September 2018

Republicans are scrambling to rewrite their history of opposing protections for pre-existing conditions now that they have been caught for their years of supporting health care repeal and sabotage. In addition to scrubbing their websites of mentions of repeal, House Republicans are trying to hide behind two figleafs — a bill (H.R. 1121) and a House resolution (H. Res. 1066) — that they falsely claim are evidence that they are on the right side of this issue. 

These pieces of legislation are nothing more than hollow promises that read well but in reality fail to protect people with pre-existing conditions from attacks by the Trump administration and their own earlier votes. Here’s what you need to know:

Two thirds of those who signed on to the House resolution (H.Res. 1066) voted to repeal the Affordable Care Act last summer. Of the 28 members of the House who have signed on to the resolution expressing support for pre-existing condition protections, 19 voted for the Republican repeal bill last summer. Last year’s repeal bill, the AHCA, would have dramatically weakened protections for 130 million Americans with a pre-existing condition, allowing insurance companies to charge people more when they get sick, for instance up to $140,510 more for people battling metastatic cancer.

All but eight co-sponsors of the House bill (H.R. 1121) voted to repeal the Affordable Care Act and weaken pre-existing condition protections last summer. Of the 75 cosponsors who voted on the AHCA last summer, 67 voted in favor of repealing the Affordable Care Act and weakening protections for 130 million Americans with a pre-existing condition. Their vote would have allowed insurance companies to charge people with pre-existing conditions more for coverage.

None of the co-sponsors of either the bill or the resolution have shown they oppose the Republican lawsuit backed by the Trump Administration that would completely gut protections for people with pre-existing conditions.

And, in reality, neither piece of legislation actually protects people with pre-existing conditions. The resolution’s language, intentionally vague, includes no specifics on exactly which protections should be preserved. Though H.R. 1121 prevents insurance companies from denying coverage to people with pre-existing conditions, it does nothing to prevent insurance companies from charging people with pre-existing conditions more for coverage or reinstating annual and lifetime limits that insurers use to restrict the amount of coverage someone can use, and it does not preserve the Affordable Care Act’s essential health benefits, essentially allowing insurers to sell plans exempt from covering basic services like maternity care, hospitalization, and prescription drugs. Absent such protections, an insurance company could sell coverage to a cancer patient, but charge them more and drop their coverage once they reach their lifetime limit.

If House members really wanted to defend people with pre-existing conditions, here are two concrete actions they could take:

• Support the House Democrats’ resolution that would allow the House to defend pre-existing condition protections in court. This summer, the Trump Administration refused to defend against a lawsuit brought by 20 conservative states aimed at overturning the Affordable Care Act and its protections for people with pre-existing conditions. In July, House Democrats introduced a resolution that would authorize the General Counsel of the House of Representatives to intervene in the lawsuit and defend protections for people with pre-existing conditions. Not a single Republican has offered support.
• Join the House effort to overturn Trump administration’s junk plan rule that lets insurance companies discriminate against people with pre-existing conditions. This summer, the Trump Administration finalized a rule that allows insurance companies to deny coverage to people with pre-existing conditions. Experts warn that this move will only increase the cost of comprehensive care, ultimately making it even harder for people with pre-existing conditions to get the care they need. House Democrats introduced legislation that would override Trump’s rule, but not a single Republican has signed on.

“Every Republican should be worried,” said Leslie Dach

Washington, DC – A new poll from Navigator Research is the latest showing that health care costs remain a top concern for voters and that the gap in perceptions of the two parties’ health care position is widening. Said Leslie Dach, chair of Protect Our Care, in response:

“The more people hear about Republican’s unrelenting war on our health care, the steeper their deficit with voters on this issue becomes. Every Republican who voted for health care repeal or stood by while the Trump administration and its allies have taken a sledgehammer to our health care should be worried. These Republicans have one thing in common: they have taken away Americans’ health care — and they’ll have to answer for this.”

Among the Navigator Research Findings:

“Health care remains a major issue continuing to drive conversation in Washington and around the country. What’s also clear is Democrats’ lead on the issue of health care has only grown.”

• Navigator has tracked which party in Congress is more trusted to handle health care since June, and Democrats’ lead just reached a new high of 15 points.
• Democrats in Congress now lead by 22 points among political independents (42% to 20%). Democrats also hold an 18 point advantage on health care when the sides are framed as “Democrats in Congress” versus “Donald Trump.”
• By 46% to 32%, Americans prefer Democrats in Congress over Republicans in Congress to handle “keeping down health care costs,” up from a lead of just five points (39% to 34%) in June
• Democrats lead by 26 points overall on protecting health care coverage for people with pre-existing conditions, including a 21-point lead among independents, a 33-point lead among college-educated whites and even a 9-point lead among whites without a college degree.

