Intro: Coronavirus & Medicaid Awareness Month

America has been hit with an unprecedented health care crisis. This April will be a challenging month for America as communities across the country grapple with the spread of coronavirus. President Trump’s botched response has left America unprepared for this crisis that has devastated communities across the country. Communicating to the press and your constituents during this unprecedented health emergency is a new challenge, but Protect Our Care is here to help you by hosting press calls, identifying storytellers, and facilitating digital events to reach the broader community.

Protect Our Care set has launched the Coronavirus War Room, to educate reporters, provide timely information to interested parties in order to hold Trump accountable for his disastrous response to coronavirus and support the efforts of health care leaders. If you would like to receive information from the Coronavirus War Room, including daily messaging and research, please reach out to Anne Shoup at [email protected]. 

President Trump has failed to prepare America for the coronavirus crisis and has misled the public on his response efforts by downplaying the threat of the virus for months. Trump refuses to take responsibility for failing to prepare America, and wasted precious time ignoring medical experts and ignoring the growing threat that has reached a boiling point. The president even went so far as to blame the nurses and medical workers on the front lines for hoarding equipment when his administration is the one to blame for mass shortages and lack of testing. Now, as hospitals across the country face widespread shortages for protective and preventive equipment, it’s more important than ever that our health care system provides the protections and care Americans desperately need. 

Last month, the Affordable Care Act reached its landmark 10 year anniversary. The law has provided coverage for 20 million Americans and protections for 135 million Americans with pre-existing conditions; all of which Trump and Republicans are trying to strip away during the height of this crisis. The Supreme Court announced just a few weeks ago it would hear the Trump-Republican lawsuit to overturn the ACA in its upcoming term. Imagine what would happen if 20 million Americans lost their coverage and could no longer afford care. Or if insurance companies could deny people with the coronavirus virus coverage because of a pre-existing condition. 

As part of the next coronavirus relief package, you should  push for key elements essential to providing health care during this unprecedented crisis:

• Stop the Trump’s Texas lawsuit that would rip health care from 20 million people
• Ban junk insurance plans that don’t full protect people with pre-existing conditions who need treatment for the coronavirus
• Reopen the federal ACA marketplaces to allow the uninsured to purchase insurance 

Medicaid Awareness Month: highlighting a critical program

April is also Medicaid Awareness Month and there has never been a more critical time to highlight Medicaid’s overwhelming importance as America grapples with a crisis that threatens every Americans’ health and safety. Medicaid is an essential program for more than 75 million Americans currently receiving coverage, including more than 35 million children, and nearly 7 million seniors. From providing health insurance to children and those with disabilities to critical programs for seniors to combating the scourge of opioid addiction, Medicaid serves as a lifeline for millions of Americans, without which many of whom would not get the care they need. 

Communicating to your community during a the crisis

This packet has resources on coronavirus and resources that make the clear connection between the benefits of Medicaid and the fight against coronavirus. It also highlights just how damaging the Trump and Republican sabotage of health care, and specifically of Medicaid, is to Americans in the midst of this crisis. The best way to highlight this dire situation is by uplifting voices of the nurses, doctors and medical workers on the front lines. Their stories are essential in making the reality of this situation clear to the press and the public. If you’d like to work with Protect Our Care in your district, contact Anne Shoup at [email protected]. 

Coronavirus: Main Messaging

Donald Trump is directly responsible for the current health and economic crisis.

• Americans are getting sick and dying needlessly
• Hospitals and health care workers across the country are overwhelmed as they face shortages of basic medical equipment
• Small businesses are threatened, millions are losing their jobs or having their hours cut

The reason is that he failed to prepare our nation and he failed to take the steps necessary to stop the virus in the early stages of the outbreak. 

• He didn’t produce or deploy enough tests;
• He didn’t secure enough personal protective equipment likes masks for healthcare workers;
• He didn’t secure enough hospital beds and ventilators for sick patients;
• He wasted precious months downplaying the severity of the crisis and making false statements, confusing the public,  and delaying the response;
• He ignored the experts and the science

Unfortunately, Donald Trump is still not taking decisive action to protect people’s health and defeat the virus.

