ACE

Category: Public Health

  • Understanding the Connected MOM Act: Federal Intervention in State Maternal Health Medicaid Coverage

    Understanding the Connected MOM Act: Federal Intervention in State Maternal Health Medicaid Coverage

    Introduction to Medicaid and Maternal Health Coverage

    Medicaid is a healthcare program designed to cover specific medical costs for individuals with lower incomes and limited resources. While the federal government sets baseline regulations and retains oversight authority over Medicaid programs, states maintain primary responsibility for program administration, which leads to variation in Medicaid coverage across the nation. Many state Medicaid programs offer insurance coverage for pregnant individuals through mechanisms such as presumptive eligibility. Presumptive eligibility allows certain vulnerable populations to receive coverage before their application for Medicaid is fully processed. For example, Iowa’s presumptive Medicaid coverage extends Medicaid benefits to all pregnant applicants while their eligibility is being determined, regardless of the final outcome.

    Maternal health remains a critical concern in the United States, where indicators such as preterm births and maternal mortality have continued to rise despite targeted policy interventions. A key factor in improving maternal health outcomes is access to high-quality prenatal care, yet adequate access to prenatal care is declining. A significant reason that many people cannot access adequate prenatal care is a lack of insurance coverage or sporadic insurance coverage during their pregnancy. Research emphasizes that increasing insurance coverage for pregnant people can improve access to prenatal care, which can improve maternal health outcomes.


    While federal regulations mandate certain Medicaid services, including maternal healthcare, the specifics of maternal health coverage are left largely to the discretion of individual states. For instance, Iowa’s presumptive eligibility for pregnant people continues until the applicant receives a determination of full Medicaid eligibility. In contrast, Minnesota’s hospital-based presumptive coverage for pregnant people only lasts for a month. 

    S.141 and the Scope of Federal Intervention

    Introduced on January 16, 2025, S.141—or the Connected MOM Act—aims to identify and address barriers to Medicaid coverage of health monitoring devices in an effort to improve maternal health outcomes. Given that health monitoring devices can expand access to prenatal care by allowing physicians to remotely monitor health metrics, the bill aims to explore how pregnant people might face challenges in obtaining these devices. The bill proposes investigating state-level obstacles to coverage of remote physiologic devices, which include: 

    • Blood pressure cuffs (used to monitor blood pressure)
    • Glucometers (used to assess blood glucose levels)
    • Pulse oximeters (used to measure blood oxygen saturation)
    • Thermometers (used to track body temperature)

    These devices enable at-home monitoring of key health metrics, facilitating earlier intervention for dangerous pregnancy-related conditions. According to legal experts, such investigative efforts generate data that can inform and support future policy development. S.B. 141, which has received bipartisan support, is currently under review by the Senate Finance Committee.

    Perspectives on S.B. 141 and Federal Medicaid Interventions

    Investigative legislation like the Connected MOM Act allocates funding for evidence-gathering to guide future policy decisions. In this case, the bill aims to collect information on how states manage Medicaid coverage for remote physiologic devices that are critical during pregnancy, with the long-term goal of shaping federal Medicaid policies. While supporters of the Connected MOM Act argue that it will provide necessary insights to catalyze Medicaid expansion for pregnant people, others point to the rules and regulations of Medicaid which make it difficult for the federal government to intervene broadly in state Medicaid programs. Given the structural limits on federal influence over state-run Medicaid programs, broad national reforms are often considered too costly or unlikely to yield systemic change. This dynamic was evident in the fate of H.R. 3055—the Black Maternal Health Momnibus Act—which failed to advance beyond the committee stage. Supporters of the Connected MOM Act argue that its incremental, investigative approach will help justify future reforms without being perceived as broad federal overreach. 

    Conclusion

    Each state administers its own Medicaid program, resulting in variations in coverage for certain medical devices, including remote health monitoring devices. Given the importance of these devices in expanding access to prenatal care, S.B. 141 seeks to investigate the best course of action for improving coverage of them across the nation. As it moves through committee, S.B. 141 may give insights on how policymakers can strategically navigate limits on federal power over state health programs.

  • Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Maternal Mortality Review Committees and the PMDR Reauthorization of 2023: Key Perspectives

    Introduction

    The United States faces a maternal mortality crisis, with maternal death rates significantly higher than other high-income nations. According to the CDC, maternal mortality disproportionately affects Black, Indigenous, and rural communities, with Black women experiencing maternal deaths at 2.6 times the rate of White women. The factors contributing to these disparities are complex and include unequal access to quality healthcare, socioeconomic barriers, and more. Despite advancements in healthcare, 80% of maternal deaths are preventable through timely medical intervention and comprehensive data collection. 

    What are MMRCs?

    State-based Maternal Mortality Review Committees (MMRCs) have been shown to play a pivotal role in analyzing maternal deaths to recommend evidence-based interventions. MMRCs are multidisciplinary teams that examine maternal deaths occurring during pregnancy or within one year postpartum. They utilize comprehensive data sources, including medical records, autopsy reports, and social service information. MMRCs assess preventability and contributing factors, allowing them to identify patterns and propose targeted policy solutions. Their review process centers on critical questions related to medical factors, social determinants, delays in care, and provider bias. By systematically addressing these factors, MMRCs generate insights that inform strategies to reduce preventable maternal deaths, which comprise 20% to 50% of all maternal deaths in the U.S.

    However, MMRCs face inconsistent funding and regulatory barriers, limiting their ability to track and analyze maternal deaths across states. Disparities in data collection methods and access to comprehensive patient records further hinder efforts to address maternal health inequities. Some states lack the authority to access certain medical records, while others experience delays in data sharing, reducing the timeliness and effectiveness of recommendations. Without consistent federal funding, many MMRCs struggle to maintain operations, particularly in rural and underserved areas, where maternal health disparities are often most pronounced. 

    Introduction to the Preventing Maternal Deaths Reauthorization Act

    The Preventing Maternal Deaths Reauthorization Act of 2023 (PMDR) was introduced to the House Committee on Energy and Commerce by Congresswoman Robin Kelly (D-IL) on May 18, 2023. The bill passed out of the Senate Health, Education, Labor, and Pensions (HELP) Committee in Fall 2023 and passed the House with bipartisan support in March 2024. However, the bill failed to pass the Senate before the end of the legislative calendar, rendering the bill “dead”. The reauthorization built upon the original Preventing Maternal Deaths Act of 2018, which helped establish and fund state-based Maternal Mortality Review Committees (MMRCs) to investigate maternal deaths and identify preventable causes. It sought to extend funding for MMRCs, enhance data collection, and address racial disparities in maternal health outcomes through the following provisions:

    1. Extending funding for state-level MMRCs to continue investigating maternal deaths
    2. Authorizing $58 million annually for the CDC to support state-level efforts
    3. Enhancing data collection on factors related to maternal health outcomes, particularly for minority populations
    4. Strengthening community-based interventions to reduce racial and ethnic disparities 
    5. Enhancing coordination among agencies to implement evidence-based solutions
    6. Expanding research on social determinants of maternal health 

    Arguments in Support

    Proponents of the PMDR Act of 2023 argue that the bill provides critical support for tried and true interventions to prevent maternal deaths. They emphasize that scientific literature identifies state-based MMRCs as the “gold standard” for preventing maternal deaths due to their multidisciplinary analysis. However, inconsistent funding threatens the effectiveness of MMRCs, particularly in states with high maternal mortality rates. In a letter to Congress, 125 public health and social services associations urged legislators to treat the PMDR as a top-priority bill, stressing the nation’s consistently high maternal mortality rate. Several national associations, including the American Medical Association, argue that continued federal funding is crucial to preventing maternal deaths. They highlight that past funding gaps resulted in reduced MMRC operations, hospital closures, and increased barriers to care. Supporters contend that the only way to ensure MMRCs can continue their vital work without funding disruptions is to pass the PMDR.

