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Trump Regime Launches Cover Up Of Its Health Care Sabotage


Washington DC — As reported by the Associated Press, the Trump White House is claiming it has done nothing to “sabotage” the Affordable Care Act. In a report expected to be released today, the Council of Economic Advisers is trying to claim that the administration’s relentless war on Americans’ health care does not constitute “sabotage.” This is blatantly false. Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“We’re just over a month into 2019 but this whopper is already in the running for the lie of the year. The Trump administration’s relentless sabotage of our health care system is well-documented. In November, voters took to the polls and rejected the Republican war on health care, and the fact that this administration is launching a massive cover-up of their sabotage means that they’re already bracing themselves against the wrath of voters in 2020.”

Don’t believe us? Take a look at our sabotage tracker:

February 2019

  • Trump predicts the Affordable Care Act will be “terminated” through the Texas lawsuit seeking to overturn the law.
  • In an effort to restrict access to information about women’s reproductive health, the Trump administration removes web pages associated with the ACA and its contraceptive coverage from HHS’s Office of Population Affairs website.

January 2019

  • Thanks to GOP sabotage, the uninsured rate surges to the its highest level since 2014. Roughly seven million fewer people are estimated to have health care now than did two years ago.
  • The Centers for Medicare and Medicaid Services (CMS) proposes changes to the ACA’s benefit and payment parameters, reducing subsidies available to those who purchase health care through the exchange, increasing premiums, and raising the out-of-pocket maximum for people with employer-sponsored health care.
  • In a win for big Pharma, the Trump administration proposes changes to the rebate system that would raise premiums, benefit pharmaceutical companies, and contain no mandate to lower list prices of drugs.

December 2018

  • Hand-picked Federal Judge Reed O’Connor rules in favor of twenty conservative states to overturn the Affordable Care Act, jeopardizing coverage for 17 million people and ripping away the ACA’s vital consumer protections such as protections for people with pre-existing conditions.
  • Under the Trump administration’s relentless sabotage, the uninsured rate increases for the first time since 2010. As the Kaiser Family Foundation finds, “In 2017, the uninsured rate reversed course and, for the first time since the passage of the ACA, rose significantly to 10.2% [from 10%].”

November 2018

  • Trump administration issues new guidance urging states to “tear down basic pillars of the Affordable Care Act, demolishing a basic rule” that federal subsidies can only be used to purchase ACA-compliant plans. Experts warn against this move, saying it will push affordable, comprehensive care further out of reach for individuals with pre-existing conditions.
  • Under the Trump administration, the number of uninsured children grows for the first time in nearly a decade. After a decade of steady decreases in the number of uninsured children, in 2017 the number of uninsured children increased from 3.6 million to 3.9 million.

October 2018

  • Republicans appoint Brett Kavanaugh to the Supreme Court. Kavanaugh is known to be hostile to the Affordable Care Act.
  • The Trump administration issues guidance that allows federal subsidies to be used to purchase junk plans that can deny coverage to people with pre-existing conditions.

September 2018

  • The Trump administration’s Department of Justice joins twenty conservative states in court in opening arguments to argue that the Affordable Care Act’s protections for people with pre-existing conditions should be overturned.
  • Nearly 4,600 Arkansans are unable to meet Arkansas’ reporting requirements for the state’s Medicaid work requirements and lose Medicaid coverage.

August 2018

  • Trump administration finalizes rule for bare-bones short-term plans that are exempt from key consumer protections, such as the requirement that insurance covers prescription drugs, maternity care, and hospitalization.

July 2018

  • CMS halts risk adjustment payments, that enable insurance companies to cover everyone, regardless of whether they are healthy or sick.
  • Trump Administration slashes funding for non-profit health navigator groups, that help people shop for coverage, from $36 million to $10 million. CMS encourages groups to use the remaining funds to push people to sign up for junk plans that skirt important consumer protections.
  • President Trump nominates Brett Kavanaugh to the Supreme Court. Kavanaugh has previously forced a young woman to continue a pregnancy against her will and has criticized Justice Roberts for upholding the Affordable Care Act’s constitutionality.

June 2018

  • Department of Justice takes to the courts to argue that insurance companies should be able to discriminate against as many as 130 million Americans with a pre-existing condition.
  • Republican coalition, the Health Policy Consensus Group, released their latest proposal to repeal the Affordable Care Act, which would gut protections for people with pre-existing conditions, let insurance companies charge older people an age tax, and deny key coverage for basic services like maternity care.
  • Trump Administration finalizes proposal to expand access to association health plans that skirt key consumer protections.

May 2018

  • President Trump boasts about health care sabotage: “We will have gotten rid of a majority of Obamacare.”
  • Trump Administration enlists help of former drug lobbyist in writing its drug plan.
  • Congressional Republicans try to use annual farm bill to authorize $65 million in taxpayer funding to set up association health plans, which can  exclude prescription drug coverage, mental health care, and maternity care.

April 2018

  • House Republicans vote on a balanced budget amendment that would cut Medicaid by $700 billion over ten years, $114 billion in a single year alone.
  • Trump Administration limits access to assistance for consumers who want to enroll in marketplace coverage. This change removes the requirement that every area has at least two “navigator” groups to provide consumer assistance and that one be local. Now, just one group could cover entire states or groups of states.

March 2018

  • Republicans sabotage efforts to pass a bipartisan bill that would have stabilized Affordable Care Act marketplaces by insisting the bill restrict access to abortion.

February 2018

  • The Trump Administration announces that it will expand access to short-term health plans that do not have to comply with key consumer protection provisions required by the Affordable Care Act.
  • Urban Institute calculates that repeal of the individual mandate and expansion of short term plans will increase individual market premiums by an average 18.2 percent in 2019.
  • Trump Administration releases budget that calls for the Affordable Care Act to be replaced by Graham-Cassidy, in a move that experts predict would reduce health coverage for 32 million Americans.

