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RWVoices

Wednesday
Jun132018

More Trump sabotage of our health care!

Trump’s Title X rule would allow biased counseling
 
Each week, we are highlighting another aspect of Trump’s proposed rule undermining the Title X family planning program, making the point that it is #MoreThanAGagRule. This week, we are flagging the rule’s new definition of “family planning,” which would allow recipients of Title X funding to give you biased counseling that leaves out any mention of contraception. 
 

 
Unlike current Title X regulations that require programs to offer a broad range ofmedically approved family planning services, this new rule would allow programs to offer asingle or a limited number of “specialized” services. The rule also waives the requirement that Title X grantees provide “medically approved” contraceptive methods. The purpose, according to the rule language, is to “encourage a broader range of applicants and permit innovative approaches that may not have been envisioned or supported by past grantees.”
 
This means a Title X grantee could choose to provide only counseling about “natural” family planning methods — like fertility awareness — and abstinence-only education, instead of a full range of methods.  Although fertility awareness is a common form of family planning, it is only 76% effective and relied upon by only 18% of all Title X female patients.  We can easily imagine fake women’s health clinics (like those “crisis pregnancy centers”) getting Title X funding to provide biased counseling to low-income women. 
 
This new approach is especially troublesome because 66% of Title X patients are under the age of 30 and extensive research has shown that abstinence-only approaches cause considerable harm to young people. In order for people to decide which family planning method is right for them, they need to be presented with all of their options.
 
Family planning is a highly personal and extremely private process for many women and navigating the various methods used to help conceive a child or not conceive can sometimes be overwhelming. Choosing to go to a specialized family planning clinic — like one of the almost 4,000 Title X clinics nationwide — can help make that decision a little easier. A staff knowledgeable in women’s health is one of the top reasons that 80% of women who use these clinics choose them for contraceptive care.
 
What can you do now? You can urge your mayor to sign on to a letter addressed to HHS Secretary Alex Azar opposing the Title X rule. Mayors can formally sign-on to the letter HEREMake it clear that this rule will lead to biased counseling and erode the patient-provider relationship. 
 
Trump administration continues to sabotage our health coverage!
 
Last Thursday, the Trump administration announced that it will not defend the Affordable Care Act (ACA) in court, and it now argues that consumer protections for people with pre-existing conditions (such as cancer, asthma or diabetes) are unconstitutional. While the ACA is still in effect, this latest act of sabotage could leave up to 130 million Americans with pre-existing conditions unable to afford comprehensive health care coverage.  If the administration gets its way, insurance companies would also be able to charge women, older people, and people with certain jobs higher premiums.
 
In an unprecedented step of abandoning its legal and constitutional responsibilities to defend current law, the Trump administration has sided with Texas and 19 other states challenging the ACA in federal court. The Republican-led states argue that because Congress repealed the individual mandate's tax penalty as part of the GOP tax law, all of the ACA is invalid. While the Trump administration has not agreed with the states’ request to completely overturn the ACA, the administration is demanding the repeal of insurance provisions protecting people with pre-existing conditions.
 
If they succeed, insurance companies could charge people more based on their health status and deny coverage for people with pre-existing conditions. People may have to fill out discriminatory health questionnaires like this again – with any “yes” responses resulting in people either paying higher premiums or being denied health care. We could return to the pre-ACA days when being a woman was a pre-existing condition.
 
“This is like some kind of sick joke,” said Senator Maggie Hassan, Democrat of New Hampshire, during questioning of Health and Human Services Secretary Alex Azar at a Senate health committee hearing on Tuesday. This attack on pre-existing condition protections magnifies the anticipated harm of the Trump administration’s proposed rules promoting the sale of “junk” health plans. These plans offer only barebones coverage and discriminate against people with pre-existing conditions.
 
By creating even more uncertainty in the health care markets, the Trump administration could raise health care costs even more for millions of people who are already facingdouble-digit hikes due to previous sabotage.
 
The court has granted permission to a coalition of Democratic attorneys general to defend the ACA. Reed O’Connor, a conservative judge, is presiding over the case in Texas, and his ruling will inevitably be appealed to the conservative 5th Circuit Court of Appeals. This case would likely go to the Supreme Court.

What can you do now? Call your members of Congress and tell them to speak out against the Trump administration’s health care sabotage. Tell them to do all they can to protect coverage for people with pre-existing conditions and make sure women are not once again charged more than men for the same health policy.

