Associated Press: Transgender people receiving Medicare may no longer be automatically denied coverage for sex reassignment surgeries, a US Department of Health and Services review board ruled Friday in a groundbreaking decision that recognizes the procedures as a medically necessary and effective treatment for individuals who do not identify with their biological sex.
Ruling in favor of a 74-year-old Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago, the agency’s Departmental Appeals Board ruled that a three-decade-old HHS rule excluding such surgeries from the procedures covered by the national health program for the elderly and disabled was unjustified.
WASHINGTON — Legally married same-sex couples just gained a little more recognition in the eyes of the federal government.
The Department of Health and Human Services announced Friday that, starting with the 2015 plan year, insurance companies that provide coverage to opposite-sex spouses must also offer that coverage to same-sex spouses.
"In other words, insurance companies will not be permitted to discriminate against married same-sex couples when offering coverage," Matthew Heinz, the director of LGBT outreach at HHS, wrote in a blog post.
The clarification to the agency’s rules stems from last year’s landmark Supreme Court ruling that the federal Defense of Marriage Act, which defined marriage as between a man and a woman, is unconstitutional. The update applies to all Qualified Health Plans, which are plans that meet the minimum standards of the Affordable Care Act and are certified by the state or federal exchange where it is purchased.
Heinz notes that it’s already the case that married same-sex couples must be treated equally when it comes to seeking financial assistance for buying coverage through the health insurance marketplace, regardless of where they live. So, for example, if a same-sex couple who is legally married in Massachusetts moves to a state like Texas, where gay marriage isn’t recognized, that couple must still be treated the same as an opposite-sex married couple when it comes to seeking financial help for purchasing coverage.
Even before President Obama signed the Affordable Care Act into law, Republicans were vowing to repeal it. It’s no wonder, because polls showed that the basic elements of the ACA were quite popular, and there was a real danger that it would become more so as people found out that the plan denounced as a “monstrosity” by the National Republican Senatorial Committee would not trample on their liberties so much as help protect their health. Desperate to avoid this, the GOP-controlled House has voted no fewer than thirty-seven times to repeal Obamacare in the three years since it was enacted.
Now letters produced by a Freedom of Information Act request reveal that many of these same anti-Obamacare Republicans have solicited grants from the very program they claim to despise. This is evidence not merely of shameless hypocrisy but of the fact that the ACA bestows tangible benefits that even Congress’s most extreme right-wing ideologues are hard-pressed to deny to their constituents.
As I reported here last September, Congressman Paul Ryan, who as Mitt Romney’s running mate in 2012 called for its repeal, sent a letter requesting ACA money for health clinics in his district two years earlier. The Nation has obtained documents revealing that at least twenty other Obamacare-bashing GOP lawmakers have similarly pleaded for ACA funds on behalf of constituents. Among them are Kristi Noem, a Republican lawmaker from South Dakota likely to run for the Senate next year, as well as Ohio Senator Rob Portman, who has been touted as a potential GOP presidential candidate in 2016.
In one of two letters sent by Portman to the Department of Health and Human Services, the senator requested ACA funds to help a federal health center in Cleveland, where the money could help “an additional 8,966 uninsured individuals” to receive ”essential services,” in his words. In Noem’s case, the congresswoman requested ACA funds to construct a community health center in Rapid City to provide primary services to the uninsured. Both Noem and Portman won office in 2010 campaigning vigorously against the law and have since worked to repeal it.
Though notably less transparent, the behavior of these GOP lawmakers parallels that of GOP governors like Arizona’s Jan Brewer, who blast the president’s health reform package while embracing the millions in Medicaid funds that it provides.
The letter writers include GOP rank-and-file Congress members, leaders and committee chairs, all of whom have supported the repeal effort. David Valadao, for example, a freshman representative who campaigned last year on his opposition to Obamacare, requested funds in a letter to HHS Secretary Kathleen Sebelius two years ago for a program to improve “the general health” of the Fresno County area, which he then served as a California assemblyman. Congressman Jeff Denham, a two-term GOP lawmaker who won his seat with support from Tea Party activists, penned a letter recommending the same application for Fresno County. The county Department of Public Health won the grant. Valadao’s and Denham’s offices declined to comment.
