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Sarah Chase

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]

Happy New Year: Drug Companies Ring In 2019 With More Price Hikes While The Trump Administration Stands Idly By

Washington DC – The Wall Street Journal reports that over a dozen drug companies have already begun jacking up prices while the Trump administration continues its repeal-and-sabotage agenda. In response, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“It’s a new year, but drug companies are still up to their same old tricks and all the Republicans in Congress are offering is smoke and mirrors. With laws rigged to benefit the big drug companies and after Republicans rewarded them with huge tax breaks, more than a dozen drug companies are once again jacking up prices for millions of Americans. Republicans even went to court to overturn the health care law that makes sure health insurance companies have to pay for some of our prescription drug costs. It’s past time for Congress to take real action on drug prices and reject the Trump administration’s sabotage agenda which benefits drug companies, not the American people.”

Background:

Wall Street Journal: Drugmakers Raise Prices on Hundreds of Medicines. “Pharmaceutical companies are ringing in the new year by raising the price of hundreds of drugs, with Allergan AGN +1.28% PLC setting the pace with increases of nearly 10% on more than two dozen products, according to a new analysis.” [Wall Street Journal, 1/1/19]

Axios: New Year, New Drug Prices: “Pharmaceutical companies are ringing in the new year by raising the price of hundreds of drugs,” The Wall Street Journal’s Jared Hopkins reports.” [Axios, 1/2/19]

Wall Street Journal: Pfizer To Raise Prices On 41 Drugs In January. “Pfizer plans to raise the list prices of 41 of its prescription drugs, or 10 percent of its portfolio, in January, according to a person familiar with the matter. The plans mean Pfizer would resume its practice of raising drug list prices after the company rolled back some increases in July under criticism from President Trump.” [Wall Street Journal, 11/16/18]

In October, Pfizer Announced That It Would Return To “Business As Normal,” Raising Prices Despite Trump Pressure. “Pfizer CEO Ian Read said the company will return to ‘business as normal’ on its drug pricing in January, after agreeing to hold off on price increases earlier this year following pressure from President Trump…Trump has touted his efforts to get drug companies to hold off on price increases. Fighting high drug prices has been a major focus of his presidency. Pfizer, though, affirmed on Tuesday that the price increases could return in January, given that the agreement only lasted until then.” [The Hill, 10/30/18]

“This Is Insanity”: Legal Scholars React To Federal Judge’s Dismantling of ACA

Last night, ultra-conservative federal judge Reed O’Connor overturned the will of Congress and declared the Affordable Care Act (ACA) unconstitutional. His decision is wrong and must be overturned. Don’t take our word for it. Here’s what legal scholars from both sides of the aisle had to say:

Nicholas Bagley, University Of Michigan Health Law Professor: “This Is Insanity In Print.” “The court’s decision is NOT limited to guaranteed issue and community rating. In the court’s view — and this is *absolutely* insane — the entire Affordable Care Act is unconstitutional…If you were ever tempted to think that right-wing judges weren’t activist — that they were only ‘enforcing the Constitution’ or ‘reading the statute’ — this will persuade you to knock it off. This is insanity in print, and it will not stand up on appeal.” [Nicholas Bagley Twitter, 12/14/18]

Timothy Jost, Washington And Lee University Law Professor: “It’s Timed To Cause Maximum Chaos.” “This is breathtaking in its sweep & I think O’Connor has no idea what he’s doing..This is going to get thrown out. But I also think it’s timed to cause maximum chaos.” [Emma Platoff, Texas Tribune Reporter, 12/14/18]

Nicholas Bagley, University of Michigan Law Professor: “It’s A Case Of Raw Judicial Activism. Don’t for A Moment Mistake It For The Rule Of Law.” “In any event, it doesn’t matter what Congress meant to do in 2010. It matters what Congress meant to do in 2017, when a different Congress made a different call about whether the mandate was essential. We know what Congress wanted to do in 2017: repeal the mandate and leave the rest of the act intact. Its judgment could not have been plainer. (I know. I was there! So were you. It wasn’t that long ago.) That’s not how O’Connor sees it. In perhaps the most remarkable passage in a remarkable opinion, he wrote that the 2017 Congress ‘intended to preserve the Individual Mandate because the 2017 Congress, like the 2010 Congress, knew that provision is essential to the ACA.’ Your jaw should be on the floor. On no account did Congress in 2017 ‘intend to preserve’ the individual mandate. It meant to get rid of the loathed mandate — and it did, by eliminating the penalty that gave it force and effect…This case is different; it’s an exercise of raw judicial activism. Don’t for a moment mistake it for the rule of law.” [Washington Post, 12/15/18]

Abbe Gluck, Professor Of Law At Yale Law: Case Is “Big Invasion Of Legislative Power.” “‘That’s a big invasion of legislative power. … Rarely would you see one tiny provision of a statute that kills a 2,000-page law,’ said Gluck. ‘Sometimes the rule of law has to win out over politics. I’m sorry to be so dramatic, but this case, it’s something else.’” [Buzzfeed, 12/14/18]

