Jeanette Contreras portrait

Leaders in Congress support safe OTC hearing aid standards

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By NCL Director of Health Policy Jeanette Contreras

Mild to moderate hearing loss is a difficult reality that millions of Americans struggle with, which is why the availability of over-the-counter (OTC) hearing aids is exciting for those who are impacted by hearing loss. While making OTC hearing aids more accessible is a promising step for consumers, we at NCL would be remiss if we didn’t underscore our concerns around the Food and Drug Administration’s (FDA) proposed OTC hearing regulations as they currently exist.

In December of last year, NCL was one of hundreds of organizations who submitted a comment to FDA’s public docket on the issue; and last month we submitted a letter voicing our concerns to the FDA that was supported by 29 not-for-profit, public health organizations across the country. These organizations collectively represent the concerns of millions of consumers, patients, and individuals impacted by hearing loss.

We want to reiterate our enthusiasm for OTC hearing aids, but as the gold standard of safety in our country, it is imperative that the FDA make sure these devices are safe for consumers and do not worsen a problem they are intended to mitigate. As written, the draft regulations would allow for a maximum sound output level of 120 dBA – equivalent to the volume of a chainsaw or fire engine siren. This is concerning, as exposure to sounds at 120 dB can be dangerous in as little as nine seconds according to the CDC. This is why NCL, along with other leading consumer and healthcare voices, encourage the FDA to follow the recommendations of hearing care professionals, including the American Academy of Otolaryngology–Head and Neck Surgery that recommend a maximum output of 110 dB and a gain limit of 25 dB. Without a limit on gain, OTC hearing aids users will be able to amplify sounds to dangerous levels, and far beyond what Congress authorized when it said these devices must be limited to adults with moderate hearing loss or less.

The safety parameters we are recommending would in no way compromise the efficacy of OTC hearing aids intended for individuals with perceived mild to moderate hearing loss. In fact, a recent study concluded that commercially-available hearing aids programmed according to parameters typical of those used for individuals with mild to moderate hearing loss yield effective output and gain levels and are within the recommended limits specified by leading hearing care organizations and medical experts.

Importantly, the FDA has already cleared several hearing aids for adults with perceived mild to moderate hearing loss that were found to be safe and highly effective during clinical trials. While these devices were authorized under a different category of hearing aids, these devices limit the maximum output to 115 dB or below and gain to 30 dB or less, lower than the amplification limits currently proposed by the FDA. At the very least, the FDA should incorporate these amplification limits in the final OTC hearing aid regulation.

Finally, as we await finalized guidance from the FDA, we applaud leaders in Congress who are standing behind consumers in supporting safe and effective amplification limits. Last month, Congresswoman Betty McCollum (D-MN) and Congresswoman Rosa DeLauro (D-CT) sent a letter to the FDA echoing their safety concerns. The letter states, “[The proposed rule] hurts consumers and patients in two ways. First, it means individuals suffering from greater levels of hearing loss could put off a needed visit with a licensed hearing professional. Doing so could lead to worsening their existing symptoms, delaying an accurate diagnosis and treatment, and even creating irreparable damage to their hearing. Secondly, it means those with perceived mild-to-moderate hearing loss would be exposed to harmful levels of noise that could result in further damage to their long-term hearing. In order to avoid these concerns, FDA should impose a gain limit of 25 dB and an overall output limit of 110 dB.”

Similar to the countless other experts that have also weighed in, we believe that establishing safe amplification limits would not reduce the efficacy of these devices or limit the advancement of innovative technologies. We thank Congresswomen McCollum and DeLauro for being a voice for consumers and patients on this important issue. To learn more about gain and output and how to protect yourself from hearing loss, check out our infographic.

Jeanette Contreras portrait

How to protect consumers from PBM greed

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By NCL Director of Health Policy Jeanette Contreras

The rising cost of health care is a sore point for all consumers and nowhere is it more glaring than at the pharmacy counter. However, consumers are largely unaware that Pharmacy Benefit Managers – or PBMs – are the middlemen working behind the scenes with very little competition and accountability. There are now just three PBMs that account for about 77% of all equivalent prescription claims. This lack of competition allows PBMs to easily manipulate the price and make it impossible for consumers to get a fair deal.

