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Discrimination complaints hit group fighting Trump's health policies

Friday, August 16th, 2019

Rachana PradhanSome of its employees have described an environment allowing mistreatment of minority and LGBTQ employees.

A legal aid organization leading the fight against several Trump administration policies, including health care for LGBTQ and low-income people, is facing its own internal allegations of discrimination.

The National Health Law Program, or NHeLP, was founded in 1969 to advocate for health care rights of underserved people. It has grown more prominent in the Trump era, taking on causes like fighting Medicaid work requirements. But some of its employees have described an environment allowing mistreatment of minority and LGBTQ employees, including instances of bullying black women; employees telling “off-color jokes” about women and Jewish people; and a “sense of not belonging among LGBTQ staff,” according to a 2018 assessment on its workplace culture obtained by POLITICO.

Elizabeth Taylor, a former Justice Department attorney who became the group’s executive director in 2014, said leadership has worked, and continues to work, to fix problems flagged by the 53-pageassessment, which the organization commissioned amid high staff turnover and concern about workplace culture.

“We appreciate the urgency of addressing racism both internally and in our outward facing work,” said Taylor. She said remedies include diversifying leadership, bringing in a human resources company to do management training, convening all-staff retreats focused on equity issues and establishing ground rules for conduct during meetings and other workplace interactions.

But a half dozen individuals who work or have worked for the social justice nonprofit claimed workplace inequities persist. All of them worked there after the January 2018 report.

NHeLP employs roughly three dozen attorneys, policy experts and administrative staff across its three offices in Washington, Los Angeles and CarrboroN.C.

“They say we hear you and we understand you but then don’t see results,” said one employee who called the pace of change too slow. “Things have to change.” That employee, as well as other current and former employees who spoke to POLITICO, asked to remain unidentified.

Taylor acknowledged that improvements may not occur quickly enough for certain employees — but that the changes can’t be rushed if they are to be done correctly and sustainably.

The January 2018 report, in addition to interviews with several former and current employees, depict an organization struggling to create an equitable workplace even as it battles the Trump administration over policies it says are discriminatory or punitive to low-income people and other marginalized groups.

The legal group is not alone in grappling with these issues; many sectors of society including Hollywood, Congress, the media and both the corporate and nonprofit worlds are uncovering mistreatment, abuse andemployee discrimination.

Since 2016, 14 people have left NHeLP, including eight people of color, according to figures the organization provided to POLITICO. Four of them left this year, including two individuals who are ethnic minorities.

It is unclear whether all these departures were related to the issues raised in the report. POLITICO was unable to reach some of the people who left in recent years; others did not respond to queries.

One employee who left after the 2018 assessment told POLITICO there were challenges around the retention of minority staff and lack of leadership opportunities.

“I think that there are situations that they are trying to improve. I just think it’s a long road ahead,” said the individual who left after concluding there was no opportunity for advancement.

NHeLP for decades has fought in court for patient access to a range of health care services, such as medications for severe chronic illness, children’s mental health benefits and abortion. It has also advocated for legislation expanding health insurance coverage. The group’s profile — along with its fundraising — has grown in the Trump era, its work seen as indispensable among health care advocates who oppose a range of Trump policies they believe will weaken the health care safety net for millions of people.

The organization has led successful lawsuits blocking the Trump administration from allowing the first-ever Medicaid work requirements in three states, though the Justice Department has appealed and other states are still planning on adding work rules. NHeLP is also likely to challenge the administration’s looming rollback of civil rights protections for LGBTQ patients, which the nonprofit helped shape as part of the Affordable Care Act.

The organization raised $8.3 million in 2017, more than triple the $2.6 million it raised in 2014, according to tax documents (though below the nearly $11 million that came in during 2013.) In 2017, as Republicans in Washington sought to repeal the Affordable Care Act, the group hired 11 people, about three times as many as the year before. Despite staff turnover, the organization grew.

NHeLP has stood out as a rare legal organization that is primarily led by womenYet it has struggled with retaining a diverse staff, even as it expanded.

“We know that we still have work to do and we’re doing it,” Taylor said.

Many nonprofits as well as for-profit entities struggle with boosting diversity and installing leadership that is more representative of the populations they serve.

“This is something that’s urgent and most every nonprofit in the country is struggling with,” said one individual in the nonprofit sphere who has worked with NHeLP for years. “Figuring out a way to address it is vital.”

Taylor said the departures in 2016 of three employees of color who worked on policy issues was one reason NHeLP stepped up its diversity and equity efforts, including hiring an outside firm to examine its workplace culture. That review by the Management Assistance Group produced the January 2018 assessment.

“There were certainly things in it that resonated with me,” said Wayne Turner, a senior attorney based in Washington, declining to give specifics. But he added, “I think for people who have been here for a while, it’s kind of history and we’ve moved beyond that.”

The group’s board in 2017 also adopted a strategic plan that included priorities to boost equity internally as well as in other areas, including partnering with organizations that represent the interests of people of color.