EVEN LAWYERS WHO HAVE PREVIOUSLY SUED TO OVERTURN ACA SAY THIS LAWSUIT IS NONSENSICAL

Conservative Legal Scholar Jonathan Adler And Abbe Gluck, Professor Of Health Law At Yale Law School: “This Decision Makes A Mockery Of The Rule Of Law And Basic Principles Of Democracy.” “A ruling this consequential had better be based on rock-solid legal argument. Instead, the opinion by Judge Reed O’Connor is an exercise of raw judicial power, unmoored from the relevant doctrines concerning when judges may strike down a whole law because of a single alleged legal infirmity buried within…We were on opposing sides of the 2012 and 2015 Supreme Court challenges to the Affordable Care Act, and we have different views of the merits of the act itself. But as experts in the field of statutory law, we agree that this decision makes a mockery of the rule of law and basic principles of democracy — especially Congress’s constitutional power to amend its own statutes and do so in accord with its own internal rules.” [New York Times, 12/15/18]

Jonathan Adler, Professor Of Law At Case Western Reserve School Of Law: “This Is A Surprising Result, And One That Is Hard To Justify.” “This is a surprising result, and one that is hard to justify…And did I mention standing? The Justice Department somehow neglected to raise standing in its briefing, but Judge O’Connor addressed it nonetheless (as he should have, as Article III standing is jurisdictional). Despite recognizing the need to address standing, Judge O’Connor completely botched the relevant analysis, concluding the plaintiffs have standing to challenge a provision of a law that has no legal effect… However superficially plausible the plaintiff states’ claims initially appear, they melt upon inspection. The more one digs into them, the less substantial they appear.” [Reason, 12/14/18]

Law Professors From Both Sides Of The Aisle, Including Jonathan Adler, Ilya Somin, Nicholas Bagley, Abbe Gluck, and Kevin Walsh, Note That Despite Their Different Policy Perspectives, They Agree That DOJ’s Arguments About Severability Are Inconsistent With The Law. “[A] court’s substitution of its own judgment for that of Congress would be an unlawful usurpation of congressional power and violate basic black-letter principles of severability. Yet that is what the plaintiff States and the United States invite this Court to do.​..This time-shifting of congressional intent misapplies severability doctrine. By expressly amending the statute in 2017 and setting the penalty at zero while not making other changes, Congress eliminated any need to examine earlier legislative findings or to theorize about what Congress would have wanted. Congress told us what it wanted through its 2017 legislative actions.” [Jonathan Adler et. al, 6/14/18]

 

“Crusade Against Obamacare”: The Trump Administration Advances Its War Against Affordable, Comprehensive Care

In response to “one of the boldest steps yet” that the Trump administration has taken to sabotage the Affordable Care Act, media, experts, and policymakers have continued to speak out against the Trump administration’s new 1332 waiver guidance.

Below is a look at what experts are saying:

Sarah Lueck, Senior Policy Analyst At Center On Budget And Policy Priorities: “Potentially What This Guidance And Concept Ideas Are Saying Is: ‘States, You Can Try To Do What Was Rejected In Congress.'” “‘Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities, told me the concepts were reminiscent of some ideas that emerged during the repeal-and-replace debate last year. She said they would allow states to ‘pursue policies that could reduce subsidies available for vulnerable populations, offer inadequate coverage options or leave people with unaffordable coverage…Potentially, what this guidance and concept ideas are saying is: ‘States, you can try to do what was rejected in Congress,’ ‘ Lueck added. ‘But whether it’s the bad ideas from the repeal debate or returning to the pre-ACA-style market, it’s not going to fare as well for people if they have a preexisting condition, if they’re older, low-income — those concerns are very real.’.” [Washington Post, 11/30/18]

Timothy Jost, Washington And Lee University Law Professor: With New Proposal, “Invariably, The Coverage Is Going To Be More Expensive For People Who Really Need Comprehensive Coverage.” “Invariably, the coverage is going to be more expensive for people who really need comprehensive coverage…As soon as any state proceeds to go somewhere with this, there will be legal challenge.” [Kaiser Health News, 11/29/18]

Sabrina Corlette, Senior Research Fellow At Georgetown University’s Center On Health Insurance Reforms: Latest Recommendations Continue A ‘Trend’ In The Trump Administration To ‘Break Up The Basic Framework Of The ACA. “‘What would happen is those products … will attract healthier, younger enrollees, leaving a smaller and sicker pool in the ACA-compliant plans,’ Corlette said. She thinks that this will lead to one of two consequences that could harm people with preexisting illnesses. ‘You’re an insurance company and you’re saying, ‘Okay, I can either offer these noncompliant options, get all the healthy people and subsidies to boot, or I can offer these ACA plans and get all the sick people.’ What are you going to do?,’ Corlette said. ‘You’re going to drop the ACA plans and offer these noncompliant plans. Or you can keep offering your ACA-compliant plans and jack up the price.’ Corlette said the latest recommendations continue a ‘trend’ in the Trump administration to ‘break up the basic framework of the ACA…They’ve been punching holes in the ACA’s minimum floor of protections for a while now,” she said. “I would say that this latest 1332 guidance and concepts is just part of that general push by the administration to sort of fray that basic national standard of protections and requirements.’” [Washington Post, 11/30/18]

