The mere existence of Donald Trump has been affecting people's health in various ways since even before the inauguration. But now his administration is bringing about more tangible change to America's health and healthcare system, by dismantling the Affordable Care Act, overhauling the Food and Drug Administration, and nominating pro-life justices to the Supreme Court, among other things. This post will be continuously updated as Congress passes legislation and President Trump signs executive orders and laws.
The Senate confirmed Trump's pick for FDA commissioner despite drug industry ties
Why you should care: Scott Gottlieb is a doctor, yes, but he's also been paid advisor to pharmaceutical companies, has invested heavily in the health care industry, and helped found a cancer biotech firm. He's been paid millions of dollars by drug companies and health investment firms. His background was such a concern that during his conformation hearing he promised to recuse himself for one year from making agency decisions involving any of the 20 (twenty!) health care companies he's worked with. Some say a one-year recusal isn't sufficient. He's also a critic of the food and Drug Administration's safety regulations: In a 2012 National Affairs article, he wrote that the FDA's review process was a hindrance to bringing new drugs to market. Both he and President Trump want to ease regulations and speed approvals. Coincidentally, a study out yesterday found that one in three drugs approved by the FDA had safety issues after approval.
What happened: The Senate confirmed Gottlieb as head of the FDA in a 57-42 vote; he returns to the agency after serving as deputy commissioner under George W. Bush. Health and Human Services secretary Tom Price spun Gottlieb's industry ties by saying that his "background will be crucial" as the FDA works to balance safe treatments with innovative solutions.
The House just barely passed an amended version of the American Health Care Act
Why you should care: Republicans wanted to vote on the updated American Health Care Act —the bill to repeal Obamacare—even though it didn't have a "score" from the Congressional Budget Office. The CBO is a nonpartisan group that analyzes legislation to determine its costs and, in the case of healthcare, how many people could get coverage; the score could come as early as next week, but they voted on it before that. Hmm, wonder why that could be? Perhaps because the bill's MacArthur Amendment would allow states to define their own "essential benefits" and raise people's premiums, forcing some people with pre-existing conditions out of the market? Or because the Upton Amendment that pledged an additional $8 billion over five years to fund high-risk pools is still not enough money? Marinate on that.
What happened: Democrats accused Republicans of trying to ram the updated bill through the House without knowing exactly how it would affect the economy and, you know, people's lives. The CBO score of the original AHCA bill estimated that it would lead to 24 million more people without health insurance by 2026. The first version of the bill was pulled before a vote on March 24 because Republicans didn't have enough support to pass it; today the bill passed 217 to 213. All 193 Democrats, and 20 Republicans, voted "no."
Trump signed an executive order to make it easier for employers to refuse to cover birth control for religious reasons
Why you should care: The full text of the order is not yet available, but it's reported to make it easier for non-profit and "closely-held" employers to object to the preventive services requirement of the Affordable Care Act on religious grounds. Those services include birth control, well-woman exams, and STD testing and treatment and the ACA says insurance plans have to cover them without a copay or deductible—meaning, for free. A one-page summary of the order given to reporters referenced the Hobby Lobby case where the Supreme Court ruled that a for-profit company didn't have to cover birth control. It's not clear how the order would make it easier for employers to object, but in a statement shared by a reporter for The Hill, health secretary Tom Price said the order directs the Department of Health and Human Services to "reexamine" the Obama administration's interpretation of the preventive services mandate. Price's statement (below) zeroes in on contraception, so it's possible that HHS will simply remove birth control as a required benefit. The order comes days after he appointed two anti-choice activists to positions in the Department of Health and Human Services, one of whom doesn't believe that birth control even works.
What happened: A chain of nursing homes run by the Little Sisters of the Poor sued over the government's workaround for opting out of birth control coverage because they argued that it still made them complicit in doling out contraception. Trump signed the order after an event marking the National Day of Prayer and nuns from the Little Sisters were at the signing. The order also loosens restrictions that prevent tax-exempt religious organizations from supporting or opposing political candidates. One sliver of good news is that it does not include anti-LGBTQ provisions that appeared in a version of the order leaked in February; those would have allowed federal employees to discriminate against people based on their sexual orientation. Some speculate that he wanted the House to vote on the updated bill to repeal Obamacare today as a distraction from this executive order.
