Health Care Reform

  • May 31, 2017

    *This piece is part of the ACSblog Symposium: 2017 ACS National Convention. The symposium will consider topics featured at the three day convention, scheduled for June 8-10, 2017. Learn more about the Convention here

    by Katie O’Connor

    In a couple of critical ways, this decade has seen a recommitment and expansion of access to reproductive health care for all Americans. To start off the decade, in early 2010, President Obama signed the Affordable Care Act, drastically reducing the number of Americans without health insurance. Between 2013 and 2015, the proportion of 15-44 year old women who were uninsured in the country fell by 36 percent, largely as a result of the ACA’s Medicaid expansion and subsidized private coverage. Moreover, the ACA guaranteed full coverage of all FDA-approved contraceptives for women. All told, millions of women who might have struggled in the past to afford contraception (and other reproductive health care), or who might have gone without, now have access as long as the protections of the ACA remain in place.

    While the ACA put access to contraception and other reproductive health services within reach for many Americans, it failed to guarantee coverage for abortion and allowed states to ban abortion coverage in their ACA marketplace plans. Nevertheless, reproductive rights advocates found reason to celebrate a victory for the right to abortion in 2016. That year, in Whole Woman’s Health v. Hellerstedt, the Supreme Court forcefully reaffirmed the constitutional right to abortion and added teeth to the “undue burden” standard that was adopted two and a half decades ago. The case challenged two parts of Texas’s House Bill 2 – the “admitting privileges requirement,” which required abortion providers in the state to have admitting privileges at a nearby hospital, and the “surgical-center requirement,” which required abortion clinics to meet expensive and often unnecessary standards as ambulatory surgical centers. The two requirements, if allowed to go into full effect, would have forced over 75 percent of the state’s abortion facilities to close. In overturning the Fifth Circuit’s opinion upholding both provisions, the Court reiterated the undue burden standard from Planned Parenthood v. Casey and clarified that the standard requires a balancing of burdens and benefits. In assessing challenges to restrictions on abortion, courts must “consider the burdens a law imposes on abortion access together with the benefits those laws confer.” Moreover, the Court rejected the notion that “legislatures, and not courts, must resolve questions of medical uncertainty” and made clear that courts should consider evidence of a restriction’s medical benefits presented during judicial proceedings in addition to legislative findings, if any, in determining the restriction’s constitutionality. Whole Woman’s Health built upon existing precedent, reinforced the constitutional right to abortion and provided further guidance for courts considering restrictions on the right. In doing so, the Court dealt a blow to sham abortion restrictions that purport to make abortion safer but really just make it less accessible.

  • May 25, 2017
    Guest Post

    *This piece is part of the ACSblog Symposium: 2017 ACS National Convention. The symposium will consider topics featured at the three day convention, scheduled for June 8-10, 2017. Learn more about the Convention here

    by Jamille Fields, Policy Analyst, Government Relations at Planned Parenthood Federation of America

    We are not long past President Trump’s first 100 days and the start of this new Congress. Despite this short timeframe, there have been several legal and policy proposals that threaten reproductive rights and women’s health care access more broadly. Here are six ways in which reproductive rights have been threatened since the start of this year alone:

    1.     Attempting to Block Access to Planned Parenthood

    The American Health Care Act (AHCA) not only attempts to repeal the Affordable Care Act (ACA), which greatly advances women’s health care, but also includes a politically motivated provision that would block low-income women and men enrolled in the Medicaid program from using their coverage to receive services at Planned Parenthood. This provision is the only non-health insurance related provision in the bill and the intent is clear--restrict low-income individuals’ access to the provider of their choice and block people’s access to safe and legal abortion. If the bill becomes law, it will harm the 2.5 million people who annually visit Planned Parenthood health centers to access birth control, cancer screenings, STI counseling, HIV treatment and other preventive health care services. Unlike most other parts of the bill, this provision would take effect immediately.

  • March 24, 2017
    Guest Post

    by Jeremy Leaming, Director of Communications, National Health Law Program

    Despite growing public opposition to the so-called American Health Care Act (AHCA), House Republicans are striving to unite behind the bill that includes provisions that not only repeal the Affordable Care Act, but gut Medicaid, shifting health care costs to state governments and cutting off health care coverage to tens of millions of Americans. At this moment the measure is still being tweaked to please hardcore conservatives whose only agenda is to kill entitlement programs and pass laws that coddle the wealthy.

    In the House, the Tea Party faction called the Freedom Caucus, has been agitating for a full repeal of the ACA, including its Medicaid expansion. Although the faction appears to be balking at these efforts, it seems safe to assume that House Republicans will eventually unite behind this atrocity. If by chance the bill would die in the House or languish in the Senate, Politico’s Dan Diamond notes that the Trump administration will continue to do serious damage to the ACA.