University Of Michigan Law Professor Nicholas Bagley Warns That Trump’s Suggested Waivers May Not Be Legally Sound.Would a future waiver be vulnerable? You bet…The ACA says that a state waiver must provide coverage at least as comprehensive as what the ACA provides. A state waiver that means loads of sick people won’t be able to get coverage, or won’t be able to get affordable coverage, shouldn’t pass muster.” [HuffPost, 11/30/18]

How the media is continuing to cover the new guidelines:

HuffPost: Trump Administration Announcement Carries On “Crusade Against ‘Obamacare’ That Voters Seemed To Reject Soundly In This Month’s Midterm Elections.” “The Trump administration just made it easier for states to rewrite some of the Affordable Care Act’s insurance rules, carrying on with a crusade against “Obamacare” that voters seemed to reject soundly in this month’s midterm elections…And among the 1332 waiver models that CMS published on Thursday was a prototype in which people could use federal tax credits to pay for alternative insurance options that exclude key benefits, like full prescription coverage or inpatient psychiatric care, and aren’t generally available to people with pre-existing conditions…Consumers who buy the plans can still face crushing medical bills if they get injured or sick and require treatment the policies don’t cover. Meanwhile, people who need or want more comprehensive coverage can end up paying more for their policies because the insurers who sell them have to raise premiums when healthier customers flock to the skimpier plans. A major goal of the Affordable Care Act was to avoid these problems ― or, at the very least, to mitigate them. By encouraging enrollment into these less-comprehensive plans, experts warned Thursday, the administration was all but certainly making it more difficult for the law to function as intended.” [HuffPost, 11/30/18]

Washington Post: Trump Administration Is Providing States With “Roadmap” For How They Can Sidestep Parts Of ACA. “The Trump administration is providing states with a roadmap for how they can sidestep parts of the Affordable Care Act in the name of giving more power back to the states. But critics fear the move will undermine key consumer protections established by the 2010 health-care law.” [Washington Post, 11/30/18]

CNN: “The Trump Administration Is Laying Out For States How They Can Use Their Sweeping New Powers To Overhaul — And Likely Undermine — Obamacare.” “The Trump administration is laying out for states how they can use their sweeping new powers to overhaul — and likely undermine — Obamacare…It’s the latest move by the Trump administration to weaken the Affordable Care Act from the inside after the collapse of Republican efforts to repeal it altogether, this time by targeting the subsidies, which are considered crucial to keeping insurance markets working well. The new waiver powers could widen the divide in health care coverage among the states, which the Affordable Care Act sought to unify with nationwide standards for benefits and assistance. Red states may seek to provide greater access to alternative plans, while blue states could try to bolster their Obamacare markets.” [CNN, 11/29/18]

New York Times: New Policy “Upends A Premise Of The Affordable Care Act.” “The new policy outlined by the administration on Thursday upends a premise of the Affordable Care Act: that federal subsidies can be used only for insurance that meets federal standards and is purchased through public marketplaces, also known as insurance exchanges. Under the new policy, states could use federal subsidies to help people pay for employer-sponsored insurance. Consumers could combine federal funds with employer contributions to buy other types of insurance.” [New York Times, 11/29/18]

Slate: “The New Guidance Is Just The Latest Step In The Trump Administration’s Long Quest To Dismantle Much Of Obamacare Through Executive Fiat.” “One of the administration’s suggestions is to restructure the law’s insurance subsidies, which help low and middle-income Americans pay their monthly premiums, so that they’re tied to age instead of income. (This would effectively give more help to high-earners and less to low-earners). Another is to let people spend those subsidies on cheap health plans that don’t meet all of Obamacare’s coverage requirements. (This would likely drive up costs for some people who needed more comprehensive coverage). It’s not clear that these sorts of changes would hold up in court. But if they did, such moves would likely undercut Obamacare’s consumer protections, including for Americans with pre-existing conditions. The new guidance is just the latest step in the Trump administration’s long quest to dismantle much of Obamacare through executive fiat.” [Slate, 11/29/18]

Kaiser Health News: Experts Predict Ideas Would Foster Parallel Market, Drive Up Premiums For Those Who Remain In ACA Plans. “Still, coupled with other ongoing efforts by the Trump administration to gut Obamacare, policy experts predict the ideas would further foster a parallel market of cheaper, less robust coverage that could draw younger or healthier consumers, but drive up premiums for those who remain in ACA market plans.” [Kaiser Health News, 11/29/18]

Axios: “This Is One Of The Administration’s Most Significant Anti-ACA Moves To Date — If It Works.”This is one of the administration’s most significant anti-ACA moves to date — if it works. States that ask for everything they’re now allowed to, and get it, could set up an insurance market that looks a lot different from what the ACA envisioned.” [Axios, 11/30/18]

