Category

Administration

The Plot Against Americans: Bombshell Report Reveals Trump Admin’s Master Strategy to Rip Apart Our Health Care System

WASHINGTON, DC – After Politico released a late-night bombshell report revealing that the Trump Administration left a paper trail of their plans to sabotage health care, Protect Our Care Campaign Chairman Leslie Dach released the following statement:

“President Trump left behind a smoking gun in this newly revealed document, and now Americans can see beyond a shadow of a doubt that the Republican plot to sabotage our care started on Day One of this Administration. This newly revealed document confirms what we knew all along – Republicans never had any plan to improve health care for Americans; they always intended to rip apart affordable coverage and vital insurance protections root and branch. After today, President Trump and Congressional Republicans can no longer deny the truth: from the outset, they were hell-bent on waging a spiteful war against Americans’ health care.”

Azar Fails Confirmation Questioning, Refuses to Protect Our Care

Following Alex Azar’s refusal to commit to protecting Americans’ care at this morning’s Senate Finance Committee hearing, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Alex Azar failed the American people at his confirmation hearing today by refusing to signal an end to the Trump Administration’s sabotage and to promise that he would protect our care. Azar showed that we can’t trust him to defend Americans’ coverage by endorsing Republicans’ wildly unpopular proposal to cut Medicaid through block grants. And as a former Big Pharma lobbyist, Azar failed to offer any assurances he would address spiking drug costs with his out-of-touch claim that costs will always go up. If confirmed as Secretary, Azar would be empowered to accelerate the Republican war on health care. Because of Azar’s failure at today’s hearing, Senators must reject his nomination.”

Protect Our Care Memo to Senators: Azar Must Answer for Trump Admin Sabotage

Ahead of tomorrow’s Senate Finance confirmation hearing for HHS nominee Alex Azar, Protect Our Care Campaign Director Brad Woodhouse sent a memo to Finance Committee Senators outlining questions Americans deserve answered about the Trump Administration’s war on our health care, and released the following statement:

“During tomorrow’s confirmation hearing, Americans deserve to find out whether Alex Azar would keep pushing the Trump Administration’s anti-health care agenda if confirmed,” said Woodhouse. “Given Azar’s anti-consumer track record as a Big Pharma lobbyist, he needs to assure the millions of people who have already signed up for 2018 HealthCare.Gov plans that, as Secretary, he would end the Trump Administration’s ongoing sabotage efforts and start giving insurers the stability they need in order to set affordable rates. In addition, Americans deserve assurances from Azar that he would end Republicans’ attempts to weaken Medicaid and deny women access to copay-free birth control. If Azar fails to signal an end to the Trump Administration’s sabotage or refuses to promise that he will faithfully administer the law of the land, the Affordable Care Act, then Senators should reject his nomination.”

New Protect Our Care Ad Urges Members of Congress to Oppose HHS Nominee Alex Azar, Stop the GOP’s War On Health Care

FOR IMMEDIATE RELEASE
January 8, 2018

Ad: “Alex Azar is ready to lead the Republican war on health care into its second year… It’s time for Congressional Republicans to stop their war against your health care. Vote no on Alex Azar.”

Washington, D.C. – Protect Our Care today announced a new digital ad urging Members of the Senate to reject Donald Trump’s nominee to head the Health and Human Services Department, Alex Azar, a former pharmaceutical executive who has agreed to lead the GOP’s war on health care into a second year. The ad comes in advance of Tuesday’s Senate Finance Hearing about Azar.

Azar has agreed to head up the GOP’s war on health care, which has included: (1) a never-ending quest to repeal health care despite the fact that doing so raises premiums by double digits and removes protections for millions of Americans; and (2) extensive administrative action to sabotage the health care law, including cutting the open enrollment sign-up period in half and slashing its advertising budget by 90 percent; stopping cost-sharing reduction payments which raise premiums; and most recently proposing a rule to offer association health plans, junk insurance which guts protections for those with pre-existing conditions.

