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America Out Loud PULSE: What Do Roe, Doe, and Dobbs Really Mean?

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From my America Out Loud Pulse podcast with Brian Johnston – https://www.americaoutloud.com/what-do-roe-doe-and-dobbs-really-mean/

Ever since the Supreme Court opinion in Roe v Wade  making privacy—which included abortion—a federal Constitutional right in 1973, the right to life debate has come and gone out of the public eye. At this point, most people who paid attention to the Roe opinion knew was not based on anything in the Constitution. It was more of a sociological and cultural decision than a legal one.

A couple of years ago, New York’s Catholic Democratic Governor had the World Trade Center in lights to celebrate its abortion-on-demand-until-the-day-of-birth law. This law was framed as empowering women through guaranteeing “reproductive health.” This and eight other similar state laws were largely ignored as merely codifying Roe v Wade. But the state of Virginia’s pediatrician former governor’s ghoulish advocacy for abortion until delivery of the infant was jaw-dropping as he explained that killing the infant after birth was allowed. Adding insult to injury, in California minors can obtain abortions without parental consent.

The normalization of the intentional killing of human beings weaved its way into our culture. Life was not only cheap for the unborn, but for other vulnerable or unwanted persons such as the elderly. Half the states have laws that charge a person for two murders if he or she kills a woman in any stage of pregnancy.

Fortunately for unborn children, the recent Supreme Court case, Dobbs v Jackson brought the abortion debate into the forefront. The pro Roe crowd went so far as to surround the homes of conservative Supreme Court justices. The media could not continue to ignore the large numbers of people participating in marches for life. More and more people publicly admitted that aborting a baby is not the solution for an unplanned pregnancy.

We can only hope that more and more physicians prefer to practice medicine in the mode of Dr. Mildred Jefferson, the first black woman accepted to Harvard Medical School: “I became a physician in order to help save lives. … I am not willing to stand aside and allow the concept of expendable human lives to turn this great land of ours into just another exclusive reservation where only the perfect, the privileged, and the planned have the right to live.”

Culture & Society, Current Events, Featured, Health Policy, Law, Op-eds, Politics, What's New

The Fox Guarding the Herpetarium

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Several days ago, a congressman had a nasty encounter with a rabid fox on the D.C. Capitol building grounds. Let’s trust that he is no worse for the wear. But the question lingers: How did the fox know he was from California? Is this some sort of sign from above?

They—whoever they are—say “as California goes, so goes the nation.” Let’s hope not. The California state legislature has put forth some bills that boggle the mind and seek to change family, physicians, and their relationship to the government forever.

First, the governor and the legislature put their imprimatur on the California Future of Abortion (CA FAB) Council recently formed by various “reproductive justice” advocates. They seek to seal California’s legacy as a “reproductive freedom” state and are lobbying legislators to enshrine into law their blueprint for abortion services, Recommendations to Protect, Strengthen, and Expand Abortion Services in California.

The legislators took the bait. The governor has already signed SB 245. This law prohibits deductibles, co-pays or any other payments by insured for abortion services. In other words, abortions must be free. Taking this a step further is SB 1142. This would establish the “Abortion Practical Support Fund” using taxpayer money to provide airfare, lodging, gas money, food, childcare, abortion doula support and more for women coming from other states for their abortions.

To ensure no fetus is left behind, SB 1375 would expand the number of clinicians who can perform aspiration abortions by allowing nurse practitioners (NPs) to do so without an attending physician. Worse yet, SB 1375 eliminates both “minimum standards” and completion of “board-recognized training” in abortion techniques. It also allows NPs and physician assistants (PAs) to determine viability and health of mother (potentially increasing the number of abortions after viability).

To “ensure the growth of a network of clinicians trained in abortion,” AB 1918 would establish the California Reproductive Health Service Corps to recruit, train, and retain a workforce of reproductive health care professionals, focusing on students from “historically excluded populations.” This includes scholarships and stipends for new reproductive health students, and loan repayment. The students must agree to complete abortion training and commit to working at a corps-approved site in a specified area with a specified “underserved” population. Is this an extension of black-on-black violence?

California is not satisfied with basic abortions. The ghoulish AB 2223 prohibits civil or criminal liability with regard to abortion for the mother or “a person who aids or assists” in the abortion, including perinatal death. As written, the bill essentially decriminalizes infanticide via neglect for up to one month after the baby’s birth.

Now for the tyranny imposed on those out of the womb.

The famous Dr. Pan, whose SB 871 proposes COVID vaccinations for all students, sponsored a trifecta. AB 2098 would charge physicians with unprofessional conduct for dissemination of yet-to-be-defined “misinformation” regarding the COVID virus, vaccine, prevention and treatments. A sister bill, SB 1390, would prohibit a social media platform from “amplifying” subjectively “harmful content” defined as “[d]isinformation or misinformation, including, but not limited to, false or misleading information regarding medicine or vaccinations, false or misleading information regarding elections, and conspiracy theories.”Platforms in violation could be fined up to $100,000. SB 1464 would require law enforcement to enforce public health orders, with no state funds for such agencies that publicly oppose or adopt a policy to oppose the orders.

