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Kentucky’s New Idea for Medicaid Access: Pass Health Literacy Course


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The New Health Care

A lot of people could do with a little more health and financial literacy, not just Medicaid recipients. But linking it to retaining medical eligibility may not make sense.


Jan. 22, 2018

Matt Bevin, the governor of Kentucky, with President Trump last week in Washington. Kentucky is the first state to win approval from the Trump administration to impose a work requirement on many Medicaid recipients.CreditCarolyn Kaster/Associated Press

If you’re on Medicaid in Kentucky and are kicked off the rolls for failing to meet the state’s new work requirements, Kentucky will be offering a novel way to reactivate your medical coverage: a health or financial literacy course you must pass.

The precise content of the courses is not yet worked out but may include instruction on household budgeting, opening a checking account, weight management and chronic disease management, said Kristi Putnam, a manager with Kentucky Health, the new state Medicaid program that includes work requirements. She said quizzes would be included that people must pass to complete the course.

Kentucky says the courses, along with the bigger elements of the recently approved waiver it received from federal Medicaid rules, will help to “empower individuals to improve their health.”

The courses are just one way people subject to and failing to meet work requirements could regain coverage. But some health policy experts express dismay with the approach. For one thing, many Americans, not just those who seek Medicaid, struggle with health and financial literacy. And to some, literacy quizzes — however well intentioned — evoke the tests used to impede voting registration of black Americans in the Jim Crow South.

“Requiring people to pass a health literacy course to get care — care for conditions that might prevent them from passing — is just expensive, punitive and cruel,” said Atul Gawande, a surgeon and a health care researcher with the Harvard T.H. Chan School of Public Health. “It serves no health benefit whatsoever. You have to be concerned about requirements like literacy tests, which states have a bad history of applying selectively and arbitrarily.”

Ms. Putnam said the courses were “intended to be a tool/support for people to improve both health and finances, and not a barrier in any way.” Her agency, she said, is looking into ways to provide help to people who might struggle with understanding the courses.

There is no standard definition for health literacy. Ms. Putnam said Kentucky’s “pertains to learning about healthy habits, how to manage chronic conditions, effectively utilizing health care benefits and understanding commercial market insurance concepts.”

However defined, health literacy is related to literacy and numeracy more generally. To understand and use health-related information, you need some fluency with written or spoken language, and usually with numbers and basic math as well. People with low skills in other forms of literacy or numeracy also have lower health literacy.

Apart from instruction aimed at specific populations with certain conditions — such as training to self-manage chronic diseases like diabetes and hypertension, or even birth training classes for pregnant women and their partners — health literacy courses are uncommon. (Say Ah! is one source for health literacy resources.)

Financial literacy courses are more widely available but still not a routine part of general education.

“If these topics are taught at all in primary education, they certainly aren’t addressed consistently or in an evidence-based way,” said Harold Pollack, a professor at the University of Chicago who was a co-author of a book on basic financial education. “But singling out the Medicaid population for classes as a condition for access to insurance suggests that shrinking and stigmatizing the program, not literacy, is the goal.”

Numerous studies document the widespread need for greater health and financial literacy. By one estimate, one-third of adults have health literacy deficits. For example, most people make errors in selecting health plans and don’t know basic features of the plans they choose.

The last large national survey of U.S. adult literacy (including health literacy) was conducted in 2003. One study found that 60 percent of Medicaid enrollees had only “basic” or “below basic” health literacy, meaning, for example, they could not recognize a medical appointment on a hospital appointment form (below basic) or would have trouble understanding why a specific test was recommended for someone with certain symptoms, even when given a clearly written and accurate explanation (basic).

But Medicaid enrollees are not the only ones. Nearly the same proportion of Medicare enrollees also had basic or below basic health literacy. Privately insured people scored better. They are typically younger than Medicare enrollees, and they typically have higher education levels and are less likely to have cognitive impairments than those with public coverage. However, only a small minority even of the privately insured had a “proficient” level of health literacy — meaning, for example, that they could deduce the employee share of health insurance costs from a table that listed that cost as a function of income and family size.

Another study, based on data collected in 2013, showed adults’ blood test results alongside the normal range (typical of reports many of us receive from our doctors after blood tests). Only about half of the subjects could recognize if the blood glucose level indicated on the test was outside the normal range. Of those with diabetes — to whom blood glucose measurement and levels should be familiar given the importance to their condition — only 56 percent could identify out-of-range values.

Poor health literacy is associated with worse health care outcomes and higher health care spending. But causality could run both ways. It is likely that people in greater need of health care are also less likely to have high literacy skills in general. It’s also possible that poor health literacy contributes to worse self-management of health and lifestyle issues that could result in worsening health and increased health care use.

Likewise, low financial literacy can contribute to insufficient or inefficient saving. One national survey found that only 14 percent of respondents got all the answers right on a five-question quiz about financial topics like interest rates, inflation, bond prices and mortgages. Only 37 percent got four out of five. (As an example of its difficulty, the true/false mortgage question was: “A 15-year mortgage typically requires higher monthly payments than a 30-year mortgage, but the total interest paid over the life of the loan will be less.”)

Other research documents high rates of errors in financial decision making even among highly educated people, including mistakes made in 401(k) investing, selection of mutual funds, use of credit, receipt of payday loans and others.

Addressing these issues through financial literacy education improves financial outcomes. A recent review of financial literacy research found that providing financial literacy education in school settings is effective. So is the approach of targeting education during teachable moments, as when individuals are making financial decisions: taking out a loan, establishing a saving plan, and the like. The Kentucky program would do neither.

Though policy experts are divided on the merits of Kentucky’s health and financial literacy program, they may at least be in agreement that education in both needs improvement. That’s true not just for would-be Medicaid enrollees, but for many of the rest of us, too.


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Part Of Oregon’s Funding Plan For Medicaid Goes Before Voters

A sign in support of Oregon’s Measure 101 is displayed by a homeowner along a roadside in Lake Oswego, Ore. Tuesday’s special election puts decisions over how the state funds Medicaid in voters’ hands.

Gillian Flaccus/AP

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Gillian Flaccus/AP

A sign in support of Oregon’s Measure 101 is displayed by a homeowner along a roadside in Lake Oswego, Ore. Tuesday’s special election puts decisions over how the state funds Medicaid in voters’ hands.

Gillian Flaccus/AP

Oregon is in a battle royal over how to pay for expanded Medicaid.

The fight revolves around Measure 101, a ballot initiative that you have to go back a few years to understand.