The Navigator Research Poll is the Latest Evidence that Health Care Will be a Major Liability for Republicans:

• Morning Consult/POLITICO Poll Finds Voters Trust Democrats over Republicans on Pre-existing Conditions Protections. Eighty-one percent of voters say it should not be legal for insurance companies to deny coverage to people with pre-existing conditions, and 71 percent say it should not be legal for insurance companies to charge more for people with pre-existing conditions and on the question of pre-existing conditions, voters trust Democrats in Congress over Republicans in Congress by 22 points (42-20), including by 17 points among voters aged 65 and older (41-24). (September  2018)
• Fox News Poll Finds Majority Of Americans Hold Favorable Opinion Of Affordable Care Act. The poll found that 51 percent of voters held favorable views the Affordable Care Act, compared to only 40 percent who held favorable views of the Republican tax bill. (August 2018)
• NBC News/ Wall Street Journal Survey Finds Democrats Have 18 Point Advantage In Dealing With Health Care. The survey found that 45 percent of voters polled think democrats would do a better job dealing with health care, compared to only 27 percent of voters who say Republicans would do a better job. (August 2018)
• Kaiser Tracking Poll Finds Almost Six In Ten Americans Say They Think President Trump And His Administration Are Trying To Make The ACA Fail, Most Say This Is A Bad Thing. “Almost six in ten (56 percent) Americans say they think President Trump and his administration are trying to make the ACA fail while one-third (32 percent) say they are trying to make the law work. Most of those who say they think the Trump administration is trying to make the law fail think this is a “bad thing” (47 percent of the public). In addition, most (58 percent) say since President Trump and Republicans in Congress have made changes to the ACA, they are responsible for any problems with it moving forward.” [Kaiser Family Foundation (July 2018)
• Kaiser Tracking Poll Finds A Candidates’ Continued Support For Protections For People With Pre-Existing Conditions Is The Single Most Important Health Position For Voters. Fourteen percent of voters said cited protections for people with pre-existing conditions as the most important factor. Sixty-six percent of voters said it was very important, if not the most important, health care issue to them. (June 2018)

“Let’s be clear: Instead of waging a war on the opioid crisis, the GOP has waged a war on our health care,” says Brad Woodhouse

Washington, DC – While the Senate is advancing a package of legislation intended to address the opioid crisis, Republicans all levels have simultaneously doubled down on their attacks on people with pre-existing conditions, including opioid use disorder, in the courts, through legislation and through regulations that promote junk plans and restrict Medicaid. In response, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“Let’s be clear: Instead of waging a war on the opioid crisis, the GOP has waged a war on our health care that has undermined the fight against the opioid crisis time and time again. Republicans must do the things that would truly support the families suffering from this crisis: end its assault on Medicaid, upon which four in 10 Americans with opioid use disorder relies; drop its lawsuit to overturn the Affordable Care Act and reverse the damage it’s already done to pre-existing conditions protections by pushing junk insurance plans. After all, if there are two things Americans agree on, it’s that the opioid crisis is serious and that pre-existing conditions protections need to be upheld.”

REPUBLICAN SENATORS COULD SUPPORT PEOPLE WITH PRE-EXISTING CONDITIONS, INCLUDING OPIOID USE DISORDER, BY DOING THE FOLLOWING:

1. Republican Senators can support the Senate Democrats’ resolution that would allow the Senate to defend pre-existing condition protections in court.
2. Republican Senators can join the Senate Democrats’ effort to overturn Trump administration’s junk plan rule that lets insurance companies discriminate against people with pre-existing conditions.
3. Republican Senators can stop working to repeal the Medicaid expansion, with Medicaid heralded by experts in the field as “the most powerful vehicle available to states to fund coverage of prevention and treatment for their residents at risk for or actively battling opioid addiction.”

PRESIDENT TRUMP AND HIS REPUBLICAN ALLIES WANT TO ROLL BACK COVERAGE THROUGH MEDICAID, A LIFELINE FOR PEOPLE SUFFERING WITH OPIOID USE DISORDER

• Republicans Have Repeatedly Taken Aim At Medicaid. The GOP has attempted to restrict access to Medicaid by allowing states to impose onerous work requirements on Medicaid coverage, trying to impose per capita limits on Medicaid funding, and repeatedly proposing legislation that would end Medicaid expansion.
• Restricting Access To Medicaid Threatens Lives And Impedes States’ Ability To Respond To The Opioid Epidemic. Four in 10 Americans with an opioid use disorder relies on Medicaid for access to treatment and life-saving overdose reversal medication. Restricting access to Medicaid puts people’s lives at risk and deprives states of funding and resources they depend on to fight the epidemic.

