Health Care Access

House passes fourth COVID-19 response package; Senate declines to act

The U.S. House of Representatives passed the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, H.R.6800, on May 15. The HEROES Act is a $3 trillion relief package that includes $915 billion for state, local, and territorial governments, $75 billion for COVID-19 testing and tracing, $11.1 billion for nutrition assistance programs, $100 billion for emergency rental assistance, $10 million of the Ryan White program, and $15 million for the Housing Opportunities for People with AIDS (HOPWA) program. The bill would also require all voters be able to vote by mail in November and guarantee another round of $1,200 stimulus checks.  

The Congressional Progressive Caucus called for more. In a letter to House leadership, they pushed for monthly $2,000 direct assistance payments for a year, an extended moratorium on evictions and foreclosures, universal coverage for COVID-19 care without co-pay, and hazard pay for essential workers – all regardless of immigration status.

The Senate has yet to release their version of a fourth COVID-19 package (Senate Majority Leader Mitch McConnell says they will consider a fourth package in about a month), but there is support for monthly direct assistance payments.

The HEROES Act does incorporate some Caucus priorities, including requiring the CDC to collect and distribute data on racial and ethnic health disparities. PWN is calling on the Senate to build upon the HEROES Act by requiring state and federal governments to collect and publicly report coronavirus cases, testing, treatment, and mortality data by race, ethnicity, gender identity, sexual orientation, disability status, and more. You can submit a letter to Congress, here.


Oklahoma asks to shift Medicaid program to block grants, undermining gains of Medicaid expansion

Oklahoma is the first state to take the Trump administration up on their offer to shift state Medicaid programs to a “block grant” structure. Medicaid has always been an entitlement program. As need increases in a state, the federal government chips in more funding to help meet that need. This way, everyone who is entitled to access the program can do so. The block grant structure would cap federal funding at a certain amount, and anything over that cap would be the state’s liability. In return, states get the ability to waive a number of Medicaid program requirements around eligibility, enrollments, benefits, cost-sharing, and oversight.

Boiled down: In the middle of a pandemic, Oklahoma governor Kevin Stitt is seeking to cap its Medicaid program. A popularly-supported Medicaid expansion ballot initiative will appear on Oklahoma’s primary ballot in June. Stitt is opposed to Medicaid expansion and has said he will implement the initiative only under special rules that include work requirements and a block grant structure.

Stitt’s proposal would impact people newly eligible under Medicaid expansion, adding monthly premiums, non-payment disqualifications, an 80-hour per month work requirement, and a per-capita spending cap. Oklahoma has already been waiting for federal approval for Medicaid work requirements since 2018.

States begin to include gender identity and sexual orientation in their COVID-19 data reporting

Multiple states are exploring adding sexual orientation and gender identity (SOGI) information to their COVID-19 data collection systems. Washington, D.C., already collects this information, and more recently, Pennsylvania Governor Wolf announced that the state Department of Health would start collecting SOGI data in COVID-19 testing and contact tracing to better inform a non-discriminatory response.

Other states are considering doing the same. Bills are pending in the New Jersey and California legislatures and some state health departments are working to add SOGI questions to health surveys. Without this information, it is impossible to track and address the disproportionate impact COVID-19 has on LGBTQ+ communities. Just as consistent and reliable data disaggregated by race and ethnicity are necessary to craft racially just policies, data disaggregated by sexual orientation and gender identity is necessary to crafting COVID-19 policies that center gender equity.


Economic Justice

Trump administration continues to try to strip food assistance from nearly 700,000 people in the middle of a pandemic

The United States Department of Agriculture (USDA) published a final rule in December 2019 that would take essential food assistance away from people who need it. The rule impacts the Supplemental Nutrition Assistance Program (SNAP); read more background here. In March, a federal court issued an order known as a “preliminary injunction” to stop the rule from going into effect while the issue proceeds through the courts. Now – in the midst of a global pandemic as unemployment and food insecurity skyrocket in the U.S. – the USDA is appealing that injunction.

The first COVID-19 response bill temporarily pauses some SNAP restrictions, so even if the USDA wins, the rule will be delayed until the public health emergency is over. Nevertheless, about 688,000 people would eventually lose their food benefits unless the appeals court upholds the preliminary injunction.

Ending Criminalization

COVID-19 surveillance, policing and criminalization still occurring at alarming rates

State and local governments have expanded the use of police powers to enforce COVID-19 public health orders, leaving Black and brown, unhoused, and no-and-low income people at particular risk of aggressive policing, steep fines, and other penalties. In New York City, for example, the NYPD reported that out of the 374 summonses handed out from March 16 to May 5 for social distancing violations, 193 were given to Black people and 111 were issued to Latinx people (81%). Of 40 arrests, 35 were of Black people, 4 of Latinx people, and only one white person. Mask-wearing requirements are being unfairly enforced across the country and in Miami, New York City, and Seattle, authorities destroyed homeless encampments well after the pandemic was underway.