• He continues putting out false, misleading information that’s endangering people’s lives
• He’s still downplaying the crisis to avoid taking decisive action (ie. saying testing is no longer a problem)
• He’s dragging his feet on securing & deploying supplies to hospitals and healthcare workers (ie. not broadly using the DPA)
• He contradicts governors and experts
• He continues to push a lawsuit to take away health care coverage from 20 million Americans and protections from preexisting conditions from 135 million Americans, sell junk plans that  won’t adequately cover you for coronavirus

Polling: Americans Concerned About Trump’s Lack of Preparation to Address Crisis

New research provides clear guidance on helpful messaging during this stage of the crisis. These are some highlights.

Background

People care. The American people are afraid and anxious about the coronavirus pandemic, with growing fears about the personal impact on their health. Instead of starting with solutions or critiques, successful messages start with people. 

• In the latest daily tracking survey from Navigator Research, 75% identify coronavirus as a major crisis and an additional 23% say it’s a major problem but not a crisis. This is a dramatic upswing from 33% who considered it a major crisis when first survey on March 6th. Navigator also finds 46% of people very worried that someone close to them will become infected and an additional 34% say they’re somewhat worried. 

People are more worried about the health of their family over the impact on the economy as a whole. The deepest concern people have about coronavirus is related to their health care, and people continue to disapprove of Trump’s handling of health care by 10-points (45-55%). Navigator Research’s latest survey found a 7-point disapproval (44-51%), which is a notable decline from just one week earlier when his disapproval was only 2 points (46-48%). 

Coronavirus concerns can move people away from Trump and those that are in lockstep with his approach. In the mid-March Hart Research survey, they identified 37% of all voters who are persuadable on this issue and they are more likely to be women and more likely to be under the age of 50. At the start of the survey, they are evenly divided in their rating of Trump’s handling of coronavirus-48% approve, 52% disapprove. But after learning about Trump’s failures to prepare and respond to the virus, the rating shifts dramatically to 32% approve and 68% disapprove. 

Message Guidance

Focus on Trump’s failure on preparation. Americans believe that Trump’s failure to prepare and repeated downplaying of the crisis have consequences – Trump’s failure has made the crisis worse. 

• In the Hart Research polling, 54% do not believe Trump did enough to make sure the United States was prepared for coronavirus. 
• In the latest Navigator Research polling, 57% say that Trump did not take it seriously enough when coronavirus first started to spread. By a 22-point margin (58-36%), people say his response was unprepared. In fact, the most serious concerns people have (57%) are that Trump “downplayed the threat of coronavirus early on” and “failed to take decisive action we needed to stop the virus.” 

Focus on Trump’s chaotic or erratic response. In the latest Navigator Research polling, people identify his response as unprepared by a 22-point margin (58-36%), chaotic by a 18-point margin (55-37%) with 34% saying it’s very chaotic and 49% say he is not honest (with 37% saying not at all). 

Focus on his refusal to listen to the experts, on downplaying the seriousness of the crisis and causing confusion. This is the conclusion from Hart Research’s Geoff Garin:

Powerful proof points are clear, tangible in their consequences for people and highlight how the current devastation is due to the mistakes in preparation and response. Americans are especially worried about the danger medical professionals now face because of a shortage of protective gear (72% serious concerns) and the failure of the U.S. to keep up with the pace of testing and preparation in other countries (70%). 

Trump’s Health Care Sabotage Only Makes the Coronavirus Outbreak Worse 

Trump Is Backing A Lawsuit That Could Rip Away Coverage From 20 Million People In The Middle Of The Outbreak. The Trump administration is currently backing a lawsuit that overturn the Affordable Care Act and, if they are successful, 20 million people would lose insurance overnight. The lawsuit also threatens protections for 135 million with pre-existing conditions. This means that anyone who contracts coronavirus – a potential pre-existing condition – could be charged more or denied coverage altogether by insurance companies. 

For more information on the Texas lawsuit, click here. 

Trump’s Texas Lawsuit And Other Efforts To Repeal The ACA Would Cut Key Funding From The CDC. GOP repeal bills would have eliminated the Affordable Care Act’s Prevention and Public Health Fund. In 2017, the Washington Post reported that this fund “provides almost $1 billion annually to CDC, now about 12 percent of CDC’s budget. It includes prevention of bioterrorism and disease outbreaks, as well as money to provide immunizations and heart-disease screenings.” The Trump administration is currently supporting a lawsuit that could repeal the ACA in its entirety, and there is no plan to maintain this funding if the courts overturn the health care law. 

