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Biden sets out to expand health coverage in pandemic economy

Dr Natalia Kanem, executive director of the United Nations Population Fund, said the move would greatly help the agency’s work not only in the area of ​​family planning, but in other health services for women. and girls in poor countries.

“We now have the support of a very important Member State,” Dr Kanem said in a telephone interview.

The rule has been riding a philosophical seesaw for decades – in place when a Republican occupies the White House and is overthrown when a Democrat moves in.

Mr Biden also ordered the Department of Health and Human Services to, “as soon as possible, consider suspending, revising or rescinding” the so-called house gag rule – a set of regulations imposed by the Trump administration that federally ban funded family planning clinics by counseling patients about abortion.

The Guttmacher Institute, which tracks access to abortion, wrote last year that the rules
halving the patient capacity of the national family planning network, jeopardizing the care of 1.6 million patients nationwide. The presidential directive virtually guarantees that the health ministry will overturn these rules, although that could take months.

The president’s order will also direct federal agencies to review policies, including state waivers, that discourage participation in Medicaid, the public health insurance program for the poor and disabled. Medicaid enrollments increased dramatically during the pandemic, in part because people who lost their jobs and health insurance turned to them.

The Trump administration has approved waivers in 12 states that would require some Medicaid recipients to work a minimum number of hours per week or risk losing their benefits. Four of those pilots have already been canceled by the courts and the Biden administration has the power to terminate them all, although the Trump administration in its final weeks has taken steps to make that process more difficult.

Another waiver, completed this month in Tennessee, would give that state fixed funding – or a block grant – to cover its Medicaid population while relaxing many rules on how the program is run. This waiver could also be canceled.

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Aetna agrees to expand coverage of sexist surgeries

Allison Escolastico, a 30-year-old transgender woman, has wanted breast augmentation surgery for a decade. In 2019, she finally thought her insurance company, Aetna, would pay for it, only to find that she viewed the procedure as cosmetic, not medically necessary, and refused to cover it.

“I knew my case wasn’t cosmetic,” said Escolastico, who contacted a lawyer after losing her appeal last year. “I knew I had to fight for this,” she says.

Ms Escolastico’s surgery is now scheduled for February. Working with the Transgender Legal Defense and Education Fund, a non-profit organization that advocates for transgender rights, and Cohen Milstein Sellers and Toll, a large law firm that represents plaintiffs, she and a small group of trans women have persuaded Aetna to cover the procedure if they could show it must be medically necessary.

To be eligible, women would need to demonstrate that they have persistent gender dysphoria, undergo one year of feminizing hormone therapy, and be referred by a mental health professional.

Aetna’s change represents a significant shift in the way health insurers perceive the medical needs of transgender people. While some insurers offer a wide range of surgeries for trans women if deemed medically necessary, others exclude breast augmentation and other treatments as simply cosmetic.

“This has the potential to be a moment of transformation,” said Kalpana Kotagal, partner at Cohen Milstein.

Insurers have generally covered genital reassignment surgery as medically necessary. But transgender women and others say breast augmentation is also a necessary treatment for people who are diagnosed with gender dysphoria. “There’s no question from a medical point of view,” said Noah E. Lewis, director of the fund’s Trans Health project.

In addition, he said, it is illegal for a health insurer to deny health care coverage because of a person’s gender identity. “It’s a very simple discrimination issue,” he said.

Aetna, who is owned by CVS Health, had been actively reviewing the need for breast augmentation surgery for trans women, said Dr Jordan Pritzker, senior director of clinical solutions for the insurer. He said he had spoken to many doctors who perform the surgery.

“Our decision to update our Clinical Policy Bulletin is in line with many changes we have made over the years to better meet the needs of the LGBTQ community,” Dr. Pritzker said in a statement.

Aetna said she would also reimburse some transgender women who were denied coverage but had surgery. The company said it is actively reaching out to people who have applied for clearance for their surgeries and been denied.

Cora Brna was denied coverage for breast augmentation surgery two years ago when she tried to schedule it at the same time she was undergoing genital reassignment, which was covered by Aetna. “I was devastated,” she says.

