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April 27, 2023 | Volume 27, No. 3| Archives
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| Are Left-Handed People 'Perverts' and 'Abnormal'?
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| In This Issue:
- Republican Budget: Cuts and Medicaid Work Requirements
- Medicaid Redeterminations (yes, this again)
- A CLOSER LOOK: Are Left-handed People “Perverts” and “Abnormal”?
- Biden Administration Announces Two Expansions in Health Care
- Substance Use: NARCAN, Opioid Settlements, and New Research
- What We’re Reading
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| Republican Budget: Cuts and Medicaid Work Requirements
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Just last night the House of Representatives passed a budget plan for FY24, called the “Limit, Save, Grow Act of 2023.” The plan includes significant cuts to domestic and safety net programs, holds federal budget increases to 1% going forward, raises the debt limit on a short-term basis, rescinds COVID‑19 funding from states, cancels Biden’s student debt forgiveness attempts, repeals climate change provisions passed just last year, and adds stricter work requirements to the SNAP (food stamp) program (as well as Medicaid—see below). This budget itself goes in the opposite direction of the one that President Biden proposed last month (see our discussion in the March Mobilizer), which expands programs by taxing the wealthy at higher rates.
The problem is the immediate need to raise the nation’s debt limit, and the Republican leadership holding this relatively routine administrative task hostage to budget negotiations over policy issues that are separate from the debt limit. Republicans in the House are hoping to push President Biden to concede on the above-mentioned policy issues in exchange for Congress raising the debt ceiling to avoid a catastrophic financial default. However, the Senate is unlikely to pass such a measure so this needless political theater only moves the country closer to defaulting on its debt and triggering a massive recession.
A significant policy change included in the plan is the provision to add a “community engagement” to Medicaid. Make no mistake—this is just another name for “work requirements.” The plan calls for at least 80 hours per month of paid employment or community service for people ages 19‑55 who are not pregnant, disabled, a parent/caretaker of a child or “incapacitated person,” participating in a drug/alcohol program, or enrolled in an educational program. If passed, states would have the option to disenroll from Medicaid any individual who does not meet the above criteria. States that choose not to drop people from coverage will not receive federal reimbursement and must pay 100% of the cost for those individuals.
Work requirements don’t work! First, most people are already working. Second, the vast majority of people who are not working have a very good reason they aren’t employed (being homeless is a full-time job in itself!). Third, getting health care shouldn’t depend on working. This proposal would kick millions of people off Medicaid—making them LESS able to work and regain stability in the future. We’ll be talking more about this in the coming months—so stay tuned!
Related reading
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Take Action on the Budget:
1. Congress must pass a “clean” debt ceiling extension and not hold the budget hostage to the nation’s economic stability.
2. Congress should REJECT cuts to safety net programs and REJECT work requirements in Medicaid.
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| Medicaid Redeterminations (yes, this again)
Last month, we emphasized the critical need to be proactive to prevent catastrophic Medicaid losses as states start dis-enrolling people from Medicaid. This month, we are continuing to push this message as even more states start dis-enrollments.
Refresher: The 2023 omnibus spending bill marked April 1 as the end of the nearly 3-year continuous enrollment of people on Medicaid. 15 million people are anticipated to lose Medicaid coverage—nearly 7 million of them will still be eligible. Worse, most people don’t know this is happening.
New HHS rules give states the option to allow a special enrollment period into private plans on the Marketplaces for those who lose Medicaid eligibility as part of redetermination (though most people experiencing homelessness will have income too low to qualify for these types of plans).
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| Heads Up:
15 states will start dis-enrolling people from Medicaid on May 1 and 23 states will start dis‑enrolling on June 1.
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Take Action on the Medicaid Redetermination: Advocate your state conduct automatic redeterminations and take other steps outlined in our fact sheet to minimize coverage losses. Listen to our March 14 webinar discussion with our national partners on this topic.
Spread the word so that everyone knows this is happening.
