Our wholly unholy safety net

A few Were you aware? questions to start off.

Were you aware that telemedicine-telehealth is not covered by Medicare effective September 30, 2025?

Were you aware that currently, the Bureau of the Census can arbitrarily define what is rural and what is not? Which affects funding for rural hospitals and clinics…

Were you aware that Medicare and related do not cover behavioral or mental health services provided by rural clinics?

Were you aware that in some states, SNAP benefits can be as low as $23/month?

Were you aware that a public health emergency has existed in Texas since July 2, 2025? It only took Bobby two months to make it official.

Were you aware that AI is making Medicare decisions now? Were you aware that Public Law 119-21, aka the Big Bad Bill, drastically increased the number of services covered by Medicare that require preauthorization? And that AI is wrong 81.7% of the time on those decisions?

Were you aware that there is a bipartisan Congressional Coffee Caucus? I want an invite!

Above the fold: Thanks to two Republicans in the House who are conservative, but who put aside party to vote on “safety net” issues that are generally deemed “Democratic” – for reasons known only to other Republicans. Michael Lawler-NY and Brian Fitzpatrick-PA, thank you.

Could you please explain to the rest of us what it will take to spread that sense of working together for common cause?

Read on for more.

BAZINGA

My favorite Democratic bill, however, has to be H.R.5609 – Stop RFK’s BS Act (Stop RFK’s Bad Science Act). Haley Stevens (D-MI) and Ted Lieu (D-CA), take a bow. That bill would restore all NIH grants or research suspended after January 21, 2025.

RURAL HEALTHCARE

For details, see legislation regarding rural hospitals and clinics: August 25, 2025 – October 9, 2025.

In September, a small bipartisan group of eighteen representatives – yes, “bipartisan” and “representatives” in the same breath – put forward a series of bills that would provide better access to healthcare for rural populations across America.

I learned a great deal from these five bills.

Did you know that telemedicine is not covered by Medicare effective September 30, 2025? Which is devastating for people living in small towns, who often rely on doctors or nurses in a distant city for prescription renewals, basic conversations regarding symptoms, or mental health sessions.

Did you also know that if a small-town clinic does not have an actual medical doctor helming the clinic or hospital, they don’t qualify for Medicare and related coverage? Did you know that currently, the Bureau of the Census can arbitrarily define what is rural and what is not?

Did you know that Medicare and related do not cover behavioral or mental health services provided by rural clinics?

I didn’t. And I live in a rural community.

Special note: Neither John Joyce nor Lloyd Smucker cosponsored any of these bills. Despite the fact that Joyce is a medical doctor and both represent rural communities.

MEDICAID

For details, see legislation affecting Medicaid: August 23, 2025 – October 3, 2025.

This snapshot does not make our Republican friends look very good, much less compassionate. The only “Republican” bill (no Democratic cosponsors) wishes to require states to increase investigations into Medicaid beneficiary fraud. It adds no new guidelines or regulations. Merely the very loud assumption that Medicaid fraud is prevalent and deserving of extra attention.

Democrats, on the other hand, are working to undo devastating changes to Medicaid contained in Public Law 119-21, aka the Big Bad Bill. They’re ensuring that Medicaid recipients receive mental health benefits. One bill sponsored by a Republican (Earl Carter), but which has no Republican support, would ensure that individuals with sickle cell disease receive “comprehensive, coordinated care” under Medicaid.

The only glimmers of hope come from two bipartisan bills. One would allow states to release excess Medicaid funds to hospitals in their state (making up for Public Law 119-21 cuts). The second, named the Michelle Alyssa Go Act, expands mental health coverage under Medicaid.

We the people are only as strong as our weakest link.

SNAP, FMLA, AND OTHER SAFETY NETS

For details, see SNAP, FMLA, and other safety nets: August 25, 2025 – October 9, 2025.

In alphabetical order. None of these programs is “more important” than others. It depends on your personal circumstances as to how you would rank their importance.

ADA

Video of September 9, 2025 meeting entitled, “Untapped Talent in America: Removing Barriers to Work and Supporting Opportunity for Individuals with Disabilities.” Transcript and meeting documents not yet available.

FMLA

God bless ‘em. Rep. Rosa DeLauro (D-CT) and Kirsten Gillibrand (D-NY) are trying one. More. Time to get a paid Family and Medical Leave Act passed. Democrats are out in full force on this one. One-hundred-and-ninety-one Democratic Representatives and zero Republicans cosponsored DeLauro’s bill. Gillibrand’s bill has been drafted but not yet introduced. Watch this space next month for the Senate version.

