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Volume 1, No. 38, November 12, 2019

District Court Strikes Down Trump Administration’s “Conscience Rule”
 
A federal district court judge in New York struck down [ [link removed] ] the Trump administration’s “Protecting Statutory Conscience Rights in Health Care [ [link removed] ] ” rule, also known as the “conscience rule.” The rule was determined to be unconstitutional on the basis of legal defects [ [link removed] ] found in the rulemaking process as well as its disproportionate impact on women and the LGBTQ community.
 
Designed to bolster the rights of providers to opt out of care, even without prior notice of their objections to their employer, the rule would allow health plans and providers to refuse to cover or perform services like abortion, contraception or gender transition procedures that they oppose on religious or moral grounds. It would also expand the type of workers who are able to file complaints about rights violations under this rule to include billing staff, receptionists and anyone else who, in any way, “assist[s] in the performance” of a procedure. The rule was set to take effect on Nov. 22 before it was halted by the District Court’s ruling.
 
During the District Court hearing, 26 plaintiffs—comprised of representatives from states, local governments and advocacy groups—argued that the rule threatened funding they have long relied on and would drastically disrupt the health care system’s ability to deliver appropriate care—especially to women, LGBTQ community members and other underserved populations.
 
The U.S. Department of Health and Human Services (HHS) asserts that the rule simply clarifies and emphasizes laws already in effect that allow a health care worker to file a complaint with HHS if they are forced to participate in medical care that violates their moral or religious beliefs.

Obamacare Open Enrollment Begins
 
This month, open enrollment began for Obamacare. The enrollment period runs from Nov. 1 to Dec. 15. This year’s premiums [ [link removed] ] for health plans purchased on the health care exchanges are expected to be 4% lower than last year’s and this year more plan options also will be available. An analysis by the advocacy group, Get America Covered, found that 67% of people shopping for coverage on the health care exchanges this year can find a plan for $10 or less, after subsidies.
 
Despite the lower premium costs and increased options, enrollment numbers are expected to decrease for a fourth consecutive year. Enrollment has slipped from a high of 12.7 million in 2016 to 11.4 million in 2019. Various actions taken by the Trump administration have been cited as impacting the enrollment decline, including backing a lawsuit to overturn Obamacare and slashing the marketing budget that would have encouraged enrollment [ [link removed] ] .

Georgia Submits Waivers Seeking to Change ACA Exchanges and Implement Partial Medicaid Expansion
 
Over the past two weeks, Gov. Brian Kemp (R) of Georgia has submitted several proposals to the Centers for Medicare and Medicaid Services (CMS) seeking to make significant changes to the state’s Affordable Care Act (ACA) exchange market as well as the state’s Medicaid program. With regards to the state’s ACA exchange [ [link removed] ] , Gov. Kemp has proposed the implementation of a reinsurance program [ [link removed] ] , which provides payments to insurers to help offset large medical claims. The proposal also includes moving the ACA exchange from federal to state control, implementing a state-based subsidies program to replace federal subsidies and offering plans that don’t meet full requirements under the ACA.
 
While several states operate their own exchange markets, Georgia would be the first to operate a decentralized exchange rather than one offered on a government platform. The state would also restructure subsidies to allow them to be used for health plans that do not offer all benefits required under the ACA. It would also place a cap on state funding for subsidies. While subsidies would be funded through a combination of state and federal funds, the cap on state funds could result in some who qualify for subsidies being placed on a waitlist if demand for subsidies is greater than the funds allocated by the state.
 
Kemp also has submitted a waiver requesting permission to implement partial Medicaid expansion [ [link removed] ] to cover individuals who earn incomes up to the federal poverty level. Under the ACA, states can expand Medicaid to individuals who earn up to 138% of the federal poverty level. If the state chooses to implement full Medicaid expansion, the federal government will provide 90% of the funds required to provide coverage to the expansion population. If a state chooses to pursue implementation of partial expansion, the state will first need to receive permission to implement the proposed expansion, and CMS will need to approve a waiver to provide the full 90% match. Utah recently attempted to implement a similar expansion and, while CMS granted the state permission to implement the partial expansion, CMS also indicated it would not approve [ [link removed] ] the 90% match in federal funding for states that implement partial expansion.
 
