Challenge to Michigan ban on taxpayer-funded abortions rejected
The lawsuit argued that the ban had no standing after Michiganders voted in 2022 to pass a constitutional amendment ensuring the right to an abortion.
Judge Brock A. Swartzle ruled that the group that filed the lawsuit had no standing to file the challenge.
The Michigan American Civil Liberties Union, along with the law firm Goodwin Procter, filed the lawsuit on behalf of the YWCA Kalamazoo, which provides financial help to people seeking abortion care.
ACLU Michigan estimates that 77 percent of the people YWCA Kalamazoo provides financial assistance to qualify for Medicaid.
In the lawsuit, the plaintiffs ask the court to declare the abortion-coverage ban unconstitutional and allow Michigan to join the 17 other states that cover abortion through Medicaid programs.
Swartzle argued in his decision that since the YWCA is a non-profit and not an individual, it does not have the legal right to present the challenge.
'The YWCA is not an individual and it, as a nonprofit organization, does not have reproductive freedom,' he wrote. 'Further, the YWCA does not provide abortion care and is not directly affected by a law that denies funding for abortions.'
'Even if it could be considered 'someone' in a corporate sense, there is no allegation there is no allegation that it was penalized, prosecuted, or adversely acted against by the state,' the decision adds.
In Michigan, Medicaid only covers abortion in order to save the life of the pregnant person or when the pregnancy was the result of rape or incest.
A spokesperson for ACLU Michigan did not immediately respond to a request for comment.
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The Hill
25 minutes ago
- The Hill
Republicans are making boogeymen of their own voters on Medicaid
Republicans love their boogeymen; the grotesquely exaggerated villains they use to justify their worst policy ideas. President Trump loves to parade his favorite boogeymen: the ' criminal aliens,' the dishonest media, the Democrats, and so on. These dehumanizing caricatures help him rile up his base and lead them to back his cruelest initiatives. As the GOP-controlled Congress argues the merits of the cuts included in Trump's 'big, beautiful bill' act — which is deeply unpopular with voters — they're discovering new boogeymen to deflect criticism. Republicans are very defensive about their $1 trillion cut in Medicaid, which will deprive almost 12 million, mostly low-income and working-class Americans, of their health care coverage. So with the aid of Health and Human Services Secretary Robert F. Kennedy Jr. and Dr. Oz, they've conjured up a new boogeyman: ' able-bodied working-age Americans without dependents.' The emblematic figure here is a ' 25-year-old living in the basement.' There's just one problem: In 2024, able-bodied adults who qualified for Medicaid (i.e., adults between the ages of 18-64 who make approximately $21,597/year or less) mostly voted for Donald Trump. In 2024, Trump won the majority of voters who made less than $50,000 and was up 14 points with men between the ages of 19 and 29, and even expanded his margin with men under 50 compared to 2020. To add to this, Trump also won over two-thirds of voters in rural areas where 1 in 4 people are Medicaid recipients. In other words, Republicans are making boogeymen of their own voters. Sen. Josh Hawley (R-Mo.) seems to be one of the few congressional Republicans to grasp this point. He says that 'slashing health insurance for the working poor… is both morally wrong and politically suicidal,' while noting that MAGA voters never signed up for Medicaid cuts. In fact, in Hawley's home state of Missouri, voters elected Trump as president and expanded eligibility for Medicaid on the very same ballot. President Trump has repeatedly promised his voters, 'We're not cutting Medicaid,' and he would veto a bill that would do that. The White House website repeats the claim that there will be no cuts to Medicaid, just the surgical elimination of waste, fraud and abuse. However, many nonpartisan groups, including the Congressional Budget Office, the National Patient Advocate Foundation and groups that focus on specific diseases, say the GOP Medicare cuts will do collateral damage to recipients who are eligible and already working, as well as all Americans, when rural hospitals close and health care costs increase. Almost two-thirds of Americans view the law unfavorably, including many Republicans. When informed that the bill would increase the uninsured rate and decrease hospital funding, half of self-identified MAGA voters didn't support the bill. When the public is informed that most people on Medicaid already meet the work requirement, but the paperwork connected to it would cause people to lose their insurance, only about one-third of people support work requirements in Medicaid. In addition, as Republicans attempt to hobble Medicaid, public support continues to grow for the program, increasing by six percentage points since January to 83 percent. Congressional Republicans don't seem to care that Medicaid covers our most vulnerable citizens, who can't just tap their bank accounts when they get sick or have an accident. Americans deserve to have a backup as they recover from job loss, as they care for their loved ones, and while they educate themselves. Medicaid is there because having fewer people uninsured helps stabilize other parts of the health care system, like rural facilities and the cost for all health care users. This was also once the belief of Vice President JD Vance, too. As for what congressional Republicans believe, it is unclear. It took less than a year for them to forget who voted them into power and go back to their usual 'tax breaks for the rich, shame on the working poor' stance. Their law, which manages to be spendthrift and stingy at the same time, is most assuredly cutting Medicaid, no matter how much Trump tries to gaslight us into thinking otherwise. These cuts are cruel and, as Hawley predicts, will likely prove hazardous to the Republicans' political health in the midterm elections.