Meanwhile, on the Republican side of the aisle, Rep. Ashley Hinson (R-IA) introduced a bill with no cosponsors that would amend the existing FMLA (unpaid leave) to include entitlement to leave “because of the spontaneous loss of an unborn child of the employee or spouse of the employee.” Shouldn’t someone tell her that in many states, women would be scared to death to declare the “spontaneous loss of an unborn child”?

LABOR AND UNEMPLOYMENT

Once again, Democrats go where Republicans dare not go. Even something as simple as grants to train workforce for the agricultural industry could not get Republican backing. You can guess how many Republicans supported bills that would allow individuals engaged in a labor dispute to receive unemployment benefits, or that would permit people to exclude strike benefits from gross income.

If you guessed zero, you would be right.

But the House bill allowing unemployment benefits while engaged in a labor dispute – including occasions when the employer hires permanent replacement workers or locks out striking union employees – had thirty-four Democratic cosponsors.

LOW INCOME HOUSING

Mark Warner (D-VA) introduced two nice pieces of legislation that would provide assistance to first-time homebuyers (S.2719) or “provide technical assistance and grants for faith-based organizations, institutions of higher education, and local governments to increase the supply of affordable rental housing,” to which he brilliantly affixed the short title, Yes in God’s Backyard Act. No Republicans cosponsored.

Linda Sánchez (D-CA) had a bit more bipartisan luck with H.R.5529, Fair Housing for Disabled Veterans Act. Veteran disability compensation would be disregarded in determining income for purposes of the low income housing tax credit and qualified residential rental project bonds.

SNAP

Democrats are working hard to make it easier for the “poorest among us” to qualify for SNAP without embarrassment or shame. Whether outreach programs to low-income seniors, or granting individuals with “drug offenses” to qualify for SNAP, or reinstatement of previous exemptions for homeless individuals, veterans, and former foster youth – they are trying to level the playing field. And are encountering no cooperation from Republican colleagues in either the Senate or the House.

I learned something. I didn’t know that SNAP benefits were based on a calculation of a “thrifty food plan” = family of four consisting of one man and one woman between 19-50 years of age, one child between 6-8, and one child between 9-11. Currently SNAP benefits are minimum of $23/month (yes, really) with maximum of $994, depending on which state you live in.

Alma Adams proposes that the USDA determine SNAP benefits based on their calculations for a low-cost food plan, and not the bare bones “thrifty” plan, removing the thrifty plan altogether.

If you’ve ever struggled to buy groceries (and don’t assume you’ll never be “there”), you’ll appreciate Alma’s legislation.

The only Republicans participating in the SNAP discussion: Michael Lawler (R-NY) cosponsored the bill regarding simplification of the SNAP process for low-income senior citizens. John Rutherford (R-FL) cosponsored the bill that would allow individuals with drug offenses to qualify for SNAP. And Jon Husted (R-OH) introduced a bill with no cosponsors that would allow students in trade schools to exclude income earned during training for determining SNAP eligibility.

Otherwise, crickets.

SOCIAL SECURITY, MEDICARE, and MEDICARE ADVANTAGE

For details, see legislation affecting Social Security and Medicare: August 22, 2025 – October 9, 2025.

I know you will be shocked to learn that RFK Jr. issued an executive communication to the Committee on Energy and Commerce declaring that a public health emergency exists and has existed in the State of Texas since July 2, 2025. EC1800 was issued on August 29, 2025. On top of things, aren’t you, Bobby?

Bipartisan legislation

There was a bit more bipartisanship than I expected. Legislation would keep the cost of prescription drugs down. Would require hospitals to provide Naloxone free of charge to prevent opioid overdoses. Would include blood contamination as a “hospital acquired” condition under Medicare (you mean it isn’t already?!).

One bipartisan bill I especially liked: H.R.5281, requiring accountability for provider directory accuracy under Medicare Advantage. I wish it applied to Medicare as well.

H.R.5439 authorizing a pilot program of “medically tailored home-delivered meals” for individuals with “diet-impacted disease (such as kidney disease, congestive heart failure, diabetes, chronic obstructive pulmonary disease)” also found bipartisan support. As did a bill to do something about the shortage of medical laboratory personnel, such as phlebotomists and lab techs – grants to schools along with student loan forgiveness to incentivize that line of study.

Also getting bipartisan support: A bill ensuring that Medicare Advantage providers are paid promptly. And another, which would require Medicare coverage of drugs prescribed for autoimmune diseases.

