limitations to those opposing vaccines, Mississippi and West Virginia do not permit religious exemptions.

The law takes effect immediately but gives unvaccinated students up to 30 days after entering a school to provide documentation of at least starting their immunization sequence. The law however, does not change in exempting children who can not have vaccines for medical reasons, nor are there any legal repercussions should a parent fail to vaccinate a child.

Analysis
While this policy change has been created in good faith, critics combat this mandate with protections of religious and moral freedoms. There are 45 other states that still having similar exemptions, allowing parents to skip vaccinations. With such allowances available in other states, anti-vaccination parents are considering leaving New York and the other four states setting limitations.

Advocates for this law stress that religious beliefs and fears about vaccines should not overshadow scientific evidence. Those who also feel as though this mandate infringes upon their rights should recall the 1905 Supreme Court ruling that provided states the right to enforce compulsory vaccinations laws. More recently, a 2018 California case upheld the law’s removal of exemptions noting “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death”.

By strengthening mandates, vaccinations are proven to increase and therefore protect. Supporters for the law also note that while the law is a step in the right direction, it does not go far enough. There are no legal sanctions for lack of compliance with the law. Additionally, some feel the focus should be shifted from reducing exemptions to tightening the medical exemption process, ensuring the waivers that are given are medically appropriate and true.

Center for Disease Control

Engagement Resources:

Photo by Ani Kolleshi

New Changes to Health Care Rights Law Threaten Transgender and Nonbinary Communities

New Changes to Health Care Rights Law Threaten Transgender and Nonbinary Communities

Policy
The Trump Administration’s Department of Health and Human Services (HHS) has submitted a major change to the administrative rule interpreting Section 1557 of the Affordable Care Act (ACA). This change will remove explicit protections for the LGBTQ+ community in healthcare programs and activities. Section 1557 was proposed by the Obama Administration intended to protect the LGBTQ community from discrimination based on sex stereotyping and gender identity. The specific Trump change of the rule removes gender identity and sexual orientation under the definition and category of sex discrimination. Under the Section 1557  change  the ACA still bans sex discrimination in the health-care industry, but defines sex “according to the plain meaning of the term” and removes any “excess” aka gender identity and sexual orientation, in accordance with a definition passed by congress in 1972. Such a change removes protections for those previously protected.

Analysis
The Office of Civil Rights (OCR) and the Trump Administration list 3 reasons for changing Section 1557. First is to alter the section so it “conforms to the law as written”, second is to reduce unnecessary spending by the OCR, and finally, OCR and the Administration found that rule exceeded the regulatory authority of the government.

Section 1557, as originally written, included gender identity and sexual orientation as a means of defining one’s sex. These attributes are not included in traditional definitions of sex. The Trump Administration argues there is no room for alterations in the meaning of sex and therefore gender identity and sexual orientation have no place, and should not be included  as a basis for protection against discrimination based on sex. The administration views that the definition of sex in Section 1557 is  more “powerful” than the  way in which the word is defined in other parts of the Affordable Care Act, and that the government exceeded its authority when it broadened the way in which the meaning of one’s sexuality is traditionally defined. The Trump Administration sees Section 1557 as creating false interpretations of the law and “unjustified cost and regulatory burdens”.

The change to Section 1557 is expected to save OCR a significant amount of money from a reduction of grievances and court fees. Because fewer people will be protected fewer people can file claims; resulting in OCR saving money. However, it is likely that the real reason behind this rule change comes from religious rights support, a key following of the Trump/Pence Administration. The religious right takes a strict traditional male/female only as options to defining one’s sexual identity; and many do not recognize the right of people to have gay lesbian, transgender, and sexual preferences or non-binary sexual identities.

Critics of this new rule highlight the likelihood of increased discrimination and a decrease of willingness to visit health care facilities by these affected communities as core reasons for rejecting proposed changes in Section 1557. The risk of trans and non-binary individuals being arbitrarily denied services or voluntarily avoiding facilities due to fear will only result in negative experiences and health complications.

The proposed rule change goes into effect after a 60-day commenting period, which will begin once it is officially submitted to the Federal Registrar.