Miami Herald
25 minutes ago
- Miami Herald
How do you find health insurance when you're turning 26? Here's some advice
It was supposed to be easier than this. When the Affordable Care Act was passed in March 2010, the goal was to help more Americans get health insurance. And, indeed, the establishment of online marketplaces and a broadening of the eligibility guidelines for Medicaid accomplished that. Fifteen years later, however, that system is anything but user-friendly. MORE: Why young Americans dread turning 26 as they face health insurance chaos Young adults looking for health insurance will likely benefit from talking with so-called navigators who work for the online marketplaces. But if you want to go it alone, here are some tips about shopping for a plan, based on the advice of policy experts and people who have spent hundreds of hours helping others navigate this unwieldy set-up. Buckle up. Begin your search at least two months before your 26th birthday. In some cases, you can sign up for a plan in advance so that it takes effect on your birthday. First, find out if your family plan ends on your birthday or at the end of your birthday month. A few states allow young adults to stay on their family plan until they are 29, with certain conditions and, generally, higher costs. A navigator will know more. You may have the option to stay, for a limited time, on your family's plan under COBRA, a federal program that allows those with group health plans to extend their coverage past age 26. Odds that you will be approved for an extension are even higher if you can claim a disability. Be aware, though, that this option will involve a considerable expense, since you will be required to pay the entire premium (the employer will no longer pay what is usually a substantial share). Those who claim a disability can often stay on the family plan after age 26, depending on the type of insurance the family holds. If you're undergoing medical treatment and can't change hospitals or doctors, paying this premium may be your best course. You don't have this option, however, if your family is insured through an Obamacare plan. Before you start your search, make a list of the medicines and physicians you rely on, and highlight those you can't do without. Rank them, even. It's quite likely that you will have fewer choices on the marketplace than you had on a parent's plan. Be prepared to make some switches and trade-offs. Thirty-two states have adopted the federal marketplace as the place residents can go to compare and buy insurance policies. The rest run their own online marketplaces. You can find out here where to shop for insurance policies in your state. Make sure you land at an official ACA website. There are many look-alikes run by private insurance brokers. The federal marketplace is found at and nowhere else. Note that official state marketplaces sometimes have unusual names. The New York State of Health, Kynect (Kentucky), Covered California, and CoverMe (Maine) are examples. In states that use the federal marketplace, shoppers can find assistance here. On the state-based marketplaces, there is often a 'find local help' button or a tab that directs you to a person who can help you find a good plan. You will generally be asked to choose a broker, who is paid a commission if you sign up, or an 'assister,' who provides the service at no cost. Assisters have received special training in the marketplace they serve, and, because they provide the service free, they have no financial incentive to steer you to a plan that pays a commission to the seller. Assisters are often navigators who are funded by the marketplace, but in some cases they work for hospitals, health plans, or local nonprofits. You'll have to ask. While navigators are generally a surefire option for sound advice, they may become harder to find now that the Trump administration has cut funding for them in states that rely on the federal marketplace. (States that run their own marketplaces are unaffected.) Many nonprofits and states run excellent programs that offer free assistance. And if, for example, you're in the middle of cancer treatment, an assister affiliated with your hospital may offer better advice on picking a plan, since they will know which ones have contracts that may cover more of your expenses. Ideally, these experts will walk you through the process and know which buttons to push to ensure you get the best coverage for your needs at the best rate for which you are eligible. Once you're on an official website that markets plans under the ACA, you will be asked to enter your personal information as well as an estimate of your income. Forty states and the District of Columbia cover single young adults with no children under Medicaid if their income is low enough to qualify. If you're eligible, you should be redirected to the Medicaid website to start the enrollment process, or you may enroll directly on the marketplace site. But be aware that the Republicans' recently passed domestic policy bill has increased the requirements and the paperwork required to get on, and stay on, Medicaid. Medicaid, a joint federal and state program that provides health insurance to low-income Americans, does not charge its members a premium, and it covers medications at a nominal cost or free. The caveat is that those enrolled in the program have a smaller number of in-network doctors and hospitals to choose from. If your income is above the threshold for Medicaid, you will need to shop on the marketplace for a policy. On