Category: Public Health

Doctors Could Refuse to Treat People Based on Race and Age Under Trump’s New Rule

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A new Trump administration proposal would change the civil rights rules dictating whether providers must care for patients who are transgender or have had an abortion. News stories have mainly focused on how the proposal might affect LGBTQ rights and abortion rights, but the sweeping proposal has implications for all Americans, because the Department of Health and Human Services seeks to change how far civil rights protections extend and how those protections are enforced.

Roger Severino, the director of the HHS Office for Civil Rights, has been candid about his intentions to overturn an Obama-era rule that prohibited discrimination based on gender identity and termination of a pregnancy. In 2016, while at the conservative Heritage Foundation, he co-authored a paper arguing the restrictions threaten the independence of physicians to follow their religious or moral beliefs. Supporters of the approach say it protects the freedom of conscience, but opponents say it encourages discrimination.

His office unveiled the proposed rule on May 24, when many people were focused on the start of the long Memorial Day holiday weekend.

The rule is the latest Trump administration proposal to strip protections for transgender Americans, coming the same week another directive was proposed by the Department of Housing and Urban Development that would allow homeless shelters to turn away people based on their gender identity.

The public was given 60 days to comment on the HHS proposal. Here’s a rundown of what you need to know about it.

What would this proposal do?

Fundamentally, the proposed rule would overturn a previous rule that forbids health care providers who receive federal funding from discriminating against patients on the basis of their gender identity or whether they have terminated a pregnancy.

The Trump administration proposal would eliminate those protections, enabling providers to deny these groups care or insurance coverage without having to pay a fine or suffer other federal consequences.

That may mean refusing a transgender patient mental health care or gender-confirming surgery. But it may also mean denying patients care that has nothing to do with gender identity, such as a regular office visit for a bad cold or ongoing treatment for chronic conditions like diabetes.

“What it does, from a very practical point of view, is that it empowers bad actors to be bad actors,” Mara Keisling, executive director of the National Center for Transgender Equality, told reporters.

The proposal would also eliminate protections based on sexual orientation and gender identity from several other health care regulations, like non-discrimination guidelines for the health care insurance marketplaces.

Does it affect only LGBTQ people?

The proposal goes beyond removing protections for the LGBTQ community and those who have had an abortion.

It appears to weaken other protections, such as those based on race or age, by limiting who must abide by the rules. The Trump proposal would scrap the Obama-era rule’s broad definition of which providers can be punished by federal health officials for discrimination, a complicated change critics have said could ease requirements for insurance companies, for instance, as well as the agency itself.

And the proposal erases many of the enforcement procedures outlined in the earlier rule, including its explicit ban on intimidation or retaliation. It also delegates to Severino, as the office’s director, full enforcement authority when it comes to things like opening investigations into complaints lodged under the non-discrimination rule.

Why did HHS decide to change the rule?

The Obama and Trump administrations have different opinions about whether a health care provider should be able to refuse service to patients because they are transgender or have had an abortion.

It all goes back to a section in the Affordable Care Act barring discrimination on the basis of race, color, national origin, age, disability or sex. President Barack Obama’s health officials said it is discrimination to treat someone differently based on gender identity or stereotypes.

It was the first time Americans who are transgender were protected from discrimination in health care.

But President Donald Trump’s health officials said that definition of sex discrimination misinterprets civil rights laws, particularly a religious freedom law used to shield providers who object to performing certain procedures, such as abortions, or treating certain patients because they conflict with their religious convictions.

“When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,” Severino said in a statement. “The American people want vigorous protection of civil rights and faithfulness to the text of the laws passed by their representatives.”

Much of what the Office for Civil Rights has done under Severino’s leadership is to emphasize and strengthen so-called conscience protections for health care providers, many of which existed well before Trump was sworn in. Last year, Severino unveiled a Conscience and Religious Freedom Division, and his office recently finalized another rule detailing those protections and their enforcement.