During the 1990s, Oregon’s then-governor, Dr. John Kitzhaber, had a background in health care — he’d worked as an emergency room doctor. His legacy in the state includes the expansion of health insurance for the poor, an idea he managed to sell to both Democrats and Republicans.

So when President Barak Obama proposed expanding Medicaid under the Affordable Care Act, Oregon lawmakers on both sides of the aisle embraced it. As a result, some 95 percent of Oregonians now have health insurance. That’s among the highest rates in the nation.

Medicaid Expansion Takes A Bite Out Of Medical Debt

But now the federal government is trimming its contribution to Medicaid. And legislatures all around the U.S. are scrambling to find money to replace those federal payments.

In Oregon last summer, Democrats joined with Republicans, hospital owners and health insurance CEOs to come up with a tax package that would fund the Medicaid expansion. And hospitals and insurance companies agreed to the plan, though they are on the hook for many of the included taxes.

Here’s where the wrinkle comes: Under state law in Oregon, voters can use the initiative process to collect signatures and force a public vote on any new tax. And that’s what state Rep. Julie Parrish did.

Parrish and others managed to get “Measure 101″ on Oregon’s Tuesday ballot — putting part of the Medicaid tax package passed last summer into the hands of voters. If it succeeds not much will happen — the tax package will continue to fund Medicaid expansion. But if it fails, Oregon’s legislature will have to go back to the drawing board and come up with a new way to pay for the health care of its poorest residents and others who rely on Medicaid.

Parrish is a Republican state legislator whose family was on Medicaid when she was a child.

But she doesn’t like the tax package.

Kentucky Gets OK To Require Work From Medicaid Recipients

“This is about a fundamental disagreement that taxing other people’s insurance is the way to fund Medicaid,” she says. Parrish says the funding package Oregon came up with is inequitable because it doesn’t apply to big corporations and unions. Instead, she says, it hurts the little guy — people who couldn’t afford to hire lobbyists.

“Small businesses — Mom and Pop businesses,” she says, ticking off the groups she thinks would unfairly bear the tax burden under the state’s plan. “Individuals who have to buy their own [health insurance].”

Parrish thinks Medicaid would be better-funded in Oregon with something like a cigarette tax increase — although it’s not clear that would generate enough money or garner enough votes to pass.

Cedric Hayden is a Republican representative from Falls Creek, Ore. He’s a dentist who accepts Medicaid patients and runs a charitable health clinic in Lane County. He’s also a member of Parrish’s Stop Healthcare Taxes committee — the group that collected enough signatures to put Measure 101 on the ballot.

Hayden says if he and other members of his committee had been against funding Medicaid altogether, they could have insisted the legislature’s entire funding plan be put up for a public vote.

“We did not,” he points out.

Instead, if approved, Measure 101 would ratify the Medicaid expansion in Oregon that the state legislature approved last summer. But if Measure 101 fails, a part of that tax package will be eliminated. A no-vote would eliminate the .7 percent increase to an existing tax on hospitals that the state legislature wants. And it would also stop a 1.5 percent tax on health insurance contracts.

It’s unclear how the passage of Measure 101 would affect consumers. That’s because, on the one hand, any new taxes would likely be passed on to consumers. But on the other hand, Measure 101 funds a program that saves consumers of health care $300 a year.

New Rules May Make Getting And Staying On Medicaid More Difficult

Some Republicans in the state want a ‘no’ vote. They don’t like the new tax and they don’t trust the Oregon Health Authority with the money. They say the OHA wasted millions of dollars on things like Medicaid overpayments and CoverOregon — the webpage that sells Obamacare insurance.

On the ‘yes’ side are all kinds of advocacy groups and the vast majority of Oregon’s health organizations. They say 48 other states have some form of this tax package to pay for Medicaid.

“The alternative of lack of coverage — we’re talking kids, seniors, people with disabilities — is unacceptable,” says Andy Van Pelt, the executive director of the Oregon Association of Hospitals and Health Systems.

He says it’s cheaper to treat people with health insurance, than to treat them without insurance, when they turn up sick in emergency rooms anyway.

“There’s a real possibility that people could lose their coverage. It will just destabilize the Medicaid program for hundreds of thousands of people and that would be utter chaos,” Van Pelt says.

While the Donald Trump administration hasn’t managed to repeal the Affordable Care Act, it has taken several steps to dismantle it. For example, Americans are no longer legally required to buy health insurance.

The effect of Measure 101 on Oregon’s Medicaid expansion remains to be seen. If it fails, state lawmakers will spend the next couple of months searching for new ways to pay for Medicaid expansion.

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Five Reasons Why Travel Is Good For Your Mental Health


What’s the first thing that comes to your mind when I say ‘travel’ – Vacation? Meeting new people? Or maybe, Instagrammable sunsets? While traveling can be exciting and exhilarating, it’s so much more than sipping margaritas on a sun-soaked beach.

It’s no news that travel is good for your physical wellbeing, but a significant amount of scientific research suggests that exploring a new place can do wonders for your mental and emotional health as well.

Here are five evidence-backed ways traveling makes your mind happy and healthy:

1. It’s a great stress buster. “The stress of work and daily demands can distract us from what we find to be actually meaningful and interesting,” says Dr. Tamara McClintock Greenberg, a San Francisco-based Clinical Psychologist and author of Psychodynamic Perspectives on Aging and Illness. Thus, taking a break from the daily hustle and bustle is essential for your mind to relax, recharge and rejuvenate. And what better way to do so than to pack your bags and cross off wanderlust-worthy destinations off your bucket list? Traveling promotes happiness and helps you take your mind off stressful situations. This leads to lower cortisol levels, making you feel more calm and content. “It also helps us reflect on our personal goals and interests,” adds Dr. Greenberg. According to a 2013 study, more than 80% Americans, who were surveyed, noticed significant drops in stress just after a day or two of traveling. “Even though I’m always busy when I travel, whether it’s sightseeing, taking photos or just exploring a destination on foot, I know I’m the calmest and most relaxed when I travel,” says Jacintha Verdegaal, an avid traveler and founder of travel and lifestyle blog, Urban Pixxels.