Trump quietly signed bill to exclude Planned Parenthood from family planning funding
Why you should care: As we wrote on March 30 when the Senate approved the bill, this piece of legislation allows states to withhold Title X family planning funding from health clinics that provide abortions outside the cases of rape, incest, and to save the mother's life. As a result, some anti-choice states will essentially block low-income people from getting birth control, cancer screenings, and STD screenings at Planned Parenthood and other health clinics. This will not actually reduce abortion rates; it will likely increase the numbers of abortions sought by women who couldn't access birth control. The Hill reports that Trump signed the bill behind closed doors in the Oval Office without media present, pretty much the same way he signed a bill overturning a gun control regulation on February 28.
What happened: Title X grants handed out by states are one portion of the funding that Planned Parenthood and other clinics get from the federal government (the other is reimbursements as a result of people with Medicaid choosing to get care there). Title X ensures that low-income people can access health services including Pap smears, breast exams, STD testing, and birth control. It serves 4 million people per year, about 1.5 million of whom get their care at Planned Parenthood. The Obama administration made it illegal for states to withhold these family planning dollars from health clinics simply because they provide abortions. But Republicans just hate when women are in control of their own bodies, so the House voted to overturn that Obama-era rule in February and the Senate did so in March, although abortion-hater Vice President Mike Pence had to swoop in to make the tie-breaking vote to send it to Trump's desk.
Senate nuked rulebook and approved Neil Gorsuch as Supreme Court Justice
Why you should care: The Senate changed the rules and invoked the "nuclear option" to approve Neil Gorsuch, meaning they only needed 51 votes instead of 60 to approve him. Democrats opposed to his nomination faced a tough choice: in voting against someone they had real concerns about, they knew Senate majority leader Mitch McConnell would change the approval rules, which will only allow Republicans to shove through more extreme judges in the future. Supreme Court Justice is a lifetime appointment. Hang in there, RBG.
What happened: In January, President Trump nominated Gorsuch, a conservative judge from the 10th Circuit Court of Appeals in Colorado, to fill the seat vacated after Antonin Scalia's death. Gorsuch has ruled in favor of employers' religious freedom in cases challenging the Affordable Care Act's birth control coverage mandate. While he hasn't ruled on abortion, he doesn't seem to like Planned Parenthood very much and he also opposes death with dignity laws.
Senate allowed states to exclude Planned Parenthood from family planning funding
Why you should care: It means that anti-choice states can prevent low-income people from getting birth control, cancer screenings, and STD screenings at Planned Parenthood and other health clinics, just because those clinics provide abortions outside the cases of rape, incest, and to save the mother's life. This anti-woman legislation will not do anything to reduce the number of abortions; in fact it will increase that amount as low-income women will be unable to get birth control. The Senate was deadlocked 50-50 on the bill and summoned longtime uterine legislator Mike Pence for the tie-breaking vote. Just the day before, Pence spoke at the White House's women's empowerment panel.
What happened: When people talk about "defunding" Planned Parenthood they're referring to reimbursements the provider gets as a result of Medicaid patients choosing to get care there as well as federal Title X funding handed out by states. The Obama administration made it illegal for states to withhold these family planning dollars from health clinics that provide abortions (and note that the Hyde Amendment already bans the use of federal money to provide actual abortions except in cases of rape, incest, or to save a woman's life). Title X ensures that low-income people can access health services including Pap smears, breast exams, STD testing, and birth control. It serves 4 million people per year, about 1.5 million of whom get their care at Planned Parenthood. The rule says states can't exclude a provider from grant money for any reason other than its ability to provide Title X services. But Republicans seem to hate women being in control of their own bodies, so the House voted to overturn the rule in February and now the Senate vote means the bill goes to President Trump's desk. There are 52 Republicans in congress; neither Senators Susan Collins of Maine nor Lisa Murkowski of Alaska voted for the bill.
