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Trump issues terrible budget, Senate plan to protect Dreamers fails

Trump proposes ACA repeal, Medicaid block grants and huge cuts to Medicare
This week, the Trump White House released its proposed budget for fiscal year 2019. While we knew it was going to be bad, we were still shocked at just how deeply and ruthlessly the administration proposed cutting services for poor and middle-class households. Coming on the heels of the GOP’s $1.5 trillion deficit-financed tax giveaway to corporations and the ultra-wealthy, the president’s budget doubles down on Speaker Paul Ryan (R-WI)’s promise to use the fiscal crisis created by the tax bill to justify gutting the social safety net. While most of the budget’s specific policy proposals have little chance of becoming law this year, the budget sets out a clear marker of what Republicans hope to do in 2019 if they retain control of Congress in the November elections.
The budget once again calls for blocking women from using their public health insurance at Planned Parenthood, repealing the Affordable Care Act (ACA) and the ACA’s Medicaid expansion and replacing them with a Graham-Cassidy style block grant program designed to disappear after a few years. The budget also doubles down on last year’s Trumpcare proposals to block grant Medicaid—eliminating its long-standing guarantee of coverage for pregnant women, children, seniors and people with disabilities. But the budget envisions even deeper cuts than what Republicans voted for in 2017. Despite Candidate Trump’s promises to protect Medicare on the campaign trail, the budget proposes $554 billion in cuts to Medicare over the next decade.
The budget envisions equally devastating cuts beyond health care. It calls for $213 billion in cuts to the food stamp (SNAP) program—slashing the program by almost one-third—elimination of community development block grants, deep cuts to housing assistance, elimination of 29 education programs that serve low-income students and $240 billion in cuts to infrastructure. Meanwhile, Trump’s infrastructure plan also introduced this week would replace direct federal investment—financed by progressive income taxes—with private investment financed by regressive tolls and fees. Women already face significant obstacles in accessing safe, affordable, and reliable transportation compared to men, with consequences for their health. In a 2013 study, the Kaiser Family Foundation found that nearly one in five low-income women nationwide (18%) cited transportation problems as a reason for forgoing medical care.
But even with these deep, deep cuts to health care, food security, education and infrastructure, the Trump budget still predicts deep red deficits every year. In fact, their numbers almost certainly aren’t dire enough, banking on unrealistic projections about economic growth and the government’s borrowing costs over the next ten years.
Trump and Ryan want to use the deficit to attack services for low- and middle-income families but their own budget shows that even eviscerating the social safety net won’t balance the budget. Instead it’s clearer than ever that the next Congress must repeal the #TrumpTaxScam. The Washington Post summed up the budget with the headline, “Trump budget highlights disconnect between populist rhetoric and plutocrat reality.” We couldn’t have said it better ourselves.
Senate Fails to Approve Bipartisan Plan to Save Dreamers
This week, the Senate debated legislation to restore legal protections for the Dreamers. Named for the DREAM Act, which would provide them with a pathway to citizenship, the Dreamers are undocumented immigrants brought to the U.S. as children, many of whom have known no other home.
As we described last month, after Republicans blocked the DREAM Act in Congress in 2010, President Barack Obama created the Deferred Action for Childhood Arrivals (DACA) program in 2012 by executive order, granting limited legal status and work authorization to Dreamers who registered with the federal government. In 2017, however, the Trump administration canceled DACA, rescinding those protections after March 5, 2018, and directed immigration officials to arrest and deport otherwise law-abiding undocumented immigrants, including the Dreamers. In 2017, the number of non-criminal immigrants arrested by Immigration and Customs Enforcement (ICE) increased 250 percent. Unless Congress takes action, the end of DACA will be not only a looming humanitarian crisis, but also a public health crisis, as hundreds of thousands of employed Dreamers lose their jobs and their work-place health insurance.
On Wednesday, a group of 16 senators evenly split between the two parties introduced legislation to extend legal status to 1.8 million Dreamers and appropriate $25 billion for border security, distributed incrementally over the next decade. However, because the bill does not slash legal immigration—a top priority for the Trump White House and the GOP’s nativist base—the administration issued a veto threat and began aggressively lobbying against it. The Washington Post reported one Trump official as saying “we are doing everything in our power” to block the bill.
This afternoon senators took four immigration-related votes, including on draconian legislation to block federal funding for “sanctuary cities” and a White House proposal to tie protections for the Dreamers hostage with steep cuts to legal immigration. Several organizations who advocate on behalf of the Dreamers had alreadyrejected the Trump proposal, warning that Dreamers won’t accept attacks on other immigrants as the price of their own freedom. All four votes failed to win the 60 votes needed for passage. The Trump proposal was rejected 39-60 while the bipartisan bill fell just 6 votes shy at 54-45.
Ironically, the bill’s path forward was complicated by a major legal victory for the Dreamers, which may have taken pressure off of reticent Republicans to pass a deal. Two federal courts have now ruled that Trump illegally terminated the DACA program, and have ordered the federal government to continue processing DACA renewal applications beyond March 5. But because the program requires Dreamers to register with a federal government now viewed as openly hostile to them, many Dreamers fear renewing their authorizations without statutory protections from Congress.
With the Senate now set to leave town for the President’s Day recess next week, it’s not clear what will happen next. But it’s not too late to make your voice heard and let your senators know what you think of their votes today. Use the congressional switchboard (202) 224-3121 to tell them they need to protect Dreamers, defend DACA and support the DREAM Act now!
You can also amplify the importance of DACA and the DREAM Act on Facebook, Twitter and other social media platforms. Reach out to your senators by tweeting at them or posting on their Facebook pages. You can use these messages and graphics from our friends at the National Immigration Law Center and the hashtag #DreamActNow.



