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Sean England

Medicaid Awareness Month Kicks Off With Events Nationwide; Advocates Sound The Alarm On Trump Lawsuit

This week, Protect Our Care and partners nationwide kicked off Medicaid Awareness Month by holding press events and rallies with elected officials and health care advocates to showcase the life-saving impact of Medicaid for millions of Americans. Leaders and advocates in Arizona, Iowa, Maine, New Hampshire, North Carolina and Ohio spoke about the importance of Medicaid for seniors, people with disabilities, children and families, and in combating the opioid epidemic. Event participants also highlighted what’s at stake in the ongoing Trump lawsuit, which would rip apart our existing health care, kick millions off their coverage, and do irreparable harm to Medicaid in the process. Next week, leaders and advocates in Georgia, Colorado, and Alaska will also speak on these important issues.

Events From April 2-5:

Arizona

Protest Outside Sen. McSally’s Phoenix Office

Speakers: Indivisible AZ

Protect Our Care AZ

Press Conference at the Arizona State Capitol

Speakers:  State Rep. Charlene Fernandez

State Rep. Kelli Butler

Will Humble, Executive Director of the Arizona Public Health Association

Iowa

Press Conference Outside Sen. Ernst & Sen. Grassley’s Offices

Speakers: Progress Iowa

Indivisible Iowa

Protect Our Care Iowa

Maine

Press Conference at Maine State House

Speakers: State Sen. Linda Sandborn

Maine Women’s Lobby

Mainers for Accountable Leadership

New Hampshire

Press Conference Outside State House

Speakers: State Senate Majority Leader Dan Feltes

Zandra Rice Hawkins, Granite State Progress

Protect Our Care NH & members of the NH Health Care Coalition

North Carolina

Trump Lawsuit + Medicaid Press Call

Speakers: Stacy Staggs, Little Lobbyists

Bob Etheridge, Former Congressman and Chair of Rural Forward

Brad Woodhouse, Executive Director of Protect Our Care

Ohio

Trump Lawsuit + Medicaid Press Call

Speakers: State Sen. Tina Maharath

State Rep. Erica Crawley

Kendall Mays, veteran and health care advocate

Brenda Searcy, Medicaid expansion advocate

Protect Our Care Praises House Democrats For Moving Forward An Agenda To Lower Health Care Costs, Improve Care And Confront President Trump’s Sabotage

Washington, DC – Late last night, the House Energy and Commerce Committee under the leadership of Chairman Frank Pallone (NJ-6) and Health Subcommittee Chairwoman Anna Eshoo (CA-18), held a marathon session to pass a dozen health care bills out of committee to lower premiums and the high cost of prescription drugs and improve access to care.

The legislation also takes direct aim at President Trump’s sabotage of health care, including his attacks on people with pre-existing conditions and his deliberate effort to sabotage open enrollment. Much of the lower cost, better care package of bills passed last night mirrors the 2019 health care agenda Protect Our Care released earlier this year, which the organization has been advocating for on Capitol Hill and in key states and congressional districts across the country.

Protect Our Care chair Leslie Dach released the following statement in response:

“Elections matter. In November, voters showed the door to scores of Republicans who stood with President Trump’s agenda of ripping health care away from millions and handed the reins of the House to Democrats who ran on lowering costs, improving care and ensuring that people with pre-existing conditions continue to have access to affordable care.

“Yesterday, Democrats delivered by passing a lower cost, better care set of bills that can now move to the House floor. These bills improve health care for millions of Americans by lowering costs, bringing down the price of prescription drugs, and reversing Republican sabotage of our health care laws. These bills are in stark contrast to President Trump’s decision to double down on support for the complete dismantling of our health care system and cutting trillions from Medicare and Medicaid.”

Republicans Stand With Trump Lawsuit; Continue Their War on Health Care

Washington, DC — Today, the House voted on a resolution condemning Trump’s lawsuit and his continued war on health care introduced by Representative Collin Allred (TX-32). Senator Jeanne Shaheen (D-NH) introduced a similar resolution in the Senate. Protect Our Care chair Leslie Dach released the following statement:

“Democrats gave their Republican colleagues a clear choice today. Republicans could vote to support ripping health care away from millions or vote to condemn the President’s disastrous lawsuit, and, unsurprisingly, they chose the former. Every Member of Congress who promised to protect people with pre-existing conditions and who voted against this resolution is lying about their position on health care. Democrats are focused on lowering costs and improving care, while Republicans remain dead set on their agenda of sabotage, higher costs, and worse care.”

###

The Republican War On Medicaid

President Trump and Republicans in Congress have waged a relentless war on Medicaid. Their war on Medicaid is a war on children, seniors, people with disabilities, rural Americans, those fighting the opioid crisis, our schools, and everyone else who benefits from Medicaid.  

FRONTAL ATTACK — REPUBLICANS HAVE REPEATEDLY TRIED EVISCERATING MEDICAID

Despite repeatedly promising not to cut Medicaid when he ran for president in 2017, President Trump’s latest budget  called for $1.5 trillion in cuts to Medicaid. Trump’s lawsuit to fully repeal the Affordable Care Act would end Medicaid expansion, kicking 12.7 million who depend on the program off their insurance.