The EPA chose not to ban a chemical it was going to ban
Why you should care: The Environmental Protection Agency, now under the direction of EPA critic Scott Pruitt, decided not to ban a chemical the agency proposed banning in 2015 and had determined unsafe in 2016. Yes, the agency went against its own advice. Chlorpyrifos, made by Dow Chemical, is a pesticide linked to learning disabilities in children, including developmental delay, reductions in IQ, autism, and ADHD. It's used at about 40,000 farms on about 50 different types of crops including citrus fruits, apples, cherries, and almonds.
What happened: The Natural Resources Defense council proposed banning chlorpyrifos almost a decade ago and the EPA proposed banning it in October 2015, saying it would issue a final decision at the end of 2016. In August, a court had ordered the agency to take final action on this proposal by March 31, 2017. An EPA analysis published in November found residues on produce could be as high as 14,000 times the level that is safe for kids and also said that chlorpyrifos is unsafe for farm workers. Now the agency is washing its hands of the matter.
Republicans pulled the AHCA from the House floor rather than vote on it
Why you should care: Paul Ryan told reporters that Obamacare is still the law of the land, but he won't do anything in the meantime to stabilize it. It's unclear if Republicans will start from scratch on a new bill, but in the meantime Obamacare will continue—even though the Internal Revenue Service is not going to be enforcing the requirement to have insurance (the individual mandate). This could undermine enrollment for 2018, which could in turn crash the whole system (since the system works as a result of everyone buying into it).
What happened: Republicans postponed a vote from Thursday to Friday, then began to debate the bill before withdrawing it Friday around 3:30pm because they didn't have enough votes to pass it.
Trump administration issued a permit for Keystone XL pipeline to continue
Why you should care: Like with the Dakota Access Pipeline, one of the many things that concerns environmentalists and indigenous tribes is water quality. Keystone XL would transport crude oil from Canada and North Dakota to refineries on the Gulf Coast, cutting across the Ogallala Aquifer, a water table beneath eight states in the Great Plains that acts as a fresh water supply and provides water for crops and livestock. Activists are worried that the pipeline could pollute this and the 2,500 other aquifiers within a mile of its proposed route.
What happened: The State Department issued a construction permit for pipeline company TransCanada; Secretary of State and former Exxon Mobil CEO Rex Tillerson recused himself from the decision. President Obama blocked Keystone XL and DAPL in late 2015 and 2016, respectively, but in January, President Trump signed an executive order to expedite their construction.
House postponed Obamacare repeal vote
Why you should care: The revised American Health Care Act, the bill to repeal Obamacare, is too stingy on coverage per moderates and too generous per conservatives, even after an 11th-hour offer to slash benefits. It's goddamn mess.
What happened: The Trump administration was reportedly negotiating yesterday with the conservative Freedom Caucus, who thus far haven't been sold on the bill, by offering a cruel olive branch: cutting the essential health benefits requirement that means insurers have to cover services like maternity care and mental health and addiction treatment. This is so insurers could sell skimpier coverage at lower prices, but anyone who needs anything more than a bare-bones plan would end up paying lots more for it. But cutting people's benefits and increasing costs wasn't enough for the caucus; they said no deal, which meant that Republicans didn't have the votes to get the AHCA passed. The bill won't get a vote until Friday at the earliest.
Senate approved Seema Verma as Medicaid head
Why you should care: Verma is in favor of letting states decide which benefits insurers should have to cover, a provision that Republicans extended to Medicaid in their Obamacare repeal bill. That means that low-income people and people with disabilities may no longer have guaranteed coverage for services that used to be considered essential, like maternity care. Not only that, but Verma's revamp of Indiana's Medicaid system has been called cruel to low-income people.
What happened: Verma wasn't an easy sell to run the Centers for Medicare and Medicaid Services, the office that falls under Tom Price's Department of Health and Human Services and also implements the Affordable Care Act. The first committee vote on her nomination was tied 9-9, and she only squeaked through in her second one by 13-12. She was confirmed on March 13 with a vote of 55-43.