    Proponents of the PMDR Act also highlight its potential to promote health equity. Beyond identifying risk factors, MMRCs are critical in addressing racial, socioeconomic, and geographic disparities in maternal health by filling critical knowledge gaps on the drivers of maternal mortality in underserved populations. The PMDR Act directly supports these efforts by requiring MMRCs to report on disparities in maternal care and propose solutions. Federal support through this bill enables MMRCs to strengthen provider training, expand access to prenatal care, and address structural barriers contributing to maternal deaths. Without reauthorization, proponents argue, efforts to close maternal health gaps would be fragmented, leaving vulnerable populations without necessary protections.

    Arguments in Opposition

    The most prominent critique of the PMDR Act is that it focuses too heavily on MMRCs. Critics voiced concerns about MMRCs’ inconsistency, lack of accountability, and failure to acknowledge all social determinants of health. 

    Opponents highlight that legal and logistical challenges, such as data collection issues and lack of legal protections for participants, can create disparities in MMRC operations. Rural populations, who face higher maternal mortality rates and limited access to care, are often overlooked in MMRCs, further exacerbating disparities. Additionally, bureaucratic barriers and state laws limiting community involvement in MMRCs reduce their effectiveness in addressing maternal health challenges. 

    Others argue that MMRCs lack accountability, particularly regarding inclusivity and equitable decision-making. Advocates contend that MMRCs often exclude community representatives or organizations that challenge the status quo, prioritizing clinical expertise over individuals with lived experience. This exclusion can foster distrust, as community members may feel their knowledge and perspective are undervalued. The lack of compensation for community members to attend all-day MMRC meetings – unlike salaried clinicians – adds another barrier, further entrenching inequalities. Laws that impose burdensome requirements on MMRCs further complicate the process and reduce diversity in ideas. Opponents of the PMDR contend that these factors contribute to a lack of accountability from MMRCs, preventing them from fully creating lasting and inclusive solutions. 

    Finally, critics assert that MMRCs often fail to adequately address the underlying social determinants of health that contribute to maternal mortality. While MMRCs focus on clinical factors, such as healthcare quality and implicit bias, they can lack the frameworks to assess other social determinants like housing instability, food insecurity, or socioeconomic status. Often, these factors are deeply rooted in the broader healthcare system and community environments. Critics argue that the absence of these social factors in MMRC reviews limits the committees’ ability to develop holistic prevention solutions. Reports suggest MMRCs could benefit from incorporating a health equity framework and utilizing socio-spatial measures to address the full spectrum of challenges mothers face. Without this consideration, critics argue that MMRCs fall short of offering effective solutions to reduce maternal deaths and disparities. 

    Due to these critiques of MMRCs, critics of the PMDR argue that the bill should allocate more funding toward alternate interventions 

    Conclusion 

    The Preventing Maternal Deaths Reauthorization Act of 2023 represented an effort to extend investment in evidence-based maternal health interventions. While it received strong bipartisan support in the House, it died before a vote in the Senate, leaving MMRC funding uncertain in the years to come. While the bill was applauded for its potential to expand access to maternal care and fill critical knowledge gaps on maternal mortality factors, critics argued it placed too much emphasis on an intervention that lacked consistency and accountability to marginalized communities. 

    Future Outlook

    The Trump administration has implemented significant changes to the National Institutes of Health (NIH), including halting medical research funding and restructuring the agency, which has led to delays and uncertainties in grant approvals. These actions have raised concerns about the future of critical medical research, including studies on maternal health. Given these developments, the future of the PMDR may depend on an evolving public health funding environment. Advocacy groups and policymakers will need to collaborate to ensure that maternal health research and interventions receive the necessary support, despite the current challenges in the federal funding landscape.

  • Understanding Chronic Disease Management Programs: Comparing New York and Georgia

    Understanding Chronic Disease Management Programs: Comparing New York and Georgia

    Background Information 

    In 2010, the Affordable Care Act (ACA), expanded Medicaid coverage for people from low-income backgrounds who were previously uninsured due to Medicaid’s previous eligibility requirements. The Medicaid expansion addressed a phenomenon known as the coverage gap, which occurs when an individual’s income is too high to qualify for their state’s Medicaid program but too low to qualify for marketplace plan subsidies. All states except the following ten accepted the Medicaid expansion plan: Texas, Wyoming, Kansas, Wisconsin, Tennessee, Mississippi, Alabama, Georgia, South Carolina, and Florida. Still, in 2022, one in five uninsured adults did not have access to medical care due to the costs. Additionally, uninsured people compared to people with insurance are less likely to receive access to preventative care and services for chronic diseases. 

    Since the ten non-expansion states have a high population of rural residents who are more likely to die prematurely from chronic illnesses, state governments have developed chronic disease management programs that are distinct from those in Medicaid-expanded states. Chronic disease management programs are structured health treatment plans for people who have chronic diseases such as asthma, breast cancer, or coronary artery disease. These programs provide coverage for regular check-ups and treatments and offer guidance on how to navigate certain diseases. Programs for chronic illness in New York and Georgia provide important insights into how states with differing Medicaid policies tackle chronic disease management. 

    New York Medicaid Health Homes: Comprehensive Care Management

    Under the ACA Section 2703, states have the authority to develop and receive federal reimbursement if they have a set of health home services for their state’s Medicaid populations with chronic illness. In 2012, New York State (NYS) launched its Medicaid Health Homes program. The program was created to reduce inpatient utilization costs, remove social and economic barriers to care, and provide general behavioral and medical care. 

    When the program initially launched, almost 1 million people met the eligibility criteria. To be eligible for the Home Health Program, an individual must: 1) be enrolled in Medicaid, 2) have two or more chronic conditions, or 3) have one single qualifying chronic condition such as HIV/AIDS, Serious Mental Illness, Sickle Cell Disease, or Serious Emotional Disturbance. However, at the start of the program, NYS prioritized enrolling 500,000 adults who had mental health and substance use conditions over those with other conditions. In early 2020, over 180,000 people were enrolled in the Health Homes program. When a member enrolls in the program, the health homes receive per-member-per-month payments from NYS. These payments are dependent on the member’s health and social needs which include comprehensive care management, care coordination, individual and family support, referral to community and social support services, and the use of health information technology to link services.