The office also said the proposed rule would save about $3.6 billion over five years. Most of that would come from eliminating requirements for providers to post notices about discrimination, as well as other measures that cater to those with disabilities and limited English proficiency.

The rule would also save providers money that might instead be spent handling grievances from those no longer protected.

The office “considers this a benefit of the rule,” said Katie Keith, co-founder of Out2Enroll, an organization that helps the LGBTQ community obtain health insurance. “Organizations will have lower labor costs and lower litigation costs because they will no longer have to process grievances or defend against lawsuits brought by transgender people.”

Why does this matter?

Research shows the LGBTQ community faces greater health challenges and higher rates of illness than other groups, making access to equitable treatment in health care all the more important.

Discrimination, from the misuse of pronouns to denials of care, is “commonplace” for transgender patients, according to a 2011 report by advocacy groups. The report found that 28 percent of the 6,450 transgender and gender non-conforming people interviewed said they had experienced verbal harassment in a health care setting, while 19 percent said they had been refused care due to their gender identity.

The report said 28 percent had postponed seeking medical attention when they were sick or injured because of discrimination.

Critics fear the rule would muddy the waters, giving patients less clarity on what is and is not permissible and how to get help when they have been the victims of discrimination.

Jocelyn Samuels, the Obama administration official who oversaw the implementation of the Obama-era rule, said that for now, even though the Trump administration’s HHS will not pursue complaints against those providers, Americans still have the right to challenge this treatment in court. Multiple courts have said the prohibition on sex discrimination includes gender identity.

“The administration should be in the business of expanding access to health care and health coverage,” Samuels told reporters on a conference call after the rule’s release. “And my fear is that this rule does just the opposite.”

[VICE]

Trump Takes Credit for Obama’s Gains for Vets

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Boastful on the occasion of Memorial Day, President Donald Trump and his Veterans Affairs secretary are claiming full credit for health care improvements that were underway before they took office.

Trump said he passed a private-sector health care program, Veterans Choice, after failed attempts by past presidents for the last “45 years.” That’s not true. The Choice program, which allows veterans to see doctors outside the government-run VA system at taxpayer expense, was first passed in 2014 under President Barack Obama.

Trump’s VA secretary, Robert Wilkie, also is distorting the facts. Faulting previous “bad leadership” at VA, Wilkie suggested it was his own efforts that improved waiting times at VA medical centers and brought new offerings of same-day mental health service. The problem: The study cited by Wilkie on wait times covers the period from 2014 to 2017, before Wilkie took the helm as VA secretary. Same-day mental health services at VA were started during the Obama administration under Wilkie’s predecessor, David Shulkin.

The half-truths and exaggerations came in a week when selective accounting was a norm in Trump’s rhetoric, extending into his trip to Japan , where he inflated the drop in the U.S. unemployment rate for women.

A look at the claims, about the Russia investigation, the border, drug prices and more:

VETERANS

TRUMP: “We passed VA Choice and VA Accountability to give our veterans the care that they deserve and they have been trying to pass these things for 45 years.” — Montoursville, Pennsylvania, rally on May 20.

THE FACTS: Wrong. Trump is not the first president in 45 years to get Congress to pass Veterans Choice; Obama did it in the wake of a scandal at VA’s medical center in Phoenix, where some veterans died while waiting months for appointments. The program currently allows veterans to see doctors outside the VA system if they must wait more than 30 days for an appointment or drive more than 40 miles (65 kilometers) to a VA facility.

Trump did expand eligibility for the program. Now, starting June 6, veterans are to have that option for a private doctor if their VA wait is only 20 days (28 for specialty care) or their drive is only 30 minutes.

Still, VA’s top health official, Dr. Richard Stone, described the new program’s start to “almost be a non-event” in testimony to Congress. That’s in part because wait times in the private sector are typically longer than at VA. In 2018, 34 percent of all VA appointments were with outside physicians, down from 36 percent in 2017.