The Congressional Budget Office published its analysis of the American Health Care Act
Why you should care: For one thing, the analysis of the AHCA found that premiums for people with individual polices will increase by 15 to 20 percent in 2018 and 2019, so that hurts. (Allegedly premiums will finally make it to 10 percent lower than they currently are...by 2026.) The bill would result in 14 million more uninsured people in 2018 compared to the current law. That number would rise to 21 million additional uninsured in 2020 and 24 million in 2026; in 2026 there would be an estimated 52 million people without insurance, compared to 28 million if the law stayed the same. The AHCA would decrease the federal deficit by $337 billion over 10 years, mostly by spending $880 billion less on Medicaid during that period.
What happened: The nonpartisan CBO analyzes proposed legislation for its economic effects. The CBO said most of the increases in uninsured people would come from repealing the individual mandate, which requires people to enroll in a healthcare plan, but there will also be 14 million fewer people covered by Medicaid. Lots of people, including conservatives, are against the bill, and that's not going to change after this CBO report.
Republicans published their bill to repeal the Affordable Care Act
Why you should care: Their bill, dubbed The American Health Care Act, will cap Medicaid payments to states and roll back the Medicaid expansion, as well as change tax credits currently based on age to ones based on income. The credits are generally lower than what's offered under Obamacare for low-income people, but they also apply to people who make $75,000 (see below). In short, the bill would help the rich and screw the poor.
What happened: A draft version of the bill was leaked on February 24 and Republicans were keeping an updated version locked in an office building basement, only allowing members of the House Energy and Commerce Committee to see it.
Seema Verma is one step closer to confirmation as head of Medicare and Medicaid
Why you should care: Verma says she's in favor of "individual choice" rather than having a set of essential covered services. What that amounts to, basically, is that insurers could charge more for people with certain health conditions.
What happened: She just squeaked through a committee vote. The Senate Finance Committee voted 13-12 along party lines to send Verma's nomination to a vote on the Senate floor. (All of Trump's nominees facing a floor vote have been approved.) Verma would be in charge of implementing the Affordable Care Act, which Trump's administration wants to demolish, as well as overseeing Medicare (should be safe) and Medicaid (at risk of deep cuts).
Senate committee vote on Medicaid pick Seema Verma was a tie
Why you should care: Verma, who ran Medicaid in Indiana under then-governor Mike Pence, said during her confirmation hearing that maternity coverage should be optional for insurance sold in the individual marketplace. This statement struck some as a demonstration that Verma has no idea how insurance really works: People can't pick which conditions they want coverage for because those who don't need or use certain benefits help cover the ones who do. Before the Affordable Care Act, insurers could and did charge women more just because they were women. Verma's comments—along with the leaked Obamacare repeal memo—suggest that we could be heading in that direction again.
What happened: Verma is the nominee to run the Centers for Medicare and Medicaid Services, the office that also implements the Affordable Care Act. The Senate Finance Committee voted 9 to 9 on advancing Verma's nomination to the full Senate floor and they'll reconvene tomorrow for a second vote.
Trump overturned a gun control regulation
Why you should care: Trump was expected to sign the bill, but he did so quietly, with no press conference, and news of the signing was placed at the bottom of an email to press about other legislation that Trump signed that day.
What happened: Both the House and Senate passed HJ Resolution 40, which revoked an Obama administration rule that would have prevented about 75,000 people with mental disorders who receive disability benefits from purchasing a firearm. President Obama recommended it after the mass shooting at Sandy Hook Elementary School. The National Rifle Association was against it, but the American Civil Liberties Union also opposed the rule, writing on its site in February that it "does not oppose gun control laws...but gun control laws, like any law, should be fair, effective and not based on prejudice or stereotype. This rule met none of those criteria."
Trump signed an Executive Order to roll back a water protection rule
Why you should care: Trump wants the Environmental Protection Agency to make sure that regulations to limit pollution in smaller bodies of water aren't harming the economy. This move follows the announcement of a proposal that would allegedly cut the EPA's budget by billions of dollars. Farmers, homebuilders, and the golf industry hate the rule; Trump owns more than a dozen golf courses.
What happened: Trump formally requested that the EPA and the Army Corps of Engineers review the 2015 Waters of the United States rule—which extended the government's authority to protect bodies of water from pollution to include tributaries and non-navigable streams—and to "rescind or revise" it. Under the rule, farmers or companies would need federal permission before using certain fertilizers if their land was near a stream or a wetland, for example. The executive order has no legal authority over the rule but kicks off the long process to change it.
