State of the Union: Key Highlights in Regards to Health
In Tuesday night’s State of the Union address, President Trump stated that he would “always protect” those with pre-existing conditions. However, the Trump Administration has supported efforts to undermine provisions of the Affordable Care Act (ACA), which provides protections to patients with pre-existing conditions. In fact, the Administration supported the outcome of the court case Texas v. United States, in which a federal judge ruled that the entire ACA is unconstitutional.
Additionally, the administration has undermined the ACA by permitting private brokers to sell short-term health plans outside of the federal and state-run health insurance exchanges. These plans do offer lower costs to patients. However, these “junk plans” don’t protect people with pre-existing conditions, or cover services such as hospital care, in many cases. The Coalition has long supported the ACA and its full implementation.
The Administration’s plan to End the HIV Epidemic in America by 2030, first announced in March 2019, was re-stated in last night’s address when the president acknowledged Congress’ approval of the funding necessary to achieve this ambitious initiative. The Coalition supports the funding for this initiative.
President Trump mentioned addressing prescription drug costs and the Administration’s efforts to lower drug prices, calling on Congress to do more. One proposal that the Administration is likely to announce shortly is an International Pricing Index (IPI) for prescription drugs, a plan that would cap U.S. drug costs within Medicare Part B, using an international reference price determined by the cost of prescription medications in other countries. Medicare Part B drugs include those administered in-clinic, such as drugs administered from doctor’s offices and dialysis facilities. This change could impact the public’s access to innovative medications and treatments, as has been shown in countries that are part of the IPI. The Coalition will continue to monitor developments and will provide an update in the next newsletter.
In 2021 Proposed Payment Notice, CMS Places Insurers’ Needs Above Consumers
Each year, the Centers for Medicare and Medicaid Services (CMS) releases a Notice of Benefit and Payment Parameters rule outlining planned changes that will impact the nation’s health insurance marketplace. This year’s proposed rule, released on January 31, issued a major blow to consumers by walking back a ban on accumulator adjustment programs (also known as co-pay accumulator programs). These programs, adopted by some insurers, prevent individuals who use coupons or “co-pay cards” provided by pharmaceutical manufacturers to off-set the cost of their prescription medications, from counting these coupons toward their deductible or out-of-pocket spending limit.
Insurance companies that use accumulator adjustment programs argue that when coupons count toward patients’ out-of-pocket spending limits it disincentives cost-effective prescribing. Pharmaceutical companies and patients’ rights advocates, on the other hand, argue that coupons and co-pay cards are an essential means of expanding access to brand name medications. By reducing or eliminating the cost-savings associated with coupons and co-pay cards, accumulator adjustment programs undermine this effort to improve access to brand name drugs.
Last year’s Notice of Benefit and Payment Parameters rule banned the use of accumulator adjustment programs under most circumstances, except when a coupon is used to pay for a brand name drug for which there is a generic alternative. Under the new rule, insurers may decide whether or not to count coupons towards an individual’s deductible or out-of-pocket maximum regardless of whether the coupon is used to pay for a brand name drug, and whether or not there is a generic alternative available. This change has serious implications for consumers, particularly those with chronic diseases. The National Coalition for LGBT Health opposes this change because not counting these cards towards deductibles or out-of-pocket expenses will shift the cost of many essential drugs onto patients.
The National Coalition for LGBT Health ran a “Co-pays Count” campaign last year to address adjustment accumulator programs. Due to the resurfacing of these programs, the Coalition is re-launching its campaign this month. The campaign will raise awareness of pharmacy benefit manager’s (PBMs) implementation of programs that no longer count drug manufacturer’s co-pay card towards deductibles. The Coalition’s campaign will highlight how shifting drug costs will impact access to essential medicines.
Read more via Health Affairs.