    The program fell short of the initial three-year target of 240,000 enrollments due to problems with the top-down enrollment process. For instance, the care management agency outreach team relied on Department of Health information to reach people with the most pressing needs, but the information was often outdated and inaccurate. Additionally, it was often difficult for outreach workers to explain the Health Homes’ benefits because the term ‘home’ suggested that patients would have to go to a particular place. Moreover, many of the eligible participants were unstably housed and were difficult to locate and inform. Overall, the New York Medicaid Health Homes program provides a robust system to assist people with chronic illnesses. Nonetheless, it is important to acknowledge that the program is not a one-step solution in addressing chronic illnesses among NYS populations, as chronic condition disparities continue to persist. 

    Georgia Pathways: A State Care Program 

    Georgia is among the ten non-Medicaid-expansion states and ties with Oklahoma for the second-highest proportion of residents without health insurance in the nation. The state’s health care system ranks 45th based on measures of health care access, cost, avoidable hospital use, reproductive care, and women’s health. Georgia has an approximate rural population of 1.5 million people. Due to the state’s denial of Medicare expansion, people with chronic illnesses in Georgia cannot access Medicaid expansion-supported chronic illness programs. Instead, Georgia launched a state program called Georgia Pathways in July 2023 that aims to provide health coverage to certain low-income people. The program covers the cost of many of the same medical services as traditional Medicaid such as doctor visits, hospital stays, and prescriptions. Georgia Pathways requires enrollees to sign a program contract and submit documentation to prove they have completed 80 hours of work or other qualifying activities in a recent month. Since the program’s approval, an average of $13,000 was spent per enrollee in combined state and federal funds. 

    When the program initially launched, it expected 100,000 enrollments. As of January 2, 2025, the program is underperforming with only 6,503 active enrollments. Between July and October of 2024, 29% of the applicants were denied because they could not meet the eligibility requirements for the documentation, specifically the need to prove they were working, in school, or volunteering for at least 80 hours per month. One reason for this gap could be that people with chronic illnesses and disabilities cannot find enough hours to work because employers often fail to provide adequate work accommodations for people with disabilities. Additionally, many people face long bureaucratic processes that prevent them from reporting their work hours monthly. Moreover, people with low-income jobs often have employers who can reduce their work hours without notice. Therefore, the hurdles associated with Georgia Pathways’ 80-hour work requirement have been a barrier for some Georgians in need of care. 

    In January 2025, state Senators introduced a bill to fully adopt Medicaid Expansion, as the state program has not been efficient enough to address people’s healthcare needs. The bill has garnered bipartisan support, with a handful of Republicans from rural districts joining Democrats as co-sponsors on the bill. However, Georgia Governor Brian Kemp stated that he would push back against attempts to adopt Medicaid expansion in the state. Instead, he signaled support for a bill to establish a Comprehensive Health Care Commission to explore health coverage options. Since the Pathways program could expire in 2025, Georgia House Speaker Jon Burns emphasized the need to gather information, hear from policy experts and stakeholders, and create an effective policy solution to support the low-income and uninsured people of Georgia. 

    Conclusion

    Even in the aftermath of the Affordable Care Act and Medicaid Expansion, significant coverage gaps exist across the country. These gaps include identifying people with the most pressing clinical and social needs, expanding access to care for people with chronic disabilities, and financing state-based healthcare expenditures for chronic disease management programs. New York’s robust system of chronic disease management, Healthy Homes, offers a centralized system of clinical care, social care, and essential services such as food. Despite the program’s benefits, it faces challenges including reliance on old data to identify high-need individuals, difficulty locating unhoused people with chronic illnesses, and trouble communicating the program’s requirements. On the other hand, Georgia’s Pathways program provides health coverage to low-income individuals if they sign a program contract and submit documentation to prove they have completed 80 hours of work or other qualifying activities in a recent month. The program fell significantly short of its projected enrollment numbers, spurring debate on other potential policy interventions for chronically ill Georgians. 

    In February 2025, the 119th Congress proposed H.R.919 to codify Internal Revenue Service (IRS) guidance relating to the treatment of certain services and items for chronic conditions. The recent bill could impact two different kinds of health insurance coverage: High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA). The proposed bill would expand coverage for health insurance plans; these health insurances would treat chronic care as preventable and cover chronic illness care that might not have been originally covered. If passed, federal bills like H.R. 919 are likely to impact state-level care programs.

  • Robert F. Kennedy Jr. Confirmed as HHS Secretary: Can He “Make America Healthy Again”?

    Robert F. Kennedy Jr. Confirmed as HHS Secretary: Can He “Make America Healthy Again”?

    As President Trump continues his push to reshape the federal government, one of his most controversial cabinet nominations has now been confirmed. Robert F. Kennedy Jr., once a Democratic challenger to Joe Biden, then an independent presidential candidate, and now a Trump ally, was officially sworn in as the 26th Secretary of the Department of Health and Human Services (HHS) on February 13th, 2025. 

    What is HHS?

    The Department of Health and Human Services is a cabinet-level Department that falls under the Executive Branch of the U.S. government. It was created with the mission to “improve the health, safety, and wellbeing of America”. While Congress creates federal health policies, they are predominantly implemented through HHS. As Secretary, Kennedy will oversee all HHS programs, including the National Institutes of Health (NIH), Center for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), and Centers for Medicare and Medicaid Services (CMS), managing nearly $2 trillion in funding dedicated to public health research and programming. 

    The Road to Confirmation

    The road to Kennedy’s confirmation as HHS Secretary was anything but conventional. Kennedy initially entered the 2024 race as a Democrat, appealing to the left on environmental issues while simultaneously drawing support from several longtime Republican donors for his stance on the weaponization of federal government and opposition to vaccines. When Kennedy’s Democratic bid for the presidency fell short, he pivoted to an independent run, seeking to carve out a path outside the two-party system. But as the race tightened and third-party candidates became a potential deciding factor, Kennedy endorsed Donald Trump. Now, in a turn few could have predicted just a year ago, he is at the helm of America’s largest public health agency. 

    Kennedy’s appointment has been met with fierce debate, given his longtime anti-vaccine advocacy. He is the Founder and Former Chairman of Children’s Health Defense (CHD), an organization that has been known to finance and produce misinformation campaigns on vaccines and the COVID-19 pandemic. During his tenure as Chairman, Kennedy has served as a lawyer in several of CHD’s lawsuits against vaccine mandates and public health institutions, including federal agencies he now oversees as HHS Secretary. In December 2021, Kennedy called the COVID-19 vaccine “the deadliest vaccine ever made”. Despite this, Kennedy has repeatedly stated that he is not anti-vaccine. His views, however, have made him a target for critics who accuse him of fueling vaccine hesitancy.

    During his confirmation hearings, Kennedy attempted to clarify his stance on vaccinations, emphasizing that he supports vaccines but believes in stronger oversight and transparency in pharmaceutical research and regulatory processes. He also faced scrutiny over his position on Medicare and Medicaid. Lawmakers on both sides of the aisle pressed him on whether he would support expansion or re-structuring for these programs, particularly in light of rising healthcare costs. Kennedy stated that he “doesn’t have a plan to dismantle the program”, but made claims about the ineffectiveness of both Medicare and Medicaid. 

    His confirmation vote was nearly along party lines, with only one Republican breaking ranks—Senate Minority Leader Mitch McConnell, a polio survivor who has been a staunch advocate for vaccination. Leader McConnell stated, “I will not condone the re-litigation of proven cures, and neither will millions of Americans who credit their survival and quality of life to scientific miracles.” 