2. It helps you reinvent yourself. Writer Patrick Rothfuss said, “ A long stretch of road can teach you more about yourself than a hundred years of quiet .” Experiential traveling, particularly to a foreign country, can help you re-evaluate and reinvent your life. “If you allow it, travel has the ability to expand your mind in a way you never realized was possible,” says solo travel expert and founder of the Trusted Travel Girl, Valerie Wilson. Moreover, the valuable lessons that you learn along the way broaden your perspective, making you more aware and open to new things. “I love traveling to places with different cultures because it forces you to think about your own,” says Jacintha Verdegaal. “Different is not better or worse, it’s just different. But being confronted with these differences helps me to re-evaluate my own principles and values and sometimes, change them,” adds the professional globetrotter. Exploring new places can also give you a fresh start if you’re recovering from a major transition in your life. “When I had Lyme disease, for several years, my world shrunk. I lost friends who didn’t know how to deal with a sick friend. I was quite alone and lost a lot of my self-confidence,” says Wilson, who began to travel “out of fear of relapsing”. “By traveling and interacting with the world around me, I found a new passion for life. I convinced myself to travel even when I wasn’t feeling well. It has brought me happiness, given me purpose, and has made me a confident, strong independent woman,” she explains.

3. It boosts happiness and satisfaction. Apart from the obvious fact that you don’t have to go to work (and can legit eat pizza for breakfast), traveling gives you the opportunity to step away from the daily grind. The new events and experiences help rewire your brain, hence boosting your mood and self-confidence. “I think people, in general, are not meant to be tied down to just one place their entire lives. I especially feel “trapped” when I have to stay in the same place for too much time without being able to really move about and explore,” says travel aficionado and co-founder of The Passport Memorandum, Marta Estevez.  “My life feels most fulfilling when I’m outside, living through new experiences and learning,” adds the travel expert who has been to more than ten countries. “Travel definitely makes me happy,” agrees Wilson. “Even the act of planning a trip gives me something to look forward to and brings me happiness,” says Wilson. And she’s not the only one who feels that way. According to a Cornell University study, the anticipation of a trip can increase your happiness substantially, even more than the anticipation of acquiring something tangible, like a new car.

4. It makes you mentally resilient. Going and living somewhere where you feel excited and intimidated at the same time can help you toughen up mentally and emotionally.When I was younger I couldn’t see myself traveling the world by myself. But now, I travel by myself most of the time. And I love it! It’s never as scary or dangerous as you make it in your head,” says Jacintha Verdegaal of Urban Pixxels. Also, facing difficulties in an unfamiliar environment, among new people, forces you to learn and adapt to a life that’s out of your comfort zone. This makes you more flexible, patient and emotionally strong. “Travel has taught me patience, to surrender control to the uncontrollable, and effectively problem solve,” says Valerie Wilson who describes herself as a “naturally anxious and impatient person.” It can also help you deal with “larger issues in life with more grace and patience,” adds the travel expert. “One of the worst experiences I had early on in my travel life was being mugged of loads of cash and my passport just a day before I was due to fly home. It taught me to accept situations like this more calmly and to attach less emotion to belongings. Now, I can get over similar stressful situations very quickly, without having the issue get me down for long,” tells Allan Hinton, a London-based photographer who quit his job to become a full-time traveler. Similarly, when travel blogger Marta Estevez injured her ankle during the famous Loi Krathong festival (Lantern festival) in Thailand, “the roads were partially closed off that night and the streets were filled with hundreds upon hundreds of people that made it incredibly difficult for us to move,” she explains. “I had to learn to accept the situation and adapt our travels accordingly, without breaking down. I’m not sure I would’ve had the same composure a few years ago in this situation,” adds Estevez. Bottom line is, the more challenges you’re faced with, the better you’ll get at overcoming them, eventually becoming more resilient, mentally and emotionally.

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Maine Voices: We must provide access to full range of reproductive health care

Forty-five years ago, the Supreme Court ruled in Roe v. Wade that women have a legal right to privacy, and that includes the personal decision to end a pregnancy. Yet numerous laws and regulations have made it increasingly difficult for women to access not only abortion but also the full range of reproductive health care, including affordable contraception, quality maternal health care and basic preventive care.

We see more and more stories of women forced to drive hours for abortion care because it is not available in their communities. You can’t pick up the paper or turn on the news without seeing another political attack on women’s health or an overall indifference to building a health care system with women in mind. Along with an alarming trend of reduced access to maternal care, particularly in rural areas, this highlights the challenges many women face in accessing high-quality, affordable care right here in Maine.


Nicole Clegg is vice president of public policy for the Planned Parenthood Maine Action Fund and Planned Parenthood of Northern New England in Maine.


Decreased funding and limited access to quality care mean the U.S. now has the highest maternal mortality rate among developed countries. Over 60 percent of these deaths are preventable. Some of these women might still be alive if they had better access to preventive care to manage their high blood pressure, weight or diabetes.

These risks are exacerbated in rural counties, where maternal mortality rates are higher and maternal health care is disappearing.

From 2004 to 2014, 9 percent of all rural U.S. counties lost access to hospital obstetric services, and more than 45 percent are now without a single local hospital where women can get prenatal care and deliver babies. Calais Regional Hospital is the latest to close its obstetric and gynecological unit, meaning that women in northern Washington County must now drive more than an hour to Machias for prenatal care and delivery.

The birth control pill has been available to American women for more than 50 years and remains the most popular form of contraception. Yet women face unprecedented attacks on access to birth control including threats to providers, insurance coverage and federal funding. Key health programs like Title X (federal family planning funding), Medicaid, Medicare, and the Affordable Care Act all disproportionately serve and benefit women. But as these programs come under attack, it is women and especially women of color and low-income people who disproportionately pay the price.

And nearly half a century later, access to abortion remains limited, especially for women in rural areas. There are only three public abortion providers in Maine, and more than half of Maine women live in a county without access to an abortion provider.

Restricted access to abortion simply compounds an already challenging environment for women to receive the care they need when they need it. Roe v. Wade may have guaranteed a right to a medical procedure, but without providers in rural areas and affordable access, the right becomes one in name only.

Abortion is the only medical procedure singled out in Maine law with provider restrictions. Today, nurse practitioners and other advanced care professionals are willing and able to provide the service in areas with no other provider, but this outdated law prohibits them, thus denying women the ability to access care in their hometown, their county or even within a few hours’ drive.

There’s no medical reason for this, and women’s health is harmed by this fundamental lack of access. Numerous health organizations, including the World Health Organization, the American College of Obstetricians and Gynecologists and the American Public Health Association, have called for a change, as have local women’s health care providers, the Maine Medical Association and the Maine State Nurse Practitioners Association.

Over the last year, we have seen a groundswell of people demand a health care system that better meets the needs of people. It bears noting that women represented the majority of this movement. We saw women in record numbers stand up to protect the Affordable Care Act and Planned Parenthood, the nation’s leading women’s health care provider. And now we need to channel that energy to ensure that women’s health isn’t sidelined but centered in the discussion.