Then the January 2018 report came. The report, which is based on interviews and observations provided by current and former staff as well as board members, detailed management styles that alienated staff of color and LGBTQ workers.

The report noted the perception among some employees that “there were instances where women of color had more experience but white staff were identified as more capable.” It also relayed descriptions of instances when individuals acted “surprised when a person of color is a good writer.”

“Management issues are so bad and pervasive,” the report quotes one employee saying. “While I’ve benefited from being a white woman, it is hard to see it because it is such a challenge. It is worse for people of color.”

The report said people observed “bullying” of black female employees, but it did not provide details or indicate how many individuals witnessed it. Nor did it provide more details about off-color jokes.

“There were things in there that were shocking as leaders of the organization to read,” Taylor said.

The report said NHeLP’s emphasis on maintaining a workplace culture of “niceness” and avoiding conflict can prevent employees from raising concerns related to treating workers equally. Managers also “often” meant to create an inclusive atmosphere, but those efforts backfired at times, the report said.

“We learned that managers often have the best intentions to make staff feel included and welcome, however due to miscommunication, disparate management styles, and assumptions about what people want, are skilled at, and need, their actions do not land as intended, and too often create an atmosphere of unintended hostility,” the report reads.

Not all employees perceived that hostility; the report found most staff believed NHeLP’s offices were pleasant and knew their colleagues had “the best intentions in mind.” Many of the current and former employees interviewed by POLITICO, who represented a diverse group, also had a positive impression.

“It was a pretty decent organization,” said one former employee who nonetheless witnessed staff turnover and people of color voicing concern about the workplace environment. This individual said that managers attributed staff departures to millennial “job hop,” rather than looking at deeper issues.

“There was definitely that brush off — ‘oh, that age group,’” the former employee said.

Taylor said she had never heard anyone on the management team make such a remark.

She said the organization views the effort to improve workplace culture as a “long-term commitment.” Employees said NHeLP set up committees to address various issues, from improving partnerships with organizations led by people of color to hiring, retention and office culture.

“I feel like staff was given a lot of leeway from management to come up with a staff-driven process on how to address these issues that were going on,” said one employee who had not personally witnessed bullying but did occasionally hear off-putting jokes at work. This individual was concerned that co-workers might be impatient and “lose faith.”

“It’s not a short-term process,” the person said. “Doing something on a consensus basis, staff-led process is going to be slower.”

Two individuals who work or have worked at the organization viewed some of the remedies as inadequate. “We have all of these committees and I honestly just don’t know why,” said one.

NHeLP’s director of health policy Leonardo Cuello said the organization is making changes deliberately and doesn’t view improving diversity and equity as “a check the box thing.”

“You have to do things in the right order and you have to do it with professional support, and you have to do it thoughtfully and kind of in accordance with the model practices. And that takes time,” he said.

“We’ve been working on it for two years and there’s a reason for that.”

This article was originally published by Politico on August 16, 2019. Reprinted with permission. 

About the Author: Rachana Pradhan is a health care reporter for POLITICO Pro. Before coming to POLITICO, she spent more than three years at Inside Health Policy focusing on implementation of the Affordable Care Act. Prior to that, Pradhan worked at The Daily Progress in Charlottesville, Va., and spent most of her time covering city government (with the occasional foray into stories on urban chicken-keeping and the closure of neighborhood pools).

Pradhan is a rare local of the Washington, D.C., area and graduated from James Madison University. She was also news editor of JMU’s student newspaper, The Breeze.

Massive grocery chain is denying HIV prevention drugs to its employees — and it won’t explain why

Wednesday, January 31st, 2018

Publix, a massive grocery store chain across the southern U.S., is refusing to provide its employees coverage for the HIV-prevention medicine known as PrEP. According to a new report from TheBody.com, a Publix employee filed multiple appeals to have his PrEP prescription covered, but the company repeatedly refused, and the insurance company indicated it was because Publix did not want the medication covered.

PrEP (pre-exposure prophylaxis) is a daily pill that people who are HIV-negative can take that reduces the risk of contracting HIV by more than 90 percent. It has massive potential to help reduce infection rates. Last year, for example, clinics in London reported noticing a significant drop in new HIV infections among gay men, speculating that it was because many were taking PrEP. In the U.S., PrEP use has increased significantly in major cities, but less so in other parts of the country — particularly the South, where Publix operates. North Carolina, Georgia, and Florida (where Publix is based) ranked in the top ten states with the highest number of HIV diagnoses in 2016.

Publix’s refusal to cover PrEP was first reported back in 2016, but to this day, the company refuses to publicly explain why it denies coverage. It offered TheBody.com a brief statement describing its health plans as providing “generous medical and prescription coverage” and noting that “there are numerous medications covered by the plan used in the treatment of HIV.”

With no explanation available, many advocates are speculating that the company is imposing its moral authority, not unlike Hobby Lobby refusing to cover contraception for its employees. Cost doesn’t make sense as an explanation, because it would cost Publix far less to cover PrEP than it would the medications necessary if someone were to contract HIV.

