October 2018

The Trump administration and Republicans are trying to take credit for stabilizing marketplaces under the Affordable Care Act. They are wrong. Before Trump and Republicans in Congress began its two year war on health care to repeal and sabotage the Affordable Care Act, independent analyses showed the marketplaces were already beginning to stabilize. Their efforts to repeal and sabotage the ACA actually led to higher costs for people, especially because they were undermining protections for pre-existing conditions.

Here are four ways the Republican National Committee gets it wrong in a recent report.

1 – REPUBLICAN REPEAL EFFORTS HAVE RAISED OUR COSTS

The Trump administration and Republicans want to take credit for premiums “getting better.” The truth: the relentless war on health care the Trump administration and Republicans in Congress have waged over the last 18 months have caused costs to increase.

• Brookings Analysis Estimates That Individual Market Premiums Would Decrease If Not For GOP Sabotage. Among its key findings:
• • Estimates That Average Premium Would Fall By 4.3 Percent In 2019 In Stable Policy Environment. “I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment.” [Brookings Institution, 8/1/18]

• • Insurance Companies’ Revenues Will Far Exceed Their Costs In 2018. “I project that insurers’ revenues in the ACA-compliant individual market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and 2016. The estimated 2018 margin also far exceeds insurers’ margins in the pre-ACA individual market. ” [Brookings Institution, 8/1/18]

• • Absent Republican Sabotage, Average Premiums For ACA-Compliant Plans Would Likely Fall In 2019. “In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for 3 2019. Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs.” [Brookings Institution, 8/1/18]

2 – PRIOR TO THE TRUMP ADMINISTRATION, PREMIUM RATES WERE STABILIZING

The Trump administration and Republicans are trying to take credit for a stabilizing marketplace. The truth: the marketplaces were stabilizing before Trump came into office.

• Before Trump became president, experts predicted ACA marketplaces were stabilizing. Prior to the Trump administration, independent analyses show that the Affordable Care Act was working. Standard’s & Poor said it expected insurers’ performance in the marketplaces to be better in 2016 than in 2015, and 2017 would be better than 2016.
• Net premiums only increased $1 from 2016 to 2017, before the Trump/GOP sabotage began. In March 2017, the nonpartisan Congressional Budget Office said it anticipated “the market to be stable” under the ACA. The average premium after tax credits increased by $1 dollar, from $100 in 2016 to $101 in 2017.

3 – REPUBLICANS ARE ACTIVELY UNDERMINING PROTECTIONS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

The Trump administration and Republicans tout their new “short-term, limited duration” plans as a way to reduce costs. The truth: Republicans have been actively undermining protections for people with pre-existing conditions.

• These are junk plans because insurance companies can deny coverage for people with pre-existing conditions and they do not have to cover essential benefits under the ACA, meaning people won’t have the coverage they need when they need it. For example:
  

Los Angeles Times: Expanding Short-Term Plans Is Opposed By Nearly Every Patient Advocacy Organization In The Country. “Expanding short-term plans also risks driving up costs for Americans with preexisting medical conditions who need more comprehensive benefits…Among the groups that have opposed the Trump administration’s moves are virtually every leading patient advocacy organization in the country, including the American Lung Assn., the American Heart Assn., the Cystic Fibrosis Foundation, the March of Dimes, the National Multiple Sclerosis Society, Susan G. Komen, AARP and the advocacy arm of the American Cancer Society. [LA Times, 8/1/18]

HuffPost: Short-Term Plans Provide Junk Coverage And Drive Up Costs Of Comprehensive Care. “Meanwhile, those seeking out comprehensive plans because they want or need them will discover those policies have gotten more expensive, thanks to the way short-term plans will affect the rest of the insurance market. Some insurance shoppers will have serious, even life-threatening diseases, such as cancer, which will mean their insurance must have a full set of benefits. But those kinds of policies will become more expensive than they can afford. [HuffPost, 8/1/18]

Bloomberg: Cheaper Plans “Can Come At A Cost.” “For some people, though, the cheaper premiums can come at a cost, such as when insurers claim that a cancer treatment shouldn’t be covered because a patient had the disease before buying coverage, as Bloomberg reported in October.” [Bloomberg, 7/31/18]

Short-Term Plans Sometimes Impose Unexpected Rules, Like For Instance Refusing To Cover Hospitalizations During The Weekend. “There may be other strange rules. A review of some plan documents from Families USA found an Illinois plan that would cover only hospitalizations beginning during the week — inpatient stays that began on the weekend would not be allowed except in rare circumstances. Some plans had waiting periods for care. Cancer treatment, for example, is not covered in certain plans during the first month a person is enrolled in a plan, and no treatment for illness is covered in the first five days. That’s the kind of detail that might be easy to overlook when signing up for a plan if you aren’t expecting a cancer diagnosis.” [New York Times, 8/1/18]

• In addition, Republicans in 20 states are suing to overturn the Affordable Care Act and eliminate its protections for people with pre-existing conditions in a Texas district court. The Trump administration is siding with them, not federal law, and asking the judge to specifically overturn the protections that ban insurance companies from denying coverage, or charging more, because of a pre-existing condition.

4 – ALLOWING INSURANCE COMPANIES ACROSS STATE LINES IS A RACE TO THE BOTTOM

The Trump administration and Republicans are pushing a proposal to allow insurance companies to sell across state lines as a way to lower costs. The truth: this would be a race to the bottom for insurance companies to sell from states with the least consumer protections, thus hurting consumers.

• CBO: Selling Across State Lines Would Result In People Living In States With More Consumer Protections To Be Offered Plans From States That Do Not Have Those Protections. “Under H.R. 2355, CBO expects that individual health insurance would be offered across state lines to individuals in states with relatively expensive coverage mandates and rate-setting rules that permit relatively little variation in the prices an insurer may charge. The insurers offering those policies would be licensed in, and regulated by, states that do not have those characteristics.” [Congressional Budget Office, 9/12/05]
• Urban Institute: Insurers Would Domicile Firms In States With Lax Regulations And The Least Consumer Protections. “Pre-ACA proposals to permit sales of insurance across state lines would have allowed insurers to take advantage of the regulatory variation across states. The same is true for current proposals to permit such sales while simultaneously repealing all or most of the ACA. Under such a policy scenario, insurers would have powerful financial incentives to domicile firms in states that have little regulation of nongroup insurance markets, such as those without guaranteed issue, those with no limits on premium rating, those permitting liberal use of benefit riders, and so on.” [The Urban Institute, 6/29/16]
• NAIC: Allowing The Sale Of Insurance Across State Lines Would “Preempt” Consumer Protections In States. “In the same vein, we strongly oppose legislation that would preempt state authority. We continue to see proposals that would preempt state licensing requirements and, thus, consumer protections by allowing sales across state lines by federal edict, without proper discretion for the states to form compacts between themselves. We also see proposals that would preempt state solvency requirements and regulations by creating federally licensed insurance pools called ‘association health plans.’ Such federal actions would strip states of the ability to protect consumers and create competitive markets and should be rejected.” [NAIC Letter to Reps. Walden, Brady, Pallone and Neal, 1/24/17]

Six in 10 Florida Voters Cite Health Care as Most or Very Important Issue in the Midterms

Sixty-five Percent of Florida Voters Oppose Scott-GOP Repeal and Sabotage Efforts, Including GOP’s Lawsuit Targeting Protections for Pre-Existing Conditions

Public Policy Polling Survey Has Bill Nelson Up Four Points in Senate Race (Nelson 48, Scott 44) and Gillum Up Four in Governor’s Race (Gillum 48, DeSantis 44)

Washington, DC – A new Public Policy Polling (PPP) survey commissioned by Protect Our Care finds that 60 percent of registered voters in Florida say health care will be one of the most important issues they consider when casting their vote in November. What’s more, 65 percent are deeply concerned about Rick Scott’s support of health care repeal and the same proportion oppose the Trump Administration’s lawsuit to end protections for those with pre-existing conditions, which Scott has refused to oppose and Florida Attorney General Pam Bondi has joined.

The poll shows that for Scott, who has opposed Medicaid expansion, whose company was fined $1.7B for Medicare fraud, and who has been one of the architects of the GOP’s repeal of America’s health care, the issue of health care is a drag on his prospects for election to the Senate. In the poll, Scott trails Senator Bill Nelson 44 (Scott) to 48 (Nelson). PPP surveyed 779 registered Florida voters between September 28-30, 2018 through automated telephone interviews.. The margin of error is +/- 3.5%.

Said Brad Woodhouse, executive director of Protect Our Care, in response to the poll:

“Fraudster Rick Scott thinks he can eke out a victory on election night by hiding from his own record of working to repeal health care, but Florida voters are having none of it. The people of Florida say health care is one of the most important issues to them this election, and as a result of Rick Scott’s disastrous health care policies as Governor and in the private sector, a majority of Florida voters disapprove of his job performance and are not likely to give him a promotion to the U.S. Senate.”

Key Findings from the Protect Our Care-PPP Poll:

• Sixty-five percent of Florida voters say health care is the most important or a very important issue for them this election.  
• Sixty-five percent of Florida voters say the elimination of protections for people with pre-existing conditions, supported by Rick Scott, is “a major concern.”
• Florida voters oppose the Florida attorney general and Trump administration’s lawsuit to eliminate protections for people with pre-existing conditions by a 49 point margin, 65 percent to 16 percent.
• Sixty-five percent of Florida voters say the “Age Tax” supported by Bill Nelson is “a major concern.”
• Over half (55 percent) of Florida voters oppose repealing the Affordable Care Act and instead want to keep what works and fix what doesn’t.
• Voters are less likely to vote for Rick Scott because of his refusal to expand Medicaid (57 percent less likely) and his company’s Medicare fraud (54 percent less likely).
• In the Senate race, the survey finds 48 percent of voters supporting Nelson and 44 percent supporting Scott, with nine percent undecided.
• In the race for governor, the survey finds 48 percent of voters supporting Gillum and 44 percent supporting DeSantis, with eight percent undecided.

You can read the full poll results here.

What Would Repeal of Health Care in Florida Mean?

• Protections for 7,810,300 with pre-existing conditions, if they buy coverage on their own
• Improvements to Medicare, including reduced costs for prescription drugs
• Allowing kids to stay on their parents’ insurance until age 26
• Ban on annual and lifetime limits
• Ban on insurance discrimination against women
• Limit on out-of-pocket costs
• Medicaid expansion currently covering 15 million people
• Rules to hold insurance companies accountable
• Small business tax credits
• Marketplace tax credits and coverage for up to 1.4 million Floridians.

The Truth about Rick Scott’s Anti-Health Care Record

1. Rick Scott Helped Design Republican Repeal Efforts That Would Jeopardize Access To Care For Up To 7.8 Million Floridians

Rick Scott Was An Advisor To The Trump Administration On Plans To Repeal The ACA.  “ Kicking off a series of meetings with incoming Trump administration officials, Gov. Rick Scott said Wednesday he hopes to help them devise a less costly alternative to Obamacare. Scott said he’s talking with Donald Trump every week or two while working closely with Rep. Tom Price, the president-elect’s choice to run the government agency that oversees Medicaid, Medicare and the landmark 2010 health-insurance law.” [McClatchy, 1/18/17]

Rick Scott Continued To Push For Repeal Even After It Failed In The Senate. “Gov. Rick Scott, whose political career is largely defined by opposition to the Affordable Care Act, still wants Republicans to repeal the federal health care law despite their apparent failure to do so. ‘Floridians simply cannot afford the high taxes and mandates of Obamacare. This law needs to be repealed,’ Scott spokeswoman Kerri Wyland said in an emailed statement.  […] Since November, Scott has written four op-eds stressing the urgency of repealing Obamacare. ‘There is absolutely no question that Obamacare must be repealed immediately so Americans can actually afford to purchase health insurance,’ Scott wrote.” [Orlando Sentinel, 7/18/17]

2. Rick Scott Says Coverage For Pre-Existing Conditions Should Be Based On Rewarding “People For Caring For Themselves.”

Rick Scott On Care For People With Pre-existing Conditions:  “We’ve Got To Reward People For Caring For Themselves.”  “‘I believe that if you have a pre-existing condition, you need to still be able to get health care, so it’s very important to me,’ Scott told reporters in Tallahassee. ‘I think everybody ought to be able to get health care insurance. I do believe that you’ve got to start working to fix the law and that law caused our premiums to skyrocket. But I don’t believe in grand bargains, I believe in incrementally trying to make change. We’ve got a lot more competition … We’ve got to reward people for caring for themselves.’” [Tampa Bay Times, 6/13/18]

Rick Scott’s callous comments could leave millions of Floridians with conditions ranging from diabetes to cancer without a way to obtain affordable coverage.

Before The Affordable Care Act, Insurance Companies Maintained Lists Of So-Called Deniable Medical Conditions. If someone had one or more ‘deniable’ conditions, they were automatically denied coverage. Common ‘deniable’ conditions included:

• Pregnancy, alcohol or drug abuse with recent treatment, dementia, arthritis, cancer, cerebral palsy, epilepsy, hemophilia, hepatitis, diabetes, paralysis, severe obesity, sleep apnea, AIDS/HIV, kidney disease, multiple sclerosis, bipolar disorder, eating disorders, pending surgery or hospitalization, and muscular dystrophy. [Kaiser Family Foundation, December 2016]

Many Insurance Companies Also Maintained Lists Of Deniable Medications — Meaning That They Could Deny Coverage To Any Applicant With A Prescription For: Anti-arthritic medications, anti-diabetic medications, medications for HIV/AIDS or hepatitis, anti-cancer medications, anti-psychotics or other central nervous system medications, anti-coagulant medications, and other common drugs. [Kaiser Family Foundation, 12/12/16]

Insurance Companies Also Denied Coverage Based On People’s Jobs. For example, Preferred One Insurance Company used to deny coverage from people with the following professions: active military personnel, air traffic controllers, bodyguards, firefighters, law enforcement professionals, detectives, professional athletes, taxi cab drivers, window washers, security guards, scuba divers, miners, pilots, and offshore drillers.

Before The Affordable Care Act, 18 Percent Of Individual Market Applications Were Denied By Insurance Companies Because Of A Pre-Existing Condition. Experts believe this shocking statistic is actually an underestimate, because “many people with health conditions did not apply [for coverage] because they knew or were informed by an agent that they would not be accepted.” [Kaiser Family Foundation, 12/12/16]

Rick Scott has refused to comment on the Trump administration’s latest attack on pre-existing conditions, a lawsuit to overturn the ACA’s protections for pre-existing conditions. The suit is being led by Rick Scott ally, Florida Attorney General Pam Bondi, but Scott himself has remained silent on the issue.

June 13:  Rick Scott Refused To Say Whether He Supported Trump’s Lawsuit.  “Gov. Rick Scott would not directly say Wednesday whether he supports a Trump administration move that critics say could wipe away health care protections for pre-existing conditions — a cornerstone of Obamacare — while saying he believes such protections are needed.” [Tampa Bay Times, 6/13/18]

3. Rick Scott Has Refused To Expand Medicaid  

After briefly supporting a failed attempt at Medicaid expansion, for years Rick Scott in collaboration with the Republican majority in the Florida legislature have refused to expand the program to cover up to 650,000 Floridians.  

2015: In A “Victory For Rick Scott,” The Florida House Rejected Medicaid Expansion For the Third Time.  In June 2015, the Florida House rejected a plan 72-41 that would have covered as many as 650,000 residents. It was the third time that legislators had considered and spurned some version of health care expansion since passage of the Affordable Care Act. It represented a victory for Gov. Rick Scott who opposed the bill, which had already passed the state Senate on a 33-3 vote.