The Affordable Care Act authorizes an array of grants to local hospitals, community health clinics and doctor training programs, as well as public health initiatives to improve health and access to care. The billions of dollars in grants are awarded on a competitive basis, and lawmakers on the state and federal levels have sent letters endorsing applicants.
Texas Senator John Cornyn, the Republican whip, wrote to the Centers for Disease Control to recommend a grant for Houston and Harris County. Congressman Michael McCaul, a Republican and the chair of the Homeland Security Committee, wrote a letter praising the same grant request, calling the effort a “crucial initiative to achieve a healthier Houston/Harris County.” Senators Johnny Isakson and Saxby Chambliss of Georgia, Mark Kirk of Illinois and Thad Cochran of Mississippi also recommended grant request approval for public health or health clinic funding.
House Republicans and the Senate Republican Policy Committee have trashed the ACA’s Community Transformation grants as an Obamacare “slush fund.” In the letters seeking these grants, however, GOP lawmakers have heaped praise on their potential. Cornyn writes in his letter that the grant would help “improve the health and quality of life of area residents.” Congressman Aaron Schock, a Republican from Illinois, congratulated a local nonprofit for winning a Community Transformation grant, noting that the program will give “people the tools to live healthier and longer lives.”
The National Republican Senatorial Committee warns of Obamacare that “as this awful legislation gets ever closer to going into effect, the negative consequences are only becoming increasingly clear.” But the NRSC’s chair, Jerry Moran, has hailed programs that exist because of it. In August, he attended a ceremony announcing a $4.7 million expansion of the Community Health Center of Southeast Kansas. A picture posted on Moran’s official Facebook page shows the senator in a suit with his foot on a shovel to break ground for the health clinic. “That funding—that came from the Affordable Care Act, and he voted no,” says Krista Postai, CEO of the CHC-SEK clinics. She adds that Moran had been supportive of health clinics in the past, and she was disappointed to see him vote against the law that made her clinic expansion possible. Postai noted that her clinics are already improving lives with ACA funding, and that there are thousands of uninsured and disabled people in her community who now receive coverage and preventive care thanks to the law.
Some of the letters obtained by The Nation are from lawmakers who are no longer in office, including Jerry Lewis, Bobby Schilling, Kay Bailey Hutchison and Robert Dold.
The letters of support for ACA grants are a reminder (if one is needed) that some Republican claims against the bill reflect politics rather than policy preferences. GOP Congressman Hal Rogers, who rails against healthcare reform as “socialistic,” wrote a letter asking for an Obamacare health clinic grant almost as soon as the money became available. Federal health centers provide a range of healthcare services regardless of a patient’s ability to pay. The ACA dramatically boosts spending on these centers, by about $11 billion, with the goal of reaching 1.25 million additional patients.
Congressman Bill Cassidy, a Louisiana Republican who has led efforts to repeal healthcare reform, stood next to a 6-foot stack of papers he dubbed the “Obamacare Red Tape Tower of Regulations” at a press conference in May. In October, Cassidy posed for a different type of press event, standing with school administrators in Baton Rouge, scissors in hand, at a ribbon-cutting ceremony for three school-based health centers. The ceremony was a celebration of a $500,000 grant authorized by the Affordable Care Act to expand health clinics in area schools.
Before healthcare reform made nearly every federal health program a political football, the Bush administration routinely requested greater funds for federal community health centers with little controversy. But health clinics once supported by the GOP are now on the chopping block. Republicans, led by Congressman Michael Burgess of Texas, have attempted to roll back the ACA’s expanded clinic funding. Also, several of the repeal bills in Congress have targeted the entire law, including funds for health centers and public health initiatives. The fact that they have sought grants for those centers has not stopped Republicans from voting against them. Louisiana’s Cassidy, for instance, voted for Burgess’s bill to shut down funding for clinics.
Whether cutting a ribbon or signing a letter, no Republicans have acknowledged that the health programs they are endorsing are provided by Obamacare.