The company is known for its conservative values. Its political action committee donates significantly more to Republican candidates than Democratic candidates, and CEO Randall Jones likewise favors Republicans with his donations.

Publix refuses to participate in the Human Rights Campaign’s Corporate Equality Index, which scores businesses on how they treat their LGBTQ employees and customers. It is conspicuously one of the only companies in the Fortune 1000 not to participate. In 2013, a company spokesperson reportedly claimed, “We are inundated with survey requests… and actually participate in very few due to the volume.” There have been, however, multiple reports of anti-LGBTQ discrimination at Publix stores.

Publix has 1,169 stores across seven states, employing some 188,000 workers.

This article was originally published at ThinkProgress on January 30, 2018. Reprinted with permission. 

About the Author: Zack Ford is the LGBTQ Editor at ThinkProgress.org, where he has covered issues related to marriage equality, transgender rights, education, and “religious freedom,” in additional to daily political news. In 2014, The Advocate named Zack one of its “40 under 40” in LGBT media, describing him as “one of the most influential journalists online.” He has a passion for education, having received a Bachelor’s in Music Education at Ithaca College and a Master’s in Higher Education at Iowa State University, and he relishes opportunities to return to classroom settings to discuss social justice issues with students. He can be reached at zford@thinkprogress.org

Trump’s new rule allows employers to drop birth control coverage with no oversight

Friday, October 6th, 2017

New contraception rules outlined by the Trump administration will allow employers to stop covering birth control — with zero government oversight.

The administration announced on Friday that, effective immediately, it was rolling back federal requirements introduced under the Obama administration which require employers to include birth control in their health insurance plans. Under the new rules, employers can simply self-exempt, citing religious or moral objections, and tell their workers that their birth control is no longer part of their health-insurance coverage.

Those employers are not required to tell the government either, according to PBS NewsHour correspondent Lisa Desjardins. They need to notify the insurers, and can send an optional note to the government.

The new rules fulfill a key campaign promise the Trump administration made to social conservatives, who have continually voiced dissent with the Obama-era federal requirement and challenged it in court. House Speaker Paul Ryan (R-WI) said it was a “landmark day for religious liberty” and would ensure that people “can freely live out their religious convictions and moral beliefs.”

But the rules are deeply damaging to women’s reproductive health, and reflect a wider trend of the Trump administration attempting to dismantle women’s access to health care by opposing abortion rights and cutting grants aimed at tackling teen pregnancy.

“They like to talk about these policies in isolation,” Adam Sonfield of the Guttmacher Institute told ThinkProgress’ Amanda Gomez. “They are not just trying to undermine contraceptive coverage. They’ve tried to cut Title IX funding, Planned Parenthood funding… you have to see it as a coordinated campaign.”

The ACLU, along with the Center for Reproductive Rights, Americans United for Separation of Church, and the state of California, have all said they intend to sue the Trump administration for denying birth control to women.

Conservatives have long insisted that the birth control rollbacks are designed to protect the religious liberty of groups who believe providing contraceptives would violate their moral beliefs. However, data provided by the Center for American Progress to Vox in August showed that the majority of the companies that had applied for and received exceptions were for-profit corporations. They included companies that worked in human resources, industrial machinery, and wholesale trade. (ThinkProgress is an editorially independent news site housed within CAP.)

According to Jamila Taylor, a senior fellow at CAP, the rules suggested Trump’s rollbacks “will open up the floodgates for nearly anyone to force women to pay out of pocket or navigate hurdles to obtaining additional cost for contraception… and simply chalk it up to moral opposition.”

About the Author: Luke Barnes is a reporter at ThinkProgress. He previously worked at MailOnline in the U.K., where he was sent to cover Belfast, Northern Ireland and Glasgow, Scotland. He graduated in 2015 from Columbia University with a degree in Political Science. He has also interned at Talking Points Memo, the Santa Cruz Sentinel and Narratively.

The GOP’s Trojan Horse on Health Care Repeal

Wednesday, July 26th, 2017

On Tuesday, 50 Republican senators showed contempt for their constituents by voting to move forward on repealing our health care, with Vice President Mike Pence stepping in to break the tie.

Nine GOP senators later broke ranks in a late-night session to vote down the Senate’s toxic version of the bill, the Better Care Reconciliation Act (BCRA) – which would have rolled back much of the Affordable Care Act and gutted Medicaid, ending coverage for 22 million – but there are more votes to come, including one that may simply repeal care and and strip coverage from 32 million.

The final version of the bill may be nothing more than a placeholder – a Trojan horse for setting up a Republican Senate-House conference committee that will use yet another secretive, undemocratic process to craft yet another version of health repeal.

GOP leaders will want the new version to look just like their previous versions: cut taxes for corporations and the rich, raise the price of coverage for the rest of us, unravel Medicaid, and take health care from 22 to 24 million people.

