BY NATHANIEL WEIXEL - 11/24/18
08:11 PM EST 741
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."
Jessie Hellmann contributed.
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