BuzzFeed News: Administration’s Guidance Is “One Of The Boldest Steps Yet” Trump Has Taken To Sabotage ACA.It is one of the boldest steps yet taken by the Trump administration to take down the building blocks of the Affordable Care Act despite the law remaining on the books…The Obama administration had taken the opposite approach. While it allowed for people to have insurance plans outside of the ACA’s regulations in certain circumstances, the individual markets were bolstered because only regulated plans qualified for subsidies. Since taking office, Trump has encouraged the proliferation of skimpier off-market plans. With ACA repeal off the table for now, this has become the foremost health policy fight in Washington.” [BuzzFeed News, 11/29/18]

The Independent: After Failing To Dismantle The ACA, The Trump Administration Is Now Offering States Suggestions On How To Undermine It. “The federal government has issued suggestions to help states undermine the waiver system of Obamacare, helping to weaken the implementation of the act. Donald Trump and the republican administration tried and failed to completely dismantle the Affordable Care Act, also known as Obamacare, soon after Mr Trump was sworn in as president. However, the administration is now helping states apply for alternative types of insurance, which could ultimately undermine Obamacare.” [The Independent, 11/29/18]

And how policymakers are responding:

Reps. Frank Pallone And Richard Neal, Top Democrats On House Energy And Ways And Means Committees: “We Are Concerned That This Guidance Is Unlawful, Will Raise Costs For Older And Vulnerable Americans, And Will Eliminate Protections For Individuals With Pre-existing Conditions.” “The interpretation disregards both the plain text of the statute, as well as the congressional intent behind Section 1332, which was to allow states to innovate to expand coverage, affordability, and comprehensive benefits. Having ‘access’ to coverage is not the same thing as having coverage, and the Administration’s attempt to read ‘access’ into the statute is transparently motivated by an ideological opposition to the benefits and protections afforded by the ACA.” [Letter To Sec. Azar, 11/29/18]

 

Kaiser Family Foundation Confirms That Trump, GOP Sabotage Means Americans Pay More For Insurance Than They Should

As President Trump repeats the lie that he is responsible for relatively low premium increases on the Affordable Care Act marketplaces this year, new Kaiser Family Foundation (KFF) analysis says otherwise. The analysis released this morning finds that President Trump has actually caused 2019 premiums to be 16 percent higher than they otherwise would have been absent GOP sabotage. Among the report’s key findings:

  • On-exchange consumers’ premiums for 2019 are 16 percent higher than they should be because of GOP sabotage. The key drivers of these higher premiums are policies enacted by the Trump Administration and its Republican allies: “Altogether, on-exchange silver premiums in 2019 are therefore approximately 16% higher than would otherwise be the case if federal CSR payments had continued (the loss of which contributed approximately 10% to silver exchange premiums), the individual mandate penalty were still enforced, and more loosely-regulated plans were not expanding (the latter changes contributed an additional 6% to 2019 rates).”
  • The repeal of the individual mandate and the expansion of junk plans has caused 2019 premiums to be  6 percent higher than they should be. Kaiser estimates that the repeal of the individual mandate penalty and the expansion of junk plans (association and short-term plans) will cause consumers to pay 6 percent more than they would absent these actions in their 2019 premiums.
  • The administration’s decision to halt cost sharing reduction payments will cause on-exchange consumers to pay 10 percent more than they would have had CSRs not been stopped.
  • Even consumers off the ACA exchange will pay 6 percent more because of Republican sabotage. Kaiser found, “Looking ahead to 2019, premiums in much of the country are holding flat or decreasing a bit, but unsubsidized off-exchange consumers on average will nonetheless pay an average of 6% more than they otherwise would have, if it were not for repeal of the individual mandate and expansion of more loosely regulated plans.”

Roundup: Trump’s Latest Attempt To Deceive The American People

From all four corners of the internet, Trump’s pack of health care lies in USA TODAY has been exposed. People will remember this as Trump’s latest detached-from-reality attempt to cover up the truth about the GOP’s war on health care.

Within hours of posting, Trump’s article received criticism from those who know health care the best. Here’s what they had to say:

Washington Post: “Almost Every Sentence Contained A Misleading Statement Or Falsehood.” “President Trump wrote an opinion article for USA Today on Oct. 10 regarding proposals to expand Medicare to all Americans — known as Medicare-for-All — in which almost every sentence contained a misleading statement or a falsehood. Many of these are claims we have already debunked. Presumably, the president is aware of our fact checks — he even links to two — but chose to ignore the facts in service of a campaign-style op-ed.” [Washington Post, 10/10/18]

Vox: Trump’s USA Today Op-ed On Health Care Is An Absurd Tissue Of Lies. “USA Today published an op-ed bylined by President Donald Trump Wednesday morning that’s so dishonest it could almost have been Trump speaking extemporaneously at a rally. In fact, it’s so dishonest that some clever editor appears to have subversively snuck links into the text that debunk some of its key claims — it’s hard to believe that Trump or his communications staff would have done so…Follow the ‘pre-existing conditions’ link and you’ll get a Washington Post fact-check item explaining that Trump has betrayed this promise. Follow the ‘new health care insurance options’ link and you’ll find Trump talking during the campaign about allowing insurance plans to be sold across state lines, which hasn’t happened. Most importantly of all, if you follow the link for ‘eviscerated Medicare’ you find a New York Times analysis of Sen. Bernie Sanders’s Medicare-for-all plan that concludes that Medicare enrollees ‘would have more generous coverage’ under his plan. This is the core lie of Trump’s op-ed.” [Vox, 10/10/18]