Some GOP lawmakers have balked at the charges of hypocrisy. “Sen. Chambliss voted against the Affordable Care Act, just as he did the stimulus package. But the bill passed, and if the money is available, we want Georgians to be able to compete fairly with folks from other states for it,” wrote Lauren Claffey, the senator’s press secretary, in an e-mail. Similarly, Senator Isakson’s office e-mailed a statement from the senator claiming: ”I voted against Obamacare and will continue to work to repeal it. However, one of the most important parts of my job as senator is to assist Georgia individuals, businesses and local governments in their dealings with the federal government. Any time one of my constituents has business with the federal government, I try to be as helpful as possible by supporting worthy projects.”
The Family Research Council has caught wind of a new theory percolating in the right-wing blogosphere and in certain circles on Capitol Hill: that the Department of Health and Human Services is using a new Obamacare rule to empower the long-defunct ACORN to commit voter intimidation and fraud.
The new rule in question is HHS’s solution to the problem of signing up 30 million uninsured Americans on the Affordable Care Act’s health insurance exchanges. Under the rule, HHS will recruit “navigators” to walk uninsured people through the process of finding an insurance policy on their state’s exchange. According to the Washington Post, “Groups such as unions, chambers of commerce, health clinics, immigrant-service organizations, and community- or consumer-focused nonprofits can use the grants to train and employ staff members or volunteers to provide in-person guidance — especially to hard-to-reach populations — and to provide space for them to work.”
Boustany’s fears were then picked up by Breitbart.com, which announced this week, “HHS resurrects ‘ACORN’ through Obamacare.”
Yesterday, the Family Research Council picked up this story and ran with it in its daily email, warning that an “army of ACORN, Planned Parenthood, and union activists” will use their roles as insurance navigators to “influence people’s party affiliation.” The email adds: “With this administration, it isn’t a question of whether they would abuse their power—but when!”
The rule, which is available for public comment for the next few weeks, also includes a “voter registration provision,” leading many—including Rep. Charles Boustany (R-La.)—to question how this army of ACORN, Planned Parenthood, and union activists would twist their access to influence people’s party affiliation. With this administration, it isn’t a question of whether they would abuse their power—but when!
ACORN, of course, disbanded in 2010 after a right-wing smear campaign accused it of large-scale voter fraud – accusations that turned out to be completely false. But that hasn’t stopped 49 percent of Republican voters from believing that ACORN stole the 2012 election for President Obama – an illusion gleefully perpetuated by groups like the FRC.
h/t: Miranda Blue at RWW
Late last week more than a dozen Republican governors declared that they will not build the insurance market exchanges called for by the Affordable Care Act, including prominent names like Bobby Jindal of Louisiana, John Kasich of Ohio, Scott Walker of Wisconsin and Rick Perry of Texas.
On Monday, Mary Fallin of Oklahoma joined them, declaring in a statementthat it “does not benefit Oklahoma taxpayers to actively support and fund a new government program that will ultimately be under the control of the federal government.”
The original deadline for states to notify the Department of Health and Human Services on whether they intend to build their own exchange was last Friday, but the administration extended it to Dec. 14. About a dozen Republican governors are weighing their options, including Chris Christie of New Jersey, Rick Scott of Florida and Terry Branstad of Iowa.
The decisions carry important implications for the long-term arc of Obamacare, which supporters and opponents alike agree is here to stay now that President Obama has been re-elected. The Obama administration wants states to build the exchanges so they have an incentive to make the law work. If the federal government takes over, state-level Republicans have a scapegoat in case things go wrong.
The more states stonewall the exchanges, the more it complicates the task of the federal government. One challenge is that the law lacks an automatic funding mechanism for HHS to set up state exchanges. Enrollment is slated to begin next October, and the exchanges are scheduled to start functioning by January 2014.
Twenty-three states, mostly Democratic, and Washington, D.C. have said they’ll move forwardwith the exchanges, either on their own or in partnership with the feds.
Propelling the GOP governors’ stance is a desire to protect themselves politically from accusations of abetting a law that conservatives fervently oppose. Some governors argue that the regulations are too stifling and provide little flexibility for them to construct the marketplaces in accordance with their states’ needs.
h/t: Sahil Kapur at TPM