Among Republicans, only Sen. Susan Collins of Maine and Sen Lisa Murkowski of Alaska had the courage to stand with their constituents and vote no on moving forward.

By voting to move ahead on the health care debate, Sen. Dean Heller of Nevada caved to pressure from Trump and casino mogul Steve Wynn. Almost 630,000 Nevadans get their health care through Medicaid and are now in jeopardy.

Sen. Shelley Moore Capito of West Virginia caved under the weight of right-wing donor money and attack ads. With three in 10 West Virginians getting their health care through Medicaid, Capito’s state will be harder hit than almost all other states the country.

Ohio’s Sen. Rob Portman also caved, representing a state where hundreds of thousands of people finally got coverage because of expanded Medicaid under the Affordable Care Act.

It was extremely irresponsible of Portman, Capito, and Heller – who have all expressed concern for constituents enrolled in Medicaid – to throw their weight behind this reckless process without a clear plan for protecting Medicaid coverage.

In statements, Capito and Portman have both said they’ll make good on their concern in the days to come, but both voted with their GOP colleagues for the BCRA on Tuesday night. Heller, who voted against the BCRA, said he wants the bill to be improved.

They need to show this is more than talk. Now more than ever, their constituents need them to stand strong, resist any bullying, and protect Medicaid and health care overall. They’ll do that, if they really do care about their constituents.

And let’s not forget the true heroes in this fight.

These heroes include the West Virginians who’ve been holding Capito’s feet to the fire for months with creative protests and civil disobedience. They also include the Mainers who delivered messages in a pill bottle to Sen. Collins and tracked Rep. Bruce Poliquin down at a Boston fundraiser and reminded him who he’s supposed to represent. And let’s not forget the seniors who braved a Great Lakes blizzard to protest in front of Speaker Paul Ryan’s Racine office.

Like these heroes, tens of thousands of people have shown up at protests and town halls, often speaking up for the first time in their lives. In every corner of the country, people have put their senators on speed-dial, camped out in congressional offices, and rallied friends.

We really are in a fight for our lives. Yet we’re motivated not just by fear but also by moral outrage. We know how fundamentally wrong it is to deprive people of health care.

And our fight isn’t over. Republican leaders wanted to put health care repeal on Trump’s desk in January. It’s the end of July, they’re still scrambling. That’s because of us.

In the coming days, let’s keep making calls and showing up at rallies and protests. Let’s track every vote this week, and raise the pressure on senators and representatives alike if repeal moves to a conference committee.

We’ve shown an incredible persistence in our fight. We’ll show plenty more when it comes to holding politicians accountable for a vote that favors big-money bullying over the people they’re supposed to represent.

This blog was originally published at OurFuture.org on July 26, 2017. Reprinted with permission. 

About the Author: Julie Chinitz is lead writer for People’s Action.

Kellyanne Conway says people who lose Medicaid should just find better jobs. It’s not that simple.

Tuesday, June 27th, 2017

During a Fox & Friends interview Monday morning, White House counselor Kellyanne Conway suggested that, for the people who lose Medicaid coverage because of the more than $800 billion in cuts included in the Senate’s health care bill, the solution is as simple as finding a better job.

“Medicaid is intended for the poor, the needy, and the sick,” she said. “And what it has done is, under Obamacare, it has expanded the Medicaid pool of people who, quote, qualified beyond that. So if you have an able-bodied American who again is not poor, sick, needy?—?we’re not talking about the elderly who benefit, the children, the pregnant women, the disabled?—?if you’re able-bodied and you would like to go find employment and have employer-sponsored benefits, then you should be able to do that, and maybe you belong, as Secretary Price has made clear, in other places.”

But Conway’s talking point mischaracterizes the life circumstances of most Medicaid recipients, a majority of whom work low-income jobs that don’t offer health insurance and that keep them near the poverty line.

According to the Kaiser Family Foundation (KFF), 59 percent of Medicaid adults have jobs, and nearly 80 percent are part of working families. While many of those people might prefer to take advantage of employer-offered health care, a large percentage do not have that option. Only 46 percent of employers offer health care coverage, according to the latest KFF data.

Conway also ignored the fact that the Senate health care bill only requires insurance companies to pay for 58 percent of costs, a significant reduction from the standard under Obamacare. That means that low-income people kicked off Medicaid as a result of the Senate bill’s $800 billion in cuts would be required to pay much more out of pocket for their health care even if they can purchase private insurance.

It’s also not true that the Medicaid cuts included in the Senate health care bill wouldn’t have a negative impact on elderly people, children, pregnant women, or disabled people, as Conway suggested. By imposing per capita caps on benefits and eventually basing the amount of money states receive each year for Medicaid on the consumer price index (instead of inflation within the health care market, for instance), the Senate bill’s cuts will negatively impact all beneficiaries of the program, including the 35 percent who cite an illness or disability that prevents them from working.

Conway’s comments on Fox & Friends come the day after she appeared on This Week and flatly denied that the Senate bill’s $800 billion reduction in Medicaid spending constitutes a “cut.” Instead, she said the bill “slows the rate for the future, and it allows governors more flexibility with Medicaid dollars.”

