November 2020

Gary Peters Will Put Michiganders’ Health Care First

Lansing, MI — Following Gary Peters’s win in Michigan’s race for U.S. Senate, Protect Our Care Executive Director Brad Woodhouse issued the following statement: 

“This race was run and won on health care. Senator Gary Peters is a health care champion and comes back to Washington with a clear mandate to pass a COVID relief package and build on the Affordable Care Act to lower costs, increase coverage and stand up to insurance and drug companies. Michigan rejected the Republican war on health care and voted for moving forward on an aggressive health care agenda in the new Congress. Gary Peters has a strong record of standing up for Michiganders’ health care by supporting the protections Americans rely on to get health care coverage. Voters in Michigan chose Gary Peters to reverse the years-long health care sabotage inflicted upon Americans by Donald Trump and make health care more accessible and affordable for everyone.” 

Mark Kelly Will Put Arizonans’ Health Care First

Phoenix, AZ— Following Mark Kelly’s win in Arizona’s race for U.S. Senate, Protect Our Care Executive Director Brad Woodhouse  issued the following statement: 

“This race was run and won on health care. Senator-elect Mark Kelly is a health care champion and comes to Washington with a clear mandate to pass a COVID relief package and build on the Affordable Care Act to lower costs, increase coverage and stand up to insurance and drug companies. Arizona rejected the Republican war on health care and voted for moving forward on an aggressive health care agenda in the new Congress. 

“Voters rejected Martha McSally because of her disastrous position on health care. From supporting the repeal of the Affordable Care Act to lying about protections for pre-existing conditions, Martha McSally was a reliable vote in favor of Donald Trump’s war on health care. Instead, voters chose Mark Kelly, who made health care a centerpiece of his campaign and will prioritize the health of Arizonans by maintaining protections Americans count on to get health care coverage. Voters in Arizona chose Mark Kelly to reverse the years-long health care sabotage inflicted upon Americans by Donald Trump and make health care more accessible and affordable for everyone.”

John Hickenlooper Will Put Coloradans’ Health Care First

Denver, CO — Following John Hickenlooper’s win in Colorado’s race for U.S. Senate, Protect Our Care Chair Leslie Dach issued the following statement: 

“This race was run and won on health care. Senator-elect John Hickenlooper is a health care champion and comes to Washington with a clear mandate to pass a COVID relief package and build on the Affordable Care Act to lower costs, increase coverage and stand up to insurance and drug companies. Colorado rejected the Republican war on health care and voted for moving forward on an aggressive health care agenda in the new Congress. 

“Voters rejected Cory Gardner because of his disastrous position on health care. From supporting the repeal of the Affordable Care Act to lying about protections for pre-existing conditions, Cory Gardner was a reliable vote in favor of Donald Trump’s war on health care. Instead, voters chose John Hickenlooper, who made health care a centerpiece of his campaign and will prioritize the health of Coloradans by maintaining protections Americans count on to get health care coverage. Voters in Colorado chose John Hickenlooper to reverse the years-long health care sabotage inflicted upon Americans by Donald Trump and make health care more accessible and affordable for everyone.”

Jeanne Shaheen Will Put Granite Staters’ Health Care First

Concord, NH — Following Jeanne Shaheen’s win in New Hampshire’s race for U.S. Senate, Protect Our Care Chair Leslie Dach issued the following statement: 

“This race was run and won on health care. Senator Jeanne Shaheen is a health care champion and comes back to Washington with a clear mandate to pass a COVID relief package and build on the Affordable Care Act to lower costs, increase coverage and stand up to insurance and drug companies. New Hampshire rejected the Republican war on health care and voted for moving forward on an aggressive health care agenda in the new Congress. Jeanne Shaheen has a strong record of standing up for Granite Staters’ health care by supporting the protections Americans rely on to get health care coverage. Voters in New Hampshire chose Jeanne Shaheen to reverse the years-long health care sabotage inflicted upon Americans by Donald Trump and make health care more accessible and affordable for everyone.”