There is plenty of blame to go around when it comes to the rising cost of prescription drugs. But PBMs ultimately control which medicines we get (and don’t get) and how much we pay out of pocket for them. That’s exactly why the Federal Trade Commission (FTC)– whose mission is to protect consumers and competition – has requested public comments on the ways these large, middlemen companies are affecting drug affordability and access.

I recently led a discussion with key experts to discuss this issue. NCL’s Executive Director Sally Greenberg, Former FTC Policy Director David Balto, and HIV + Hepatitis Policy Institute Executive Director Carl Schmid, shared their insights with us.

David Balto explained, “There are three things needed for a market to really function effectively – you need to have choice (competition); second, transparency – that is you know what you’re getting and what the benefit of the bargain is; and third, that there’s no conflict of interest. In the PBM market, PBMs fail on all three grounds.”

PBMs initially came into existence to streamline how consumers get their medicines and were intended to lower costs. However, as Sally Greenberg pointed out, “The fact that PBMs have the influence and decision-making authority they do should be concerning for all consumers. PBMs have the power to negotiate discounts with drug manufacturers, they work with insurance companies to determine which drugs will ultimately be covered, and they work with pharmacists to reimburse them for dispensing drugs. All along the way, they’ve found ways to profit – and all along the way this impedes the savings that should be going to consumers.”

Carl Schmid shared more about how this impacts patients, “We’re now seeing the creation of specialty drugs or specialty tier (on formularies). This is a term created totally by the PBMs…now it’s just any new drug – all HIV drugs, all Hepatitis drugs, all cancer drugs – they’re all specialty drugs these days and they put them in the highest tier. And this not only creates higher out-of-pocket costs for patients, but it’s also discriminatory.”

These unfair PBM practices lead to unnecessarily high out-of-pocket costs for prescriptions while PBMs continue to find ways to game the system to their benefit. The FTC wants to hear from consumers and patients who have been negatively impacted by these PBM practices.

Watch the full discussion here to learn more about the PBM problem. Then share your story with the FTC here.

NCL Briefing: measuring the 340B program’s impact on charitable care and operating profits for covered entities

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Join the National Consumers League for a panel discussion with experts from Health Capital Group, the Community Oncology Alliance, and Johns Hopkins on this new white paper, which analyzes 340B’s impact on hospital profit margins and charitable care spending and attempts to quantify the amount of program benefits accruing to covered entities, contract pharmacies and patients.

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Breyault and Amazon’s Alyssa Betz discuss policing fake reviews and counterfeits

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By NCL Staff

 

This week, John Breyault, our Vice President of Public Policy, Telecommunications, and Fraud, sat down with Amazon’s Director of Public Policy, Alyssa Betz. On this episode of NCL’s We Can Do This! podcast, Alyssa and John discussed fake reviews, Amazon’s product liability, and more. This has been the latest collaboration between Amazon and NCL in our partnership towards improving consumer safety and online experiences.  

Fake Reviews 

With users increasingly relying on user reviews to make buying decisions, having access to trustworthy reviews is critical for consumers. Last month, Amazon sued a group of review brokers who were allegedly paying for fake reviews at large scale. In addition to discussing the suit, Betz outlined some of the steps they have taken to ensure that user reviews are trustworthy and accurately reflect consumers’ experiences. 

Counterfeits 

Given the vast number of products sold through nearly two million sellers worldwide, Amazon has an enormous responsibility to ensure consumer safety. Alyssa discussed some of the measures Amazon has taken to reduce criminals’ ability to operate on their platform, including investing over $700 million and employing more than ten thousand people to protect its store from fraud and abuse, including counterfeit products.

To hear the full episode, including John and Alyssa’s conversation about product liability and how to spot those phony Amazon delivery phishing texts, click here. 

If you have received suspicious communications or packages claiming to be from Amazon, you can find Amazon’s support page here. 

Nancy Glick

Consumers need accurate product names and labeling of plant-based meat products

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Nancy GlickBy Nancy Glick, Director of Food and Nutrition Policy

With mounting information that plant-based diets are generally better for people’s health and the environment, many consumers are giving “meatless meats” a try.