January 2018

  • The Trump Administration announces that it will support states that impose onerous work requirements on Americans covered by Medicaid, and approves Kentucky’s worst-in-the-nation waiver the next day.
  • The Trump Administration announces a move to allow providers to discriminate by allowing them to deny patient care for almost any reason.
  • The Trump Administration makes plans to announce even more exemptions from the requirement people have health coverage before this provision is repealed altogether.

December 2017

  • The Trump Administration proposes a rule to expand association health plans, which would gut consumer protections, raise costs for people with pre-existing conditions and further destabilize the insurance markets.
  • Congressional Republicans pass their tax scam, which doubles as a sneaky repeal of the Affordable Care Act  by kicking 13 million people off of their insurance and raising premiums by double digits for millions more.

November 2017

  • Republicans refuse to move forward on the bipartisan Alexander-Murray bill to address the CSR crisis even though it had a filibuster-proof majority in the Senate.

October 2017

  • The Trump Administration takes direct aim at birth control by rolling back a rule that guaranteed women access to contraception. (A court has since questioned the legality of the action.)
  • President Trump signs an Executive Order to roll back key consumer protections that will result in garbage insurance, raise premiums, reduce coverage and again expose millions of Americans to discrimination based on pre-existing conditions.
  • The Trump Administration dramatically cuts in-person assistance to help people sign up for 2018 health coverage.
  • After threatening for months to stop funding cost-sharing reduction payments (CSRs) that help lower deductibles and out-of-pocket costs, the Trump Administration stops the payments altogether. The CBO finds that failing to make these payments will increase premiums by 20% and add nearly $200 billion to the debt.

September 2017

  • The Administration orders the Department of Health and Human Services’ regional directors to stop participating in Open Enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell says, “I didn’t call it sabotage…But that’s what it is.”

August 2017

  • The Administration cuts the outreach advertising budget for Open Enrollment by 90 percent, from $100 million to just $10 million – which resulted in as many as 1.1 million fewer people getting covered.

July 2017

  • The Trump Administration uses funding intended to support health insurance enrollment to launch a multimedia propaganda campaign against the Affordable Care Act.
  • President Trump, again, threatens to end cost-sharing reduction payments.

June 2017

  • Senate Republicans embark on a monthslong failed attempt to pass BCRA, Skinny Repeal and Graham-Cassidy, all repeal bills that would have caused millions of Americans to lose their health coverage and raised premiums by double digits for millions more. They would have ended Medicaid as we know it, putting the care of children, seniors and people with disabilities at risk.

May 2017

  • House Republicans vote for and pass a health care repeal bill that would cause 23 million people to lose coverage and gut protections for people with pre-existing conditions. It would have imposed an age tax and allowed insurers to charge people over 50 five times more for coverage and ended Medicaid as we know it, putting the care of seniors, children and people with disabilities in jeopardy.

April 2017

  • The Trump Administration cuts the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
  • In an effort to convince Democrats to negotiate a repeal of the Affordable Care Act, President Trump threatens to cut off cost-sharing reduction payments (CSRs) that help low-income marketplace customers pay for out-of-pocket costs.

March 2017

  • The Trump Administration sends a letter to governors encouraging them to submit proposals which include provisions such as work requirements that make it harder for Medicaid beneficiaries to get affordable care and increase the number of people who are uninsured.

February 2017

  • The Trump Administration proposes a rule to weaken Marketplace coverage and raise premiums for millions of middle-class families.

January 2017

  • On his first day in office, President Trump signs an Executive Order directing the administration to identify every way it can unravel the Affordable Care Act.
  • Also on January 20th, the Department of Health and Human Services begins to remove information on how to sign up for the Affordable Care Act.
  • The Trump Administration pulls funding for outreach and advertising for the final days of 2017 enrollment. This move is estimated to have reduced enrollment by nearly 500,000.

Anti-Health Care Nominee Chad Readler Is Voted Out Of Committee By Senate Republicans 


Senate Republicans Once Again Turn Their Backs On People With Pre-existing Conditions With Anti-Health Care Vote

Washington DC — Today, on a party-line vote, Republicans on the Senate Judiciary Committee voted to allow Chad Readler’s nomination to the Sixth Circuit Court of Appeals to proceed to the full Senate for debate and a vote. Readler led the effort in the Trump Justice Department to eliminate protections for pre-existing conditions by filing a brief on behalf of the Trump administration in Texas v. United States arguing in favor of striking down the Affordable Care Act’s provisions to prevent insurance companies from denying coverage, or charging more because of a pre-existing condition. In December 2018, U.S. District Court Judge Reed O’Connor ruled in favor of the Republican plaintiffs and said the entire ACA should be struck down. Now, Mitch McConnell is breaking with longstanding Senate norms to jam through this nomination by ignoring the objections of Readler’s home state senator, Sherrod Brown. Leslie Dach, chair of Protect Our Care, issued the following statement:

“A vote for Chad Readler is a vote for full repeal of the Affordable Care Act. His confirmation vote is a litmus test for Republican’s claims to protect people pre-existing conditions and today they failed that test. Readler wants to go back to the days where insurance companies could deny, drop or charge more for coverage and end protections for millions of people with pre-existing conditions. The stakes couldn’t be clearer, the full Senate must stand up for people with pre-existing conditions and block Chad Readler from a lifetime appointment to the court.”