Mark Warner Will Put Virginians’ Health Care First

Richmond, VA — Following Mark Warner’s win in Virginia’s race for U.S. Senate, Protect Our Care Chair Leslie Dach issued the following statement: 

“This race was run and won on health care. Senator Mark Warner is a health care champion and comes back to Washington with a clear mandate to pass a COVID relief package and build on the Affordable Care Act to lower costs, increase coverage and stand up to insurance and drug companies. Virginia rejected the Republican war on health care and voted for moving forward on an aggressive health care agenda in the new Congress. Mark Warner is a health care champion with a strong record of standing up for Virginians’ health care by supporting the protections Americans rely on to get health care coverage. Voters in Virginia chose Mark Warner to reverse the years-long health care sabotage inflicted upon Americans by Donald Trump and make health care more accessible and affordable for everyone. 

Read the Guide to the Health Care Election Here

Washington, DC — Donald Trump and his Republican allies have waged a relentless war on Americans’ health care for four years, sabotaging care and doing everything in their power to dismantle the Affordable Care Act and the protections it provides for more 135 million Americans with pre-existing conditions. The Trump administration will argue before the Supreme Court days after the election in the middle of a deadly pandemic that the entire ACA should be struck down. Now, more than ever, health care is on the ballot. This guide shows what’s at stake as Americans head to the polls to make their voices heard and the disastrous health care results of Donald Trump’s presidency. 

“This is a health care election. After four years, voters finally have a chance to hold President Trump accountable for his war on Americans’ health care,” said Protect Our Care Executive Director Brad Woodhouse. “Since taking office, he has made the wrong choices for Americans’ health care at every turn. He’s completely failed to respond to coronavirus. He’s threatened to overturn the Affordable Care Act. When he couldn’t accomplish that legislatively, he backed a lawsuit to dismantle the health care law and installed handpicked anti-ACA justices on the Supreme Court to do his bidding. On top of all that, he continues to lie about having a plan to protect Americans with pre-existing conditions. Another four years of Trump would be a disaster for health care.”

Read the Guide to the Health Care Election Here

Watch the Event Here

Washington, DC — Today, House Speaker Nancy Pelosi and health care storytellers from Arizona, Colorado, Georgia and North Carolina joined Protect Our Care to discuss what’s at stake for Americans’ health care and the Affordable Care Act on Election Day. President Trump has completely fumbled his response to the coronavirus pandemic and has taken every opportunity to undermine Americans’ health care. Just one week after Election Day, the Supreme Court will hear oral arguments in California v. Texas, Trump’s lawsuit to overturn the ACA. The lawsuit would rip coverage from more than 20 million Americans, remove protections for 135 million people with pre-existing conditions and throw the entire health care system into chaos in the midst of a global pandemic. 

“We are in a life or death election for the health of the American people,” said Speaker Nancy Pelosi. “Americans’ health care will never be safe with Mitch McConnell and Donald Trump. While Republicans keep trying to tear down protections for people with pre-existing conditions, when we expand the Democratic House, win the Senate Majority and elect Joe Biden President, we will defend the pre-existing condition benefit and deliver lower health costs and prescription drug prices for every American.”

“The Affordable Care Act, to me, is a tool that helps elevate people out of poverty. It’s one of many tools that we, as Americans, have at our disposal and to think next week it could possibly be struck down really puts a lot of fear in people in our community,” said Marcos Castillo, a paralyzed car crash survivor from Arizona.

“I think it’s more important than ever to listen to the people whose lives are at stake because 135 million Americans have pre-existing conditions, and many of us are uninsurable without the Affordable Care Act,” said Laura Packard, a stage 4 cancer survivor from Colorado. “We could die if we didn’t have insurance, so every time Republicans in Congress and Trump talk about dismantling the Affordable Care Act, what they’re saying is that millions of Americans would have to go without health care because it’s more important to give tax breaks to billionaires than to make sure every American gets the health care that they need.”

