JustCare

Tag: Trump administration

  • 2025: What will become of Medicaid?

    2025: What will become of Medicaid?

    At the moment, Republicans in Congress are eyeing major cuts to Medicaid–a program that provides critical health care to more than 70 million low-income Americans–as part of their push to cut government spending significantly. In January, President Trump had said he would not cut Medicaid, except to address fraud and abuse, report Ben Leonard for Politico and Ryan Levi for NPR. What will become of Medicaid?

    Proposed Medicaid cuts are not simply about fraud and abuse. Many Republicans also want to include work requirements as part of Medicaid eligibility. To be clear, lots of people with Medicaid are over 65 or have a disability and are unable to work.

    As a result of the Affordable Care Act, 21 million more people have been able to enroll in Medicaid. Their incomes were under $45,000 for a family of four. The federal government covers up to 90 percent of that cost.

    What’s on the chopping block in Congress? As much as $230 billion a year in Medicaid cuts over the next ten years to help cover the cost of enormous tax cuts. If it happens, a significant number of the 70 million Americans with Medicaid would lose Medicaid coverage. Some would die needlessly.

    Medicaid saves lives. The research shows a nine percent reduction in adult mortality in the four years after passage of  Medicaid expansion with the Affordable Care Act.

    Some Republicans, including Robert F. Kennedy Jr., claim that Medicaid does not improve people’s health. Those not supporting Medicaid point to one experiment in Oregon, which showed that people with Medicaid had a higher chance of receiving preventive services than people without it. They were less depressed and received fewer medical bills. But, their cholesterol and blood pressure levels were no different from those who did not get Medicaid. [This seems hardly a basis for denying Medicaid’s value.]

    Republicans also claim that Medicaid dollars flow too easily to the states. The federal government covers between 50 to 90 percent of Medicaid costs. Republicans say that states game the system to get extra money from the feds.

    Could people with Medicaid afford to buy insurance in the private market, as some conservatives claim? It’s hard to imagine, given the high cost of private insurance, including premiums, deductibles and copays. Most Medicaid dollars are spent on older adults and people with disabilities for nursing home care, which Medicare does not cover.

    How are the states reacting? Some Republican states are already moving to end Medicaid expansion, reports Anna Claire Vollers for Stateline. Idaho, Montana and South Dakota are leading the way to end Medicaid expansion. If Idaho ends expansion, close to 90,000 people would lose their Medicaid coverage.

    Nine states have “trigger” laws that require them to reduce Medicaid spending if the federal government reduces its contribution to Medicaid.

    Will big cuts to Medicaid happen this year? It’s possible. If so, it would happen soon, in the reconciliation package. Hospitals and Democrats are pushing back. About 20 percent of hospital revenue comes from Medicaid.

    What happens to the cost of individual health insurance if Medicaid is cut significantly? Many states would likely end Medicaid expansion, millions of Americans would be uninsured, and individual health insurance premiums would likely rise a lot. A new report finds that if Montana stopped its Medicaid expansion, as many as 74,000 Montanans would lose coverage and the uninsured could represent as much as half of Montanans. In addition, health insurance premiums would increase as much as eight percent or $767 a year because the people signing up who had had Medicaid are a sicker cohort than the group with private insurance currently. Rural health care would be at risk.

    Here’s more from Just Care:

  • Trump’s health care executive orders

    Trump’s health care executive orders

    As with many sectors of our economy, when it comes to health care you should expect a lot of changes from the Trump administration. And, based on Trump’s recent executive orders, millions of Americans could face higher health care and prescription drug costs. Tarena Lofton lays out the latest developments for KFF Health News.

    But, Trump’s most consequential health care act is to push Republicans in Congress to drastically cut Medicaid spending in order to pay for massive tax cuts for the wealthiest Americans. Republicans intend to push through these cuts in a reconciliation package to be finalized shortly. Cuts to Medicaid will affect more than 70 million Americans directly and their families and communities indirectly. If you oppose Medicaid cuts, please reach out to your Congressperson and Senators and let them know.