    Beyond vaccines, Kennedy’s confirmation hearing touched on other major health crises, including the opioid epidemic, rising healthcare costs, and chronic disease prevention. His critics argue that his unconventional views on medicine could make it harder to implement evidence-based policy, while his supporters see him as a disruptor willing to challenge entrenched interests and focus on pressing issues like processed foods and big pharma. 

    The “Make America Healthy Again” Commission

    Kennedy’s confirmation coincided with President Trump’s signing of an executive order establishing the “Make America Healthy Again Commission.” This initiative aims to investigate the root causes of America’s chronic health crisis, with a particular focus on childhood diseases. In his remarks, Kennedy expressed gratitude for the opportunity, stating, “I have prayed each morning for the past two decades for God to put me in a position to solve the childhood chronic disease epidemic, and now, thanks to you Mr. President, we will make this promise a reality.” 

    With trust in public health agencies facing a decline along partisan lines, the coming months will reveal whether Secretary Kennedy’s policy priorities succeed in “making America healthy again”. 

  • Understanding Midwife and Doula Healthcare Integration

    Understanding Midwife and Doula Healthcare Integration

    Background

    In the U.S. today, Black women are nearly three times more likely to die during childbirth as White women. One potential remedy to address this and other disparities in maternal health outcomes, which has gained recent attention, is the integration of midwives and doulas into the U.S. healthcare system. Doulas are trained professionals who provide physical, emotional, and educational support before, during, and after childbirth. While their role is non-medical, doulas often enhance maternal outcomes by reducing stress, increasing patient satisfaction, and lowering the need for interventions like Cesarean sections. Midwives are licensed healthcare providers who manage pregnancy, childbirth, and postpartum care. Unlike doulas, midwives perform clinical duties, including monitoring fetal development, conducting births, and providing postpartum care.

    Community-based midwives and doulas, particularly those who serve Black, Indigenous, Latinx, and LGBTQ+ communities, play an essential role in supporting populations disproportionately affected by adverse maternal health outcomes. These birth practitioners provide critical culturally relevant care that reflects the cultural values, communication styles, and traditions of their patients, filling gaps in treatment that general hospitals do not address. Despite this, their integration into mainstream healthcare has faced obstacles. 

    The current regulatory landscape for midwives and doulas is complex and varies widely by state. Some states require licensing, training, and specific scope-of-practice guidelines for midwives, given that they provide medical care. Regulations on doulas are less stringent, but still differ state-to-state. Regulatory variation affects insurance coverage and reimbursement, creating inconsistent support for integrating doulas and midwives into mainstream care nationwide.

    Pros of Integration

    Proponents argue that integrating midwives into the U.S. healthcare system could significantly improve maternal and infant health outcomes, particularly in underserved communities. Establishing a nationwide credentialing system would standardize qualifications and scope of practice, ensuring consistent, high-quality care across states. This approach would address disparities caused by restrictive state-specific regulations, which currently limit midwives’ ability to practice. Under current guidelines, midwives oversee only about 8% of U.S. births. Research shows that healthcare systems with greater midwife involvement report better maternal and infant health metrics, including higher rates of vaginal deliveries, fewer C-sections, and reductions in preterm births and low-birthweight infants. Nationwide credentialing policies could enhance collaboration between midwives and traditional medical providers, creating a more cohesive maternity care model. These measures would expand access to midwife and doula care and optimize care delivery nationwide.

    Rather than establishing a national credentialing system for doulas, proponents of doula integration point to solutions like reimbursement policies, standardized training programs, and partnership programs with healthcare centers. Reimbursement policies would increase insurance coverage of doula care, which could significantly increase low-income families’ access to doula services. Nationwide training programs could ensure consistent qualifications and high-quality care, ensuring that families who opt to receive doula services can expect a certain standard of care. Proponents also hold that national training programs are uniquely poised to recruit trainees from underserved populations, which would expand the pool of trained professionals serving diverse communities. Additionally, much like credentialing programs for midwives, collaboration programs between doulas and hospitals could embed doulas within care teams and strengthen the continuity of care for birthing families. 

    State regulations for doulas and midwives vary widely, creating disparities in access and care quality. Proponents advocate for nationwide standards for Medicaid and private insurance reimbursement to establish a uniform baseline for coverage of doula and midwife services. Proponents of nationwide coverage point to the example of Rhode Island, where demand for doulas among high-risk pregnant clients increased significantly after the state expanded its coverage guidelines for doula services. However, given that few doulas currently accept insurance, consistent certification and reimbursement processes are necessary to ensure that expanded coverage effectively connects patients to providers. Collaborating with doulas to design reimbursement structures that reflect their unique services– such as extended client access and billing for long labor–would ensure proper recognition and compensation for their work. Standardized insurance policies, supporters argue, would promote equity, reduce administrative burdens, and enable consistent, high-quality care across states. 

    Cons of Integration

    Opponents argue that regulating and standardizing midwives and doulas may undermine their autonomy and ability to advocate for birthing people, particularly those in underserved communities. While formalizing doula services with official billing codes could expand insurance coverage, critics warn it could also introduce conflicts of interest and compromise patient-centered advocacy. Regulation under hospital systems or boards could stifle advocacy due to fears of repercussions such as losing credentials or hospital partnerships. Michelle Drew, a maternal health historian, highlights that nationwide regulation of midwives and doulas risks repeating the historical erasure of Black birthing practitioners. Critics also warn that credentialing programs could reduce the already limited pool of doulas, counteracting efforts to expand care access amid rising maternal mortality. They worry that standardizing care through rigid oversight may ultimately compromise the culturally tailored, client-focused support that doulas and midwives provide. 

    Critics also argue that integrating midwives and doulas into mainstream healthcare systems raises challenges related to medical oversight, liability, and professional dynamics. One significant concern involves the potential for malpractice or birth injuries, especially in high-risk scenarios where midwives or doulas prioritize natural birth over necessary medical intervention. Some say this tension can lead to critical disagreements with medical professionals, persuading patients to refuse essential care and endangering maternal and infant health. 

    Resistance from medical professionals complicates the integration of doulas and midwives into traditional healthcare settings. Studies indicate that the role of doulas and midwives is often unclear to providers, leading to tension in healthcare practices. Many obstetricians assume that doulas and midwives “work against the hospital” because they advocate for their clients’ birthing preferences. Only 48% of obstetricians agree that doulas improve maternal and newborn outcomes. Moreover, doulas often report feeling unsupported by physicians, labor and delivery nurses, and other clinicians, which hinders collaboration and limits their effectiveness. Critics warn that integrating doulas and midwives into healthcare settings could exacerbate provider conflict and add unnecessary stress to patient experiences. 

    Conclusion and Future Outlook

    Integrating midwives and doulas into the U.S. healthcare system requires consideration of the complex benefits and drawbacks to standardized care  While proponents argue that nationwide standards for training, certification, and reimbursement will expand access to crucial midwife and doula services, critics warn that these solutions risk limiting practitioner autonomy and adding tension to healthcare workspaces. Moving forward, efforts to integrate doulas and midwives into mainstream services through insurance coverage expansion, hospital partnerships, and investments in community-based programs must balance the need for integrated birthing care with the need for an autonomous and diverse workforce of doulas and midwives. 