“I don’t believe we can have quality of life without health care,” said Rev. Leela Waller, a type 1 diabetic and COVID-19 survivor from Georgia. “We’re in the middle of a pandemic, and health care is truly, truly important for all Americans.”

“They are trying to rip health care away while lying in our face saying, ‘Oh, there’s a plan.’ There’s not a plan. If there was a plan, we would have seen the plan. There’s no plan. Please stop lying to the American people,” said DonnaMarie Woodson, a cancer survivor from North Carolina. “All of us deserve to have health care. It’s not a luxury, it’s a necessity. It’s truly a live or die election.”

“This is a health care election. After four years, voters finally have a chance to hold President Trump accountable for his war on Americans’ health care,” said Protect Our Care Executive Director Brad Woodhouse. “Since taking office, he has made the wrong choices for Americans’ health care at every turn. He’s completely failed to respond to coronavirus. He’s threatened to overturn the Affordable Care Act. When he couldn’t accomplish that legislatively, he backed a lawsuit to dismantle the health care law and installed handpicked anti-ACA justices on the Supreme Court to do his bidding. On top of all that, he continues to lie about having a plan to protect Americans with pre-existing conditions. Another four years of Trump would be a disaster for health care.”

There are 61 million adults with a disability in the United States. According to the Centers for Disease Control and Prevention (CDC), adults with disabilities are three times more likely to have chronic conditions, like heart disease, diabetes, and cancer, that put them at higher risk for severe illness if they contract the coronavirus. Additionally, data has shown that people with intellectual disabilities are both contracting and dying from coronavirus at higher rates than people without disabilities.

People With Intellectual And Developmental Disabilities Are Seeing Higher Rates Of Infections and Deaths From Coronavirus. Early data revealed that people with intellectual/developmental disabilities were experiencing alarming rates of infections and deaths from the virus. Many of these individuals live in group settings or rely on direct care workers to meet their daily needs, increasing their likelihood of exposure to the virus. Individuals residing in congregate settings are particularly at risk: a growing body of research has shown that individuals residing in facilities are more likely to die from the virus. By May, more than one in five Illinoisans living in state homes for adults with disabilities had tested positive for coronavirus. A June 2020 NPR Analysis found that people with intellectual disabilities and autism in Pennsylvania and New York who test positive for coronavirus were dying at about twice the rate of the general public. Data has also indicated that children with intellectual and developmental disabilities are facing higher fatality rates from COVID-19.

President Trump’s Failure To Contain The Virus And To Shore Up Supplies To Fight COVID-19 Have Put People With Disabilities In Danger. As the virus surges and hospitals are overwhelmed, people with disabilities are in unique danger as supply shortages loom. Faced with increasing caseloads and acute supply shortages, some states have drafted guidelines for medical rationing to determine which patients are deserving of life-saving and limited supplies. These guidelines have, in some states, excluded people with disabilities from receiving equipment or treatment. As cases in Arizona surged this summer, disability rights groups filed a federal complaint that the state’s crisis standards discriminated against those with disabilities (as well as people of color and the elderly). The complaint suggested that people with disabilities would be perceived as having shorter life expectancy, thus making them less deserving of care. 

How President Trump Made Health Care Worse For People With Disabilities Ahead Of The Pandemic

Medicaid and the Affordable Care Act (ACA) remain critical sources of care for people with disabilities during this crisis. At a time when millions of people are facing the possibility of coronavirus and devastating health care bills, protecting coverage of our nation’s most vulnerable is more important than ever. However, Trump has spent his presidency sabotaging the ACA and Medicaid, undermining access to care for people with disabilities. 

