Health Care Access

Appeals court declares individual mandate in Affordable Care Act unconstitutional

A three-judge panel on the Fifth Circuit Court of Appeals has ruled the Affordable Care Act’s individual mandate unconstitutional in Texas v. United States. The panel did not answer the larger question of whether the ACA is unconstitutional as a whole. Instead they sent the case back to the lower court to determine whether the law can stand without the individual mandate. Rather than upholding the ACA and protecting health care for millions, the Fifth Circuit did something dangerous. It placed the fate of the landmark law in the hands of the very same court that ruled the entire ACA unconstitutional just last year.

This ruling is not a good sign. But rest assured that health care coverage is not affected right now. The ACA is still the law of the land, California Attorney General Xavier Becerra said Thursday night that he plans to immediately appeal to the Supreme Court, asking them to hear the case without it going back to the lower court judge first. All of this only highlights the urgent need for legislative action to ensure universal health care.

The U.S. House of Representatives passes drug pricing reform

The House of Representative passed H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act. The bill has changed since it was first introduced in September, but the three main components have remained the same. First, it caps annual out-of-pocket costs for Medicare Part D beneficiaries at $2,000. Currently there is no annual cap, exposing many beneficiaries to high costs. Second, it aims to control inflation for Medicare Parts B and D drugs by requiring drug companies who raised prices above inflation levels since 2016 to either lower drugs costs or pay the above-inflation amount back to the U.S. Treasury. Third, it would dramatically shift the power that the U.S. has to directly negotiate prescription drug prices by allowing the Secretary of Health and Human Services to negotiate price for as many as 250 drugs annually. H.R. 3 is an ambitious reform bill, but it is not expected to pass the U.S. Senate.

Kentucky will not have Medicaid work requirements; Idaho might; South Carolina will

Newly elected Kentucky Governor Andy Beshear rescinded former governor Matt Bevin’s plan to implement work requirements on the state’s Medicaid program. Beshear’s announcement marks a significant victory for health care access in Kentucky, as Bevin’s plan would have stripped health coverage from an estimated 95,000 residents.

News is less hopeful in other U.S. states this month. The Centers for Medicare and Medicaid Services (CMS) approved South Carolina’s request to add work requirements to their Medicaid program. This is unprecedented development makes South Carolina the only state in the U.S. to apply work requirements to parents of minor children with incomes under 100 percent of the federal poverty level.

The Centers for Medicare and Medicaid Services (CMS) also approved Idaho’s plan to implement Medicaid expansion beginning January 1, 2020. However, state lawmakers are trying to add restrictions, like work requirements, to the state’s expansion process. CMS has not yet approved the changes but could do so at any time.

Work requirements generally require certain Medicaid receipts prove they worked or volunteered a certain number of hours every month or risk losing their Medicaid coverage. It is cruel policy and a failed experiment. Arkansas, for example, enacted work requirements for five months in 2018. During that time 18,000 people lost coverage, and there was no significant change in enrollee employment. As of December 2019, eight states have plans pending approval from CMS; three states have plans blocked by the courts; six states have had work requirements approved but not implemented; and only Indiana’s plan has been approved and implemented.


Sexual and Reproductive Health, Rights, and Justice

Supreme Court leaves invasive, unnecessary anti-abortion law in place

This month the U.S. Supreme Court allowed a shocking Kentucky law to go into effect that would force doctors to perform ultrasounds and describe them in detail to patients who want abortions. The law requires doctors to “display and describe” fetuses in detail – which generally requires the use of an invasive and unnecessary medical procedure known as a transvaginal ultrasound – regardless of the pregnant person’s wishes. There is no exception for cases of rape, incest, or the health of the patient.

A lower federal court ruled the law unconstitutional in 2017, stopping it from going into effect. However, in April 2019, an appeals court reversed that decision, saying that the law does not violate doctors’ First Amendment Rights. By refusing to review the appeals court’s decision, the Supreme Court has effectively rubber-stamped the law and political interference in private medical decisions. In March 2020, the Supreme Court will hear oral arguments a different, high-stakes case related to abortion, June v. Gee. This case out of Louisiana could re-affirm the constitutional right to abortion or render it meaningless.