 

Thursday
Jun072018

It’s more than a gag rule!

Trump’s Title X rule is much more than a gag rule

It’s bad enough that the Trump administration’s proposed Title X family planning rule would require clinics to relocate abortion services elsewhere, at considerable expense, or lose federal funding. It’s bad enough that the rule would “gag” clinic staff, preventing them from directly referring patients elsewhere for abortion care. But that isn’t all Trump’s rule would do.  

It’s much more than a gag rule! In a series of articles in this weekly newsletter, and through social media postings, Raising Women’s Voices will walk you through the multiple ways in which the proposed rule would undermine and interfere with low-income patients’ access to desperately needed reproductive health care. We will also explain how you can speak out against this harmful rule within the 60-day public comment period that started June 1 and ends July 31.


 
This week’s focus: Trump’s rule instructs Title X providers to offer intentionally confusing information if a patient requests an abortion referral. Under the rule, the provider could only give out a list of health care providers that includes both those that do provide abortion care and those that don’t. The list wouldn’t identify abortion providers in any way. The patient would have to figure out where to go.

For a patient who hasn’t clearly stated “that she has already decided to have an abortion,” her Title X provider would only be allowed to share a list of providers who don’t offer abortion care, including prenatal care providers. In fact, the proposed rule requires Title X clinics to refer this type of pregnant patient (those who haven’t specifically asked for an abortion) to prenatal and/or social services and to assist with setting up the referral appointment “to optimize the health of the mother and unborn child.” 

These requirements would exacerbate the impact of existing state- and federal-level abortion restrictions that already make it difficult for patients — especially those under 18, those with low incomes and women of color — to obtain timely abortion care. In many states, particularly in rural areas, finding a nearby abortion provider can be very challenging. Targeted regulation of abortion providers (TRAP) laws, such as hospital admitting privilege requirements and building standards, have led to clinic closures across the country. With fewer clinics providing abortions, more women must travel longer distances for abortion care. According to the Guttmacher Institute, 27 percent of women aged 15-44 would have to travel at least 30 miles. They face extra financial hardships, such as paying for transportation, overnight accommodations, childcare and lost wages from missed work (if they don’t have paid sick time). And these are just the costs associated with getting to the clinic. 


Insurance coverage restrictions -- such as the Hyde Amendment (which restricts federal funding for abortion except in cases of life endangerment, rape and incest) -- increase the out-of-pocket costs for the abortion itself. Waiting periods (which require women to wait 18 to 72 hours between her pre-abortion consultation and the actual procedure or medication process) can further complicate the challenges of obtaining a timely abortion. All these barriers and built-in delays could push a woman beyond her state’s gestational limit for abortion, making it no longer an option.

Trump’s rule and the deliberately confusing health care provider list would create another hoop for women to jump through to exercise their constitutional right to a safe and legal abortion.

What can you do now? Today is the anniversary of the U.S. Supreme Court’s 1965 Griswold v. Connecticut decision that legalized the use of birth control by married couples (unmarried people got this right later).  It’s a perfect time to speak out against the proposed rule, which would undermine Title X family planning programs!

We’re joining the National Family Planning and Reproductive Health Association (NFPHRA) in a social media “thunderclap” today at noon to mark the Griswold anniversary. Get on Twitter and raise your voice, too! Urge your members of Congress to co-sponsor and support resolutions H.Res.915 in the House and S.Res.526 in the Senate that would make clear that the proposed Title X restrictions would erode the patient-provider relationship and prevent patients from receiving care.
 
Court orders Maine Governor to expand Medicaid

On Monday, the Maine Superior Court ruled that the Maine Department of Health and Human Services must follow the voter-approved Medicaid expansion law. Maine DHHS must also submit a State Plan Amendment.

Maine Gov. Paul LePage has been a long-time opponent of Medicaid expansion and has refused to implement it, despite voters approving it last November. The LePage administration now has a deadline of June 11 to comply.

Consumers for Affordable Health Care, our regional coordinator in Maine, Maine Equal Justice Partners, Maine Primary Care Association, Penobscot Community Health Care and five individuals together sued the Maine Department of Health and Human Services in late April.

Under the law, starting July 2, about 70,000 Mainers can sign up for Medicaid under the expansion. Maine advocates are prepared to file another lawsuit if the state doesn't start accepting applications from eligible Mainers on July 2nd.