Engagement Resources

  • American Civil Liberties Union : A national organization working to defend civil liberties across the United States.
  • Human Rights Campaign : America’s largest civil rights organization, working to achieve lesbian, gay, bisexual, transgender and queer equality.
  • Lambda Legal : A national organization committed to achieving full recognition of the civil rights of the LGBT community as well as those living with HIV/AIDS through litigation, societal education, and public policy work.
  • National Center for Transgender Equality : The nation’s leading social justice advocacy organization winning life-saving change for transgender people.

 2020 Candidate Involvement:

  • TX-D Beto O’Rourke: Advocate for same sex rights and protections against discrimination.
  • CA-D Kamala Harris: Historically refused to defend CA’s Proposition 8, which would ban same sex marriage.
  • MA-D Elizabeth Warren: Co-sponsor of the Equality Act, scores a 100% rating on Human Rights Campaign Congressional Scorecard.
  • IN-D Pete Buttigieg: Pledged to pass federal legislation making it illegal to discriminate based on sexual orientation, strong advocate for the Equality Act.
  • NY-D Kirsten Gillibrand: Advocate for the repeal of Don’t Ask Don’t Tell, supporter of the Equality Act.

 

Photo By unsplash-logoDenin Lawley

Trump Administration Proposes New Faith-Based Protections for Health-care Providers

Trump Administration Proposes New Faith-Based Protections for Health-care Providers

Policy
The Trump Administration has announced an expansion of the Conscience Rule, allowing medical professionals to refuse providing or payment of services should professionals choose. The US Department of Health and Human Services has expanded upon its rule within the Protecting Statuary Conscience Rights in Health Care policy. The rule specifies that clinicians and institutions do not have to provide, participate in, pay for, cover or make referrals for procedures they object to on moral or religious grounds. Additionally, the rule provides protections involving advance directives that detail a patient’s wishes for care at the end of life. According to HHS the rule mandates that hospitals, clinics, universities and other institutions that receive federal funding  comply with such rules. While this expansion is not a creation of a new law, the rule guarantees and mandates that the law and protections will be enforced.

Analysis
Rules like this one will pave the way for discrimination for countless demographics. The expansion of this rule undermines access to care for women, people of color, and members of the LGBTQ+ community. The oath taken by medical professionals instils a commitment to providing safe healthcare with no discrimination.  Permitting such allowances puts the previously mentioned groups in harm’s way.  Residents of rural areas will also be affected. Many rural area medical facilities are religious hospitals which prohibit procedures deemed “intrinsically immoral”. These  procedures include abortion, preventative care for HIV or AIDS, providing naloxone, sterilization, contraception and assisted suicide, in addition to treating people of the LGBTQ+ community, all of which would fall into the category of “intrinsically immoral.”

Such a regulations ensure facilities comply by holding necessary funding ransom.  If a provider decides not to comply with the conscience regulations, they face losing federal funding. The Office for Civil Right’s Conscience and Religious Freedom Division will oversee complaints of violated rights

While this expansion is focused on protecting the rights of the providers, it ignores the rights of patients based on moral belief, regardless of medical necessity. A major portion of Trump’s base, religious conservatives, find the conscience rule is key in protecting their rights. It can be assumed that this rule expansion was created to directly connect with his base amid similar court cases and the 2020 election. A person’s belief should in no way determine the services a patient should receive.  By allowing this expansion of the conscience rule the Trump Administration is permitting the discrimination and harm of patients with impunity.

In addition to civil liberty organizations like the ACLU and Planned Parenthood, other opponents like San Francisco City Attorney Dennis Herrera have all promised to fight and bring lawsuits against the expansion of the Conscience Rule,  citing that the expansion will reduce access by vulnerable groups to critical healthcare.

Engagement Resources:

  • American Civil Liberties Union : A national organization working to defend civil liberties across the United States.
  • The National Women’s Law Center : A non-profit that advocates for women’s rights through litigation and policy initiatives.
  • Planned Parenthood : Reproductive rights advocacy group that provides affordable and accessible health services to women across the US.
  • Human Rights Campaign : America’s largest civil rights organization, working to achieve lesbian, gay, bisexual, transgender and queer equality.
  • Lambda Legal : A national organization committed to achieving full recognition of the civil rights of the LGBT community as well as those living with HIV/AIDS through litigation, societal education, and public policy work.

Photo by Aaron Burden

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