Top Ways Trump Has Sabotaged Health Care For People With Disabilities

• Trump Is Trying Repeal Medicaid Expansion And Protections For Pre-Existing Conditions Through His Lawsuit To Overturn The ACA. After trying and failing to repeal the ACA legislatively, the Trump administration is now backing a lawsuit to completely dismantle the health care law and, if they are successful, more than 20 million people would lose insurance, and protections for pre-existing conditions would be eliminated overnight. The lawsuit would also terminate Medicaid expansion, threatening to rip away coverage from 15 million people, including people with disabilities, and cut key funding for already-struggling rural hospitals during the pandemic.
• Republican Efforts To Repeal Medicaid Expansion Would Mean 64 Percent Of Medicaid Adults With Disabilities Could Lose Coverage. Per the Center on Budget and Policy Priorities: “The Affordable Care Act’s Medicaid expansion covers 11 million people. Many of them struggle with a chronic illness or a disability (such as a mental health condition) that wouldn’t, by itself, qualify them for Medicaid. Only 36 percent of non-elderly Medicaid beneficiaries with disabilities receive Supplemental Security Income, which allows them to enroll in Medicaid even without the expansion.” 
• The Trump Administration Is Encouraging States To Impose Work Requirements And Other Bureaucratic Restrictions On Medicaid Enrollment In Order To Deny Coverage. For years, Trump has empowered states to impose red tape and paperwork requirements as part of his ongoing efforts to dismantle Medicaid. Work requirements have been at the center of these efforts. After Arkansas imposed the nation’s first work requirements program, more than 18,000 residents lost Medicaid coverage. While work requirements have been blocked by a federal judge repeatedly, the Trump administration keeps fighting to impose these onerous rules in Medicaid. In addition to work requirements, the administration has encouraged states to impose other barriers such as increased eligibility verification as well as premiums and other cost-sharing. All of these efforts amount to blatant attempts to strip health care away from vulnerable Americans.
• Requiring People To Work To Maintain Medicaid Coverage Is Particularly Burdensome For People With Disabilities. Though some states are claiming to exempt people with disabilities from their work requirements, these exemptions are narrow and leave many behind. Among those who should qualify for exemptions, work requirements make it more difficult to keep coverage by requiring enrollees to provide documentation, testimony, and records to prove they have disabilities.
• Trump Wants To Gut The Medicaid Budget & Has Encouraged States To Pursue Harmful Block Grants. Trump has repeatedly sought deep health care cuts in his budget proposals, most recently seeking more than a trillion in cuts to Medicaid and the Affordable Care Act for 2021. This budget essentially ends Medicaid expansion by eliminating the enhanced federal payment and proposes nationwide work requirements. Under the Trump administration’s recently finalized block grant proposal, federal funding would no longer necessarily increase in response to a public health emergency like coronavirus. This could lead to people losing coverage and access to care, undermining prevention and treatment of diseases nationwide.
•  President Trump Is Pushing Short-Term Junk Plans That Allow Insurance Companies To Discriminate Against People With Pre-Existing Conditions. The Trump administration expanded access to health plans that are allowed to discriminate against people with pre-existing conditions, meaning that people with disabilities could be left with devastating health care bills under these plans. These plans can also deny coverage for prescription drugs, preventative care, and other essential health benefits. Junk plans are particularly harmful during the coronavirus crisis: One analysis found widespread misleading marketing of short-term plans during the pandemic. Reports have already shown that patients covered by these plans have been left with thousands of dollars in medical bills for seeking treatment for coronavirus symptoms. 
• President Trump And His Administration Have Refused To Reauthorize Money Follows the Person (MFP). In the 2019 budget, the Trump administration refused to reauthorize the Money Follows the Person program, which allows Medicaid beneficiaries to move from institutional settings into the community. The Administration’s refusal to extend MFP beyond the end of the year 2020, continues to put people with disabilities at risk.

Trump Is Still Fighting To Overturn The ACA

Overturning the ACA would be devastating for people with disabilities. The ACA ensures that insurance companies cannot deny coverage, drop coverage for no reason, or charge people more because of a pre-existing condition. The ACA’s Medicaid expansion also plays a key role in ensuring adults with disabilities are covered. It’s critical that Americans understand just what’s at stake if this outrageous and irresponsible lawsuit succeeds.