With the support of the Trump Administration, House Republicans in 2017 voted to repeal the ACA — the American Health Care Act (AHCA) — which would have cut Medicaid by $834 billion and turned it into a per capita program. The Senate repeal bill — Graham-Cassidy —  would have slashed Medicaid funding by $4 trillion over 20 years.

SABOTAGE ATTACK — ONEROUS REQUIREMENTS

When they are not calling for dramatic cuts to Medicaid, Republicans are finding other ways to sabotage the program. For instance, Republicans in state after state are proposing illegal and burdensome “work requirements” which do nothing but take health care away from people who need it. Medicaid work requirements are blatantly designed to strip health care away from low-income Americans. Thankfully, they have now been declared illegal by multiple courts. Republican governors now want to appeal these decisions.

Despite these court decisions, President Trump’s 2020 budget proposed a nationwide work requirement which experts estimate will cause up to 4 million people to lose coverage, mostly due to paperwork and red tape. More than 18,000 people lost their Medicaid in Arkansas because of the work requirement the courts have now overturned.

In November’s elections, voters moved to expand Medicaid in three states and elect pro-Medicaid governors in even more. Now, Republlican officials are doing everything in their power to deny voters’ will in states that elected to expand Medicaid and prevent Medicaid expansion initiatives in states now starting to consider them. Just last week the Trump administration approved a request from Utah to cap its Medicaid enrollment, fundamentally restricting the number of people who can access life-saving health care.

WHO BENEFITS FROM THE GOP WAR ON MEDICAID? THE WEALTHY AND BIG CORPORATIONS

In 2017, President Trump signed a $1.5 trillion tax bill that disproportionately benefits the wealthy and that is already padding health company’s profits. How do Republicans plan on paying for it? Former Speaker Ryan’s answer left no doubt: “Frankly, it’s the health care entitlements that are the big drivers of our debt.” In an attempt to pay for these tax cuts, last April, House Republicans passed a balanced budget amendment that would slash Medicaid funding by $114 billion in a single year alone. President Trump’s fiscal 2020 budget called for $1.5 trillion in cuts over ten years.

The Republican plan is clear: give companies like drug giant Pfizer a $563 million tax benefit, and make low and middle income Americans pay the price.

WHO GETS HURT FROM THE GOP WAR ON MEDICAID? PRETTY MUCH EVERYONE ELSE.

  • Children & Families. Roughly 34.9 million children in the United States are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Nationally, nearly 2 in 5, or 39% of children in America have health insurance through Medicaid, as do 17 Percent of parents. 49 percent of births are covered by Medicaid.
  • Seniors. More than 6.9 million American seniors have Medicaid coverage. More than 8.5 million Americans ages 50 to 64 have health coverage through Medicaid. Medicaid covers 6 in 10 nursing home residents.
  • People with disabilities. Nearly 8.7 million adults enrolled in Medicaid have a disability. Of this group, only 43 percent qualify for social security income. More than 1 in 3 adults under age 65 enrolled in Medicaid lives with at least one disability. Medicaid covers 45 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illness.
  • People in rural areas. The ACA has expanded access to health care to nearly 1.7 million rural Americans who have gained coverage through the Medicaid expansion, not only playing a central role in improving rural communities’ health, but also supporting these communities’ economic well-being. Medicaid covers nearly 24 percent of rural Americans, 45 percent of rural children, 15 percent of rural seniors, and pays for 51 percent of rural births. The uninsured rate in rural areas in states that expanded Medicaid has dropped by a median of 44 percent since expansion.
  • Fighting the opioid crisis. More than half of people with an opioid use disorder earn incomes below 200 percent of the federal poverty line. In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide. It is estimated that Medicaid expansion covers four in ten people with an opioid use disorder.

Big Drug Companies: Billions in Profits for THEM, Price Hikes for YOU

Meanwhile, the Administration Talks Big and Does Nothing to Reduce Prices

As CEOs and top executives from seven of the largest drug companies are set to testify before the Senate Finance Committee, the American people deserve answers. The big drug companies have seen billions in profits while Americans have seen the costs of their medications soar. They reaped billions of dollars from the Trump tax scam bill and used it for stock buybacks, enriching their already wealthy investors and CEOs. Headline after headline demonstrates that drug companies are jacking up the prices of vital medications, proving that their commitment to freeze drug prices last year was all political posturing. It’s time for Congress to hold these CEOs accountable.

Big Drug Companies Raked in Billions of Profits Last Year and Paid Their CEOs Millions…

Pharmaceutical Company 2018 Profit ($ Billion) Stock Buybacks Since the 2017 GOP Tax Cut[1] CEO CEO Pay[2] Ratio of CEO Compensation to Median Employee Salary[3]
Pfizer $11.1[4] $10 billion Albert Bourla $27.9 million 313:1
Merck $6.22[5] $10 billion Ken Frazier $17.6 million 215:1
Johnson & Johnson $15.3[6] $5 billion Alex Gorsky $29.8 million 452:1
Sanofi $4.9[7] Oliver Brandicourt $11.1 million[8]
Bristol-Meyers $4.9[9] $5 billion[10] Giovanni Caforio $18.7 million 169:1
AbbVie $5.7[11] $15 billion Rick Gonzalez $22.6 million 144:1
AstraZeneca $2.2[12] Pascal Soriot $12.3 million[13]