About two-thirds of Americans consumed “plant-based meat alternatives” – or PBMAs – in the past year, with 20 percent eating them at least weekly, according to an August 2021 survey from the International Food Information Council (IFIC).[1] As a result, current estimates put the market for PBMAs at $1.4 billion – up from $962 million in 2019[2] –and a Bloomberg Intelligence Report predicts a 500 percent increase in global sales of plant-based foods globally by 2030.[3]

It is easy to understand consumers’ excitement about meatless products that closely resemble the look, feel and taste of burgers, sausages, deli meat and other products made from beef, pork, chicken, eggs and seafood. Polling shows consumers’ top reason for buying these products is the perceived healthfulness of PBMAs. The most sought-after benefits consumers cite are heart health and a good source of high quality and complete protein.

Yet, the reality is that plant-based meat products vary in their formulations, nutritional content and can be high in saturated fat and sodium. These products are often packaged in the same way as their animal protein counterparts and routinely sold next to the meat section in supermarkets. Thus, consumers need clarity in labeling to ensure product names, descriptions and packaging are not misleading and consumers have the qualifying terms to make informed decisions.

As the agency that regulates plant-based foods in the US, the Food and Drug Administration shares this viewpoint. Later this year, FDA will issue draft guidance on the labeling of plant-based milks and plant-based alternatives to “animal-derived foods” (meats) under the umbrella of the agency’s Nutrition Innovation Strategy. The strategy addresses the need for FDA to modernize its regulatory approach for new categories of foods, like PBMAs, developed through the latest technologies.

In developing its draft labeling guidance, FDA has sought information on a range of issues related to labeling, including whether consumers understand terms like “milk” when used in the name of plant-based alternatives and are aware of the nutritional differences between traditional meat and dairy products and their plant-based substitutes. In response, the agency has received thousands of comments from industry groups, manufacturers, academic institutions and professional societies offering their viewpoints. However, the National Consumers League contends that the consumer’s voice must be articulated and heard. Unless the information needs of consumers are clearly defined, FDA’s goal of labeling for transparency and clarity will not be realized.

To provide the consumer perspective, especially regarding decisions about plant-based meat alternatives, in November 2021 NCL and the Academy of Nutrition and Dietetics (AND) convened a panel of experts to assess consumers’ needs for accurate naming, labeling and claims on the package of PBMAs. Comprising regulatory specialists, market researchers, consumer advocates and food industry leaders, the panel also addressed how some key principles laid out in FDA’s Nutrition Innovation Strategy – a common nomenclature, accurate naming and labeling, and elements that assure honesty and fair dealing — can be applied to improve consumer understanding, perception, and decision-making of PBMA products.

In the near future, NCL will issue a full report of the findings of the expert panel and the implications for consumer education efforts and public policy. However, the need to articulate the consumer perspective on labeling PBMAs shouldn’t wait. Therefore, NCL has translated the consensus from the expert panel into a blueprint for FDA and the food industry.

The following are the seven priorities for labeling, naming and marketing plant-based meats alternatives that are in the best interest of consumers:

  1. Establish a definition for the category of “plant-based meat alternatives” that will unite all stakeholders
    Today, many brands, companies and organizations define the term “plant-based” differently and there is not collective agreement on definition of a “meat alternative.” Since these terms represent an entire class of food products, FDA guidance should define what constitutes a “plant-based meat alternative” to promote consistency in labeling across the category.
  2. Ensure brand names are not deceptive
    NCL’s position is it is a deceptive practice to use brand names for PBMAs that suggest a product contains meat, seafood or eggs when none is present or is better/healthier than the traditional animal protein product. Even when the label states the product contains no meat or eggs, consumers are influenced by the brand name, especially if the packaging and content on the website, social media platforms and in ads shows pictures and iconography of animals or the type of meat. 
  3. Require that labels on PBMAs are standardized and clarify the protein source

For labels of PBMAs to be transparent, the naming and labeling of PBMAs must be uniform and consistent and ensure that consumers can readily identify the protein source. Accordingly, FDA should require that all labels and advertisements for PBMAs must:

  • Use a common name that links the protein source and the form, such as “soy burger.”
  • Make clear that the product contains some animal protein in addition to plant-based proteins like soy. Qualifying terms can include “plant-based” and “made from plants.”
  • Make clear when the PBMA contains no meat. These terms can include vegan,” “meatless,” “vegetarian,” “veggie,” and “veggie-based” as well as “plant-based” and “made from plants.”
  • Place the phrase “contains no meat,” “contains no poultry,” or “contains no eggs” on the principal display panel of vegan PBMAs near the common name and in letters at least the same size and prominence as shown in the product’s common name.
  • Not use pictures, icons or vignettes on the packaging, in marketing materials or in advertising that suggests nutrition superiority or that the product is the same as the comparable meat product.
  1. Regulate health/nutrition claims for PBMAs
    Consistent with how FDA regulates the health claims allowed on traditional food products, FDA must make clear in its guidance that nutrition/health claims must undergo review by the FDA through a petition process and there must be significant scientific agreement that the claim is supported by available scientific evidence.
  2. Ensure website, social media, and advertising content for PBMAs conforms to what is on the product label

The guidance must make clear that FDA considers websites and social media to be an extension of the product label, meaning the claims and information that PBMA manufacturers put online must conform what FDA allows on the label.

  1. Address the nutritional composition of the PBMAs in FDA guidance
    In Canada, regulation of PBMAs includes nutritionally required amounts of vitamins and mineral nutrients that must be added to the PBMA product and a minimum limit of total protein content, among other requirements. While NCL supports this approach, FDA should at least recommend levels of key vitamins and nutrients in its guidance and address concerns, such as allergenicity with labeling requirements to flag known allergens, such as soy.
  2. Educate consumers about the nutritional composition of plant-based protein alternatives

It is in the public interest for FDA and the US Department of Agriculture – along with nutrition societies – to conduct education programs that explain the nutritional composition of plant-based protein food products. This will allow consumers to make informed decisions based on science-based information.

Plant-based meat alternatives are a popular and valued part of our food supply. That is why the public needs regulatory policies that ensure the labels on these products are accurate, complete, and provide the qualifiers necessary for consumers to understand what they are purchasing.

[1] International Food Information Council. “Consumption Trends, Preferred Names and Perceptions of Plant-Based Meat Alternatives. November 3, 2021.

[2] Good Food Institute. US retail market data for the plant-based industry. Accessible at: https://gfi.org/marketresearch/

[3] Fortune. Plant-based food sales are expected to increase fivefold by 2030. August 11, 2021. Accessible at: https://fortune.com/2021/08/11/plant-based-food-sales-meat-dairy-alternatives-increase-by-2030/

Why we need more Black health professionals in the workforce

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By NCL Health Policy Associate Milena Berhane

A lack of diversity in the health care workforce has been a persistent issue in the United States, posing significant implications to health equity, particularly for the Black or African American community.

An estimated five percent of physicians identify as Black, despite making up 13 percent of the U.S. population. A recent study utilizing U.S. Census Bureau information found that the proportion of Black physicians in the United States has only increased by four percent in more than a century — from 1900-2018. This study also reported that the percent of Black male physicians has remained relatively stagnant since 1940. Diversity issues also exist in other health care professions, with an estimated 7.8 percent of nurses, 3.8 percent of dentists, and 2.5 percent of physical therapists being Black.

The education, testing, application, and interviewing process required to pursue a career in health care is rigorous and costly. In addition to a four-year degree, candidates are also required to take standardized exams, pay expensive application fees, and pay for travel to interview. Most medical students expect to spend up to $10,000 for the application process. Once accepted to a health professional program, the tremendous monetary and time costs of schooling are immense obstacles for many. Medical school attendees accumulate an average $200,000 of student loans by the time they are finished with their programs.

Due to generations of systemic racism in our country, Black Americans are less resourced — financially and in terms of social capital — than their white counterparts. The rigorous process of applying to and remaining in health professional programs creates a pipeline that excludes disadvantaged students from the ability to pursue careers in clinical care.

