Ryan Blackledge

Our last and next president has tried to distance himself from #Project2025, claiming he "has no idea who is behind it." But it was developed by a broad coalition of conservative organizations, spearheaded by the Heritage Foundation, perhaps the leading conservative think tank in the U.S., "for the next conservative administration." And at least 140 people who worked in the Trump administration had a hand in Project 2025. These include Roger Severino, the Trump appointee who led the HHS Office for Civil Rights through its many successful efforts to rescind regulations clarifying civil rights in health care and drastically expand the rights of health care providers and staff to deny their patients essential care. Severino currently serves as Heritage's VP of Domestic Policy and authored Project 2025's plans for HHS: a frightening playbook to narrow health care access (including abortion) and related civil rights across the entire country, using mechanisms that will affect those in seemingly "safe" states (e.g., those that have passed ballot initiatives and legislation to strengthen state abortion rights). I previously wrote about some of the plan's most frightening proposals for Medicaid, the ACA, and Section 504 of the Rehabilitation Act in the National Health Law Program blog post below. It doesn't stop there. Six of his former Cabinet secretaries co-authored or collaborated on Project 2025. Four of his ambassadors and several enforcers of his racist immigration agenda were involved. About 20 pages are credited to his first deputy chief of staff. Democracy Forward has a great resource summarizing what Project 2025 will mean to the American people, called "The People's Guide to Project 2025." https://lnkd.in/e79aAJxe. As Democracy Forward writes, "these threats aren't hypothetical. These are their real plans." It's important to not give into despair. We cannot give up hope; we must keep fighting to hold the line on health care access and democracy at large. But first, for those who have not already done so, it is time to understand and steel yourselves for what's to come. https://lnkd.in/epmRHi8Y

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In a new blog post, I address how the authoritarian #Project2025 agenda endangers the future of Medicaid and the Affordable Care Act, with some specific implications for sexual and reproductive health and disability. #ProtectMedicaid https://lnkd.in/epmRHi8Y

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Back in 2022, the U.S. Department for Health and Human Services (HHS) proposed a new rule on #Section1557 of the Affordable Care Act, the law’s nondiscrimination provision and the first federal law to broadly prohibit sex discrimination in health care. Through NHeLP’s comments and template comments for the broader advocacy community, we pushed for HHS to not only restore regulations on the ACA’s nondiscrimination protections, but to affirm for the first time that Section 1557 prohibits sex discrimination in pain management, including the undertreatment or dismissal of pain on the basis of sex. This discrimination is a pervasive and millennia old problem in health care that many women and people assigned female at birth have experienced, often over and over again. It’s one of the reasons so many of us are afraid to go to the emergency department when we are experiencing crisis-levels of pain, that many of us experience years or decades-long delays in health condition diagnoses, and the reason most reproductive providers still aren’t offering pain management for IUD insertion up front, despite CDC recommendations to the contrary. It’s an issue that I have extensive lived experience with. NHeLP won (on this and other issues). In a historic move earlier this year, the Biden-Harris administration not only restored regulations that the prior administration rescinded, but affirmed that sex discrimination in pain management can indeed violate our #CivilRights. Most health care providers must comply with Section 1557. Regardless of your own insurance type or status, if the health care entity they work for (e.g., hospital, office, clinic) accepts Medicare (most do) among certain other insurance programs and plans, they must follow the law (as an aside, this is one of the reasons that the movement to stop taking insurance is so insidious—they generally no longer need to follow certain civil rights laws). If you or someone you know experiences discrimination in health care on the basis of sex, race, color, national origin, disability, age, or any combination thereof, you have 180 days from when you learned the discrimination occurred to file a complaint with HHS. You don’t need a lawyer and only need to provide a few sentences about what happened. You can file your complaint online here: https://lnkd.in/eEJxyybG However, this interpretation of the law is at risk. Project 2025 recommends that the next conservative administration rescind the 2024 final rule on Section 1557. Read more about this and other health care rights at risk in this election on the National Health Law Program’s blog:

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Very exciting news from HHS, CDC and OCCHE! Today, the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (ATSDR), in partnership with the U.S. Department of Health and Human Services (HHS) Office of Climate Change and Health Equity (OCCHE) and HHS Office of the Assistant Secretary (OASH), have released the Heat and Health Index (HHI) as the latest in a set of tools and resources intended to improve the nation’s ability to stay safe during heat events.  The HHI combines historic temperature data and Emergency Medical Services (EMS) data on heat-related emergency responses from the past three years, as well as data on community characteristics, including pre-existing health conditions, socio-demographic information, and characteristics of the natural and built environment, to provide a final heat and health index ranking by ZIP code, which can be used to empower strategic, data-informed decision-making. Access the HHI and explore its capabilities at https://lnkd.in/git_9mMa. This link will guide you to the landing page of the Heat and Health Tracker; please click on “Heat and Health Index” in the left navigation pane of this landing page to access the HHI.