New York Magazine: “The Most Perfectly Emblematic Fact About Trump’s Health-care Record Is That He Has Written An Op-ed Pointing Out That He Has Broken His Own Promises.” “The most striking thing about the op-ed, other than the ludicrous claim to have fulfilled his promise on preexisting conditions, is that it does not mention his biggest and most important health-care campaign promise: to cover everybody. Trump promised this over and over…If protections for people with preexisting conditions remain in place, it will be only because his administration loses its legal fight to eliminate them. Whether Trump is more than dimly aware of any of these facts is an open question. The most perfectly emblematic fact about Trump’s health-care record is that he has written an op-ed pointing out that he has broken his own promises.” [New York Magazine, 10/10/18]

PolitiFact: Trump’s Claims on Medicare Are “Horrible Mischaracterization.” “This is a ‘horrible mischaracterization of the proposal,’ said Linda Blumberg of the Urban Institute. Medicare for All would actually give an expanded version of traditional Medicare to everyone, with broader coverage — including items such as dental and vision care — while eliminating virtually all out of pocket costs, she said.” [PolitiFact, 10/10/18]

Michael Hiltzik For Los Angeles Times: “The op-ed Bristles With Lies And Misrepresentations.” “USA Today gave President Trump a big gift Wednesday by publishing a largely fact-free attack on the “Medicare for all” plan promoted by Sen. Bernie Sanders (I-Vt.), disguised as an op-ed written by Trump himself. In strictly factual terms, the op-ed bristles with lies and misrepresentations about Medicare for all, Medicare itself, Trump’s own healthcare policies, and Democratic and Republican approaches to Medicare.” [Los Angeles Times, 10/10/18]

NPR: “The President Is Trying To Play On The Fears Of Seniors.” “The president is trying to play on the fears of seniors — who vote in large numbers — with the claim that any effort to improve health security for younger Americans must come at their expense. But that is a false choice.” [NPR, 10/10/18]

Trump Claims Health Premiums Are Decreasing, When Some Are In Fact Rising. PolitiFact: “Trump references an article about the cost of ‘benchmark’ plans under the Affordable Care Act falling 2 percent in 2019. But it’s worth noting that the decline occurred after ACA premiums rose significantly in 2018 due to uncertainty about what the Trump administration would do with the law. In addition, ACA premiums are a minority of all private health insurance premiums. In its annual survey of health insurance benefits, Kaiser reported earlier this month that for employer-sponsored health insurance, the average premium for a solo policyholder increased 3 percent over the past year, while the average family premium increased by 5 percent. That exceeded the growth in employee wages and overall inflation.” [PolitiFact, 10/10/18]

Media Matters: “The Piece Is A Conglomeration Of Previously Debunked Distortions And Outright Lies.” “The piece is a conglomeration of previously debunked distortions and outright lies common to Trump’s stump speeches, leading several reporters to criticize the paper for its role…In one particularly gobsmacking case, USA Today allowed Trump to claim that as ‘a candidate, I promised that we would protect coverage for patients with pre-existing conditions’ and that as president, he has ‘kept that promise.’ The paper’s Twitter feed even highlighted that passage in a tweet. Republicans’ position on this issue is one of bottomless bad faith, an effort to confuse the public by saying they supports protections for people with pre-existing conditions while acting to deregulate the health insurance industry.” [Media Matters, 10/10/18]

Jim Acosta, CNN’s Chief White House Correspondent: “This Column May Break The Record For The Number Of Falsehoods From A President Ever Published In A Newspaper Op-ed.” “This column may break the record for the number of falsehoods from a President ever published in a newspaper op-Ed. Just this tweet alone is false – ‘outlaw private health care plans’ and ‘letting anyone cross our border’ Huh? Fact check: false and false. Come on USA Today.” [Acosta, 10/10/18]

Dan Gillmor, Professor At Arizona State University’s Walter Cronkite School of Journalism And Mass Communication: Op-ed “Full Of Outright Lies.” “Publishing this op-ed is journalistic malpractice. It is full of outright lies, easily demonstrated lies. Disgraceful.” [Gillmor, 10/10/18]

GQ: Publishing Lie-ridden Op-ed Launders Trump’s “Standard-issue Dishonesty Through A Medium That Readers Depend On For Independence And Objectivity.” “At this point we all know that the president is an unhinged serial liar who literally makes things up for applause. Because the First Amendment exists, there is no way to prevent him from doing so. But publishing this embarrassing collection of inane vagaries—and hiding behind its “opinion” framing, as if there is no distinction between good-faith, fact-based disagreements and facially absurd lies—launders his standard-issue dishonesty through a medium that readers depend on for independence and objectivity.” [GQ, 10/10/18]