The barriers to enter the workforce have further negative impact on communities and health equity. Black patients face a variety of issues that can influence their ability to access medical care, including medical mistrust caused by historical unethical medical mistreatment faced by Black Americans, dismissal of health concerns that Black patients express to health care providers, and others. Time and time again, Black patients have shared their experiences of medical providers ignoring their health concerns, and therefore being undertreated and going undiagnosed for their conditions. In addition, research indicates that Black patients report poorer patient-provider communication and shared decision-making. These issues lead to Black patients receiving lower quality care from medical providers, further worsening health conditions that could be treated.

Racial bias and a lack of culturally competent medical care in the healthcare system has led to poorer health outcomes for Black patients. Black Americans of all ages already face higher rates of hypertension, asthma, diabetes, and other health issues due to systemic racism and how it has affected the environments they live in, the food they have access to, their education prospects, income, etc. These inequities compiled with a culturally incompetent and bias medical system leaves Black Americans with little ability to receive proper medical treatment and improve their health and well-being. Although medical schools are attempting to teach the importance of culturally competent care, it is crucial that Black patients are also able to access healthcare providers that look like them and come from their communities.

Clearly, the current make up of racial diversity of the health care workforce has failed to keep up with the demographic shifts in the United States. Although public health efforts are important in addressing and improving health equity, inequities within the medical system must be addressed simultaneously. The COVID-19 pandemic has only highlighted and exacerbated health inequities. Increasing the amount of Black health professionals across the United States is a critical step in ensuring better health outcomes for Black patients and their overall well-being.

Illicit drugs and the digital marketplace

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By NCL Health Policy Associate Milena Berhane

Technology has brought into the homes of millions of consumers many wonderful tools for accessing the drugs and medical products we need. We, as consumers — at the touch of a few buttons — have access to drugs and devices that would have required far more time and effort to acquire in the past. But with that ease of access, we also have millions of tainted or suspect products peddled to consumers, including counterfeit drugs.

At any one time, there are 35,000 active pharmacies online, according to ASOP Global. Ninety-five percent of them do not comply with applicable laws and pharmacy standards. Counterfeit products sold by this 95 percent are manufactured in often unsafe conditions and contain little or no active ingredients.

Those in charge of online registries could better control this. These registries control the websites that can be set up on the Internet, managing domain name extensions such as .com, .gov, and .org, and .pharmacy. It is critical that Internet registries and registrars monitor the activity on their domains and ensure that illegal activity is prevented.

Consumers look for drugs online for both cost and convenience reasons. It’s understandable that consumers are turning to the Internet for cheaper options when the cost of many prescription drug costs is so high. Those who do undoubtedly don’t understand the risk of illegal online pharmacies; research shows only an estimated 37 percent see little danger in ordering from such a pharmacy. In addition, 7 in 10 Americans incorrectly believe that appearing at or near the top of Internet search results legitimizes such a website.

The COVID-19 pandemic has also played a role in these risks, with an increased sale of online goods, including prescription drugs. About 31 percent of consumers who bought prescription medication online did so for the first time in 2020 because of the pandemic. As a result, now more than ever, we need to ensure that illegitimate online pharmacies are far better regulated, and frankly, put out of business.

The examples are stark. In 2021, the Drug Enforcement Administration (DEA) seized more than 9.5 million counterfeit pills, which is more than what was seized in 2020 and 2019 combined. Due to these high numbers, in late 2021, the DEA warned that “fake prescription pills are widely accessible and often sold on social media and e-commerce platforms — making them available to anyone with a smartphone, including minors.”

We believe that online platforms have the responsibility to enforce their terms and conditions. These registries and registrars are choosing profit over safety by allowing online pharmacies to sell fake drugs and products.

For this reason, the National Consumers League is supporting the DRUGS Act (H.R. 6352/S.3399) which aims to holds Internet registries and registrars responsible for any illegal and illegitimate drugs being sold through their online platforms. Modeled after a pilot “trusted notifier” program, this bill would require registries to suspend a website, conduct an investigation, and then shut the platform down if it is found to be selling illegal substances.