Trump will propose hacking the EPA's budget to pay for defense increases
Why you should care: Trump's 2018 budget proposal calls for a $54 billion increase in military spending and a corresponding reduction across most other federal agencies, including steep cuts at the Environmental Protection Agency, the State Department, and for foreign aid and unnamed social safety net programs. Health concerns aside, it's unclear how slashing international relations funding will make our country safer.
What happened: Addressing a group of governors on Monday, Trump called it "a public safety and national security budget" that "will include a historic increase in defense spending to rebuild the depleted military of the United States of America at a time we most need it." Treasury Secretary Steven Mnuchin said the budget wouldn't affect Social Security or Medicare. Trump said he's going to submit it to Congress in March, but he'll give more details on Tuesday night when he addresses a joint session of Congress. Whatever Trump submits will essentially be an outline; House and Senate committees will craft a budget resolution and vote on it. Fiscal year 2018 begins in October.
Senate confirmed EPA critic Scott Pruitt to run the EPA
Why you should care: Pruitt sued the Environmental Protection Agency more than a dozen times during the Obama administration as Oklahoma's Attorney general; he challenged the agency's authority to regulate smog, carbon emissions from power plants, toxic mercury pollution, and more. His confirmation means there are even more foxes guarding the henhouse, to borrow Chuck Schumer's analogy about Health Secretary Tom Price.
What happened: The senate voted 52-46 to approve him, with two Democrats (Joe Manchin of West Virginia and Heidi Heitkamp of North Dakota) voting for him and one Republican (Susan Collins of Maine) voting against. Democrats held the floor for hours overnight to try to delay a vote until after his office releases thousands of emails between Pruitt and oil, gas and coal companies. Yesterday, a judge ruled that the emails had to be released by Tuesday. But now, Pruitt is already confirmed.
House voted to let states block Planned Parenthood from family planning funding
Why you should care: Allowing states to deny funding to healthcare providers like Planned Parenthood simply because they offer abortion services will only reduce access to other essential services they provide, like birth control and STD testing. Consider this your cue to call your Senator to vote against House Joint Resolution 43.
What happened: A measure disapproving of an Obama Administration rule to protect Title X family planning funding passed the House by a vote of 230-188. Health experts seriously doubt that community health centers, which do not specialize in reproductive health, can pick up the slack if family planning clinics lose funding. (See Item from January 30 for more context on Title X.) The Senate still has to vote on the resolution, which only needs 51 votes to pass.
Trump overturned a rule to protect streams from coal mining waste
Why you should care: Trump dismissed a measure that would have protected waterways from coal mining pollution as a "job-killing rule."
What happened: Under the Obama administration, the Interior Department finalized a so-called stream protection rule (see item from February 2 for more info) but Trump's Congress quickly moved to dismantle it using the Congressional Review Act. The Senate passed a measure of disapproval on February 2, one day after the House approved it. Trump signed it into law on Thursday.
The IRS said it would ease enforcement of the ACA's individual mandate
Why you should care: Health insurers need both healthy and less-healthy people (aka the risk pool) to buy coverage in order to cover costs. Not enforcing coverage requirements (that is, not enforcing the individual mandate) means fewer healthy people will buy in. As a result, insurers will lose money and either charge more, drop out, or both.
What happened: The Internal Revenue Service told tax preparers it was abandoning plans to automatically reject tax returns that didn't indicate if the people filing had health insurance in 2016. In a statement, the IRS cited President Trump's January 20 executive order, which gave federal agencies the authority to ease 'economic and regulatory burdens' of the ACA, as the impetus for the change. It noted, however, that "legislative provisions of the ACA law are still in force until changed by the Congress, and taxpayers remain required to follow the law and pay what they may owe." Meaning the IRS won't reject returns outright but might follow up with taxpayers later. Key word being "might." The IRS quietly made this move on February 6 but it was only reported this week.
Department of health proposed 2018 insurance changes
Why you should care: This appears to be the next step in undermining the ACA.