Trump Is Pushing Short-Term Junk Plans That Would Not Need To Cover Coronavirus Treatment. Junk plans do not need to comply with the consumer protections established by the Affordable Care Act, including coverage of essential health benefits. The expansion of junk plans under Trump has already led to reports of patients receiving thousands of dollars in unexpected medical bills: In February, a Florida man covered by Trump-backed short-term plan discovered he “may owe thousands” after he sought a test for coronavirus.

Efforts To Undermine Medicaid Expansion Threaten Coverage For Millions. In addition to seeking to repeal the health care law altogether, Trump has proposed measures that specifically target the ACA’s expansion of Medicaid. The administration has encouraged states to impose illegal work requirements on the expansion population that are designed to throw people off coverage. Additionally, under the Trump administration’s proposed block grant, federal funding would no longer necessarily increase in response to a public health emergency. This could lead to people losing coverage and access to care, undermining prevention and treatment of diseases nationwide. 

Medicaid Is A Critical Part of America’s Response to the Coronavirus, But President Trump Wants to Gut It 

The Medicaid program is a critical part of our response to coronavirus, but President Trump is waging a war on Medicaid. Here are the ways the Trump administration is trying to gut Medicaid and the ways Medicaid is essential to America’s coronavirus response: 

Trump Administration’s War On Medicaid Threats The U.S. Coronavirus Response

Trump Wants To Repeal Medicaid Expansion Through His Texas Lawsuit To Overturn The ACA. The Trump administration is currently backing a lawsuit that overturn the Affordable Care Act and, if they are successful, 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 17 million and cut key funding for already-struggling rural hospitals during the pandemic.

Trump Continues To Support Medicaid Block Grants. 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. 

Trump Paved The Way For Medicaid Work Requirements. The administration has encouraged states to impose illegal work requirements on Medicaid beneficiaries that are designed to throw people off coverage. When Arkansas imposed the nation’s first work requirement program, 18,000 people lost coverage. The policy has since been struck down by the courts. While the federal government has temporarily halted any state efforts to impose new eligibility requirements that make it more difficult to enroll, including work requirements, states like Oklahoma and Utah are continuing to pursue Medicaid work requirements and other enrollment restrictions.

Trump Wants To Gut The Medicaid Budget. 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. 

Experts Agree: Attacks On Medicaid Put The Country Even More At Risk During the Coronavirus Crisis 

Sara Rosenbaum, Medicaid Expert At George Washington University, Said Trump Administration’s Anti-Medicaid Ideology “Is Clouding Their Response To A Crisis.” “’Medicaid could be the nation’s biggest public health responder, but it’s such an object of ire in this administration,’ said Sara Rosenbaum, a Medicaid expert at George Washington University. ‘Their ideology is clouding their response to a crisis.’” [Los Angeles Times, 3/13/20]

Joan Alker, Executive Director Of The Center For Children And Families At Georgetown University, Said That “Work Requirements And Premiums Are Precisely The Kinds Of Policies That Are Dangerous Now.” “‘Work requirements and premiums are precisely the kinds of policies that are dangerous now and divert energy for state government staff, who are under enormous stress,’ said Joan Alker, executive director of the Center for Children and Families at Georgetown University. ‘They need to focus on facilitating as many people’s access to care as they can.'” [Modern Healthcare, 3/18/20] 

1. Gregg Bloche, M.D., J.D., Professor Of Law At Georgetown University, Argued Medicaid Expansion Should Be Part Of The Coronavirus Response. “Nationwide Medicaid expansion should be part of our emergency response to coronavirus. Texas, Florida, and 12 other states are putting lives at risk across America by refusing to extend Medicaid coverage to millions who are poor and uninsured. This ensures that many Americans who become infected will go undiagnosed and untreated: people for whom going to the doctor portends financial calamity tend not to do so before their health circumstances become dire.” [The Hill, 3/9/20] 

Why Medicaid Is So Important

Medicaid’s Funding Can Increase In Response To A Public Health Emergency Like Coronavirus. “Medicaid fills an essential role as a safety-net insurer because of its special flexible design made possible by its open-ended federal funding base. This sets it apart from all other sources of health insurance and allows the program to fund major, unexpected health care costs other insurance plans are structured to avoid.” [Commonwealth Fund, 3/9/20] 