most sites, a search tool allows you to check whether your doctor or hospital is in a particular plan's network. But beware: The directories on which this search relies are notoriously inaccurate, despite federal laws mandating otherwise. So, before you select a plan, call the doctor or hospital to confirm they accept the insurance plan you're considering purchasing. When it comes to the math, it's better to work on a computer than a phone. Generally, you can compare the costs of, and coverage offered by, only three plans at a time. The following factors include premiums (taking account of any subsidy you get based on your income), as well as other expenses you'll have to pay, called collective cost sharing: The deductible — the amount you generally have to pay out-of-pocket before your insurance kicks in. (You may get a few 'covered' visits with a primary care doctor; these won't count against the deductible.) Copayments — a fixed payment that you owe for any visit to a doctor or emergency room. Coinsurance (this one can break the bank) — a percentage of the total bill, generally applied to hospital bills, that you have to pay. The plan may make it sound small, say, 10% to 30%. But if you have, for example, the common 80-20 split (in which the insurer pays 80% and you pay 20%), that can add up to a substantial sum. A single day in the hospital can cost tens or even hundreds of thousands of dollars, and 20% percent of that is a large amount. The out-of-pocket maximum — the most you'll have to pay out in a year, so long as you stay in network and pay the deductible. Doing the math means looking at this holistically, balancing what you can pay in a premium against what you can afford for the above charges. If the deductible is over $3,000 and the out-of-pocket maximum allowed yearly is $9,200 — do you have that much money on hand? Generally, the lower the monthly premium in a plan, the higher the share of costs you'll have to pay should you need medical care. Note that an insurer may offer very different plans on the same marketplace, with different payment policies and networks. People with incomes up to 2½ times the poverty level may gain some relief from cost-sharing charges, but only if they sign up for silver plans. Plans are typically labeled bronze, silver, gold, and platinum; each tier reflects the percentage of your medical expenses that your plan pays overall. Bronze plans offer the least amount of coverage. Once you've narrowed your choices to a few plans, study each closely. A plan with a low deductible might require a $1,000 daily copayment, or 50% coinsurance (you pay 50%) for hospital stays. A plan that lists your desired hospital system as in-network may include only some of its locations, and not necessarily the ones close to you or that offer the type of care you need. When looking at a plan's details, make sure to scroll down and read its 'summary of benefits and coverage' for examples of the plan's coverage of common medical needs. Pay close attention to which services require preauthorization and, for example, how many physical therapy visits they'll cover each year. Preauthorization can be a long and cumbersome process. Generally, the lower the premium, the more preauthorization will be required and the more limited the coverage will be. And check what drugs the plan covers (called the formulary) to see if yours are included, as well as its network of providers, to see whether your doctors are in it. Marketplace plans tend to have limited offerings compared with job-based insurance; there aren't as many doctors and hospitals to choose from. Click on the 'provider directory' to see if an insurer's network includes doctors and specialists you're most likely to need, and hospitals that are acceptable and accessible to you. Check to see if the policy offers any coverage for out-of-network providers. Some will pay, say, 60% or 70% of approved charges. It's a useful perk if you need to see an out-of-network specialist, or if the wait for an in-network appointment is too long. One study found that patients with marketplace plans have access to only 40% of doctors near their home, on average, and in some areas that figure was as low as 25%. It's quite likely even lower for mental health providers. If you've tried to choose a plan and you're still confused, look for one of the 'easy pricing' or standard plans. These conform to certain basic standards laid out by the federal Centers for Medicare & Medicaid Services, which oversees the marketplaces for the federal government. These plans offer some primary care appointments before you have to start paying the deductible. The government says these plans must carry the label 'easy pricing' on federal marketplace sites. But they may be identified differently on state-run marketplaces. In New York state, for example, they are simply marked with an ST (for standard). Still, funding for premium subsidies is in place for this year at least, and free expert assistance is still out there, so don't delay. There are good deals to be had, if only you put in the work. Good luck. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism
Miami Herald
25 minutes ago
- Miami Herald
Lawyers in Hope Florida Medicaid settlement distanced clients from rushed deal