AstraZeneca CEO Pascal Soriot Complained That Despite His $12 Million Salary He Was “The Lowest Paid CEO In The Whole Industry” Which Was “Annoying To Some Extent.” “Soriot, who heads AstraZeneca, has a penchant for going off message — and making headlines when he does…he groused to a reporter at London’s The Times earlier this year that despite his $12 million salary he was ‘the lowest-paid CEO in the whole industry,’ which he added was ‘annoying to some extent.’” [Stat, 2/21/19]

…All While Raising Prices on 1,000 Drugs for YOU

Nearly 30 Pharmaceutical Companies Are Raising Prices on Consumers This Year Alone. Pharmaceutical companies continue to increase prices. In January 2019 alone, drugmakers raised prices on nearly 490 prescription drugs. Johnson & Johnson raised prices on around two dozen drugs, and Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills. All in all, nearly 30 drugmakers are expected to raise prices in 2019. 

CBS News: “Big Pharma ushers in new year by raising prices of more than 1,000 drugs” [CBS News, 1/2/19]

Reuters: “Big Pharma returning to U.S. price hikes in January after pause” [Reuters, 12/20/18]

Nostrum CEO Mulye: “I Think It Is A Moral Requirement to Make Money When You Can .. To Sell The Product For The Highest Price.” “Last month, Nostrum Laboratories, a small Missouri-based drugmaker, more than quadrupled the price of a bottle of nitrofurantoin from $474.75 to $2,392, according to Elsevier’s Gold Standard drug database. Nitrofurantoin is an antibiotic used to treat bladder infections…In an interview, Nirmal Mulye, Nostrum chief executive, said he had priced the product according to market dynamics, adding: “I think it is a moral requirement to make money when you can . . . to sell the product for the highest price.” [Financial Times, 9/11/18]

Mylan Chairman Coury Responds to Critics After Mylan Charged More Than $600 per Box of the EpiPen When It Only Contained $1 Worth of Ephinephrine: They Ought to Go Copulate with Themselves. “In meetings, the executives began warning Mylan’s top leaders that the price increases seemed like unethical profiteering at the expense of sick children and adults, according to people who participated in the conversations…At one gathering, executives shared their concerns with Mylan’s chairman, Robert Coury. Mr. Coury replied that he was untroubled. He raised both his middle fingers and explained, using colorful language, that anyone criticizing Mylan, including its employees, ought to go copulate with themselves.” [New York Times, 6/4/17]

In 2017, the FDA approved Marathon Pharmaceuticals’ request to charge $89,000 for a drug, a 6,000% price increase. “A drug company has brought a drug that has been available as a generic elsewhere in the world for decades at a shockingly inflated price…Yet a pharmaceutical company in Deerfield, Ill., has gotten approval from the U.S. Food and Drug Administration to sell deflazacort (snazzy brand name: Emflaza). The company, Marathon Pharmaceuticals, is charging a list price of $89,000 – a 6,000% price increase.” [Forbes, 2/10/17]

In 2015, Martin Shkreli hiked the price of a life saving drug by 5,000% overnight, from $13.50 a pill to $750, when it reportedly only cost $1 to make. “Shkreli, a former hedge fund manager and entrepreneur, earned his unflattering nickname by raising the cost of the drug from $13.50 per pill to $750 per pill. After a Bloomberg reporter suggested it cost around $1 to make, Shkreli acknowledged the drug cost ‘very little money’ to make.” [HuffPost, 3/9/18]

Meanwhile, Drug Companies Reaped Billions from The GOP Tax Cut

Pharmaceutical Companies Have Reaped Billions Of Dollars From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. [Axios, 3/5/18]

Since 2017, Pharmaceutical Companies Have Announced $73 Billion in Share Buybacks. “Collectively, drug companies have announced nearly $73 billion in share buybacks since the tax law passed in December 2017, according to Americans for Tax Fairness. Stock buybacks mostly enrich the already wealthy, including CEOs: the wealthiest 10% of American households own 84% of all corporate shares, the top 1% own 40%. About one-half of households own no stock.” [Americans for Tax Fairness, 1/8/19]

Don’t Be Fooled: Big Drug Companies Promises to Lower Costs are “Nothing-Burger Steps”

Pharmaceutical Company Lobbyist On So-Called Concessions to the Trump Administration: They Are a “Calculated Risk” And “Nothing-Burger Steps.” “The gestures turned out to be largely symbolic — efforts to beat Trump at his own game by giving him headlines he wants without making substantive changes in how they do business. The token concessions are ‘a calculated risk,” said one drug lobbyist. ‘Take these nothing-burger steps and give the administration things they can take credit for.’” [Politico, 8/3/18]

Trump’s Proposals Always Fall Far Short Of His Promises. President Trump promised that he would allow Medicare to use its buying power to negotiate drug prices directly with suppliers, but after meeting with pharmaceutical executives early in 2017, Trump abandoned that pledge, calling it “price fixing” that would hurt “smaller, younger companies.” The planned announcement to move some drugs from Medicare Part B, in which pharmaceuticals are purchased and administered by medical providers, to Part D, will do little to restrain the cost of prescription drugs for America’s seniors and falls far short of Trump’s promises.