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| A Closer Look: Are Left-Handed People 'Perverts' and 'Abnormal'?
Question: Why are there four times as many left-handed people in the U.S. as there were ~100 years ago?
Answer: Historic stigma and discrimination. Prominent criminologists and psychologists in the early 1900s considered left-handed people “primitive and abnormal,” “stubborn, rebellious, rigid people,” and people who “may signify homosexuality, incest, and perversion.” Did you know that schools used to tie children’s left arms to their bodies to train them to be right-handed (or other corporeal punishment)? Stigma and discrimination existed against left-handed people for decades, which makes this 1971 newspaper’s begrudging acknowledgement that “left-handers…are becoming increasingly accepted and enabled to find their right (or left) place in the world” particularly telling.
Relevance: Does this framework (and vocabulary) for stigma and discrimination—based on naturally occurring human traits—sound familiar? It's with this context that I turn to the recent public policy attacks on transgender and non-binary people.
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These public policy attacks fall across a wide range of basic freedoms and rights:
· Health care: Laws limiting access to health care services or health insurance coverage; creating criminal penalties for providers delivering such care
· Education: Laws prohibiting participation in school sports; limiting/censoring what can be said about LGBTQ people or issues in classrooms
· Civil rights: Laws weakening nondiscrimination laws make it easier to fire people or refuse them treatment
· Accurate identification: Laws limiting the ability to change official documents, such as birth certificates or drivers’ licenses
· Free speech: Laws limiting access to books and how/where people can express themselves freely; prohibiting performances like drag shows
· Public accommodations: Laws limiting the ability to use public facilities like bathrooms and locker rooms
These laws are not just being advanced at the state level—but also at the federal level. The House of Representatives just passed a law that restricts transgender students from playing on women’s sports teams, and no doubt plans to advance more legislative attacks that seek to elevate state-level laws to nationwide policy allowing for trans discrimination. Worse, public policy attacks like these make it more acceptable for people to commit violence against transgender and non-binary people as well. Given the stigma and discrimination towards trans folks, it should not come as a surprise that this group experiences high rates of homelessness. All of this is shockingly wrong and unjust.
At the same time, five states have proposed laws protecting health care for those who identify as transgender or non-binary, and 19 states offer legal refuge to trans youth and their families. Let’s acknowledge these examples and promote more solutions to protect our friends and neighbors who are struggling to be safe, seen, heard, valued, and live their lives free of violence and discrimination.
Vision and values: Let’s commit to achieving a society where it is just as irrational and ridiculous to discriminate against transgender and non-binary people as it is to punish those who are left-handed. When we allow human beings to be their authentic selves, greater numbers of diverse expression naturally emerge. Let’s re-commit to centering our advocacy on values that promote dignity, love, inclusion, human rights, and equity in our struggle towards Justice.
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Take Action to Support Trans/Nonbinary People:
As health care providers, testify at legislative hearings in support of gender-affirming care (or take other actions, such as writing op-eds, writing letters to elected officials, etc.). Use our Advo-Kit to help you navigate advocacy actions.
Call your Congressional representatives and ask them to support The Transgender Bill of Rights (H.Res 269), a resolution to recognize the federal government’s duty in protecting and codifying the rights of transgender and nonbinary people, as well as to ensure trans people have access to medical care, shelter, safety, and economic security.
Stand up for trans/non-binary folks in your everyday interactions with friends, family, coworkers, and others to check instances of stigma and discrimination.
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| Biden Administration Announces Two Expansions in Health Care
DACA/”Dreamer” expansion: On April 13, President Biden announced intentions to expand both Medicaid and private coverage to those eligible for the Deferred Action to Childhood Arrivals (DACA) program (often called the “Dreamers”). The Department of Health and Human Services released a proposed rule that will amend the definition of “lawful presence” for purposes of Medicaid and Affordable Care Act coverage, to include DACA recipients. Once finalized, the rule will make DACA recipients eligible for these programs for the first time. (See the White House Fact Sheet for more information.)
