Five controversial health actions on Trump’s agenda

Five controversial health actions on Trump’s agenda

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The Trump administration is expected to push ahead with a range of controversial health policies next year despite Democrats retaking the House.

Democrats captured the House majority in part on their health-care message. But despite that there are a slew of actions where the administration is moving ahead on its own agenda.

Here are five controversial moves Trump officials are expected to make on health care.

 

Roll back transgender protections

A new policy from the Trump administration could limit or completely eliminate federal protections for transgender individuals.

The move would narrow the definition of gender under a federal civil rights law to either male or female, as defined by a person’s sex at birth.  It’s being spearheaded by the Department of Health and Human Services and reportedly being pushed across multiple agencies.

The potential change has alarmed activists and medical professionals. The American Medical Association, the country’s largest physician lobbying group, said it will “oppose efforts to deny an individual’s right to determine their stated sex marker or gender identity.”

The new policy could be related to a broader proposed rule that’s been under review by the White House Office of Management and Budget since April, that opponents say would make it easier for doctors and hospitals to deny treatment to transgender patients and women who have had abortions.

That rule is expected to roll back a controversial anti-discrimination provision buried within ObamaCare, which prohibits health care providers and insurers who receive federal money from denying treatment or coverage to anyone based on sex, gender identity, or termination of pregnancy, among other conditions.

Religious providers say they expect the Trump administration’s rule would merely reinforce their right not to provide treatment that’s against their beliefs.

 

Limit abortion providers from getting federal money

The administration is expected to finalize regulations in January that would make it harder for Planned Parenthood and other abortion providers to receive federal family planning money.

The rule would ban clinics that receive Title X family planning funds from referring women for abortions while also removing a requirement that clinics counsel women on abortion as an option.

It would also require Title X grantees have a physical and financial separation from abortion providers.

Anti-abortion groups, like the Susan B. Anthony List, have pushed the Trump administration to implement these rules as a way to cut Planned Parenthood and other abortion providers from the program.

Title X funds organizations offering family planning services, like birth control and pregnancy tests, to low-income women and men.

Similar regulations were issued under former President Ronald Reagan, and later upheld by the Supreme Court, but never went into effect due to a lengthy legal battle.

The regulations are expected to be in effect for the next batch of Title X grants, which begin in April.

 

Approve more state Medicaid work requirements

The Department of Health and Human Services is committed to allowing states to impose work requirements on Medicaid beneficiaries.

The administration has approved work requirements in five states so far, and several more are expected in the coming months.

Just this week, the administration reapproved a plan in Kentucky to charge premiums, impose work requirements and remove people from the Medicaid program if they don’t comply.

The initial effort was blocked by a federal judge, but by re-approving it with only technical changes, the administration showed its commitment to forge ahead despite criticism.

Opponents say the requirements are a way to punish poor people. They argue the requirements are only meant to kick people off Medicaid and save states money.

Arkansas was the first state to implement a work requirement, and more than 12,000 people have lost health coverage as a result.

The administration insists work requirements are empowering, and help people lift themselves out of poverty and government dependence.

Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma sounded a defiant tone when she announced the administration’s approval of Wisconsin’s work requirements at the end of October.

“We will not retreat from this position,” Verma said. “Community engagement requirements in Medicaid are not a blunt instrument. This is a thoughtful and reasonable policy, and one that is rooted in compassion.”

 

Indefinitely detain migrant families

The Trump administration is seeking to indefinitely jail migrant children with their families, a policy that would overturn 20 years of protections for immigrant children.

The administration is expected to issue final regulations that would terminate and replace the Flores agreement, which has governed the detention of migrant children since 1997.

The plan, which was issued in September, would allow immigration officials to keep children and their parents detained together for the entire length of their court proceedings, which could take months in some cases.

Comments on the proposal were due earlier this month, and the rule could be made final next year.

The Flores rules are the result of a settlement in a federal class-action lawsuit over the physical and emotional harm done to children held in jail-like settings for extended periods. The settlement was only meant to be temporary, until it could be written into federal law.

Multiple administrations have challenged the rules and attempted to extend the time migrant children can be detained, but the federal judge overseeing the case has rejected those attempts.

The Trump administration is trying something novel; no administration has attempted to replace the Flores agreement with new regulations. It’s not a guarantee of success, and advocates have promised a challenge as soon as the final rules are announced.

 

Loosen nursing home emergency preparedness rules

Senate Democrats are decrying a move by the Trump administration to change safety rules for nursing homes.

The administration says the proposal would reduce a regulatory burden and save money for providers. But critics say that instead of making nursing homes safer, the proposal would put seniors at risk.

Sen. Ron Wyden (D-Ore.), ranking member of the Senate Finance Committee, said the administration is moving in the opposite direction of what they should be doing in the wake of hurricanes last year that left dozens of people dead across multiple states.

Last year, 12 people died when a Florida nursing home lost power in the wake of Hurricane Irma. In Texas, multiple facilities decided not to evacuate after Hurricane Harvey, despite warnings about the threat of catastrophic flooding.

The original emergency preparedness requirements went into effect just last year, more than a decade after the Department of Health and Human Services (HHS) Office of Inspector General first called for reform in the wake of hurricanes Katrina and Rita.

A report from Senate Finance Committee Democrats included 18 recommendations to improve nursing home safety during natural disasters. But Wyden said the administration is ignoring them in order to “pad the pockets of medical providers.” 

 

California’s anti-abortion pregnancy centers want the Supreme Court to overturn state notice law

http://www.latimes.com/local/lanow/la-me-ln-pregnancy-court-20180318-story.html

California's anti-abortion pregnancy centers want the Supreme Court to overturn state notice law

At a faith-based pregnancy center here, rooms are crammed with baby supplies, both new and used, for expectant mothers, and a medical office contains equipment to allow pregnant women to view their fetuses.

“Life is not about waiting for the storm to pass,” reads a saying on a wall, “but learning to dance in the rain.”

The Alpha Pregnancy Center, located in a storefront on a busy street in the Mission District, is one of about 200 centers in California and thousands across the country pushing the U.S. Supreme Court to spare them from government regulation.

The California centers are challenging a state law that requires them to inform clients that contraception, prenatal care and abortion may be obtained free or at low cost from the state, along with a state phone number for information about Medi-Cal. The law also requires clinics to disclose if they are not licensed.

The case, which will be argued on Tuesday, pits the free speech rights of the anti-abortion centers against government consumer regulations. The decision is likely to affect abortion laws in other states.

The U.S. 9th Circuit Court of Appeals upheld California’s law, but similar requirements passed by cities and counties elsewhere in the nation have fared poorly in the courts.

Mark L. Rienzi, a religious liberties lawyer who represents pregnancy clinics, frames the debate as a question of whether the government can force anti-abortion activists to give clients phone numbers of abortion providers.

“Can the government make you say something you don’t want to say?” Rienzi asked. “They are pro-lifers. They exist to tell people you shouldn’t get an abortion.”

Rienzi said 11 states and local governments have passed laws to regulate what the pregnancy centers must tell clients — rules he argues amount to discrimination against abortion opponents.

Other analysts view California’s law as mere consumer protection. It was passed in response to reports that the centers were luring pregnant women without clearly identifying themselves as anti-abortion.

“The law is so clearly constitutional,” said UC Berkeley Law School Dean Erwin Chemerinsky. “It is one thing to compel somebody to speak. It is another thing to say you have to post on your wall information that is completely accurate.”

Rienzi, though, said California has plenty of resources to let low-income women know that they may be eligible for government-assisted contraception and abortion.

“I don’t think the government gets to turn private speakers into government billboards,” he said.

At the Alpha Pregnancy Center, nothing on the outside of the storefront indicates the group opposes abortion, but it states on its website that it does not provide abortion referrals.

The government-required notice is posted not on a wall, but is included near the end of three pages of a handout that deals primarily with privacy rights. Clients are required to sign that they have been given the form.

During a recent visit, only the executive director and a receptionist were working. A woman walked out pushing a baby carriage.

Most of the center’s clients are unmarried and about 80% decide to give birth, said the executive director, who declined to give her name. The center tries to help the women financially with donated goods and offers classes in money management, life skills, time management, child behavior and potty training, she said.

Brochures in the center are designed to steer women away from abortion.

One contains information on fetal development. At eight weeks, “the elbows and fingers can be seen,” it reads. There are photographs of fetuses at various stages.

Another pamphlet describes all that could go wrong with an abortion and links the procedure to breast cancer, mental illness and relationship problems, claims that those on the other side of the debate say are either false or misleading.

Elizabeth Nash, a policy analyst for the Guttmacher Institute, a research organization that favors abortions rights, said some pregnancy centers use deception to lure pregnant women who may be seeking abortions, while others are straightforward and even help women obtain government-funded healthcare.

The Supreme Court’s decision to review California’s 2015 law delighted crisis pregnancy centers, but it doesn’t mean they will win the case. Votes of only four of the nine justices are needed to take a case, and the court does not disclose those votes.

Justice Anthony M. Kennedy, often a swing vote, is likely to be the decisive vote in the case, National Institute of Family and Life Advocates v. Becerra, analysts said.

“It’s really hard to know what the Supreme Court is going to do here, ” said Stanford University Law School professor Pamela S. Karlan. “They have two competing impulses.

“On one hand the Supreme Court is extraordinarily receptive to a wide variety of 1st Amendment claims. On the other hand, this is a consumer protection statute, and the Supreme Court has at least so far not shown much interest in telling government they can’t regulate the information” that must be given to medical patients, Karlan said.

Some legal analysts said a ruling against California could hurt the anti-abortion movement by imperiling dozens of state laws that require providers to counsel patients that abortion may harm them.

The Supreme Court’s 1992 decision in Planned Parenthood v. Casey said that “counseling requirements are OK in the sense that the state is allowed to prefer childbirth over abortion,” Nash said.

Of 29 states with abortion counseling requirements, 20 require providers to give patients “misleading or inaccurate information” on such topics as fetal pain, fetal personhood, and links between abortion and breast cancer, future fertility and mental illness, she said.

The National Academy of Sciences released a major study Friday that found abortion was safe and debunked claims it increased the risk of infertility, breast cancer and mental illness.

Many of the state laws that require providers to make such claims have not been challenged because of the high costs of litigation, Nash said. But if the Supreme Court rules that California’s law violates free speech, these laws might become stronger targets, she and other analysts said.

“If the state can’t require that pregnant women be able to read a sign that gives them accurate information,” Chemerinsky said, “it seems an even stronger argument that healthcare professionals cannot be forced to utter falsehoods.”