[1] Americans For Tax Fairness, 1/8/19

[2] Data for FY2017, Bloomberg, 2/22/19

[3] Data for FY2017, Bloomberg, 2/22/19

[4] Pfizer Fourth Quarter And Full Year 2018  Results,” Pfizer, 1/29/19

[5] SFGate, 2/5/19

[6] 2018 Fourth Quarter Results, Johnson & Johnson, 1/22/19

[7] Converted from 4.3 billion euro; The Pharma Letter, 2/7/19

[8] Converted from 9.8 million euro for FY2017; Bloomberg, Accessed 2/22/19

[9]  Fourth Quarter And Full Year Financial Results, Bristol-Myers Squibb, 1/24/19

[10] “Bristol-Myers Squibb expects to execute an accelerated share repurchase program of up to approximately $5 billion, subject to the closing of the transaction, market conditions and Board approval,” Bristol-Myers Squibb, 1/3/19

[11]Fourth Quarter And Full Year 2018 Results, Abbvie, 1/25/19

[12] Market Screener, Accessed 2/22/19

[13] Converted from 9.4 million GBP for FY2017; Bloomberg, Accessed 2/22/19

SOTU Excerpts On Drug Prices: Same Exact Promise As Last Year, Expect the Same Inaction

Trump’s pledge on lowering prescription drug prices looks familiar…

“It is unacceptable that Americans pay vastly more than people in other countries for the exact same drugs, often made in the exact same place. This is wrong, unfair, and together we can stop it.”

…where have we heard this before? Ah yes, last year’s State of the Union.

“One of my greatest priorities is to reduce the price of prescription drugs. In many other countries, these drugs cost far less than what we pay in the United States. That is why I have directed my Administration to make fixing the injustice of high drug prices one of our top priorities. Prices will come down.”

Donald Trump: Cheap Talk. Sky High Drug Prices.

THE TRUMP ADMINISTRATION IS ALL TALK ON DRUG PRICES, BUT NO ACTION:

Drug Prices Continue to Soar Under Trump. A report by Senate Democrats finds that the prices of the 20 most-prescribed drugs under Medicare Part D have increased substantially over the past five years, rising 10 times faster than inflation. Another report from the Pharmacy Benefits Consultants finds that drug prices soared over the first 14 months of Trump’s presidency, during which 20 prescription drugs saw list-price increases of more than 200 percent. In 2018, there were about 1,800 prescription drug price increases according to data compiled by 46brooklyn Research. This year already, Pharma giants Pfizer and Novartis have raised prices on dozens of drug.

Trump Installed Big Pharma Executives In Key Administration Posts. President Trump installed a former Eli Lily executive, Alex Azar, as his secretary of Health and Human Services and his appointment of Scott Gottlieb at FDA was described as “music to pharma’s ears.” Other pharma lobbyists writing Trump’s health policy include senior adviser at FDA, Keagan Lenihan, who joined the administration after lobbying for the drug distribution giant McKesson, former Gilead lobbyist, Joe Grogan, who reviews health care regulations at the Office of Management and Budget, and Deputy Assistant to the President for Domestic Policy Lance Leggitt, who has lobbied for a variety of drug-industry clients.

Trump’s Proposals Always Fall Far Short Of His Promises. President Trump promised that he would allow Medicare to use its buying power to negotiate drug prices directly with suppliers, but after meeting with pharmaceutical executives early in 2017, Trump abandoned that pledge, calling it “price fixing” that would hurt “smaller, younger companies.” The planned announcement to move some drugs from Medicare Part B, in which pharmaceuticals are purchased and administered by medical providers, to Part D, will do little to restrain the cost of prescription drugs for America’s seniors and falls far short of Trump’s promises.

Republican Health Care Sabotage Makes Prescription Drugs More Expensive For Millions. The Trump Administration wants to let states sell junky short-term health plans that skirt Affordable Care Act requirements. Typical short-term policies do not cover prescription drugs or maternity care, mental health care, preventive care, and other essential benefits. Not only that, but short term plans result in higher costs for people enrolled in full coverage plans as well as soaring premiums.

… WHILE PHARMACEUTICAL COMPANIES ARE RAKING IT IN

Pharmaceutical Companies Have Reaped Huge Benefits From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. According to Axios, nine pharmaceutical companies are are spending a combined $50 billion on new share buyback programs. All of the buybacks were announced during or after passage of the tax bill. Some drug companies are also increasing dividends for shareholders, with AbbVie increasing its cash dividend by 35 percent while also announcing a new $10 billion share repurchase program.

Massive Profits And Price Increases. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion — the highest of any publicly traded healthcare company. Of the 19 companies that tallied at least $1 billion of third-quarter profit, 14 were drug companies.  Meanwhile, pharmaceutical companies continue to increase prices. In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills.  All in all, nearly 30 drugmakers are expected to raise prices in 2019.  

Soaring CEO Pay. According to an Axios study, the CEOs of 70 of the largest U.S. health care companies cumulatively have earned $9.8 billion since 2010. CEOs took home nearly 11 percent more money on average every year since 2010 — far more than the wage growth of nearly all other workers. In 2017 alone, 30 health care executives made a combined $976 million.