The Affordable Care Act Provided Health Security To People With Disabilities

The Affordable Care Act Prevents Insurance Companies From Charging Americans With A Disability More Or Denying Them Coverage Altogether. Prior to the ACA, insurance companies were allowed to charge people more or deny coverage simply because they had a pre-existing condition. The ACA banned this practice, requiring that insurance companies offer people coverage regardless of their health status.

Thanks To The Affordable Care Act, Insurance Companies Can No Longer Impose Annual And Lifetime Limits On Coverage. Before the ACA, insurance companies could restrict the dollar amount of benefits someone could use per year or over a lifetime. At the time the ACA was passed, 91 million Americans had health care through their employers that imposed lifetime limits. Many such plans capped benefits at $1 million annually, functionally locking people with complex medical needs out of coverage. 

Under The ACA, Insurance Companies Can No Longer Practice Medical Underwriting, A Process That Let Insurers Make It Harder For People With Disabilities To Get The Coverage They Needed. Before the ACA, insurance companies could screen applicants for any conditions that might be costly to the company. If someone had condition that was predicted to cost the insurance company more, the insurance company would follow a practice called “medical underwriting” that allowed them to charge the applicant a higher premium, specifically exclude coverage for the condition that was expected to be costly, charge the applicant a higher deductible, or limit the applicant’s benefits (for instance, offer a policy that did not cover prescription drugs).

The ACA Requires Insurance Companies To Cover Basic Health Services. The Affordable Care Act established the ten essential health benefits, requiring insurance companies to cover rehabilitative or habilitative services, hospitalization, maternity care, prescription drugs, maternity care, and mental health services. Before the ACA, many people with disabilities had insurance that didn’t cover basic health care needs.

Eliminating Medicaid Expansion Would Harm The Disability Community

More Than 15 Million People Covered By Medicaid Expansion Could Lose Coverage. If the Texas Lawsuit succeeds, 15 million people—including individuals with disabilities— covered by Medicaid expansion will lose this coverage. 

Medicaid Is A Lifeline For People With Disabilities. Research has shown the people with disabilities covered by Medicaid are more likely to receive comprehensive and consistent care than those who are privately insured. Medicaid expansion has also been linked to increasing employment among individuals with disabilities. Protecting access to Medicaid, particularly during the pandemic, is essential to ensuring people with disabilities continue to get the care they need. 

• 61 Million Americans Have A Disability. Without the Affordable Care Act, insurance companies could once again deny them coverage, drop their coverage for no reason, or charge them more because of a pre-existing condition. 
• 8.7 Million Nonelderly Adults With Disabilities Depend On Medicaid For Care. Of this group, only 43 percent qualify for supplemental security income (SSI). The remaining 5 million beneficiaries do not receive SSI and therefore do not qualify for coverage based on their disability status alone, meaning they rely on the ACA’s Medicaid expansion or eligibility as low-income parents. 
• More Than One In Three Medicaid Enrollees Under 65 Has A Disability. More than 1 in 3 adults under age 65 enrolled in Medicaid lives with at least one disability. 
• 45 Percent Of Adults With Disabilities Have Medicaid Coverage. Medicaid covers 45 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illness.

Ahead of Election Day, health care continues to be one of the most important issues for American voters across the country in 2020 — just as it was when Democrats captured the House in 2018. Coverage points out that Democrats have once again focused their efforts on reminding voters of Trump and Republicans’ years-long effort to destroy the Affordable Care Act legislatively, and now at the Supreme Court. One week after the election, the court will hear oral arguments in California v. Texas, the Trump-GOP lawsuit that if successful would rip coverage from more than 20 million Americans and remove protections for 135 million people with pre-existing conditions in the middle of an ever-worsening pandemic. Now, more than ever, Americans’ health care is on the ballot.