Government Agencies Issue Guidelines Expanding Religious Organizations’ Access to Federal Funds
Multiple federal agencies, including the Departments of Education (ED), Veterans Affairs (VA), and Health and Human Services (HHS) have issued notices of proposed rulemaking (NPRMs) that seek to comply with President Trump’s Executive Order on the Establishment of a White House Faith and Opportunity Initiative. The order dictates that faith-based social service providers must be granted an equal opportunity to receive federal funds. In application, the order has led the aforementioned agencies to propose rules peeling back Obama-era regulations that applied only to religious social service providers. For example, faith-based clinics are currently required to provide referrals to patients who wish to receive care in a secular setting, and to post notice of their referral process. The newly released VA and HHS guidelines revoke this requirement on the grounds that it applies only to faith-based providers, and not secular providers. As a result, patients at VA and HHS-funded clinics may be unable to obtain a referral to receive care in a secular setting. Opponents of the NPRMs cite concerns that these guidelines will result in the diversion of federal funds toward faith-based organizations, leaving secular programs and services underfunded. The new rules are each subject to a 30-day public comment period.
View the HHS Rule.
View the VA Rule.
View the ED Rule.
Trump Administration Announces Controversial Medicaid Block Grant Plan
The Trump Administration has unveiled a long anticipated, controversial plan to allow states to apply for block grant funding to cover the costs of Medicaid expansion via a 1115 Waiver. In contrast to existing funding structures, which require the federal government to chip in to cover the costs when Medicaid expenditures exceed expectations, a block grant is paid out as a one-time lump sum, leaving states wholly responsible for any program costs beyond that amount. A block grant funding structure is problematic, particularly during times of economic recession, when more Americans rely on Medicaid to pay their health care costs, and during public health emergencies. Block grants were at the heart of Congressional Republicans’ 2017 push to repeal and replace the Affordable Care Act (ACA). This new plan also seeks to undermine the ACA by preemptively capping funding for individuals who gained coverage under Medicaid expansion. Tennessee became the first state to apply for a 1115 Waiver late last year. We covered Tennessee’s application in our December 20 advocacy brief.
Read more via Politico.
UPDATE: Supreme Court Denies Request to Rule on ACA’s Legality this Term
The Supreme Court has denied a request from a coalition of Democratic states and House lawmakers to review a lower court ruling undermining the constitutionality of the Affordable Care Act (ACA) this term. The lower court ruled that the individual mandate (the requirement that everyone in the U.S. maintain health insurance) is unconstitutional because it can no longer be read as a tax, since Congress voted to reduce the tax penalty for those who do not have insurance to $0 in 2017.
In two separate petitions filed last month, 20 Democratic states and the District of Columbia, and House lawmakers called on the Supreme Court to review the appeals court ruling this term in order to limit uncertainty for patients and providers. By declining to fast-track the case, the Court has ensured that a ruling will not be issued until after the 2020 presidential election. This is widely viewed as a boon to Republicans, as the growing popularity of the law makes Republican opposition to the ACA an area of vulnerability in the upcoming election cycle.
Read more via Kaiser Health News.
LGBTQ+ Advocates Decry State Legislation that Undermines Civil Rights
LGBTQ+ advocates have identified at least 25 bills being introduced in state legislatures across the country that seek to undermine the civil rights of LGBTQ+ individuals. The rights of trans youth, in particular, are under attack in what the deputy director of the ACLU’s LGBT and HIV Project has called, “one of the most hostile” legislative sessions in recent years.
Three states – South Dakota, Colorado, and Florida – have introduced bills making it a criminal offense for health professionals to provide gender-affirming care, including hormone therapy, to transgender minors. Four additional states – Illinois, Oklahoma, South Carolina, and Missouri – have introduced legislation imposing professional penalties on providers who offer transgender health care to minors. In Missouri, the proposed law would also punish parents who allow their transgender children to receive gender-affirming care, mirroring a law under consideration in New Hampshire, which seeks to add “sexual reassignment” to the state’s definition of child abuse. If passed, transgender advocates and health experts fear these bills will strike a devastating blow to the health of many transgender youth, exacerbating existing health disparities.
In addition to bills blocking access to gender-affirming medical care, a host of states have introduced legislation barring transgender youth from participating in gender-segregated sports based on their gender identity, enabling students to sue their school for not providing bathrooms and locker rooms segregated by sex assigned at birth, forcing public school teachers to address students using the pronoun associated with their sex assigned at birth, and promoting a sexual education curriculum focused on biological sex over gender identity.