Background:

As Acting Assistant Attorney General, Chad Readler filed a brief on behalf of the Trump administration in Texas v. United States arguing that protections for people with pre-existing conditions under the Affordable Care Act should be struck down. This put the full weight of the Department of Justice behind the Republican war on health care to overturn the entire Affordable Care Act (ACA).  In December, a federal judge ruled in favor of the Republican plaintiffs, striking down the entire ACA. If this ruling is allowed to stand:

  • Marketplace tax credits and coverage for 10 million people: GONE.
  • Medicaid expansion currently covering 15 million people: GONE.
  • Protections for more than 130 million people with pre-existing conditions when they buy coverage on their own: GONE.
  • Allowing children to stay on their parents’ insurance until age 26: GONE.
  • Free annual wellness exams: GONE.
  • Ban on annual and lifetime limits: GONE.
  • Ban on insurance discrimination against women: GONE.
  • Contraception with no out-of-pocket costs: GONE.
  • Limit on out-of-pocket costs: GONE.
  • Requirement that insurance companies cover essential benefits like prescription drugs, maternity care, and hospitalization: GONE.
  • Improvements to Medicare, including reduced costs for prescription drugs: GONE.
  • Closed Medicare prescription drug donut hole: GONE.
  • Rules to hold insurance companies accountable: GONE.
  • Small business tax credits: GONE.

Back At It Again: Trump Administration Hostile to Medicaid Ignored Rules That Protect Patients


Washington DC — Today, the Los Angeles Times reports that the Trump administration is scrambling to overhaul Medicaid by requiring burdensome work requirements, but are failing to enforce federal rules directing states to analyze the devastating impact such requirements will have on millions of Americans who rely on this life-saving program. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:   

“The actions by this administration are egregious, but unfortunately par for the course considering President Trump has put people in charge of Medicaid who are simply out to destroy it. Failing to enforce rules requiring states to access the impact of Medicaid work requirements shows that the Trump administration doesn’t care who their policies hurt. This is part and parcel to Trump-led Republican sabotage agenda: they oppose Medicaid expansion — which would provide health care coverage to millions more Americans, support so-call ‘block grants” — a euphemism for slashing coverage, and are pushing ‘work requirements’ – which are little more than gotcha paperwork meant to kick eligible people off the rolls. Medicaid is the nation’s largest health insurance program and is more popular today than ever before. These senseless work requirements are already jeopardizing health care for thousands of low-income families — nearly all of whom are already working — and the Trump administration is breaking every rule in the book in their rush to implement it as just another deliberate attack on American health care.”

Background:

IN STATES WHERE SIMILAR RULES HAVE TAKEN EFFECT, THOUSANDS OF PEOPLE HAVE LOST CARE

  • Results from Arkansas confirm that Medicaid work requirements are fundamentally bureaucratic hurdles, threatening access to health coverage for thousands across the state. “A review of monthly data related to the new requirements released by the Arkansas Department of Human Services shows that from September through December 2018, over 18,000 people were disenrolled for failure to comply with the new requirements for three months.” [Kaiser Family Foundation, 1/17/19]
  • This summer, a federal district court blocked Kentucky from imposing similar rules for the negative effects it would have on Kentuckians. Said the court in its ruling, “[Secretary Azar] never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders his determination arbitrary and capricious. The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review.”
  • In Indiana, 25,000 people with health insurance through Medicaid were dropped from coverage because they were unable to pay their premiums. The Washington Post reported, “About 25,000 adults were disenrolled from the program between its start in 2015 and October 2017 for failure to pay their premiums, according to state reports. Yet, state officials estimate that based on surveys of recipients, about half of those who were disenrolled found another source of coverage, most often through a job…In addition to those who were disenrolled, another 46,000 adults who signed up for Medicaid during 2016 and 2017 were not accepted because they did not pay their initial premium, the state reported.”

WORK REQUIREMENTS ADD ADMINISTRATIVE HURDLES, MAKING IT HARDER FOR PEOPLE WHO ARE ELIGIBLE FOR CARE TO GET IT

  • Requiring People On Medicaid To Prove They Are Working Adds An Administrative Burden That Is Hardest On Low-Income Americans. “[Administrative hurdles] may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access.  There is also a lot of research about the Medicaid program, specifically, that shows that sign-ups fall when states make their program more complicated.” [New York Times, 1/18/18]
  • Documentation Requirements Increase The Chances That People Will Lose Care, Simply Because They Have Trouble Navigating The Process. “There is a real risk of eligible people losing coverage due to their inability to navigate these processes, miscommunication, or other breakdowns in the administrative process. People with disabilities may have challenges navigating the system to obtain an exemption for which they qualify and end up losing coverage.” [Kaiser Family Foundation, 1/16/18]

THE VAST MAJORITY OF  PEOPLE WITH MEDICAID COVERAGE WHO WHO CAN WORK ARE WORKING

  • 60 percent of nondisabled people with health coverage through Medicaid have a job and are working, including 42 percent working full-time.
  • 51 percent of working adult Medicaid enrollees have full-time jobs year-round, but their salaries are still low enough to qualify for Medicaid coverage, or have Medicaid because their employers do not offer insurance.  
  • Nearly 80 percent of nondisabled people with Medicaid coverage live in a family where at least one person is working, including 64 percent working full-time. The other adult family member may not be working because they have caregiving or other responsibilities at home.
  • A state by state breakdown can be found HERE

SOTU PREVIEW: Five Ways The Trump Administration Has Continued To Sabotage Americans’ Health Care Since The Midterms

In November, voters took to the polls and sent a clear message to GOP leaders: end the Republican war on health care. National exit polls showed health care was the top issue to voters, and exit polls of competitive districts found Democrats had an eight point advantage on health care, 52 to 44 percent. Thirty-three members of Congress who voted to repeal the ACA lost their seats.