Watch the ad urging opposition to Mr. Azar here.

“The GOP war on health care is already forcing higher costs and ripping away coverage, and the Trump Administration’s first leader had to resign for abusing taxpayer resources,” said Protect Our Care Campaign Director Brad Woodhouse. “Now they’ve recruited a new general who will embrace the twin weapons of repeal and sabotage, no matter how much higher they force our costs or how many people get hurt.”

Mr. Azar opposes the health care law that covers millions of people, going so far as to say it is ‘circling the drain,’ echoing the Administration’s blatant lie that the law is not working. Despite the GOP’s years-long efforts, the Affordable Care Act is more popular than ever, and nearly 9 million Americans signed up for coverage during the open enrollment period. Alternatively, the GOP’s approach to health care has led to historically-unpopular approval ratings for Congressional Republicans and President Trump and drove widespread electoral losses in November and in the Alabama Senate race.

##

“By The Time They Discover They’ve Been Sold A Fraudulent Product, The Promoter Will Be On His Way To The Caribbean”: Responses to the Trump Administration’s Proposed Junk Insurance Rule

Yesterday, the Trump Administration announced a proposed rule to expand association health plans, which will gut protections and raise costs for people with pre-existing conditions and further destabilize the marketplace. The coverage of these plans has focused on what they are: junk insurance plans. Don’t believe us? Take a look for yourself…

Chris Hansen, American Cancer Society Cancer Action Network: “The Rule Proposed Today Will Almost Certainly Result In More People Facing Financial Distress When An Unexpected Health Crisis Happens.” “Consumer groups, state officials and Blue Cross and Blue Shield plans have strenuously opposed similar ideas for years. Association health plans, they say, will tend to attract employers with younger, healthier workers, leaving behind sicker people in more comprehensive, more expensive plans that fully comply with the Affordable Care Act. That could drive up premiums, which already have risen steadily as Republicans have taken aim at President Barack Obama’s signature domestic achievement. ‘Those with serious health conditions like cancer would be left paying ever-increasing premiums for comprehensive coverage,’ said Chris Hansen, the president of the American Cancer Society Cancer Action Network. ‘The rule proposed today will almost certainly result in more people facing financial distress when an unexpected health crisis happens.’” [New York Times, 1/4]

Marc I. Machiz, Former Labor Department Investigator: “Any Idiot With A Word Processor Can Create An Association In 10 Minutes…By The Time They Discover They’ve Been Sold A Fraudulent Product, The Promoter Will Be On His Way To The Caribbean.” “Similar health plans have a history of fraud and abuse that have left employers and employees with hundreds of millions of dollars in unpaid medical bills. Marc I. Machiz, who investigated insurance fraud as a Labor Department lawyer for more than 20 years, said the proposed rules were an invitation to more scams. ‘Any idiot with a word processor can create an association in 10 minutes and market it to small employers and individuals who certify that they are self-employed,” Mr. Machiz said. ‘The employers and individuals will pay premiums. By the time they discover they’ve been sold a fraudulent product, the promoter will be on his way to the Caribbean.’” [New York Times, 1/4]

Health Affairs: “The Proposed Rule Itself Acknowledges That Some AHPs Have ‘Failed To Pay Promised Benefits To Sick And Injured Workers While Diverting, To The Pockets Of Fraudsters, Employer And Employee Contributions.” “The proposed rule itself acknowledges that some AHPs have ‘failed to pay promised health benefits to sick and injured workers while diverting, to the pockets of fraudsters, employer and employee contributions from their intended purpose of funding benefits’ and that Congress enacted reforms to address AHP abuse in the past. Yet, by broadening the availability of AHPs and relaxing commonality of interest standards, the proposed rule likely opens the door to additional fraudulent AHP behavior and the insolvency and unpaid claims that accompany it. The rule acknowledges that the Department would need to commit additional resources to AHP oversight if the proposal is finalized to address AHP mismanagement and abuse.” [Health Affairs, 1/5]