Justice settings expansion: On April 17, CMS issued guidance to state Medicaid directors to help states design Section 1115 demonstration projects to improve care transitions for incarcerated individuals who are eligible for Medicaid. These new rules would allow states to cover a package of pre-release services for up to 90 days prior to the individual’s expected release date. Goals of this expansion include increasing health and well-being; improving coordination and communication between correctional systems, Medicaid systems, managed care plans, and community-based providers; and increasing investments in health care and related services. (See the CMS press release for further highlights.)
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| Substance Use: NARCAN, Opioid Settlements, and New Research
Over the counter Narcan/Naloxone: On March 29, the FDA approved the first over-the-counter naloxone nasal spray, Narcan. Naloxone – a medicine that can reverse an opioid-related overdose – has been shown to be a critical tool to prevent fatal overdoses, connect more people to treatment for substance use disorder, and save lives. This decision allows Narcan to now be available without a prescription and in places without pharmacies — like convenience stores and supermarkets. However, this change may not reach those most in need if the cost is too high (e.g., it’s initial cost is estimated at $50). It’s also unknown how this change will impact the current Naloxone supplies that are distributed to public health departments and others in the safety net. Stay tuned for more information on this!
Opioid lawsuit settlements: $50 billion is being distributed to states as a result of lawsuits against the companies that flooded communities with addictive painkillers for years, causing untold dependence, disability, and death. The problem is that there’s little information for how that money will be spent, and there are few requirements or strings attached. If you are interested in tracking this money, check out this great opioid settlement tracker!
Related reading
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| New Research
The Harms of Encampment Sweeps: National HCH Council staff Dr. Alaina Boyer and Dr. Courtney Pladsen, along with NCAB Co-chair David Peery, were co-authors of a recent study, Population-Level Health Effects of Involuntary Displacement of People Experiencing Unsheltered Homelessness Who Inject Drugs in US Cities, which examined how encampment sweeps impact health care outcomes of people who use drugs. Not surprisingly, the study showed continual sweeps cause 151% increase in overdose mortality, 50% increase in hospitalizations, and a 38% decrease in starting opioid medication treatment. Our press release gives more information, along with some great graphics! This study gives even more evidence to support our prior fact sheet on the impacts of sweeps on people experiencing homelessness. Take-away message: Stop sweeping encampments and provide housing instead!
The Benefits of Harm Reduction in Primary Care: Another new study, Estimated Clinical Outcomes and Cost-effectiveness Associated With Provision of Addiction Treatment in US Primary Care Clinics, asks the question: What are the estimated clinical outcomes, costs, and cost-effectiveness of integrating buprenorphine and harm reduction kits into primary care for people who inject opioids? (Note: they defined a harm reduction kit as a package of 10 sterile syringes with injection preparation equipment, safer smoking kit, and skin hygiene and wound care supplies. Spoiler alert: fewer people die, and it’s cheaper. Take-away message: Integrate buprenorphine and harm reduction kits into primary care!
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Take Local Action on Encampments & Harm ReductionCall your local officials (your mayor or county/city commissioners) and advocate against encampment sweeps! Use this research and our fact sheet to emphasize the critical need for permanent housing and the provision of needed health care and support services as a more constructive way to end homelessness.
If you work in a primary care setting (that’s you, health centers!), advocate internally for greater harm reduction services. If you have not yet become a Syringe Service Program (SSP), partner with your local SSP to provide on-site access to life-saving supplies. If your community doesn’t allow SSPs, advocate with your state lawmakers using this model SSP legislation.
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Did you receive Mobilizer as a forwarded email or hear about it via social media? Register now to receive our action alerts each month!
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Barbara DiPietro
Senior Director of Policy
National HCH Council
Baltimore, MD
bdipietro@nhchc.org
(443) 703-1346
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This publication and all HCH advocacy are funded by dues from Organizational Members of the Council and by private donations. Consider joining the Council to support this work.
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604 Gallatin Ave., Suite 106 | Nashville, TN 37206 US
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