New York Times: Fueled by Cash, Health Care and Trump’s Woes, Democrats Aim for Senate Control. “Democrats have focused relentlessly on health care in their campaigns, scorching Republicans for their yearslong drive to overturn the Affordable Care Act and its protections for pre-existing conditions. The power of the message has been amplified by the pandemic and public anxiety about health costs.” [New York Times, 10/31/20] 

Wall Street Journal: Health Care in Spotlight as ACA Enrollment Begins Days Before Election. “The start of the Affordable Care Act’s open enrollment Sunday comes as millions of Americans have lost or are losing job-based coverage during the coronavirus pandemic, casting a spotlight on health care in the final sprint of the presidential and congressional elections…The attention to open enrollment could mean more focus on health care in the election. Polling shows that the issue is already a paramount concern to voters. An October Wall Street Journal poll found the economy is the top issue for most registered voters followed closely or matched by the combined issues of health care and the coronavirus pandemic. Fifty-five percent of Americans had a favorable view of the ACA in October, up from 49% in September, according to the Kaiser Family Foundation.” [Wall Street Journal, 11/1/20] 

HuffPost: Here Are Voters’ Top Issues for 2020. “Voters’ perception that Biden is most focused on health care and the coronavirus lines up well with data on his campaign’s TV ad spending. It also makes sense: Both are major concerns for voters, and areas on which he holds the advantage. Trump’s ratings for handling the coronavirus have steadily worsened throughout the year, and voters now give Biden a significant edge in trust to handle the pandemic.” [HuffPost, 10/30/20]

Texas Tribune: At the Center of Many Texas Congressional Battles: Who Will Protect Preexisting Conditions Rules? “The issue has taken on even more salience during the coronavirus pandemic. Texas already had the highest rate and largest number of people without health insurance in the U.S. and the pandemic increased that rate — as of May, 29% of Texans under the age of 65 were uninsured. It has also sprouted worries that having had the virus would be a preexisting condition if protections were eliminated.” [Texas Tribune, 10/31/20] 

New York Times: A Chance to Expand Medicaid Rallies Democrats in Crucial North Carolina. “North Carolina, a crucial battleground for the presidential race and control of the United States Senate, has another coveted prize at stake in this election, one that is drawing serious out-of-state money, dominating television ads and driving get-out-the-vote efforts. Democrats believe they have a chance of gaining control of the State Legislature for the first time in a decade, which would make it possible to expand Medicaid to cover half-a-million more low-income adults here after years of Republican resistance.” [New York Times, 10/27/20] 

Rural Americans are especially vulnerable to the coronavirus pandemic due to higher prevalence of pre-existing conditions, lower coverage rates, and other barriers to accessing health care. As the virus has spread, rural communities are now facing severe outbreaks, overwhelming hospitals that were already vulnerable before the pandemic. Through his failed coronavirus response and attacks on the Affordable Care Act (ACA) and Medicaid, President Trump is only fueling this crisis in rural America. 