What happened: The Health and Human Services Department proposed a rule meant to keep insurers AND healthy customers in the individual marketplace during the transition to whatever alternative Republicans come up with to replace Obamacare—or so it claims. The rule would shorten the enrollment window for 2018 plans from three months to six weeks (this was already planned for 2019). You can still get insurance outside of that period if you have a qualifying life event like getting married, having a child, or losing your job, but in the past, only half of people applying for special enrollment had to provide documentation first. The new rule would require all people in these cases to be pre-screened. These provisions are allegedly intended to reduce the number of people who wait three months to buy insurance until they get sick or need it, but critics say the changes will make it harder to enroll and will reduce the number of healthy people in insurers' risk pools. The rule is open for public comment through March 7.
The Senate voted to override a rule against certain mentally ill people buying guns
Why you should care: The measure is a weakening of the federal background check system and NRA-endorsed President Trump is expected to sign it.
What happened: The Senate voted 57-43 on House Joint Resolution 40, a measure that formally disapproves of an Obama-era rule which would have prevented about 75,000 people with mental disorders who receive disability benefits from purchasing a firearm. (For more about this rule, see the item from February 2.) Under the Congressional Review Act, a rule finalized in the final 60 days of a president's term can be undone if both chambers pass a resolution of disapproval with a simple majority and the new president signs it.
Anti-vaxxer Robert F. Kennedy Jr. said Trump's vaccine panel is moving forward
Why you should care: Not only does a federal commission on vaccine safety already exist, but large-scale studies have repeatedly failed to establish a link between childhood vaccines and autism.
What happened: Kennedy said back on January 10 that he accepted a position within the Trump administration as chair of a panel on vaccine safety. Trump spokeswoman Hope Hicks said in a statement hours later that while the then president-elect was "exploring the possibility of forming a commission on Autism...no decisions have been made at this time." Now, Kennedy says it's his understanding that the commission is still being developed. He made the comments at a Washington DC event with vaccine skeptic Robert DeNiro, whose son has autism.
David Shulkin confirmed as head of Veterans Affairs
Why you should care: Shulkin wants to majorly reform the VA, which still hasn't solved structural problems that led to a 2014 wait-times scandal. In Arizona alone, at least 40 vets died while they waited for appointments.
What happened: Shulkin has been the VA undersecretary for health since July 2015, making him the only holdover from the Obama administration among Trump's cabinet picks. He received bipartisan support and was confirmed in a unanimous 100-0 vote. Shulkin, a doctor and former healthcare executive, is the first head of the VA in history without military experience. He wants to allow vets to get care in private health facilities when necessary to reduce wait times and he oversaw the implementation of the emergency Veterans Choice Program, which subsidized care and is set to expire in August or whenever funding runs out.
The House fought over a death with dignity law
Why you should care: Conservatives who claim they favor small government are legislating your healthcare. Again.
What happened: A House of Representatives committee will vote today on whether to send a resolution to the House floor that would block a Washington DC "death with dignity" law. The law, signed in December by DC mayor Muriel Bowser, would allow terminally ill people to end their lives with the help of a physician. (California, Colorado, Oregon, Vermont, and Washington state have similar laws.) House Oversight Committee chairman Jason Chaffetz, who's also an anti-choice zealot, has called the law "misguided" and immoral. Congress can invalidate DC laws with a resolution of disapproval but it hasn't done so since 1991. The Associated Press says there's no indication that the Senate would take up the measure.
Tom Price confirmed as head of Health and Human Services
Why you should care: Senator Chuck Schumer put it best in November, saying: "Congressman Price has proven to be far out of the mainstream of what Americans want when it comes to Medicare, the Affordable Care Act, and Planned Parenthood. Thanks to those three programs, millions of American seniors, families, people with disabilities and women have access to quality, affordable health care. Nominating Congressman Price to be the HHS secretary is akin to asking the fox to guard the henhouse."
What happened: In an early-morning vote along party lines, the Senate confirmed Price (52-47) after a contentious debate over the Georgia Republican's ethical conduct—since, as a member of the House, Price shaped health policy while actively managing a portfolio of healthcare investments. Price, a former orthopedic surgeon, has been a critic of Obamacare from the beginning, is opposed to contraception coverage, and has a robust anti-LGBTQ track record. He'll likely take swipes at Medicaid and Medicare as well.