“I felt like a group of people were deciding whether or not I was a woman,” said Ms Brna, 32, who works as a health care worker in Pittsburgh and was one of the women who petitioned Aetna. She had genital surgery but only had the breast augmentation procedure after being covered by a different health plan.

Aetna’s new policy also comes at a time when the federal government is reconsidering whether denying certain types of care to transgender people is discriminatory. Under the Affordable Care Act, insurers cannot discriminate against individuals on the basis of gender identity, and most insurance companies provide coverage for people who require gender reassignment surgery. But the law never mandated a specific benefit or detailed exactly what services insurers would cover, said Katie Keith, who teaches law at Georgetown University and follows this area of ​​the law closely.

“It’s almost like a parity issue,” she says.

While the Trump administration sought to overturn protections for transgender people with a rule last June, the issue is still being resolved in the courts, said Ms Keith, who also highlighted the recent court ruling. supreme that gay and transgender workers are protected. discrimination in the workplace under civil law.

The new Biden administration has already issued an executive order saying it will enforce civil rights laws that protect people from discrimination on the basis of gender identity.

The major insurance companies are uneven in their coverage. Health Care Service Corp., which offers Blue Cross plans in five states, will pay for breast augmentation and other services for trans women if they are deemed medically necessary. The insurer said it developed these policies in accordance with guidelines set by the World Professional Association for Transgender Health, a non-profit organization.

But other big insurers, including Anthem and UnitedHealthcare, continue to view surgery as cosmetic, as they typically don’t cover procedures for women without a diagnosis of gender dysphoria. They say they don’t discriminate against trans women.

Anthem states that “its medical policy is applied fairly to all members, regardless of their sex or gender identity.”

And UnitedHealthcare said in a statement that its “coverage for the treatment of gender dysphoria is comprehensive and, depending on member benefit plans, current coverage may include doctor visits, mental health services, prescription drugs and surgery to treat gender dysphoria. He added that he uses “evidence-based medicine to make coverage policy decisions,” which are updated regularly.

But lawyers for the women involved in the Aetna deal say they are looking closely at the policies of other insurers to see if they can argue that their refusal to offer coverage is discriminatory. “This is something that needs to be changed throughout the industry,” said Ms. Kotagal of Cohen Milstein.

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More than half of states expand access to vaccines, sparking hope and chaos

More than half of states expand access to vaccines, sparking hope and chaos At least 28 states have started immunizing older people. In the midst of a changing deployment, here’s a look at what each state is doing: By Lucy Tompkins, Amy Schoenfeld Walker, Jasmine C. Lee, Danielle Ivory and Mitch Smith

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Federal government orders states to expand vaccine targets as Covid-19 deaths rise

The Centers for Disease Control and Prevention recommended last month that after vaccinating healthcare workers and residents of long-term care facilities, states should vaccinate people over the age of 75 and some workers ” frontline ‘who cannot do their homework. Only after that, the CDC advised, should states turn to people aged 65 to 74 and adults of all ages with high-risk medical conditions. The CDC’s recommendations were not binding, but many states have largely followed them as demand still greatly exceeds supply.

It is not clear how the threat to execute Mr. Azar worked; in two weeks, Mr. Biden will have already been sworn in as president. Mr Azar said the incoming Biden administration would be notified of the changes, while adding that the Americans “operate with one government at a time, and this is the approach that we believe serves the mission best.

Mr Biden is expected to announce the details of his own vaccination plan – which will include federally-backed mass vaccination clinics – this week. Biden’s transition team declined to comment on Trump’s new policy on Tuesday. But a person familiar with the president-elect’s plans said Mr Biden also plans to expand the universe of those eligible for vaccination.

Mr Azar said people seeking the vaccine because they have high-risk medical conditions should provide “some form of medical documentation, as defined by the governors”, but he did not specify. A significant portion of the population has conditions that the CDC has determined increase the risk of severe Covid disease, starting with obesity, which affects at least 40 percent of adults.

Other people who would be immediately eligible for vaccines under Mr Azar’s directive include the more than 30 million adults with heart problems, 37 million people with chronic kidney disease and 1 in 10 with chronic kidney disease. of diabetes.