    Increasingly the media and public have caught on to the fact that House Republicans are seeking more than just a repeal of the President Obama’s landmark health care reform law – one that has brought health care coverage to more than 20 million Americans and dropped uninsured rates to the lowest in 50 years. The AHCA includes provisions that would end Medicaid as we know it. The National Health Law Program, which has defended Medicaid for almost 50 years, has provided numerous reports on the provisions in AHCA that would affect Medicaid. For example AHCA envisions ending Medicaid as an entitlement program by slashing its federal funding either with per capita caps or block grants. Mara Youdelman, managing attorney of NHeLP’s DC office, explains how per capita caps would shift health care costs to states, forcing them to cut health services and/or limit those who are eligible for Medicaid. Republicans argue that these provisions are intended to give state’s more “flexibility” in how they provide health care to low-income individuals in their states. But with far less federal funding, states will not have a lot of options – either find ways to pay for quality health care services or cut services. Many states – led by conservative lawmakers – will opt for cutting health care services.

  • January 17, 2017
    Guest Post

    by Nicole Huberfeld, Ashland-Spears Distinguished Research Professor of Law, University of Kentucky

    The Patient Protection and Affordable Care Act (also called Obamacare) has extended health insurance coverage to more than 20 million Americans and achieved historically low un-insurance rates, yet most do not know much about the law or why its dramatic measures were necessary. The ACA responded to a constellation of health care and health insurance failures, including that un-insurance had reached an historic high of more than 16 percent at the time of the 2008 election. Fewer and fewer employers offered health insurance as an employment benefit for more than a decade before President Obama was elected and those that did had significantly increased employee cost sharing over time. The long-standing American assumption that people who work have health insurance was no longer true.

    Further, the uninsured were concentrated among the working poor, who were not offered health insurance as an employment benefit or could not afford insurance that was offered. Though slightly more than half of Americans receive health insurance as an employment benefit, that is only meaningful for people earning more than the average income of about $51,000 per year. For people earning below 400 percent of the federal poverty level ($47,250), employers are significantly less likely to offer health insurance; part-time workers are even less frequently offered health insurance.

    Additionally, individual and small group health insurance markets have had such high prices as to be inaccessible. And, in every market, insurers used tools such as preexisting condition exclusions, caps on coverage and other discriminatory practices to eliminate subscribers deemed not healthy. While public financing covered the elderly in Medicare, for the poor, Medicaid has offered an incomplete safety net, only covering the “deserving poor”, which meant about 40 percent of low-income individuals. The nation’s millions of uninsured citizens sought treatment in emergency rooms, which offered a point of rescue but not a permanent source of access to care (and which was unsustainably expensive for hospitals).

  • July 18, 2016
    Guest Post

    by Simon Lazarus, Senior Counsel, Constitutional Accountability Center

    *This post originally appeared on the Constitutional Accountability Center's Text & History Blog.

    Republicans in the U.S. House of Representatives – undaunted despite having come up short for six years with ceaseless efforts to kill or maim the Affordable Care Act – struck again, on Thursday, July 7, and Friday, July 8, with back-to-back hearings in two separate committees. As touted in the headline of their joint press release, the two committees – Ways & Means and Energy & Commerce – sought to “Highlight Obama Admin’s Unprecedented Obstruction to Withhold Facts On Billions In Illegal Obamacare Payments.” 

    The purported occasion for the redundant hearings was the release of a 158 page “investigative report” amplifying House Republicans’ claim that the Administration has funded the ACA “Cost-Sharing Reduction” program without a “constitutionally required appropriation from Congress.”  The cost-sharing reduction (CSR) program currently helps 6.4 million lower income individuals to afford deductibles, co-pays, and co-insurance prerequisites for purchasing health care services and products. Many of these individuals could not afford health care, and therefore might forego buying buy health insurance without it, antithetical to the outcome the ACA was designed to produce.

    The CSR subsidies work in tandem with the ACA tax credit program subsidizing insurance premiums, which the Supreme Court held applicable nationwide one year ago in King v. Burwell, rejecting a high-profile lawsuit by anti-ACA activists. If successful, that lawsuit would have barred the premium assistance tax credits in the 30+ states with exchange marketplaces managed by the federal government, rather than by the state on its own.  

    Much like that failed legal challenge, the committees’ attack on the complementary CSR program, itself the subject of an unprecedented lawsuit by the House Republican majority now pending in the D.C. Circuit Court of Appeals, promotes two persistent partisan objectives: to render the ACA dysfunctional, and to reiterate Republicans’ chestnut that President Obama constantly breaches his legal authority, violating his constitutional obligation to “take care that the laws be faithfully executed.”