Junk Plans Ripe For Fraud, Dangerous For Consumers

In August, the Trump administration finalized a rule that expands the availability of short-term coverage, limited-duration plans from three months to just under twelve months and allows them to renew such plans for up to three years. The rule allows insurance companies to skirt vital consumer protections in the Affordable Care Act like protecting people with pre-existing conditions. In other words, the Trump administration has allowed insurance companies to flood the market with junk plans that do not provide the care people need, when they need it. Since finalizing the rule, the Trump administration has urged navigator groups that help people sign up for coverage to push consumers toward junk plans and has issued guidance urging states to let ACA subsidies be used to purchase these skimpy plans.

The fact of the matter is simple, junk plans are a recipe for fraud and leave consumers at risk of bankruptcy when they get sick. Take a look below:

SINCE THE TRUMP ADMINISTRATION’S JUNK PLAN RULE, THESE PLANS HAVE ALREADY ATTRACTED FRAUD, SPURRED CONFUSION FOR CONSUMERS

January 2019 – Georgetown University Health Policy Institute Finds Consumers Searching Online For ACA Compliant Plans Are Often Directed, Instead, To Junk Plans. “Our marketing scan suggests that consumers shopping online for health insurance, including those using search terms such as ‘Obamacare plans’ or ‘ACA enroll,’ will most often be directed to websites and brokers selling STLDI or other non–ACA compliant products. These websites and brokers often fail to provide consumers with the plan information necessary to inform their purchase. Brokers selling STLDI over the phone push consumers to purchase the insurance quickly, without providing written information…Even during ACA open enrollment, only 19 percent of searches using the previously delineated terms returned sites offering solely ACA-compliant plans. Before open enrollment, the return was less than 1 percent. Generally, regardless of the search terms used, companies selling short-term plans dominated the returns. However, short-term plan insurers’ and brokers’ sites appeared more frequently when we searched for ‘short-term health insurance.’” [Georgetown University Health Policy Institute, 1/31/19]

November 2018 – New York Times: Federal Officials Shut Down Sales Of ‘Ruinous’ Health Insurance Plans. “‘There is good cause to believe’ that the Florida companies have sold shoddy coverage by falsely claiming that such policies were comprehensive health insurance or qualified health plans under the Affordable Care Act, Judge Darrin P. Gayles of the Federal District Court in Miami said in a temporary restraining order issued last week at the request of the Federal Trade Commission…The trade commission said the financial consequences of the misrepresentations ‘have been ruinous for consumers, many of whom do not realize’ the limits of the coverage until they incur substantial medical expenses. The commission described Mr. Dorfman as ‘the architect of this scam’ and said he had ‘siphoned millions of dollars of proceeds from defrauded consumers to pay for private jet travel, gambling sprees in Las Vegas, the rent for his oceanfront condominium, luxury automobiles, over $1 million in jewelry, and even the nearly $300,000 cost of his recent wedding at the St. Regis Hotel in Miami.’” [New York Times, 11/5/18]

November 2018 – Federal Trade Commission Condemned One Company’s Junk Plan Scheme As “Classic Bait-and-Switch Scheme Designed To Trick Consumers.” “The members of the trade commission — three Republicans and two Democrats — voted unanimously to take action against the Florida operation, which the commission described as ‘a classic bait-and-switch scheme designed to trick consumers into paying hundreds of dollars for substandard products under the pretense that they are actually receiving comprehensive health insurance.’” [New York Times, 11/5/18]

December 2018 – Short-term Plans, Filled With Confusing Parameters, Only Add To Difficulty During Open Enrollment Season. “The woman arrived at the University of South Florida’s navigator office in Tampa a few weeks ago with a 40-page document describing a short-term health insurance plan she was considering. She was uncomfortable with what the broker had said about the coverage, she told Jodi Ray, a health insurance navigator who helps people enroll in coverage, and she wanted help understanding it. The document was confusing, according to Ray, who oversees Covering Florida, the state’s navigator program. It was hard to decipher which services would be covered. ‘It was like a bunch of puzzle pieces,’ she said. Encouraged by her wife, the woman eventually opted instead for a marketplace plan with comprehensive benefits.” [NBC News, 12/10/18]

JUNK PLANS HAVE A LONG HISTORY OF LEAVING THOSE WHO GET SICK WITH THOUSANDS OF DOLLARS IN UNPAID BILLS

2019 – Stephanie Sena Contracted Sepsis And Needed Amputation — Her Junk Insurance Wouldn’t Pay. “Stephanie Sena was about to have half her foot amputated, an urgent procedure to keep a blood infection from spreading to the rest of her body. But the surgeon required payment up front and the insurance plan that the 39-year-old Villanova University adjunct professor bought months earlier was refusing to pay. She had less than 24 hours to come up with $1,920. Sena’s insurance plan, it turned out, was not real health insurance. It was an accident and sickness hospital indemnity plan that paid a set dollar amount for certain services. This surgery was not on the list. She has since gotten a $1,725 refund for seven months of premiums, after The Inquirer contacted the company, but that will barely put a dent in the $19,000 medical debt she’s accumulated since enrolling in a plan that covers virtually nothing.” [Philadelphia Inquirer, 4/5/19]