Despite voters’ clear rejection of the GOP sabotage agenda, President Trump has continued to ruthlessly target Americans’ health care. Here’s a look at five ways he has ignored the will of the American people and taken aim at health care since this fall’s midterm elections:

  1. Just Last Week, President Trump Admitted That He Supports The Goal Of The Lawsuit Led By Republican Attorneys General And Governors To Completely “Terminate” The Affordable Care Act. Trump predicted the Affordable Care Act would be “terminated” through the Texas lawsuit seeking to overturn the law. In December, cherry-picked Federal Judge Reed O’Connor ruled in favor of twenty conservative states to overturn the Affordable Care Act, jeopardizing coverage for 17 million people and ripping away the ACA’s vital consumer protections such as protections for people with pre-existing conditions.
  2. In January, Experts Blamed Trump Administration Sabotage for Driving The Uninsured Rate To Its Highest Level Since The Implementation Of The Affordable Care Act In 2014. Thanks to GOP sabotage, the uninsured rate surged to its highest level since 2014. Roughly seven million fewer people are estimated to have health care now than did two years ago.
  3. In Its Notice Of Benefit And Payment Parameters, The Centers For Medicare And Medicaid Services Actually Proposed Changes That Would Make Consumers Pay More. The Centers for Medicare and Medicaid Services’ (CMS) proposed changes to the ACA’s benefit and payment parameters would reduce premium tax credits by $1 billion per year, cause 100,000 people to lose marketplace coverage starting in 2020, increase annual premiums, and increase the out-of-pocket maximum for people with employer-sponsored health care.
  4. The Trump Administration Just Gave PhRMA a Big Win After The Pharmaceutical Industry Spent $280 Million On Lobbying In 2018. In a win for big Pharma, the Trump administration proposed changes to the rebate system that would raise premiums, benefit pharmaceutical companies, and contain no mandate to lower list prices of prescription drugs.
  5. After The Midterm Elections, The Trump Administration Urged States To Allow Federal Subsidies To Be Used To Purchase Junk Plans That Discriminate Against People With Pre-existing Conditions. The Trump administration issued new guidance urging states to “tear down basic pillars of the Affordable Care Act, demolishing a basic rule” that federal subsidies can only be used to purchase ACA-compliant plans. Experts warn against this move, saying it will push affordable, comprehensive care further out of reach for individuals with pre-existing conditions.

Ahead of Trump’s State Of The Union Address, Protect Our Care Releases Ad Outlining Health Care Agenda For Congress

View The Ad: An Agenda for American Health Care

Washington, D.C. — Ahead of President Trump’s State Of The Union address tonight, Protect Our Care released a new digital ad outlining a health care agenda that responds to Americans’ call for lower prescription drug costs, more affordable health care, and enhanced protections for patients like those with pre-existing conditions. During the 2018 midterm elections, Americans went to the polls to voice their outrage over Republican attacks on health care and the result was clear: voters elected a “Health Care Congress” to lower costs, improve care and expand coverage. The ad will run heavily on social media today and during the State of the Union address tonight targeting voters, members of congress and their staff, and reporters covering the address.

“No matter what the president says tonight, his record is clear. This administration had two years to find ways to lower costs and improve health care coverage for Americans but instead worked overtime to repeal and sabotage American health care,” said Brad Woodhouse, executive director of Protect Our Care. “This ad lays out the agenda for health care the American people voted for in November and serves as a blueprint for action in 2019. The time has come for Congress to lower costs, safeguard protections, and rein in the greed and abuses of insurance companies and the pharmaceutical industry. The American people rejected the anti-health care agenda that has defined the Republican Party for almost a decade now. If Donald Trump and his Republican allies truly care about the state of our union, they would heed the message voters sent in November and end their war on health care.”  

Watch Protect Our Care’s new ad here:

Background:

Read Protect Our Care’s full 2019 Agenda here. A summary of the agenda from the report can be found below.

Do Everything Possible to Overturn the Federal Court Decision that Struck Down the Affordable Care Act

  • Oppose the Texas ruling by a conservative federal judge in the Northern District of Texas that overturned the entire Affordable Care Act by passing a Senate Resolution to similar to the House measure that authorizes the House legal counsel to intervene in the lawsuit and oppose the Republican attorneys general, governors, and Trump Administration who are continuing the war on health care through the courts.

End the War on People with Pre-Existing Conditions

  • Stop insurance companies from selling junk health insurance that allows them to deny quality, affordable coverage to people with pre-existing conditions.  These kinds of short term plans should be limited to three-months with no option for renewal.
  • Guarantee protections for pre-existing conditions and essential health benefits. Require all health plans to cover the “essential health benefits” included in the law, ensure guaranteed issue and community rating, and prohibit insurance companies from imposing lifetime and annual limits on the amount of care a patient can receive.

Lower Costs

  • Lower the costs of prescription drugs. Pass legislation to allow Medicare to negotiate drug prices for all beneficiaries; end price gouging by requiring drug manufacturers to give notice and justify significant price increases; and require transparency of rebate amounts.
  • End surprise medical bills. 57 percent of Americans have received a surprise bill. Too many  people go to a hospital or Emergency Room that is in their network, but get billed for services provided out-of-network, subjecting them to huge bills, as much as six figures. Congress should pass legislation to end surprise medical bills and limit the amount a provider can charge to a negotiated rate.  
  • Expand financial assistance by expanding the eligibility for premium tax credits above 400 percent of the federal poverty limit and increase the size of the tax credit for all income brackets.
  • Expand services before deductibles, examples would include three primary care visits and one specialist visit that are not subject to a plan’s deductible.

End Republican Sabotage

  • Fully support Open Enrollment by restoring funding to the pre-Trump levels and making all information about ways to sign up for coverage easily accessible for everyone.
  • Oppose waivers that undermine the ACA and allow states to skirt key provisions of the law.