Also key to the Choice program’s success is an overhaul of VA’s electronic medical records to allow seamless sharing of them with private physicians, a process expected to take up to 10 years. Wilkie has said full implementation of the expanded Choice program is “years” away.

[Associated Press]

Trump administration bans CDC from saying ‘diversity,’ transgender,’ ‘fetus,’ and more

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The Trump administration has banned seven words from the Centers for Disease Control’s upcoming budget documents, the Washington Post reports. The words are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”

CDC analysts were not given a reason for the banned words, they were simply informed of the new policy. Some phrases can be replaced or retooled, like by saying “CDC bases its recommendations on science in consideration with community standards and wishes” – an actual alternate phrase offered to CDC analysts in the first briefing about these words.

But not all the words are as easy to work around. It’s no secret that the current administration is anti-abortion and pushing back significantly in the fight for trans rights. Banning these words from CDC documentation directly affects communication around HIV/AIDS and the Zika virus, among others. 

This isn’t the first attempt to curb the use of language that threatens the Trump administration’s regressive policies. In March, the U.S. Department of Health and Human Services (HHS) removed questions about sexual orientation and gender identity from two surveys of elderly people. The department also archived a webpage containing resources for LGBTQ+ people and their families.

On a more fundamental level, this aligns directly with the Trump administration’s mistrust of words and facts, and its tendency to dismiss whichever words and facts conflict with the administration’s views and messaging. The inclusion of “diversity,” “entitlement,” and “vulnerable” in the new list reflects this directly; it erases the words from relevant discourse and by extension threatens to sweep larger problems under the rug. 

Matt Lloyd, an HHS spokesperson, said that the department “will continue to use the best scientific evidence available to improve the health of all Americans. HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions.”

[Mashable]

New emails show Trump’s unqualified Mar-a-Lago buddies are influencing VA policies

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A new batch of emails obtained by Pro Publica show that three members of President Donald Trump’s Mar-a-Lago resort are influencing contract and budget decisions at the Department of Veterans Affairs — despite being completely unqualified to do so.

The emails show that the three Mar-a-Lago members — Marvel Entertainment chairman Ike Perlmutter, West Palm Beach physician Bruce Moskowitz and lawyer Marc Sherman — were involved in “some of the agency’s most consequential matters, most notably a multibillion-dollar effort to overhaul electronic health records for millions of veterans,” Pro Publica writes.

According to Pro Publica, the trio reviewed a draft of a $10 billion contract to overhaul the VA’s electronic medical records system, and they were listed among 40 different outside “experts” consulted for the contract despite lacking “any relevant expertise.”

Additionally, the emails show that Moskowitz used his position as an adviser to get the VA to adopt his mobile medical app, even though IT officials at the VA said that the app had serious functionality problems. In fact, one email shows that a VA IT official believed that “some of the code needs to be refactored and even rebuilt” for the app to work properly.

Moskowitz even recruited his son, Aaron Moskowitz, to pitch the benefits of the app during a conference between the VA and Apple CEO Tim Cook. Apple experts similarly pushed back on Moskowitz’s mobile app and said that “the national databases needed to make the app accurate didn’t exist,” Pro Publica writes.

[Raw Story]

OSHA to reduce Obama-era injury report requirements for large companies

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The Trump administration has proposed rolling back an Obama-era Labor Department rule requiring companies with 250 or more workers to submit detailed forms to the agency on workplace injuries, a move labor advocates say will allow companies to cover up the extent of injuries.

The department’s Occupational Safety and Health Administration (OSHA) issued a notice on Friday stating that it is seeking to roll back the rule passed under the Obama administration that greatly increased the amount of detail supervisors are supposed to provide to the federal government on workplace injuries.

Some of that information was then posted publicly by the Labor Department under the rule, and included summaries of incidents that occurred in larger-scale companies.