The new distribution plan, first reported Tuesday morning by Axios, is a reversal for the Trump administration, which had withheld around half of its vaccine supply – millions of vials – to ensure second doses would be available . Mr Azar said the administration always expected to make the switch when they were confident in the supply chain.

Dr Paul Offit, a professor at the University of Pennsylvania and a member of the Food and Drug Administration’s Vaccine Advisory Committee, praised the administration’s decision, comparing the current situation to the Titanic, where there was no enough lifeboats to save everyone, “and you have to decide who you’re going to let talk to.”

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Democrats fight for control of the Senate as they push to expand the House majority

In the fight for the House, Democrats started the night more clearly on the offensive, backed by a surprising advantage in fundraising, Republican recruiting failures and the erosion of Mr. Trump’s support in cities and towns. American suburbs. Two years after winning 41 seats to reclaim a majority, Democrats were trying to establish themselves in suburban neighborhoods Republicans had not lost for decades around St. Louis, Indianapolis, Atlanta, Phoenix, Omaha and even formerly ruby ​​red regions of Texas.

Strategists from both parties said a second Blue Wave could eliminate 10-20 Republicans, and a less successful evening could earn Democrats just a handful of new seats. The early returns on Tuesday night, however, did not appear to reflect the scale of losses for the GOP they had anticipated in the final days of the race, as a handful of Republican incumbents in suburban districts retained their seats and than some Democratic challengers. failed in the solidly red districts that the party had hoped to make competitive.

“Tonight, House Democrats stand ready to further strengthen our majority, the largest, most diverse, most dynamic and vastest majority led by women, led by women,” Speaker Nancy said Tuesday. Pelosi from California before the polls close.

“There is nothing normal about what is in the White House,” she added, “but normally that would be the start of healing.”

Republicans started the cycle in hopes of clinging to Mr Trump’s ponytails and a booming economy to ravage the 30 or so districts he won in 2016 that Democrats claimed two years older late. But those hopes have been dashed by the pandemic, which has left the economy in tatters and the nation with more than 230,000 dead to date, and Democratic candidates in many of the districts they once hoped to claim were on the verge of collapsing. qualify for a second term, with signs of consolidating Democratic support that could keep districts out of Republican reach for years.

Republicans have found unexpected bright spots in Florida. With Mr. Trump making significant inroads among Cuban Americans in Miami, Representative Debbie Mucarsel-Powell, a first-term Democrat, was edged out by Carlos Gimenez, the mayor of Miami, and Representative Donna E. Shalala lost to Maria Elvira Salazar, a former TV presenter.

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Pushing deep into the GOP turf, Democrats set to expand House majority

VERONA, NY – Pushing further into Republican territory a week before Election Day, Democrats are set to expand their House majority while Republicans, overwhelmed by President Trump’s weak position in election fields crucial battles, scramble to make up for the losses.

Armed with a huge cash advantage, a series of critical Republican recruiting failures and a wave of liberal enthusiasm, Democrats strengthened their grip on hard-fought seats in 2018, which saw them take control of the House. They trained their firepower and huge campaign coffers on once-strong Republican foundations in affluent suburban neighborhoods, where many voters became disillusioned with Mr. Trump.

That left the Republicans, who started the cycle hoping to take over the House by reclaiming a number of competitive districts they lost to Democrats in 2018, striving to achieve a darker goal: to limit the reach for another Democratic sweep, largely winning rural, white areas. working-class neighborhoods like this one in central New York where Mr. Trump is still popular. Depending on the success of those efforts, Republican strategists, citing a national environment that has turned against them, privately plan to lose between a handful of seats and up to 20.

This is totally at odds with Mr. Trump’s own prediction just days ago that Republicans would take back control of the House, which Speaker Nancy Pelosi said was “illusory,” echoing the private assessments of many members. from the president’s party.