Because Maine has two options.

We can regress to a health system that overlooks women’s needs and limits access to women’s reproductive health care, including abortion and maternal care.

Or we can progress toward a system that meets women’s needs with better outcomes, integrated women’s health providers and improved access to the full range of reproductive health care: contraception, abortion and maternal health.

The choice is ours.






Send questions/comments to the editors.

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The religious activists on the rise inside Trump’s health department

A small cadre of politically prominent evangelicals inside the Department of Health and Human Services have spent months quietly planning how to weaken federal protections for abortion and transgender care — a strategy that’s taking shape in a series of policy moves that took even their own staff by surprise.

Those officials include Roger Severino, an anti-abortion lawyer who now runs the Office of Civil Rights and last week laid out new protections allowing health care workers with religious or moral objections to abortion and other procedures to opt out. Shannon Royce, the agency’s key liaison with religious and grass-roots organizations, has also emerged as a pivotal player.

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“To have leaders like Roger, like Shannon, it’s so important,” said Deanna Wallace of Americans United for Life, an anti-abortion group that was frequently at odds with the Obama administration. “It’s extremely encouraging to have HHS on our side this time.”

But inside HHS, staff say that those leaders are steering their offices to support evangelicals at the expense of other voices, such as a recent decision to selectively post public comments that were overwhelmingly anti-abortion. “It’s supposed to be the faith-based partnership center, not the Christian-based partnership center,” said a longtime HHS staffer, referencing the HHS Center for Faith-Based and Neighborhood Partnerships led by Royce.

More than a dozen current and former HHS staffers, who requested anonymity to speak freely, spoke with POLITICO for this story. HHS declined to make top officials available for interviews.

Short-term victories fuel long-term plan

The agency’s evangelical leaders have set in motion changes with short-term symbolism and long-term significance. One of those moves — a vast outreach initiative to religious groups spearheaded by Royce, asking how to serve them better — came in October 2017 while the health department reeled from the resignation of former Secretary Tom Price and congressional Republicans struggled to repeal the Affordable Care Act.

That outreach initiative began a rulemaking process that could culminate in a rollback of Obama-era protections for transgender patients and allowing health providers more protections to deny procedures like abortion. It worried abortion rights and LGBT advocates, who acknowledge that while abortion laws and other regulations remain mostly intact, the groundwork is steadily being laid to revise them.

“This administration is focused on recognizing one set of religious beliefs,” said Gretchen Borchelt of the National Women’s Law Center. “It’s going to do whatever it can to reshape or violate the law to do that.”

The October effort surprised Royce’s own staff and close colleagues, many of whom weren’t aware that the center’s request for information — a key tool in rulemaking that lets agencies solicit comments that they can use to revise or introduce regulations — was even being developed until it was publicly posted. The reason: Royce, the center’s director, didn’t tell them.

“Shannon put it together with Roger Severino and jammed it out the door,” said one staffer, who noted that the center had never issued a request for information before. “We were messaging each other — ‘did our office just put out an RFI?’”

It wasn’t the first time that Royce, Severino and their allies pushed their HHS offices to pull off groundbreaking maneuvers. That’s helped raise their stature with evangelical groups, as well as with anti-abortion Republican lawmakers, a powerful bloc that includes Vice President Mike Pence.

“You’re over at HHS, a true bright spot in this administration when it comes to protection of life and protection of conscience,” a moderator at the Evangelicals for Life conference said when introducing Royce last Thursday. “It’s no exaggeration to say that you guys have just had a monster year over at HHS.”

But those same actions have alarmed the ACLU and other groups, which warn that the health department’s leaders are blurring the lines between church and state. “Time and time again, we have seen this administration radically redefine religious freedom to impose one set of ultraconservative beliefs on all Americans,” said Sara Hutchinson Ratcliffe of Catholics for Choice.

Shifts in process and priorities

The political leaders’ moves also worry career agency staff, who say that important decisions about controversial issues like abortion, contraception and transgender care are increasingly being kept secret at the nation’s largest government agency. “The American people deserve to know and deserve to weigh in,” said one staffer, referencing the agency’s decision to withhold thousands of critical comments on the RFI. “This shouldn’t be sprung on them as a finished product.”

Anti-abortion, evangelical leaders now shape HHS’ daily communications and overarching legal strategy — a major departure from the Obama administration and arguably leaving them more empowered than under previous Republican administrations. Charmaine Yoest, the former head of Americans United for Life, is the department’s top spokesperson and steers the agency’s messaging. Matthew Bowman is now the HHS deputy general counsel, a post in which he advises the secretary and helped roll back the same birth control protections that he once fought before the Supreme Court.

The roster of anti-abortion leaders at HHS is deep enough to adjust to sudden departures. Teresa Manning had been overseeing Title X programs at the agency, which included funding contraception care — a striking appointment, given that Manning publicly had said that contraception didn’t work. After Manning’s abrupt departure last week after less than nine months, she was replaced by Valerie Huber, an advocate for abstinence education who also joined the department last year.

“One of the axioms of politics is that personnel is policy,” Royce said last Thursday, appearing at the anti-abortion conference. “We have such an amazing team at HHS that is absolutely a pro-life team across the spectrum.”

That team has found new ways to expand HHS’ powers and engage evangelicals, most recently by setting up a “Conscience and Religious Freedom” division of its civil rights office on Thursday. The newly created division, which POLITICO first reported on Tuesday, will work to strengthen health workers’ ability to opt out of procedures when they have religious or moral objections. It’s a dramatic broadening of conscience protections that have long been on the books.

“These protections have been under-enforced in the past,” Severino reportedly said on a media call with mostly conservative and Christian publications last week. “We are back in business.” (POLITICO and other national media outlets were not invited to the call, and HHS declined to make Severino available for an interview.)

But longtime HHS officials say that the existing civil rights office was more than capable of handling these issues and that creating an entire division to focus on religious liberty sends the wrong message.

“This is a classic solution in search of a problem,” said one official who’s handled civil rights issues at HHS. “And it’s a problem that doesn’t really exist, because hospitals tend to be really compliant on this kind of stuff.”

During the Obama administration, evangelical groups had even hailed HHS for its efforts to enforce religious freedom, such as intervening in a lawsuit filed by an anti-abortion nurse against Mount Sinai Health System in New York.

“Pro-life medical personnel should not be forced to assist abortions, and Mount Sinai’s new policy reflects that, thankfully, after Alliance Defending Freedom brought lawsuits and complaints to HHS,” Bowman said at the time, four years before he would join HHS himself.