A spokesperson for the Labor Department told NBC News that the rule change would not alter the agency’s ability to collect information from companies on workplace injuries and safety violations.

“This proposal maintains safety and health protections for workers while protecting sensitive worker information from public disclosure,” communications director Megan Sweeney told NBC. “The data OSHA continues to collect is robust and enables the agency to most effectively protect workers on the job.”

The Labor Department argued that the original rule violated workers’ privacy by exposing incidents that they were involved in to Freedom of Information Act requests.

Public safety advocates argued that the rule’s rollback would only hurt workers.

“The existing rule is in place to protect workers,” said Sean Sherman, an attorney at the Public Citizen Litigation Group which is involved in a lawsuit over the rule. “The idea that you can protect workers by rolling back a strong worker protection is absurd.”

http://thehill.com/regulation/labor/399323-osha-reduces-obama-era-injury-report-requirements-for-large-companies

Trump’s EPA rolls back Obama-era coal ash regulations

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The Trump administration announced Wednesday that it is relaxing rules for the disposal of spent coal used to fuel hundreds of power plants nationwide.

But environmental groups say the rollback of coal ash storage regulations established by the Obama administration in 2015 could affect drinking water near dozens of sites.

Dalal Aboulhosn, Sierra Club’s deputy legislative director for land and water, said legal action was being considered. “We are pouring through the rule change see what our next steps might be,” she said

The coal industry petitioned the Trump administration for the roll back, announced by Environmental Protection Agency Acting Administrator Andrew Wheeler — a former lobbyist for the coal industry.

It’s not like EPA has granted us free pass here,” said James Roewer, executive director of the Utility Solid Waste Advisory Group, an industry organization that had pushed for the changes. “It just gives us additional time to operate those facilities and better synch them up” with the upcoming wastewater guidelines.

The EPA states that the relaxed rules will save affected utility companies $28 to $31 million a year in regulatory costs.

These amendments provide states and utilities much-needed flexibility in the management of coal ash, while ensuring human health and the environment are protected,” Wheeler said in a statement. “Our actions mark a significant departure from the one-size-fits-all policies of the past and save tens of millions of dollars in regulatory costs.”

The EPA extended the time by 18 months that the industry can use unlined coal ash ponds and groundwater-adjacent sites for dumping. The Obama administration sought to phase out those sites by April 2019.

The unlined ponds are considered by environmentalists to be the worst offenders for polluting groundwater that sometimes is tapped for drinking.

“The Trump administration is turing a blind eye to damage done to our drinking water,” said Lisa Evans, senior counsel for environmental group Earthjustice. “This is aimed at saving industry money instead of protecting the public.”

[NBC News]

Trump attacks NYT over breastfeeding story

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President Donald Trump on Monday attacked a New York Times story that reported how his administration attempted to weaken a World Health Assembly resolution to promote breastfeeding, saying women shouldn’t be denied access to formula.

The president’s tweet was spillover from a feud over a proposed breastfeeding resolution earlier this year at the WHA, the decision-making body of the World Health Organization. The U.S. opposed the resolution so strongly it threatened trade measures against the country that introduced it, according to the Times.

“The failing NY Times Fake News story today about breast feeding must be called out. The U.S. strongly supports breast feeding but we don’t believe women should be denied access to formula. Many women need this option because of malnutrition and poverty,” Trump said in a tweet.

According to the Times, the resolution was written to encourage breastfeeding and to limit “inaccurate or misleading” marketing for breast milk substitutes. The resolution, introduced by Ecuador, did not bar the use of formula.

When attempts to soften language in the resolution were unsuccessful, the U.S. stunned the global community by threatening retaliatory trade measures against Ecuador and the withdrawal of military aid, according to the Times report.

Ecuador backed off, as did a number of countries that said they feared the same retaliation. The resolution was later introduced by Russia. At that point, the U.S. did not fight back, the Times noted.