Los Angeles Times: CBO: Previous Proposals “Would Have Made Coverage Unaffordable For Many Consumers With Preexisting Medical Conditions.” “Many patient groups and consumer advocates — who are already alarmed by Trump administration efforts to undermine the 2010 health law — fear that less comprehensive health plans will leave Americans without vital protections… By allowing healthier Americans to buy plans that don’t cover expensive medications or other medical benefits, these plans also risk driving up costs for sick patients who need the more extensive coverage. For example, proposals last year by congressional Republicans to allow health plans to offer slimmed down benefits would have made coverage unaffordable for many consumers with preexisting medical conditions, according to analyses by the nonpartisan Congressional Budget Office.” [Los Angeles Times, 1/4]

The Hill: Association Plans “Would Likely Drive Up Premiums” And “Unlike Obamacare Plans, AHPs Could Charge Higher Premiums Based On Age And Gender.” “Critics say AHPs could still find other ways to cherry-pick only the young, healthy people. ‘You can be sure they are going to design benefit packages to attract healthier people,” and “siphon them away from the individual market,’ said Sabrina Corlette, a professor at the Georgetown University Center on Health Insurance Reforms. Leaving the less healthy individuals in the individual and small group markets would likely drive up the premiums. AHPs could also decline to cover prescription drugs, which could discourage sick people from enrolling and, unlike ObamaCare plans, AHPs could charge higher premiums based on age and gender.” [The Hill, 1/4]

America’s Health Insurance Plans: “We Are Concerned That This Could Create Or Expand Alternative, Parallel Markets For Health Coverage, Which Would Lead To Higher Premiums For Consumers, Particularly Those With Pre-Existing Conditions.” “Supporters of the ACA have said that relaxing the rules on associations could destabilize the individual insurance market, where roughly 17 million people buy their own insurance either on or off the ACA exchanges. And they say enabling individuals to join associations would provide an off-ramp from the exchanges that would drain away the younger, healthier people who are needed to keep premiums in check. ‘We are concerned that this could create or expand alternative, parallel markets for health coverage, which would lead to higher premiums for consumers, particularly those with pre-existing conditions,’ said a Dec. 14 letter from groups including America’s Health Insurance Plans, a top insurers’ trade association.” [Wall Street Journal, 1/4]

Washington Post:”The Rules Would Allow Such Plans To Be Reclassified So They No Longer Would Have To Include A Set Of 10 Essential Health Benefits – Including Maternity Care, Prescription Drugs And Mental Health Services.” “Specifically, the rules would allow such health plans to be reclassified so they no longer would have to include a set of 10 essential health benefits — including maternity care, prescription drugs and mental health services — that the ACA requires of insurance sold to individuals and small companies… Unlike [marketplace plans], the association plans could charge customers different prices depending on their age, gender and location. ‘The potential is that it creates an uneven playing field,’ said Kevin Lucia, a research professor at Georgetown University’s Center on Health Insurance Reforms, who worked on early stages of the 2010 health-care law within the Obama administration.” [Washington Post, 1/4]

Politico: State Insurance Advocates “Have Warned That Lax Rules Could Open The Door To A New Wave Of Poorly Regulated Health Plans That Exclude Coverage Of Key Services. However, state insurance regulators and Obamacare advocates have warned that lax rules could open the door to a new wave of poorly regulated health plans that exclude coverage of key services required by the Affordable Care Act, such as hospitalizations and prescription drugs. ‘The Trump administration has declared open season for fraudsters selling junk insurance while those with pre-existing conditions will find health care further and further out of reach,’ said Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee.” [Politico, 1/4]