The administration’s misinformation is having an impact?—?a recent poll indicated less than 40 percent of Americans know that the health care plan being pushed by Republicans includes any Medicaid cuts.

This piece was originally published at ThinkProgress on June 26, 2017. Reprinted with permission. 

About the Author: Aaron Rupar is an editor at Think Progress. He came to DC from Minneapolis, where he wrote for the City Pages and Fox 9, among other outlets.

Veto the Cold-Hearted Health Bill

Monday, June 26th, 2017

Donald Trump is right. The House health insurance bill is “mean, mean, mean,” as he put it last week. He correctly called the measure that would strip health insurance from 23 million Americans “a son of a bitch.”

The proposal is not at all what Donald Trump promised Americans. He said that under his administration, no one would lose coverage. He said everybody would be insured. And the insurance he provided would be a “lot less expensive.”

Senate Democrats spent every day this week pointing this out and demanding that Senate Republicans end their furtive, star-chamber scheming and expose their health insurance proposal to public scrutiny. That unveiling is supposed to happen today.

Republicans have kept their plan under wraps because, like the House measure, it is a son of a bitch. Among other serious problems, it would restore caps on coverage so that if a young couple’s baby is born with serious heart problems, as comedian Jimmy Kimmel’s was, they’d be bankrupted and future treatment for the infant jeopardized.

Donald Trump has warned Senate Republicans, though. Even if the GOP thinks it was fun to rebuff Democrats’ pleas for a public process, they really should pay attention to the President. He’s got veto power.

Republicans have spent the past six years condemning the Affordable Care Act (ACA), which passed in 2010 after Senate Democrats accepted 160 Republican amendments, held 110 bipartisan public hearings and conducted 25 consecutive days of public floor debate. Despite all of that, Republicans contend the ACA is the worst thing since Hitler.

That is what they assert about a law that increased the number of insured Americans by 20 million, prohibited discrimination against people with pre-existing conditions and eliminated the annual and lifetime caps that insurers used to cut off coverage for sick infants and people with cancer.

The entire cavalry of Republican candidates for the GOP nomination for President promised to repeal the ACA, but Donald Trump went further. He pledged to replace it with a big league better bill.

In May 2015, he announced on Twitter: “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

In September 2015, he said of his health insurance plans on CBS News’ 60 Minutes, “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

In another 60 Minutes interview, this one with Lesley Stahl last November, he said, “And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.”

In January, he told the Washington Post, “We’re going to have insurance for everybody.” He explained, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

But then, the House Republicans betrayed him. The nonpartisan Congressional Budget Office said the measure they passed, called the American Health Care Act (AHCA), would cut more than $800 billion from Medicaid. It said people with pre-existing conditions and some older Americans would face “extremely high premiums.”

Extremely high is an understatement. Here is an example from the CBO report: A 64-year-old with a $26,500 income pays $1,700 for coverage under the Affordable Care Act (ACA), but would be forced to cough up more than half of his or her income – $16,000 – for insurance under the House Republican plan. Overall, premiums would increase 20 percent in the first year. And insurers could charge older people five times the rate they bill younger Americans.

House Republicans said states could permit insurers to squirm out of federal minimum coverage requirements, and in states where that occurred, the CBO said some consumers would be hit with thousands of dollars in increased costs for maternity care, mental health treatment and substance abuse services.

In the first year, the House GOP plan would rob insurance from 14 million Americans.

So much for covering everyone with “great health care at much less money.”

It’s true that President Trump held a party for House Republicans in the Rose Garden after they narrowly passed their bill. But it seems like he did not become aware until later just how horrific the measure is, how signing it into law would make him look like a rank politician, a swamp dweller who spouts promises he has no intention of keeping.

By last week when President Trump met with 15 Senate Republicans about their efforts to pass a health insurance bill, he no longer was reveling in the House measure. He called it “cold-hearted.” He asked the senators to be more “generous,” to put “additional money” into their version.

Senators told reporters that President Trump wanted them to pass a bill that is not viewed as an attack on low-income Americans and provides larger tax credits to enable people to buy insurance.

Now that sounds a little more like the Donald Trump who repeatedly promised his health insurance replacement bill would cover everyone at a lower cost. Still, those goals remain amorphous.

The House bill is stunningly unpopular, almost as detested as Congress itself. President Trump seems to grasp the enormity of that problem. But even his calling it a “son of a bitch” doesn’t seem to have been enough to persuade senators that he’s serious about getting legislation that achieves his promises to leave Medicaid intact, cover everyone and lower costs.

Republican senators deciding the fate of millions of Americans must hear from Donald Trump that passing a health insurance bill that doesn’t fulfill his campaign promises is, shall we say, a cancer on the Presidency.

A veto threat would get their attention.

This blog originally appeared at OurFuture.org on June 21, 2017. Reprinted with permission. 