Royce’s partnership center has sparked controversy with how it handled its request for information. POLITICO in December reported that the center was deliberately withholding thousands of critical comments of its plan while posting just 80 comments, overwhelmingly from anti-abortion and evangelical respondents who called on HHS to roll back protections related to abortion and transgender care. (The center released the missing 12,000-plus comments four days after POLITICO’s story.)

After adjustment, leaders look ahead

Some of the anti-abortion leaders have also had occasionally bumpy transitions, particularly because many of them had little, if any previous experience in the federal government or in relevant positions and often don’t consult the career staff.

Yoest — the public affairs chief — was criticized for the agency’s handling of questions about Price’s controversial use of charter jets. HHS seemed unconcerned by the stories at first and felt there was little need to respond, according to White House officials, who griped about the agency’s crisis-management strategy last year. The communications office has seen a steady stream of departures and remains under-staffed.

Jane Norton, an anti-abortion activist tapped to be HHS’ top liaison, was pushed out after less than seven months in the job, as she struggled to communicate the department’s work to governors, business associations and other groups. She was also the plaintiff in a long-running lawsuit against Planned Parenthood of Colorado, which created an eye-catching legal situation: one of HHS’ top leaders actively suing one of HHS’ grantees. Oral arguments in the case were held in November 2017, while Norton was still at seat in HHS.

But staff acknowledge that the political leaders are starting to achieve a steady stream of symbolic, anti-abortion goals, led by Royce and Severino. “She’s a force of nature,” said one staffer who’s worked with Royce inside HHS. “She just goes after and goes after it.”

“I think he’s very sincere,” said a civil rights lawyer who’s worked with Severino. “He tries to be principled — we just have different principles.”

The agency’s political leaders understand that a future Democratic administration could reverse some of their own regulations. According to an individual familiar with their thinking, leaders like Severino and Yoest have celebrated Trump’s record number of appellate judges confirmed last year, which have stocked the judiciary with jurists who favor their causes. Severino’s wife, Carrie Severino, is a judicial activist who’s worked to get Trump’s nominees confirmed.

HHS’ leaders also are waiting on the arrival of HHS Secretary-designate Alex Azar, a George W. Bush administration veteran who’s likely to get confirmed. In his testimony, Azar has praised the need for conscience protections, comments that strengthened his support among evangelicals.

“Praying for Alex Azar II this morning,” Royce posted last Wednesday, ahead of a committee vote to advance Azar’s nomination. “Please join me.”

The health department is poised to keep playing an outsize role on issues important to evangelicals, with a series of decisions looming related to enforcing transgender protections, funding contraception and paying for programs related to family planning. Meanwhile, the agency’s four-year strategic plan is being finalized and is expected to include policy positions sought by evangelicals, such as stating that life begins at contraception.

“You will see exciting things in the coming days, and that’s all I can say right now. But good stuff is coming,” Royce promised attendees at last Thursday’s anti-abortion conference. She then urged the audience — with hundreds of attendees in town for the March for Life, the nation’s largest anti-abortion rally — to play a part in helping HHS achieve its strategy.

“I’m a goal-setter for every new year,” Royce said. “My challenge to you this year … ask the Lord to show you one thing you can do consistently that is pro-life.”

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Hispanics forgo health services to avoid officials’ attention, advocates say

The number of legal immigrants from Latin America who access public health services and enroll in federally subsidized insurance plans has dipped substantially since President Trump took office because many of them fear that their information could be used to identify and deport relatives living in the United States illegally, according to health advocates nationwide.

Trump based his presidential campaign on promises to stop illegal immigration and deport undocumented immigrants, but many legal residents and U.S. citizens are losing their health care as a result, advocates say.

After Trump became president a year ago, “every single day families canceled” their Medicaid plans and “people really didn’t access any of our programs,” said Daniel Bouton, a director at the Community Council, a nonprofit organization in Dallas that specializes in health-care enrollment for low-income families.

The trend stabilized a bit as the year went on, but it remains clear that the increasingly polarized immigration debate is having a chilling effect on Hispanic participation in health-care programs, particularly during the enrollment season that ended in December.

Bouton’s organization has helped a 52-year-old housekeeper from Mexico, a legal resident, sign up for federally subsidized health insurance for two years. But now she is going without, fearing that immigration officials will use her enrollment to track down her husband, who is in the country illegally. She is also considering not re-enrolling their children, 15 and 18, in the Children’s Health Insurance Program (CHIP), even though they were born in the United States.

“We’re afraid of maybe getting sick or getting into an accident, but the fear of my husband being deported is bigger,” the woman, who declined to give their names because of fears about her husband’s status, said through an interpreter in a phone interview.

Hispanic immigrants are not only declining to sign up for health insurance under programs that began or expanded under Barack Obama’s presidency — they’re also not seeking treatment when they’re sick, Bouton and others say.

“One social worker said she had a client who was forgoing chemotherapy because she had a child that was not here legally,” said Oscar Gomez, chief executive of Health Outreach Partner, a national training and advocacy organization.

My Health LA provides primary-care services in Los Angeles County, Calif., to low-income residents and those who lack the documents to make them eligible for publicly funded health-care coverage, such as state Medicaid. According to its annual report, 189,410 participants enrolled in the program in fiscal 2017, but 44,252, or about 23 percent, later unenrolled. It’s not clear how many of those who dropped out are Hispanic; the report did not describe ethnicity.

Enticing Hispanics to take advantage of subsidized health care has been a struggle that began long before Trump’s presidency.

Hispanics are more than three times as likely to go without health insurance as are their white counterparts, according to a 2015 study by Pew Research Center. Whites represented 63 percent, or 3.8 million, of those who signed up for Affordable Care Act plans last year; Hispanics made up 15 percent, or just under 1 million, according to the Centers for Medicare and Medicaid Services. The reasons vary, but some have always feared deportation, regardless of who is in the White House.

Recent events have not helped. Despite initial signs of a compromise agreement, Trump now isn’t supporting a deal to support young people who identified themselves to the federal government so that they could qualify for protections against deportation after being brought to the United States illegally as children.

Last fall, Border Patrol agents followed a 10-year-old immigrant with cerebral palsy to a Texas hospital and took her into custody after she had surgery. She had been brought to the United States from Mexico when she was a toddler.

And in Okeechobee, a small city about an hour and a half north of Miami that is home to many immigrant farmworkers, green-and-white-striped immigration vehicles were spotted driving around town and parking in conspicuous places last spring and summer. After a few immigrants were picked up and deported, health advocates said patients canceled their appointments, waiting until immigration officials left to reschedule them.