Further intruding into the family unit, SB 866 would permit California children 12 and older to be injected with various vaccines without parental notification or consent.

Finally, authoritarian agendas tend to ignore the facts. COVID is waning, the current vaccine was formulated for a virus that is no longer dominant and does not prevent infection or transmission as evidenced so well by the outbreak among White House personnel and Congresspersons, including thrice-vaccinated Speaker Pelosi. Nonetheless, AB 1993 would require proof of the COVID vaccine for all employees and independent contractors beginning January 2023. The bill was pulled by the author due to push back from labor unions. It’s too bad regular citizens don’t have that much clout.

These soulless legislators would not even move out of committee SB 1042, a bill to place human trafficking within the definition of a violent felony and serious felony for the Three Strikes Law.

There is some good news. At least one judge still believes in the Constitution. AB 979 mandated that corporate boards satisfy certain racial, ethnic, and LGBT quotas. The Court reasoned that this was not a case where discrimination should be remedied by more discrimination and ruled that the law “violates the Equal Protection Clause of the California Constitution on its face.”

I feel sorry that the congressman was bitten and sorry for the new mama fox who had to be euthanized. But I’m sorrier still that our legislators have hearts of stone and minds of fertilizer.

Culture & Society, Law, Medical Ethics, Medicine

The Soylent Green New Deal is Three Years Away

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By Marilyn M. Singleton, M.D., J.D.

In an effort to cut carbon emissions from burials and cremations, the state of Washington, led by staunch environmentalist Governor Jay Inslee, became the first U.S. state to legalize human composting. To think, people can be criminally prosecuted for disrespecting a human corpse, a symbol of a once-living person. But the religion of Mother Earth now supersedes all cultural decency.

We’ve already cemented the contempt for life at the front end. I thought we had evolved since the ancient Greek elders determined that only the strong newborns survived and the weak were left to die. Virginia’s Governor Ralph Northam made it clear that infants were once again throwaways at will. In explaining the procedure of an “abortion” of a child who was born alive, he said “the infant would be resuscitated if that’s what the mother and the family desired, and then a discussion would ensue between the physicians and the mother.”

Now we must be acutely aware of what is happening at the other end of life’s spectrum. In the U.S., elders are all too often considered expendable by society at large and sadly, by their own families. Such disregard in some 10 million cases escalates to abuse in many forms. Government-certified entities make a significant contribution to this contemptible crime.

In many states court-appointed guardians cravenly plunder their wards’ assets with no repercussions. A U.S. Government Accountability Office (GAO) report identified hundreds of allegations of abuse, neglect, and exploitation by guardians in 45 states and the District of Columbia between 1990 and 2010. An investigation of a small sampling of the allegations found that court-appointed guardians had stolen or otherwise improperly obtained $5.4 million from 158 incapacitated victims, mostly older adults. Moreover, such crimes were frequently overlooked by judges.

Soon after coming into office, President Trump signed into law the Elder Abuse Prevention and Prosecution Act that provided for 90 prosecutors and “elder justice coordinators” nationally to prosecute those committing elder abuse, including guardianship cases. Currently, a sleepy little bill in the wings, the Stamp Out Elder Abuse Act, will direct the proceeds of a new postage stamp to enforcing laws against elder abuse.

These new laws may be for naught with the advent of more physician-assisted suicide laws. New Jersey is the latest, complete with a cute acronym: MAID – Medical Aid in Dying. All the calls for government-controlled medicine are terrifying to those of us who remember a dystopian film where in 2022, with rampant food shortages and homelessness, the only food available is a high-energy wafer purportedly made from plankton. Alas, we witness humans entering a processing center for a happy death and emerging as the main ingredient of Soylent Green.

I contend that the trend of placing older people into hospice before the ink is dry on the hospital admission papers is a new form of elder abuse. Hospice has become the new Medicare cash cow for unscrupulous facility owners who abuse and neglect patients. One study found that 8 percent of the hospices studied did not provide a single skilled visit—from a nurse, doctor, social worker, or therapist—to any patients who were receiving routine home care in the last two days of life in 2014.

Recall that President Obama robbed Medicare of $716 billion to fund the Affordable Care Act, including $56 billion from hospitals serving poor people. Recall that an ethics advisor for ObamaCare, Ezekiel Emanuel, MD, advocates for the “Complete Lives System” of medical care where resources are directed to those with “future usefulness.” Dr. Emanuel proudly claims he wants to die at 75 years of age. Tell that to the countless lives Mother Teresa transformed when she was her 80s. Tell that to John Glenn, who went back into space for 9 days at 77, and to the 20 million other over-75 disposables—or should I say, recyclables.

Quite coincidentally, eliminating the over-75 crowd from the insurance pool would help fund government-sponsored insurance for this country’s remaining uninsured. In other words, hurry up and die before the Medicare program goes bankrupt.