Congress Acts to Fund Key Health Priorities, But Leaves Dreamers Behind

Congress Funds Key Health Priorities, But Leaves Dreamers Behind

Early this morning, Congress passed a wide-ranging budget bill to end the second government shutdown of 2018 a few hours after it began. The bill funds the government at current levels through March 23—the fifth short-term funding measure since the start of the current fiscal year in October.
But this stop-gap, unlike previous ones, finally includes a desperately needed deal to set longer-term spending levels, repealing sequestration for two years and investing in starved domestic priorities. The bill also includes an additional four years of funding for the Children’s Health Insurance Program (CHIP) for a total of ten years, two years of funding for community health centers, and disaster relief for Puerto Rico and the U.S. Virgin Islands. But, the bill does nothing to protect the future of close to 800,000 Dreamers—young immigrants brought to the U.S. as children, many of whom have known no other home. This is why we must urge Congress to pass a clean DREAM Act now. The DREAM Act would protect the ability of DACA recipients to live and work without fear of deportation and provide them a path to citizenship.
Following Congress’ action early this morning, appropriators will now use the next six weeks to draft a rest-of-the-year omnibus appropriations package based on new spending limits.
But before we get into the details of what was in the budget bill, a quick overview of the history. In 2011, the new Republican majority (elected in the 2010 Tea Party wave) held the debt limit hostage in the middle of the Great Recession in exchange for deep cuts to spending. The result was the Budget Control Act (BCA), a two-part attack on public investment.
The first part of the BCA instituted dangerously low statutory caps on discretionary spending, the category of funding for health care programs like Title X family planning and Ryan White HIV/AIDS care, K-12 education, housing assistance, infrastructure, food and drug safety, consumer safety, environmental regulation, and more. The second part of the BCA imposed sequestration—a process of deep, automatic, across-the-board spending cuts—if Congress failed to find other ways to reduce the deficit.
Bipartisan deals in 2013 and 2015 mitigated some of those cuts, but sequestration was set to come roaring back in 2018, with hardline conservatives poised to slash critical social programs while pushing for new spending for the Pentagon.
But in a key win for progressives, today’s deal not only eliminates sequestration for FY18 and FY19, it also increases discretionary spending above the BCA caps for those years too, adding $26 billion above the caps to non-defense in FY18 and $31 billion in FY19. Just how starved for funding have these programs been since the BCA? As the Center on Budget Policy and Priorities notes, even with this boost, funding on critical domestic priorities still remains “below its level of eight years ago in inflation-adjusted terms—a sign of how much this part of the budget has been squeezed in recent years.”
However, as we noted above, the deal does not include relief for the Dreamers. Activists had hoped that blocking the budget deal would give them additional leverage in the immigration debate, with the goal of pressuring House Speaker Paul Ryan (R-WI) into scheduling a vote. On Thursday, Democratic Leader Nancy Pelosi (CA, left) gave a record-breaking 8-hour speech on the House floor, reading the personal stories of over three hundred Dreamers.
But because they have no control over the House floor, House Democrats are in an even weaker position than House Republicans were when they unsuccessfully pursued a shutdown strategy in 2013 over the Affordable Care Act and again in 2015 over Planned Parenthood. It’s not clear whether blocking the budget deal this morning would have pressured Ryan or simply strengthened the hand of House conservatives hoping to strip progressive priorities from the deal.
On Monday, the Senate is scheduled to start debate on a narrow, bipartisan immigration package designed to provide relief to the Dreamers in exchange for additional funding for border security. As reported by the Washington Post, the emerging deal "would grant legal status to Dreamers who have been in the country since 2013—a larger pool of undocumented immigrants than the 1.8 million Trump supports legalizing." Importantly, it would not cut legal immigration or authorize funding for a border wall, two poison pills for progressive but top priorities for the White House.
Ryan has so far refused to commit to a House vote on the Senate package unless it satisfies hard-liners in the Trump administration, but the real power lies with moderate House Republicans. Under House rules, it only takes 23 Republicans banding together with the Democrats to bring up a bipartisan immigration bill. If a majority of House members from both parties defeat a previous question or sign a discharge petition, they could win far more than just a promise from Ryan. They could take over the House floor.
That is why it is absolutely critical that we keep up the pressure on moderate Republicans. You can use the congressional switchboard at (202) 225-3121 to call your members of Congress, and urge them to protect young immigrants by passing the DREAM Act now. 
The Fight Against Harmful Medicaid Waivers Continues in the States
As we noted last week, states continue their march toward imposing burdensome new red tape on families with Medicaid under the guise of work requirements, lifetime limits, and unnecessarily frequent confirmations of eligibility. Earlier this week, we submitted joint comments with our Phoenix-based regional coordinator, Trans Queer Pueblo, urging CMS to reject Arizona’s proposed waiver, which would particularly harm women, immigrants, people of color, and LGBTQ people. 



How would Medicaid waivers hurt women and LGBTQ people?

The dangers of proposed Medicaid work requirements
House Speaker Paul Ryan (R-WI)—rumored to be retiring at the end of the year, with possible presidential ambitions—still wants to bolster his conservative legacy by forcing a vote on a stand-alone package of “reforms” that he hopes can win the support of vulnerable red-state Democratic senators. Using Orwellian phrases like “personal responsibility” and “promoting independence,” he wants to push forward radical changes to the Medicaid statute that would allow or require states to impose work requirements, drug testing, onerous new paperwork burdens and more.
With the blessing of the Trump administration’s Center for Medicare and Medicaid Services (CMS), states are already attempting to ram through these changes under the guise of “demonstration projects.” But because the statute itself does not grant this leeway, these state waivers are subject to litigation.Former CMS official Eliot Fishman recently wrote about why:
"[W]aivers must meet a legal requirement that they try to strengthen the Medicaid program: by expanding coverage, improving care delivery, or help safety net hospitals and other providers. But CMS’s recent announcement is directly opposed to the central Medicaid goal of covering low-income people. This is the first time in the 52-year history of the program that Medicaid waivers have been approved to reduce coverage instead of to expand it."
If Republicans are successful in changing the underlying law itself, they may have achieved through the backdoor, many of the same coverage losses they’d hope to carry out through block grants and other proposed direct coverage cuts last summer. The danger is that, right now, few people understand what “work requirements” really mean. Moreover, Senators up for re-election this year from conservative states may be reluctant to vote against proposals that appear to be getting people back to work.
In reality, there are very few Medicaid beneficiaries who could be working but aren’t. As the Center on Budget and Policy Priorities notes, the overwhelming majority of adults with Medicaid already work, are too sick to work, are going to school, are taking care of family members, or are already actively looking for work and can’t find it.
Work requirements won’t change those circumstances, but the red tape associated with compliance will cause many of those people to lose coverage. As the New York Times recently reported, “a large body of social science suggests that the mere requirement of documenting work hours is likely to cause many eligible people to lose coverage, too.” As the article notes, “these [administrative hurdles] may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access.”
The consequences for women and people of color would be particularly severe, as we noted in our 2016 research brief. While women and men have had roughly equivalent unemployment rates post-recession, women are far more likely to work part-time, making them vulnerable to the kinds of hourly requirements legislators have proposed. In 2014, for example, women accounted for 66% of the part-time work force and only 41% of the full-time workforce. Likewise, since the 1940s, the unemployment rate among African Americans has been consistently double that of white Americans.
Work requirements would also have serious consequences for LGBTQ people, who may disproportionately fall within the category of “able-bodied adults without dependents,” which work requirements often seek to target. It’s likely that the states where work requirements are more likely to be adopted are also the states with few or no workplace protections for LGBTQ people. In other words,  LGBTQ people could be subject to work requirements, while also facing discrimination that keeps them from being hired, or causes them to be fired.
A few weeks ago, Kentucky became the first state to gain approval for a Medicaid waiver that will impose harmful work requirements on Medicaid recipients. RWV and our Louisville-based RC, Kentucky Health Justice Network, submitted joint comments urging the state not to pursue work requirements, and highlighting the negative impact they will have on Kentucky women. Officials estimate that the waiver’s approval will lead to as many as100,000 Kentuckians losing coverage (a number that doesn’t even account for the people who will be deterred from seeking Medicaid coverage in the future). This will have serious implications for Kentucky women, particularly the 22% of Kentucky women between the ages of 15 and 49 who depend on Medicaid for health coverage.
Unfortunately, work requirements are not the only harmful provisions making appearances in state Medicaid waiversStates are seeking to impose premiums and lock-out periods, mandate drug testing, eliminate retroactive coverage, and impose lifetime limits on coverage, all of which will have devastating consequences for women. Some states, such as New Mexico, have used their waiver applications to try to limit eligibility for family planning services and supplies. Earlier this week, we submitted joint comments with our Albuquerque-based regional coordinator, New Mexico Religious Coalition for Reproductive Choice, urging CMS to reject harmful aspect of New Mexico’s proposed waiver.
We’ll be continuing to follow and comment on Medicaid waivers being put forth by other states, and highlighting their impact on women and LGBTQ people.
Congress stalled on must-do actions
Meanwhile, Congress is still nowhere close to a deal on several major issues with significant implications for health policy. Four months into fiscal year 2018, Congress still can’t agree on FY 2018 funding levels or a budget deal to prevent sequestration, the deep, automatic, across-the-board cuts set to hit everything from the military to family planning and HIV/AIDS services to road and bridge safety. Hardline conservatives are happy to let sequestration hit non-defense priorities like health care, education, and infrastructure, but are pushing for new spending for the Pentagon. Democrats have said that’s a non-starter.
Moreover, there’s little evidence that Congress is any closer to a resolution to the threat created for nearly 800,000 “Dreamers” as a result of the president’s decision to terminate the Deferred Action for Childhood Arrivals (DACA) program. There are significant concerns that, even if the Senate can pass something, Republican leadership in the House won’t bring it to a vote unless moderate Republicans face more public pressure.

If there’s a silver lining to this madness it’s that the likelihood of a third round of reconciliation seems less and less likely the deeper we get into 2018 with so many must-pass items left undone. Reconciliation is the special process that allows GOP leaders to bypass a Democratic filibuster in the Senate and pass legislation with just 50 senators and the vice president. Last January, Congressional Republicans announced a plan to use an FY 2017 reconciliation package to kill the ACA and Medicaid, and then use another reconciliation package for FY 2018 to enact deep tax cuts for themselves and their wealthy donors. Republicans had hoped to use a third reconciliation package for FY 2019 to launch another attack on health care and the social safety net.  But with their Senate majority reduced by one following the surprise special election of Democratic Senator Doug Jones (AL) and time running out on their long to-do list, it appears that reconciliation may no longer be a threat.
If that holds true, it’s great news for protecting the ACA and Medicaid, as well as Planned Parenthood and other abortion providers who were at risk of losing their ability to bill Medicaid for services in all of last year’s Trumpcare proposals. But that doesn’t mean we can breathe a sigh of relief quite yet.
RWV News!
Today, one of RWV’s three coordinating organizations – MergerWatch – joined the national consumer health advocacy organization Community Catalyst to create a Women’s Health Program.  The new program will continue to work in close partnership with the National Women’s Health Network and the Black Women’s Health Imperative to guide RWV. To learn more, see Community Catalyst’s press release.
The newest addition to the RWV website is here -- the events calendar. Check out the upcoming events RWV staff and/or our Regional Coordinators will be participating in across the country! Click here to learn more, including whether you or your organization could participate. For more information or questions, please contact RWV's Regional Field Manager, Kalena Murphy at



The march for women’s health is far from over!

Our fight continues in Washington and across the country
Raising Women’s Voices marched for women’s health across the nation over weekend.  In New York City, for example, Raising Women’s Voices-NY graduate student intern Empress James raised our banner high in one of the largest of the weekend’s women’s marches.
Our fight continues this week in Washington, where Raising Women’s Voices staffers Sarah Christopherson, Kalena Murphy and Ann Danforth are attending the Families USA annual conference. Also on hand are some of our RWV regional coordinators, including Consumer Health First from Maryland, Maine Consumers for Affordable Health Care,New Jersey Citizen Action and EverThrive Illinois. They’ll be connecting with other health care advocates and attending panels throughout the week to discuss what’s ahead in 2018, how we can work together to protect and expand women's health and LGBTQ health, and how can make real progress toward health equity.

This morning, they cheered on U.S. Senator Cory Booker, a New Jersey Democrat, when he told the conference attendees, “We can’t say we are a country who believes in life, liberty, and the pursuit of happiness if all people do not have access to health care.”

Congress renews CHIP, but  fails to act on health centers, Dreamers
After a brief government shutdown over the weekend, Congress passed a short-term funding bill on Monday to re-open government through February 8—the fourth such stop-gap funding bill since the start of the 2018 fiscal year in October. We were relieved that after months of hostage-taking, Congress finally reauthorized the Children’s Health Insurance Program (CHIP) for six years, providing needed coverage for nine million children. States that had already taken steps to freeze their enrollment and shutter their programs now have the certainty they need to get their programs back on track.

Unfortunately, the package passed this week leaves undone a number of key priorities. These include funding for community health centers, funding for disaster relief for Puerto Rico or the U.S. Virgin Islands months after the islands were devastated by Hurricane Maria, and resolution of the future for 800,000 Dreamers, thousands of whom have already lost their legal status.
Congress delayed for several years certain taxes that were supposed to be imposed under the Affordable Care Act, such as the medical device tax, the tax on health insurance companies  and the “Cadillac tax” on high cost health plans. Those delays added more than $31 billion to the federal deficit without a “pay-for,” which means a corresponding cut in federal spending so that the result would be neutral from a budgetary standpoint.
But meanwhile, in an egregious example of a political double standard, Republicans in Congress have refused to fund community health centers without corresponding cuts to other health care programs. In the midst of a major flu epidemic that has already killed dozens of children and an ongoing opioid crisis, over a thousand community health centers around the country have been forced to postpone hiring, or even lay off staff.
The fate of the Dreamers is as uncertain as ever. Named for the DREAM Act, which would provide them with a pathway to citizenship, the Dreamers are undocumented immigrants brought to the U.S. as children, many of whom have known no other home.  In 2012, President Barack Obama created the Deferred Action for Childhood Arrivals (DACA) program by executive order, granting limited legal status and work authorization to the Dreamers. Under DACA and other Obama-era initiatives, DHS officials were directed to prioritize immigration enforcement against individuals with violent or criminal backgrounds.
In 2017, however, the Trump administration canceled DACA, rescinding legal protections for Dreamers after March 5, 2018, and directed immigration officials to arrest and deport otherwise law-abiding immigrants. Under Trump’s direction, immigration raids have been targeted at schools, churches, hospitals, workplaces, and even family courts, where undocumented victims of domestic violence have sought protection against abusive partners.
Unless Congress takes action, the end of DACA will be not only a looming humanitarian crisis, but also a health crisis. Over 90 percent of the Dreamers surveyed in a recent study are currently employed, and hundreds of thousands of them get their health insurance through their employer. So, loss of their work permits also means the loss of their health care. “At the Families USA conference this morning, Gaby Pechco of The Dream.US spelled out the consequences for Dreamers: “I’m not going to have my DACA anymore, which means I’m not going to have my job, which means I’m not going to have any health care, which means I won’t have access to the medication I need to have babies.”