In the meantime, NCL will continue to educate consumers about the dangers of counterfeit drugs. NCL’s FakeRx Action Center provides consumers with the tools to protect themselves from fake drugs and illegal online pharmacies — as well as a place to report counterfeits. Consumers have a duty to do their homework, but we have to make it far harder for fakes and counterfeits to be peddled to unwitting consumers. The DRUGS Act will go a long way to make that a reality.

Airline executive testimony conflicts with travelers’ reality

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By Eden Iscil, Public Policy Associate

Last month, the Senate Committee on Commerce, Science, and Transportation held a hearing titled “Oversight of the U.S. Airline Industry,” which featured the CEOs of the major domestic airlines (American, Delta, Southwest, and United). With the federal government’s $50 billion bailout of the aviation industry serving as the primary focus of the hearing, airline CEOs managed to avoid serious scrutiny despite the massive service failures seen in 2021 and early 2022.  

The underlying problem centers around the air traffic companies choosing to incentivize employees to leave their jobs, despite receiving billions of dollars in assistance from the federal government with the primary condition being not to fire workers. The bailout, officially known as the Payroll Support Program, served as an undeniably central piece to America’s quick economic rebound from the early COVID-19 recession. Yet, airlines still could not service hundreds of thousands of flights over the past seven months due to a lack of staffing. This caused a meltdown of delays and cancellations in the summer and early fall of 2021 and again during the end-of-year holidays over the previous two weeks. 

While certain conditions understandably contributed to flight schedule changes, such as the Omicron variant, the airlines’ lack of preparation remains a consistent problem. For example, in October 2021, Southwest Airlines cancelled more than 2,000 flights, blaming weather and FAA issues. But these excuses do not hold water, as consumers quickly pointed out that while Southwest cancelled 28 percent of its schedule, competitors only cancelled around 3 percent of their flights. A couple weeks later, CEO Gary Kelly acknowledged staffing shortages that had led to Southwest’s service problems. 

The reality travelers have faced does not match the rosy picture airline executives painted at the Senate hearing. Southwest’s Kelly expressed pride in not cutting hours or laying off employees throughout the pandemic. Yet, his airline was still understaffed at the end of October (according to Southwest’s own hiring goals) after the airline reduced its workforce by 28 percent at the onset of the pandemic. To get around the prohibition on involuntary firing, air traffic carriers like Southwest incentivized early retirement and extended time off packages. The results of these practices are visible in every major airport nationwide. 

Additionally, American Airlines CEO Doug Parker told senators that “large events” of cancellations “don’t happen very often” and that a shortage of employees is not a problem. Just a week later, airlines began experiencing staffing troubles, which led to more than 18,000 flight cancellations between Christmas Eve and January 3. Given the predictable spike in COVID infections we have seen during periods of high travel for almost two years, especially during the winter holidays, it is unclear why airlines were entirely unprepared for the latest holiday traffic.  

To be clear, employees absolutely should not report to work when they are ill (hopefully by taking paid sick leave). Given the record-breaking transmissibility of the Omicron variant, workers’ safety needs to remain paramount. It is unfortunate that airlines did not take steps to rectify previous mistakes and increase staffing ahead of the winter travel season in order to avoid the enormous wave of cancellations. In addition to the headaches and last-minute adjustments stranded travelers needed to make, the service failures were especially impactful as this was the first holiday season for many people to enjoy with loved-ones since before the pandemic.

MLK 2022: Reflecting on victories

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By Sally Greenberg, NCL Executive Director

This weekend we celebrate the life of the great American civil rights icon and hero, Reverend Dr. Martin Luther King Jr. This is a good time to reflect on civil rights victories won by Dr. King during his lifetime and the work left do to achieve his vision for voting rights and protections.

This past year, I revisited the site of Dr. King’s 1968 assassination in Memphis and spent the day walking through the powerful civil rights museum attached to the motel where Dr. King was shot. The museum provides the most complete history I’ve ever seen of America’s legacy of slavery and its aftermath. It was so inspiring but also so sad. I contemplated how different the world might be if we had the wisdom of Dr. King’s words and deeds to guide us all these decades.

Greenberg (right) and friend at MLK Rally for Voting Rights in Washington, DC on January 17, 2022.