  • Understanding the Accountability for Overprescription Debate

    Understanding the Accountability for Overprescription Debate

    Background: The Opioid Epidemic

    Over the past two decades, the opioid epidemic has emerged as a key public health issue in the United States. The first wave of the epidemic was characterized by an increase in opioid prescriptions in the late 1990s paired with marketing from pharmaceutical companies that ensured that opioids were safe for pain management. In the early 2010s, a second wave arose when individuals who had become dependent on opioids sought out heroin as a cheaper and more accessible alternative for pain management. The third wave, starting in the mid-2010s, saw a rise of synthetic opioids such as fentanyl in illegal drug markets, leading to unprecedented levels of overdoses. 

    Prescription opioids are chemicals, both natural and synthetic, that are prescribed for pain management and include commonly-prescribed drugs such as Hydrocodone (Vicodin),  Oxycodone (Oxycontin, Percocet), and Morphine (Kadian). While prescription drugs are used to treat acute to chronic pain related to surgery, injury, or illness, prescription can come with risks. Side effects of commonly-prescribed opioids include increased sensitivity to pain, increased drug tolerance, and withdrawal post-medication. These side effects can lead the way to opioid misuse and addiction. In 2023, 125 million opioid prescriptions were filled in America, and 8.6 million Americans misused prescription opioids.

    Calls for Accountability

    In recent years, blame for the opioid epidemic has shifted towards pharmaceutical companies that produce the drugs and initially advertised their safety. Specifically, many consumers seek to hold pharmaceutical companies legally accountable using the argument that their deceptive marketing tactics have created a public health crisis and therefore constitute a public nuisance. Between 2014 and 2021, more than 3,000 lawsuits were raised against pharmaceutical corporations based on the public nuisance argument. However, 2021 decisions from California and Oklahoma State Supreme Courts held that false advertising was not enough to constitute a public nuisance, weakening the prospects of accountability arguments in other pending cases. 

    Most recently, the U.S. Supreme Court struck down a bankruptcy plan for Purdue Pharma – a major pharmaceutical company – that would have facilitated an $8 billion settlement to the individuals, states, and local governments that had sued the company over opioid-related deaths. While some praised the Court for its refusal to grant Purdue Pharma the bankruptcy relief it desired, others say the Court failed to hold the company accountable by jeopardizing the $8 billion settlement to victims. Today, avenues for holding major pharmaceutical corporations – collectively referred to as Big Pharma –  accountable are highly debated. 

    The Case for Holding Big Pharma Legally Accountable

    Supporters of holding pharmaceutical companies legally accountable for the opioid epidemic cite the companies’ use of deceptive marketing techniques to sell opioids. For example, Purdue Pharma’s Evolve 2 Excellence initiative aimed to increase the sale of OxyContin by instructing their marketing team to promote higher dosages and target high volume opioid prescribers. In 2003, Purdue Pharma launched a misleading marketing campaign about the effectiveness of their prescription drugs despite a lack of proven efficacy in treating pain. In 2014, the city of Chicago sued Janssen Pharmaceuticals, Cephalon, Purdue Pharma, Endo Health Solutions, and Actavis for “knowingly and aggressively marketing [opioids] as rarely addictive” and contributing to several Chicagoan overdose deaths. 

    Proponents of legal accountability for Big Pharma believe that successful lawsuits against major pharmaceutical companies could set important precedents and ensure that other corporations are held accountable for their public health impacts on the US population. When polled, 57% of Americans believed that pharmaceutical companies should be held legally and financially accountable for the worsening opioid crisis. This belief existed across party and ideological lines. An even larger segment of the U.S. population supports compelling Big Pharma to remedy their contributions to the epidemic in other ways, with 73% stating that they want drug companies to fund opioid addiction treatment and 72% arguing that they should distribute naloxone kits for free. 

    Arguments Against Legal Accountability for Big Pharma

    Critics of legal accountability for pharmaceutical corporations argue that lawsuits are temporary solutions that will not deter pharmaceutical companies from producing and marketing harmful drugs in the long term. They hold that given the massive annual profits of the top five pharmaceutical companies, civil suits act as no more than a slap on the. Critics also emphasize the increasing difficulty of using the public nuisance argument against Big Pharma due to the complexities of state and federal oversight.

    Additionally, some opponents of legal accountability for Big Pharma argue that highly-publicized lawsuits only provide a false sense of closure and ignore other factors that underlie the opioid crisis. Critics believe there are multiple causes of the opioid epidemic such as housing and food insecurity, and thus argue that the social determinants of health framework must be adopted in order to best tackle the crisis. Mimi Walters, former United States Representative, discussed how prioritizing settlements with pharmaceutical companies is illogical if people are not simultaneously addressing unfair federal housing programs that create barriers to housing for those who have substance use disorders. Citing lack of economic opportunity, limited drug treatment, and need for pain management as causes of opioid overuse, some believe taking a holistic approach is the only way to manage the opioid crisis from the grassroots. They contend that legal settlements are simply a bandaid solution.

    Moreover, some argue that overprescribing doctors hold just as much responsibility for the opioid epidemic as the corporations that market the drugs. Patient satisfaction and expectations for pain-free experiences have become central to the healthcare industry, leading some doctors to prescribe strong opioids for slight injury rather than saving them for persistent, chronic pain. Critics believe that this push for patient satisfaction, along with a focus on the monetary value of patients, creates a cycle in which physicians prescribe to make money. Opponents also cite the Food and Drug Administration’s (FDA) lack of regulation as a contributing factor. In 2017, the Presidential Commission on Combating Drug Addiction and the Opioid Crisis found that the epidemic was partially caused by gaps in FDA oversight. In 2002, 8 out of 10 members of an FDA advisory committee on opioid prescription had ties to Big Pharma. The committee advised the FDA against regulating overprescription, causing many to argue that accountability efforts should include government agencies and not just corporations.

    Conclusion

    Efforts to hold pharmaceutical companies legally accountable have gained traction in recent years. In 2023, Michigan became the last state in the nation to repeal its legal immunity for pharmaceutical companies. In October 2024, the U.S. Department of Justice brought charges against several pharmaceutical companies and brokers for their role in the unlawful distribution of nearly 70 million opioid pills. While many applaud these efforts, some see them as short-term solutions and argue they must be part of a larger comprehensive approach to address the far-reaching consequences of the opioid epidemic in the years to come.

  • The Pros and Cons of the Black Maternal Momnibus Act

    The Pros and Cons of the Black Maternal Momnibus Act

    Background on Black Maternal Health 

    The Centers for Disease Control and Prevention (CDC) estimates that Black women are over three times more likely to die during or after childbirth than white women, often facing life-threatening complications from early pregnancy to postpartum. Unfair treatment and lower quality of care contribute to these disparities, with more than 80% of pregnancy-related deaths among Black women being preventable. For every maternal death, 100 Black women experience near maternal death, highlighting the broader maternal health crisis for Black women in the U.S.