In Washington state and Florida, health-care workers report that immigrant patients start the enrollment process but drop out once they are required to turn in proof of income, Social Security and other personal information. The annual report from My Health LA noted that it denied 28 percent more applicants in fiscal 2017 than it had the year before, mostly because of incomplete applications.

In a survey of four Health Outreach Partner locations in California and the Pacific Northwest, social workers said some of their patients asked to be removed from the centers’ records for fear that the information could be used to aid deportation hearings.

The dilemma has forced social workers at Health Outreach Partner to broaden their job duties, Gomez said. Now, in addition to signing people up for health insurance or helping them access medical treatments, they are fielding questions about immigration issues and drawing up contingency plans for when a family member is deported.

“That planning is seen as more helpful and immediate to their patients than their medical needs right now,” he said.

Associated Press

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Trump’s doctor shares ‘unbiased, 100 percent accurate’ health assessment in ‘SNL’ cold open

“Saturday Night Live” opened this week’s episode with a parody of President TrumpDonald John TrumpDems flip Wisconsin state Senate seat Sessions: ‘We should be like Canada’ in how we take in immigrants GOP rep: ‘Sheet metal and garbage’ everywhere in Haiti MORE‘s doctor sharing Trump’s physical results at a White House press briefing. 

Castmember Beck Bennett played Trump’s doctor, Navy Rear Adm. Dr. Ronny Jackson, who earlier this week declared the president is physically and mentally fit enough to perform his job.

“This is the president’s unbiased, 100 percent accurate health assessment,” Bennett says as Jackson.

“At the time of examination, the president was 71 years and seven months young, his resting heart rate was a cool 68 bpm, his weight a very svelte 248 pounds, he has a gorgeous 44-inch coke-bottle waist, and his height, 75 inches with legs that seem to go on forever,” he continued. “It’s my expert medical opinion that the president has a rockin’ bod with an excellent cushion for the pushin’. And if given the chance, I would.” 

“He’s healthy enough to be president for another 10 to 20 years easy.”

“SNL”‘s Jackson went on to accept questions from reporters, which included one journalist, played by Kate McKinnon, asking “how broke that brain?”

“We did do a cognitive exam at the president’s request and he passed it with flying colors, almost no hits,” Beckett answered as Jackson. “

Aidy Bryant, as Sarah Huckabee Sanders, cut in to conclude that Trump ultimately “crushed” every physical exam as well as the “tide pod challenge,” — referring to the risky viral video challenge.

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Saunas Are A Hot Trend That’s Good For Your Health : Shots – NPR

Is it the heat that makes you healthier? Or the chance to chill?

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Is it the heat that makes you healthier? Or the chance to chill?

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It’s not even a month into winter, and the cold temperatures have already crushed my spirits. Bundling up every time I leave the house, unexpected school snow days, a sidewalk obstacle course of frozen dog poop: I’m over it. I find myself dreaming of not just spring but warmth in any form. So a sauna is sounding particularly good about now. And besides the respite from the cold, there are a host of claimed health benefits from regular sessions.

And indeed, research has shown an association between certain positive health outcomes and regular sauna use. A 2015 study covering more than 2,300 middle-aged men in Finland found the more frequently a man took a sauna, the lower his risk of fatal heart disease and early death. The same group of researchers has also reported an association between regular sauna use and a lower risk of high blood pressure, and between moderate to heavy use of saunas and a lower risk of dementia, among other benefits.

One caveat, besides the fact that the subjects were all men, is that saunas are so ingrained in the culture in Finland that it’s hard to find anyone who doesn’t use them. So there’s no control group that used them not at all — only those who used them more or less frequently.

And with this type of study, it’s not possible to know whether it’s the sauna itself or some related factor, like the ability to afford time for frequent RR, that is bringing the benefit. As Rita Redberg, a cardiologist at UCSF Medical Center, wrote in a JAMA Internal Medicine editor’s note accompanying the 2015 study, “We do not know why the men who took saunas more frequently had greater longevity (whether it is the time spent in the hot room, the relaxation time, the leisure of a life that allows for more relaxation time or the camaraderie of the sauna).”

Tanjaniina Laukkanen, an author of those studies and a researcher at the University of Eastern Finland, tells Shots in an email that the team believes both heat and relaxation are important factors. Heart rate increases with full-body heat exposure. That helps improve cardiac output.

Saunas also seem to improve the function of the blood vessels. Christopher Minson, a professor of human physiology at the University of Oregon, studies the effects of heat — in his case, hot water immersion — on the human body. He says that like exercise, heat is a global stressor, with likely a host of beneficial mechanisms throughout the body. He’s researching heat therapy for people who are unable to get the full benefits of exercise, such as people with spinal cord injuries.

This comparison to exercise doesn’t mean you should skip working out if you’re physically able to do it. Another study from Laukkanen’s team suggests that there are some independent effects of cardiovascular exercise and sauna use, and that the men who were in good aerobic shape and frequently hit the sauna had better cardiovascular outcomes than those who only fit one of those categories.

So should we all be taking a regular sauna? Redberg’s 2015 editor’s note said that “clearly time in the sauna is time well spent.” She elaborated in a recent email to Shots, saying that that study and subsequent ones show an association between sauna use and some positive health outcomes such as lower blood pressure and possible relief from musculoskeletal pain and headaches. Saunas are among the relaxing and stress-relieving activities she recommends to patients, including massage, yoga and Pilates. She also recommends physical activity, especially walking.

Of course, there are cautions. People who faint or who have low blood pressure might want to be careful, or at least drink a lot of water before and after, which is good advice for all sauna-goers. If you have unstable heart disease, you should be cautious and consult a doctor first.

And what about the infrared saunas that are trendy now?

How To Make Disease Prevention An Easier Sell

While traditional saunas heat up the surrounding air to about 185 degrees, which in turn heats you, infrared saunas (also called far-infrared saunas) only reach about 140 degrees, according to a 2009 review of evidence on infrared saunas and cardiovascular health. But the infrared rays penetrate more deeply into the body, which means you start sweating at a lower temperature than in a traditional sauna. That produces a lighter demand on the cardiovascular system, similar to moderate walking, according to the review, and so might benefit people who are sedentary for medical reasons. It’s also good for people who like the idea of a sauna, but find the high heat unpleasant.

The review, which covered nine studies, found “limited moderate evidence” for improvement in blood pressure and symptoms of congestive heart failure with infrared saunas, and some limited evidence for improvement in chronic pain. Infrared saunas are also a part of waon therapy, used in Japan, which consists of 15-minute stints in the heat followed by 30 minutes of reclined rest, wrapped in a towel. (Sign me up!) Evidence suggests waon therapy can benefit people with heart failure.