    Now, to some of the executive orders:

    1. Revoked: Trump revoked a Biden administration executive order requiring the Centers for Medicare and Medicaid Services to focus on new ways to lower prescription drug costs, including a Medicare project that would have established a list of drugs with a $2 copay. The bigger question is whether Republicans will try to undo provisions in the Inflation Reduction Act that allow Medicare to negotiate drug prices and set an annual out-of-pocket cap in Medicare Part D at $2,000.
    2. Revoked: Trump undid a Biden administration executive order that extended the enrollment period for Affordable Care Act health plans, as well as money dedicated to assisting people with enrollment. The bigger question is whether Republicans will end subsidies for people with lower incomes who are insured through the ACA health insurance exchanges. Those subsidies are set to expire at the end of this year.
    3. Withdrawn: Trump withdrew the US from the World Health Organization. The US had been a large supporter, giving the organization $1.3 billion in 2022 and 2023. WHO focuses on global health. It funds health projects around the world and responds to public health emergencies. Trump says he did not like the way the WHO handled the COVID pandemic. The bigger question is how the US will respond to public health emergencies.
    4. Unrecognized: Trump ordered the federal government to not recognize transgender and nonbinary identities. He ended federal support of health care delivered to people on the basis of gender identity. This order will likely be challenged in court. The bigger question is whether this order will be reversed in court.
    5. Expanded: Trump ended a policy that kept immigration officials from arresting people not legally in the US near schools, hospitals and churches.
    6. Withdrawn: Trump withdrew the US from the Paris Climate Agreement for the second time. The agreement specifically states that this process takes a year, but Trump ordered the immediate withdrawal.

    Here’s more from Just Care:

  • How to make America healthy again

    How to make America healthy again

    Adam Gaffney writes for In These Times about how to make America healthy again: A universal single-payer system. President-elect Donald Trump and the Republican-led Congress is set to defund many health care programs and policies, including making large cuts to Medicaid and possibly eliminating income-based subsidies for people receiving coverage through the Affordable Care Act.

    To ​“Make America Healthy Again” (MAHA), Robert F. Kennedy, Jr., president-elect Trump’s pick to head the US Department of Health and Human Services (HHS), is planning a number of initiatives that will only make us sicker, writes Gaffney. He agrees with Trump and Kennedy that the US health care system is flawed in a variety of ways, leading to lower life expectancy than every other wealthy country, an opioid epidemic, as well as millions of uninsured Americans and unaffordable health care for tens of millions more Americans.

    One in four working Americans cannot afford their health care. Twenty-five million Americans are uninsured. In total, nearly half of working-age Americans are either uninsured or underinsured. But, the upcoming Trump administration is hell-bent on a path forward that is most likely to boost profits for UnitedHealth and other big health corporations, drive up health care costs, and increase the number of Americans who cannot afford their health care, while contaminating the air we breathe and the water we drink.

    Americans who oppose this path should support “a bold, populist progressive healthcare vision.” RFK Jr. continues to promote an anti-vaccine agenda that is likely to be seriously harmful to people around the world; he also denies AIDS. He appears to support a healthy eating agenda, but that is less likely to have legs in the next administration.

    RFK, Jr. claims that seed oils are “poisoning” Americans. But, there’s no data to support his claim. On the other hand, air pollution is responsible for 48,000 needless deaths each year in the US. And, if Trump sticks to his first-term agenda, he will allow weaker automobile emission standards and power plant pollution standards. The Environmental Protection Agency projects that weakening standards could add as many as 1,200 needless deaths and 1,900 asthma cases each year.

    Childhood poverty is another serious issue in the US, leading to childhood obesity and disease. Policy reforms are critical, but they are not on the Trump administration agenda. Instead of improving the nutritional value of school lunches, the first Trump administration permitted fewer fruits and vegetables and an increase in poor quality food.

    RFK Jr. wants to end direct-to-consumer advertising of prescription drugs, which is a good idea. But, it is unlikely the Supreme Court would allow this, supporting what the Supreme Court will claim are the first amendment rights of pharmaceutical companies over the value of consumer protections. RFK Jr. also correctly called out the malfeasance of the FDA for approving drugs that have little or no benefit to mollify industry. But, again, Trump is unlikely to address this issue, and RFK’s views on certain drugs are unfounded in science and dangerous to the public health.

    As bad as RFK Jr., Jim O’Neill, a biotech investor whom president-elect Trump has proposed as deputy secretary of HHS, does not believe the FDA should weigh drug efficacy when deciding whether to approve drugs. And, Mehmet Oz, whom Trump has proposed to head the Centers for Medicare and Medicaid Services (CMS), has a history of promoting supplements and other products that have no value whatsoever. Oz’s own Columbia University colleagues have condemned his views, expressing  “dismay” that he is on the faculty there.