The reauthorization bill to extend funding for the Special Diabetes Program for Indians has both Republicans and Democrats on board. As does H.R.5496, which would make telehealth services permanently covered by Medicare. Coverage for telemedicine expired on September 30, 2025.

PFAS testing for seniors would be covered – bipartisan bill. And coinsurance payments for certain services furnished in an ambulatory surgical center would be limited. And H.R.5644 would establish new payment rules for certain catastrophic specialty hospitals under the Medicare program.

Republican legislation

Far less in the way of Republican legislation. What there is, is mostly detrimental to people relying on Social Security, Medicare, and Medicare Advantage.

Republican bills would ensure that home health agencies get paid. Recognizes the damage done to prescription drug costs by middlemen – no solutions offered, just recognition of a fact. Seeks to reform the 340B drug pricing system, and since it’s only Republicans cosponsoring, I have to assume it does not benefit those of us who buy prescription drugs.

Glenn Grothman (R-WI) introduced the “Randy Susen Visitation Rights Act of 2025.” When I read the short version, I wondered that no Democrats cosponsored and that Paul Gosar did. Until I read the bill and Grothman’s press release about it. If you thought for a New York minute that Grothman introduced a bill allowing “unmarried” partners of LGBTQ+ or others to visit family and friends in a hospital or skilled nursing facility, you’d be wrong. Grothman’s bill prohibits hospitals and skilled nursing facilities from preventing loved ones to visit patients… who are in wards for care of “highly infectious” diseases.

Democratic legislation

Although none of this stands a snowball’s chance in Vegas of even making it past committee, it’s nice to see how Democrats are thinking.

Three weeks before H.R. 5496, which would make telehealth services permanently covered by Medicare, was introduced with strong bipartisan support, Earl Carter (R-GA) and a passel of Democrats introduced legislation which would have extended it to September 30, 2027.

The cost of so-called “orphan drugs,” which Public Law 119-21 (the Big Bad Bill) removed from pricing constraints, would be lowered. Democrats want orphan drugs subject to pricing regulations same as other drugs. And Maxine Waters with the support of dozens of Democrats proposed that HIV prevention drugs be provided at no cost under Medicare, Medicare Advantage, and Medicaid.

Democrats are also fighting back against the doge-ification of Social Security and Medicare, calling for a halt to the use of AI to determine Medicare coverage. Another resolution calls for an end to the Wasteful and Inappropriate Service Reduction Model (WISeR), which not only employs AI in Medicare decision, but which requires preauthorization for 30% more Medicare decisions. Democrats point out in this resolution that when challenged, AI-WISeR decisions are overturned 81.7% of the time.

Jennifer McClellan (D-VA) introduced a bill which would require greater public transparency of supplemental benefits of Medicare Advantage providers, demanding annual reporting on a number of KPIs.

Bills would provide Medicare coverage of inhalers and nebulizers. Would make all vaccines recommended by the CDC as of October 25, 2024 free under Medicare, Medicaid, CHIPs, and group-private health insurance plans. Would make fall prevention items such as rails and grab bars covered under Medicare. Would eliminate the coinsurance requirement for colorectal screening tests.

Val Hoyle (D-OR) introduced H.R.5433, Patients Over Profits Act. This would prohibit health insurance issuers and certain health care providers under Medicare from being under common ownership. It’s a simple ethics bill. No Republican cosponsors.

Democrats also pushed back strong against an executive communication involving Medicare, EC1949, dated September 17, 2025. The very same day, Emilia Strong Sykes (D-OH) and thirty-one of her Democratic colleagues, and not one damn Republican, put forward H.Res.123, Providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Centers for Medicare & Medicaid Services relating to “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability.” Taking back their power! That EC is on my FOIA list.

Poignant legislation proposed by Sydney Kamlager-Dove (D-CA) regarding “kinship guardianship” and related, “for children who cannot be safely cared for in their own homes.” Both her H.Res. 771 and H.R.5583 are a master class in caring legislation. I wasn’t familiar with her before this, but I am paying attention now. On her Web site, she says she’s a “caring creative.” Yes, she is. (But why, oh why, is this a “Democratic” bill? Can someone explain that to me?)

Numerous executive communications regarding Medicare, especially drug pricing. I hate that the texts of those are not public.

HEALTHCARE

For details, see legislation that affects our health: August 22, 2025 – October 9, 2025. In this summary, I am omitting technical legislation. If healthcare is your thing, please read the details.

Bipartisan legislation

More than I expected. (Note that if fifty million Democrats cosponsored and the only Republicans were Brian Fitzpatrick and Michael Lawler, it’s “Democratic” and not bipartisan.)