“The Democrats’ green wave in 2018 has turned into a green tsunami in 2020, which, combined with the ongoing struggles with suburban college voters, is creating an extremely difficult environment,” said Corry Bliss, a Republican strategist who helped lead the party’s failed 2018 effort to protect its majority in the House, referring to the torrent of Democratic campaign money. “There are about a dozen 50-50 races across the country, and the most important factor in each is whether the president can close hard down the home stretch.

The field for House Republicans was not supposed to be that dark. But Mr. Trump’s stumbling response to the pandemic and the incendiary policy of politics has alienated critical segments of the electorate, particularly suburban voters and women, dragging Republicans into Congress and paving the way for them. Democrats in districts that would once have been unfathomable.

“I don’t think too many people would have thought that at the start of this cycle, but we are playing deep in Trump country,” said Rep. Cheri Bustos of Illinois, the chair of the House Democrats’ campaign arm. , noting that “a third of a billion dollars” and solid recruits had given “a good secret sauce”.

Seeking new opportunities in neighborhoods that were traditionally conservative strongholds, Democrats stormed into the country’s suburbs. In the Midwest, they target Reps Don Bacon from Nebraska, Ann Wagner from Missouri, and Rodney Davis from Illinois. They are also storming once ruby ​​red areas of Texas, positioning themselves within striking distance to take up to five seats on the outskirts of Houston and Dallas.

Nowhere is the dynamic perhaps more marked than outside of Indianapolis, in a seahorse-shaped neighborhood run by Rep. Susan W. Brooks, Republican from Indiana, who is retiring. The district, one of the wealthiest and most educated in the state, has been reliably conservative, sending Republicans to the House since the early 1990s and backing Mr. Trump in 2016 by eight points.

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But this year, Democrats see the district as one of their best opportunities to change seats, betting that disgust for Mr. Trump will bolster support for their candidate, Christina Hale, a former member of the General Assembly of the United Nations. ‘Indiana who boasts of working to pass legislation with Vice President Mike Pence when he was state governor.

“People here are so tired of all the drama and the constant cycle of news,” Ms. Hale said in an interview. “They’re just looking for practical, knowledgeable, and empathetic people to represent them in Washington and people who will collaborate across the aisle.”

Two years ago, armed with similar marks and messages, Democrats won 31 districts where Mr. Trump had prevailed in 2016. Most of them are expected to re-elect, capitalizing on their huge fundraisers and weak challengers republicans.

If Republicans have any reason for optimism, it’s in largely rural areas like New York’s 22nd District, populated mostly by white voters who still strongly support the president. They are optimistic about their chances in this race, where Claudia Tenney seeks to reclaim her seat from Representative Anthony Brindisi, the Democrat who ousted her in 2018 after winning by less than 4,500 votes.

While Ms Tenney described herself in an interview as independent, her campaign is betting that Mr Trump’s presence on the ballot this year could help him overtake Mr Brindisi on polling day. Across the neighborhood, along roads that wind through farmland and nestled among elaborate Halloween displays, the garden signs paid for by Tenney’s campaign ring out, in all caps, “Trump Tenney” – a clear indication of the way their fortunes are intertwined. (Mr. Trump Tuesday also tweeted in support of Mrs. Tenney.)

“I just can’t believe he won’t win this double-digit district, and I think his policies have worked really well for our region,” Ms. Tenney said of Mr. Trump. “They would rather have a president and a leader who will stand up for them rather than hang on to personality issues.”

But Mr Brindisi, who has sought to create a platform rooted in health care, labor and local constituency legislation, argued Ms Tenney lost in 2018 because she failed to keep her promises to the district.

“People don’t want to go back. They want to keep moving forward, ”Mr. Brindisi said. “At the end of the day, if I run into people on the street in this neighborhood, they’re going to say, ‘Anthony, I don’t care if you’re a Democrat or a Republican, just do it right. “”

Elsewhere in the country, some challengers the Republicans had promoted as strong recruits, like Nancy Mace, the first female Citadel graduate to run against Rep. Joe Cunningham of South Carolina, found themselves held up by a dismal national environment. and unable to keep up their attacks on centrist lawmakers.

“When you try to paint someone who is clearly a moderate like a super extreme, I just don’t think it works,” said AJ Lenar, an advertising designer and Democratic strategist who works with Mr. Cunningham and who is mocks attempts to label him as a socialist.