The lead agency involved in the resolution negotiations, the Department of Health and Human Services, denies the U.S. made any trade sanction-related threats. HHS spokesperson Caitlin Oakley touted the country’s “long history” of support for breastfeeding in a statement Monday afternoon.

“Recent reporting attempts to portray the U.S. position at the recent World Health Assembly as ‘anti-breastfeeding’ are patently false,” Oakley said. “The United States was fighting to protect women’s abilities to make the best choices for the nutrition of their babies. Many women are not able to breastfeed for a variety of reasons, these women should not be stigmatized; they should be equally supported with information and access to alternatives for the health of themselves and their babies.”

The Times defended its reporting in a tweet to the president, and provided a link to the story in question.

“Our report is accurate. You can read it here,” the Times said.

[Politico]

U.S. Opposition to Breast-Feeding Resolution Stuns World Health Officials

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A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly.

Based on decades of research, the resolution says that mother’s milk is healthiest for children and countries should strive to limit the inaccurate or misleading marketing of breast milk substitutes.

Then the United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations.

American officials sought to water down the resolution by removing language that called on governments to “protect, promote and support breast-feeding” and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children.

When that failed, they turned to threats, according to diplomats and government officials who took part in the discussions. Ecuador, which had planned to introduce the measure, was the first to find itself in the cross hairs.

The Americans were blunt: If Ecuador refused to drop the resolution, Washington would unleash punishing trade measures and withdraw crucial military aid. The Ecuadorean government quickly acquiesced.

The showdown over the issue was recounted by more than a dozen participants from several countries, many of whom requested anonymity because they feared retaliation from the United States.

Health advocates scrambled to find another sponsor for the resolution, but at least a dozen countries, most of them poor nations in Africa and Latin America, backed off, citing fears of retaliation, according to officials from Uruguay, Mexico and the United States.

“We were astonished, appalled and also saddened,” said Patti Rundall, the policy director of the British advocacy group Baby Milk Action, who has attended meetings of the assembly, the decision-making body of the World Health Organization, since the late 1980s.

“What happened was tantamount to blackmail, with the U.S. holding the world hostage and trying to overturn nearly 40 years of consensus on best way to protect infant and young child health,” she said.

In the end, the Americans’ efforts were mostly unsuccessful. It was the Russians who ultimately stepped in to introduce the measure — and the Americans did not threaten them.

The State Department declined to respond to questions, saying it could not discuss private diplomatic conversations. The Department of Health and Human Services, the lead agency in the effort to modify the resolution, explained the decision to contest the resolution’s wording but said H.H.S. was not involved in threatening Ecuador.

“The resolution as originally drafted placed unnecessary hurdles for mothers seeking to provide nutrition to their children,” an H.H.S. spokesman said in an email. “We recognize not all women are able to breast-feed for a variety of reasons. These women should have the choice and access to alternatives for the health of their babies, and not be stigmatized for the ways in which they are able to do so.” The spokesman asked to remain anonymous in order to speak more freely.

Although lobbyists from the baby food industry attended the meetings in Geneva, health advocates said they saw no direct evidence that they played a role in Washington’s strong-arm tactics. The $70 billion industry, which is dominated by a handful of American and European companies, has seen sales flatten in wealthy countries in recent years, as more women embrace breast-feeding. Overall, global sales are expected to rise by 4 percent in 2018, according to Euromonitor, with most of that growth occurring in developing nations.

The intensity of the administration’s opposition to the breast-feeding resolution stunned public health officials and foreign diplomats, who described it as a marked contrast to the Obama administration, which largely supported W.H.O.’s longstanding policy of encouraging breast-feeding.

During the deliberations, some American delegates even suggested the United States might cut its contribution the W.H.O., several negotiators said.

Washington is the single largest contributor to the health organization, providing $845 million, or roughly 15 percent of its budget, last year.