About the Author: Leo Gerard is president of the United Steelworkers.

The House GOP health care bill is a job killer, says a new report

Wednesday, June 21st, 2017

 In addition to potentially increasing the number of uninsured by 23 million and being unequivocally unpopular, House Republicans’ Obamacare replacement plan could leave nearly a million people unemployed.

That’s according to a new study published Wednesday by the Milken Institute School of Public Health at George Washington University and The Commonwealth Fund projects, which finds that the U.S. economy could see a loss of 924,000 jobs by 2026 if the American Health Care Act (AHCA) becomes law.

The study concentrated on coverage-related and tax repeal policies included in the AHCA. Some of the key provisions it said could add to job losses would:

  1. Phase out enhanced funding for Medicaid expansion by restricting eligibility in 2020, and imposing either a block grant or per capita caps.
  2. Replace premium tax credits with age-based tax credits. The premiums can be five times higher for older individuals, compared to the current threefold maximum.
  3. Allow states to waive key insurance rules, like community rating and essential health benefits. (The study does account for the Patient and State Stability Fund, a $8 billion grant meant to relieve states of high-cost patients.)
  4. Eliminate the individual mandate tax penalty and premiums hikes for people who do not maintain continuous coverage.
  5. Repeal numerous taxes and tax increases, like a tax on high-cost insurance (i.e. the “Cadillac tax”).

Short-term gain, long-term pain

Federal health funding stimulates the economy and job creation. Health funds pay hospitals, doctor’s offices, and other providers, and these facilities pay for their own respective employees and other goods and services, like rent and equipment. Health care employees and private businesses then use their earnings to purchase consumer goods like housing and transportation, circulating this money through the larger economy.

The GWU study found government spending or subsidies stimulate the economy more than tax cuts. Tax cuts do help, but only in the short term. The way AHCA is set up is that the tax cuts take effect sooner than federal funding cuts, which is why some states see net job growth by 2018. Then, when federal dollars are eventually pulled, states begin to see job losses by 2026.

Who’s most affected:

The employment rate among states that expanded Medicaid eligibility could disproportionately be affected, because those states received more federal dollars. New York, a state that expanded Medicaid, could be among the hardest hit with 86,000 job losses by 2026.

Between April 2016 and April 2017, New York added 76,800 jobs and the educational & health services sector saw the largest job gains, at 46,600 jobs. “The Affordable Care Act [ACA] contributed to that [growth],” Ronnie Kauder, senior research director at the New York City Labor Market Information Service, told ThinkProgress.

Kauder emphasized that the ACA wasn’t solely responsible for New York’s job growth, even in the health care sector. Uncontrollable factors like the state’s growing aging population and increasing life expectancy contribute to job growth as well.

New York has reaped the employment benefits of comprehensive health care, said Kauder. That’s in part because ACA encouraged states to test new models of health care delivery and shifted from a reimbursement system based on volume of services to value of services.

For example, New York received ACA grant funding to test effective ways to incentivize Medicaid beneficiaries, who struggle with chronic diseases, to participate in prevention programs and change their health risks. With that grant, New York created new programs at existing managed care organizations, which required new hires. The grant created positions like care coordinators, who connect and follow-up up with patients and providers in the program, said Kauder. “They are heavy on the training, but not licensed professionals,” she said.

But while she attributed some of New York’s job gains to the ACA, Kauder was skeptical that the GOP replacement plan would kill as many of them as the GWU study projects. “We don’t know what the state response will be,” he said. “It could be worse in Kentucky.”

The largest health care provider in New York, Northwell Health, hires on average 150 people a week. Northwell chief public relations officer Terry Lynam told ThinkProgress he doesn’t think the ACA directly contributed to a spike in job growth; however, it did help expedite the provider’s move from hospitals to outpatient care centers, also called ambulatory care, in an effort to slow rising health costs.

“What [ACA] has done was contribute to the ambulatory net growth [by cutting costs],” said Lynam. Northwell Health has 550 outpatient locations.

Northwell Health has qualms with the House GOP bill; specifically its cuts to Medicaid and change in coverage rules. “We are in a stronger financial position to survive that kind of reduction in revenue,” said Lynam. “But what about small providers serving low income areas, who need those Medicaid [dollars]?”

This blog was originally published at ThinkProgress on June 15, 2017. Reprinted with permission. 

About the Author: Amanda Michelle Gomez is a health care reporter at ThinkProgress.

The Trump administration has started rolling back the birth control mandate

Thursday, June 1st, 2017

Federal officials, under orders by President Donald Trump, have drafted a rule to roll back the Obama-era mandate that birth control be included under all employer insurance plans.

The final shape of roll back is still uncertain: The White House Office of Management and Budget (OMB) website says that it is reviewing the “interim final rule” to relax the requirements on preventative services. The rule change is specifically aimed at accommodations for religious organizations, some of whom have strongly objected to requirements that they include birth control coverage under their insurance for employees.