Making matters worse for Republicans is the state of their fundraising. Democrats in the most competitive races have a 5-to-1 advantage over their Republican opponents, and Democratic candidates overall were on the verge of spending nearly twice as much on Labor Day TV commercials by Labor Day. ballot, according to strategists follow purchases. In New York City, Democrats overtake Republicans by $ 9 million on television to support Representative Max Rose, who has a seat on Staten Island that Republicans see as one of their best opportunities.

Some Republican candidates, including Ms Tenney, were so easily raised that outside groups, like the Congressional Leadership Fund, a Republican House super PAC, were forced to step in to carry out the fundamentals of the campaign. like advertising and phone calls. as exit voting programs. Ms Tenney is one of a group of Republican candidates in this cycle who have aired almost no ads themselves, leaving the super PAC to run their entire TV campaign.

The Democrats’ giant monetary advantage also means they can afford to play in longer races in Alaska and Montana, forcing Republicans to sink millions into those loose seats in an effort to build a firewall against a potential wave.

Even though his party seemed to be playing more defense than offense, Representative Tom Emmer of Minnesota, chairman of the National Republican Campaign Committee, argued in an interview that Republicans can still take back the House. Democrats in districts like New York’s 22nd, which Mr Brindisi ousted two years ago, appear to be on more solid footing than they actually are, he said, due to polls nationals who underestimate conservatives – a claim few of his peers share.

But he admitted that his prediction assumed Mr. Trump was as popular with voters in those districts as he was four years ago.

“It really depends on how well the president is performing at or near 2016 levels,” Emmer said. “Otherwise, it becomes much more difficult.”

This is also the challenge for Victoria Spartz, the state Republican Senator running against Ms Hale in suburban Indiana, where internal polls show support for Mr Trump’s erosion. She used her story of emigrating from Soviet Ukraine to emphasize her strong belief in limited government.

But Ms Spartz faces the same headwinds that are rocking her party in districts across the country. After triumphing in a crowded primary by flaunting her conservative credentials, she must now convince voters of her independence from Mr. Trump and the Republicans.

“I wish people would pay more attention and vote for the candidate,” she said in an interview, “not for the party”.

Emily Cochrane reported from Verona, NY, and Catie Edmondson from Washington. Luke Broadwater contributed reporting from Washington.

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Chance to Expand Medicaid Brings Democrats in Crucial North Carolina

If registered low-income voters voted at the same rate as high-income voters in 15 states who spoke to Mr. Trump in 2016, including North Carolina, they would equal or exceed his margin of victory in those states, according to the study. And for many, access to health care has been an elusive goal, often with devastating consequences.

In an interview, Dr Barber said the coronavirus pandemic has turned this lack of access into a crisis.

“Covid has forced the conversation on healthcare,” he said. “There’s no way you can’t talk about it.

Dr Barber is quick to remind his audience in North Carolina that Senator Tillis helped lead a successful effort in the legislature to pass legislation banning the expansion of Medicaid in 2013, when he was president of representatives room. The Campaign of the Poor has recruited more than 5,000 volunteers in eight states “who are committed to calling over a million poor, low-wage people who did not vote last time, are ready to observe the polls, or are going. canvas communities with their face shields and masks and gloves, ”he said,“ because it’s a matter of life and death in the truest sense of the word.

Jessica Holmes, a Democrat candidate for labor commissioner, said such efforts motivate people like her 84-year-old grandmother, who she says has never voted in a presidential election until now.

“We’re in the biggest medical crisis of a lot of our lives,” Ms. Holmes said, “and yet all over North Carolina we’re talking about selling hospitals or clinics shutting down.

Joseph Danko, 54, who lost his construction job in March and suffers from asthma, was distressed to learn he was not eligible for Medicaid despite having virtually no income. Anxiety over health care was one of the main reasons Mr Danko, of Raleigh, voted early for Mr Biden and other Democrats, he said, handing over his ballot to vote in person “to be 100% sure” that it would be counted.

“It has been a crazy year,” he said, “but we hope and pray for change.”