Rural Health: By The Numbers

• More Than 120 Rural Hospitals Have Closed Since 2010. A record 18 rural hospitals closed in 2019, and 14 closures have been reported so far in 2020. The vast majority closed in states that had not expanded Medicaid at the time of the hospital closure.
• 430 Rural Hospitals Were Already At A High Financial Risk Of Closing Before The Pandemic. This represents roughly 21 percent of the country’s rural hospitals. 
• More Than Half Of All Rural Low-income Communities In The U.S. Have Zero ICU Beds. A study published in Health Affairs found that on average, even the poorest urban areas had more ICU beds per capita than the wealthiest rural areas.
• Rural Hospital Closures Are Associated With A 6 Percent Increase In Death Rates In Surrounding Counties. Rural hospital closures were associated with a 5.9 percent increase in death rates in surrounding counties according to researchers from the University of Washington. The study was published before the pandemic. 
• Rural Hospitals In Medicaid Expansion States Are 62 Percent Less Likely To Close. 75 percent of vulnerable rural hospitals are in non-expansion states. 
• The Affordable Care Act Led To A $12 Billion Reduction In Uncompensated Care Costs. Between 2013 and 2015, hospitals’ uncompensated care costs decreased by $12 billion, or roughly 30 percent. The majority of this reduction was concentrated in states that chose to expand Medicaid. 
• Medicaid Covers Nearly One In Four Rural Americans. Medicaid covers nearly 24 percent of rural Americans, 45 percent of rural children, 15 percent of rural seniors, and pays for 51 percent of rural births. 
• Nearly 1.7 Million Rural Americans Gained Coverage Through Medicaid Expansion. Thanks to the ACA, nearly 1.7 million rural Americans gained Medicaid coverage. The uninsured rate for low-income adults dropped from 35 percent to 16 percent in rural areas and small towns in states that expanded Medicaid. 
• In 2017, Nearly 1 In 5 Marketplace Enrollees Lived In Rural Areas. 1.6 million enrolled in ACA coverage lived in rural areas in 2017. 
• 1 In 3 Rural Adults Report Issues Affording Medical Bills. A survey published in January 2020 found that 32 percent of rural adults reported problems paying medical bills even before the pandemic. 

How Trump and His Republican Allies Are Failing Rural Communities

Rural Hospitals Got Shortchanged In Initial Round Of Relief Funds. Even before the pandemic, hundreds of rural hospitals were on the brink of closing. The situation became more dire as rural hospitals needed to quickly obtain supplies and personal protective equipment to fight the pandemic — all while they lost significant revenue from elective procedures. By basing hospital relief on its Medicare payments, federal relief funds initially excluded many rural hospitals. After receiving widespread criticism, Trump’s HHS announced in late April that it would carve out $10 billion for rural health clinics and hospitals, but these funds are running out. Additional aid came in the form of Medicare loans, but rural health providers fear they could be on the hook for paying back the money even as cases and hospitalizations rise in rural communities. 

Trump And GOP Senators Are Refusing To Pass Additional Relief. In May, the House passed the Heroes Act, landmark legislation that provides more than $1 trillion to state, local, territorial and tribal governments to pay vital workers like first responders, health workers, and teachers. Additionally, the legislation allocates $75 billion in funding for testing and contact tracing, including provisions to specifically serve rural communities. Heroes also guarantees free coronavirus treatment without cost-sharing, opens a special enrollment period for the uninsured to gain coverage through the ACA marketplace and increases in federal funds to support state Medicaid programs. Months later, Senate Republicans have refused to negotiate and failed to vote on this essential relief. 

Trump Has Continued His War On Medicaid. The Trump administration has worked tirelessly to dismantle Medicaid, particularly through his efforts to impose enrollment barriers and red tape. After Arkansas imposed the nation’s first so-called work requirements program, more than 18,000 residents lost Medicaid coverage. While these state efforts have been blocked by a federal judge several times, the Trump administration keeps fighting to impose work reporting requirements in Medicaid, appealing federal court rulings that blocked such requirements because they are illegal. Meanwhile, a recent GAO report found that the administrative costs to implement the failed work requirement programs in five states topped $400 million. Additionally, Trump has repeatedly sought cuts to the program, most recently in his 2021 budget, which called for more than $1 trillion in cuts to the ACA and Medicaid. 

Red States Have Blocked Medicaid Expansion. As the nation faces this unprecedented health care crisis, Medicaid expansion is especially important for reducing uncompensated care costs and protecting rural hospitals from financial peril. Medicaid expansion is a critical part of our response to coronavirus, but Republicans in 12 states have rejected expansion, blocking an estimated two to four million people from gaining Medicaid coverage. All of these states are in the southern and midwest regions with significant rural populations. While Democrats have proposed incentivizing these holdout states to expand Medicaid in response to the pandemic, these efforts have been blocked by Senate Republicans. 