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The National Health Law Program (NHeLP) cheers the reintroduction of the Health Equity and Accountability Act (#HEAA) of 2024, a critical, comprehensive, and strategic roadmap to address and help eliminate health care inequities experienced by communities of color. HEAA represents a crucial opportunity to comprehensively fight the vast racial health inequities that mark the U.S., as well as their intersections with xenophobia, sexism, ableism, ageism, and classism. HEAA builds upon the Affordable Care Act’s achievements through groundbreaking reforms such as closing Medicaid’s immigrant and post-pregnancy coverage gaps; establishing Medicaid doula payment models among other payment and service delivery innovations that center racial health equity; and strengthening data collection and access to culturally and linguistically appropriate health care. HEAA also recognizes that we cannot achieve racial health equity without a federal right to abortion that includes Medicaid coverage. The National Health Law Program urges Congress to pass this vital legislation. The Congressional Tri-Caucus has reintroduced HEAA since 2003. This year, CAPAC is championing HEAA’s reintroduction. Representative Barbara Lee and Senator Mazie Hirono are the lead sponsors for the first-ever bicameral introduction. Over the last decade, more than 150 Members of Congress have co-sponsored HEAA. Since its inception, over 300 racial and health equity organizations, community-based organizations, researchers, and provider groups have contributed to HEAA’s development as part of the Community Working Group (CWG). This year, Association of Asian Pacific Community Health Organizations (AAPCHO) and Asian & Pacific Islander American Health Forum coordinated the CWG. A proud longtime member of the CWG, NHeLP contributes to various HEAA titles. Over the last two Congresses, I have had the privilege of leading the Title V Committee, which rewrites 500+ pages of bill text with policies to foster racial health equity in the contexts of sexual and reproductive health and children’s health. I am grateful to Title V Committee members for their powerful contributions and especially my colleague Michelle Yiu for their hard work on the most recent rewrite. Racial health equity cannot wait. It’s time for Congress to pass HEAA. #HealthEquityForAll NHeLP’s statement: https://lnkd.in/gqBuGxZT CAPAC’s statement: https://lnkd.in/gD4dprM6 Press conference: https://lnkd.in/gN7waA4Q

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Still wrapping your head about the HHS Office for Civil Rights' final rule on § 1557 of the Patient Protection and Affordable Care Act? Check out this new Q&A from § 1557 experts on National Health Law Program's Federal Advocacy team. We answer the following questions for health advocates: Q.1 What is § 1557?  Q.2 Does § 1557 address intersectional discrimination?  Q.3 What kinds of programs and providers must comply with § 1557?  Q.4 What is the scope of the 2024 Final Rule?  Q.5 Why did the Biden administration revise the 2020 Final Rule?  Q.6 Does the 2024 Final Rule expand the applicability of § 1557?  Q.7 How does the 2024 Final Rule address discrimination on the basis of sex?  Q.8 How does the 2024 Final Rule affect LGBTQI+ persons?  Q.9 How does the 2024 Final Rule address pregnancy or related conditions?  Q.10 How does the 2024 Final Rule address sex stereotypes in health care?  Q.11 How does the 2024 Final Rule impact people with HIV/AIDS and other serious or chronic medical conditions?  Q.12 How does the 2024 Final Rule address health care refusals based on religious or moral beliefs?  Q.13 How does the 2024 Final Rule affect individuals with limited English proficiency (LEP)?  Q.14 How does the 2024 Final Rule affect people with disabilities?  Q.15 How does the 2024 Final Rule affect requirements to inform individuals of their rights?  Q.16 How does the 2024 Final Rule affect compliance and enforcement of § 1557’s protections?  Q.17 What are some of the other notable changes in the 2024 Final Rule?  Q.18 When is the 2024 Final Rule effective? If we didn't answer your question, don't hesitate to reach out: morcelle@healthlaw.org. #HealthLaw #CivilRights #Nondiscrimination #ACA https://lnkd.in/ePZNFvEm