2018 – Short Term Plans Deceive Consumers Like Milton Rodriguez, Who Learn Their Plans Don’t Cover Emergency Room Services After Going To The Hospital For Emergency Room Services. “If there was ever a time Rodriguez needed health insurance, this was that time. He called an insurance broker who had reached out to him when he was shopping around for a plan. ‘I called at night and just needed something that would cover me right away,’ Rodriguez said.The broker sent a policy, which Rodriguez approved. He then sent a payment to the insurance company. The broker told him he’d be covered starting at 12 a.m. As soon coverage kicked in, Rodriguez went to the closest hospital, St. David’s in South Austin. It turned out he had appendicitis. While he was waiting for a bed in the ER, hospital staff took his insurance information. He had surgery and was sent home to recover. Rodriguez started getting phone calls from doctors and the hospital asking about his insurance plan. ‘And then the next thing I know is, I get my bills in the mail and it seems like the most important part – which was the emergency room, everything that happened within the emergency room – none of that was covered,’ he said. His bill: $62,620. At the bottom of that bill, there was a code explaining why coverage wasn’t applied: ‘This policy does not provide benefits for services provided in the emergency room.’” [KUT, 10/31/18]

2017 – Under Short-Term Plan, Insurance Company Was Able To Cancel Jeanne Balvin’s Insurance When She Got Sick, Leaving Her With $97,000 In Hospital Bills. “When Jeanne Balvin had emergency surgery for diverticulitis in June 2017, her short-term health insurance plan—a policy she bought instead of more comprehensive insurance—covered most of the bills after she paid a $2,500 deductible. But when she landed back in the hospital with an abdominal infection a few weeks later, she says her insurance company, UnitedHealthcare, wouldn’t cover the charges—and then canceled the three-month policy she had just renewed. UnitedHealthcare said the infection was a pre-existing condition related to the diverticulitis and wouldn’t be covered under terms of the contract. And when Balvin, 61, was hospitalized a third time at the end of July—this time for a blood clot probably caused by inactivity following the hospitalizations—she had no insurance at all, leaving her with $97,000 in hospital bills.” [Consumer Reports, 10/2/18]

2014 – Atlanta Woman With Short-Term Plan Was Diagnosed With Cancer And Left With $400,000 Medical Bill. “Dawn Jones…bought a short-term plan from Golden Rule Insurance, a unit of UnitedHealth Group Inc., so she’d be covered between jobs, according to court documents. Then, she was diagnosed with breast cancer. Despite showing evidence she was unaware of the cancer when she bought the policy, the insurer didn’t pay for Jones’s treatment, leaving her with a $400,000 medical bill, according to a complaint she filed against the company in September 2016… the judge sided with Golden Rule and dismissed the case in August, finding the policy agreement clearly stated that preexisting conditions wouldn’t be covered, even if the customer was unaware of the condition. Jones wasn’t diagnosed until after she bought her policy.” [Bloomberg, 10/17/17]

2014 – Short-Term Insurance Plan Refuses To Pay For Man’s Triple Bypass Surgery, Leaving Family With $900,000 In Bills. “One case pending in federal court involves Kevin Conroy, who had a heart attack in 2014 and underwent triple bypass surgery, just two months after his wife, Linda, obtained a short-term policy over the telephone. Their insurer, HHC Life, refused to pay the bills. ‘We freaked out,’ Ms. Conroy said. ‘What were we going to do? It was $900,000.’ The insurer informed the Conroys the policy was ‘rescinded,’ to use the industry jargon. “[New York Times, 11/30/17]

2013 – In San Francisco, Woman Was Hit With $150,000 Charge After Short-Term Health Plan Refused Coverage. “Grace Wood, an instructor at a university in San Francisco, bought a short-term plan in 2013. When she had to have a heart procedure, her insurer, HCC Life, balked, leaving her with roughly $150,000 in unpaid medical bills.” [New York Times, 11/30/17]

2008 – San Antonio Man Paid Premiums To Short-Term Plan Company For Six Years, And Was Denied Coverage When He Developed Kidney Disease. “Pat’s decision to save some money by buying short-term insurance was a big mistake, says Karen Pollitz, project director of Georgetown University’s Health Policy Institute and a leading expert on the individual-insurance market. ‘These short-term policies are a joke,’ she says. ‘Nobody should ever buy them. It is false security that is being sold. It’s junk.’ That’s because diagnosing and treating an illness may not fall neatly into six-month increments. While Pat had been continuously covered since 2002 by the same company, Assurant Health, each successive policy treated him as a brand-new customer. In looking back over Pat’s medical records, the company noticed test results from December, eight months earlier. Though Pat’s doctors didn’t determine the precise cause of the problem until the following July, his kidney disease was nonetheless judged a ‘pre-existing condition’ — meaning his insurance wouldn’t cover it, since he was now under a different six-month policy from the one he had when he got those first tests…A paradox of medical costs is that people who can least afford them–the uninsured–end up being charged the most. Insurance companies, with large numbers of customers, have the financial muscle to negotiate low rates from health-care providers; individuals do not. Whereas insured patients would have been charged about $900 by the hospital that performed Pat’s biopsy (and pay only a small fraction of that out of their own pocket), Pat’s bill was $7,756. For lab work–and there was a lot of it–he was being charged as much as six times the price an insurance company would pay. One pathology lab’s bill alone was $3,290.” [Time, 3/5/09]