Typically, when an agency considers changing a rule?—?which can have immediate and sweeping policy impacts?—?they publish a preliminary version, solicit comments from the public, and incorporate the feedback into revisions before handing down the final change. If the OMB is reviewing the interim final rule, however, that means the rule has already been drafted by the relevant agencies and is in the last step before being published, according to the National Women’s Law Center.

“We think whatever the rule is, it will allow an employer’s religious beliefs to keep birth control away from women. We are sure that some women will lose birth control coverage,” Gretchen Borchelt, the vice president of the National Women’s Law Center, told the New York Times.

Under the current rules, implemented under President Obama, birth control coverage is considered part of preventative medical care and must be covered by all insurers with no co-pay. The mandate has guaranteed an estimated 55 million women access to birth control and other preventative services at no additional cost to them, regardless of their employer.

In 2013, the mandate saved women $1.4 billion on birth control pills, and since the law went into effect, there has been a nearly 5 percent uptick in birth control subscriptions, according to the NWLC. The increased access to contraceptives has also correlated with a sharp drop in unintended pregnancy and abortion rates.

These public health outcomes make it easy to see why the requirement has been widely lauded by women’s health advocates and providers.

“Without question, contraception is an integral part of preventive care; women benefit from seamless, affordable access to contraception, and our health system benefits as well,” the American College of Obstetricians and Gynecologists (ACOG) said in a statement about the mandate. “ACOG strongly believes that contraception is an essential part of women’s preventive care, and that any accommodation to employers’ beliefs must not impose barriers to women’s ability to access contraception.”

The law has been hotly contested, however, by religious organizations who object to having to include birth control in their insurance plans. Trump seized on their complaints while campaigning for the presidency, and in early May, fulfilled his pledges to evangelical Christian supporters by handing down an executive order on “religious freedom” that aimed to do two things: To make it easier for faith leaders to preach politics, and to allow employers to claim a religious exemption against providing contraceptive coverage for their employees.

Trump made the proclamation alongside representatives of Little Sisters of the Poor, an order of nuns who have been some of the most vocal opponents of Obamacare’s mandate that insurance include birth control coverage?—?taking the fight up all the way up to the Supreme Court.

“Your long ordeal will soon be over,” Trump told them when he announced the order.

Secretary of Health and Human Services Tom Price immediately issued a statement saying that he’d be happy to take have the opportunity to reshape the requirements on birth control coverage.

“We welcome today’s executive order directing the Department of Health and Human Services to reexamine the previous administration’s interpretation of the Affordable Care Act’s preventive services mandate, and commend President Trump for taking a strong stand for religious liberty,” he said in a press relief.

Price has long been a vocal critic of the birth control mandate on grounds of religious freedom, and has also been dismissive of its benefit to women.

“Bring me one woman who has been left behind. Bring me one. There’s not one,” Price said about women having trouble paying for birth control in an interview with ThinkProgress in 2012. “The fact of the matter is this is a trampling on religious freedom and religious liberty in this country.”

According to a recent survey by polling form PerryUndem, 33 percent of American women said they couldn’t afford to pay any more than a $10 copay for their birth control. Fourteen percent said that if they had to pay for birth control at all, they couldn’t afford it.

This article was originally published at ThinkProgress on May 30, 2017. Reprinted with permission.

About the Author: Laurel Raymond is a reporter for ThinkProgress. Previously, she worked for Sen. Patrick Leahy (D-VT) and served as a Fulbright scholar at Gaziantep University in southeast Turkey. She holds a B.A. in English and a B.S. in brain and cognitive sciences from the University of Rochester, and is originally from Richmond, Vermont.

Congress’ Cuts in Health Care Will Hit Women Harder

Tuesday, March 7th, 2017

Republican leaders in Congress are working on plans to cut health benefits for tens of millions of people. The harms from these cuts are likely to have the biggest impact on women, both for their own health benefits and as they try to manage health care for their families.

Every major source of health coverage is now at risk under the Republican health plans. This includes individual coverage bought through the Affordable Care Act, workplace health plans, Medicaid benefits for people struggling to make ends meet, and Medicare for seniors and people with disabilities.

The ACA included important changes in the law requiring women to be treated fairly. Repealing the ACA outright, as Republican leaders say they want to do, could mean going back to the days when insurance companies could legally discriminate against women by charging them higher monthly premiums for individual coverage than men.

Repeal also could mean getting rid of protections requiring individual policies to cover pregnancy and pay for preventive services, like women’s well visits and birth control.

Republican leaders also are intent on slashing Medicaid by more than a half trillion dollars over 10 years, which will take health coverage away from millions of people and cut benefits for many others. This government health program for people struggling to make ends meet pays for one-half of all childbirths in the United States. It also covers the bill for more than three-in-five nursing home residents—a group made up disproportionately of older women who otherwise might have nowhere to go.

The fallout for women does not stop there. Women already are much more likely than men to be the ones navigating our complicated health care system for their families and dealing directly with its high costs. Women make about 80% of their family health care decisions, like deciding on the right care and how to pay for it. They also are far more likely than men to be caregivers, including for older adults, such as parents or spouses.