As DeSantis administration officials scrambled last year to craft a Medicaid overbilling settlement that diverted millions to the Hope Florida Foundation, lawyers for healthcare contractor Centene and the Florida Attorney General's Office tried to distance their clients from the agreement, a trove of newly released records shows. Over 22 days in September, then-Chief Deputy Attorney General John Guard repeatedly removed references to his office in drafts of the settlement passed among negotiators. Centene's lawyers inserted language emphasizing that the company was 'directed by the state' to donate $10 million of its $67 million settlement to the foundation. The attorneys insisted that Florida's Office of Inspector General or attorney general be mentioned in the agreement. And they inserted language absolving the company from liability in 'any dispute that may arise' from how the money was used. The haggling was prescient. When the settlement was revealed this year, it ignited a firestorm among Republican lawmakers. Nearly all the $10 million donation to the state-created Hope Florida Foundation was diverted to a political committee created by Gov. Ron DeSantis' then-chief of staff James Uthmeier to run ads opposing last year's recreational marijuana ballot initiative. A top GOP lawmaker accused the DeSantis administration of illegally laundering federal Medicaid funds, and former federal prosecutors have said the transactions may have been illegal. Prosecutors in Tallahassee launched a criminal investigation related to the claims. The agreement had ramifications in Washington, as well. Guard, who eventually signed the settlement, has seen his nomination by President Donald Trump for federal judge held up after Republican U.S. Sen. Rick Scott said he should face questions about it. Guard declined to comment. Emails and draft settlement agreements included among 1,000 pages of records reviewed by the Herald/Times detail how DeSantis' administration crafted the unusual legal settlement last fall, as mail-in ballots were set to go out to voters. At the time, DeSantis was crisscrossing Florida and spending millions of taxpayer dollars on ads to defeat an initiative that would legalize recreational marijuana. Centene and outside lawyers had asked the state repeatedly since 2021 to settle the company's claims that it overbilled Florida for prescription drugs, records show, but Florida's Agency for Health Care Administration didn't take action until a phone call with the company on Sept. 5, 2024. The initial draft of the settlement made no mention of the Hope Florida Foundation. Agency officials prepared to brief the governor's office on the settlement on Sept. 10. Whether the meeting happened, or who attended, is not reflected in the records. But the next day, the Agency for Health Care Administration's general counsel sent a version to Secretary Jason Weida that required Centene to give $5 million of its settlement to the Hope Florida Foundation. More changes followed. A draft sent to Guard on Sept. 12 removed all references to the state's Office of Inspector General. Guard pushed back. The agreement required the attorney general, instead of the Agency for Health Care Administration, to handle the remaining $62 million. Guard also questioned how much would have to be paid to the federal government, which oversees and mostly funds Medicaid. The agreement 'is different than I have seen in a settlement with Medicaid monies,' Guard wrote. He did not question the diversion of $5 million to the Hope Florida Foundation. The Agency for Health Care Administration's general counsel agreed with Guard and changed the settlement to make the agency receive and distribute the money on behalf of the state. He also increased the donation to the foundation to $10 million before sending another round of changes to Centene. The records do not show why the donation to Hope Florida Foundation was added to the drafts, or why it was doubled. The Agency for Health Care Administration did not answer questions asked by the Herald/Times. Centene's general counsel responded six days later with more changes apparently designed to protect the company. Money from Medicaid-related legal settlements belongs to state and federal taxpayers, and diverting it to charities or political committees could amount to theft of federal funds or other crimes, four former federal prosecutors told the Herald/Times in May. Centene held a phone call with the state's lawyers to discuss the changes on Sept. 20. The company's version of the settlement stated that the 'Attorney General directs' the company to donate the $10 million and that Centene wasn't responsible for how the money would be allocated. Centene lawyers also wanted to mention that the Office of Inspector General was one of the state entities authorizing the settlement. It's not clear why, as the office isn't typically a party to legal settlements. Centene resolved similar overbilling claims with at least 20 states, and only one other settlement that is publicly available mentions inspectors general, according to a Herald/Times review. 'We would like FL OIG to continue to be explicitly listed,' one of their attorneys wrote. When the Attorney General's Office received the newest draft, Guard balked. On Sept. 24, he deleted seven references to the Attorney General's Office and clarified that the Agency for Health Care Administration, not the attorney general, was directing the company to make the donation. 'I get that they [Centene] negotiated this in every other state with the AG,' Guard wrote to the agency's general counsel. 