Unlike Private Insurance, Medicaid Allows Eligible People To Enroll Whenever They Need Health Care. “Unlike traditional insurance, which depends on specific enrollment periods to avoid adverse selection, people can enroll in Medicaid whenever health care is needed. In addition, Medicaid provides for offsite enrollment at hospitals and clinics, and temporary eligibility (also known as presumptive eligibility) can be granted.” [Commonwealth Fund, 3/9/20] 

Medicaid Can Provide Retroactive Coverage. “Eligibility can begin three months prior to the date of application, which means that providers will not be penalized financially for furnishing emergency care to Medicaid-eligible patients who have not yet enrolled.” [Commonwealth Fund, 3/9/20] 

Medicaid’s Flexibility Gives States The Opportunity To Cover More Services When Necessary. “State Medicaid programs can rapidly scale up benefits and adjust normal cost-sharing rules when conditions demand it. This flexibility allows programs to quickly add coverage for new vaccines or begin paying for treatment in nontraditional settings, such as the temporary emergency housing that Washington State is now pursuing for coronavirus patients.” [Commonwealth Fund, 3/9/20] 

Why Medicaid Expansion Is So Important

As more than a million workers are expected to lose their jobs by the end of March, it is especially important for low-income adults to have a place to turn for coverage in this public health emergency. 

Medicaid Expansion Covers More Than 17 Million. Thanks to the ACA, states can get additional federal money to expand Medicaid to vulnerable populations. More than 17 million Americans now have coverage through Medicaid expansion. 

Expansion Provides Key Support For Rural Hospitals. The ACA 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. As hospitals prepare for an influx in patients, it is critical that they are paid for the treatment they provide.

• Rural Areas Are Vulnerable To Coronavirus Outbreak, Especially In States That Have Not Expanded Medicaid. “‘Vulnerable’ states, where more than 40% of rural hospitals risk closure, include Florida, Mississippi, Missouri and Tennessee. Alongside Texas, none expanded Medicaid under the Affordable Care Act, which would have insured more low-income people. Rural hospitals in non-Medicaid expansion states are treating more people who have no insurance. Therefore, they are providing more care for which they aren’t reimbursed.” [Stateline, 3/17/20]

Medicaid Is Essential to Helping Rural Hospitals Fight Coronavirus

Rural Americans are especially vulnerable to the coronavirus pandemic due to higher rates of uninsurance and barriers to coverage and care. Research confirms that Medicaid expansion in particular has played a vital role in expanding coverage and protecting rural hospitals. As the nation fights the unprecedented coronavirus outbreak, it is critical that the Trump administration halt any barriers to accessing Medicaid coverage. 

Medicaid Plays A Central Role In Rural Health Coverage

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. 

1.7 Million Rural Americans Gained Coverage From Medicaid Expansion. Nearly 1.7 million rural Americans gained coverage through Medicaid expansion under the Affordable Care Act (ACA). 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. 

Medicaid Expansion Helped Reduce Uncompensated Care Costs. The ACA 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. 

Rural America Is Especially Vulnerable To Coronavirus

Los Angeles Times: “Many Rural Hospitals Appear Woefully Unprepared To Deal With A Pandemic.” “Rural hospitals across the United States were in trouble long before the coronavirus, partly because people in the countryside tend to be sicker, older and poorer than Americans as a whole — hence more expensive to treat. Nearly 100 have closed since 2010, victims of rural flight, workforce shortages and government payments that reimburse less than private insurers. Now many rural hospitals appear woefully unprepared to deal with a pandemic that few parts of the United States are expected to escape.” [Los Angeles Times, 3/25/20] 

More Than Half Of U.S. Counties Have No Intensive Care Beds, Posing A Danger To More Than 7 Million People Who Are Over 60. “More than half the counties in America have no intensive care beds, posing a particular danger for more than 7 million people who are age 60 and up ― older patients who face the highest risk of serious illness or death from the rapid spread of COVID-19, a Kaiser Health News data analysis shows.” [Kaiser Health News, 3/20/20] 

• 2.7 Million Seniors Reside In Counties With No Hospital. “Overall, 18 million people live in counties that have hospitals but no ICU, about a quarter of them 60 or older, the analysis shows. Nearly 11 million more Americans reside in counties with no hospital, some 2.7 million of them seniors.”

