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#HIVResists Monthly Policy Update: Health Care, Rights, and Justice

November 3, 2017

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Table of Contents

Federal Updates

FY18 Budget Update -- House and Senate Pass Budget Resolutions

Republicans have proposed $1.5 trillion in tax cuts for the ultra-rich. To make up the difference in that lost tax revenue, Congress is slashing funding for programs that serve low-income people, including people living with HIV and people with disabilities.

The Senate passed a budget that includes cutting $26 million from the Housing Opportunities for People living with HIV/AIDS (HOPWA) program, along with cuts for housing for people with disabilities and vouchers for public housing. Over the next 10 years, $473 billion will be cut from Medicare and $1 trillion from Medicaid. Meanwhile, an extra $5 million will be poured into abstinence-only education programs. The House approved the bill on October 26.

The approved budget includes reconciliation instructions that will allow the Senate to pass its tax reform measure with a simple majority, allowing the Republicans to push tax reform despite opposition from most Democrats.

Senate Confirms Anti-ACA Leader as Acting Secretary of Health and Human Services

The Senate confirmed Eric Hargan as Deputy Secretary of Health and Human Services (HHS) on October 4. Hargan, who served on 45's transition team and held various positions at HHS during the Bush administration, will serve as Acting Secretary until a new secretary is confirmed. In a recent statement, Hargan praised Trump's new executive order on "health care choice," which will allow the sale of insurance plans that cover fewer benefits and offer fewer consumer protections compared with those mandated by the ACA. The current frontrunner for HHS secretary is Alex Azar, a former drug company executive and George W. Bush-era health official. Azar has also made statements calling Obamacare "broken" and supports Republican efforts to repeal and replace the health care law.


Health Care Updates

"Healthcare Choice" Executive Order Attempts to Dismantle Affordable Care Act

On October 12, after multiple attempts to repeal the Affordable Care Act (ACA) failed in Congress, Trump took matters into his own hands, issuing an executive order on association health plans (AHPs) designed to sabotage the ACA. Trump directed federal agencies to look for ways to expand the use of AHPs, which are groups of small businesses that join together to buy health insurance. The executive order also changed ACA rules that required business to be located in the same state and that prevented the forming of associations exclusively for the purpose of purchasing health insurance.  The result? Small businesses located in states that are strict about what needs to be included in their health insurance plans can choose to buy coverage in a state with fewer protections for lower cost instead. AHPs will be treated as large employers, meaning that they are exempt from many Obamacare rules, such as covering the set of "essential health benefits" mandated in the ACA and key protections that ban discrimination against people with pre-existing conditions.

Trump Ends Cost Sharing Reduction Subsidies Threatening Access to Affordable Coverage for Millions

In the same week, Trump also announced that effective immediately, the Department of Health and Human Services (HHS) would no longer pay cost sharing reduction subsidies (CSRs) directly to insurers in state marketplaces -- a measure which made health care more affordable for millions of low-income individuals across the country. CSRs were included in the ACA to reduce out-of-pocket expenses (including premiums, cost-sharing and co-pays) for individuals under 250% of the federal poverty line (FPL). Formerly under the ACA, individuals eligible for CSRs pay lower cost-sharing than typical market insurance charges; the federal government then reimburses the insurance company for the millions of dollars paid to clinicians, clinics, hospitals and other health care providers, so that they will charge eligible consumers less. This sudden cut to payments could leave millions of people without coverage by next year and destabilize the insurance market for millions more.  Following the announcement, 18 states and the District of Columbia filed a lawsuit against the administration to continue the payments, but the request was subsequently denied by a federal judge in California. Read more here.

Senators Murray and Alexander Introduce Bipartisan Market Stabilization Bill

On October 17, Senators Patty Murray (D-WA) and Lamar Alexander (R-TN) introduced a bipartisan bill to stabilize the health insurance market for the short term. The Murray-Alexander bill would ensure funding for CSRs through 2019 and set aside $105 million to help enroll people during the Affordable Care Act open enrollment period through 2018. However, the bill also makes it easier for states to obtain waivers that can exclude important ACA provisions in their coverage. The bill's supporters had hoped to pass the legislation before the November 1st open enrollment period. It is now likely that the legislation, if passed, will not have any impact on the cost of premiums until 2019.

LGBTQ Rights and Inclusion

Anti-Discrimination Protections for Trans Employees Removed

On October 5, Attorney General Jeff sessions released a memo stating that federal civil rights law does not protect transgender individuals from workplace discrimination. This memo is in direct contradiction to Obama administration guidance that extended the anti-sex discrimination provision of the Civil Rights Act of 1964 to include gender identity. This follows a series of attacks by the Trump administration on LGBTQ communities, which includes ending sexual orientation anti-discrimination protections, implementing of a military ban on people of trans experience now temporarily blocked by a federal court, and rescinding guidance that ensures trans students have bathroom access.

Criminalization Reform

Pretrial Integrity and Safety Act of 2017

Rep. Ted Lieu (D-CA) introduced the Pretrial Integrity and Safety Act of 2017 in the House on October 11. The bill, which is the companion legislation to S.1593, introduced by Sens. Kamala Harris (D-CA) and Rand Paul (R-KY) in the Senate earlier this year, would provide grants to states and Native American tribes to reform their criminal justice system and replace the use of bail money payments as a condition of pretrial release. The bill recognizes bail as a mechanism to punish poverty as individuals are often kept in extended custody based solely on their inability to pay. The bill also recognizes that the bail money system has disproportionately harmed low-income communities and communities of color. 

Religious Exemptions

HHS: Religious Freedom Trumps Contraceptive Coverage

On October 6, the HHS issued new rules that would allow almost any employer, including educational institutions, to deny birth control coverage based on a claim of religious or "moral" objection. The ACA requires most health plans to cover FDA-approved contraceptives with no-out of pocket cost. The broadening of these rules leave the personal health care decisions of millions of women to the whims of their employers.

Department of Justice Supports Right to Discriminate

On the same day, the Department of Justice also issued a memo making religious freedom a "fundamental right of paramount importance," meaning that special consideration will be given for people's religious objections to complying with federal laws. This is a cause for concern as religious exemptions are increasingly being used as a vehicle to erect barriers to sexual and reproductive health care services and to undermine LGBTQ rights.

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This article was provided by Positive Women's Network of the United States of America. Visit PWN-USA's website to find out more about their activities and publications.

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