Laukkanen says her group’s work can’t be applied directly to infrared saunas, and that more studies are needed to suss out their longer-term benefits. Whatever kind appeals to you, just don’t think that you are “sweating out toxins” to the benefit of your health (a frequent marketing claim). Toxin removal is chiefly the job of the kidneys and liver, not your sweat.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She’s on Twitter: @katherinehobson.

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How the government shutdown might affect your health

A government shutdown will have far-reaching effects for public health, including the nation’s response to the current, difficult flu season. It will also disrupt some federally supported health services, experts said Friday.

In all, the Department of Health and Human Services will send home — or furlough — about half of its employees, or nearly 41,000 people, according to an HHS shutdown contingency plan released Friday.

Here are some federal services and programs consumers might be wondering about:

Image: A pharmacist administers a flu vaccination at a pharmacy in Los Angeles, California, on Jan. 19, 2018.

Image: A pharmacist administers a flu vaccination at a pharmacy in Los Angeles, California, on Jan. 19, 2018.

Centers for Disease Control and Prevention

According to the HHS plan, the CDC will suspend its flu-tracking program. That’s bad timing, given the country is at the height of a particularly bad flu season, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. Without the CDC’s updates, doctors could have a harder time diagnosing and treating patients quickly, he said.

Although states will still track flu cases, “they won’t be able to call CDC to verify samples or seek their expertise,” said Dr. Thomas Frieden, who was the director of the agency during the 2013 government shutdown.

A government shutdown will also affect the CDC’s involvement in key decisions about next year’s flu vaccine, which are scheduled to be made in coming weeks, said Dr. Arnold Monto, a professor of global public health at the University of Michigan.

Related: Congress, pointing fingers amid shutdown stalemate, returns to work

Beyond the flu, the CDC will provide only “minimal support” to programs that investigate infectious-disease outbreaks. The Atlanta-based agency’s ability to test suspicious pathogens and maintain its 24-hour emergency operations center will be “significantly reduced,” according to the plan.

That could prevent the CDC from identifying clusters of symptoms and disease “that are the earliest indicators of outbreaks,” Frieden said.

National Institutes of Health

Although the NIH will continue to treat patients at its clinical center in Bethesda, Md., the agency will not enroll new patients in clinical trials — which many people with life-threatening illnesses see as their last hope.

Beneficiaries will be largely unaffected by a shutdown, especially if it is short. Patients will continue to receive their insurance coverage, and Medicare will continue to process reimbursement payments to medical providers. But those checks could be delayed if the shutdown is prolonged.


States already have their funding for Medicaid through the second quarter, so no shortfall in coverage for enrollees or payments to providers is expected. Enrolling new Medicaid applicants is a state function, so that process should not be affected.

States also handle much of the Children’s Health Insurance Program (CHIP), which provides coverage for lower-income children whose families earn too much to qualify for Medicaid. But federal funding for CHIP is running dry — its regular authorization expired on Oct. 1, and Congress has not agreed on a long-term funding solution. Federal officials announced Friday that the staff necessary to make payments to states running low on funds will continue to work during a shutdown.

Community health centers

According to the HHS plan, the Health Resources and Services Administration will continue to operate the nation’s 1,400 community health centers — clinics that serve about 27 million low-income people, providing preventive care, dentistry and other basic services. It will also continue the Maternal, Infant and Early Childhood Home Visiting Program, which targets low-income and at-risk families with house calls and lessons for healthy parenting. That program served about 160,000 families in fiscal year 2016.

But even those programs may not be at full speed. Funding for community health centers and the home visiting program was not renewed last fall — a casualty of Congress’ fight over the CHIP reauthorization — so, they are operating on left-over funds.

Related: Government shutdown 2018: What’s open and what’s closed?

ACA premium subsidies

The shutdown will not affect some of the most politically charged health care programs, including ones created by the Affordable Care Act. Subsidies for people who get their health insurance through or state marketplaces will not be affected, according to HHS.

Veterans Affairs

Staffing for the Department of Veterans Affairs will remain largely intact. “Even in the event that there is a shutdown, 95.5 percent of VA employees would come to work, and most aspects of VA’s operations would not be impacted,” said department press secretary Curtis Cashour in an email.

More than 99 percent of employees of the Veterans Health Administration, which runs the health care system, will continue working, according to the department’s contingency plan.

However, the Veterans Benefits Administration, responsible for overseeing benefits such as life insurance and disability checks, will face larger cutbacks. Over a third of its employees face furlough under a government shutdown.

Food and Drug Administration

In the short term, the crucial activities that protect consumers will get done, said Jill Hartzler Warner, who was the associate commissioner for special medical programs at the FDA during the 2013 shutdown.

Programs that are critical for the public safety will continue, as will positions paid for by user fees, including work under the Center for Tobacco Products, according to the HHS plan.

The hundreds of staff members who conduct sample analysis and review entry of products into the U.S. will continue to work. However, routine inspections and laboratory research will cease.

Warner, who left the agency in March 2017 and now works as an industry consultant, said grants for rare-disease drug development were determined in 2013 to not be necessary and were postponed.

Nutrition services for seniors

The Administration for Community Living will not be able to fund federal senior nutrition programs during any shutdown, according to HHS officials. But it was not immediately clear how quickly clients would be affected.

A shutdown could delay federal reimbursements to independent Meals on Wheels programs, which serve more than 2.4 million seniors nationwide, according to Colleen Psomas, a spokeswoman for Meals on Wheels America. That could force programs to expand waiting lists for meals, reduce meals or delivery days, or suspend service, she said.

The magnitude of the effect could vary by the length of the shutdown and any final allocation. Some programs, however, could weather a shutdown, staffers said. In Portland, Ore., Meals on Wheel People spokeswoman Julie Piper Finley said meal delivery there will not be suspended. That agency receives about 35 percent of its funding through the Older Americans Act, but raises the rest of the money, ensuring that services are not disrupted.

Meanwhile, services connected to food and nutrition services for other needy populations are likely to keep operating with state partners who have funding through February and, in some cases, March, according to a Department of Agriculture spokesperson. Those programs include the Supplemental Nutrition Assistance Program, the Child Nutrition Programs and the Special Supplemental Nutrition Program for Women, Infants and Children.

Food safety

The FDA’s food safety programs will cease, according to the HHS plan, but inspections conducted by Agriculture’s Food Safety and Inspection Service (FSIS) will continue.