My gratitude goes to those congresspersons who recognize that our elders need protection. Given that the federal trust fund that finances much of the Medicare program is projected to run out in 2026, let’s hope these compassionate people realize that the first losers of Medicare for All are our elders.

Bio: Dr. Singleton is a board-certified anesthesiologist. She is President of the Association of American Physicians and Surgeons (AAPS). She graduated from Stanford and earned her MD at UCSF Medical School.  Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. 

Culture & Society, Doctors, Healthcare Reform, Medical Ethics, Medicine, Op-eds

The Morality of Life and Death and Doctors

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By Marilyn M. Singleton, MD, JD

June has been a month of reflection on life, death, our values, and the greater good. We commemorated the 75th anniversary of the 1944 Normandy invasion (D-Day), which began the liberation of France from German occupation and turned the tide of World War II. In what must have been a decision fraught with soul searching, generals sent young soldiers into what could be certain death on the shores of Normandy. Their bravery was an act of unquestionable honor.

Contrast that with a law school ethics class scenario. The leader of an invading horde tells the mayor of your town that if he lets him kill a child, he will spare the lives of the town’s residents. Does the mayor sacrifice one innocent child for the good of many? On a practical level, anyone who would wantonly kill a child is not to be trusted. Morally, is the life of an innocent child reduced to a numbers game? What justifications can the mayor offer to convince the townsfolk to act like mindless, soulless, cowardly creatures and decide not to fight for the sanctity of life?

Life is precious and fleeting. Once gone, you can’t get it back. This month the news has presented two ends of the spectrum: physician assisted suicide and abortion.

Years ago, people found Dr. Jack Kervorkian’s “death machine” ghoulish. He likely was well-meaning but was misguided. Now physician assisted suicide is culturally acceptable and legal in several states. New Jersey is the latest state to jump on thephysician-assisted suicide bandwagon that includes Colorado, the District of Columbia, Hawaii, Oregon, Vermont, Washington, and Montana. Maine’s bill has made it to the governor’s desk.

Physician-assisted suicide (aka aid in dying or death with dignity) now has an oft-used abbreviation (PAS) to mask a deed that runs counter to the command in the Oath of Hippocrates not to harm our patients. Some reasonably argue that it is harmful to refuse to follow a patient’s request to be irreversibly put out of her misery. But when does relieving pain—whether physical or emotional—transition into hastening death?

Some of these suicide laws have a requirement for counseling, but this can be merely one visit with a psychiatrist or psychologist. Moreover, the death may not be so dignified. A study in the New England Journal of Medicine of euthanasia and physician-assisted suicide in the Netherlands found complications in 7 percent of assisted suicide patients, including failure to remain unconscious, extreme gasping for air, vomiting, and muscle spasms. Physicians had to complete the procedure.

Did the cultural acceptance of physician-assisted suicide lead an Ohio critical care physician to take it upon himself to end some of his patients’ lives? His defense to the indictment on 25 counts of murder is that he was providing “comfort care” with massive amounts (up 10 to 40 times the therapeutic dose) of fentanyl. Merely because the patients were receiving palliative care did not mean they consented to lethal overdoses. Keep this in mind as we are steered toward hospice in our later years.

Simultaneously, several states passed or introduced laws prohibiting abortion after a fetal heartbeat is detected. Rep. Ilhan Omar decried the “horrifying” opposition to abortion as religious fundamentalists imposing their will on lawmakers. There are pro-life atheists who view abortion as an issue of respecting humanity. I am absolutely flummoxed by how the same ultrasound and anatomy can be described as a vibrating clump of cells or a baby on its way into the arms of a loving parent depending on the mindset of the mother.

Additionally, to “promote the dignity of human life from conception to natural death”, theDepartment of Health and Human Services (HHS) will stop funding research with fetal tissue from elective abortions. Private research is unaffected. Some researchersobjected, arguing that fetal tissue has aided in the advancement of medical science. Nazi experiments during World War II likewise provided novel medical information. Their experimental bone grafting, use of sulfa drugs, limb transplantation, and artificial insemination are now standard medical procedures. And the United States cannot justify its Tuskegee experiment in which black men were not given treatment for syphilis so doctors could see the natural progression of the disease. This experiment ended not during the 1940s in the wake of Nazi atrocities or penicillin being accepted as the treatment of choice for syphilis in 1945, but in 1972.

Does the end justify the means, if eventually the means will lead you down the road to perdition? I prefer to practice medicine in the mode of Dr. Mildred Jefferson, the first black woman accepted to Harvard Medical School: “I became a physician in order to help save lives. … I am not willing to stand aside and allow the concept of expendable human lives to turn this great land of ours into just another exclusive reservation where only the perfect, the privileged, and the planned have the right to live.”

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law. She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012.