    Advances in health care treatments are only beneficial for those who can afford them. The Trump administration is ready to make these treatments even less affordable than they already are, among other things, planning to cut the Medicaid budget dramatically. Such a move will mean tens of thousands more preventable deaths. During his first presidency, President Trump attempted to repeal the Affordable Care Act. Had it succeeded, it would only have increased the number of preventable deaths.

    As Sen. Bernie Sanders has proposed, what we need to ​“Make America Healthy Again” is a very different agenda from Trump’s–one that promotes guaranteed affordable access to care, clean air and clean water.

    Here’s more from Just Care:

  • What will happen to ACA subsidies in 2025?

    What will happen to ACA subsidies in 2025?

    The Trump administration, in partnership with the next Congress, will determine whether or not subsidies will continue for people getting health insurance through the state health insurance exchanges under the Affordable Care Act. Axios reports on the state of play.

    Republicans in Congress, who will be the majority in both the House and the Senate, will spark a lot of rage among millions of people in the state health insurance exchanges, if they do not extend the subsidies. They will force millions of people to lose their insurance because, without the subsidies, they won’t be able to afford it. Without subsidies, the Republicans will force others to pay far higher health insurance premiums. Of note, the premium subsidies are most helpful to residents of Republican states that have not expanded Medicaid. So, Republicans in Congress could pay a big price if they eliminate the subsidies.

    But, as of now, the Republicans are not biting. They would not agree to a Democratic proposal to extend the ACA subsidies for one year.

    The Senate Finance Committee’s new Chairman, Mike Crapo (R-Idaho), is considering whether to include the subsidies in the budget reconciliation process that will happen in early 2025. He has not taken the subsidies off the table.

    However, Republicans in the House are saying that they do not support the subsidies. Jodey Arrington, who chairs the House Budget Committee, does not see an extension of the subsidies in the future. His response, when asked about extending the subsidies, was “hell no.” But, who knows?

    What would be the consequences of not extending the subsidies? Without the ACA subsidies in 2026, 2.2 million Americans are projected to lose their health insurance. In 2027, 3.8 million would lose their health insurance. People in the state health insurance exchanges would see their premiums rise 4.3 percent in 2026 and 7.7 percent in 2027.

    As of yet it is unclear what the Republicans in Congress would do for the millions of uninsured Americans, particularly if they end the ACA subsidies.

    Here’s more from Just Care:

  • Biden administration should remove Trump’s Social Security Administration appointees

    Biden administration should remove Trump’s Social Security Administration appointees

    The Biden administration is going to have a lot of work to do in its initial days just in removing the Trump administration’s political appointees, among them those at the Social Security Administration. Joe Davidson writes in an opinion piece for The Washington Post that Social Security Works and other advocacy groups have a petition demanding that these Social Security Administration Trump appointees be removed, signed by nearly 230,000 people. The Association of Administrative Law Judges and National Council of SSA Field Operations Locals agree, saying they have “no confidence” in Commissioner Andrew Saul and Deputy Commissioner David Black.

    Social Security Works is also asking President-elect Joe Biden to remove Deputy Commissioner Mark Warshawsky. Social Security Works says that he is behind Social Security’s attack on people with disabilities. The current Social Security administration is conducting more eligibility reviews of people with disabilities that can lead to lower or no benefits. And, a proposed regulation calls for  reviewing eligibility at the “earliest point” to ensure people return to work as soon as possible.

    Biden has not agreed to removing Commissioner Saul. Even if he does, it might not be easy, although Social Security Works says that the Supreme Court gives the President the authority to do so. Trump appointed Saul for a six-year term ending 2025. It’s also possible that Saul might agree to resign.

    With Saul as Commissioner, Biden could face a challenge reversing the SSA final regulations as well as the ones that are still pending. It appears that the law requires the Commissioner to do so.

    According to Social Security Works, Trump’s appointees have closed Social Security field offices, reduced staffing and more to make it hard to get Social Security benefits. In addition, they have left people feeling unsure about Social Security’s future.

    President Obama appointed Carolyn Colvin to head the Social Security Administration. But, the Republican-led Senate would not confirm her appointment. Consequently, SSA has only been run by Senate-confirmed Democratic appointees in eight of the last 40 years.