2002 – Heather Kofke-Egger’s Experience With Short-term Plans Demonstrates How Junk Plans Can Leave Customers Behind When They Need Support The Most. “Heather Kofke-Egger knows first-hand the risks of depending on a plan with skimpy benefits. Just out of college in 2002, she could pay $450 a month for a health plan offered to new graduates, or $85 a month for a short-term plan. ‘I knew I was taking a risk,’ she said. ‘Plans didn’t cover pre-existing conditions, but without a job lined up, I had no way to pay the [higher] premiums.’…Diagnosed with depression in college, Kofke-Egger was doing well upon graduation. She filled a 90-day supply of antidepressants before leaving school and hoped to have a job with health insurance by the time she needed a refill…Without a prescription drug benefit, Kofke-Egger was paying more than $600 a month for medication and therapy. ‘About half my gross pay went to medical care,’ she said. ‘I was struggling to get myself to work each day.’ Short-duration plans give you a feeling of safety, Kofke-Egger said, but not a full understanding of the lack of protections. ‘You have to read the fine print really carefully,’ she said. Young people may be especially vulnerable.”  [CNBC, 10/7/18]

KEY INSURANCE STAKEHOLDERS AGREE: JUNK PLANS ARE RIPE FOR ABUSE, OFTEN SOLD IN MISLEADING WAY

Georgetown Center On Health Insurance Reforms: As Bills Start To Pile Up Under Short-Term Plans, Many Folks Would Realize “They’re Not Really Insured At All.” “If you are pregnant, you will have to find another way to pay for the cost of your pre-natal care and labor and delivery (maternity care charges for a normal birth average $32,093; $51,125 for an uncomplicated C-section). If you get cancer, your plan will not cover oncology drugs, which can cost an average of $10,000 per month. If you are hospitalized, you may find yourself owing hundreds of thousands of dollars for services that are not covered by your plan.” [Georgetown Center On Health Insurance Reforms, 7/26/18]

State Insurance Regulators Express Concern That Short-Term Plans Are Being Marketed To Consumers In Misleading Way. “State insurance regulators, gathered over the past three days for a meeting of the National Association of Insurance Commissioners, expressed deep concern that short-term plans were being aggressively marketed in ways likely to mislead consumers. Many said the plans, which need not comply with the Affordable Care Act’s coverage mandates, were a poor substitute for comprehensive insurance.” [New York Times, 8/6/18]

North Dakota Insurance Commissioner: There Are Plenty Of “Bad Actors” Selling Short-term Plans That Are “Looking To Take Advantage Of Consumers.” “There are plenty of good actors in the marketplace who are reputable and will offer these products appropriately, but there are also many bad actors that are looking to take advantage of consumers as they explore their health insurance options.” [Bismarck Tribune, 9/19/18]

Troy Oechsner, Deputy Superintendent At New York Department Of Financial Services: “These Are Substandard Products.” “‘These are substandard products,’ sold on the premise that ‘junk insurance is better than nothing’ for people who cannot afford comprehensive coverage, Troy J. Oechsner, a deputy superintendent at the New York Department of Financial Services, told the insurers.” [New York Times, 8/6/18]

National Association of Insurance Commissioners Report Confirms That With Short-Term Plans, A Significantly Higher Percentage Of Money Goes Toward Administrative Costs And Profits Than Care. The NAIC report reveals that the largest seller of short-term plans, UnitedHealth, has a medical loss ratio, the ratio of money that goes toward care versus administrative costs and profits, of 43.7 percent, compared to the ACA-mandated minimum of 80 percent. [NAIC, July 2018]

98 Percent Of Health Groups That Submitted Comments To HHS Have Serious Concerns About The Short-Term Proposal.  “More than 98% — or 335 of 340 — of the healthcare groups that commented on the proposal to loosen restrictions on short-term health plans criticized it, in many cases warning that the rule could gravely hurt sick patients.” [Los Angeles Times, 5/30/18]

Protect Our Care Statement On Gallup Poll Showing The Uninsured Rate Jumping To The Highest Level In 5 Years

YEARS OF REPUBLICAN SABOTAGE RESULTS IN THE FEWEST PEOPLE COVERED SINCE THE PASSAGE OF THE ACA, HURTING WOMEN, LOWER-INCOME HOUSEHOLDS, AND YOUNG PEOPLE THE MOST

Washington DC — Today, according to a new Gallup Health and Wellbeing-Index, about 7 million fewer people had health care in 2018 compared to the previous year. The uninsured rate has steadily increased during the Trump administration from a low of 11 percent in 2016, the lowest since the passage of the Affordable Care Act (ACA). The rate was 14 percent in the last quarter of 2018. Brad Woodhouse, executive director of Protect Our Care, released the following statement:

“Years of Trump administration and Republican sabotage of the ACA continues to take its toll. The Trump administration regularly claims it’s making health care better, but the proof is in the pudding — he’s sabotaging the system and ripping coverage away from millions of families.  And Trump’s sabotage hits women, lower income households, and young people especially hard.

“President Trump and his allies in Congress must stop their partisan war on health care before they rip coverage away from millions more. Our focus should be on lowering costs and helping more people get coverage, but Republicans insist on taking us backwards – the exact approach voters rejected in November.  It’s past time for Congress to step in and put the brakes on Trump’s health care sabotage because millions of Americans are paying the price with less coverage and higher costs.”