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

More info about Dr. Marilyn Singleton

Culture & Society, Doctors, Health Policy, Law, Medical Ethics, Medicine, Op-eds, Politics

Eugenics, Euthanasia, Infanticide, and the Lord’s Work

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by Marilyn M. Singleton, MD, JD

New York’s Catholic Democratic Governor had the World Trade Center in lights to celebrate its abortion-on-demand-until-the-day-of-birth law. This law was framed as empowering women through guaranteeing “Reproductive Health.” Women in New York must be really powerful since New York’s abortion rate is twice the national average. This and eight other similar state laws were largely ignored as merely codifying Roe v Wade.But the state of Virginia’s pediatrician governor’s ghoulish advocacy for abortion until delivery of the infant was jaw-dropping as he explained that killing the infant after birth was allowed.

How can we tolerate this moral regression? Infanticide was the norm throughout ancient Athens and Sparta where the elders inspected the newborns to ensure that only the strong survived, and the weak were left to die. Early Roman law decreed that deformed children would be put to death. Fortunately, by the 4th century, European law, religion, and medicine rejected the intentional killing of an infant.

Americans have been sucked in before by pretty words that mask the brutal reality of “evolved” policies. There was a time when America’s best and brightest were teaching Dr. Josef Mengele a thing or two about eugenics, the “science” of improving the human gene pool for the preservation of society.

At the First International Eugenics Congress in 1912, a Carnegie Institute-supported paper, Preliminary Report of the Committee of the Eugenic Section of the American Breeder’s Association to Study and to Report on the Best Practical Means for Cutting Off the Defective Germ-Plasm in the Human Population (“Breeder’s Report”), analyzed the problem of the “unfit” and the need to find solution to “cut[ting] off the supply of defectives.”

Even black intellectuals jumped on board. The Harvard-educated professor and civil rights activist W.E.B. DuBois believed only fit blacks should procreate to “eradicate the race’s heritage of moral iniquity.” The NAACP promoted eugenics theory by hosting “Better Baby” contests.

The Model Eugenical Sterilization Law (1914) was the blueprint for the sterilization of the “socially inadequate” including the feebleminded, insane, criminalistic, epileptic, inebriate, diseased, blind, deaf, deformed, dependent, orphans, ne’er-do-wells, tramps, the homeless, and paupers. By the 1920s, thirty-three states had compulsory sterilization laws.

Margaret Sanger, the founder of Planned Parenthood, advocated for mandatory IQ testing for the lower classes and the issuance of government-approved parenthood permits as a prerequisite to having children. Sanger criticized philanthropy as tending to perpetuate “human waste.” She also proposed that “the whole dysgenic population would have its choice of segregation or sterilization.”

Compulsory sterilization of the “feebleminded” was etched in stone by the revered liberal Supreme Court Justice Oliver Wendell Holmes. Buck v. Bell (which has never been overruled) concluded that “the principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”

With Congress steamrolling exclusively government-controlled medical care with Medicare-for-All, we must reflect on our past as well as the present policies of our civilized neighbors. What happens when the government runs out of money to pay for everything our politicians promised?

The Model Sterilization law’s selling point was that sterilization of those maintained wholly or in part by public expense was cost-effective: segregation for life cost $25,000 and sterilization a mere $150.

In Belgium, a nine and an eleven-year-old were euthanized for conditions that we in the United States vigorously treat: cystic fibrosis and muscular dystrophy. Canada is considering allowing such barbarism–aka medical assistance in dying—to be perpetrated upon its children.

Iceland has virtually eliminated Down’s syndrome through abortion. Coincidentally the Ministry of Health lists Down’s syndrome as the most expensive disease for the state-funded health care program.

The British National Health Service’s Institute for Health and Care Excellence supports the use of “quality-adjusted life years” (QALY) to measure the quality and quantity of life added due to a particular medical treatment. If the cost per QALY gained exceeds a predetermined amount, the government denies payment for that treatment. ObamaCare architect Ezekiel Emanuel’s “Complete Lives System” prioritizes adolescents and persons with “instrumental value,” i.e., individuals with “future usefulness.” With current nursing home costs averaging $7,500 per month, hospice care could be the default medically necessary treatment for the disabled.

It was not too long ago that the top Democrat official, Nancy Pelosi said “[Republicans] pray in church on Sunday and they prey on people the rest of the week. And while we’re doing the Lord’s work, ministering to the needs of God’s creation, they are ignoring those needs which is to dishonor the God who made them.” I don’t know whose “lord” she is talking about—perhaps the overlords who aim to take over mankind in sci-fi stories or the “Lord of the Flies.”

The day erecting a barrier to stop drug and human trafficking is considered immoral and killing viable live babies is celebrated is the day some Americans tossed morality into the abyss.

Dr. Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and member of the Association of American Physicians and Surgeons (AAPS).

Dr. Marilyn Singleton ran for Congress in California’s 13th District in 2012, fighting to give its 700,000 citizens the right to control their own lives.

Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School.

Dr. Marilyn Singleton then completed two years of surgery residency at UCSF, followed by an anesthesia residency at Harvard’s Beth Israel Hospital.