Trump Is Still Trying To Overturn The ACA. Trump notoriously tried and failed multiple times to repeal the Affordable Care Act. All of the repeal bills that went through Congress would have caused millions of Americans to lose their health coverage and raised costs for millions more. Now the Trump administration has thrown its full support behind a lawsuit that would do the same. If the Republican lawsuit is successful, more than 20 million Americans will lose their coverage and more than 135 million people will lose protections for pre-existing conditions, including the millions of Americans who contracted the coronavirus. The lawsuit would also terminate Medicaid expansion, which covers 15 million people and provides important funding for already-struggling rural hospitals during the pandemic. The lawsuit will be heard one week after the election.

President Trump’s Failure to Control Coronavirus Allowed It To Spread To Rural Communities, Overwhelming Already-Vulnerable Hospitals

The Third Wave Of Coronavirus Has Hit Rural Areas Especially Hard. In contrast to the spring, when the virus was spreading rapidly in urban areas, rural counties are now bearing the brunt of the pandemic. America’s most rural areas are currently seeing twice as many new cases per-capita as the nation’s biggest cities, while about one in four COVID-19 deaths are occuring in rural areas. Rural hospitals are especially ill-prepared for surges in patients, as they have little staff and specialized equipment like ventilators. More than half of hospitals in rural areas have no ICUs. Hospitals are easily becoming overwhelmed, and critically ill patients are being forced to travel miles, sometimes out of state, to receive care. Rural areas also have populations that are older and sicker, meaning that a higher proportion of people who contract the virus will end up in the hospital.

• The Virus’ Resurgence In Texas Is Stranding Acutely Ill Patients In Rural Areas. As large hospitals in Texas cities like Lubbock and El Paso are becoming overwhelmed by coronavirus patients, smaller rural facilities have nowhere to transfer those who are critically sick. Hospitalizations in Texas are up more than 75 percent since the beginning of October. Bigger facilities are out of staff and beds — so rural hospitals have nowhere to send patients experiencing other life-threatening emergencies, like heart attacks or strokes. Rural hospitals’ emergency rooms have also been stretched so thin that patients with COVID-19 are waiting in their cars. 
• Rural Areas In The Midwest Are Being Ravaged By COVID-19. On October 29, Illinois, Minnesota, North Dakota and Ohio all reported record highs for new cases in a day. Rural areas in Minnesota are “lit up with cases.” Since the beginning of October, the 10 Minnesota counties with the biggest increase in cases are all in rural parts of the state. Wisconsin is on track to run out of ICU beds, and nurse capacity, in “as little as two weeks.”

Shortages Of Cash And Supplies Make It Harder For Rural Areas To Respond To The Crisis. According to Stateline, “forty-eight percent of rural hospitals have negative operating margins, and the median number of days of cash on hand for all rural hospitals is less than 33.” Many facilities also lost revenue during the first wave of the virus when they were forced to cancel elective procedures. As the administration failed to ramp up supplies of tests and PPE, rural hospitals on shoe-string budgets had to compete with larger health systems and states for access to protective supplies. This problem persists: with the virus still raging, the propensity of larger systems to stockpile this gear has meant that rural clinics are desperate for supplies. Meanwhile, rural hospitals have struggled to ramp up testing. Many can’t afford their own testing labs, so they’ve been forced to send samples to commercial labs that are experiencing delays. Amid the constant financial problems that plague rural facilities, at least 15 rural hospitals have closed in 2020.

Rural Residents Are Experiencing Serious Financial And Health Hardships As A Result Of The Pandemic. More than 40 percent of rural families have reported that, since the pandemic broke out, at least one person in their family had lost a job, been furloughed, or had wages or hours reduced. More than half of rural families have reported having a hard time caring for their children. Meanwhile, one in four rural households have been able to get medical care for serious health problems amid the pandemic, while half of those have reported that a family member experienced serious consequences as a result.