    Saul and his Republican colleagues at SSA also want to put SSA lawyers in charge of hearing appeals from people with disabilities challenging the denials of their eligibility for benefits. Putting SSA lawyers in charge would prevent these appellants from having administrative law judges conduct independent reviews or from having judges with experience conduct reviews.

    Alex Lawson, Executive Director of Social Security Works says: “Union busting and the demoralization of the SSA workforce is causing many employees to resign. This makes it difficult for SSA to provide beneficiaries with a high-quality level of service. The agency needs new leadership at the top who will work to strengthen the agency and make it a desirable place to work, instead of driving people away.”

    Here’s more from Just Care:

  • Trump administration attempts to privatize traditional Medicare

    Trump administration attempts to privatize traditional Medicare

    The Trump administration is deep into rolling out a pilot plan that, over time, could privatize the public fee-f0r-service Medicare program unless the Biden administration hits the pause button on its implementation. Several open issues with this payment and care delivery or “Geo” model–a capitated payment system–highlight its ability to undermine access to care for millions of older and disabled Americans who might be forced into it.

    1. How can CMS ensure that capitated corporate plans regulating access to care for people in traditional Medicare won’t undermine quality of care or increase costs? Government audits indicate that capitated corporate Medicare Advantage plans systematically engage in widespread inappropriate delays and denials of care. They also overcharge the government for their services to the tune of billions of dollars a year. And, MedPac continues to report that taxpayers are paying more for them on a per capita basis than for people in traditional Medicare. Moreover, Medicare Advantage plans have not released accurate and complete encounter data, as required by law, which would allow a meaningful assessment of each of them.
    2. How will CMS effectively assess quality based on consumer surveys and “measuring outcomes?” Information from people who are relatively healthy is of little relevance as they don’t use the health care system much. The 20 percent of people with Medicare who are very ill or who need complex care will likely be unable to assess and report the quality of care they receive.
    3. How will the government know whether the GEO model improves quality without increasing costs over the short and long-term? How will CMS uncover fraud, detect inappropriate care, or identify practices that harm patients without this data?The model does not provide for a meaningful way for CMS to oversee the direct contracting entities (DCEs) that will be assuming full financial risk for all medical and hospital services people receive. It does not call for the DCEs to turn over encounter or claims data. 
    4. What protections will be available to people in Medicare who are forced into the GEO model if they are unable to get the care they need? The model does not allow them to opt out. Their out-of-pocket costs should not increase, but how will CMS know if they do?
    5. CMS suggests that the DCEs, corporations assuming full financial risk, can use “value-based” payments to providers. How will DCEs determine value-based payments? Will these payments lead physicians to delay and deny people needed care?
    6. Some people with Medicare need a substantial amount of care during the course of the year.  How will CMS know whether people with complex and costly conditions are getting the care they need rather than low-quality ineffective care or no care at all?
    7. Given that Medicare rates are already significantly lower than commercial rates, does CMS believe that high-quality providers will accept lower rates from DCEs? 
    8. How will CMS know whether DCEs are fostering health inequities, rationing care based on ability to pay and ability to navigate their complex system?
    9. What assurances are there that DCEs wouldn’t end up behaving like chain nursing home owners, pocketing the vast share of their government payments and leaving our nation’s most vulnerable people without access to care? How will they be held accountable if they do? Even if CMS were able to analyze every aspect of DCEs, DCEs can change their methodologies as they please when they please. 

    Everyone wants a healthcare system that improves quality and reduces costs. But, conducting this large scale costly social experiment with vulnerable older adults and people with disabilities seems imprudent and misguided at best.

    Here’s more from Just Care:

  • Avoid buying junk insurance

    Avoid buying junk insurance

    The Obama administration banned the sale of junk health insurance–policies that offer only limited coverage–as an alternative to comprehensive coverage because junk insurance provides very limited coverage. President Trump lifted that ban so that insurers could sell people policies that cost less than comprehensive coverage. But, when it comes to health insurance, less does not offer the protection people need, causing much pain and financial distress. Who should beware?

    Fortunately, people with traditional Medicare or a private Medicare Advantage plan are not buying junk insurance. Health insurers are not allowed to sell junk insurance to older adults and people with disabilities with Medicare. People with Medicare have “comprehensive” coverage.