USA Today: As Proposed, “These Plans Are Governed By State Insurance Rules So Might Not Have As Sweeping Coverage Of What the ACA Considered ‘Essential Health Benefits.’” The regulations would allow the expansion of so-called ‘association health plans,’ which are groups of small businesses and possibly individuals that band together to purchase insurance. These plans are governed by state insurance rules so might not have as sweeping coverage of what the ACA considered ‘essential health benefits,’ such as maternity care, prescription drug coverage or hospitalization. Some states actually require more comprehensive benefits though… Consumers could buy these plans across state lines, although whether doctor and hospital networks would be sufficient remains a question.” [USA Today, 1/4]

Associated Press: Insurance Industry Groups Are Skeptical Of Trump’s Idea, Saying It Could Undermine The Current State Markets.” “The new rule would make it easier for groups, or associations, to sponsor health plans that don’t have to meet all consumer protection and benefit requirements of the Obama law… Insurance industry groups are skeptical of Trump’s idea, saying it could undermine the current state markets. Patient groups are concerned about losing protections. Some state regulators object to federal interference.” [AP, 1/4]

Reuters: “The Rule Could Destabilize Several States’ Individual Insurance Markets.” “Proponents of Obamacare say the rule would undermine the individual insurance market created under the law by allowing young and healthy people to purchase cheaper insurance, leaving the sickest and most expensive patients in the Obamacare markets, driving up costs. Hospitals, insurers and medical groups criticized the rule in December and said it would make health insurance unaffordable for people with pre-existing conditions. The rule could destabilize several states’ individual insurance markets because healthier people could access cheaper insurance, said Evercore ISI analyst Michael Newshel, adding that it is still unclear whether significant numbers of people will opt for the slimmer plans.” [Reuters, 1/5]

2018 Is the Year of Health Care

To: Interested Parties

From: Brad Woodhouse, Campaign Director, Protect Our Care

Subject: 2018 Is the Year of Health Care

Date: January 2, 2018

In 2017, the Trump administration and Republicans in Congress waged a war on our health care – from ACA repeal to Medicaid cuts to health care sabotage. Under their planned agenda, costs would rise, coverage would fall and millions of Americans would lose protections against abuses from insurance companies.

The story of 2018 is a simple one: it will be the year the politics of health care will haunt Republicans at the polls. Poll after poll shows that health care is the number one issue on voters’ minds and that they strongly oppose the GOP war on health care. Relatedly, the Affordable Care Act is more popular than ever, and more than 8 million people have already signed up for coverage in open enrollment.

Now, some Republicans want to keep their war on health care going.  They do so at their political peril.

The American people see health care as their top issue.

  • 48 percent in a recent Associated Press-NORC poll rated health care as their top concern for 2018, a number double-digits ahead of the second issue, taxes.
  • Health care topped people’s concerns in a POLITICO/Harvard T.H. Chan School of Public Health poll. The number one issue people wanted Congress and President Trump to address was to renew funding for the Children’s Health Insurance Program (CHIP).
  • Health care was the most important issue to people in a recent Economist/YouGov poll (18 percent), followed by Social Security (17 percent).

The American people reject President Trump and Congressional Republicans’ approach to health care.

  • The recent AP/NORC poll had President Trump’s approval/disapproval on health care at 30/70. More voters disapprove of his performance on health than any other issue.
  • According to the November 2017 Kaiser Health Tracking Poll, “The majority of the public (60 percent) – including majorities of Democrats (89 percent) and independents (57 percent) – do not trust President Trump to do what’s best when it comes to health care in this country.”
  • FOX News polling showed only 33% of voters approve of President Trump’s work on health care while 60% disapprove.  

And it will cost Republicans politically if they continue their war on health care, like it did last November.

  • The latest Quinnipiac poll showed 41% of voters as being less likely to vote for a Senator or Member of Congress who backed the GOP’s health care plan with only 19% more likely to support them.
  • Health care was the most important issue for people who voted in the Virginia gubernatorial race in November, more than double any other issue, and Ralph Northam beat Ed Gillespie by 54 points, 77-23, among these voters.
  • In Maine, voters backed a referendum to endorse a key element of the Affordable Care Act by an 18-point margin (59-41), the first time the ACA had ever been on the ballot.