Dakota Access Pipeline will proceed
Why you should care: The pipeline could contaminate the water supply and threaten cultural sites. The Army Corps halted the pipeline in December following massive protests. At the time, a spokesperson said, "The best way to complete that work responsibly and expeditiously is to explore alternate routes for the pipeline crossing." Continuing with the original route? Neither responsible nor expeditious.
What happened: The Army Corps of Engineers said in a letter to the House committee on natural resources that it would grant a permit for the controversial oil pipeline to cross the Missouri River for the final phase of its construction. In the letter, the Corps said it would waive the standard 14-day waiting period after congressional notification and drilling resumed on Thursday, February 9. The Standing Rock Sioux Tribe and Cheyenne River Sioux Tribe filed a motion for a temporary restraining order on February 9 and a judge will hear arguments on February 13.
About that replace part of "repeal and replace"... Trump seems to be backtracking
Why you should care: Maybe you won't lose your health coverage as soon as we thought?
What happened: Creating a better option to replace Obamacare is harder than it looks. President Trump said in an interview with Fox News' Bill O'Reilly that a replacement for the Affordable Care Act would likely not be ready until the end of 2017 or in 2018. In January, Trump was singing a different tune, saying: "We're going to be submitting, as soon as our [health] secretary is approved, almost simultaneously, shortly thereafter, a plan."
Congress moved to gut gun control regulation
Why you should care: A weakening of the background check system will allow people with schizophrenia and severe anxiety to buy guns.
What happened: The House of Representatives voted 235 to 180 to strike down an Obama Administration rule that would have prevented some people with mental illness from buying guns. The rule would have required the Social Security Administration to report to the FBI's federal firearm background check system any person who receives disability benefits because of a severe mental health condition and has a third part manage those benefits, starting in December. The National Rifle Association supported the repeal, but so did the American Civil Liberties Union. The Senate still has to approve the measure.
Congress yanked a rule to protect streams from coal mining
Why you should care: Between this and the Dakota Access Pipeline, it appears that our government favors oil and coal over clean water.
What happened: The Senate voted to strike down the Interior Department's so-called stream protection rule just one day after the House moved to repeal it. The Obama administration finalized the rule on December 19 and it was set to take effect on January 19. It would have protected 6,000 miles of streams, and the fish that live in them, from mountaintop removal mining by requiring companies to avoid mining practices that permanently pollute streams or destroy drinking water sources with toxic heavy metals. It also would have established baseline pollution levels in waterways and then monitored them during and after mining, and returned streams and mined areas to the uses they were capable of before mining. Trump is expected to sign the repeal.
Vote on Health Secretary took place without Democrats
Why you should care: Ignoring ethical concerns about Tom Price, the Senate Finance Committee went as far as to suspend rules that require at least one Democrat to be present to send a nominee to the full Senate. Not reassuring.
What happened: Democrats called to delay the Price vote until they could investigate whether his health stock transactions were conflicts of interest. When that didn't happen, they boycotted the vote on January 31, but Republicans muscled him through the following day. They did the same thing for Steven Mnuchin for Treasury Secretary. Price was officially confirmed on February 13.
Trump announced his pick for the Supreme court vacancy
Why you should care: At 49, he's the youngest nominee since 1991 and could shape the court for decades to come.
What happened: Trump nominated Neil Gorsuch, a conservative judge from the the 10th Circuit Court of Appeals in Denver, Colorado. Gorsuch has notably ruled in favor of religious freedom in cases challenging the Affordable Care Act's contraception coverage mandate. (One of them involved craft store chain Hobby Lobby and was appealed up to the Supreme Court). While he hasn't ruled on abortion, he doesn't seem to like Planned Parenthood very much. Happily, he won't likely sway the court on matters of reproductive rights (the Supremes voted 5-3 in June case). Read more on Gorsuch here.
Bills introduced to block abortion providers from family planning funding
Why you should care: Conservative lawmakers argue that blocking providers like Planned Parenthood from receiving funding will protect life, but the fact is that reducing access to birth control will only increase abortion rates, not lower them.
