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Trump v. California

In this corner: Health

For basic background, start with The weigh-in: Health

issue
Family Planning
Medi-Cal
Obamacare
status
All talk, no action—yet
It's on!
Punch
Counter-punch
On the ropes
Draw!
California wins!
Trump wins!
Counter-punch

The state of California filed a petition yesterday seeking to pause new Trump administration rules that allow employers to opt out of providing birth control coverage through employee insurance.

State Attorney General Xavier Becerra is asking for a nationwide injunction on the rule. In October, Becerra sued the administration over the rule, claiming it is discriminatory and violates the First Amendment because employers can use religious reasons to deny benefits.

“A woman’s birth control and health decisions should be made by a woman in consultation with her doctor—not by her employer and not by politicians,” Becerra said yesterday in a statement.

Last week, attorneys general in Virginia, New York, Maryland and Delaware joined Becerra’s lawsuit.

Under the Affordable Care Act, employer-provided health insurance is required to cover birth control.

Counter-punch

California requested a temporary restraining order today against the Trump administration, to ensure it continues to pay the health care subsidies it slashed last week while a lawsuit filed by state Attorney General Xavier Becerra and 18 other attorneys general and the District of Columbia winds its way through the justice system.

Announcing the move, Becerra said if his request is granted the federal government would have to continue to make cost-sharing payments that help low and middle-income individuals afford health care through the Affordable Care Act.

“These payments must be made,” said Becerra, who was in Congress when the Affordable Care Act passed. “We are going to fight to make sure the presidents doesn’t pick and choose which laws he’s going to follow.”

Healthcare experts say cutting subsidies weakens the health care law and opens the door for higher premiums and for some insurers to close in certain markets.

In California, consumers would not see such effects for some time. The state’s insurance exchange, called Covered California, developed rates for 2018 on the assumption that the subsidies might disappear and asked providers to add a surcharge to certain plans to cover the uncertainty.

But in 2019 Californians could see significant increases in premiums and care costs if the subsidies do not resume. Rates for 2019 have not yet been set.

About 670,000 people in California receive significant discounts on premiums, deductibles and co-pays due to the federal subsidies, said Tam Ma, a director for Health Access California, a consumer advocacy group. She said those who qualify for the aid are working, earning up to $29,000 annually for an individual and up to $61,000 for a family of four.

“Discounts allow families to have financial stability,” she said.

Last week, the Trump administration said it would stop paying the subsidies, arguing they were illegal because Congress did not approve them.

Covered California is gearing up to begin open enrollment Nov. 1.

But “for too many people,” Becerra said, “it’s a decision between paying rent or paying medical bills.”

Today’s action follows a lawsuit that Becerra and the other attorneys general filed against the Trump administration Friday for cutting the subsidies.

“I and many of my attorney-general colleagues will fight vigorously to ensure Californians and all Americans as taxpayers receive the healthcare the law provides,” Becerra said Friday.

It's on!

The Trump administration will cut off health care subsidies to insurers that help cut health care costs for low-income Americans, the White House announced  yesterday.

California Attorney General Xavier Becerra immediately threatened to sue the administration to protect the health subsidies.

Health care experts say not issuing the assistance to cover health care costs for the neediest could derail the health insurance exchanges and will push up the price of premiums and cause some insurers to leave the marketplace.

In a statement, the administration said it “cannot lawfully” make the payments anymore. Nationwide, those payments are estimated to be worth about $7 billion this year, about $800 million of which is earmarked for California. Former President Barack Obama began the subsidy payments, despite the lack of approval by Congress.

“The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system,” a White House statement read. “Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people.”

The subsidies help individuals and families that earn between 100 and 250 percent of the federal poverty level buy health insurance on the exchanges.

Covered California, the state-run insurance exchange, announced its new pricing Wednesday and planned for the possible cuts Trump announced a day later. The program added a surcharge to the price of Silver-tier plans to make up for any potential loss of the assistance from the federal government, Covered California said. As a result, the state projects that premiums for four of five consumers will remain the same or decrease, including those who do not qualify for subsidies and those who buy directly from health insurers.

As of March, there were 1.2 million Californians receiving subsidies through the Affordable Care Act, also known as Obamacare.

It's on!

The Trump administration is rolling back a contraceptive mandate that required nearly all employers to provide birth control to employees at no cost through employer-provided health insurance—and California immediately vowed to sue to retain the Obama-era regulation.

“There is no entity more impacted with more women who would feel the harm more immediately than California,” state Attorney General Xavier Becerra said today during a call with journalists. “We’re prepared to act, including in court, and we’ll do it swiftly.”

The U.S. Department of Health and Human Services issued the new rules today and U.S. Attorney General Jeff Sessions released a memo saying that employers have a right to choose not to offer birth control.

“To the greatest extent practical and permitted by law,” the memo said, “religious observance and practice should be reasonably accommodated in all government activity, including employment, contracting, and programming.”

This comes three years after  Hobby Lobby sued over this issue arguing it should not have to provide birth control through its insurance program because of religious beliefs. The company won that battle because the court decided closely-held private companies could be exempt from the mandate.

Under former President Barack Obama, the mandate required that contraception be provided at no cost as a preventative measure. A limited number of exemptions were granted to churches and other faith-based entities that are religiously opposed to birth control.

Experts say the change under President Trump could allow many more employers to drop coverage. That’s because the rule covers two groups: entities that hold religious beliefs and businesses that object “on the basis of moral conviction which is not based in any particular religious belief.”

Becerra called the move a violation of the First Amendment and said it constituted discriminating against women.

The National Women’s Law Center reports that over 55 million in the U.S. women obtain birth control at no cost to them through health insurance.

The ACLU and the National Women’s Law Center are also preparing legal challenges to the change.

On the ropes

A bill that would have allowed Californians to buy “pro-choice” license plates—designed as a small but symbolic rebuke to President Trump and congressional Republicans—has died in an Assembly fiscal committee.

The bill had sailed through the state Senate and an Assembly policy committee, but it was among dozens of bills the Assembly Appropriations Committee blocked as the Legislature heads into its final days of the session.

Senate Bill 309’s author, Democratic Sen. Hannah Beth Jackson of Santa Barbara, said she was disappointed. “I hope to continue pursuing this effort,” she said in a statement, “because I think it is an important statement and opportunity for Californians to express their strong support for women’s reproductive healthcare.”

Her legislation would have directed the California Department of Motor Vehicles to offer a “California Trusts Women” specialty license plate if 7,500 orders were placed.

Proposed pro-choice license plate

One proposed pro-choice license plate, featuring an image by Mimi Pond

Jackson wrote the bill so that the money raised would help fund the state’s Family Planning, Access, Care and Treatment program, which helps pay for services for $1.8 million low-income Californians. But bill came with a price tag: An analysis by the Assembly Appropriations Committee estimated it would cost the up to $590,000 to create the specialized license plate, including computer programming changes, new forms and administrative costs. The state would have been reimbursed by the fees Californians would have paid to get the plate.

Earlier this year, Trump and Congressional Republicans had targeted abortion providers in their unsuccessful rewrites of the Affordable Care Act, seeking to gut federal funding to any provider that offers abortions as part of its family planning services.

More than two dozen other states offer residents a “pro-life” license plate option—an idea that has not advanced in the California Legislature given that Democrats hold super-majorities in both chambers.

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