The Affordable Care Act is more popular than it has ever been.

  • Pew Research Center: “Today, more Americans say the 2010 health care overhaul has had a mostly positive than mostly negative effect on the country (44% versus 35%), while 14% say it has not had much effect. Overall support for the health care law also has grown since last year. Currently, 56% of the public approves of the law while 38% disapproves, according to a new national survey by Pew Research Center, conducted Nov. 29-Dec. 4.”
  • A Public Policy Poll for Protect Our Care found that 57% say they approve of the Affordable Care Act to just 36% who say they disapprove – a 21 point gap. This is up 5 points from a September poll done for Save My Care, where approval was 54/38.

Enough is Enough: Here Are Some of the Ways The Trump Administration And Republicans In Congress Have Waged War on Health Care in 2017

Since taking office earlier this year, President Trump, his administration and allies in Congress have waged an unrelenting war against our health care. Their twin weapons have been repeal and sabotage. The innocent victims are the American people. Their agenda takes  health care away from millions, raises costs for millions more, guts protections for people with preexisting conditions, and purposely destroys the insurance markets.  And they have done it without listening to the American people, health care experts, or engaging in a hint of bipartisanship.

President Trump famously said “the best thing we can do…is let Obamacare explode” and “let it be a disaster because we can blame that on the Democrats.” But as his actions this show clearly, he and his allies in Congress are not letting Obamacare fail, they are making Obamacare fail.

In Congress,  they tried five separate times to completely  repeal health care — starting with the so-called American Health Care Act (AHCA) in the House, then the Better Care Reconciliation Act (BCRA), a partial repeal bill, Graham-Cassidy, and “skinny” repeal bills in the Senate.  At the White House and HHS, they sabotaged open enrollment, took direct aim at birth control, instructed their cabinet secretaries to disobey the law, and  stopped funding the payments that kept out of pocket costs low for millions of our fellow citizens. They just snuck in a repeal of a key provision of the Affordable Care Act that will raise premiums by double digits and increase the number of uninsured by millions, so they can  give massive tax breaks to billionaires and large corporations.

Here is some of what they did  in 2017:

  • On his first day in office, President Trump signed an Executive Order directing the administration to find any ways they could to unravel the Affordable Care Act.
  • The Trump administration cut the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
  • House Republicans voted for and passed a health care repeal bill that causes 23 million people to lose coverage and guts protections for people with pre-existing conditions.
  • The Trump administration cut the outreach advertising budget for open enrollment by 90 percent, from $100 million to just $10 million – likely to result in 1.1 million fewer people getting covered. Advertising is a critical way for people to know when and how they can get covered.  
  • Republicans refused to move forward on the bipartisan Alexander Murray bill even though it had a filibuster proof majority in the Senate.
  • Senate Republicans tried but failed to pass BCRA, Skinny Repeal and Graham-Cassidy, all of which would cause millions to lose their health coverage and raise premiums by double digits for millions more..
  • The administration ordered the Department of Health and Human Services’ regional directors to stop participating in open enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell said, “I didn’t call it sabotage…But that’s what it is.”
  • The administration dramatically cut in-person assistance that helped people sign up for 2018 coverage.
  • The Trump administration took direct aim at birth control by rolling back a rule that guaranteed women access to contraception. (A court has since delayed their effort.)
  • After threatening for months to stop funding cost-sharing reductions (CSRs) that help lower deductibles and out-of-pocket costs,  the Trump administration stopped CSR payments altogether in October. The CBO found failing to make these payments would increase premiums by 20 percent and add nearly $200 billion to the debt.
  • President Trump signed an Executive Order that would roll back key protections and result in garbage insurance, raise premiums, reduce coverage and expose millions of Americans again to discrimination based on pre-existing conditions.
  • House and Senate Republicans repealed the individual mandate in their tax bill in order to pay for massive tax breaks to the ultra wealthy and big corporations.  CBO predicts millions will lose coverage and premiums will go up double digits.