We cannot police our way out of a pandemic. Attempting to do so only exacerbates existing class, racial and gender inequities in policing and health outcomes. The Community Resource Hub, PWN, and other partners created a new digital organizing resource that contains a searchable database of current COVID-19 related orders and enforcement actions. The project will connect individuals with legal support, amplify calls for mobilization, provide regular updates on and analyze national policing patterns and trends, and make recommendations for local, state and federal action. Learn more at www.covid19policing.com.


LGBTQ Rights, Safety and Justice

Trump administration fast tracking a rule to undermine health care non-discrimination protections

The Trump administration is reportedly moving quickly to remove health care protections for LGBTQ people and those who have had an abortion. The rule would dramatically weaken Section 1557 of the Affordable Care Act (ACA) – the non-discrimination provision – by eliminating any recognition that the ACA prohibits discrimination 1) against LGBTQ people, 2) based on one’s pregnancy-related decisions, or 3) based on sex stereotypes. The rule would also remove a provision that stops health insurers from designing benefits in a way that discriminates against certain groups, including people living with HIV. Learn more about the rule here.

Section 1557 currently applies to a wide range of health care programs and entities. If the final rule aligns with the proposed rule, it will limit the scope of non-discrimination protections to apply only to specific programs receiving federal funding so, for example, certain health care plans and insurers would no longer be bound by the civil rights law.

This rule is dangerous – even more so during a pandemic – and will undermine efforts to end the HIV epidemic. The rule opens the door for increased discrimination, especially against LGBTQ people and people who have had an abortion. The resulting inability to access safe, stigma-free health care could exacerbate health disparities already faced by LGBTQ people, including higher rates of HIV.

Ending Violence Against Women & People of Trans Experience

New Trump administration regulations creates barriers to reporting campus sexual assault

The Department of Education released new Title IX regulations, which govern how schools, colleges, and universities must manage sexual harassment and assault. The regulations drastically roll back the types of misconduct that schools are required to investigate. They also require schools to dismiss all complaints of sexual harassment that happen off school grounds or outside of a school program or activity. Given a study showing that only about 8 percent of sexual assaults happen on school property, schools could now ignore a vast majority of reports. Schools would also be allowed, and in some cases required, to implement unfair and re-traumatizing procedures, such as live, adversarial cross-examination. The regulations are currently being challenged in court. If they are allowed to take effect, it will make schools more dangerous and undermine the right to safe and equal education.

Election Updates

California prepares to have universal vote-by-mail for the November 2020 elections

California Governor Newsom signed an executive order declaring that every registered voter in the state will be mailed a ballot for the November 2020 elections. The state’s 20.6 million voters will no longer have to make the unconscionable choice between protecting their health in a pandemic and exercising their right to vote. While all states have at least some absentee ballot options, currently only five states – Colorado, Hawaii, Oregon, Utah, and Washington – conduct all elections by mail.

PWN is hosting a webinar on organizing and mobilizing around voting by mail on June 17. Register here.

Texas Supreme Court blocks the expansion of vote-by-mail

The Texas Supreme Court made a decision that could result in the disenfranchisement of millions of people. The state court ruled that avoiding potential exposure to coronavirus is not an eligible reason for Texas residents to vote by mail. Texas law puts strict limits on voting by mail. In order to vote by mail, the voter must be 1) over 65, 2) away from their county on election day, 3) have a “sickness or physical condition” that prevents them from voting in person, or 4) in jail. This case involves reason number three. Civil rights groups and the Texas Democratic Party argued that being susceptible to an easily transmittable, deadly virus ought to qualify as a “physical condition” in the midst of the Covid-19 pandemic. Texas residents should be able to request an absentee ballot in order to keep themselves, their family, and their community safe from Covid-19. The Texas Supreme Court said no.

Another case, Texas Democratic Party v. Abbott, involves the first reason to vote-by-mail in Texas: age. In this case, the Texas Democratic party is arguing that prohibiting voters under 65 from voting by mail violates federal constitutional rights. A federal court ruled that Texas must allow all eligible voters to vote by mail, regardless of age, during the pandemic and while the case proceeds through the courts. This is teeing up a battle in the Fifth Circuit Court of Appeals and potentially the U.S. Supreme Court.

Federal Court rules Florida cannot deny the right to vote because of unpaid fines or fees

A federal court has stopped the Florida state government from implementing what is in essence a poll tax to disenfranchise the Black community. Back in 2018, Florida voters approved by 65% a ballot initiative restoring voting rights to people who have completed all terms of their sentences for most felony offenses – otherwise known as Amendment 4.

Florida Governor Ron DeSantis then signed a bill, SB 7066, into law that would effectively gut the Amendment by requiring people to repay all court-ordered fines and fees before registering to vote. Florida has no centralized system or established process to show whether someone had paid back their fines and fees. Black people have disproportionately registered to vote under Amendment 4, and the bill would have created immense barriers for them to safely remain, or for others to become, registered.

Even with the bill struck down, it has succeeded in one of its goals: making eligible voters confused about whether or not they can register.


Other Updates