Dr. Marilyn Singleton was first an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before she returned to private practice in California.

While still working in the operating room, Dr. Marilyn Singleton attended UC Berkeley Law School, focusing on constitutional law and administrative law.  She also interned at the National Health Law Program and has practiced both insurance and health law.

Dr. Marilyn Singleton has taught specialized classes dealing with issues such as the recognition of elder abuse and constitutional law for non-lawyers. She also speaks out about her concerns with Obamacare, the apology law and death panels.

Dr. Marilyn Singleton has conducted make-shift medical clinics in two rural villages in El Salvador.

Congressional candidate Dr. Marilyn Singleton presented her views on challenging the political elite to physicians at the Association of American Physicians and Surgeons annual meeting in 2012. (Audio version of the speech to AAPS doctors by Dr. Marilyn Singleton.)

Follow Dr. Marilyn Singleton on Twitter @MSingletonMDJD

Featured, Health Policy, Healthcare Reform, Law, Medicare, Medicine

Legislative Update February 6, 2017

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As we enter the second month of the 115th Congress, Marilyn Singleton, MD, JD is out with her review of the latest medical care related proposals on Capitol Hill, from full ACA repeal to Medicare for all and everything in between.

 

Full Repeal of the Affordable Care Act

On January 9, 2017, H.R. 370, a bill to repeal the patient Protection and Affordable Care Act and health care-related provisions in the Health Care and Education Reconciliation act of 2010, was introduced by Rep. Bill Flores (R-TX) and referred to the House Appropriations, House Committee on Education and the Workforce Committee, and 7 other committees. The bill would repeal the Patient Protection and Affordable Care Act and the health care provisions of the Health Care and Education Reconciliation Act of 2010. The repeal is effective on January 1, 2020. Provisions of law amended by the repealed provisions are restored.

The budgetary effects of this bill must not be entered on the PAYGO scorecards maintained by the Office of Management and Budget.

Full text: https://www.govtrack.us/congress/bills/115/hr370/text.

On January 12, 2017, S. 106, the ObamaCare Repeal Act, was introduced by Sen. Ted Cruz (R-TX) and referred to the Senate Finance Committee. The bill repeals the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 and restores provisions of law amended by those Acts, effective January 1, 2018.

Full text: https://www.govtrack.us/congress/bills/115/s106/text.

Some of the Latest “Replacement” Plans and News

We mentioned Sen. Rand Paul’s “ObamaCare Replacement Act” in our last update, and since then the full bill, S. 222, has been released. Read a summary here and the full text here.

Rep. Darrell Issa appears to be set to reintroduce his “Access to Insurance for All Americans Act.” It was know as H.R. 138 in the 114th Congress and would “offer Federal employee health benefits plans to individuals who are not Federal employees.”

Senators Cassidy and Collins are back with S. 191, the “Patient Freedom Act of 2017.” It would be a partial repeal tied to provisions that allow states to keep ACA on a state-by-state basis or fund state-based market-oriented reforms.

Amid the replacement plans there are reports that the GOP is shifting from “Repeal and Replace” to “Repair” as well as reminders that, “Yes, We Can Repeal Every Word of ObamaCare.”

Also there’s talk of extending the repeal time frame and discussion about how soon-to-be HHS head Dr. Tom Price “will have plenty of room to singlehandedly shift health care toward a free-market system… .”

Changes to the Affordable Care Act

There is much repetition in these bills. It seems everyone wants to get in on the ACA changes. What this telegraphs is that the ACA will likely not be repealed any time soon.

On January 10, 2017, H.R. 407, the Tax Free Health Insurance Act of 2017, was introduced by Rep. Steve King (R-IA) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code to allow an individual taxpayer a deduction from gross income of insurance premiums paid for the health care coverage of the taxpayer and the taxpayer’s spouse and dependents. The bill makes the deduction available whether or not the taxpayer itemizes other deductions.

Full text: https://www.govtrack.us/congress/bills/115/hr407/text.

On January 12, 2017, H.R. 499, the No Exemption for Washington from Obamacare Act, was introduced by Rep. Ron DeSantis (R-FL) and referred to the House Energy and Commerce and House Administration Committees, and 2 other committees. The bill amends the Patient Protection and Affordable Care Act to extend the requirement for participation in a health insurance exchange to the President, Vice President, executive branch political appointees, and employees of congressional committees and leadership offices of Congress. Currently, this requirement applies to Members of Congress and their staff.

The government is prohibited from contributing to or subsidizing the health insurance coverage of officials and employees subject to this requirement

Full text: https://www.govtrack.us/congress/bills/115/hr499/text.

On January 13, 2017, H.R. 521, Protection from Insurance Exchange Monopolies Act, was introduced by Rep. Mark Amodei (R-NV) and referred to the House Ways and Means Committee. This one page bill would amend the Internal Revenue Code of 1986 to provide an exemption to the individual mandate to maintain health coverage for individuals residing in counties with fewer than two health insurance issuers offering plans on an Exchange.