During Dr. King’s lifetime and because of his work, the nation made great strides in the movement for racial equality:

  • the 1954 decision in Brown v. Board of Education overturning the doctrine of “separate but equal” and forcing the integration of public schools in America, argued by brilliant litigator and future Supreme Court Justice Thurgood Marshall
  • the 1955 Montgomery Bus Boycott, when 40,000 Black bus riders—the majority of the city’s bus riders—boycotted the system. Black leaders met to form the Montgomery Improvement Association (MIA). The group elected Martin Luther King Jr., the 26-year-old-pastor of Montgomery’s Dexter Avenue Baptist Church, as its president, and decided to continue the boycott until the city met its demands. After several federal court cases, Montgomery’s buses were integrated on December 21, 1956, and the boycott ended. It had lasted 381 days.
  • Civil Rights Act of 1957, the first major civil rights legislation since Reconstruction allowing federal prosecution of anyone who tried to prevent someone from voting and creating a commission to investigate voter fraud
  • The 1963 March on Washington organized and attended by civil rights leaders such as  Philip Randolph, Bayard Rustinand Martin Luther King Jr. when Dr King gave his “I have a dream speech”
  • The Civil Rights Act of 1964 and the Voting Rights Act of 1965, banning all voter literacy tests and provided federal examiners in certain voting jurisdictions.
  • The Fair Housing Act, which became law on April 11, 1968, just days after King’s assassination. It prevented housing discrimination based on race, sex, national origin and religion. It was also the last legislation enacted during the civil rights era.

Greenberg marching across the Frederick Douglass Memorial Bridge.

Sadly, as we start this 2022 MLK weekend, many states have chipped away at voting rights and protections. The Brennan Center reports that an unprecedented 19 states have enacted 33 laws that will make it harder for Americans to vote.

A bill to counteract these attacks on voting rights, “Freedom to Vote: John R. Lewis Act” combines the Freedom to Vote Act and the John R. Lewis Voting Rights Advancement Act is awaiting action in the Senate but its prospects for passage are dimming.

If enacted, it would push back against the undermining of voting rights, affecting everything from how votes are cast to how they are tallied across the country. And it would sweep beyond that, remaking campaign finance laws and calling for a significant redraw of the nation’s House districts.

On this MLK Jr. weekend, the best tribute we could pay to Dr. King and his legacy and sacrifice would be to pass the Freedom to Vote Act in the Senate and get it to President Joe Biden’s desk. I’m still hoping for that miracle to happen.

Jeanette Contreras portrait

Reason to celebrate: No more surprise medical bills in the new year!

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By NCL Director of Health Policy Jeanette Contreras

Consumers have grown to expect surprise medical bills as a given in the fragmented U.S. healthcare system. Even people with large employer-sponsored health insurance coverage could expect to receive a surprise bill for an out-of-network medical service. A 2021 report from the U.S. Department of Health and Human Services outlined how more than half of U.S. consumers reported recently receiving an unexpected medical bill — many related to essential services like childbirth, elective surgeries, or emergency services. Thanks to the No Surprises Act, signed into law as part of the Consolidated Appropriations Act of 2021, surprise medical bills will be a thing of the past.

Beginning January 1, 2022, federal protections ban surprise medical bills any time a person receives emergency care, including some non-emergency services. For example, the new law bans out-of-network charges for out-of-network providers who work at an in-network facility. It also requires that cost-sharing for emergency services, like co-pays and co-insurance, be based on in-network rates.

Healthcare providers and facilities will be required to give patients easy-to-understand notice regarding out-of-network care, explaining that it could be more expensive. Providers will also need to tell patients whom to contact if they think the provider or facility has violated the surprise billing protections. Patients will be able to dispute a claim if they receive a medical bill that is higher than the estimated cost given in advance of care.

Whether or not a patient has insurance, they can submit a complaint about a medical billing issue if they have a question or are concerned that their provider may not be following the new rules. For more help, consumers can go to the CMS.gov webpage to submit a claim online or call the No Surprises Help Desk at 1-800-985-3059, 8am-8pm ET seven days a week; (TTY: 800-985-3059).