'But, they are negotiating this agreement with AHCA [Agency for Health Care Administration] and it is going to have to look slightly different.' After the health agency's attorney made most of the changes, Guard still seemed less than enthusiastic. He wrote that he didn't really want to represent the state in the legal settlement, 'but I am fine with this.' The assurances from the attorney general's office — the state's top law enforcement entity — seemed crucial to Centene's lawyers, however. On Sept. 27, they sent a draft that added back nine references to the office. Each reference clarified that both the Agency for Health Care Administration and the attorney general were directing Centene's payments. 'I think we are down to one real issue,' wrote Centene's general counsel, Chris Koster, the former attorney general for Missouri. 'I agree that we are down to one issue,' the agency's general counsel, Andrew Sheeran, responded. The two held a phone call later that afternoon, and Centene backed down. The final version, signed later that day, did not include the additional references to the attorney general or the inspector general. Centene declined to answer questions and pointed to its past statements on this issue. 'The terms in the settlement document speak for themselves,' the company said. 'Centene had no part in or knowledge of any decision by the Hope Florida Foundation regarding the subsequent use of any Foundation funds.' 'Red flags' DeSantis' administration kept the settlement secret until April this year, when Republican lawmakers and the Herald/Times obtained copies of the Hope Florida Foundation's Oct. 14 meeting minutes. The minutes showed the foundation received $10 million as a result of 'a longstanding dispute with the Agency for Health Care Administration.' Herald/Times reporting previously revealed that for years, the charity didn't keep meeting minutes, had no budget or bylaws and didn't file its tax returns. And the money did not stay with the foundation , a state-created charity designed to support the state's Hope Florida program to move people off government assistance. Within days, it was routed to two political nonprofits, which gave nearly all of it to a political committee controlled by Uthmeier that was dedicated to defeating the marijuana amendment. The leader of one of the nonprofits said Uthmeier called her to request the money from the foundation, according to a Republican lawmaker who investigated the matter. The nonprofit director later said that Uthmeier 'had limited involvement' and never told her what to do with the money. DeSantis has defended the settlement, saying that Centene's donation was a 'cherry on top' of what the company owed. Uthmeier, who was appointed attorney general by DeSantis this year, said he had nothing to do with the final settlement talks. He was involved in meetings with Centene in 2021, records show. Neither has disputed that the $10 million was used for political purposes. Uthmeier's office hadn't released any records about the transactions until last week, when it gave hundreds of pages to Politico Florida 'exclusive for the next two weeks,' according to copies of text messages between a reporter and Rep. Alex Andrade, the Republican representative who probed Hope Florida. The messages were obtained by the Herald/Times. Uthmeier's spokesperson, Jeremy Redfern, emphasized two things about the records, according to the texts from the reporter to Andrade: That they showed Guard was initially concerned about the legality of the settlement but eventually 'got it,' and that the money sent to the state in the settlement 'was more than three times the size of the state's actual financial loss.' The Attorney General's Office last week released 390 pages of documents – many of which were requested in April – after the Herald/Times threatened to sue. Reporters also obtained hundreds of pages of emails and draft settlements from sources. Redfern did not answer questions about the settlement or why the state first gave the records to Politico. He also said Uthmeier 'never participated in any settlement negotiations and doesn't know anything about' the scheduled September 10 meeting last year regarding the draft agreement. 'Your questions demonstrate that you are deliberately misreading the public records our office provided you on a very expedited basis,' Redfern wrote in an email. Medicaid statutes allow states to recover as much as three times damages. Centene's records show that other states received settlements based on the same formula. Part of that formula also included a baseline of $10.8 million to encourage states to settle with the company and not litigate their claims. Regardless, that doesn't mean the money can be divided for purposes that aren't related to Medicaid, Andrade said, pointing to 2008 federal guidance. 'It looks very much like red flags were raised by the attorney general's office and by Centene,' Andrade said after reviewing the records himself. 'They were at the 10-yard line. And while they had some heartburn about it, it wasn't sufficient to blow the whole thing up.' He added: 'The CYAs [Cover Your Asses] were evident.' Andrade said it was also clear the state understood the money transferred to the foundation belonged to Medicaid, which would restrict how it could be spent. When the agency's lawyers inserted the donation into the agreement, they also justified it by referencing how the Hope Florida program was expanding into Medicaid. The justification that remained in the final agreement was crafted by one of Centene's lawyers: the state Agency for Health Care Administration 'desires an expanded role for Hope Florida in the Medicaid program.' 'That says it all,' Andrade said.