Training programs for medical personnel generally received bipartisan support. Nurses, medical students who will serve in medically underserved communities, and physical therapists would all see more scholarships and greater student loan forgiveness after graduation.

Legislation would reduce the threat to human health posed by exposure to indoor air contaminants in schools. Another bill would raise awareness of colorectal cancer among young people.

Organ donations are covered in great detail in one bill, especially reporting on source and efficacy of transplants. Newborns would be screened for congenital Cytomegalovirus. Digestive health would get a boost. Representatives from both parties want the CDC to study the effect of social media on children’s mental health.

Reauthorizations of Stem Cell Therapeutic and Research Act, as well as the Special Diabetes Programs for Type I Diabetes, found bipartisan sponsorship. Both Republicans and Democrats agreed that hospital billing should be written in plain language, full disclosure, transparent.

The House Energy and Commerce Committee recommended that the full House consider making TeleHealth grant programs permanent (now they need to provide coverage of telehealth under Medicare), and reauthorized George H.W. Bush’s Healthy Start (Head Start) program.

A few mental health measures enjoyed support from both sides of the aisle. One would require the Secretary of Health and Human Services to carry out a pilot program to support evidence-based mental health peer support activities for students. LGBTQ+ youth would see 9-8-8 suicide hotline services geared for them, added to the current offering.

I learned something new: Farmacy! The Food Farmacy Act has bipartisan support, although not strong (yet).

Republicans and Democrats also joined together on some resolutions. H.Res.666 supports “the goals of Overdose Awareness Day and strengthening efforts to combat the opioid crisis in the United States.”

Both parties signed on to resolutions for prostate cancer awareness, malnutrition awareness, rare cancer challenges, hydrocephalus research, gynecologic cancers awareness, and dyspraxia research and awareness.

The best bipartisan resolution? H.Res.784 - Recognizing the value of coffee to the United States and expressing support for September 29, 2025, to be designated as “National Coffee Day.”

Republican legislation

Nastiness showed up in the GOP title for a September 9 meeting: Hearings to examine how the corruption of science has impacted public perception and policies regarding vaccines. I would wager that most Democrats would agree, but not as the Chair of the committee intended.

Otherwise, Republicans worried about ensuring we have access to compounded medications. That Nevada should do something about “certain psychedelic compounds.” That the Biden-era rules regarding medications used in opioid treatment programs be nullified. That states providing substance use prevention services have lots more reporting to do.

Michael Lawler recognized that Trump’s Executive Order regarding Bobby’s MAHA is not law, and introduced a bill to codify it. Lawler also introduced a resolution expressing support for the designation of September 19, 2025, as Black Autism Acceptance and Awareness Day.

Democratic legislation

Grace Meng did what Bobby says he wants and introduced a bill that would cause certain food dyes to render food “adulterated.” She’s a Democrat. No Republicans cosponsored.

Democrats introduced bills that would allow wheelchair users to get their chairs repaired. That would prevent health risks of heat (no Texans cosponsored). That would require epinephrine to be covered by all health insurers. That would establish an advisory council for research into headache disorders.

Democratic bills also seek to expand the pool of health professionals. One bill with strong support would expand grants to schools that accept well-qualified low-income students, allowing them the freedom to study without financial worries. H.R.5370 in case you’re interested. Another would require a “set-aside” for Indian populations under the health profession opportunity grant program. Yet another bill would add faith-based programs with proven track records to the short list of those eligible “to address persistent health inequities and disease challenges.”

Democrats proposed numerous resolutions concerning suicide prevention. One stressed parity for mental health services – same as physical health. Another would officially recognize suicide as a public health problem (Michael Lawler + 35 Democrats). Yet another concentrated on youth suicidal ideation and called for “increased investments in youth mental health.”

Shri Thanedar (D-MI) penned an eloquent resolution (H.Res.697) recognizing suicide as a serious public health problem and expressing support for the designation of September as “National Suicide Prevention Month” as well as September 10, 2025, as “World Suicide Prevention Day.” Fifty-two Democrats plus our friends Michael Lawler (R-NY) and Brian Fitzpatrick (R-PA) cosponsored.

Other Democratic resolutions focused on fall prevention. On contraception. Another – thank you, Delia Ramirez (D-IL) – recognized the psychological impact of immigration enforcement overreach on individuals, their families, and their community. If ICE violence bothers you, read her resolution.

COMMENT WORTH KEEPING

Thanks, Denise. This is a great in-depth overview and helps my jumbled mind keep things straight.

--PJ Hinton, October 14, 2025.

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