Economic Justice

Trump Administration finalized rule to strip food assistance from nearly 700,000 adults

The United States Department of Agriculture (USDA) finalized a rule that would take food assistance through the Supplemental Nutrition Assistance Program (SNAP) away from adults that need it. Currently, adults without children can only receive three months of food assistance every three years unless they show that they work at least 20 hours per week. States used to be able to waive the SNAP work requirements in areas with high unemployment for good reason: no one should starve because they cannot find long term employment. The final rule makes it more difficult for states to waive these callous work requirements, likely kicking about 688,000 adults off the rolls.

Ultimately, this rule is rooted in racial discrimination. It will impact people of color and people leaving prison the hardest, reducing economic mobility for those already most likely to face barriers to employment. The rule will take effect April 1, 2020 unless it is blocked by the courts.

The USDA is also reviewing two other proposed rules that could restrict SNAP eligibility. The Urban Institute estimates that if all three are finalized, a total of 2.1 million households could lose access to essential nutritional assistance.

Ending Criminalization

Bill introduced in the House that could pave the way to repealing SESTA/FOSTA

Representative Ro Khanna (D-CA) introduced the SAFE Sex Worker Study Act in the U.S. House of Representatives December 17, on the International Day to End Violence Against Sex Workers. The bill would study the impact of a controversial package of bills known as SESTA/FOSTA — the Stop Enabling Sex Traffickers Act (SESTA) in the Senate and the Allow States and Victims to Fight Online Sex Trafficking Act (FOSTA) in the House.

When Trump signed SESTA/FOSTA in April 2018 it was framed as a tool to curb online sex trafficking. However advocates were clear from the start that the bills 1) conflate consensual sex work and sex trafficking and 2) would put sex workers at risk of increased economic insecurity and violence. The SAFE Sex Worker Study Act would establish a record about SESTA/FOSTA’s impact and daily threats that sex workers face more generally when losing access to online platforms. Such a factual basis could then be used to justify repealing SESTA/FOSTA or even decriminalizing sex work altogether.


Voting Rights will be restored to over 140,000 Kentuckians

Newly-elected Kentucky Governor Beshear signed an executive order to automatically restore voting rights to more than 140,000 people with past felony convictions. Previously, the state permanently barred people with past felony convictions from voting. The restoration applies to people who have completed their sentences, probation, and parole as well as those who only remain on probation or parole because of unpaid fines. Certain offenses, like treason and violent crimes, were excluded from the order, leaving more than 100,000 people in the state disenfranchised despite having completed their sentence, probation and parole.

Beshear’s order is a significant, though imperfect, step forward for voting rights and racial equity in Kentucky, and a clear example of why elections matter across the U.S.


LGBTQ Rights, Safety and Justice

Appeals court affirms right to name change for people of trans experience

The Arizona Court of Appeals set a strong precedent for trans-inclusive name change policy in the state. The case revolves around transgender man who filed a name change petition so that his state documents would reflect his gender identity. A trial court denied his request because of “failure to show good cause.” The appeals court took up the case, ruling that a trial court abused its discretion by denying the name change request. The case sends a clear message for other courts in Arizona: using a gender-transition rationale to deny a name change petition is improper. Judges are not gatekeepers who determine the legitimacy of a name change request short of fraudulent or criminal purposes.

Other News

  • Kansas City, Missouri, will become the first major U.S. city to have free public transportation.
  • The House of Representatives passed the Voting Rights Advancement Act (H.R. 4), important legislation that would combat voter suppression and restore voter rights protections.
  • A federal appeals court ruled that DHS’s public charge rule could take effect in certain states; however, the rule remains blocked due to multiple, nationwide injunctions issued in other courts.
  • Multiple New York Police Department (NYPD) officers revealed that they were pressured to engage in racial profiling by targeting Black and Latinx men for arrest and faced retaliation for objecting to a racist “collar quota” system.
  • The Department of Homeland Security set up a fake university to lure international students into an elaborate scheme and then arrested about 250 people on largely civil immigration charges.