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Last week CMS released eagerly anticipated guidance on the requirements to provide Medicaid/CHIP services to incarcerated youth. States will need to move quickly to put into place the foundational policy and operational processes necessary to come into compliance. Over the next five months, states will need to, at a minimum: develop state policies and operational plans; coordinate with and provide technical assistance to correctional facilities so that they can enroll as providers and establish billing and claiming processes; ensure smooth information sharing processes between facilities and state Medicaid agencies for Medicaid/CHIP enrollment, suspension, and delivery of services; and submit and obtain approval for federal legal authorities.  All states will need to work shoulder-to-shoulder with their correctional facility partners in order to ensure successful implementation.  See our SHVS summary of the newly released CMS' guidance with Patricia Boozang, Chris Cantrell, and Gini Morgan

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CSH has updated their Policy Brief on Medicaid coverage of Housing Related Services. We are up to twenty-seven state & DC that cover these vital services for some populations. More details at https://lnkd.in/efKNS9Tk And coming soon, rating states on the quality of those programs, based on CSH's Six Strategies to use with Medicaid to Scale Supportive Housing https://lnkd.in/eAiJbsNf

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From Mifepristone to federal agency rulemaking authority, the current Supreme Court term could shape the future of health care policy. In our inaugural Supreme Court Term in Review, moderated by Professor Michele Goodwin, experts will analyze this year's legal changes and challenges. Register: https://bit.ly/3VCdxRi

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This is a great paper with implications for Medicaid Estates Recovery and the future of federalism after NFIB…congrats Isabella!

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Combining care that focuses on the whole person just makes sense. See our newest report below to learn more about what’s working in West Virginia.

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God bless Samuel Bagenstos and his team at the HHS Office of General Counsel (OGC). Yesterday, General Counsel Bagenstos issued an advisory opinion stating that the HHS Secretary lacks the legal authority to approve #Section1115 demonstration projects that impose #Medicaid work requirements. From where I sit, the most important takeaway from the advisory opinion is this: "It would exceed the Secretary’s statutory authority to approve Section 1115 demonstrations that impose work requirements as a condition of Medicaid eligibility or continued enrollment, because they conflict with that core objective [of providing medical assistance, rehabilitation, and other services to eligible people]." Thank you, HHS OGC team. You can access the HHS OGC advisory opinion here: https://lnkd.in/efgRMrEf From a policy standpoint, Medicaid work requirements are just severe Medicaid cuts by another name. Research demonstrates that most working-age Medicaid enrollees work, and nearly all those who do not work cannot due to disabilities, serious health conditions, childcare or caregiving responsibilities, or because they are in school. Studies also show that work requirements in safety net programs create burdensome and confusing red tape, paperwork, and reporting requirements that result in sweeping eligibility losses, including for low-wage workers. For example, under Georgia’s current “Pathways to Coverage” Medicaid work requirement program, only 5,542 of the 300,000 low-income Georgians who should have gained coverage through Medicaid expansion have been able to do so. Moreover, Medicaid work requirements hurt state economies because they are extremely expensive to implement, increasing state spending on insurance. They also make it harder for people to stay employed. Medicaid work requirement “exemptions” for those who cannot work are ineffective and misleading. We know from experience that exemptions from safety net program work requirements, such as those on the basis of pregnancy, disability, caregiving responsibilities, or interpersonal violence are extremely difficult to obtain due to documentation requirements. Enrollees also often experience significant power differentials with program caseworkers, who have a great deal of discretion in whether to grant work requirement exemptions, and often arbitrarily refuse them. Many people would fall through the cracks and lose their health insurance coverage. #ProtectMedicaid #SaveMedicaid

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This report from our Population Health team highlights how state health agencies can use Medicaid data for population health improvement. Specifically, this analysis assesses how pandemics, like COVID-19, change or disrupt healthcare utilization. This analysis can shed light on the populations most impacted and guide preparedness planning efforts for future pandemics.

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Check out this excellent summary of the impact of the FTC's "non-compete" rule on the health care industry by my colleagues Marci Rose Borenstein and Callan Smith.