Strengthen Medicaid and Medicare

  • Improve Medicare’s affordability by adding an out-of-pocket maximum after which beneficiaries would be protected from additional costs; including prescription drugs in the limit on out-of-pocket spending; adding coverage for vision, hearing, and dental; and making cost-sharing more affordable.
  • Extend and increase federal funding for Medicaid expansion.

Conduct Oversight on Trump Administration Actions that Undermine The Affordable Care Act

  • Topics to conduct oversight on include the Trump Justice Department’s decision not to defend all of the Affordable Care Act in federal court, cuts to outreach and navigator funding, rules opening the door to junk insurance, 1332 guidance that allows federal funds to be used to purchase skimpy health plans, relationships between Administration political appointees and regulated industries, the administration’s push to encourage states to impose work requirements on Medicaid coverage, drug prices and pharmaceutical profits.

State Leaders Praise Protect Our Care’s Agenda For “The Health Care Congress”

Health care activists and elected officials from across the country are praising Protect Our Care’s agenda for the 116th Congress that will lower costs and improve care for all Americans. Leaders in Arizona, Colorado, Iowa, North Carolina and Ohio are among those who have weighed in on the opportunity Congress has to build on the current health care law by making access to health care more affordable and accessible to all Americans.

 

Arizona Republic: Gallego, Kirkpatrick Call For ‘Health Care Congress’ To Fight For ACA. “The partisan battle over health care continued Tuesday as the liberal group ‘Protect Our Care Arizona’ demanded that Congress keep fighting for the Affordable Care Act amid ongoing attacks by President Donald Trump’s administration. Joined by Reps. Ruben Gallego and Ann Kirkpatrick, the Democratic coalition known for defending former President Barack Obama’s signature health-care-reform law — which critics on the right dubbed ‘Obamacare’ — called for the new 116th Congress to right the wrongs they say Republicans have done in the health-care realm. [AZCentral,1/30/19]

Tucson Weekly: Reps. Gallego And Kirkpatrick Talk Health Care.Ruben Gallego (CD-7) and Ann Kirkpatrick (CD-2), two Democratic representatives in U.S. Congress joined Alicia Held, an Arizona healthcare advocate, to talk about the state of health coverage in Arizona. They discussed what citizens can expect in the future during a press call hosted by Protect Our Care Arizona. Rep. Gallego said more than 20 million Americans have healthcare because of the Affordable Care Act, while Republicans have ‘waged a war’ against it. He said Democrats need to fight back in order to keep coverage for those who need it most. ‘Americans shouldn’t have to choose between paying for healthcare and buying groceries,’ he said.” [Tucson Weekly, 1/29/19]

Denver Westword: Attacking Outrageous Health-Care Costs In Colorado And Beyond.A new report released today suggests ways for the U.S. Congress to fight rising health-care costs. Meanwhile, Colorado Governor Jared Polis just signed an executive order creating what’s been dubbed the Office of Saving People Money on Health Care. Anne Shoup, communications director for Protect Our Care, a coalition in Washington, D.C. (with staff assigned to Colorado), that put out the report, ‘The Health Care Congress: Cost, Coverage, Consumer Protections,’ sees these efforts as both timely and complementary. As Shoup notes, ‘We’re calling on Congress to enact cost-saving measures for people, but it’s hard to say what we can actually get done…it’s encouraging to see a state like Colorado step forward to find ways to lower costs for its constituents.’” [Westword, 1/24/19]

Daily Iowan, Iowa Starting Line, Iowa State Daily: This Must Be The Health Care Congress. “Iowans and Americans have demanded access to quality, affordable coverage at the ballot box and millions in our state and across the country deserve to have this year’s Congress be the ‘Health Care Congress. What would that mean, for this to be the Health Care Congress? First,Congress should do everything possible to overturn last year’s federal court decision that struck down the ACA, which President Trump has repeatedly celebrated and which has faced virtually no opposition from Senator Ernst and other Republican members of Congress…the Health Care Congress also has to end the Republican war on people with pre-existing conditions…the Health Care Congress can and should strengthen Medicaid and Medicare. Aside from extending and increasing federal funding for Medicaid expansion, they can improve Medicare’s affordability by adding an out-of-pocket maximum for older Americans.” [The Daily Iowan, 1/24/19]

BlueNC: Protect Our Care Announces Health Care Agenda for New Congress. “This week, Protect Our Care unveiled their health care agenda for the new Congress. The agenda is detailed in a new report, which calls for bold Congressional action to defend the Affordable Care Act against Republican attacks, strengthen Medicaid and Medicare, lower costs, and enact further protections for individuals with pre-existing conditions. Congressman David Price and State Sen. Jay Chaudhuri joined Protect Our Care North Carolina on a press call yesterday discussing the report – The Health Care Congress: Cost, Coverage, Consumer Protections – and what it means for North Carolina. ‘The voters want us to protect their health care,’ Representative David Price said. ‘They want us to protect the Affordable Care Act…and they want us to do whatever it takes to bring affordable, good health care to all of our people.’ ‘In November…affordable health care was the top issue for North Carolinians,’ State Sen. Jay Chaudhuri said. ‘Republicans…have two options for how they will govern – they can work with Democrats to find common ground, or they can continue to carry out a highly partisan agenda.’” [BlueNC, 1/25/19]