 

Friday
Jun012018

Trump is politicizing the Census!

Undermining the 2020 Census
 
The Trump administration is attempting to undermine the 2020 census in ways that would diminish counts of immigrants and LGBTQ individuals. States with large immigrant communities could lose congressional representation and receive less federal funding for health and welfare programs.

 
Every 10 years, the Constitution requires the federal government to conduct a census of people living in the United States—both citizens and noncitizens. The population count then determines the number of representatives each state gets in the U.S. House of Representatives, informs congressional, state and local re-districting and also determines federal funding in a number of programs.
 
What is happening? First, the administration is reinstating a citizenship question in the 2020 census that hasn’t been asked since 1950. The citizenship question is seemingly designed to discourage immigrants—particularly those who are undocumented or live in mixed-status families—from participating in the census.
 
Commerce Secretary Wilbur Ross said the 2020 census would use the same language (shown below) used in the Census Bureau’s American Community Survey (ACS), which asks respondents to describe their citizenship status. Unlike the census, ACS is an annual survey that goes out to only 2.6 percent of the population.


Even though it is illegal to share a person’s census responses with law enforcement or immigration agencies, the chilling effect of the citizenship question could result in an inaccurate count of state populations with large immigrant communities. These states could lose congressional seats vital to protecting and advancing progressive policies on the national level (e.g. the Affordable Care Act). They could also lose substantial federal aid. The federal government uses census data to figure out how much federal funding to distribute to states, much of it for programs critical to the health and welfare of women and their families, such as Medicaid, the Children’s Health Insurance Program (CHIP), and the Supplemental Nutrition Assistance Program (formerly known as food stamps).
 
As we’ve discussed before, cuts to Medicaid would endanger access to family planning services, maternity care, mental health and behavioral health services, and long-term care for chronic conditions. Medicaid covers more than 25 million women, with a disproportionate share of women of color and single mothers.
 
A coalition of 18 states, 10 cities, four counties and the U.S. Conference of Mayors have filed a lawsuit to try to remove the citizenship question. Meanwhile, the Republican-led House Oversight and Government Reform Committee has tried to stifle investigation of the citizenship question. At a May hearing, Committee Chairman Trey Gowdy (R-SC) allowed Acting Assistant Attorney General John Gore of the Civil Rights Division at the Department of Justice to refuse to respond to questions on the issue.
 
The administration is also refusing to include questions in the 2020 census on sexual orientation and gender identity, citing “no federal data need,” despite the apparent gap in LGBTQ-focused health research. The Trump administration’s interference in the 2020 census exacerbates the historical lack of data collection on sexual orientation and gender identity, making it more difficult for researchers to assess the health needs and barriers to care of the LGBTQ population. In turn, policymakers and health care providers won’t have the information necessary to address the unique health challenges of LGBTQ people.
 
Since the federal government conducts the census every 10 years, the Trump administration’s politicization of the census could have long-lasting consequences, perpetuating the cycle of health inequities and poor health outcomes. Undercounting means underrepresenting and underserving the most vulnerable.
 
What can you do? Here are some steps you can take with allies in your state:
  • Educate state and local decision-makers on how an inaccurate census count could threaten public health programs that provide crucial services to the populations they serve;
  • Educate local and state officials, community leaders and small business owners on the economic implications an inaccurate census count could bring to their communities;  
  • Support organizations such as the Leadership Conference on Civil and Human Rights in their efforts to move senators and representatives to call on Secretary Ross to testify on his reasoning behind adding a citizenship question; and
  • Prepare for upcoming public comment periods later this year to elevate how the citizenship question threatens the integrity of the U.S. Census and jeopardizes the economic vitality and civil rights of immigrants and communities of color.

Virginia lawmakers vote to expand Medicaid!
 
On Wednesday, the Republican-led Virginia Senate approved a bill to expand Medicaid, becoming the 33rd state, along with Washington, D.C., to do so. As many as 400,000 low-income residents will gain coverage. But the deal feels a bit “two steps forward, one step back.” In exchange for the Medicaid expansion, Virginia plans to impose premiums, as well as a requirement to take away coverage from people who earn more than the federal poverty level and who don’t meet arbitrary work requirements.  As we’ve discussed before, proposals to take away health care from people who don’t work a set number of hours per month are particularly harmful to women and LGBTQ people.
 