Full text: https://www.govtrack.us/congress/bills/115/hr521/text.

On January 13, 2017, H.R. 537, Budget Process Accountability Act, was introduced by Rep. Andy Biggs (R-AZ) and referred to the House Energy and Commerce and House Administration Committees, and 2 other committees. The bill would amend the Internal Revenue Code to exempt individuals from the requirement to maintain minimum essential health care coverage if they reside in a county where fewer than two health insurers offer insurance on the health insurance exchange. This bill amends the Patient Protection and Affordable Care Act to extend the requirement for participation in a health insurance exchange to the President, Vice President, executive branch political appointees, and employees of congressional committees and leadership offices of Congress. Currently, this requirement applies to Members of Congress and their staff.

The government is prohibited from contributing to or subsidizing the health insurance coverage of officials and employees subject to this requirement

Full text: https://www.govtrack.us/congress/bills/115/hr537/text.

On January 13, 2017, H.R. 563, the Unaffordable Care Act, was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code to exempt from the requirement to maintain minimum essential health coverage an individual who: (1) resides in a location with fewer than two qualified health plans offered through an exchange established under the Patient Protection and Affordable Care Act, or (2) was covered under minimum essential coverage for the last month of the preceding year and the premium is at least 125% percent of the premium for that month.

Full text: https://www.govtrack.us/congress/bills/115/hr563/text.

On January 24, 2017, H.R. 633, the Patient Fairness and Relief Act of 2017, was introduced by Rep. Gregg Harper (R-MS) and referred to the House Energy and Commerce and House Ways and Means Committees. The bill would authorize health insurance issuers to continue to sell health insurance coverage that was offered in the individual market before the enactment of the Affordable Care Act in satisfaction of the minimum essential health benefits.

Full text: https://www.govtrack.us/congress/bills/115/hr633/text.

On January 24, 2017, H.R. 661, the Employee Fairness and Relief Act of 2017, was introduced by Rep. Brett Guthrie (R-KY) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would authorize health insurance issuers to sell previously available health insurance coverage in the small group market in satisfaction of the minimum essential health insurance coverage requirement.
Full text: https://www.govtrack.us/congress/bills/115/hr661/text.

On January 13, 2017, H.R. 562, Obamacare Regressive Tax Relief Act, was introduced by Rep. Luke Messer (R-IN) and referred to the House Ways and Means Committee. The bill would amend the Internal Revenue Code of 1986 to return the penalty to 1 percent of the excess of the taxpayer’s household income that is above the yearly tax filing requirement (gross income of at least $10, 350 (individuals), $20,700 (married filing jointly). Currently the law increased the penalty to 2.5 percent as of 2015.

Full text: https://www.govtrack.us/congress/bills/115/hr562/text.

On January 17, 2017, S. 147, the Obamacare Taxpayer Bailout Prevention Act, was introduced y Sen. Marco Rubio (R-FL) and referred to the Senate Health, Education, Labor, and Pensions Committee. The bill repeals the provision of the Patient Protection and Affordable Care Act that directs the Department of Health and Human Services to establish a program of risk corridors for 2014, 2015, and 2016 under which qualified health plans must participate in a payment adjustment system based on the ratio of a plan’s allowable costs to its premiums. (Qualified health plans are sold on health insurance exchanges, are the only plans eligible for premium subsidies, and fulfill an individual’s requirement to maintain minimum essential coverage.)

Full text: https://www.govtrack.us/congress/bills/115/s147/text.

On January 27, 2017, H.R. 710, the Health Coverage State Flexibility Act of 2017, was introduced by Rep. Bill Flores (R-TX) and referred to the House Ways and Means Committee. The bill amends the ACA to better align the grace period required for non-payment of premiums before discontinuing coverage with the grace periods provided for under State law.

Full text: https://www.govtrack.us/congress/bills/115/hr710/text.

Independent Payment Advisory Board (IPAB)
On February 1, 2017, S.J. Res. 16 regarding the Independent Medicare Advisory Board was introduced by Sen. Ron Wyden (D-OR) and referred to the Senate Finance Committee. The resolution approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act.

The resolution also requests that Congress approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board.

Full text: https://www.govtrack.us/congress/bills/115/sjres16/text.

On February 1, 2017, S.J. Res. 17 regarding the Independent Medicare Advisory Board was introduced by Sen. John Cornyn (R-TX) ad referred to the Senate Finance Committee. (Exact wording as S.J. Res 16). The resolution approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act.

The resolution also requests that Congress approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board.

Full text: https://www.govtrack.us/congress/bills/115/sjres17/text.

On January 31, 2017, H.J. Res 51 regarding the Independent Medicare Advisory Board was introduced by Rep. David Roe (R-TN) and referred to the House Energy and Commerce and Ways and Means Committees. Exact wording as S.J. Res 16). The resolution approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board under section 1899A of the Social Security Act.