    However, if you get really ill and need costly care, beware of denials from your Medicare Advantage plan and/or out-of-pocket costs that could be as high as $7,550 a year beginning in 2021. In traditional Medicare, you need supplemental coverage to protect yourself from financial risk. With that, you should have few out-of-pocket costs.

    Younger people need to recognize the difference between junk health insurance and comprehensive coverage. Michelle Andrews reports for Kaiser Health News on the fate of a 31-year old man whose insurance broker convinced him to buy junk insurance because it was less expensive than insurance available to him on his state health insurance exchange. When he was diagnosed with stage four cancer, his insurance would not cover his costly care. His junk insurance only provided limited benefits and did not cover treatment for his “pre-existing conditions.”

    Keep in mind that big insurers market their junk health insurance wherever they can and don’t explain to you that they do not offer comprehensive coverage. In the case of this man, his junk insurance was issued by UnitedHealthcare. And, it did not cover the stem-cell transplant he needed or, for that matter, $800,000 in bills he incurred to treat his cancer.

  • Coronavirus: Lack of timely data jeopardizes public health

    Coronavirus: Lack of timely data jeopardizes public health

    In a new report, Sins of Omission: How Government Failures to Track Covid-19 Data Have Led to More Than 1,700 Health Care Worker Deaths and Jeopardize Public Health, National Nurses United (NNU) underscores the need to reform our health care system. Federal and state governments do not have systems in place to protect  the health and well-being of Americans, much less our nation’s nurses and other health care workers.

    NNU reports that more than 1,700 health care workers have tested positive for COVID-19. Of those, at least 213 registered nurses have died unnecessarily. The federal government does not have the systems in place to keep health care workers safe in a pandemic. Hospitals and other health care companies are not reporting infection rates or deaths accurately or in real time. Workplaces have not been safe.

    Without reliable and timely information, there is no way to respond effectively to the novel coronavirus pandemic. We need to know where the virus is, we need the resources to protect people in those areas, and we need to know what is working to contain the spread of the virus. The NNU report explains that rather than tracking this data, federal and state governments are hiding it or ignoring it. They are also playing with available data to mislead the public.

    Federal and state governments are not requiring health care facilities to turn over mortality or infection rate data. Of course, these facilities have no interest in so doing. It could tarnish their images.

    Fewer than one in three states are providing infection data for health care workers. Without good data, there is no way to understand the breadth of the pandemic. There is no way to respond to it as warranted.

    The Centers for Medicare and Medicaid Services (CMS) has only required nursing homes to provide mortality and infection rate data for health care workers. That data is publicly available on its web site. Hospitals are not required to collect this data.

    The Trump administration has kept a lot of the COVID-19 data hidden at the department of Health and Human Services (HHS). It has traditionally been kept by the CDC, but the administration transferred it to HHS. The Trump administration is interfering in scientific work and failing to release accurate public health information. To be sure, it is not coming up with a strong national plan to keep the novel coronavirus from spreading.

    The CDC must be charged with tracking this data and given the resources and tools to do the job that is needed. Data should be independent and not played with for political or business reasons.

    Specifically, NNU calls for:

    • Daily reporting of data (as well as cumulative totals) on diagnostic testing and case counts at national, state, and county/local levels.
    • Daily reporting and cumulative totals of data on health care worker infections and deaths at an establishment level, such as the specific hospital or business.
    • Data on symptomatic cases must be reported at national, state, and county/local levels (influenza-like illness and Covid-like illness).
    • Daily reporting of data on hospitalizations and deaths must be reported at national, state, and county/local levels.
    • Hospital capacity data must be reported at national, state, and county/local levels; must be updated in real time; and must include total and available hospital beds by type (e.g., ICU, medical/surgical, telemetry, etc.), staffing, health care worker exposures and infections, and nosocomial (hospital-acquired) patient infections.
    • Data on the stock and supply chain of essential personal protective equipment (PPE) and other supplies must be reported at national, state, and county/local levels.

    Here’s more from Just Care:

  • Trump administration drug proposals will keep prices high

    Trump administration drug proposals will keep prices high

    Nicholas Florko reports for Stat News on minor and arguably risky efforts by the Trump administration to drive competition in the Medicare Part D prescription drug marketplace through the promotion of biosimilars and generic drugs. The administration’s drug proposals will keep prices high. To bring down drug costs, Congress should set prices at the average of what other wealthy countries pay for them.