By November, a few more states may join the ranks of Medicaid expansion states. Utah residents will get to vote on a measure to expand Medicaid in the upcoming election. Advocates in Idaho collected enough signatures to add Medicaid expansion to the state’s ballot in November. Election officials are now reviewing signatures to make sure they meet Idaho’s requirements. In Nebraska, advocates are working to collect enough signatures by July 5 to include Medicaid expansion on the November ballot. Advocates are also collecting signatures for a ballot initiative in Montana to make the state’s Medicaid expansion (set to expire June 30, 2019) permanent.
 
Not only are states making moves to expand health care coverage, they are also taking the lead to stabilize the ACA marketplaces and to lower premiums. Along with their allies, New Jersey Citizen Action, our Newark-based regional coordinatorhas been advocating for state policies to offset Trump’s ACA sabotage.  New Jersey Gov. Phil Murphy (D) just signed two of those bills into law: a state individual mandate for health insurance and a bill providing funding for a reinsurance program—a separate fund to help insurers offset the expenses of high-cost individuals.
Wednesday
May232018

New Trump rule an ideological attack on women’s health!

Trump’s rule a blow to family planning clinics and their patients

The Trump administration has issued a proposed rule that would have a devastating impact on Title X family planning providers and their millions of low-income patients. It’s an attempt to achieve administratively what Trump and Congressional Republicans have repeatedly failed to do through legislation – end federal funding for any clinics that provide or refer for abortions.

We must speak out in opposition to this harmful rule, which would force family planning clinics to stop providing abortion care on site or even referrals elsewhere for abortion services. Those clinics that don’t comply with these and other onerous restrictions would lose all federal Title X funds, depriving their low-income patients of birth control services, STI screenings and other preventive care!

Join Raising Women’s Voices on social media using the hashtag #NoGagRule to protest this action. Join protest rallies that are being held today at 5:30 pm on Capitol Hill in Washington, D.C. or tomorrow around the country in cities where there are regional offices of the Department of Health and Human Services (HHS), which issued the rule yesterday.  Go here  to find out if there is a protest near you tomorrow. Also, stay tuned to our social media outlets for news of a 50-state strategy over the Memorial Day recess  to encourage Congressional members to speak out against the proposed rule.

How harmful is this rule? Let us count the ways

We and our women’s health allies are still studying the details of this 129-page proposed rule, and we will be preparing comments to submit by the 60-day comment deadline before HHS can issue a final rule that will go into effect. (That comment period has not yet started, because the rule has not been published in the Federal Register.) So, we will have much more to say about it in the weeks ahead. But for now, we want to explain the key elements of this rule.

First, we want to make clear that family planning providers are already prohibited from using Title X federal funds to provide abortionsThey must use other funds, such as direct payments by patients, to fund abortion care, and keep those funds separate from federal dollars, creating what is called “financial distance.”

This proposed rule would go well beyond the current restrictions, with the following requirements:
  • Family planning providers would be required to establish physical distancebetween services funded by Title X and any provision of abortion services. This requirement would mean family planning providers would have to move abortion care to another location, a crushing burden on clinics that are already financially stretched, or stop providing abortion care altogether.
  • Family planning providers that receive Title X funding would be barred from providing referrals elsewhere for abortion care. Currently, Title X clinics are able to provide referrals for abortion care, upon request from patients. Under the proposed rule, Tile X providers would only be allowed to give out a list of health providers that includes both those that do provide abortion care and those that don’t. The patient would have to figure out where to go herself.
  • Counseling of pregnant women by Title X providers would not have to be comprehensive and non-directional. So, providers opposed to abortion could omit any mention of abortion as an option when counseling pregnant women.  For example, if a woman’s pregnancy would severely affect her health, due to a diagnosis of cancer or another medical condition, her clinician could refuse to tell her about abortion as an option.
  • The rule would change the definition of “family planning” to include non-medical approaches such as abstinence-only or “fertility awareness” methods that have high failure rates. 
  • The rule would change the definition of “low income” to include women who have lost their contraceptive coverage because their employers object to it on religious grounds. However, the rule provides no additional funding for Title X clinics to serve such patients, and thus would likely prove a financial burden to clinics that are already underfunded.
Raising Women’s Voices joined 110 organizations that sent a letter to HHS Secretary Azar last week expressing grave concerns about the expected rule.

What can you do now? First, join a protest. There will be a #NoGagRule rally in Washington, D.C., today at 5:30 pm on Capitol Hill.  You can
RSVP here. Planned Parenthood affiliates around the country will also be holding local rallies tomorrow, Thursday, outside regional offices of HHS.  Contact your allies at your local Planned Parenthood for information about how to join.
 
Second, speak out online in opposition to this harmful proposed rule. It’s not too late to speak out, because there has to be a 60-day comment period before HHS can issue a final rule! Here are some talking points from Planned Parenthood, which provides 41 percent of all Title X funded services:
  • This is an attempt to take away women's basic rights. Period.
  • Everyone should have the right to information about their health care - including information about safe, legal abortion.
  • The result of this rule is that people will not get the health care they need. They won't get birth control, cancer screenings, STD testing or other primary care services.
Third, work in your state! You can work to win approval for state funds to be provided to clinics that could lose their Title X funding because of this rule. Last year, our Maryland regional coordinator, Consumer Health First, did just that. They and other women’s health allies successfully advocated for the adoption of the Family Planning Services – Continuity of Care Act, the first policy in the country to proactively address the threat to women’s health if the federal government revokes funding under Title X.

Under Maryland’s new law, which went into effect on July 1, 2017, $2.7 million in state funding would be put towards establishing a Family Planning Program at the Department of Health and Mental Hygiene if federal support for Title X providers is withdrawn due to “the scope of services offered by the providers or the scope of services for which the providers offer referrals.” While the $2.7 million is only a portion of the full $4 million Maryland can receive under Title X, according to the bill’s fiscal analyst, this policy helps to ensure that patients can continue to access care from providers like Planned Parenthood

“We are proud that Maryland has committed to ensuring that women have access to the vital health services that are their right,” said Leni Preston, Vice President of Consumer Health First.

Other states, including Massachusetts and Connecticut, have also proposed setting aside funding at the state level to fill the gap that would be caused by the loss of federal Title X funds. And last week, New York Governor Andrew Cuomo sent a letter to the NYS Department of Health Commissioner directing him to take immediate action to protect family planning services in New York in light of federal actions.
Thursday
May172018

It’s National Women’s Health Week!

We celebrate women’s health, while the House GOP works to undermine it
 
This week, May 13-19, is National Women’s Health Week! It’s a great time to remind women to take charge of our health and discuss well-woman visits and other preventive care that women need. Many women’s health organizations, including Raising Women’s Voices, are taking part in social media and other outreach activities throughout the week to promote women’s health and topics.

But we also have an eye on Congress, where the U.S. House of Representatives is preparing to vote Friday on a farm bill that will hurt women and our families by raising health insurance premiums and denying food aid to low-income families.  Below, we describe what harm the farm bill would cause.

So what is RWV doing to celebrate women’s health? On Tuesday, May 15th, we hosted a Twitter Chat using the hashtag #HerHealth to share information on a range of women’s health topics, such as what to expect at a well-woman visit, why we need to address black maternal health disparities, how to take advantage of cost-free preventive services and how to navigate the health care system.

The Twitter Chat was a success, reaching nearly 1.2 million people and garnering almost 4 million impressions! Special thanks go out to our co-sponsors who helped make this happen: the National Partnership for Women and Families, People for the American Way, National Institute for Reproductive Health, Young Invincibles, Positive Women’s Network USA, Out 2 Enroll, The Afiya Center, Wisconsin Alliance for Women’s Health, Women with a Vision, and Ever Thrive Illinois.

We’re also spreading the word about the “Mothers and Offspring Mortality and Morbidity Awareness Act (MOMMA)” announced by Congresswoman Robin Kelly of Illinois and other members of Congress at a press conference on Capitol Hill last week. The MOMMA Act is federal legislation that will address our nation’s rising maternal mortality and morbidity crisis. TheBlack Women’s Health Imperative (BWHI) – a co-founder of Raising Women’s Voices – endorsed the bill and BWHI’s Tammy Boyd (shown at right in photo) was present at the press conference.

The legislation ensures sharing of best practices between practitioners and hospital systems, appoints an expert federal review committee to establish and enforce a national obstetric emergency protocol, improves access to culturally-competent care training and workforce practices throughout the care continuum, standardizes data collection, empowers a designated federal agency to collect uniform data and expands Medicaid coverage to the full postpartum period.

Farm bill would drive up health insurance costs
 
The push to remake our health system into Trumpcare continues in the U.S. House of Representatives on Friday, when the chamber is set to vote on a farm bill that would drive up health insurance costs for millions of people while denying food aid to 2 million more.
 
Though little attention has been given to the provision, the farm bill crafted by House Republicans without Democratic input would create a $65 million slush fund for the Secretary of Agriculture to promote association health plans (AHPs). As we wrote last year when the Trump administration first proposed dramatically expanding AHPs, the move is intended to gut consumer protections under the Affordable Care Act and drive up premiums for anyone seeking comprehensive health coverage.
 
Pre-ACA, national trade associations like the Farm Bureau could pick a state with the worst coverage and use those rules to offer insurance nationwide. So, for example, they could offer coverage that complies with Mississippi’s consumer protections to small businesses in Massachusetts, regardless of Massachusetts state law. Under current rules, small businesses can still band together to form AHPs for their members, but they have to operate within states, not across state lines. Most importantly, they have to abide by ACA coverage requirements for small businesses. For example, they have to cover essential health benefits like maternity care. 
 
Under the changes Trump is proposing and that the farm bill would fund, AHPs would be exempt from a host of ACA consumer protections and would once again be able to operate under the rules of any state they choose. The small businesses with the youngest, healthiest people would face strong incentives to exit the ACA’s small business marketplaces and buy a cheaper, skimpier association plan, raising prices for all of the small businesses that remained.
 
In fact, the Society of Actuaries has concluded that Trump’s AHP proposal would cause ACA enrollment to decline by up to 10 percent as the youngest and healthiest dropped out. The National Association of Insurance Commissioners has been even more blunt, warning that “AHPs would fragment and destabilize the small group market, resulting in higher premiums for many small businesses.”
 
The impact on women could be significant. A small business looking at a highly qualified female candidate and a less qualified male candidate would face a strong financial incentive to pick the male candidate, simply because it would mean lower insurance premiums. There is every reason to think that the Trump proposal would reinstate barriers to hiring women, particularly older women or those with pre-existing conditions.
 
And, of course, those premium hikes in comprehensive insurance would come on top of other Trumpcare components already impacting enrollment, including the administration’s promotion of year-long individual “junk” plans exempt from ACA protections (expected to be finalized later this year) and last year’s repeal of the individual mandate.
 
Fortunately, this week it became even easier for the public to track GOP efforts to sabotage the ACA and impose Trumpcare. The national Protect Our Care Coalition, of which Raising Women’s Voices is a member, rolled out a new website atratewatch.us to highlight how the GOP is driving up health care premiums around the country. Check out their interactive map to see predicted rate hikes in your state.
 
The farm bill would also slash food stamps
 
Attacks on health insurance aren’t the only part of the farm bill we’re tracking. The farm bill cuts $23 billion from the Supplemental Nutrition Assistance Program (SNAP, formerly called the food stamp program). As the Center on Budget and Policy Priorities notes“women are especially likely to receive SNAP benefits due to their higher poverty rates and their role as mothers and as caregivers for other family members.”
 
While SNAP already imposes strict work requirements, the House GOP farm bill would go much further for the explicit purpose of taking away assistance. Much like the Trump administration’s push to take away Medicaid coverage under the guise of “supporting work,” the farm bill proposal is all about denying food assistance to the poor to help pay for the GOP’s deficit-busting tax bill for the ultra-wealthy.
 
Under the bill, low-income adults—including those with children 6 and older—who don’t meet an arbitrary number of work hours per month, or who can’t jump through bureaucratic hoops proving that they met the requirement or qualify for an exemption, will lose their food assistance. The first time a mother raising young children, a woman with a serious health condition, or a part-time worker fails to meet the work requirements or to properly fill out her paperwork for an exemption, she could be locked out of the program for a full year under the bill. The next time she could be locked out of food support for three years. 
 
All told, more than 2 million people—including women, parents of young children, children, people with disabilities and serious health conditions, including veterans with PTSD—will lose their food aid under the program if the bill becomes law. This is the dystopian future the GOP also has planned for Medicaid, where an inability to meet monthly requirements, or even making minor paperwork mistakes, can mean the difference between life and death.