The confrontation was the latest example of the Trump administration siding with corporate interests on numerous public health and environmental issues.

In talks to renegotiate the North American Free Trade Agreement, the Americans have been pushing for language that would limit the ability of Canada, Mexico and the United States to put warning labels on junk food and sugary beverages, according to a draft of the proposal reviewed by The New York Times.

During the same Geneva meeting where the breast-feeding resolution was debated, the United States succeeded in removing statements supporting soda taxes from a document that advises countries grappling with soaring rates of obesity.

The Americans also sought, unsuccessfully, to thwart a W.H.O. effort aimed at helping poor countries obtain access to lifesaving medicines. Washington, supporting the pharmaceutical industry, has long resisted calls to modify patent laws as a way of increasing drug availability in the developing world, but health advocates say the Trump administration has ratcheted up its opposition to such efforts.

[The New York Times]

Utah oil drillers won pollution break from Pruitt

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Utah oil and gas producers tried for years to get the EPA to exempt them from smog rules meant to prevent ailments like asthma.

They finally got their relief after Scott Pruitt took charge of the agency, newly released emails show.

To groups opposed to President Donald Trump’s policies, the records are yet another sign that Pruitt has transformed an agency created to protect the environment into a tool for granting favors to industry. They say that’s troubling even if it falls short of the overt collusion his critics have accused him of amid revelations about his ties to lobbyists who helped him arrange housing and travel.

“The public is being shut out of the decisions that affect the air we all breathe while polluters have Pruitt at their beck and call whenever they ask to throw out a life-saving protection,” said Matt Gravatt, the associate legislative director at the Sierra Club, which obtained the emails in a lawsuit over a public records request.

EPA’s aid for the oil and gas companies in Utah came after an industry lobbyist, Marc Himmelstein, a former American Petroleum Institute executive with longstandingconnectionsto top GOP fundraisers, enlisted help from another like-minded Republican, House Natural Resources Chairman Rob Bishop (R-Utah), who has pushed legislation to promote oil and gas development and ease permitting requirements.

Himmelstein coordinated a July 2017 phone call between the Utah lawmakers and Pruitt, offering specific talking points for Bishop to use, according to the records obtained in a lawsuit by the Sierra Club.

EPA was set to declare that the tribal land in the Uinta Basin in Utah was not meeting standards for smog, or ozone pollution. Once that happened, oil and gas producers wouldn’t be able to use a streamlined permitting process and would instead have to seek approval for each of the thousands of wells they aim to drill there.

“We ask the Agency to develop a streamlined permitting solution for future development of the Basin,” Himmelstein’s talking points for Bishop said.

In April, EPA proposed just that.

[Politico]

Trump rescinds Obama policy protecting oceans

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President Trump is repealing a controversial executive order drafted by former President Obama that was meant to protect the Great Lakes and the oceans bordering the United States.

In his own executive order signed late Tuesday, Trump put a new emphasis on industries that use the oceans, particularly oil and natural gas drilling, while also mentioning environmental stewardship.

“Ocean industries employ millions of Americans and support a strong national economy,” the new order states, mentioning energy production, the military, freight transportation and other industries.

“This order maintains and enhances these and other benefits to the Nation through improved public access to marine data and information, efficient interagency coordination on ocean-related matters, and engagement with marine industries, the science and technology community, and other ocean stakeholders,” it states.

The order encourages more drilling and other industrial uses of the oceans and Great Lakes.

The order stands in contrast to Obama’s policy, which focused heavily on conservation and climate change. His policy was written in 2010, shortly after the deadly BP Deepwater Horizon offshore drilling explosion and 87-day oil spill.

“America’s stewardship of the ocean, our coasts, and the Great Lakes is intrinsically linked to environmental sustainability, human health and well-being, national prosperity, adaptation to climate and other environmental changes, social justice, international diplomacy, and national and homeland security,” Obama’s order stated.

[The Hill]

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