The resolution also requests that Congress approves the discontinuation of the process for consideration and automatic implementation of the annual proposal of the Independent Medicare Advisory Board.

Full text: https://www.govtrack.us/congress/bills/115/hjres51/text.

Health Savings Accounts
On January 4, 2017, S. 28, the Health Savings Account Expansion Act of 2017, was reintroduced by Sen. Jeff Flake (R-AZ). The House companion bill, H.R. 247 was introduced by Rep. Dave Brat (R-VA). This bill amends the Internal Revenue Code to modify the requirements for health savings accounts (HSAs) to increase the maximum contribution amounts, permit the use of HSAs to pay health insurance premiums and direct primary care expenses, repeal the restriction on using HSAs for over-the-counter medications, eliminate the requirement that a participant in an HSA be enrolled in a high deductible health care plan, and decrease the additional tax for HSA distributions not used for qualified medical expenses.

Full text (Senate): https://www.govtrack.us/congress/bills/115/s28/text
Full text (House): https://www.govtrack.us/congress/bills/115/hr247/text

On January 10, 2017, S. 85, the Restoring Access to Medication Act of 2017, was introduced by Sen. Pat Roberts (R-KS) and referred to the Senate Finance Committee. The sister bill in the House, H.R. 394, was introduced on January 10th by Rep. Lynn Jenkins (R-KS) and referred to the House Ways and Means Committee. These bills would repeal provisions of the Internal Revenue Code, as added by the Patient Protection and Affordable Care Act, that limit payments for medications from health savings accounts, medical savings accounts, and health flexible spending arrangements to only prescription drugs or insulin (thus allowing distributions from such accounts for over-the-counter drugs).

Full text (Senate): https://www.govtrack.us/congress/bills/115/s85/text.
Full text (House): https://www.govtrack.us/congress/bills/115/hr394/text.

Contraception/Abortion-Related

On January 13, 2017, H.R. 7, the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act of 2017, was introduced by Rep. Christopher Smith (R-NJ). The bill passed in the House on January 24, 2017 and goes to the Senate next for consideration. Title I–Prohibiting Federally Funded Abortions (Sec. 101). This section makes permanent the prohibition on the use of federal funds, including funds in the budget of the District of Columbia, for abortion or health coverage that includes abortion. The prohibitions in this bill, and current prohibitions, do not apply to abortions in cases of rape or incest, or where a physical condition endangers a woman’s life unless an abortion is performed.

Abortions may not be provided in a federal health care facility or by a federal employee.

Title II–Application under the Affordable Care Act (Sec. 201). This section amends the Internal Revenue Code and the Patient Protection and Affordable Care Act to prohibit qualified health plans from including coverage for abortions. (Qualified health plans are sold on health insurance exchanges, are the only plans eligible for premium subsidies and small employer health insurance tax credits, and fulfill an individual’s requirement to maintain minimum essential coverage.) Currently, qualified health plans may cover abortion, but the portion of the premium attributable to abortion coverage is not eligible for subsidies.

Sec. 202 revises notification requirements for qualified health plans regarding abortion coverage and charges for abortion coverage.

In the 114th Congress, similar legislation (H.R.7) passed the House by a vote of 242-179.

Full text: https://www.govtrack.us/congress/bills/115/hr7/text.

On January 10, 2017, S. 93, Allowing Greater Access to Safe and Effective Contraception Act was introduced by Sen. Joni Ernst (R-IA) and referred to the Senate Finance Committee. The sister bill, H.R. 421 was introduced by Rep. Mia Love (R-UT) and referred to the House Energy and Commerce and Ways and Means Committees.

This bill requires the Food and Drug Administration (FDA) to prioritize review of supplemental drug applications (applications to modify the approved use of a drug) for contraceptive drugs intended for routine use that would be available to individuals aged 18 and older without a prescription. The FDA must waive user fees for such supplemental drug applications. Any drug that is eligible for this priority review must be a prescription drug for individuals under age 18.

This bill repeals provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 to allow health savings accounts and health flexible spending accounts (HFSAs) to be used to pay for medicine without a prescription and to remove the limit on salary reduction contributions to a HFSA under a cafeteria plan, effective as if the provisions had never been enacted.

Full text (Senate): https://www.govtrack.us/congress/bills/115/s93/text.
Full text (House): https://www.govtrack.us/congress/bills/115/hr421/text.

Medicaid
On January 6, 2017, H.R. 352, State Health Flexibility Act of 2017, was introduced by Rep Todd Rokita (R-IN) and referred to the House Appropriations, House Committee on Education and the Workforce Committee, and 6 other committees. The bill amends the Social Security Act (SSAct) to replace federal requirements for Medicaid and the Children’s Health Insurance Program (CHIP) with health care block grants to states. A state may use block grant funds to: (1) provide health care services to indigent individuals; (2) fund risk adjustment mechanisms for the purpose of subsidizing the cost of private health insurance for the high-risk population; and (3) support other welfare-related programs, as specified by the bill.