Five things to watch for in today’s MPR MN03 debate

Minneapolis, MN—The debate today between Rep. Erik Paulsen and challenger Dean Phillips will make it very clear to voters where they stand on key issues, including health care. Health care remains among the top issues in MN03, with over 60% of voters saying it is either the top issue or very important this election. Polls also show that Paulsen has a steep hill to climb on this issue, with Democrats holding a decisive advantage on who voters trust more, what to do with the Affordable Care Act, and how to handle protections for the 2.3 million Minnesotans with preexisting conditions. Given Paulsen’s record on health care here are five things to watch for today:

1)    How will Paulsen try and claim he supports protections for people with preexisting conditions while actively trying to subvert them? Since 2011 Erik Paulsen has voted no less than five times to fully repeal or substantially alter the  Affordable Care Act (ACA), all of which would have taken away protections for 2.3 million Minnesotans with preexisting conditions and cut essential health care programs. These actions directly contradict his stated position that he has “long supported protections for people with preexisting conditions.”

2)    How will Paulsen try and distance himself from Donald Trump on health care when he’s supported him all the way on the issue?  When it comes to health care Erik Paulsen has supported Donald Trump 100% of the time, doubling down on attacks on people with pre-existing conditions, in the courts, through legislation and through regulations that promote junk plans and restrict Medicaid.

3)    Will Paulsen claim that he’ll protect Medicare, Medicaid and Social Security? Just Last week Erik Paulsen joined other House Republicans in passing a second set of tax cuts to benefit the wealthiest Americans and big corporations at the expense of working families. These tax cuts have led to trillion dollar deficits, which Republicans are now using as an excuse to go after Medicaid, Social Security and Medicare.

Earlier this month, Larry Kudlow, Director of the National Economic Council, confirmed that they still have their sights set on Americans’ care. Asked when programs like Social Security and Medicare will be looked at for reforms, Kudlow replied, “Everyone will look at that — probably next year.” And last December, when President Trump signed the first round of $1.5 trillion tax bill that disproportionately benefits the wealthy, Speaker Paul Ryan made it clear they would cut programs like Medicaid that support working families. “Frankly, it’s the health care entitlements that are the big drivers of our debt.”

4)    How will Paulsen claim he’s doing all he can to fight the opioid crisis? Medicaid and protections for preexisting conditions are the best tools in the policy toolbox to combat it, and Paulsen’s politically expedient votes to support legislation to confront the opioid crisis don’t change the damage he would do by eliminating those.

  • In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide.
  • It is estimated that Medicaid expansion covers four in 10 people with an opioid use disorder.
  • The opioid epidemic is now the most deadly drug overdose crisis in U.S. history. In 2016, roughly 64,000 Americans died of drug overdoses, meaning that more American lives were lost due to drug overdoses in 2016 than were lost in combat during the entirety of the Vietnam War. Two-thirds of 2016 drug overdoses involved opioids.
  • Medicaid expansion has reduced unmet need for substance use treatment by more than 18 percent. Recent research finds that Medicaid expanding reduced the unmet need for substance use treatment by 18.3 percent.

5)    Will Paulsen claim to support MinnesotaCare?

Republican attacks on the Affordable Care Act have jeopardized MinnesotaCare, Minnesota’s twenty-five year old health care program for the working poor. The Trump Administration has threatened to cut hundreds of millions of dollars for this crucial program that helps low-income Minnesotans access affordable health coverage, and votes by Paulsen to repeal the Affordable Care Act would also lead to hundreds of millions in cuts. 

Additional Background

What would full repeal of the Affordable Care Act eliminate?

  • Protections for 2,331,000 Minnesotans, including 310,200 of Paulsen’s constituents in MN-03, with pre-existing conditions, if they buy coverage on their own
  • Improvements to Medicare, including reduced costs for prescription drugs
  • Allowing kids to stay on their parents’ insurance until age 26
  • Ban on annual and lifetime limits
  • Ban on insurance discrimination against women
  • Limit on out-of-pocket costs
  • Medicaid expansion currently covering 15 million people
  • Rules to hold insurance companies accountable
  • Small business tax credits
  • Marketplace tax credits and coverage for up to 120,000 Minnesotans

What would have the American Health Care Act (Republican ACA replacement bill Paulsen voted for) meant for Minnesota?

  • In 2026, more than 254,000 Minnesotans would lose coverage under this bill, including 27,700 in Paulsen’s district.
  • The nonpartisan Congressional Budget Office found that the American Health Care Act would have raised premiums 20 percent in 2018.
  • AHCA imposed what the AARP calls an “age tax” on older Americans. In Minnesota, out-of-pocket costs for older people could increase by as much as $11,564  by 2026.
  • The negative economic impact of the American Health Care Act would cause 24,785 Minnesotans to lose their jobs by 2022, including 1,062 in the 3rd congressional district

MN03 survey findings:

  • A majority of voters (56%- 37%) – say they trust Democrats more than Republicans with their health care.
  • MN03 voters oppose repealing the Affordable Care Act and instead want to keep what works and fix what doesn’t by a27-point margin.
  • MN03 voters oppose the Trump Administration’s efforts to eliminate the health care law’s protections for people with preexisting conditions by a margin of 68% – 17%. 

You can read the full polling results for MN03 here

A Year Ago Today: Remember in November

Just a year ago, Republicans in Congress voted to take away 23 million Americans’ health care. Click to share the tweets below with the hashtag #RememberInNovember!

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