The Root: USA Today Allows Trump To Publish Fake News. “For some reason—possibly because USA Today is trying to get into the good graces of the president, or maybe they just wanted some press—USA Today allowed the Donald J. Trump to publish an op-ed that is full of mistruths that only become apparent when you’re done reading the lies. In short, USA Today published fake news.” [The Root, 10/10/18]

Final Rates Confirm Ohioans’ Insurance Is Getting Even More Expensive

Trump Administration and Washington Republicans’ Health Care Sabotage Raises Rates

Washington, D.C. – Yesterday, Ohio announced final rates for 2019 individual-market health insurance plans, which indicate that premiums will increase by an average of 6.3 percent statewide, in contrast to the average nationwide 4.3 percent decrease that Brookings Institution analysts predicted would occur absent GOP sabotage, on top of last year’s double-digit rate hike due to Washington Republicans’ repeal-and-sabotage agenda. Brad Woodhouse, executive director of Protect Our Care, released the following statement in response:

“For the past year and a half, President Trump and his Republican allies in Congress have engaged in a deliberate, aggressive campaign to undermine health care, and families in Ohio are once again forced to pay the price. Until we stop Republicans’ war on health care, insurance companies will continue to make huge profits and enjoy record tax breaks from Republicans while they charge working families more and more. Washington Republicans should start working on bipartisan solutions to make coverage more affordable, instead of helping their friends in the insurance industry make another buck on the backs of hardworking Ohioans.”

From the Experts:

Loren Anthes, Cleveland-based Center for Community Solutions: Unpredictability In Marketplace Causing Rates To Increase. Cut funding for outreach and navigator groups, repeal of individual mandate, shorter open enrollment period, and expanded association health plans create unpredictability — “That kind of unpredictability also creates the conditions where you have to raise prices…Insurance companies are businesses.” [Cleveland Plain Dealer, 6/22/18]

Brookings Analysis Estimates That Individual Market Premiums Would Decrease If Not For GOP Sabotage. Among its key findings:

  • Estimates That Average Premium Would Fall By 4.3 Percent In 2019 In Stable Policy Environment. “I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment.” [Brookings Institution, 8/1/18]
  • Insurance Companies’ Revenues Will Far Exceed Their Costs In 2018. “I project that insurers’ revenues in the ACA-compliant individual market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and 2016. The estimated 2018 margin also far exceeds insurers’ margins in the pre-ACA individual market. ” [Brookings Institution, 8/1/18]
  • Absent Republican Sabotage, Average Premiums For ACA-Compliant Plans Would Likely Fall In 2019. “In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for 3 2019. Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs.” [Brookings Institution, 8/1/18]

Final Rates Confirm Coloradans’ Insurance Is Getting Even More Expensive

Trump Administration and Washington Republicans’ Health Care Sabotage Raises Rates

Washington, D.C. – Yesterday, Colorado announced final rates for 2019 individual-market health insurance plans, which indicate that premiums will increase by an average of 5.6 percent statewide and as much as 21.6 percent in Denver, in contrast to the average nationwide 4.3 percent decrease that Brookings Institution analysts predicted would occur absent GOP sabotage, on top of last year’s double-digit rate hike due to Washington Republicans’ repeal-and-sabotage agenda. Brad Woodhouse, executive director of Protect Our Care, released the following statement in response:

“For the past year and a half, President Trump and his Republican allies in Congress have engaged in a deliberate, aggressive campaign to undermine health care, and families in Colorado are once again forced to pay the price. Until we stop Republicans’ war on health care, insurance companies will continue to make huge profits and enjoy record tax breaks from Republicans while they charge working families more and more. Washington Republicans should start working on bipartisan solutions to make coverage more affordable, instead of helping their friends in the insurance industry make another buck on the backs of hardworking Coloradans.”

From the Insurance Companies:

Colorado Insurance Commissioner Michael Conway: “Decisions At The Federal Level Continue to Make Life Interesting.” “In past years, challenges continue. Just last week, the Trump administration decided to freeze a key ACA program designed to discourage insurers from favoring healthy people over less healthy ones. ‘Decisions at the federal level continue to make life interesting,’ said Commissioner Conway. ‘But as we have in the past, we will find a solution to this most recent announcement. To that end, just this morning, I informed the insurance carriers that we will require that they account for their respective risk adjustment receivables or payables as they are reflected in the July 9, 2018 federal report. I will take any subsequent steps that are necessary to protect Coloradans and to maintain market stability.’” [Colorado Department of Regulatory Agencies, 7/13/18]

Office Of Colorado Insurance Commissioner Michael Conway: Individual Market Premiums Increasing An Average Of 5.94 Percent, Increasing As High As 12.3 Percent. “For 2019 individual plans, the average premium increase request is 5.94 percent across all companies and metal levels. In the small group market, the average premium increase request is 7.15 percent. Remember, these are averages across all plans from all companies, across all areas of the state where a company offers plans, for all ages. These averages are not representative of how one individual’s premium could change. Looking closer, the requested average premium increase for individual gold plans is 6.85 percent, and is 12.3 percent for silver plans. For bronze plans, the requested average premium increase is 0.9 percent.” [Colorado Department of Regulatory Agencies, 7/13/18]

From the Experts:

Brookings Analysis Estimates That Individual Market Premiums Would Decrease If Not For GOP Sabotage. Among its key findings:

  • Estimates That Average Premium Would Fall By 4.3 Percent In 2019 In Stable Policy Environment. “I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment.” [Brookings Institution, 8/1/18]
  • Insurance Companies’ Revenues Will Far Exceed Their Costs In 2018. “I project that insurers’ revenues in the ACA-compliant individual market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and 2016. The estimated 2018 margin also far exceeds insurers’ margins in the pre-ACA individual market. ” [Brookings Institution, 8/1/18]
  • Absent Republican Sabotage, Average Premiums For ACA-Compliant Plans Would Likely Fall In 2019. “In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for 3 2019. Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs.” [Brookings Institution, 8/1/18]

Final Rates Confirm North Dakotans’ Insurance Is Getting Even More Expensive

Trump Administration and Washington Republicans’ Health Care Sabotage Raises Rates

Washington, D.C. – Today, North Dakota announced final rates for 2019 individual-market health insurance plans, which indicate that premiums will increase by as much as 25.9 percent, in contrast to the average nationwide 4.3 percent decrease that Brookings Institution analysts predicted would occur absent GOP sabotage, on top of last year’s comparable rate hike due to Washington Republicans’ repeal-and-sabotage agenda. Brad Woodhouse, executive director of Protect Our Care, released the following statement in response:

“For the past year and a half, President Trump and his Republican allies in Congress have engaged in a deliberate, aggressive campaign to undermine health care and families in North Dakota are once again forced to pay the price. Until we stop Republicans’ war on health care, insurance companies will continue to make huge profits and enjoy record tax breaks from Republicans while they charge working families more and more. Washington Republicans should start working on bipartisan solutions to make coverage more affordable, instead of helping their friends in the insurance industry make another buck on the backs of hardworking North Dakotans.”

From the Insurance Companies:

Sanford: GOP Repeal Of Individual Mandate Driving Up Rates. “A rate change is needed to account for medical trend as well as revisions to the following pricing assumptions… Removal of the individual coverage mandate penalty in 2019.”[Sanford, accessed 8/1/18]

Medica: Rate Increases Driven By “Unprecedented Amount Of Uncertainty” In Marketplace. “The significant factors driving the proposed rate increase primarily include: Unprecedented amount of uncertainty and risk inherent in the marketplace.” [Medica, accessed 8/1/18]

From the Experts:

Brookings Analysis Estimates That Individual Market Premiums Would Decrease If Not For GOP Sabotage. Among its key findings:

  • Estimates That Average Premium Would Fall By 4.3 Percent In 2019 In Stable Policy Environment. “I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment.” [Brookings Institution, 8/1/18]
  • Insurance Companies’ Revenues Will Far Exceed Their Costs In 2018. “I project that insurers’ revenues in the ACA-compliant individual market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and 2016. The estimated 2018 margin also far exceeds insurers’ margins in the pre-ACA individual market. ” [Brookings Institution, 8/1/18]
  • Absent Republican Sabotage, Average Premiums For ACA-Compliant Plans Would Likely Fall In 2019. “In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for 3 2019. Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs.” [Brookings Institution, 8/1/18]

If Republicans Win In November, They Admit They’re Coming For Your Health Care

Story after story has predicted that Republicans plan to repeal Americans’ health care should they win in November. Now, prominent Republicans are admitting the plan themselves. Despite trying to rewrite their records on health care, Republicans are letting the truth slip — should they win in November, make no mistake — they will try to take away your health care.

No matter how hard they try to change the topic or hide the truth, it’s clear they’ve started to let the truth slip, which isn’t good for Americans who work for a living and need affordable health care.

IN THEIR OWN WORDS:

Senate Majority Leader Mitch McConnell: “If We Had The Votes To Completely Start Over, We’d Do It.” “If we had the votes to completely start over, we’d do it. But that depends on what happens in a couple weeks… We’re not satisfied with the way Obamacare is working.” [Reuters, 10/17/18]

President Trump Reiterates That Republicans Will Go After Repeal Again If Elections Go Their Way. “You know, we want to repeal and replace it, and if we get enough Republicans, we will.” [Washington Post, 9/24/18]

Vice President Pence: ‘We Made An Effort To Fully Repeal And Replace Obamacare And We’ll Continue, With Leah Vukmir In The Senate.” “We made an effort to fully repeal and replace Obamacare and we’ll continue, with Leah Vukmir in the Senate, we’ll continue to go back to that.” [The Hill, 8/31/18]

Speaker Paul Ryan (R-WI): Maintaining Majority In Senate Means Republicans Will “Be Able To Pass Health Care Reform.” “I think the election will have to determine that because, based upon our vote count in the Senate. We keep the House majority in the house, which I think we will, and then you have to have enough of a majority in the Senate to be able to pass heath care reform.” [Roll Call, 9/12/18]