Gongwer News Service: Advocates Urge Congress To Expand Health Care Access. “During a Columbus press conference, representatives from Protect Our Care Ohio and several allied groups touted the organization’s January report laying out the group’s health care priorities for Congress. Titled ‘The Health Care Congress: Cost, Coverage, Consumer Protections,’ the paper outlines several steps advocates argue would shore up health care options and lower treatment costs for residents of the Buckeye State. The group’s report comes a day after Gallup found that the percentage of U.S. adults without health insurance increased 1.3 percentage points in the fourth quarter of 2017 compared to a year before, representing the largest single-year increase measured by the polling firm and Sharecare since they began tracking the rate in 2008. ‘There are many things this Congress could be doing to improve care and lower costs,’ Protect Our Care spokeswoman Amanda Wurst said. ‘Republicans in the Congress need to end their continued attack on the Affordable Care Act and join their Democratic colleagues in protecting our care.’” [Gongwer, 1/28/19]

Hannah Report: Groups Urge Congress to Protect the Affordable Care Act, Health Care. “Advocates who favor the Affordable Care Act (ACA), also known as Obamacare, urged Congress Friday to take steps to protect health care for Americans, including for those with pre-existing conditions and people who enrolled in Medicaid thanks to the ACA’s expanded requirements. The groups, which include For Our Future, Protect Our Care Ohio, ProgressOhio, and the Universal Health Care Action Network (UHCAN) Ohio, said the biggest threat to health care is a federal lawsuit originating in Texas that saw a federal judge rule the ACA was unable to stand on its own after Congress eliminated the tax penalty for not having health insurance. But they said there are other threats to the law as well, including efforts by the Trump administration to weaken it. Amanda Wurst, the Ohio director of Protect Our Care, said at a press conference held Friday in Columbus that Congress can take other steps to help lower the cost of health care in addition to preserving protections for those with preexisting conditions.” [Hannah Report, 1/25/19]

NEW NYT Interview, Trump Reveals Goal of Texas Lawsuit: “Terminate” Health Care

Washington DC — According to the newly released transcript of President Trump’s interview with The New York Times, Trump boasted that his Texas lawsuit will “terminate” the Affordable Care Act and that was a political “victory” for him and Republicans in Congress. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:

“President Trump confirmed what we all know to be true: he and Republicans are using the Texas lawsuit to overturn the entire Affordable Care Act – eliminating all the protections for people with pre-existing conditions – with no plans for a replacement. Voters overwhelmingly rejected Trump’s health care repeal and sabotage agenda back in November, yet President Trump and his allies in Congress are dead set on accomplishing through the courts what they couldn’t do legislatively: fully repeal the law, devastate American health care and leave millions of Americans at risk.”

New Web Video: Time To Stand Up To Big Drug Companies

Yesterday, House Oversight Chairman Elijah Cummings kicked off the new Health Care Congress by taking a stand for Americans and standing up to the drug companies. Cummings explained that when these drug companies (some of the most powerful corporations in the world) raise prices suddenly, everyday Americans are “left holding the bill.” That’s why we proposed in our Health Care Agenda that Congress should end price gouging and lower prescription drug prices for all Americans. We look forward to working with this health care Congress as they fight to push our health care system in the right direction.

Watch Video Here:

 

 

Breaking: State-based Exchanges Break Enrollment Record

Washington DC — As reported by health care analyst Charles Gaba, the state-based exchanges have broken an all-time enrollment record despite the Trump administration’s relentless attempts to sabotage access to coverage. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:

“Millions of Americans rely on the Affordable Care Act for quality coverage and today’s announcement is evidence that the American people want and need coverage through the exchanges despite constant sabotage from the Trump administration. The fact that states who manage their own marketplaces saw record-breaking numbers this year while federal marketplaces saw a substantial decline is all the evidence one needs to prove that President Trump’s repeal-and-sabotage agenda is hurting millions of Americans.”

 

BREAKING: State-based exchanges collectively break all-time enrollment record!

ACA Signups // Charles Gaba // January 30, 2019

 

 

With Covered California releasing their final, official 2019 Open Enrollment Period data, and the latest updates from New York (which still has 2 days to go) and Massachusetts (which wrapped up last week), I now nearly all 2019 OEP data on hand.

I say nearly all because there are still three numbers missing:

  • Vermont has yet to release any 2019 enrollment data. This is the 3rd year in a row that they’ve been radio silent. Assuming they’re close to last year (28,763 QHP selections), they should add around 28,000 to the national total.
  • New York still has 2 days left for people to #GetCovered. I’m going to assume they’ll tack on perhaps 5,000 more people today and tomorrow.
  • The District of Columbia hasn’t posted any updates since December 11th, which means not only do they still have 2 days for people to sign up, they’re actually missing a whopping 51 days worth of enrollment data. Again, assuming they wrap up close to last year, that should mean another 1,400 or so from DC.

Between the three, I’d expect another ~34,000 QHP selections to be tacked onto the totals below.

However, even without that, the 12 state-based exchanges have collectively broken their all-time record for ACA Open Enrollment, racking up more than 3,018,000 QHP selections this season.

Here’s what that looks like visually…and the contrast between the Federal Exchange and the State-Based Exchanges is dramatic:

  • After a dramatic enrollment increase in 2015 and a lesser increase in 2016, the 39 states hosted by HC.gov have seen a gradual, steady decline each year since. They closed out the 2019 Open Enrollment Period with 1.3 million fewer people having signed up than at their peak in 2016. Perhaps 200,000 or so of this was due to Louisiana and Virginia expanding Medicaid in recent years, but that does nothing to explain the other 1.1 million drop-off, which is almost certainly due to having the HC.gov marketing & outreach budgets being slashed to the bone, the Open Enrollment Period being cut in half and so forth.
  • Meanwhile, the 12 states which operate their own full ACA exchanges (and which have their own marketing/outreach budgets) saw less-dramatic increases in 2015 & 2016…but they’ve collectively stayed virtual dead even for every year since then. In fact, when the dust settles on the 2019 Period, I expect the 12 state-based exchanges to reach around 3.05 million QHP selections, which would be 1.5% higher than last year and 1.3% higher than their collective all-time high in 2017.