Multiple states have also introduced religious exemption legislation. Similar to federal policies proposed by the Trump Administration, these laws would enable health care providers and publicly-funded social service programs to discriminate against LGBTQ+ individuals on the grounds of religious objection. In Florida and West Virginia, lawmakers have also introduced bills to prevent local officials from enforcing anti-discrimination policies at the county or city-level.
Despite this onslaught of anti-LGBTQ+ legislation, efforts are underway in many states to uphold and expand LGBTQ+ rights. In Virginia, a bill has been introduced that would add LGBTQ+ individuals to the list of protected classes in existing anti-discrimination legislation. Utah recently became the 19th state to ban conversaion therapy. New Jersey has become the ninth state to ban so-called gay and transgender panic defenses, and has joined Illinois in introducing an LGBTQ+-inclusive public school curriculum.
Read more via NBC News.
American Medical Association Foundation Launches LGBTQ Fellowship Program
In an effort to address health disparities among LGBTQ+ individuals, the American Medical Association (AMA) Foundation has launched a new fellowship program dedicated to promoting best practices and establishing a national network of LGBTQ+ health specialists. In a press release announcing the new program, the AMA cited discriminatory state and federal policies and a lack of cultural competence in regard to the needs of LGBTQ+ patients as two factors that contribute to health disparities among sexual and gender minority populations.
“It is critical we eliminate health care disparities facing the LGBTQ community,” said John D. Evans, chairman of the newly established AMA Foundation Fellowship Commission for LGBTQ Health, which will guide the development of the fellowship program. “Intersectional issues of discrimination, stigma, access to and quality of care are experienced at a higher rate by lesbian, gay, bisexual, and transgender individuals, and we believe this new initiative will improve the health of LGBTQ people across the country.”
Are you a person with an LGBT or related identity who has ever served in the US Armed Forces?
The Health for Every Veteran Study Team is seeking veterans with an LGBT or related identity to participate in a study focusing on their health behaviors and life experiences.
The goal of the Health for Every Veteran Study is to better understand the experiences of veterans from all backgrounds and promote their health and well-being, including those with LGBT or related identities. The study team is especially interested in hearing the diverse voices within their communities.
The study is being conducted by researchers at the VA Puget Sound Health Care System. It consists of completing a confidential, web-based questionnaire every 9 months for approximately 2 years (for a total of 4 questionnaires). All research activities are completed online, with no in-person visits required. For more information, please go to: https://healthforeveryvet.questionpro.com.
SURVEY: Tell Us Your LGBTQ+ Health Advocacy Priorities!
The National Coalition for LGBT Health is assessing 2020 health advocacy priorities and gathering input on its annual National LGBT Health Awareness Week, to be held March 23 – 29, 2020. Please complete a brief survey below by Monday, February 10th. Thank you for your participation.
Join the National Coalition for LGBT Health at SYNChronicity (SYNC) 2020, May 10-12, 2020
SYNChronicity (SYNC) 2020 brings together medical professionals, service providers, government officials, and health advocates to sync effective approaches to address HIV, HCV, STI, and LGBTQ+ health in the changing and dynamic health care landscape, with a focus on underserved racial/ethnic minorities and LGBTQ+ communities. The conference is organized by HealthHIV, HealthHCV, and the National Coalition for LGBT Health with the guidance of a diverse planning committee.
This year’s LGBTQ+ Health track will contain four dynamic sessions focused on improving health care access for LGBTQ+ communities, using data to advance quality care and identify gaps in care, advocating for smoking cessation practices and programs to reduce smoking rates, and advancing sexual health and other allied health programming to promote health equity. Additionally, SYNC 2020 will offer a Transgender Health Institute providing learning and engagement opportunities to promote integration of transgender health in practice. Plus, there for will be a poster hall and vendor exhibits.
The conference is an opportunity to connect with your colleagues and peers to discuss LGBTQ+ health advocacy, education, and health services research! You can register now to attend the conference May 10-12, 2020 at the Grand Hyatt Hotel in Washington, DC.