    Structural racism and various social determinants of health (SDOH), such as access to quality healthcare, safe housing, nutrition, and socioeconomic conditions, shape maternal health outcomes. Both implicit and explicit provider biases worsen these disparities. Research suggests the accumulated experiences of interpersonal racial discrimination across life can negatively impact Black women’s pregnancy outcomes, increasing the risk of complications. Further, surveys that sampled more than 2,500 women in the U.S. showed that Black women were more likely than white women respondents to report experiencing discrimination during childbirth, communication barriers with providers, and a lack of emotional support. Additionally, many Black mothers report feeling unheard or pressured into medical decisions, which can sometimes be attributed to providers’ implicit racial biases around pain tolerance and treatment. 

    The Momnibus

    The Black Maternal Health Momnibus Act of 2021, introduced by Congresswoman Lauren Underwood [D-IL], is still in the early stages of the legislative process and has been stuck in committee since April 2021. The bill targets multiple agencies’ efforts to improve maternal healthcare, particularly among ethnic and racial minority groups, veterans, and other vulnerable populations. The bill is a comprehensive package of several individual bills that support investments in: 

    1. Social determinants of health that influence maternal health outcomes 
    2. Expanding WIC eligibility for postpartum and breastfeeding parents
    3. Funding for community-based organizations
    4. Maternal healthcare for veterans and incarcerated moms
    5. Growing and diversifying the perinatal workforce
    6. Improving data collection processes and quality control measures 
    7. Maternal mental health
    8. Digital tools like telehealth and innovative payment methods
    9. Access to maternal vaccinations

    Arguments in Support of the Momnibus

    Proponents of the Black Maternal Health Momnibus Act argue that systemic racism and healthcare inequities drive the higher maternal mortality rates among Black women, and that the Act is a necessary intervention. While racial health disparities were once wrongly attributed to biological differences, research now shows that systemic racism affects social determinants of health (SDOH) – specifically access to nutrition, clean water, and safe housing. These inequalities, along with fewer healthcare facilities, food deserts, and environmental hazards in Black neighborhoods, restrict access to essential prenatal care, proper nutrition, and timely medical interventions. Compounding these issues, Black women often experience gaps in Medicaid coverage and limited access to quality birthing hospitals. Proponents assert that the Momnibus Act’s investments will improve these conditions, thereby supporting better outcomes for Black mothers. 

    Supporters of the Momnibus Act also argue that expanding access to comprehensive prenatal and postpartum care is crucial for addressing disparities that disproportionately affect Black mothers. They contend that programs like extended Women, Infant, and Children (WIC) eligibility for up to two years postpartum ensure consistent access to essential nutritious foods during critical recovery and developmental periods. Advocates highlight that limited prenatal care and late entry into antepartum care often correlate with lower attendance at postpartum visits, which leaves vulnerable Black women without vital health monitoring. They hold that expanding the availability of these services throughout the care spectrum – from preconception to postpartum – is therefore essential to ensure mothers receive the monitoring and support needed for positive health outcomes. 

    Proponents also praise the Momnibus for its provisions to address gaps in the healthcare workforce, arguing that diversifying the perinatal workforce is crucial in addressing the maternal health crisis among Black mothers. Although Black Americans make up 13% of the U.S. population, they represent only 5.7% of physicians, with Black women making up just  2%. Studies show that Black patients experience better health outcomes, including lower infant mortality when treated by Black doctors or culturally competent providers. This may be due to the shared experience of facing racism, which fosters trust and understanding between patients and providers. Supporters of the Momnibus Act praise its investments in measures such as implicit bias and anti-racism training to ensure culturally responsive care, viewing these steps as essential for improving health outcomes for Black mothers.  

    Arguments Against the Momnibus

    Critics argue that while the Momnibus Act brings essential attention to maternal health disparities, it may fall short of fully addressing the root causes of Black maternal health crisis. They argue that the Momnibus will necessitate large-scale government expenditures, increase taxes, and add to the national debt without delivering sustainable solutions. Critics contend that many provisions of the Momnibus do not account for the broader socio-economic factors contributing to Black maternal mortality, such as healthcare deserts, insurance coverage, and institutionalized racism that cannot be eliminated with bias trainings. Research suggests that policies focused on race and maternal health fail to yield positive outcomes without provisions to address institutional racism in areas like housing, employment, and education as well, so critics hold that addressing maternal health alone is insufficient. They argue that broader reforms across these areas are essential and emphasize the need for a robust, structural approach to truly address health disparities. 

    Many opponents specifically question the effectiveness of implicit bias training included in the Momnibus Act, suggesting that implicit bias is deeply ingrained in the healthcare system and cannot be eliminated via occasional trainings. Without robust, systemic reforms – such as building quality healthcare facilities in low-resource communities and providing long-term maternal health support – they believe the Act’s provisions will yield only temporary improvements leaving underlying inequalities largely unchallenged. 

    Conclusion

    The Black Maternal Health Momnibus Act seeks to address racial disparities in maternal health by investing in prenatal and postpartum care, diversifying the perinatal workforce, and investing in social determinants of health. Supporters argue these measures are essential for reducing maternal mortality among Black women, while critics question whether the Act alone can tackle deep-rooted systemic issues. The future success of the bill’s central goal may depend on securing federal support and enacting comprehensive, structural changes beyond healthcare.

  • The Pros and Cons of the Honor Our Living Donors Act

    The Pros and Cons of the Honor Our Living Donors Act

    Introduction to Organ Donation

    As of September 2024, more than 100,000 individuals nationwide were on the waiting list for organ transplants. Despite the fact that over 46,000 organ transplants were performed in the U.S. last year, thousands of Americans still die annually waiting for a new organ. While some believe financial incentives for living donors may improve the organ shortage crisis, any type of direct monetary transaction for an organ is punishable under the National Organ Transplant Act (NOTA) of 1984. NOTA prohibits the sale of human organs and tissues, with fines up to $50,000 and/or 5 years of imprisonment, citing altruism as the sole permissible motivator behind organ donation in America. 

    However, some living donors are eligible for reimbursement under the National Living Donor Assistance Center (NLDAC). NLDAC covers up to $6,000 of a living donor’s donation-related expenses such as traveling or lodging. Living organ donors may only be eligible for reimbursement if their organ recipient’s income does not exceed 350% of the HHS Poverty Guidelines, or $52,710 in the U.S. mainland. In September 2020, former President Donald Trump issued an executive order that expanded covered expenses to lost wages, childcare, and eldercare on top of travel and lodging costs. Today, many legislative efforts to mitigate the organ shortage crisis have been entertained by Congress, including the Honor Our Living Donors Act. 

    What is the Honor Our Living Donors Act?

    The Honor Our Living Donors (HOLD) Act was introduced to the House on October 24th, 2023 by Representative Jay Obernolte [R-CA-23]. The bill proposes that donation-related reimbursements for living donors should be considered based on the organ donor’s income rather than the organ recipient’s income. The latest action on the bill was on July 23rd, 2024, when it was placed on the Union Calendar. 

    Arguments in Favor

    Proponents of the HOLD Act argue that potential donors may be more inclined to help patients on the waiting list when they incur less costs related to organ donation. In the status quo, economic barriers deter low-income individuals from donating organs, as the average donation requires $5,000 in out-of-pocket expenses. Thus, organs are disproportionately donated by those with high median household income. If enacted, supporters argue, the HOLD Act would render organ donation a cost-neutral endeavor and thus increase the pool of potential donors. 