While the Trump administration and Republicans in Congress want to keep up this war on health care in 2018, the American people are saying “Enough is Enough.” Nearly 9 million people just signed up for coverage through healthcare.gov despite all the sabotage efforts. The Affordable Care Act is more favorable than it has ever been. And millions of people across the country made their voices heard at rallies, town halls and calling their member of Congress to fight these repeal efforts.

The American people are right: enough IS enough.

Protect Our Care Statement On Trump Administration Proposed Rule to Sabotage Health Care Markets

In response to the Trump administration’s proposed rule to expand association health plans,, which will gut protections and raise costs for people with pre-existing conditions and further destabilize the marketplace, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Just days after passing a tax bill that throws 13 million people off health insurance and raises premiums by double digits, the Trump Administration has resumed their war on our health care,” said Woodhouse. “Now they want to let insurance companies sell plans that gut protections and charge more for people with pre-existing conditions. This proposed rule attacks the protections most supported by Americans, and is opposed by leading patient and insurance groups. It’s only the latest act of sabotage from a president who wants to raise your costs and take away your coverage. Only Donald Trump could give America this kind of New Year’s present. Unfortunately, it is the American people who will suffer.”

FACT SHEET: ASSOCIATION HEALTH PLANS

ASSOCIATION HEALTH PLANS ALLOW PROVIDERS TO CHERRY PICK HEALTHIER PEOPLE, RAISING COSTS ON PEOPLE WITH PRE-EXISTING CONDITIONS AND DESTABILIZING THE MARKET

Tim Jost: “It Will Destroy The Small-Group Market…We’ll Be Back To Where We Were Before The Affordable Care Act.” “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.If that change were made, association health plans would be freed to craft skimpier (and cheaper) health plans that appeal only to businesses with younger and healthier employees. Small businesses left in Obamacare’s marketplace would likely face higher costs and fewer options as the market became less attractive to insurers. ‘It will destroy the small-group market,’ Tim Jost, a law professor at Washington and Lee University who generally supports Obamacare, told me before the order was signed. ‘We’ll be back to where we were before the Affordable Care Act.’” [Vox, 12/29/17]

Georgetown Center on Health Insurance Reforms: Prior To ACA, AHPs Would Set Up Headquarters In A State With Fewer Regulations And Market To States With More Regulations. “Additionally, AHPs would often set up headquarters in one state with limited regulatory oversight and market policies to businesses and consumers in other states with more robust regulation, thereby bypassing those states’ more protective rating and benefit standards.” [Georgetown Center on Health Insurance Reforms, December 2017]

Deep Banerjee, S&P Global Ratings: “No One Healthy Is Now Going To Sign Up In The ACA Risk Pool, Because They Have This Cheaper Option.” “With associations, health care providers can effectively choose the most desirable participants, allowing the healthy to make the switch to save money — and potentially shutting out the less healthy. ‘No one healthy is now going to sign up in the ACA risk pool, because they have this cheaper option,’ Deep Banerjee, a health care analyst at S&P Global Ratings said.” [UPI, 10/12/17]

ASSOCIATION HEALTH PLANS WOULD ALLOW PROVIDERS TO GUT CONSUMER PROTECTIONS AND MAKE IT HARDER TO PURCHASE 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]

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]

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]