Reminder: Association Health Plans Have Long History Of Fraud And Unpaid Claims

The fact of the matter is simple: association health plans (AHPs) are not required to cover the essential health benefits put in place by the Affordable Care Act and are allowed to charge people more based on their age, health status, and gender. This means that while AHPs are required to cover people with pre-existing conditions, they can refuse to cover any treatment associated with a pre-existing condition. Because these plans lack consumer protections, plans that do cover essential health benefits could scale back coverage at some point, and consumers wouldn’t know until it was too late. Fundamentally, association health plans open the door to coverage that is not comprehensive and have a long, well-documented history of fraud and abuse.

ASSOCIATION HEALTH PLANS HAVE A HISTORY OF FRAUD AND UNPAID CLAIMS

Former Insurance Fraud Investigator: “Fraudulent Association Health Plans Have Left Hundreds Of Thousands Of People With Unpaid Claims.” “Marc I. Machiz, who investigated insurance fraud as a Labor Department lawyer for more than 20 years, said the executive order was ‘summoning back demons from the deep.’ ‘Fraudulent association health plans have left hundreds of thousands of people with unpaid claims,’ he said. ‘They operate in a regulatory never-never land between the Department of Labor and state insurance regulators.’” [New York Times, 10/21/17]

Between 2000 and 2002, AHPs Left 200,000 Policyholders with $252 Million In Unpaid Medical Bills. “There have been several documented cycles of large-scale scams. According to the GAO, between 1988 and 1991, multiple employer entities left 400,000 people with medical bills exceeding $123 million. The most recent cycle was between 2000 and 2002, as 144 entities left 200,000 policyholders with $252 million in unpaid medical bills.” [United Hospital Fund, 3/6/18]

[GAO, February 2004]

2017: Labor Department Filed A Suit Against An AHP For 300 Employers In Washington State Alleging The AHP Had Charged Employers More Than $3 Million In Excessive Fees And Violating Its Fiduciary Duty By Using Assets For Personal Interests. “The problems are described in dozens of court cases and enforcement actions taken over more than a decade by federal and state officials who regulate the type of plans Mr. Trump is encouraging, known as association health plans. In many cases, the Labor Department said, it has targeted ‘unscrupulous promoters who sell the promise of inexpensive health benefit insurance, but default on their obligations.’ In several cases, it has found that people managing these health plans diverted premiums to their personal use. The department filed suit this year against an association health plan for 300 small employers in Washington State, asserting that its officers had mismanaged the plan’s assets and charged employers more than $3 million in excessive ‘administrative fees.’ Operators of the health plan violated their fiduciary duty by using its assets ‘in their own interest,’ rather than for the benefit of workers, the government said.” [New York Times, 10/21/17]

2016: A Labor Department Lawsuit Revealed An AHP Had Concealed Financial Problems And Left $3.6 Million In Unpaid Claims. “The Labor Department filed suit last year against a Florida woman and her company to recover $1.2 million that it said had been improperly diverted from a health plan serving dozens of employers. The defendants concealed the plan’s financial problems from plan participants and left more than $3.6 million in unpaid claims, the department said in court papers.” [New York Times, 10/21/17]

A Health Plan For New Jersey Small Businesses Collapsed With $7 Million In Unpaid Claims. “In another case, a federal appeals court found that a health plan for small businesses in New Jersey was ‘aggressively marketed but inadequately funded.’ The plan collapsed with more than $7 million in unpaid claims.” [New York Times, 10/21/17]

In Florida, A Man Pleaded Guilty To Embezzling $700,000 In Premiums From An AHP To Help Build A Home For Himself And Was Sentenced To 57 Months In Prison. “A Florida man was sentenced to 57 months in prison after he pleaded guilty to embezzling about $700,000 in premiums from a health plan that he had marketed to small businesses. The Labor Department and the Justice Department said he had used some of the plan premiums to build a home for himself.” [New York Times, 10/21/17]

In South Carolina, A Man Pleaded Guilty To Diverting Nearly $1 Million From An AHP For Churches And Small Businesses, Leaving $1.7 Million In Unpaid Claims. “A South Carolina man pleaded guilty after the government found that he had diverted more than $970,000 in insurance premiums from a health plan for churches and small businesses. ‘His embezzlement and the plan’s consequent failure left behind approximately $1.7 million in unpaid medical claims,’ the Labor Department said.” [New York Times, 10/21/17]

In Louisiana, Two People Pleaded Guilty To Using Money From The AHP For Spa Treatments, Diamond Cuff Links, Foreign Travel And Other Personal Expenses. “And in Louisiana, two people pleaded guilty to conspiracy charges after the government found that they had taken money from the medical benefit fund of a trade association and used it to pay for spa treatments, diamond cuff links, evening gowns, foreign travel and other personal expenses.” [New York Times, 10/21/17]

One AHP Scheme Shows How AHPs Can Move From State To State. Families USA chronicled an AHP scheme involving the American Trade Association, Smart Data Solutions, and Serve America Assurance. They found:

  • “Even after one state identifies a problem, the company may continue to operate for years in other states. North Carolina issued a cease and desist order to stop many of the players in this case from selling insurance in 2008.”
  • “But by June 2010, when Maryland issued a cease and desist order, the plans sold by these players had been identified in at least 23 states.2 „ Estimates of total premiums paid to these companies for unauthorized, unlicensed plans range from $14 million to $100 million.”
  • “This particular scheme operated through associations that went by many different names. (At least one of the players in this case was involved in a previous case concerned with fraudulent insurance sold through an association of employers in 2001-2002.”
  • “Consumers are often ill-protected when they buy coverage through an association, and the web of relationships among salespeople, associations, administrators, and actual insurers can be difficult for regulators to unravel and oversee. Consumers may be encouraged to join fake associations to buy health insurance so they have an illusion of coverage—and the insurers collect membership dues and premiums while illegally avoiding state oversight).” [Families USA, October 2010]