A TRUMP-GOP LAWSUIT COULD OVERTURN THE AFFORDABLE CARE ACT, WHICH PROTECTS PEOPLE WITH SUBSTANCE USE DISORDER

• Because Of The Affordable Care Act, Insurance Companies Can No Longer Deny Coverage Or Charge More Because Of Pre-Existing Conditions. The Affordable Care Act prevents insurance companies from denying someone coverage or charging them more because of a health problem they had before the date that new health coverage starts. It also prevents insurance companies from rescinding or canceling someone’s coverage arbitrarily if they get sick.
• The ACA Outlawed Medical Underwriting, The Practice That Let Insurance Companies Charge Sick People More. As the Brookings Institution summarizes, “The ACA outlawed medical underwriting, which had enabled insurance carriers to court the healthiest customers while denying coverage to people likely to need costly care. The ACA guaranteed that all applicants could buy insurance and that their premiums would not be adjusted for gender or personal characteristics other than age and smoking.”
• The ACA Requires That Insurance Companies Cover Mental Health And Substance Use Disorder Services, And Paved The Way For Medicaid Expansion, Which Helps People Access Services For Substance Use disorders. The Affordable Care Act established ten essential health benefits, including mental health services, substance use disorder services, and prescription drug coverage, that insurance companies are required to cover. Without these protections, people in the individual market could be on their own — before the ACA, 45 percent of individual market plans did not cover substance use disorder services, and 38 percent of plans did not include mental health services.  The ACA also enabled states to expand Medicaid, which has helped people with substance use disorders and mental illness receive treatment. Recent research finds that Medicaid expanding reduced the unmet need for substance use treatment by 18.3 percent.

TRUMP-GOP JUNK INSURANCE PLANS OFTEN EXCLUDE COVERAGE FOR PRE-EXISTING CONDITIONS, MENTAL HEALTH CARE AND MORE

Short-Term Plans May Exclude Coverage For Pre-Existing Conditions. “Policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition could be considered pre-existing and so excluded from coverage.” [Kaiser Family Foundation, 2/9/18]

• As Many As 130 Million Nonelderly Americans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]
• 1 in 4 Children Would Be Impacted If Insurance Companies Could Deny Or Charge More Because Of A Pre-Existing Condition. [Center for American Progress, 4/5/17]

Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits. “Typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways.” [Kaiser Family Foundation, 2/9/18]

Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits –  “for example, many policies cap covered benefits at $1 million or less.” [Kaiser Family Foundation, 2/9/18]

Short-Term Junk Plans Can Retroactively Cancel Coverage After Patients File Claims. “Individuals in [short-term (STLDI)] plans would be at risk for rescission. Rescissions are retroactive cancellations of coverage, often occurring after individuals file claims due to medical necessity. While enrollees in ACA coverage cannot have their policy retroactively cancelled, enrollees in STLDI plans can.” [Wakely/ACAP, April 2018]

After Wisconsin Governor Scott Walker specifically “signed-off” on Attorney General Brad Schimel joining a partisan lawsuit to dismantle protections for pre-existing conditions protections and the other consumer consumer protections in the Affordable Care Act, today Scott Walker’s spokesperson reportedly said that Walker would call a special session if his own lawsuit is successful.

Said Amanda Harrington, communications director of Protect Our Care, in response:

“Scott Walker, no special session is needed. You authorized this lawsuit in the first place, and if you really want to protect Wisconsinites with pre-existing conditions, now you need to call it off.”

SHOT: For months, national patient groups, physicians, hospitals and insurers have emphasized how much the lawsuit could threaten care for people across the country. Health industry experts in the states involved in the lawsuit are making their concerns known, too.

USA Today: “Health Industry Experts Fear ‘Chaos’ if Texas Judge Suspends Affordable Care Act”

“The market would just be in chaos,” said Karen Bender, an actuary and president of Snowway Actuarial and Healthcare Consulting in Little Suamico, near Green Bay, Wisconsin, one of the states that has asked the judge to suspend the ACA.

Marty Anderson, chief marketing officer for Security Health Plan in Wisconsin, said the same.

“There would be chaos in the entire insurance market across the nation,” Anderson said. “That is the only way to describe it….I don’t understand what the end game is.”

CHASER: Feeling the heat not only from the medical community, but also from voters who strongly oppose ending protections for pre-existing conditions, the attorneys general who brought this case in the first place are trying — and failing — to duck and cover from it.

McClatchy: “Hawley Under Fire on Pre-existing Conditions as Pressure from Dems Mounts”

Missouri Attorney General Josh Hawley won’t offer details about his role in the Republican lawsuit that could strike down insurance protections for people with pre-existing conditions. […]

With pressure mounting, Hawley’s office has refused to clarify his role in the case after oral arguments took place in Texas last week. McClatchy first asked the office for an explanation of Hawley’s work on the case Monday.

[…] Hawley’s office already faces a Missouri Sunshine Law complaint from Protect Our Care, a liberal-leaning coalition of Missouri health care groups, for not turning over records related to his communications with President Donald Trump’s administration on the case.

HPR1 (North Dakota): “All Questions Go to Texas”

All questions related to the federal Texas lawsuit set to terminate current healthcare laws are still being referred to Texas, the North Dakota Attorney General’s office reported.

“We have no comments at this time,” Liz Brocker, public information officer for the Attorney General for North Dakota’s office stated when asked. The state, under Attorney General Wayne Stenehjem, joined the lawsuit along with 19 other Attorney’s General and two governors after the Tax Cuts and Jobs Act eliminated penalties for not obtaining insurance for health coverage.