• American Hospital Association Said The Country May 20 Times The Current Supply Of ICU Beds To Fight The Virus. “Many experts predict that demand may soon exceed the supply. Over a period of months, the country may need 1.9 million ICU beds — 20 times the current supply ― to treat COVID-19 patients, according to the American Hospital Association.” 

Axios: “Rural America Has A Higher-Risk Population And Fewer Safety-Net Programs For People Who Get Sick.” “The novel coronavirus can spread faster in densely populated cities than in rural areas, but rural America has a higher-risk population and fewer safety-net programs for people who get sick. By the numbers: Rural residents are, overall, older than urban dwellers and are therefore more susceptible to this virus. Per Census Bureau data, 17.5% of the rural population is 65 or older.” [Axios, 3/18/20] 

Stateline: Rural Areas Are Especially Vulnerable To Coronavirus Outbreak. “Rural areas face numerous challenges should they encounter a coronavirus outbreak. There are fewer hospitals, residents travel longer distances to get medical care and a higher proportion of people are older, poorer and sicker.” [Stateline, 3/17/20] 

1 In 4 Rural Hospitals Are At Risk Of Closing. “A new report from the Chartis Center for Rural Health puts the situation in dire terms: 2019 was the worst year for rural hospital closures this decade, with 19 hospitals in rural America shutting their doors. Nearly one out of every four open rural hospitals has early warning signs that indicate they are also at risk of closing in the near future. Since 2010, 120 rural hospitals have closed, according to University of North Carolina researchers. And today, 453 of the 1,844 rural hospitals still operating across the country should be considered vulnerable for closure.” [Vox, 2/18/20] 

Pew Stateline: Nearly 80 Percent Of Rural Counties Are Short On Primary Care Doctors. “A contributing factor is the notoriously hard time rural areas have attracting and keeping medical professionals. Nearly 80% of rural counties are short on primary care doctors, and 9% have none, according to the National Rural Health Association’s Policy Institute.” [Pew Stateline, 1/31/20] 

Medicaid Expansion Is A Lifeline For Rural Hospitals

Rural Hospitals In Medicaid Expansion States Are 62 Percent Less Likely To Close. “But there was one other leading indicator that has an obvious political explanation and which should be entirely avoidable: whether the hospital is in a state that expanded Medicaid under Obamacare. According to Chartis, being in a Medicaid expansion state decreases by 62 percent the likelihood of a rural hospital closing. Conversely, being in a non-expansion state makes it more likely a rural hospital will close.” [Vox, 2/18/20] 

75 Percent Of Vulnerable Rural Hospitals Are In Non-Expansion States. “The states that have experienced the most rural hospital closures over the last 10 years (Texas, Tennessee, Oklahoma, Georgia, Alabama, and Missouri) have all refused to expand Medicaid through the 2010 health care law. It seems their rural hospitals are paying the price. Of the 216 hospitals that Chartis says are most vulnerable to closure, 75 percent are in non-expansion states. Those 216 hospitals have an operating margin of negative 8.6 percent.” [Vox, 2/18/20] 

77 Of 106 Hospital Closures Over The Past Decade Were In States That Refused To Expand Medicaid. “Rural America is in the midst of a deep and prolonged crisis that resulted in 106 hospital closures since 2010. Nearly 700 more are on shaky ground, and nearly 200 are on the verge of collapse right now, according to reports from Massachusetts consulting firm iVantage Health Analytics and the Sheps Center for Health Services Research at the University of North Carolina in Chapel Hill. Hospitals faring the worst are mainly in states that refused to expand Medicaid. Those states account for 77 of the 106 closures over the past decade. They also are home to a greater percentage of money losing facilities and lower collective profit margins.” [Gatehouse News, 7/28/19] 

Republicans Want To End Medicaid Expansion Through Their Lawsuit To Overturn The ACA

• Seventeen Million People Enrolled Through Medicaid Expansion Could Lose Coverage.
• Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in ten, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
• Key Support For Rural Hospitals Would Disappear, leaving hospitals with $9.6 billion more in uncompensated care.