In addition to repealing titles XIX (Medicaid) and XXI (CHIP) of the SSAct, the bill repeals: (1) the Patient Protection and Affordable Care Act, and (2) the Health Care and Educational Reconciliation Act of 2010.

With respect to an alien not lawfully admitted for permanent residence in the United States, a state may use grant funds to provide only emergency health care services, as specified by the bill.
The bill limits the authority of any federal agency to supervise a state’s use of funds received under the block grant program.

Full text: https://www.govtrack.us/congress/bills/115/hr352/text.

Changes to Medicare
On January 5, 2017, S. 41, Medicare Prescription Drug Price Negotiation Act of 2017, was introduced by Sen. Amy Klobuchar (D-MN) and referred to the Senate Finance Committee. This bill amends title XVIII (Medicare) of the Social Security Act to require the Centers for Medicare & Medicaid Services (CMS) to negotiate with pharmaceutical companies regarding prices for drugs covered under the Medicare prescription drug benefit. Current law prohibits CMS from doing so.

Full text: https://www.govtrack.us/congress/bills/115/s41/text.

On January 10, 2017, H.R. 409, the Putting Patients and Providers Ahead of Compressed Regulatory Timelines Act of 2017, was introduced by Rep. Steve King (R-IA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill would amend title XVIII (Medicare) of the Social Security Act to eliminate provider penalties for failure to comply with electronic health records (EHR) use requirements.

Under current law, certain hospitals, Medicare Advantage organizations, and professionals participating in Medicare are subject to negative payment adjustments if they fail to comply with established requirements for EHR use. The bill eliminates these penalties and requires the Centers for Medicare & Medicaid Services to reimburse such providers for payments that they would have received within a specified timeframe had such penalties not been applied.

Full text: https://www.govtrack.us/congress/bills/115/hr409/text.

On January 10, 2017, H.R. 410, Protecting Life Until Natural Death Act, was introduced by Rep. Steve King (R-IA) and referred to the House Energy and Commerce and House Committee on Ways and Means Committees. The bill amends title XVIII (Medicare) of the Social Security Act to exclude from Medicare coverage advanced planning services, with the exception of certain hospice-related services that may include advising on end-of-life or advanced care planning.

Full text: https://www.govtrack.us/congress/bills/115/hr410/text.

On January 12, 2017, H.R. 508, Seniors Have Eyes, Ears, and Teeth Act of 2017, was introduced by Rep. Lucille Roybal-Allard (D-CA) and referred to the House Energy and Commerce and Ways and Means Committees. The bill amends title XVIII (Medicare) of the Social Security Act to expand Medicare coverage to include eyeglasses, hearing aids, and dental care.

Full text: https://www.govtrack.us/congress/bills/115/hr508/text.

On January 27, 2017, H.R. 707, the Health Care Choices for Seniors Act, was introduced by Rep. Marsha Blackburn (R-TN) and referred to the House Energy and Commerce and House Ways and Means Committees. The bill amends title II (Old Age, Survivors, and Disability Insurance) (OASDI) of the Social Security Act to require the Department of Health and Human Services (HHS) to establish the Medicare Alternative Voucher (MAV) Program, under which a voucher may be used as a contribution into a health savings account and for the payment of enrollment premiums under a high-deductible health plan. HHS must establish a procedure under which an individual otherwise entitled to Medicare benefits may waive such entitlement and be automatically enrolled in the MAV Program.

Additionally, the bill amends the Internal Revenue Code to increase the amount of the deduction from gross income for health savings accounts by the amount of the MAV that is contributed to an individual’s health savings account.

The bill also suspends Medicare late enrollment penalties for an individual between ages 65 and 70.

Full text: https://www.govtrack.us/congress/bills/115/hr707/text.

Medicare for All!?
On January 24, 2017, H.R. 676, the Expanded and Improved Medicare for All Act, was reintroduced by Rep. John Conyers (D-MI) and referred to the House Energy and Commerce and Natural Resources Committees. Conyers has introduced this bill in every session of Congress since 2003.

This bill aims to establish the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with “free” health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.

Only public or nonprofit institutions may participate. Nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities may participate. Patients may choose from participating physicians and institutions.

Health insurers may not sell health insurance that duplicates the benefits provided under this bill. Insurers may sell benefits that are not medically necessary, such as cosmetic surgery benefits.

The bill sets forth methods to pay institutional providers and health professionals for services. Financial incentives between HMOs and physicians based on utilization are prohibited.

The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill.

The program must give employment transition benefits and first priority in retraining and job placement to individuals whose jobs are eliminated due to reduced clerical and administrative work under this bill.

The Department of Health and Human Services must create a confidential electronic patient record system.

The bill establishes a National Board of Universal Quality and Access to provide advice on quality, access, and affordability. The Indian Health Service must be integrated into the program after five years. Congress must evaluate the continued independence of Department of Veterans Affairs health programs.

Full text: https://www.govtrack.us/congress/bills/115/hr676/text.

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