In New York, Governor Andrew Cuomo took steps to protect the health of New York Dreamers who might lose their jobs.  He announced that the 42,000 New York Dreamers will still be eligible for state-funded Medicaid coverage, regardless of their immigration status. "The federal government's failure to take action to protect DACA recipients is appalling, un-American, unjust and puts hundreds of thousands of children at risk,” Cuomo said. “Here in New York we will do everything in our power to protect DACA recipients and ensure they receive health care.”
In exchange for re-opening the government this week, Senate Republican Leader Mitch McConnell (R-KY) promised Democrats and moderate Republicans that the Senate would vote on a DACA package. But the House conservatives who determine whether current Speaker Paul Ryan (R-WI) retains his Speakership have sworn that the House won’t vote on the Senate package.
While pundits obsess over the horserace question of who “won” or “lost” the shutdown, the truth is that the fight has simply been delayed for three weeks. By February 9, the GOP’s long-standing hostility to the Dreamers won’t have faded, setting up the potential for another government shutdown. Fortunately this time around, the GOP will no longer be able to use CHIP as a cudgel.
Voters in Oregon approve funding for continued Medicaid expansion 

On Tuesday, Oregon voters overwhelmingly approved a ballot measure that will protect access to health care for Oregon women and families by preserving Medicaid expansion in the state. Measure 101 will allow the state to continue taxing hospitals and certain health insurers to help pay for the state Medicaid expansion program. Through Medicaid expansion under the ACA, Oregon has achieved one of the highest uninsured rates in the country, with close to 94% of the state insured. At stake in this referendum was the health coverage of 350,000 low-income Oregonians, including women who rely on Medicaid for critical reproductive health services, said supporters of the measure.

NARAL Pro-Choice Oregon, the political action arm of our Portland-based RWV regional coordinator Oregon Foundation for Reproductive Health, worked hard alongside nurses and doctors, firefighters and teachers, AARP, local hospitals and families across the state, to ensure that Measure 101 passed. NARAL Pro-Choice Oregon made phone calls and led a door knocking campaign to urge people across the state to support the measure.

Following Tuesday’s vote, Hannah Rosenau, Program Director at NARAL Pro-Choice Oregon (second from right in photo), said “We are proud to be a part of the successful YES on Measure 101 coalition, standing with over 175 organizations representing hundreds of thousands of Oregonians to protect and support health care. We believe that everyone deserves access to affordable health care and Medicaid is essential for children, people with disabilities and working families in Oregon.”



Trump rule a #LicensetoDiscriminate

Raising Women’s Voices calls on HHS to #PutPatientsFirst

Today, the Trump administration proposed a sweeping new rule designed to ensure that health care providers – hospitals, insurance plans, doctors, nurses, technicians and even volunteers at hospitals – can refuse to provide medical care to which they have religious or moral objections.  We fear the result could be the enshrining of discrimination against women and LGBTQ people, denying them not only needed care, but also the information they need to make informed health care decisions and find alternative medical providers when they are refused care.

Nowhere in the 216-page proposed rule is there an explanation of how the Department will ensure that patients can get the medical care they need, when their health providers refuse.  In fact, the proposed rule specifies that an objecting health provider cannot be required to even provide patients with a written notice about where else they can go to obtain needed care. There is no explanation of what a hospital should be expected to do when a patient desperately needs emergency care, such as treatment of a miscarriage or ectopic pregnancy, but the facility objects on religious grounds. 

The rule was issued on the same day that a new study reported that women of color in 19 states are disproportionately affected by Catholic hospital restrictions on reproductive health care. Among the pregnant women who have been harmed by such refusals is Tamesha Means, pictured, who was turned away from the emergency department at a Catholic hospital in Michigan, after presenting with premature rupture of membranes. Only when she returned to the ER for the third time did she finally receive needed care, but she suffered an unnecessary infection as a result of the delay.

In contrast to the lack of protections for patients, the proposed HHS rule would requirehealth care institutions to prominently post government-specified notices about the rights of employees to refuse to deliver medical care they find objectionable. Institutions would face the potential loss of federal funding for non-compliance.

Existing federal laws already allow individual clinicians and health care institutions to refuse to provide such services as abortions and sterilizations, based on religious beliefs. So, is unclear why HHS needs to take these additional steps, especially when the Department itself estimates it will cost affected entities (such as health providers, insurers and state governments) $312.3 million to implement in the first year and $125.5 million annually after that.  HHS could better spend such funds enforcing, rather than undermining, section 1557 of the Affordable Care Act, which prohibits discrimination against women and LGBTQ people in the provision of health care.

The religious objections of a health care provider cannot be allowed to leave a patient without access to timely medical information and care. In health care, the patient’s rights and needs must come first!