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A Deep Concern: The Looming Transformation of America's Healthcare Safety Net I write today with profound concern about the emerging policy architecture that threatens to fundamentally dismantle Medicaid's protective framework. The convergence of Project 2025, the Republican Study Committee budget plan, and the House GOP budget resolution presents a deeply troubling vision for healthcare access in America. At the heart of these proposals lies an unsettling transformation: the replacement of Medicaid's responsive funding structure with rigid block grants and per capita caps. This isn't merely a technical adjustment—it represents an existential threat to healthcare access for millions of our most vulnerable citizens. The implications are profoundly disturbing: The proposed funding caps would fail to respond to unexpected crises—recessions, natural disasters, public health emergencies, or breakthrough medical treatments. States would face impossible choices between raising taxes substantially or—far more likely—severely cutting healthcare services for children, seniors, and individuals with disabilities. Most alarming is the compound effect of these proposals: Eliminating enhanced funding for Medicaid expansion, threatening coverage for nearly 20 million Americans Imposing bureaucratic work requirements that create barriers to essential healthcare Restricting states' ability to finance their Medicaid programs through provider taxes Opening the door to drastic cuts in eligibility and benefits This represents more than a policy shift—it's a fundamental retreat from our societal commitment to ensure healthcare access for our most vulnerable populations. The human cost would be staggering: families losing health coverage, disabled individuals facing reduced services, seniors struggling to access long-term care. These proposals reflect a troubling vision of American healthcare—one that prioritizes fiscal constraints over human wellbeing, bureaucratic hurdles over healthcare access, and abstract policy goals over real human needs. We must recognize this moment for what it is: a critical juncture that demands our attention and action. #HealthcareAccess #MedicaidMatters #HealthcareJustice #PublicHealth #HealthcareEquity

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"Mr. Kennedy, you have been nominated to be the Secretary of Health and Human Services (HHS), the largest department in the United States government. HHS has an annual budget of $1.85 trillion and supervises 80,000 employees. I have some concerns about your appointment: Question #1: On July 6, 2023, while appearing on a popular podcast, you said “no vaccine is safe and effective.” However, CDC has estimated that between 1994 and 2023, childhood vaccines in the United States have prevented 1.1 million deaths, 508 million illnesses, and 32 million hospitalizations. Do you disagree with the CDC’s assessment? And, if so, why? Question #2: On that same podcast, when asked about the polio vaccine, you said, “The polio vaccine contained a virus called SV40. It’s one of the most carcinogenic viruses known to man…98 million people who got that vaccine in my generation now have this explosion in soft tissue cancers [that] kill many, many, many, many, many, many more people than polio ever did.” This concern has now been examined in more than a dozen studies. Researchers compared cancer rates in children who had received SV40-contaminated polio vaccines with unvaccinated children. Eight years after receiving the tainted vaccines, the cancer incidence was identical in both groups. The same was true fifteen and thirty-five years later. And it was true for children who received SV40-contaminated vaccines in the United States, the United Kingdom, Germany, and Sweden. By the mid-1990s public-health officials were confident that the inadvertent contamination of several lots of polio vaccines with SV40 in the early 1960s hadn’t caused cancer. Further, the CDC has estimated that in 1952, three years before Jonas Salk’s polio vaccine was available, 21,000 people were paralyzed by the virus and 1800 killed. In 1960, five years after the vaccine was licensed, 2,525 cases were reported: in 1965, 61 cases. By 1979, paralytic polio was eliminated from the United States. Do you still believe that the polio vaccine caused “many many more deaths” than it prevented? And, if so, on what do you base that statement?"

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“As former secretaries of state from opposing political parties and an emergency physician on the frontlines of healthcare, we have witnessed first hand how health and civics intersect.” Today, USA TODAY spotlighted our work at Vot-ER leading the civic health movement in an article co-authored by two former Secretaries of State alongside emergency physician Dr. Ali Raja, unpacking the powerful potential of voter engagement in healthcare settings. Trey Grayson (R-KY) and Miles Rapoport (D-CT) joined forces with Dr. Raja from Harvard to ask healthcare workers to lead the charge in nonpartisan civic engagement. Look, the message is clear: healthcare has a unique opportunity to strengthen democracy by making civic participation as essential as the care it provides. Organizations like Vot-ER paving the way, offering a seamless blend of medical care and civic empowerment. In a country where health and civic health are deeply intertwined, the work of connecting patients and staff to voter registration isn’t just a democratic duty; it’s a step toward A Healthier Democracy. Our team at Vot-ER is proving that the act of voting can start in the waiting room, and in times like these, that’s a powerful remedy. https://lnkd.in/dYH8DXmp #2024 #civichealth

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