House Majority Whip Steve Scalise (R-LA): “If We Get More Senate Seats, Which I Think We Will, We’ve Got To Go Back To Health Care.” “‘We’ve got to hold the House, but if we get more Senate seats, which I think we will, we’ve got to go back to health care. Obamacare’s only getting worse. There is no private marketplace for families out there,’ House Majority Whip Steve Scalise.” [Fox Business, 9/12/18]

Senior Senate GOP Aide: Senate Would “Absolutely” Vote Again To Repeal ACA. “A senior Senate GOP aide said the chamber would ‘absolutely’ vote again to repeal ObamaCare but cautioned it would depend on ‘if we keep the House.’” [The Hill, 8/29/18]

Sen. David Perdue (R-GA): On Repealing The ACA, “I’d Love To Have Somebody Take Care Of That.” “‘I’d love to have somebody to take care of that,’ Sen. David Perdue (R-Ga.) said of repealing ObamaCare.” [The Hill, 8/29/18]

Sen. John Thune (R-SD): It Would Be Nice To Have Members Who Will Help Us Repeal The ACA. “‘If we re-engage in that discussion in some point in the future, it would be nice to have members who enable us to pass it,’ Senate Republican Conference Chairman John Thune (S.D.) said when asked about the possibility of ObamaCare repeal legislation coming up for a future vote.” [The Hill, 8/29/18]

Sen. Ron Johnson (R-WI): Hopes Next Senator From Arizona Is “Strong Ally” Who Recognizes “Obamacare Is Not A Proper Solution.” [The Hill, 8/29/18]

Sen. Lisa Murkowski (R-AK): If Republicans Expand Senate Majority, Another Repeal Vote Is Likely. “I suppose that it’s all in the numbers, and if you had a significant enough shift in the Senate and you came up with a replacement that really did generate a level of support, yep.” [Axios, 8/6/18]

Rep. Mike Rogers (R-AL): If Republicans Win In November, Republicans Could Repeal Health Care. “Republicans could repeal and replace the Affordable Care Act next year if the GOP holds onto its majority in the U.S. House of Representatives, Rep. Mike Rogers, R-Saks, told a crowd in Anniston on Tuesday. ‘Assuming this fall turns out as some of us hope it does, and we pick up a majority in the House, we’re also going to pick up two or three seats in the Senate,’ Rogers said.” [The Anniston Star, 8/15/18]

Sen. Thom Tillis (R-NC): “With 53 Members We Can Get Health Care Done.” [Politico, 7/31/18]

“Repeal Is Like Fight Club, First Rule Is Not To Talk About It.” “Repeal is like fight club,” one GOP operative told Axios’ Caitlin Owens. “First rule is not to talk about it.” [Axios, 8/6/18]

BACKGROUND: IF REPUBLICANS RETAIN A MAJORITY IN CONGRESS NEXT YEAR, THEY WILL TRY TO REPEAL HEALTH CARE AGAIN

The Hill: GOP Lawmakers “Vow” To Try Again At Repeal Next Year If They Keep Majorities. “GOP lawmakers say they won’t have time to hold another vote to repeal the law in 2018 but vow to try again next year if they manage to keep their Senate and House majorities.” [The Hill, 8/29/18]

Axios: “Many Republicans Assume Their Party Will Take Another Stab At Repeal” If Midterms Go Their Way. “Many Republicans assume their party will take another stab at repealing and replacing the Affordable Care Act if the midterm elections go their way, even though GOP candidates aren’t making a big deal about it on the campaign trail.” [Axios, 8/6/18]

New York Magazine: “It Is Hard To Think Of A Legislative Priority That Would Rank Higher In [Trump’s] Mind” Than Health Care Repeal. “If Republicans can add a couple more seats, they could give themselves enough margin to overcome the squishy reservations of Susan Collins and Lisa Murkowski. If they merely hold their narrow majority, they might simply prevail on the two senators to submit. (Murkowski appeared to have been bought off by a special deal for her state last year.) Trump has never stopped talking about the failed repeal vote nor reliving his anger with McCain. It is hard to think of a legislative priority that would rank higher in his mind. A congressional party shorn of its most prominent Trump skeptics, many of whom are retiring, would behave even more submissively toward its leader.” [New York Magazine, 8/6/18]

Politico: With Larger Majority, No Longer Could Collins Or Murkowski Block Health Care Repeal. “With even a slightly larger GOP majority, no longer could Murkowski or her independent-minded brethren like Susan Collins of Maine or Rand Paul of Kentucky effectively dictate which nominees or majority-vote legislation make it through the chamber. Gone, too, would be the constant headaches for Republican leaders sweating an absence, wavering senator or Vice President Mike Pence’s availability to break a tie. Republicans might even have another shot at repealing Obamacare or shrinking the size of the federal government.” [Politico, 7/31/18]

Vox: If Republicans Win In November, “Repeal Could Quickly Be Back On The Agenda.” “It’s not at all out of the question that Republicans will hold on to the House and expand their Senate majority in the 2018 midterms. And if they do, repeal could quickly be back on the agenda. ‘There would certainly be forces pushing for this, so I take it seriously,’ Kim Monk, who tracks health care policy for Capital Alpha. Senate aides say privately that Republicans remain open to taking on repeal again next year.” [Vox, 5/14/18]