Author: Maria Martinez

            The U.S. Public Health Emergency (PHE) that began at the start of the COVID-19 pandemic concluded on May 11, 2023, ending the temporary policies started in response to the pandemic. These changes have affected the American public in different ways. For those with Medicare, over-the-counter COVID-19 tests are no longer free, and coverage regarding COVID-19 testing and treatment will change depending on the insurance plan. Another change that comes with the termination of the PHE is that COVID-19 vaccines and boosters will continue to be free, but only until the federal stockpile lasts. While these changes might seem obvious as COVID is not as prominent as it once used to be, there are some changes that have negatively impacted underserving a community’s way beyond COVID-19 coverage.

            One of these changes includes Medicaid redeterminations restarting. Continued Medicaid enrollment ended March 31, 2023, and states have restarted Medicaid and Children’s Health Insurance Program (CHIP) edibility reviews. Some patients that usually do not qualify for Medicaid, did qualify during the PHE period. This means that these patients have the dreadful task of finding and transitioning to another type of insurance. Unfortunately, the only insurance option was Medicaid for some of these patients, as they could not afford anything else.

            A direct consequence of the end of the PHE will be the looming loss of Medicaid eligibility for the millions of Americans who come from low-income households. There could be as many as eighteen million enrollees without coverage as a result of the new eligibility requirements. The U.S. Department of Health and Human Services predicts that people of color will lose coverage because of administrative barriers, not because they don’t qualify in many instances. 

The end of PHE will affect more Black and Hispanic communities since they are twice as likely to be Medicaid recipients. This sudden cut in coverage will only worsen an already failing healthcare system for people of color; this is because the cut in coverage will reduce access to screenings and preventive care for chronic diseases that are more common in people of color, overload already overburdened hospitals with emergency care, and cripple low-income families with medical debt.

 To avoid or lessen all of these inequalities in the healthcare system, states must act as soon as possible. For example, states can market campaigns to encourage citizens to sign up for alternative care that has COVID-19 benefits, as well as communicate with Medicare enrollees so that they at least know their coverage is coming to an end. The state of Colorado has already taken a proactive approach to healthcare insurance by opening enrollment for a program called OmniSalud that assists undocumented residents and individuals with protections through the Deferred Action for Childhood Arrivals program in obtaining affordable healthcare insurance. Communities that lack these kinds of programs should follow suit and protect their most vulnerable residents.

  It is an overstatement to say that COVID has ended when it has not. It is important to remember that moving out of an emergency state does not mean the impact on vulnerable communities has concluded. It is imperative that states enact policies that prevent the worsening of COVID-induced inequities in the most vulnerable communities.

Gender-affirming care is a form of healthcare that includes medical, surgical, mental health, and non-medical services for transgender and nonbinary people. Early-gender affirming care is crucial to the well-being of transgender and nonbinary children (TGNB) and adolescents because it helps with social transitions and can provide resources while navigating the complicated American healthcare system. Overall, the gender-affirming care model affirms diversity in gender identity and highly focuses on the needs of each individual. 

Gender-affirming care is important. In the United States alone, an estimated 1.4 million people identify as transgender, and 1.2 million adults identify as nonbinary. Studies have shown that receiving gender-affirming care has been associated with lowering nearly 73% of the odds of suicidal thoughts among TGNB. Many prestigious medical organizations such, as the American Academy of Pediatrics, the American Medical Association, and the Endocrine Society, support gender-affirming care. 

Unfortunately, a number of bills have been introduced in the last two years attempting to limit, ban, or criminalize access to gender-affirming treatment for minors. Republican state senators have taken several measures to limit access to gender-affirming care by banning critical components of this care such as puberty blockers, hormone therapy, and surgeries for minors. For example, the “Arkansas Senate passed a bill prohibiting doctors from treating transgender, and nonbinary minors (TGNB) with puberty blockers and gender-affirming surgery…” To that end, Arkansas is not the only state to propose these types of bills. Just last month, Tennessee’s Senator Jack Johnson opened a discussion on a bill he is co-sponsoring to limit gender-affirming care such as hormone therapy and other medical services for TGNB. Moreover, there is recent news that Georgia Congresswoman Marjorie Taylor Green will introduce a bill calling gender-affirming care for minors a felony. Congresswoman Green called gender-affirming care “a new-disturbing ideology” that is making billions from “confused children who believe they are transgender.” Several states across the country have acted to restrict such care for minors. 