    Those in favor of the bill also claim that the HOLD Act may decrease government expenditures on organ-related healthcare. Currently, Medicare allocates $150 billion—or roughly 18% of the program’s total spending—on individuals who suffer from kidney diseases. If the organ shortage crisis improves with the help of the HOLD Act, proponents believe less money would have to be allocated toward curative or diagnostic care, saving the government billions of dollars in the long run.

    Arguments in Opposition

    Critics of the HOLD Act point to ethical and legal issues with the HOLD Act’s reimbursement system. Opponents believe that financial incentives may deter living donors from donating out of altruism, taking away from what they argue is the core tenet of organ donation. They point to research on the overjustification effect, a phenomenon in which individuals become less compelled to exhibit an intrinsically-motivated behavior when external rewards such as money are offered. Critics worry that reimbursements for organ donation might induce this effect and deter altruistically-motivated donors from giving. They also warn that potential donors may avoid donating due to a fear of being perceived as financially desperate rather than generous. 

    Opponents of the HOLD Act also argue that the bill does not adequately address the core causes of the nationwide organ shortage crisis. They believe that Americans do not donate their organs due to several reasons including a lack of information, religious exemptions, and fear of objection on top of financial inability. Critics also argue that the Act’s expanded coverage of donation-related expenses does not provide enough financial relief to spur organ donation nationwide. 

    Conclusion

    Given the HOLD’s Act current bipartisan support and President-Elect Trump’s previous executive order to expand reimbursement for living organ donors, the bill is likely to receive both congressional and presidential support during Trump’s second term. As the HOLD Act moves forward, the debate over the root causes of America’s organ shortage crisis will continue.

  • Pros and Cons of the SUPPORT Act of 2018

    Pros and Cons of the SUPPORT Act of 2018

    Background

    The opioid epidemic has emerged as a major public health issue in the United States. Beginning with a surge in opioid prescription in the 1990s and followed by waves of addiction to synthetic opioids such as fentanyl, the crisis has grown and morphed since its inception. Since 1999, there have been more than 600,000 opioid-related deaths in the U.S. and Canada. Over the years, U.S. lawmakers have responded to the opioid epidemic with several policies including the Comprehensive Addiction and Recovery Act (CARA) and the 21st Century Cures Act, which both laid a promising groundwork for prevention and treatment but had limited outreach and funding. In 2018, Congressed passed the SUPPORT Act with the goal to tackle the crisis in a new way.

    What is the SUPPORT Act of 2018?

    The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018 was signed into law by former President Trump on October 24th, 2018. The bill aimed to address the opioid epidemic through prevention, treatment, and recovery, with emphasis on law enforcement and provisions to Medicare & Medicaid. Its core provisions are as follows:

    • Prevention: The Act includes a set of policies that aim to reduce the incidence of cases related to opioid use and addiction. The bill expands public health education, implements opioid stewardship in hospitals and clinical settings, and promotes the use of alternative pain management theories.
    • Treatment and Recovery: The Act expands access to medication-assisted treatment (MAT), building on top of the work of the TREAT Act and the Addiction Treatment Access Improvement Act. Expansion of MAT will allow administrators of MAT — doctors, nurse practitioners, physician assistants — to combine medications with therapy to address the biopsychosocial aspects of opioid addiction. 
    • Emphasis on Law Enforcement: The Act emphasizes the importance of law enforcement in limiting the distribution of synthetic opioids. The Act also connects law enforcement to healthcare systems in hopes of monitoring the trafficking of opioids. 
    • Provisions to Medicare & Medicaid: The Act expands Medicare and Medicaid to cover a wider range of treatments related to substance use disorders including MAT, therapy, and counseling.

    Arguments in Favor of the SUPPORT Act

    Supporters of the Act emphasize its role in expanding Medicare and Medicaid coverage. They highlight the expansion of coverage including new medications, outpatient services, and health home programs under both Medicare and Medicaid. Proponents believe that the growth of access to treatment allows patients in both residential facilities and outpatient programs to have greater access to treatment. In the past, Medicare has been criticized for its limitations on coverage for substance abuse treatment, so proponents believe that the SUPPORT Act was a crucial intervention to reimburse older patients for medicated treatments, behavioral therapies, and counseling.

    Proponents of the SUPPORT Act also applaud the Act for expanding and developing the healthcare workforce; they hold that it eliminated some systemic barriers to care like long waitlists that previous bills did not address. According to the Department of Labour, the SUPPORT Act piloted several grant programs to “deliver training and employment opportunities to encourage more individuals to enter professions that could address the crisis”. Proponents believe one pilot grant program through the Employment and Training Administration  allowed more people from under-resourced communities join the healthcare workforce and tackle the epidemic in their own communities. Proponents highlight that in addition to providing grants to expand the opioid response workforce, the bill also established funds to respond to economic harm in towns whose workforces are impacted by opioid addiction. 

    Finally, proponents applaud the SUPPORT Act for increasing the authority of healthcare workers and hospital systems in administering substance abuse treatments. Proponents believe medication-assisted treatment, or MAT, is especially important in the fight against the opioid epidemic as it combines the use of medications like buprenorphine and counseling, addressing the physical and mental aspects of opioid addiction simultaneously. The Act gained support from several healthcare advocacy groups for giving registered nurses, nurse practitioners, and physician assistants the ability to prescribe buprenorphine once they obtain certification. They argue that this provision increased access to MAT nationwide. Proponents also praise the Act for its funding of health education programs that educated patients on the dangers of opioid misuse, preventing health consequences early-on. 

    Arguments Against the SUPPORT Act

    Opponents of the bill cite concerns over sustained funding and support from the federal government. The American Hospital Organization raises the issue that Medicaid and Medicare rarely cover the full cost of hospital expenses, leaving a $75.8 billion annual gap that falls on hospitals and other patients to close. With the Act’s expansion of Medicaid and Medicare coverage for substance use treatments like MAT, they argue that hospitals became even more overburdened with costs. The SUPPORT Act provided $6 million for health centers and $2 million for rural health centers for buprenorphine treatment, which critics argued was not enough to sustain the number of patients that need to be served. Similarly, critics contend that the Act did not account for the long-term sustainability of its workforce expansion goals, since the end date for most of its grants was set to January 2023. 

    Critics also emphasize how the SUPPORT Act failed to fully address the housing crisis, one of the socioeconomic factors underlying the opioid epidemic. Mimi Walters, former United States Representative, flags a provision of the SUPPORT Act that provided grants for temporary housing but only extended this funding to 50% of states. She warns that inconsistent funding like this only worsens the ongoing challenge of ensuring that people with substance use disorders secure housing. 

    Opponents of the bill worry about the impact the SUPPORT Act has on sober homes and residential substance use treatment facilities, locations that help people in recovery transition back into their communities and avoid homelessness. The Eliminating Kickbacks in Recovery Act, a part of the SUPPORT Act, made it punishable by either a $200,000 fine or 10 years in prison for sober homes to receive monetary kickbacks. This worried critics who believe that the lack of access to housing and the overcriminalization of residents who utilize sober homes could create a cycle in which people in recovery struggle to find housing and start using substances again.

    ConclusionThe SUPPORT Act of 2018 embodies the struggles the federal government faces in responding to a healthcare epidemic as large and multi-sector as the opioid crisis. Proponents cite the role the SUPPORT Act played in expanding Medicare and Medicaid, developing the workforce, and increasing the abilities of various healthcare workers to provide treatment. Conversely, critics of the SUPPORT Act highlight the bill’s failure to provide enough funding to sustainably support its goals. Congress failed to reauthorize the Act in 2023, signaling a desire for a new approach to the opioid epidemic. Future measures to combat the crisis must learn from the SUPPORT Act’s successes and drawbacks in order to deliver long-term solutions.

  • Medicare-For-All Act 2023: Pros and Cons

    Medicare-For-All Act 2023: Pros and Cons

    Introduction

    Today, health insurance in America is decentralized. Private insurance companies—composed of  employer-sponsored health insurance (ESI) and the non-group market—make up 54.8% of health insurance coverage nationwide, while government-issued programs like Medicare and Medicaid cover 35.9% of the population. Private health insurance options operate as follows:

    • ESI encompasses any health insurance option selected by an employer, in which employees and their dependents can opt into the plan. Employers and employees share the cost of deductibles, co-pays, and premiums. 
    • Non-group insurance is an option for households who do not qualify for public programs or employer-sponsored healthcare. These households shop for insurance plans directly from private insurers.

    Still, 7.9% of Americans, or roughly 26 million people, remain uninsured as of 2023. Legislators have proposed insurance expansion policies such as the Medicare-For-All Act of 2023 to fill this gap. 

    What is the Medicare-For-All Act of 2023?

    The Medicare-For-All Act of 2023, commonly referred to as M4A, proposes a single-payer universal health insurance program in the United States. In single-payer healthcare systems, the government is the sole payer for the eligible population’s healthcare costs. Single-payer programs like M4A would use public funds to support Americans in accessing medical services that are provided through the private sector. M4A would expand the single-payer models of Medicare and Medicaid, government-funded health insurance plans primarily for senior citizens and low-income individuals, to all U.S. residents.

    The Medicare for All Act has been reintroduced to Congress multiple times with the backing of Senator Bernie Sanders [I-VT] and Representative Pramila Jayapal [D-WA]. The bill’s provisions include covering primary, dental, vision, mental health, rehabilitation, gender-affirming and reproductive care for all U.S. residents. Under M4A, Americans would not have to pay deductibles, co-pays, nor premiums. The program would roll out over a four-year implementation period, prioritizing senior citizens, individuals with disabilities, and children as the first enrollees. 

    Arguments For The Medicare-For-All Act of 2023

    Proponents of M4A argue that the bill will decrease healthcare costs, increase healthcare access for vulnerable populations, and increase economic mobility. 

    First, proponents contend that by covering previously uninsured residents, M4A will increase the accessibility of preventative care and thus decrease expensive late-term healthcare costs. They cite research that suggests diverting patients from emergency rooms to preventative care sites could save U.S. residents roughly $4.4 billion each year. Bill sponsor Sanders explained that the pandemic shed light on the shortcomings of healthcare in the status quo, contending that many Americans realized the benefits of preventative care, such as vaccinations, in preventing the sizable costs of hospitalization. Moreover, proponents argue that M4A’s coverage of preventative healthcare could cut the cost of all medical expenses in the long run. By increasing access to preventative check-ups, studies suggest M4A could save the U.S $450 billion each year. Proponents refute the claim that M4A would raise taxes to an extent that cancels out these healthcare savings for the average American, pointing to Sanders’ progressive taxation plan and the fact that federal taxes already fund single-payer systems like Medicaid in the status quo.  

    Supporters of M4A also praise the bill’s inclusion of all U.S. residents. Bill sponsor Senator Sanders emphasizes that M4A would provide health insurance to every person in the United States, including undocumented immigrants. This addition differs from Medicare and Medicaid programs, where “undocumented immigrants are not eligible to enroll in federally funded coverage.” Proponents of M4A argue that the bill would help the U.S. government to fulfill its duty to protect all of its residents equally, especially vulnerable populations. They contend that since undocumented immigrants pay taxes – 96.7 billion dollars in taxes in 2022 – they should not be left out of government healthcare services. 

    In addition, proponents argue that M4A will decrease job locks, the phenomenon in which workers are compelled to keep working a job they would otherwise leave due to their reliance on job- or employer-specific health benefits. Since employers can differentiate benefits of ESI plans based on the job title and seniority of their workers, a switch in careers may threaten a worker’s access to quality healthcare. In this system, proponents argue, career mobility and job searching are discouraged. With 48.6% of Americans covered by an employer-sponsored health insurance (ESI) plan as of 2023, job locks are highly influential on the U.S. economy. Proponents of M4A emphasize that workers give up shorter commute times, higher wages, or more relevant positions to maintain their healthcare, which can decrease life satisfaction and worker productivity. Under M4A, they argue, Americans would have more flexibility to seek jobs that leverage their skills without the pressure of obtaining adequate healthcare. 

    Arguments Against The Medicare-For-All Act of 2023

    Opponents of The Medicare-For-All Act of 2023 cite funding and longer wait times as concerns for the proposal. 

    Critics argue that while the prospect of a no-cost sharing health insurance program is promising at first glance, under the $30 trillion Medicare-For-All project, households and businesses will pay more in taxes than they would save in premiums and other health expenditures. To fund M4A, the government would leverage a 21.2% tax on worker’s wages while employers would undergo a 7.5% income-based premium. While Senator Sanders’ funding plan proposes a progressive tax rate, with a wealth tax on the top 0.1% of American earners, critics maintain that increasing taxes for the purpose of increasing healthcare coverage is not justifiable. In particular, some argue that small businesses, which hire within the regional economy and partner with local charities, may face closures amid M4A-related tax hikes. In turn, critics believe this may harm community identity, competition, and local employment.

    Another common critique of M4A is that the bill will create longer wait times for patients. Opponents highlight that past efforts to expand Medicaid in certain states resulted in a 10% increase in hospital wait times compared to states that did not expand the program. They argue that even though M4A will increase the number of people who can afford healthcare, the accompanying increase in wait times will render healthcare inaccessible for those whose jobs do not allow them time to wait for service. They contend that delayed healthcare is just as harmful as expensive healthcare, because both have the effect of deterring low-income populations from seeking services. Since M4A covers a range of services, critics claim that patient numbers will surge and the finite numbers of hospitals, doctors, and resources will not be able to meet the demand. Critics point to research suggesting that the expansion of Medicaid in certain states decreased hospital efficiency, arguing that M4A would exacerbate this inefficiency nationwide. 

    Conclusion 

    Healthcare in America remains a contentious topic in the domestic political climate, and the future of the Medicare-For-All Act of 2023 remains unclear. Supporters of the bill argue it will increase healthcare access and decrease job locks, boosting the economy. Opponents of the bill argue high taxation and longer wait times under M4A cancel out any potential economic or health accessibility benefits. Moving forward, legislators will continue to debate the relative importance of these factors in improving Americans’ day-to-day lives.