KEY STAKEHOLDERS CAME OUT AGAINST PRESIDENT TRUMP’S EXECUTIVE ORDER ON AHPS SAYING THEY WOULD DESTABILIZE THE MARKETS, RAISE COSTS AND GUT PROTECTIONS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Crohn’s And Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Lutheran Services In America, March Of Dimes, Muscular Dystrophy Association, National Health Council, National Multiple Sclerosis Society, National Organization For Rare Disorders, United Way Worldwide, Volunteers Of America, Womenheart: “This Order Has The Potential To Price Millions Of People With Pre-Existing Conditions And Serious Illnesses Out Of The Individual Insurance Market And Put Millions More At Risk.” “This order has the potential to price millions of people with pre-existing conditions and serious illnesses out of the individual insurance market and put millions more at risk through the sale of insurance plans that won’t cover all the services patients want to stay healthy or the critical care they need when they get sick…Together, these actions would likely split the market between those who need the comprehensive benefits provided under current law and those who are currently healthy and can gamble with substandard coverage. Siphoning off healthy people into risky, low-value plans, could leave millions of Americans with chronic or serious illnesses in an unsustainable insurance pool with rising premiums and fewer choices. It could also leave those who are healthy seriously underinsured when they face an unexpected health crisis.” [Letter, 10/12/17]

American Cancer Society Cancer Action Network: “Health Care Changes Could Leave Millions Of Cancer Patients And Survivors Unable To Access Meaningful Coverage.” “Today’s executive order jeopardizes the ability of millions of cancer patients, survivors and those at risk for the disease from being able to access or afford meaningful health insurance. Exempting an entire set of health plans from covering essential health benefits like prescription drugs or specialty care and allowing expansion and renewability of bare-bones short-term plans will split the insurance market. If younger and healthier people leave the market, people with serious illnesses like cancer will be left facing higher and higher premiums with few, if any, insurance choices.  Moreover, those who purchase cheap plans are likely to discover their coverage is inadequate when an unexpected health crisis happens leaving them financially devastated and costing the health care system more overall.” [ACS CAN, 10/12/17]

American Hospital Association: “These Provisions Could Destabilize The Individual And Small Group Markets, Leaving Millions Of Americans Who Need Comprehensive Coverage To Manage Chronic And Other Pre-Existing Conditions.” “Today’s Executive Order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections…In addition, these provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions, as well as protection against unforeseen illness and injury, without affordable options.” [AHA, 10/12/17]

American Medical Association: “The Executive Order’s Proposal To Expand Access To Association Health Plans And Allow Short-Term Plans To Cover Longer Time Periods May Weaken Important Patient Protections And Lead To Instability In The Individual Health Insurance Market.” “The AMA supports patient choice and promoting market competition, and supports the concept of association health plans. We have concerns, however, the Executive Order’s proposal to expand access to association health plans and allow short-term plans to cover longer time periods may weaken important patient protections and lead to instability in the individual health insurance market.” [AMA, 10/12/17]

American Academy Of Actuaries: “These Effects Could Include Tilting The Market In Favor Of Entities With Weaker Benefits Or Solvency Standards And Weakening The Protections For Consumers With Pre-Existing Health Conditions.” “‘Creating exemptions from the Affordable Care Act (ACA) insurance market rules can have far-reaching and unintended effects,’ said Academy Senior Health Fellow Cori Uccello. ‘These effects could include tilting the market in favor of entities with weaker benefits or solvency standards and weakening the protections for consumers with pre-existing health conditions.’” [AAA, 10/12/17]

Small Business Majority: “These Changes Would Be Bad For Small Businesses And Their Employees Because They Could Lead To Higher Premiums, Unbalanced Risk Pools And Lower-Quality Insurance.” “We are extremely disappointed this administration continues to undermine the Affordable Care Act (ACA), as evidenced today when President Trump signed an executive order allowing insurance companies to sell health insurance products across state lines and making it easier for groups to establish association health plans (AHPs). These changes would be bad for small businesses and their employees because they could lead to higher premiums, unbalanced risk pools and lower-quality insurance. While President Trump’s order would make it easier for a few select small businesses with younger and/or healthier employees to purchase association health plans that might be cheaper in other states, the tradeoff is that this would result in the emergence of parallel insurance markets for small businesses, leading to major spikes in premiums for small firms that remain in the small-group market.” [SBA, 10/12/17]