When the Republican health care cuts come, women are likely to have to deal with the consequences in their daily lives.

When they can no longer afford a private insurance policy or they get dropped from Medicaid, women likely will be the ones struggling to figure out how to get and pay for the care needed by a small child with an ear infection.

When Medicaid support is cut for seniors who need help so they can stay in their homes or who need to go to a nursing home, women are likely to be the family members who are figuring out how to care for an elderly parent with dementia.

When family paychecks are smaller or health benefits are cut back because Republicans have taxed workplace health plans, women are likely to be the ones at the doctor’s office figuring out how to pay the family health care bill.

Yes, women will be hit harder by the Republican health care cuts.

This blog originally appeared in aflcio.org on March 6, 2017.  Reprinted with permission.

Shaun O’Brien works for AFL-CIO.  His interests include retirement security and health care. Follow him on twitter @ShaunOBrien30.

What’s Happening to Your Health Care: 3 Things to Know Right Now

Friday, February 17th, 2017

There is definitely lots of talk about how President Donald Trump and Congress are planning to make major changes to Americans’ health benefits. That’s because Trump and Republican leaders in Congress have said that repealing the Affordable Care Act is one of their top priorities. Although it is not clear when they will act or exactly what they will do, here are three things to know right now:

1. Your health benefits are at risk, no matter where you get them:

  • Medicare: A straight-up repeal of the ACA would eliminate some Medicare benefits by reinstating the full Medicare prescription drug donut hole and taking away free preventive care. House Speaker Paul Ryan (R-Wis.) is still pushing his plan to turn Medicare into a voucher system, meaning benefits would no longer be guaranteed and health costs for seniors and people with disabilities would go up dramatically.
  • Workplace Health Benefits: Kevin Brady (R-Texas), the powerful chairman of the tax writing committee in the U.S. House of Representatives, wants to tax part of the cost of workplace health benefits by including the cost in working people’s taxable income. So does the person Trump hired to be in charge of health care, Health and Human Services Secretary Tom Price. If you get your health benefits on the job, this will raise your taxes and lead to even higher deductibles and co-pays. Some employers could even cancel their health plans in response.
  • Health Insurance You Buy Yourself: Most media coverage is focused on what impact repeal of the ACA will have on the approximately 10 million people who now buy individual health coverage through the ACA’s health insurance marketplaces, often with the help of federal tax credits. A straight-up repeal of the ACA would not just take away the tax credits that help people buy health insurance. Full repeal also would eliminate the ACA’s protections that require insurance companies to treat people fairly, to give them meaningful insurance without tricks and traps, and not to discriminate against anyone because they have a pre-existing condition or even because of their gender.
  • Medicaid: Medicaid is the health plan run by states with significant federal funding that enables 74 million people to get the medical care they need. One-in-three kids in the United States get their health coverage from Medicaid or the Children’s Health Insurance Plan. Millions of seniors and people of all ages with disabilities also count on Medicaid for nursing home care and the long-term supports and services that allow them to live independently in their homes and communities. A straight-up repeal of the ACA would take health coverage away from some 11 million people who now have benefits because the ACA allowed states to expand Medicaid. Trump and Republican leaders in Congress also want to cut Medicaid for everyone who receives it by imposing new limited caps on what the federal government will contribute, even if the cost of health care keeps going up much faster than prices in the rest of the economy. That will shift costs onto states and likely force cuts in benefits.

2. People are speaking up, and that’s having an impact on Washington: Lots of people are showing up to meet with their members of Congress about health care and to let them know just how important it is to them personally. Many people are asking their members of Congress tough questions. For example, check out this article about a Tennessee high school teacher who attended a town hall and watch the video showing her tough question for Rep. Diane Black (R-Tenn.), Meet the Teacher Whose Powerful, Christian Defense of Obamacare Made a GOP Town Hall Go Viral. The hard questions and strong show of concern from voters are affecting what’s going on in Congress. What once was a mad dash to repeal the ACA right away has slowed to a crawl for the moment, and there now is a split among Republicans in Congress. While many congressional Republicans still want to repeal the ACA immediately regardless of whether they have a replacement, at least a few are saying they want to figure out what the impact will be on real people and how they might address the harm that will do.

3. We’re still waiting to hear what the plan for repealing and replacing the ACA is: In mid-January, Trump said he had a plan that was finished except for some finishing touches and that he was just waiting for Price to be confirmed by the Senate as his HHS secretary. Price was confirmed last Friday, so maybe we will see his plan soon. Congressional Republicans are still trying to figure out what their plan should be. Some Republicans want to go ahead with repeal of the ACA now and figure out whether and how they might replace it later.

This blog originally appeared in aflcio.org on February 16, 2017.  Reprinted with permission.

Shaun O’Brien works for AFL-CIO.  His interests include retirement security and health care. Follow him on twitter @ShaunOBrien30.

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