Although the ideology behind restricting gender-affirming care for minors was due to minors not having the “mental capacity to make such decisions,” republican senators are now also reaching out to take away access to affirming care from low-income people, including adults. Senator Jackson is also backing the HB1215 bill which prohibits Tennessee’s Medicaid program from working with healthcare insurance companies from covering gender-affirming care. Until this year, most proposed legislation targeted people under 18, but now some block Medicaid from covering it for all ages. 

While the opposition against gender-affirming care started to “protect” youth, now it is targeting all the transgender and nonbinary communities. Transgender rights advocates view bans on gender-affirming care as part of a broader attack on transgender rights. To have gender-inclusive health care means to have gender-affirming care as an option for transgender and nonbinary people.  

In recent years, plant-based meat products have gone from an option for a vegan diet to a popular dish, in fact one in every ten Americans say they do not eat meat. However, plant-based meat products are no longer the only alternative to traditional meat. Cell-based meat is a new alternative that is way “beyond” plant-based meat—it is real meat. Cell-based meat is grown in a laboratory from cells taken from living animals. This technique requires zero animal slaughter,  uses fewer natural resources,  potentially produces less air pollution, and yields less potential for environmental contamination.

The evolution of cell-based meat and sea food as a potential human food has resulted in significant disagreement about how and who should regulate the products. Since cell-based meat is produced by stem cells obtained from the species of livestock and parts of the animals, the meat may satisfy the U.S. Department of Agriculture’s (USDA) current definition of meat and trigger its jurisdiction. Still, the Food and Drug Administration (FDA) has jurisdiction over most food products according to the Federal Drug and Cosmetic Act, which authorizes, among many other things, the FDA’s jurisdiction over biologics. Appropriately, the FDA has taken the lead role involving the safety determination of new biotechnological approaches to foods. Under 7 U.S.C § 1639(1), bioengineered food refers to food made up of genetic material that is modified in vitro using certain laboratory techniques and which modification could not have been obtained through conventional breeding or found in nature. The FDA and USDA agreed in 2019 to ensure that, when it comes to the market, cell-based meat is “safe and properly labeled.” FDA will oversee the cell collection, banking, and growth, using existing rules such as facility registration, and Current Good Manufacturing practices while USDA will conduct inspections and develop labeling for cell-based meat.

When asked about consumers being worried about a product in the market that may have such recent FDA approval, Arye Elfenbein, co-founder at Wildtype Foods, one of the food biotechnology companies that is currently working on the field of cell-based salmon, answered “the imminent availability of cultivated meat and seafood options have resulted in an illuminating dialogue between us and our future customers… the process of FDA consultation has mirrored our discussion with future customers, resulting in a thoughtful and productive exchange from the beginning.” He also added that “the process with FDA is one that has transpired over the past 4 years; it’s been an extremely thorough review, one that we believe will further bolster customer confidence when these products hit the market,” giving us a bit of an insight of the rigorous FDA approval process every cell-based startup is currently going through.

In December 2020, Singapore became the first nation to approve the sale of cultivated meat—chicken nuggets from the company Eat Just. In comparison the U.S. seems to be making regulatory strides to get cell-based meat approved by administrative agencies. The agencies published a request for comment in November of last year, asking interested parties to suggest what the cell-based meat should be called. More excitedly, as of November 16, 2022, the FDA announced the pre-approval of Upside foods, a cell-based chicken startup, making it the first company in the U.S. cell-based space to receive pre-approval from FDA. Products are expected to appear as early as 2023, and it will be interesting to see how the American public will respond to this new innovative and refreshing idea to the market.