Top of mind: HHS’s reversal of Obama-era transgender nondiscrimination healthcare protections

Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

On June 12, the Trump Administration finalized a rule that proposed to revise, and in effect reverse, Obama-era protections offered in Section 1557 of the Affordable Care Act (ACA). Section 1557, known as the Health Care Rights Law, prevents discrimination of patients based on “race, color, national origin, sex, age, or disability.” In 2016, the Obama Administration expanded the definition of sex to encompass aspects of gender identity as well—extending protections to transgender and gender non-conforming individuals. 

The finalized rule will drastically impact how LGBTQ individuals navigate their health care and health insurance, with regard to nondiscrimination protections. The rule would essentially affect aspects of coverage related to access, cost-sharing, and health plan benefits, specifically, denial of treatment based on someone’s gender transition and/or a provider’s moral or religious beliefs.

The U.S. Department of Health and Human Services (HHS) released a statement following this news expressing that reinstating the original definition of the protections offered would relieve the American people of approximately $2.9 billion in “unnecessary regulatory burdens”. These so-called burdens also include eliminating mandates for regulated entities to provide patients and customers with language accessibility pertaining to health care literature.

Considering the nexus of a global pandemic, civil unrest due to systemic racism, compounded by the epidemic of fatal violence against Black transgender people – the timing of this rule is not only inopportune but exceptionally cruel. The National Consumers League is appalled at the reversal of these protections during a pandemic that is disproportionately impacting vulnerable communities. We urge health insurers and providers to do the right to protect patients by keeping politics out of professional medical judgment when providing services to their patients and customers.

The National Consumers League supports expanded COBRA coverage

By Sally Greenberg, NCL Executive Director

In a perfect world, every person in the United States would have quality health care coverage, irrespective of whether they were employed or whether their employer-offered health insurance. The National Consumers League (NCL) has long advocated for universal access to health insurance for every American.

For political reasons, however, we still have a hybrid, expensive, and patchwork health care system. Thankfully, the Affordable Care Act addresses some of these disparities for millions, but our health care system in the United States still leaves many gaps in who can get coverage. And now, with the COVID-19 pandemic, the gaps in our social safety net have been made very stark indeed. Estimates are that 27 million Americans who have lost their jobs have lost their health insurance as well, according to an analysis from the Kaiser Family Foundation.

An estimate from the Robert Wood Johnson Foundation found between 25 million and 43 million people could lose their employer-sponsored insurance in the coming months if job losses continue.

However, help is on the way.

The Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act passed the House of Representatives on May 15, 2020. The bill addresses the COVID-19-induced massive unemployment/loss of health insurance crisis for Americans who receive their health insurance through their employer.

The HEROES Act allows individuals eligible for Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage to maintain their employer-sponsored coverage after a layoff, reduction in hours or furlough without having to pay premiums through January 2021. The bill also would provide two special enrollment opportunities for individuals to obtain health insurance: (a) during the emergency period for Medicare-eligible individuals residing in an emergency area who have not previously enrolled in Medicare and (b) during an eight-week enrollment period for an Affordable Care Act exchange for individuals who are uninsured for whatever reason. The bill would authorize veterans without a disability or health insurance to qualify for special enrollment in the Veterans Affairs (VA) healthcare system for a 12-month period. Finally, the bill would expand the Medicaid expansion pathway provided for in Families First, which covered 100 percent of testing costs. HEROES would expand this pathway to include full federal coverage for COVID-19 treatment and vaccines without cost-sharing for certain Medicaid enrollees.

There are issues, of course, with handing over billions of dollars to the health care industry through expanded COBRA that they might not have received otherwise. Among them, they pay excessive salaries to their CEOs that should trouble all of us who pay insurance premiums.

There is also the possibility that increasing access to private insurance via COBRA subsidies could stunt nationwide efforts to expand Medicaid for more vulnerable populations, to some degree.

But this is a case where we cannot let the pursuit of perfection be the enemy of the good. For nearly 40 million Americans struggling with loss of employment, passage of the HEROES Act will mean that they will not have to worry that neither they, nor their families, will lose health insurance.

We agree with Actors’ Equity, which issued this statement before the HEROES Act was adopted, “it is time for Congress to consider a 100% COBRA subsidy to ensure that no one loses their health care in the middle of a pandemic.” Similarly, our friends at Families USA have echoed the call for fully subsidizing COBRA coverage for displaced workers, among other robust consumer assistance measures. To read more, click here.  

Fully or heavily subsidizing COBRA coverage will have multiple benefits – particularly for consumers with chronic illnesses who have already satisfied their annual deductible- who would either be faced with potentially starting a new deductible from scratch, or with an entirely new provider altogether. By subsidizing COBRA coverage, families will be able to seek medical care, access vaccines and testing for COVID, and will have the full array of health care protections. It is a measure that will be good for the entire nation and will lessen the already frightening and painful loss of employment.

As a result, NCL strongly supports the HEROES Act provisions to subsidize COBRA benefits to the many millions who have lost employment. The House of Representatives has done its part. Now we need the Senate to approve the HEROES Act and move it to the President’s desk for signature. The nation will be far healthier if everyone can have access to health care in the age of this catastrophic COVID-19 pandemic.

NCL expresses concern about Trump Administration’s NBPP rule for 2021

Media contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832
Washington, DC—The National Consumers League (NCL), the nation’s pioneering consumer advocacy organization, expresses concern about the Trump Administration’s Notice of Benefit and Payment Parameters Rule for 2021.

An old threat to public health is resurfacing amidst COVID-19 worries

By Sally Greenberg, NCL Executive Director

While all of us have learned to adapt to the ‘new’ ways to stay healthy we can’t let our need to avoid contact with others get in the way of the important steps we have always taken to keep disease at bay; staying up to date on vaccinations.

Since the COVID-19 pandemic hit, most of us have dutifully complied with stay-at-home orders to avoid contracting the virus. While that is critically important, there are other diseases that we must guard against. While the world awaits a COVID-19 vaccine, we need to keep ourselves and our families safe by protecting overall health. This includes taking steps to diminish the risk of other dangerous outbreaks that would weaken our immune systems and put additional strain on the healthcare system.

Before the coronavirus, low vaccination rates were already a concern for many populations. But in the last several weeks, we have been alarmed to learn that the numbers of people receiving vaccinations—from the very young to the very old—have plummeted. That is extremely worrisome for public health officials.

In fact, prominent organizations like the World Health Organization (WHO) and the National Foundation for Infectious Diseases (NFID) have stressed the importance of maintaining vaccination against illnesses like the flu and pneumonia, which affect lung health during the pandemic. This is even more important for those with underlying conditions and those over the age of 65 who are more vulnerable to these diseases.

Early in the pandemic, we thought children might be spared from much of the outbreak. That turns out not to be true. Children need their vaccinations more than ever! Time has proven that there is still much we don’t know about the Coronavirus and how it affects the vulnerable—so staying up-to-date on pediatric vaccines is equally important.

Hesitation to visit the doctor’s office is completely understandable, but I can speak from personal experience that our health care providers are making doctor visits very safe.

When I visited the doctor on a non-coronavirus issue, they staggered patient appointments so patients never had to share a waiting room; everyone wore a mask; we observed 6-foot social distancing; there was an abundance of soap and water and hand sanitizer. The staff at the office was exceptional. They were organized, completely protected with all of the proper PPE, and very focused on making sure that I—the patient—felt safe and secure.

The best advice? Call ahead to ask your health care provider about the precautions they have in place and the best timing for a visit to update your vaccines. Adults, get your shingles, pneumococcal pneumonia, and flu shots. You don’t want those illnesses! And every child needs the array of measles, mumps, tetanus, diphtheria, whooping cough, and other vaccines recommended by the Centers for Disease Control (CDC) for children.

As we continue to live in this new world, we have a responsibility to ourselves, to our families, and our communities to stay as healthy as possible. Modern medicine’s gift to humankind is an array of extremely safe and effective childhood and adult vaccines to prevent diseases that once, collectively, have killed billions globally. As the COVID-19 pandemic has shown, we are lucky to have these vaccines. They keep us safe and healthy. We all have to do our part and get vaccinated from preventable diseases.

Top of mind: Full coverage should mean full coverage

Nissa Shaffi

By Nissa Shaffi, NCL Associate Director of Health Policy

The National Consumers League is troubled by the recent report by Public Citizen, “Insurers’ Offers of Free Care for Coronavirus Are Often Confusing and Limited.” In these traumatic and confusing times, it’s critical that consumers can rely on their healthcare insurers to follow the spirit of the law as well as the letter of the law. This includes being crystal clear about what is covered, under what conditions, and for how long. 

Public Citizen’s research into 25 of the largest health insurers turned up a range of concerning practices. Most fee waivers will expire by early summer, well before the crisis will subside. Few appear to cover costs of out-of-network care, a hardship when the urgency of the illness and overwhelmed facilities may make it untenable to get in-network care. The 60 percent of people in private insurance plans who are covered by their employers’ self-insured plans may not even be covered if the employer does not opt-in. And of long concern to NCL, even free tests may come with associated services the patient may not be aware of, and that lead to surprise billing not prohibited by the law.

We urge insurers to act in good faith. Use the savings you are accruing from lower elective care costs to fully cover the costs associated with this pandemic. Remove arbitrary restrictions. Be clear and fully transparent about what you are offering. Hold the course for the duration. The consumer community is here to help make it happen.

More tips for staying healthy during the COVID-19 outbreak and beyond

By Sally Greenberg, NCL Executive Director

COVID has changed the way we live and has brought with it some drastic changes, like social distancing.

While we don’t want to live like this any longer than we have to, there are new habits that will not only help us get through this challenging time, but can stay with us as helpful tools in our everyday lives.

  1. Maintain hand hygiene, cough and sneeze etiquette. Wash your hands with antibacterial soap and cover your nose and mouth when you sneeze or cough.
  2. Wear face coverings. Even in pre-COVID times, it has been common practice in other countries to wear face masks to protect oneself from those sick with a cold or flu and to protect others when you are sick.
  3. Establish routines. It’s important for your mental, emotional, and physical health to maintain healthy eating habits and to get adequate sleep.
  4. Be wise on portion size. Most of us are less active during this time and it’s easy to overeat. Drink plenty of water and buy small cans of soda rather than super-sized containers.
  5. Plan your meals. This will help you reduce the number of trips you take to the grocery store, stick to your budget, and avoid food waste. Knowing what portions are appropriate for you and your family is also helpful. Try not to overdo it with fast food consumption, which tends to be higher in fat, salt, and sugar.
  6. Stay physically, mentally active. Walk outside and get some sunshine! If that’s not an option, there are plenty of workouts on YouTube! Pilates, yoga, Zumba, and many other exercise programs are available for free if you can’t get out of the house.
  7. Keep everyone connected. We have so many options nowadays like phone calls, text, Facetime, Zoom, and more. Houseparty, for example, is a newly popularized app that allows you to play games with a group of family and friends.
  8. Get some sun! Vitamin D is important for the immune response and getting sun will increase your vitamin D reserves. Open shades and windows while sitting in sunny areas of your home. And, if possible, go outside. Just remember to adhere to social distancing guidelines (maintaining 6+ feet between yourself and others).
  9. Manage your environment. This is especially important for those of us working from home. If you have the ability, designate a work area so that you can keep your work life and personal life separate.
  10. Stay informed. Pay attention to the Center for Disease Control (CDC) and check your local government website. Getting your news from a variety of sources will ensure that you’re in the know about new developments in the fight against COVID-19 internationally and locally.

NCL calls on insurers to cover air medical services during COVID-19 crisis

May 5, 2020

Contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC –The National Consumers League (NCL) last week sent a letter to the CEOs of Cigna, Aetna, and UnitedHealth Group, urging them to enter into productive negotiations with air medical service providers to ensure coverage of emergency air medical transportation. The ask comes as the COVID-19 pandemic spreads across the country, making air medical services even more essential, particularly in rural America.

In its letter, NCL notes that it is increasingly concerned about emergency air medical access during this crisis, and that it believes this life-saving care should be covered by every insurance plan. NCL asks that insurers review the robustness of their coverage policies and immediately to enter into network negotiations with air medical providers so that this critical service is covered, and patients are never left with a bill they cannot pay.

Text of the letter, signed by NCL Executive Director Sally Green is below:

Dear Mr. Wichmann, Mr. Cordani, and Ms. Lynch:

The National Consumers League has long advocated for health care as a right and argued for fair treatment for all stakeholders across the health care spectrum – patients, physicians, hospitals, health plans, and health care providers. Our mission is particularly acute during the global COVID-19 pandemic, when medical professionals are on the frontlines fighting for our health and safety, stricken patients need life-saving care, and nearly everyone is focused on their health and that of their loved ones.

In this vein, we are increasingly concerned about access to emergency medical care, especially in rural America, as the virus indiscriminately makes its way across the country. When minutes count, Americans who fall victim to COVID-19 must be assured that they can get to the nearest, most appropriate medical facility as quickly as possible. As COVID-19 strains hospital capacity and critical medical equipment like ventilators become attenuated, emergency air medical transports between facilities are often the only way for patients to get the care they need.

According to the Centers for Disease Control and Prevention (CDC), 85 million Americans can only reach a Level 1 or Level 2 trauma center within one hour if they are flown by an air medical helicopter. The effects of this access problem are staggering, and even more pronounced as we wrestle with the COVID-19 crisis. For many Americans, air medical ambulances are a vital link to timely, life-saving care.

We believe that such life-saving care should be covered by insurance. Patients pay their monthly premiums – and copays and deductibles – so they are not bankrupted should the worst befall them or their loved ones. Unfortunately, there have been far too many stories of people who were transported by air ambulance because it was ordered by a first responder or doctor, only to be told later by their insurance company that they would have to shoulder the bulk of the cost. This should not be the case anytime, but especially now as our nation wrestles with a pandemic.

This explains why we at the National Consumers League are writing to you for your input and thoughts. We believe that emergency air medical transportation should be included in every health coverage plan. We think that insurance companies and air medical providers must work together to bring these services in-network, so patients are not left footing a bill they can never hope to pay.  Adequate network agreements are imperative so that patients are not told – after the fact – that they were transported by an air ambulance that was not in-network. When an emergency happens, or worse yet, a pandemic strikes, patients are not choosing whether to take an air ambulance, let alone choosing a particular provider.  Similarly, coverage denials based on “medical necessity” should be the exception, not the rule, in light of the fact that patients are not a part of the decision-making process.

We ask that your companies immediately take a comprehensive look at your coverage policies for air medical services and the robustness of your provider networks. We urge you and the air ambulance community to enter into network negotiations, take patients out of the middle, find a middle ground on reimbursement that fairly compensates both sides, and ensure rural communities have access to air ambulance transports. Refusing to fairly negotiate is simply not an option in light of the current crisis. Entering into productive negotiations immediately will ensure that patients across the country have access to the medical care they need and that they are simultaneously protected from balance bills.

Thank you for your attention to our concerns.

Sincerely,

Sally Greenberg
Executive Director
National Consumers League

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.

Coronavirus and unsafe working conditions for poultry workers

By Nailah John, Linda Golodner Food Safety and Nutrition Fellow

In these uncertain times of COVID-19, many workers are being exposed to the disease at poultry plants across the United States. Eater notes that many of these workers are Black, Latino, or immigrants earning low wages and working in overcrowded conditions to package the items that end up on the plates of many families across the States.

Let us dive in a little deeper. The Los Angeles Times has highlighted the spike in coronavirus and meat plants across the United States, with hundreds of reported cases in the last week. This is, of course, a concern to the food supply chain and worker safety. The Associated Press has reported that massive meat processing plants have temporarily closed due to workers contracting COVID-19. This raises concerns about shortages of beef, pork, and poultry. At the same time, workers are being exposed and are succumbing to COVID-19.

The New York Times also reported that workers are standing elbow-to-elbow to do the low-wage work of cutting and packing meat. Many have been on the front line of these packing plants while being sick because they cannot afford to stay home and sacrifice paychecks. Some have staged walkouts to protest being insufficiently protected. United Food and Commercial Workers (UFCW), which has a seat on the National Consumers League’s Board of Directors, has engaged in talks with Cargill, which has agreed to give employees a $2/hour emergency pay increase in addition to a pay raise. The union and Cargill are working on ways to better practice social distancing within the packing plants. Increased sanitization and screening at the plants, and virtual health visits will be expanded for those seeking care health care.

Each day brings new information about COVID-19. When going to the store to purchase meat, let us remember that someone stood in a plant slaughtering and packing it. They are on the frontline risking their lives so that we can eat. UFCW is calling on ALL food employers to step up by developing ways to protect workers and by compensating them commensurate with the risks they are taking to deliver quality products to the grocery stores, restaurants, and family tables of America.

Nation’s pioneering consumer-worker organization demands massive COVID-19 testing production, universal testing

April 23, 2020

Contact: National Consumers League – Carol McKay, carolm@nclnet.org, (412) 945-3242 or Taun Sterling, tauns@nclnet.org, (202) 207-2832

Washington, DC –The National Consumers League (NCL), the nation’s oldest consumer and worker advocacy organization, is demanding that the federal government put its support behind massive COVID-19 test production and, as quickly as is feasible, put in place a testing protocol for every citizen so that America can get back to work.

“There are calls across the country to reopen businesses; we understand and share that frustration,” said NCL Executive Director Sally Greenberg. “However, as we are currently not allowing tests for people who are asymptomatic—and because 25 percent of people who carry the virus don’t show symptoms—doing so would be reckless. It’s a Catch-22. Until everyone is tested, we can’t send symptom-free people back into the world. So the government’s first order of business must include giving America’s labs and drug companies the goal and the means to produce rapid-response testing for every American within the next month.”

NCL has laid out the following recommendations:

Meet the need for testing in clinics and doctors’ offices

The Food and Drug Administration (FDA) must oversee the process of improving techniques and reliable, accurate test production. Many labs are working on this, addressing the immediate need for care providers to have enough, high-quality tests.

“The Senate has voted to include $25 billion for the clinical labs that make the tests in the next COVID legislative package” said Greenberg. “That is welcome news because states cannot do this alone; they end up competing against each other for tests and other supplies.”

As Maryland Governor Larry Hogan (R-MD) said this week, “Every governor in America has been pushing and fighting and clawing to get more tests, not only from the federal government, but from every private lab in America and from across the world. It’s nowhere where it needs to be.” Virginia Governor Ralph Northam (D-VA) noted that the President’s claims that the country has enough tests for the virus are “delusional.”

Clearly, quality is paramount. The serious stumbles at such premier institutions as the Centers for Disease Control and Prevention (CDC) cannot continue. “The federal government must continue to support and expand the production of quality tests, and at capacity to meet the current needs of care providers,” said Greenberg.

Universal testing

As stated above, though, in order to get people back out to restart the economy, we cannot only test those who show serious symptoms and go to care providers to get tested. We must develop tests that can be self-administered, and in adequate numbers so that each person can test for COVID before leaving the home on any given day.

“Millions of workers have to take drug tests every day to keep their jobs; those tests are rapid-response. Consumers can buy rapid response tests for strep throat and pregnancy,” said Greenberg. “Those are approved FDA products that are tested for accuracy and safety. We must get to a rapid response COVID-19 home test as soon as possible.”

In order to determine who has COVID-19 and should be quarantined, every American must be able to test for the virus on a regular basis. Those who test positive, with or without symptoms, go into quarantine for 14 days, as do the people in that individual’s household. Those who test negative are cleared to go out in the world to get the trains running again. This would call for hundreds of millions of tests to enable on-going testing, as it is the only path forward at this time.

And the technology is not “pie-in-the-sky.” The FDA has already approved one home-test kit, though it requires lab analysis. And BARDA/HHS has funded another company to develop “a rapid antigen and antibody diagnostic to identify current or past SARS-CoV-2 infections in 60 seconds.” We are on the road.

Antibody testing

While it’s not clear how long antibodies create immunity, there is a belief that they at least do so for the short-term. So the next step would be to provide serology testing for people who test negative for COVID-19, using only tests approved by the FDA to ensure quality and accuracy. To date, the FDA has approved only four tests of the many available, but this is an important start.

Those who are determined to have a sufficient level of antibodies should be cleared to go back to work, while still wearing masks and gloves until science has confirmed decisively that antibodies create immunity. If the individuals don’t have antibodies, they would be advised to stay home, but could be cleared to go back to work so long as they test every day before heading out.

Contact tracing

Everyone who tests positive reaches out to everyone they’ve had contact with and those people test for COVID-19. Anyone then testing positive goes into quarantine, and the process repeats.

Use technology to self-surveil

Finally, we need a system for uploading test results each day to our phones – like the bar codes we use to board an airplane – or to carry evidence that we have taken the test, have antibodies to COVID-19, and can work or otherwise go out.  Enforcement would be a new challenge, given our commitment to civil liberties, but one that we can certainly work out.

Longer term: Vaccinate

In a year or more, when a vaccine arrives, 95 percent of Americans will need to be vaccinated to achieve herd immunity and widespread protection.

“Our nation has the know-how and manufacturing infrastructure to produce the millions of tests needed to determine whether someone has the virus,” said Greenberg. “But due to lack of leadership at the top, our testing capacity is still, several months after the outbreak, extremely limited. To date only 3.3 million people have been tested, according to the COVID Tracking Project. That’s about 1 percent of the population. That is simply not enough.”

NCL is demanding that the Federal government respond to the current national Coronavirus emergency as President Roosevelt responded to World War II, and challenge Americans to “harness the efficient machinery of America’s manufacturers” to fight the pandemic.

“We need that call to action now, to challenge America’s labs and drug companies with the goal of producing testing for every American within the next month. Federal health care agencies including CDC, National Institutes of Health (NIH), and FDA should be their partners, and this should be a shared cost,” said Greenberg. “In the midst of the worst unemployment numbers ever seen in American history, and with millions of businesses having their existence threatened, we need federal leadership, expertise, and financial support to make this happen, and we need it now.”

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About the National Consumers League

The National Consumers League, founded in 1899, is America’s pioneering consumer organization. Our mission is to protect and promote social and economic justice for consumers and workers in the United States and abroad. For more information, visit www.nclnet.org.