What happened: Legislators in the House and Senate simultaneously introduced legislation to overturn an Obama administration rule that prohibits states from withholding federal family planning dollars from health clinics that provide abortions. The family planning program, Title X, ensures that low-income people can access health services including Pap smears, breast exams, STD testing, and birth control. It serves 4 million people per year, about 1.5 million of whom get their care at Planned Parenthood. The existing rule says that states can't exclude a provider from grant money for any reason other than its ability to provide Title X services. (A legislative rider known as the Hyde Amendment already bans the use of federal money to provide abortions except in cases of rape, incest, or to save a woman's life.) Neither bill has been voted on yet.
Congress attempted to block insurance coverage of abortion
Why you should care: These requirements disincentivize insurers from covering abortion and discriminate against low-income women.
What happened: The House passed HR 7 by a vote of 238-183. This bill would make permanent the Hyde Amendment, a budget rider Congress has approved every year since 1976, which blocks the use of federal funds to cover abortion services for women insured via Medicaid or those who work for the military or the government except in cases of rape, incest, or to save the life of the mother. Notably, Hyde excludes instances of unintended pregnancies that aren't the result of rape or incest as well as diagnoses of fetal anomalies incompatible with life. Hyde blatantly discriminates against low-income women and women of color and perpetuates inequality. But that's not all HR 7 would do. The bill would also prohibit private insurers from offering policies via the Affordable Care Act exchanges that cover abortion and would withhold the small business tax credit from employers who offered health plans with abortion coverage. Women who qualify for a healthcare subsidy would be ineligible if they purchased an insurance plan that covers termination.
Trump forged ahead with the Dakota Access Pipeline
Why you should care: Members of the Standing Rock Sioux tribe are concerned that the pipeline will pollute the water they rely on and threaten sacred indigenous lands. The tribe and environmental activists have been camped out at the site for nearly a year.
What happened: Trump signed an executive order to expedite the construction of both the Keystone XL and Dakota Access oil pipelines. In December, The Army Corps of Engineers denied a permit that would have allowed construction of the Dakota Access Pipeline's final portion. The Corps also initiated an environmental impact study that could have delayed construction for years; Trump's executive order canceled the study.
Trump blocked US healthcare funding abroad
Why you should care: Trump effectively signed a death sentence for thousands of women worldwide and his expansion of the policy compared to other Republican administrations should send a shiver down the spine of anyone who believes in bodily autonomy.
What happened: Trump reinstated the so-called Global Gag Rule with a presidential memorandum. The rule, also known as the Mexico City Policy, blocks international NGOs from receiving US funding if they counsel patients about abortion or refer them to a place where they can get an abortion. The organizations already can't use US aid money to cover abortions thanks to the Helms Amendment; the policy is known as a "gag rule" because if groups accept US funding they're essentially prohibited from talking about abortion or using private funds to cover abortions. (President Ronald Reagan introduced it in 1984 and it's been axed by every Democrat and reinstated by every Republican since.) Trump expanded the rule to not only apply to family planning organizations but also to global health organizations. As a result, women will die from unsafe abortions as well as myriad other health problems, since these clinics offer broader services, including maternal healthcare and lifesaving treatment for HIV, malaria, and tuberculosis. The rule will also paradoxically increase the abortion rate by reducing access to birth control. Trump signed this order the day after women's marches worldwide.
Trump put the Affordable Care Act repeal in motion
Why you should care: If the ACA is repealed without a replacement, it will affect the 20 million people who have insurance through the exchanges or the Medicaid expansion. Coverage changes could impact people with employer-sponsored plans, too.
What happened: President Trump's first executive order, signed on his inauguration day, is the first step in gutting the ACA. The order gave federal agencies the authority to ease 'unwarranted economic and regulatory burdens' of the law by waiving or delaying the enforcement of key rules under their jurisdiction. For example, the IRS could choose not to enforce the tax penalty for failing to purchase health insurance. If fewer healthy people bought insurance through the exchanges, premiums would go up for everyone. It seems like the order would also allow the Department of Health and Human Services to shrink the preventive care benefits that insurers are required to offer. Copay-free birth control could be on the chopping block. HHS Secretary Tom Price is also against the contraception mandate.