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

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.

Racial Justice and Civil Rights

FBI Targets "Black Identity Extremists"

The ACLU is demanding the FBI release documents related to surveillance of people it has designated "black identity extremists." The ACLU and Center for Media Justice (CMJ) are investigating a leaked report from the FBI citing black individuals as a growing threat to police and have expressed concern that the FBI is unconstitutionally targeting people based on race and their participation in protests. CMJ has highlighted the stark contrast and contradiction in the current administration's profiling and crackdown on black activism while remaining silent on the resurgence of white supremacist demonstrations.

Disability Rights and Inclusion

DeVos Rescinds Protections for Students with Disabilities

The Department of Education has rolled back 72 guidance documents outlining the rights of students with disabilities. Particularly concerning is the removal of guidance as to how schools should use federal funding for special education programs and how parents can advocate for their children. While disability rights activists are still evaluating the potential impacts, there is concern that schools will deny services to students with disabilities now that there is no guidance.  An additional concern is that the DOJ will not be helpful when it comes to protecting accessibility in schools since Jeff Sessions has been an opponent of integrating students with disabilities in educational settings.

State Updates

Texas

Abortion access and immigration

After being prevented for more than a month by the Trump administration, Jane Doe, an undocumented teen in federal custody in Texas was able to get an abortion.  Jane Doe, who learned she was pregnant after being detained by immigration enforcement, sought to get an abortion in Texas, where state law requires parental consent before a minor can get an abortion. Since Jane's parents were not with her, she was granted permission by a Texas court to proceed with the abortion. Yet despite being granted permission by the court to proceed, immigration enforcement refused to provide transportation to a clinic and forced her to go to a "crisis pregnancy center" instead. The Department of Health and Human Services (HHS) backed the decision and stated that federal policy was to "promote child birth and fetal life." This was followed by weeks of conflict between courts before before a federal court ordered that she be allowed to have the abortion "promptly and without delay."

Reproductive rights and justice organizations are using Jane Doe's case to shine light on and call into question the mistreatment and abuse of other young people in the custody of the Office of Refugee Resettlement, who are being stripped of their right to bodily autonomy.

California

SB 239 signed (HIV criminalization reform)

On October 6, Gov. Jerry Brown signed a bill that reforms California's former HIV criminalization law. The law no longer unfairly punishes and stigmatizes people living with HIV but addresses exposure to HIV in the same manner as exposure to other serious communicable diseases by eliminating extra punishment for people living with HIV who engage in consensual sexual activity. Additionally, the law lets courts vacate convictions as well as dismiss charges and sentences arising from felony provisions that were included in the former law and will take effect on Jan 1, 2018.

SB 219 signed (Long-Term Care Bill of Rights)

Gov. Brown also signed into law a bill that prohibits discrimination against senior in long-term care facilities based on their sexual orientation, gender identity, or HIV status.

SB 179 signed (Gender Recognition Act of 2017)

Gov. Brown also signed the Gender Recognition Act of 2017 which enables transgender, intersex and non-binary people to obtain state-issued identity documents that accurately reflect their gender identity, making California the second state to not require people to officially identify as "male" or "female." The also law creates a third, non-binary gender marker on California birth certificates, drivers' licenses, ID cards and gender-change court orders, in addition to streamlining the processes for a person to change their gender marker and name on these identifying documents.

Iowa

72-hour abortion waiting period halted

The Iowa Supreme Court has put a hold on implementation of a 3 day mandatory waiting requirement for women seeking an abortion in the state, while a legal challenge to the requirement is still in progress.

Pennsylvania

Low-income trans youth and access to care

Lawmakers in Pennsylvania are trying to amend the state's reauthorization of its Children's Health Insurance Program (CHIP) to bar access to care for trans youth. The CHIP program provides funding for healthcare for low-income children. The proposed amendment would bar access to prescription drugs, doctors' visits, counseling, and surgery for trans youth looking for transition-related care

Mississippi

Legalized discrimination goes into effect

House Bill 1523, also known as the Protecting Freedom of Conscience from Government Discrimination Act, went into effect in October. It explicitly legalizes discrimination motivated by one of three beliefs: that marriage is a union between one man and one woman, that sexual relations can take place only within such a marriage, and that gender is an immutable biological characteristic.

[Note from TheBody.com: This article was originally published by PWN-USA in Oct. 2017. We have cross-posted it with their permission.]