Kemp’s plan also includes a work requirement for Medicaid expansion recipients. A federal judge has struck down work requirements [ [link removed] ] in three other states.

The Impact of Recent Elections on Health Care and Higher Education
 
Last week, voters went to the polls to decide state office holders in a handful of states [ [link removed] ] , and the results could have an impact on health care and higher education. Gubernatorial elections were held in Kentucky and Mississippi, and New Jersey, Mississippi and Virginia decided on representation in state legislatures:
 • Kentucky

While the Kentucky race is currently too close to call, the Democratic candidate and current state Attorney General Andy Beshear holds a slim lead and appears to be the likely winner, although incumbent Gov. Matt Bevin (R) has so far refused to concede [ [link removed] ] the race.
 
If the results hold and Beshear is declared Governor-elect, he has stated that he will rescind the state’s Medicaid waiver [ [link removed] ] , which calls for the implementation of work requirements as well as premiums for recipients. While a federal judge has twice struck down the state’s work requirements, Bevin was appealing the ruling in the U.S. Court of Appeals. With regards to higher education, Beshear’s potential election could have an impact on funding in a state that has seen some of the largest cuts [ [link removed] ] to higher education in the last decade. During his tenure, Gov. Bevin had proposed multiple cuts to higher education, and shifted the state’s funding model to one that is performance based. Beshear is on the record calling for increases [ [link removed] ] to higher education funding, and even won a lawsuit challenging an attempt by Gov. Bevin to implement a funding cut without legislative consent.
 
 • Virginia

In Virginia, Democrats took control of the state legislature, giving the party control of both chambers of the legislature and the Governor’s office for the first time since 1994. Their agenda [ [link removed] ] will likely tackle a number of issues including gun control, K-12 education and health care. With regards to Medicaid specifically, it could mean the state will not roll out work requirements as part of the state’s Medicaid expansion plan.
 
Implementation of the Medicaid work requirement had stalled [ [link removed] ] over a dispute between the Gov. Ralph Northam (D) and the Trump administration regarding the federal government’s role in providing funds for workforce training programs, but with Democratic majorities in the legislature, it is possible the requirements will be removed completely [ [link removed] ] .
 
 • Mississippi

In Mississippi [ [link removed] ] , Republicans maintained control of the legislature and the Governor’s office. Mississippi is one of 14 states that has yet to expand Medicaid and while Governor-elect Tate Reeves (R) has stated his opposition to Medicaid expansion, the state’s incoming Lt. Gov. Delbert Hosemann (R) has voiced his support. In Mississippi, the Lieutenant Governor holds some legislative power as the person in that position also serves as President of the Senate. In this role, the Lieutenant Governor presides over the State Senate, appoints committee chairs and has the tie-breaking vote. This authority could give Lt. Gov. Hosemann the ability to push for Medicaid expansion.
 
 • New Jersey

The election in New Jersey is unlikely to result in significant change from the status quo. While Republicans gained some ground in the New Jersey Legislature, they did not gain enough seats to have a significant impact in the majority Democrat state legislature.

ADEA State Calendar [ [link removed] ]

ADEA Washington Calendar [ [link removed] ]

ADEA U.S. Interactive Legislative and Regulatory Tracking Map [ [link removed] ]

Key Federal Issues [ [link removed] ]

Key State Issues [ [link removed] ]

The ADEA Advocate [ [link removed] ] is published weekly. Its purpose is to keep ADEA members abreast of federal and state issues and events of interest to the academic dentistry and the dental and research communities.
 
©2019
American Dental Education Association
655 K Street, NW, Suite 800
Washington, DC 20001
202-289-7201, adea.org [ [link removed] ]

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B. Timothy Leeth, CPA
ADEA Chief Advocacy Officer
 
Bridgette DeHart, J.D.
ADEA Director of Federal Relations
 
Phillip Mauller, M.P.S.
ADEA Director of State Relations and Advocacy
 
Brian Robinson
ADEA Program Manager for Advocacy and Government Relations
 
Ambika R. Srivastava, M.P.H.
ADEA/Sunstar Americas, Inc./Jack Bresch Legislative Intern
 
[email protected] [ mailto:[email protected]?subject=State%20Update%3A%20 ]

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