Consumers Union: “Executive Order On Health Plans Destabilizes Insurance Markets, Hurts Consumers, Drives Up Costs.” “While this executive order claims to help improve consumers’ access to affordable care, it would have the exact opposite effect. Allowing insurers to sell substandard association health plans that aren’t required to cover basic services and benefits will further fragment and destabilize the insurance markets as a whole. This action splits the market into two, pitting the healthy against those with preexisting conditions and life-threatening illnesses — but ultimately both groups lose in this new scheme.” [Consumers Union, 10/12/17]

American Federation Of Teachers: [Donald Trump] “Is Ignoring The Rule Of Law, Refusing To Compromise, And Doing An End-Run Around Congress In Order To Strip People Of Their Healthcare.” “Donald Trump owns the unwinding of the Affordable Care Act. He is ignoring the rule of law, refusing to compromise, and doing an end-run around Congress in order to strip people of their healthcare. Millions of Americans will be worse off because of his actions. This is an ongoing pattern of the Trump administration’s callous sabotage of Obamacare, and it will cause real harm to American families, leading to increased premiums and loss of coverage for those most in need of healthcare and flooding markets with cheap, limited ‘junk’ insurance.” [AFT, 10/12/17]

NETWORK Lobby: “The Trump Administration Continues To Do As Much As Possible To Destabilize The American Healthcare System, Increase Costs For Families, And Prevent People From Accessing The Care They Need.” “The Trump Administration continues to do as much as possible to destabilize the American healthcare system, increase costs for families, and prevent people from accessing the care they need. Today’s executive order is the latest attack on our healthcare, following a long line of attempts to repeal and cripple the ACA. This executive order will drive up premiums for many—especially middle-class families and people with pre-existing conditions—to further undermine the ACA. It is morally reprehensible to hurt people through unjust policies for political gain.” [Statement, 10/12/17]

KENTUCKY’S EXPERIMENT WITH ASSOCIATION HEALTH PLANS SHOW THE NEGATIVE IMPACTS THEY COULD HAVE

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

Protect Our Care Statement On Federal Open Enrollment Numbers

In response to the news that 8.8 million people signed up for health insurance on the federal marketplace, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“A day after Republicans repealed a key provision of the Affordable Care Act and declared the law ‘dead,’ the results of open enrollment made clear the ACA is very much alive and demonstrated just how out of touch the GOP’s priorities are,” said Woodhouse. “More than 2 million new customers signed up for ACA coverage. The Affordable Care Act is working, and people’s lives are improving because of it. Despite widespread sabotage by the Trump Administration, including cutting the open enrollment period in half and dramatically slashing the advertising budget, these numbers prove that people want and need the affordable, quality health coverage the ACA provides, they rely on it for health and financial peace of mind and any further attempts at sabotage will be met with severe resistance. It’s time for the GOP to abandon efforts to take away people’s health care.”

Protect Our Care Statement On Potential Inclusion Of Alexander-Murray In Senate Spending Bill

In response to the news that the Senate plans to include the Alexander-Murray legislation in its must-pass spending bill this week, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“This is not nearly enough to offset the damage caused by this tax bill, and for senators to pretend otherwise is wrong and short-sighted” said Woodhouse. “13 million people will lose health insurance due to sneaky repeal and millions more will see their premiums rise double digits, and Alexander-Murray will do virtually nothing for these people even it is able to pass the House, far from a sure thing.

“Perhaps Senators Collins and Murkowski think this legislation will allow them to justify supporting a tax scam benefiting the wealthiest and big corporations at the expense of everyone else, but it provides little comfort to the American people losing sleep over their health care being put in jeopardy by the GOP tax scam.”