Meat and poultry inspections are “such a critical, essential task, and the meat and poultry inspection acts require that inspectors be present continuously,” otherwise processing plants would have to close, said Brian Ronholm, former head of FSIS who now works for the law firm Arent Fox.

Ronholm added that many FSIS employees are “career folks” who have worked there through previous government shutdowns. “There was a lot of built-in knowledge of how to function during the [2013] shutdown,” he said, adding that this expertise would help the agency if there is another shutdown.

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HHS releases new rule on health workers’ religious, moral objections

This post has been updated.

Citing President Trump’s “pro-life mission,” the Health and Human Services Department announced actions on Friday that are designed to roll back key health-care policies of the Obama administration.

Roger Severino, director for the HHS Office of Civil Rights, said a proposed rule on “conscience rights” will further protect health-care workers who think they are being punished or discriminated against because of their moral or religious beliefs.

belSpeaking as thousands of abortion opponents gathered on the Mall for the annual March for Life, Severino told reporters that the division’s focus would be on “actions,” as in types of medical procedures, rather than groups of people. He drew parallels with Target refusing to sell guns. “This is not about denying anyone health care,” he said during a conference call.

The rule follows the department’s announcement on Thursday that it was creating a new civil rights division to review complaints from doctors, nurses and others under 25 existing statutes, most of which allow workers to opt out of procedures like abortion, assisted suicide and sterilization.

The document released describes an approach to conscience and religious protections that is significantly broader than current regulations. The number of entities that would be covered by the new rule is massive — as many as 745,000 hospitals, dentists’ offices, pharmacies, ambulance services and others — and the steps any entity must take to show it is in compliance is increased.

It also adds a definition of discrimination, which did not exist under a 2008 rule, and lays out how this could provide the federal government with grounds to challenge a state’s enforcement of its own laws, such as a statute requiring abortion insurance coverage.

Under that rule of the George W. Bush administration, which was rescinded and replaced by the Obama administration in 2011, covered institutions or groups could continue to receive federal funding by signing a certification that they were aware of existing legal protections. The new regulation would incorporate elements of the older rule but also would go further and require entities to post notices of the protections. Officials say they expect them to ensure that organization-wide safeguards are in place, update policies as needed and implement staff training.

The draft language notes that the Office of Civil Rights could initiate a compliance review of organizations that get federal funding and  look at whether the notice is in personnel manuals and employment applications, among other details.

HHS estimates that implementing the new rule would cost $312.3 million in the first year and $125.5 million annually in the second through fifth years. The department said it expects to add the equivalent of 4.5 full-time staff to provide oversight.

In a separate action Friday, officials rescinded a guidance letter about Medicaid that was issued by the Obama administration in 2016, which they say limited states’ authority to regulate providers within their borders. That letter said states attempting to disqualify abortion providers from their Medicaid programs could come under federal scrutiny.

By contrast, officials explained, a new guidance letter aims to empower states to make the most appropriate decisions for themselves. In recent years, Indiana and other states have blocked Medicaid funds from Planned Parenthood because of the abortion services it offers. The new policy could allow states to receive millions in federal funding while banning abortion providers from participating in a family planning program for low-income women.

The state likely to take immediate advantage of the policy reversal is Texas, which last year submitted a waiver petition to the Centers for Medicare and Medicaid Services asking to regain funding it stopped accepting for its Healthy Texas Women program when it chose to exclude providers that “perform or promote elective abortions” or contract or affiliate with such providers.

The administration has yet to issue a decision in that case.

Dawn Laguens, executive vice president for the Planned Parenthood Action Fund, said the reversal is meant to encourage states to block access to care at Planned Parenthood and “control where women can go for health care.”

“The law is clear: It is illegal to bar women from seeking care at Planned Parenthood. Long-standing protections within Medicaid safeguard every person’s right to access care at their qualified provider of choice,” Laguens said in a statement.

Some health and legal experts question whether the proposed rule on conscience rights could be broadly interpreted and whether, as an example, a doctor could refuse sex-reassignment surgery to someone who is transgender. Existing laws do not specifically address if a doctor can deny services related to an individual’s sexual identity; “the statutes focus on actions providers say they can’t do in good conscience,” Severino said.

Severino did not rule out that LGBT-related cases could come up once the rule becomes final. “It’s difficult to deal with every hypothetical in a law-enforcement context because we can’t prejudge every case that comes through,” he said.

Under the Obama administration, Severino said, HHS did not provide much guidance, enforcement or outreach on medical issues involving moral or religious liberty claims. The department received 10 complaints under Obama, and it has received 34 since Trump took office a year ago.

“The regulations make clear and give notice to the public that we’re in business on these statutes, and we’ll give it the proper focus and energy they deserve because they’ve been ignored for too long,” he said.

Severino said the regulations are an outgrowth of Trump’s 2017 executive order that included a section on “conscience protections.” That order was seen as a direct response to some of the Obama administration actions that upset religious conservatives.

Several religious groups battled the Obama administration over the Affordable Care Act’s mandate that employers and insurers provide no-cost contraceptive coverage for employees. In October, HHS introduced rules expanding the range of businesses that can object to the requirement on religious or moral grounds and receive an exemption.

“The protection of conscience is a freedom that for too long has not been given the attention it deserves,” Severino said Friday.

Many religious conservative groups are praising HHS’s moves this week.

“Americans should not be forced to choose between their faith and their desire to help patients,” Tony Perkins, president of the Family Research Council, said in a statement. “As President Trump continues to follow through on his promises on these core issues, he will continue to have the support of social conservatives on his policy initiatives.”

Those on the political and religious left, however, see the actions as an attack on all patients’ right to receive health care. HHS is setting up a system to allow discrimination, said the Rev. Mike Scheunemeyer, who leads Health and Wholeness Advocacy Ministries, United Church of Christ.

“When I look at how Jesus responded to the people who came to him to be healed, I can find no example of him turning anyone away,” Scheunemeyer said in a statement. “This is the example we should emulate in America.”

Camilla Taylor, acting legal director of Lambda Legal, said in an interview that the proposed conscience regulations would not only allow health-care providers to turn away patients “in violation of medical and ethical rules which require they provide care without discriminating” but also to excuse them from having to give referrals for other providers.

“The proposed regulations are an outrageous attack on the most vulnerable Americans,” Taylor said. “They allow health-care providers to deny care while receiving federal funding to certain patients based on who they are.”

Read more:

Why HHS is targeting health-care workers’ religious objections

Trump will address Friday’s March for Life via satellite. Here’s what abortion opponents want.

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