GAO Report In 1992 Showed Similar AHPs Left At Least 398,000 Participants With More Than $123 Million In Unpaid Claims And More Than 600 Plans In Almost Every State Failed To Comply With State Laws. “Back in 1992, the Government Accountability Office issued a scathing report on these multiple employer welfare arrangements (known as MEWAs; they’re pronounced “mee-wahs”) in which small businesses could pool funds to get the lower-cost insurance typically available only to large employers. These MEWAs, said the government, left at least 398,000 participants and their beneficiaries with more than $123 million in unpaid claims between January 1988 and June 1991. Furthermore, states reported massive and widespread problems with MEWAs. More than 600 plans in nearly every U.S. state failed to comply with insurance laws. Thirty-three states said enrollees were sometimes left without health coverage when MEWAs disbanded…’MEWAs have proven to be a source of regulatory confusion, enforcement problems and, in some instances, fraud,’ the GAO wrote at the time.” [Washington Post, 10/12/17]

Kentucky Experiment Showed AHPs Destabilize The Market And Caused Insurers To Leave Individual Market Or Not Sell New Policies Subject To Higher Standards. “In 1994, Kentucky passed a set of health insurance reforms (for the individual and small-group markets) that were very similar to the ACA’s market reforms.  These included a requirement for insurers to accept all applicants regardless of their health status, restrictions on exclusions of pre-existing health conditions, and a requirement that premiums be set without regard to health status, claims experience, or gender.  Premium variations for age, family size, and geographic factors were limited, and plan benefits were standardized. Insurers in the state resisted the reforms and lobbied to repeal parts of it. In 1996, Kentucky’s legislature passed legislation that repealed many of the market reforms.  Crucially, the law exempted associations of employers or individuals from the premium-rating and benefits requirements, a loophole that allowed associations to sell coverage under a much weaker regulatory scheme. In part because healthy individuals could buy association plans, the risk of adverse selection against the reformed individual market increased.  Nearly all insurers left Kentucky’s individual market or declined to sell new policies that were subject to the stronger rating and benefits standards. In 1998, the Kentucky legislature passed a bill that repealed many of the state’s remaining health insurance reforms.” [Center on Budget and Policy Priorities, 11/29/17]

STATE INSURANCE OFFICIALS, EXPERTS HAVE WARNED OF SUCH FRAUD UNDER NEW RULES

As Coalition Urges States To Allow AHPs, State Officials Push Back, Warn Of Fraud. “A coalition of business groups wants to ensure that the states aren’t setting up hurdles that will make it difficult for small employers to participate in group health plans established under a new rule by the U.S. Labor Department… [Pennsylvania Insurance Commissioner Jessica Altman] reminded the DOL before the rule was finalized about the history of fraud among past association health plans. She wasn’t the only official in Pennsylvania to oppose the plans. Attorney General Josh Shapiro also pushed back against the rule, joining 11 other attorneys general in a lawsuit against the DOL and the U.S.” [Bloomberg, 9/11/18]

State Insurance Commissioners Want To Know What Restrictions They Can Put On AHPs. “But given the looming sales of AHPs, state regulators want to know as soon as possible what restrictions they can place on the plans. They fear the Trump administration may argue that state regulation is pre-empted by the federal Employee Retirement Income Security Act, which governs self-insured employer health plans…The states that so far have issued new rules or policy statements limiting AHPs are Democratic-led states. But insurance regulators in both red and blue states are nervous about an expansion of AHPs given the long history of fraud and insolvencies involving these types of plans.” [Modern Healthcare, 8/7/18]

Dr. James Madara, CEO of the American Medical Association: Association Health Plans Have Potential To Threaten Health And Financial Stability. “Fraudsters prey upon areas of regulatory ambiguity and may challenge such authority in courts to further delay enforcement, which allows more time to increase unpaid medical claims…Without proper oversight to account for insolvency and fraud, AHPs have the potential to … (threaten) patients’ health and financial security and the financial stability of physician practices and other providers.” [Modern Healthcare, 3/7/18]

Insurance Commissioners Have Had Difficulty Finding Answers On The Ground About Association HealthPlans.“‘We’re asking questions and finding it very difficult to get answers,’ said Washington state Insurance Commissioner Mike Kreidler.” [Politico, 8/6/18]

ASSOCIATION HEALTH PLANS DON’T HAVE TO OFFER COMPREHENSIVE COVERAGE

Katherine Hempstead, Robert Wood Johnson Foundation: “The Easier You Make It Not To Buy Comprehensive Coverage, The Harder You Make It Buy Comprehensive Coverage.” [New York Times, 10/11/17]

Vox: Association Health Plans Could Allow Groups To Act As Large Employers Which Do Not Have To Cover Essential Benefits Under The ACA. “The result could in many cases be that these new association health plans would be considered large employers when it comes to health insurance. Large employers are not subject to the same rules as individual or small-group plans under Obamacare. Most notably, they do not have to cover all of the law’s essential health benefits or meet the requirement that insurance cover a minimal percentage of a person’s medical bills.” [Vox, 10/12/17]

Treating Association Health Plans Like Large Employers Would Exempt Them From Guaranteeing Essential Health Benefits And Allow Them To Charge People Based On Health Status And Gender. Treating Association Health Plans like large-employers would exempt them from key consumer protections under the Affordable Care Act. Large employers do not have to offer plans with the Essential Health Benefits like maternity care, prescription drug coverage or mental health and substance abuse services. Insurers for large employers can also charge more based on health status and gender. [Georgetown Center on Health Insurance Reforms, December 2017]