    One administration proposal would give bonuses to Medicare Part D drug plans if they steered their members towards generic drugs. Right now, drugmakers pay insurers to push their costly drugs, so the insurers tend to do so. Another proposal recommends that insurers create a special low-cost tier in their formularies for lower-cost medicines.

    Promoting the use of generic drugs or biosimilars, which are generic versions of biologicals made from living cells, should not be controversial. They make sense. But, for a host of reasons, patient advocates, pharmaceutical companies, health insurers and pharmacists are pushing back against these proposals. 

    Of course, health insurers should not need to be incentivized to promote generics and biosimilars. But, they are not doing so in many instances where they should be. So, the Centers for Medicare and Medicaid Services (CMS) has proposed that it would factor in the frequency with which Part D insurers have patients taking generics and biosimilars as part of their star-rating, which in turn affects the amount of money CMS pays them.

    One issue is that insurers receive rebates, money back from pharmaceutical companies, when they put certain brand-name drugs on their formularies and promote them. The insurers say that sometimes these rebates make brand-name drugs less costly than generic drugs. So, they argue that pushing generics could drive up costs.

    The pharmaceutical companies argue that biosimilars are not identical to biologics. So, it would be wrong to push the biosimilars in many cases.

    What’s particularly troublesome about the fights over these proposals is that the insurance and pharmaceutical industries seem to win them with the argument that they will drive up costs because pharmaceutical companies will respond with higher prices for drugs. The fact is that any attempt to “save” money can be met with higher brand-name drug prices since Congress has given pharmaceutical companies the power to set prices through the patent system.

    For brand-name drugs, pharmaceutical companies control the price. Insurers will pay an agreed upon high price because they will benefit financially–with a rebate–from the pharmaceutical companies. So long as drugmakers can set the price and insurers can pocket rebate dollars–they can also keep the amount of the rebates secret–there’s no way for the American public to see lower drug prices.

    The simplest and fairest solution in a global marketplace is for the federal government to establish drug prices in the US that are on average what other wealthy countries pay for their drugs. Although President Trump at one point argued that Americans should not be paying higher drug prices than people in other wealthy countries, it appears he has since been swayed otherwise.

    Here’s more from Just Care:

  • Trump administration proposes rule that would take benefits from people with SSDI

    Trump administration proposes rule that would take benefits from people with SSDI

    Arthur Delaney reports for The Huffington Post on a Trump administration proposed rule which would make it harder to receive Social Security disability benefits and Medicare, if you are under 65. If finalized, the rule is expected to take SSDI benefits from thousands people with disabilities.

    As it is, it is very difficult to qualify for Social Security Disability Income (SSDI). The majority of people who apply are denied benefits.  But, some people who do qualify for benefits may now be at risk of losing them.

    The administration’s proposal could hurt tens of thousands of Americans. If the policy becomes law, some people with disabilities will need to get certified as disabled more frequently. 

    The administration argues that some of the eight million people with disabilities receiving SSDI benefits should not be receiving them. It believes that there are many older workers with conditions that were likely to improve when they received SSDI who no longer qualify for SSDI because their conditions have improved. It claims that these people are able to work, and it wants them off Social Security. 

    The administration claims that the proposed added reviews would identify people who no longer qualify. But, it could also cut people off of SSDI who do qualify. For example, people with disabilities are at risk of losing their benefits if they are unaware of the need for an additional review or unable to navigate the review process even if their conditions have not improved. If the rule goes into effect, the Trump administration expects to conduct 2.6 million additional reviews.

    To be clear, reviews are already in place for SSDI recipients, depending upon whether they are classified as having conditions that are “expected to improve,” “possible to improve” or “not expected to improve.” The Trump proposed rule would add a fourth category of “likely to improve.” This category fits between “possible to improve” and “expected to improve.”

    The Trump administration hopes to save Social Security two hundred million dollars a year in benefit outlays. It also plans to spend an additional $180 million a year on reviews. The net gain is $20 million a year and the loss could be thousands of people wrongly cut off disability benefits.

    At this point, the rule is not in effect. And, there is no indication when it will become final or whether a lawsuit or public pressure could stop the rule from going into effect. Calling the Trump administration proposal “harmful and unjustified,” more than 140 members of Congress have signed open letters urging SSA to withdraw it.

    Here’s more from Just Care: