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Support for ACA Continues to Rise – Over 2/3 of Voters Want ACA Kept and Fixed, Not Repealed; Voters Oppose Tax Bill Killing ACA Mandate

From: Jim Williams, Public Policy Polling

To: Interested Parties

Subject: Support for ACA Continues to Rise – Over 2/3 of Voters Want ACA Kept and Fixed, Not Repealed; Voters Oppose Tax Bill Killing ACA Mandate    

Date: December 14, 2017

A new Public Policy Polling survey finds that approval of the Affordable Care Act continues to rise among voters, and nearly 7 in 10 want Congress to keep what works about the ACA and fix what doesn’t rather than repeal it and start over with a new healthcare law. Further, only 29% of voters say they support the Republican tax bill currently being debated in Congress after learning it includes a health care repeal that removes the individual mandate in the Affordable Care Act.

Key findings from the survey include:

  • Voter approval of the Affordable Care Act continues to rise. 57% say they approval of the law compared 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.
  • Voters continue to strongly think that Congress should keep what works about the ACA and fix what doesn’t rather than repeal it and start over with a new healthcare law – voters say so by a 68/30 margin in this poll expanding to 71/26 among independents. That 38 point advantage is up from a 27 point advantage of 60/33 from an October poll done for Save My Care.
  • Just 29% of voters say they support the Republican tax bill currently being debated in Congress after learning it removes the individual mandate in the Affordable Care Act.

PPP surveyed 585 registered voters nationally from December 12-13, 2017.  The margin of error is +/- 4.1%. This poll was conducted using automated telephone interviews for Protect Our Care.

Protect Our Care Fact Sheet on Health Repeal in Senate Tax Bill

Senate Republicans just passed a tax bill that repeals your health care to pay for another massive tax break for the wealthiest and corporations. What this means is simple: while the wealthy and corporations get a tax break, middle-class families will get double digit premium increases, 13 million people will lose their coverage, older Americans will get an age tax and $25 billion in Medicare funding will be cut.


Congressional Budget Office: Republican Tax Bill Will Result In 13 Million More Uninsured People. “The number of people with health insurance would decrease by 4 million in 2019 and 13 million in 2027.” [CBO, 11/8/17]

CBO: Average Premiums Will Increase By 10 Percent In Most Years Of The Next Decade Due To The Republican Tax Bill. “Average premiums in the nongroup market would increase by about 10 percent in most years of the decade (with no changes in the ages of people purchasing insurance accounted for) relative to CBO’s baseline projections.” [CBO, 11/8/17]

CBO: Healthier People Less Likely To Purchase Health Coverage, Raising Costs For Everyone Else. “Those effects would occur mainly because healthier people would be less likely to obtain insurance and because, especially in the nongroup market, the resulting increases in premiums would cause more people to not purchase insurance.” [CBO, 11/8/17]

AARP: Premiums For People Over 50 Would Increase Up To $1,500 Because Of Health Care Repeal In The Republican Tax Bill. “The Tax Cuts and Jobs Act as reported by the Senate Finance Committee on Nov. 16, 2017 includes a new provision that would both reduce health care coverage and increase costs for millions of Americans. Older adults ages 50–64 would be at particularly high risk under the proposal, facing average premium increases of up to $1,500 in 2019 as a result of the bill.” [AARP, 11/21/17]

CBO: Republican Tax Bill Would Trigger A $25 Billion Cut To Medicare. “Without enacting subsequent legislation to either offset that deficit increase, waive the recordation of the bill’s impact on the scorecard, or otherwise mitigate or eliminate the requirements of the PAYGO law, OMB would be required to issue a sequestration order within 15 days of the end of the session of Congress to reduce spending in fiscal year 2018 by the resultant total of $136 billion. However, the PAYGO law limits reductions to Medicare to four percentage points (or roughly $25 billion for that year), leaving about $111 billion to be sequestered from the remaining mandatory accounts.” [CBO, 11/14/17]

Sen. Marco Rubio (R-FL): Republicans Need To Cut Medicare Next To Pay For Tax Cuts. “‘I analyze this very differently than most,’ Rubio told the crowd. ‘Many argue that you can’t cut taxes because it will drive up the deficit. But we have to do two things. We have to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future,’ the senator said.” [Financial Advisor Magazine, 11/30/17]

Center On Budget And Policy Priorities: “Senate Tax Bill Would Add 13 Million To Uninsured To Pay For Tax Cuts Of Nearly $100,000 Per Year For The Top 0.1 Percent.” “The savings from eliminating the mandate would come entirely from reducing health coverage. For example, the federal government would spend less on premium tax credits because fewer people would sign up for marketplace coverage, less on Medicaid because fewer people would enroll, and less on the tax exclusion for employer-sponsored health insurance because fewer employees would enroll in job-based coverage. These savings are what let Senate leaders make their full corporate rate cut permanent…The benefits of corporate rate cuts go overwhelmingly to high-income households.” [CBPP, 11/15/17]


CBO: Passing Alexander-Murray After The Repeal Of The Individual Responsibility Provision Would Not Undo The Damage. “In your letter of November 21, 2017, you asked about the combined effects of simultaneously passing the BHCSA and legislation that would repeal the requirement that most U.S. citizens and noncitizens who lawfully reside in the country have health insurance meeting specified standards. Specifically, you asked if legislation that combined the provisions would change the agencies’ previous estimates of the number of people with insurance coverage or premiums in the nongroup insurance market. In the estimate for the BHCSA, the agencies wrote that, relative to the Summer 2017 baseline, the legislation would not substantially change the number of people with health insurance coverage, on net.” [CBO, 11/29/17]

There Is No Guarantee Alexander-Murray Would Pass The House, Let Alone Become Law. There is no guarantee Alexander-Murray would pass the House, let alone become law. Speaker Ryan dodged questions about its fate in the House. House conservatives called it a “nonstarter.” And President Trump has been all over the map on this issue his word cannot be trusted.


American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, And 16 More Leading Patient Groups: People With “Serious Health Care Needs” And With Pre-Existing Conditions “May Not Be Able To Afford Coverage.” “Many individuals with serious health care needs, including patients with chronic or major health conditions, who by definition, have a pre-existing condition, may not be able to afford coverage.” [The Hill, 11/28/17]

America’s Health Insurance Plans, American Academy Of Family Physicians, American Hospital Association, American Medical Association, Blue Cross Blue Shield Association, Federation Of American Hospitals: Leading Industry Groups Warn Of “Serious Consequences” Should The Mandate Be Repealed. “As providers of healthcare and coverage to hundreds of millions of Americans, we are committed to assuring everyone has access to a range of high quality, affordable coverage options so they can access the care they need, regardless of pre-existing conditions. To achieve this critical goal, we are urging you to maintain the individual mandate unless and until Congress can enact a package of reforms to adequately assure a balanced risk pool and prevent extraordinary premium increases.” [Letter, 11/14/17]

More Than 2,400 Faith Leaders: “That The Number Of Uninsured Individuals Would Increase By 13 Million By 2025…Violates Our Faith Teaching.” “The individual mandate is critical to keeping individual market coverage affordable and keeping the individual market stable. By repealing the individual mandate, legislation will cause catastrophic losses in health coverage. The CBO estimates that the number of uninsured individuals would increase by 13 million by 2025, which violates our faith teaching.” [Letter, 11/29/17]

A GOP Senator Held A Town Hall Yesterday: Health Care Dominated the Discussion

In Charles City, Iowa yesterday, GOP Sen. Joni Ernst held the first town hall by a Republican senator since four of her colleagues held a press conference announcing their iteration of the least popular bill in three decades, legislation which would raise costs, lower options, remove protections for pre-existing conditions and gut Medicaid. Sen. Ernst’s constituents had one topic most on their mind: health care. And perhaps unsurprisingly, they were not thrilled with the GOP’s latest plan. Maybe the Republican Senate caucus should start listening to the American people, just 24% of whom support the bill?

Des Moines Register: Joni Ernst is ‘leaning yes’ on Graham-Cassidy health care bill: “Kill the bill. Don’t kill us.”

“Many in the crowd of about 75 weren’t so sure the proposal could deliver. In one impassioned exchange, Tami Haught, a community organizer from Nashua, told Ernst that she has been living with HIV since 1996, and worried the changes proposed in the bill could make her ongoing treatment unaffordable. Before treatment breakthroughs, Haught said, she felt like she was living to die. Now, ‘I am living to live, but I need access to my care, treatment and lifesaving medications,’ she said. ‘I will die without them.’ Haught, who buys her insurance on Iowa’s individual market and said she was arrested outside Ernst’s Washington, D.C., office earlier this year during a health care protest, called Graham-Cassidy ‘one of worst versions of the health care repeal that has come out.’ ‘We will not let this tea-party GOP kill us now without a fight,’ she told Ernst. ‘Kill the bill. Don’t kill us.’”

Globe Gazette: Ernst shifts health care blame on Democrats at Charles City town hall: “Ethically, do you see it as your responsibility to ensure the state cannot offer a waiver so that they abandon me?”

“Those in attendance, however, continued to express doubts with the Graham-Cassidy bill, including Laura Wright of Decorah, who fears she will lose valuable medication under the new plan. ‘If I don’t have that, I become a cripple at 55 or 60,’ she told Ernst through tears. ‘Ethically, do you see it as your responsibility to ensure the state cannot offer a waiver so that they abandon me?’ She added that rural areas are at risk of losing a significant part of Medicaid funds through the new bill.”

KCRG: Ernst hears harsh words on health care at town hall meeting: “You have a voice, Senator. You have a voice. Show your backbone”

“Ernst invited her constituents to bring their opinions about the latest health care bill and other topics. Several of those in attendance didn’t hold back. ‘Senator Grassley said last night he couldn’t name anything good in it but he was going to vote for it because politically he had promised. That’s a piss-poor way to run a government,’ said one attendee. ‘You have a voice, Senator. You have a voice. Show your backbone,’ said another.”

12 Facts You Need To Know About The Latest GOP Health Care Repeal (Graham-Cassidy)

  1. MASSIVE STATE BY STATE FUNDING CUTS. The Center on Budget and Policy Priorities released a report showing in 2027, every state in the nation would see federal funding cuts under Graham-Cassidy, totaling nearly $300 billion.
  2. NO FULL CBO SCORE. The Congressional Budget Office announced it would not be able to produce a complete analysis on Graham-Cassidy that includes the impact on deficits, how many will lose coverage or the increase in premiums by September 30. Senator Bill Cassidy admitted, “I just don’t care about the coverage numbers.”
  3. PRE-EXISTING CONDITION PREMIUM HIKES. The Center for American Progress released a report showing how much more people with pre-existing conditions would pay each year under Graham-Cassidy. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320 and $142,650 more for patients with metastatic cancer.
  4. WORSE THAN BEFORE. Fitch Rating Agency found that this bill was “more disruptive for most states than prior Republican efforts.” The Washington Post found this bill is worse than previous health care repeal bills, writing “”The latest Obamacare overhaul bill gaining steam on Capitol Hill slashes health-care spending more deeply and would likely cover fewer people than a July bill that failed precisely because of such concerns.”
  5. MORE UNINSURED VETS. Rand Corp study showing Republican repeal efforts would increase the number of uninsured veterans. The report showed that the ACA’s Medicaid expansion had increased coverage for low-income veterans who lived further from VA facilities. The report found that the ACA was responsible for reducing the uninsured rate of veterans by about one-third, from 9.1% to 5.8%, in 2015.
  6. MORE UNINSURED CHILDREN. The Center for American Progress released an analysis showing that children are at immediate risk of losing coverage in Arizona, California, Connecticut, Hawaii, Idaho, Mississippi, Nevada, Oregon, Pennsylvania and Utah with CHIP funding running out quickly.
  7. KEY STAKEHOLDERS OPPOSE. The AARP, AMA, six leading physician groups, American Cancer Society Cancer Action Network and 15 more high-profile patient groups and Children’s Hospital Association — who are all unified in opposing the Republican repeal bill.
  8. GOP GOVERNORS OPPOSE. Republican Governors from Alaska, Ohio, Massachusetts and New Hampshire have come out against the plan.
  9. FAILS THE MCCAIN TEST. The NYT’s David Leonhardt’s column, “John McCain Faces a New Test of His Principles.”
  10. RAND PAUL IS A ‘NO.’ GOP Senator Rand Paul opposes Graham-Cassidy, writing in an op-ed, “In all ways, this bill is also ObamaCare Lite. In no way is it repeal the way we promised. I will oppose this bill as I did the other fake repeal bills, and I urge those who want repeal to do so, as well.”
  11. INCLUDES THE AGE TAX. This repeal bill still lets insurance companies charge up to 5 times more for people over 50, what AARP has dubbed an “Age Tax.”
  12. NO GUARANTEE IN THE HOUSE. Because this repeal bill is worse than previous ones, the Washington Post reports, “Would the House pass Graham-Cassidy? It’s not a slam dunk.”

Stories of Note

  • Washington Post: “The new GOP health-care measure goes further than the failed one”
  • New York Times: “John McCain Faces a New Test of His Principles”
  • Washington Post: “Moderates would have to swallow deep Medicaid cuts for GOP health-care push to succeed”
  • VOX: “How Cassidy-Graham brings back preexisting conditions”
  • POLITICO: “Obamacare repeal plan won’t get full CBO analysis by key deadline”
  • Axios: “What’s missing from Graham-Cassidy”

112 Days Ago, Bill Cassidy Cared About The Damage of Health Care Repeal, Now He Doesn’t

Senator Bill Cassidy doesn’t care about how damaging the nonpartisan Congressional Budget Office says his health care repeal bill will be to people.

It’s far different from 112 days ago when he actually cared about the impact of health care repeal. The latest repeal scheme bears Cassidy’s name but was written in secret without hearings or expert input.

See here.

5/26/17 — Senator Bill Cassidy on CBO: “I think we need to be instructed by [the score],”

9/15/17 — Senator Bill Cassidy on CBO: ““I just don’t care about the coverage numbers”

Senate Republican Repeal Bill That Guts Protections for Pre-Existing Conditions Now Worse

The current Senate Republican health care repeal bill already puts health insurance at risk for those with pre-existing conditions.

Now, to appease the far right wing in the Senate, Republican leaders are considering making it even worse.

In the House of Representatives, Republicans gutted protections for people with pre-existing conditions by allowing states to opt out of them. The Senate Republicans promised they wouldn’t do that but they are now pushing Ted Cruz’s plan that allows the insurance companies to opt out instead. Either way, the result is the same: people with pre-existing conditions who depend on their health care will lose these protections and pay more for worse coverage.

Here’s what the proposal would really mean:


Sen. Chuck Grassley (R-IA): “There’s A Real Feeling That That’s Subterfuge To Get Around Pre-Existing Conditions.” “‘There’s a real feeling that that’s subterfuge to get around pre-existing conditions,’ says Grassley. ‘If it is subterfuge and it has the effect of annihilating the pre-existing condition requirement that we have in the existing bill, than obviously I would object to that.’” [Iowa Public Radio, 7/5/17]

Sen. Shelley Moore Capito (R-WV): Cruz Amendment “Would Make It Too Difficult For People With Pre-Existing Conditions To Get Coverage.” “‘I think that reopens an issue that I can’t support, that it would make it too difficult for people with pre-existing conditions to get coverage,’ she said.” [Charleston Gazette-Mail, 7/8/17]

Sen. Susan Collins (R-ME): “It Would Lead To Adverse Selection In The Marketplace, And It Would Vitiate The Important Consumer Protection Of Having A Prohibition Against Annual And Lifetime Caps.” “‘It would lead to adverse selection in the marketplace, and it would vitiate the important consumer protection of having a prohibition against annual and lifetime caps,’ Senator Susan Collins of Maine said in an interview.” [Bloomberg, 6/29/17]

Sen. Susan Collins (R-ME): “It Would Erode Protections For People With Pre-Existing Conditions, And It Is Simply Not The Answer.” “‘I have a lot of concerns about Sen. Cruz’s amendment,’ she said. ‘It would erode protections for people with pre-existing conditions, and it is simply not the answer. I think it would cause premiums to go up for a lot of people.’” [Washington Examiner, 7/11/17]


Larry Levitt, Senior Vice President, Kaiser Family Foundation: Cruz Plan “The Perfect Recipe For Destabilizing The Market And Turning The Marketplaces Into High-Risk Pools.” “‘If there were a Joy of Cooking for insurance, this would be the perfect recipe for destabilizing the market and turning the marketplaces into high-risk pools,’ said Larry Levitt, senior vice president at the Kaiser Family Foundation.” [CNN Money, 7/6/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: “Segmenting The Risk Pool Is Inherently Destabilizing.” “‘Segmenting the risk pool is inherently destabilizing,’ he said, pointing out that individuals who make too much money to qualify for subsidies would likely face a particularly grim situation. ‘They wouldn’t be able to get noncompliant plans because of their medical conditions and would face astronomical premiums in the compliant market.’” [Politico, 7/11/17]

Douglas Holtz-Eakin, Former Director, Congressional Budget Office Director, And President, American Action Forum: “That’s A Recipe For A Meltdown.” “‘What that will do is allow insurers to offer cheap policy to young invincibles. And on the exchange you’re going to get all the sick people,’ said Douglas Holtz-Eakin, a former Congressional Budget Office director and president of the American Action Forum. ‘That’s a recipe for a meltdown. You’ve split the risk pool into two exchanges.’ And, he added: ‘I think it would end up being bad politics.’” [Politico, 7/1/17]

Tara O’Neill Hayes, Deputy Director Of Health Care Policy, American Action Forum: “I Think That Really Would Be The Definition Of A Death Spiral.” “‘I think that really would be the definition of a death spiral,’ said Tara O’Neill Hayes, deputy director of health care policy at the conservative American Action Forum. ‘I think it would no longer be a question of whether that’s happening.’” [Politico, 7/11/17]

Insurance Industry Official: “Insurers Are Concerned That Would Make It Challenging To Keep Premiums Low For Everyone.” “Insurance groups and policy experts warn, however, that this approach would create instability in the individual market by fragmenting the risk pool and driving up premiums for sicker people who need expensive care. They say it would turn the market for ACA-compliant plans into a de facto high-risk pool, but without an adequate, dedicated funding stream to make that model viable. ‘Insurers are concerned that would make it challenging to keep premiums low for everyone,’ said an insurance industry official who did not want to be named.” [Modern Healthcare, 6/30/17]

Craig Garthwaite, Health Insurance Expert, Northwestern University: “The Sick Would Be Attracted To Cheaper Plans, With The Knowledge They Could Always Move Into More Generous Plans If They Got Sick.” “‘The sick would be attracted to generous plans, while the healthy would be attracted to cheaper plans, with the knowledge they could always move into more generous plans if they got sick,’ said Craig Garthwaite, a health insurance expert at Northwestern University. ‘That kind of adverse selection makes pricing and offering insurance very hard.’” [Modern Healthcare, 6/30/17]

Vox: “The Fundamental Problem Is Sicker People Would Be Drawn To The More Robust Obamacare Plans, While Healthier People Would Gravitate Toward The Skimpier Non-Obamacare Coverage.” “The fundamental problem is sicker people would be drawn to the more robust Obamacare plans, while healthier people would gravitate toward the skimpier non-Obamacare coverage. That’s a reality that even Cruz acknowledges. Then inside the Obamacare market, as more and more sick people buy coverage there, costs for health insurers go up and so they increase premiums. It has the makings of a classic death spiral. Because only sick people remain, premiums eventually increase to astronomic levels. It turns the Obamacare exchanges into a high-risk pool.” [Vox, 6/29/17]

Vox: “The Whole Idea Is Dependent On An Effectively Unlimited Federal Commitment To Pay The Bills.” “So it becomes a question of the federal government’s willingness to pay that bill, indefinitely into the future. Otherwise, people with high medical costs could be stuck with a market that doesn’t function and isn’t adequately subsidized. The whole idea is dependent on an effectively unlimited federal commitment to pay the bills.” [Vox, 6/29/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: “How Long Would Congress Allow The ACA Tax Credits To Stand As The Costs Increase Rapidly?” “‘The marketplaces would turn into de facto high-risk pools,’ Levitt said. ‘How long would Congress allow the ACA tax credits to stand as the costs increase rapidly?’” [Vox, 6/29/17]


Sen. Susan Collins (R-ME): “His Proposal Would Lead To Unaffordable Rates For People With Pre-Existing Conditions.” “His proposal would lead to unaffordable rates for people with pre-existing conditions. It would result in the re-imposition of annual caps on how much your insurance will cover, which will be devastating for people who develop or have a chronic, expensive disease to treat. And it would call into question whether someone with preexisting conditions could even buy insurance, so I do not support his plan.” [Associated Press, 7/10/17]

Ceci Connolly, CEO, Alliance Of Community Health Plans: “You Are Increasing The Likelihood That There Will Be Some Smaller, Sicker Group With Higher Rates.” “Separating the sick and the healthy is ‘not the best path forward,’ said Ceci Connolly, CEO of Alliance of Community Health Plans, a lobbying group for non-profit, community-based insurers. Instead, it’s better to spread the risk around in a larger pools of enrollees. The Cruz option would do the opposite. ‘You are increasing the likelihood that there will be some smaller, sicker group with higher rates,’ Connolly said. ‘That’s what you want to get away from.’” [CNN Money, 7/6/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: “If They Have Pre-Existing Conditions, They’d Be Stuck In Plans With Escalating Premiums.” “Americans with higher incomes who wanted to buy an Obamacare-compliant plan, people likely to have high medical costs themselves, would have no protection from skyrocketing premiums. ‘If they’re healthy, they could buy inexpensive non-compliant plans. But if they have pre-existing conditions, they’d be stuck in plans with escalating premiums,’ Levitt said.” [Vox, 6/29/17]

Tim Jost, Law Professor, Washington And Lee University: “If This Were Adopted, Premiums Would Skyrocket For People Who Need Comprehensive Coverage.” “Health analysts said the amendment would cause premiums for that demographic to jump, resurrecting a thorny political issue that drew national attention earlier this year when House Republicans added a similar measure to their bill, known as the MacArthur amendment. ‘If this were adopted, premiums would skyrocket for people who need comprehensive coverage,’ said Timothy Jost, a law professor at Washington and Lee University in Lexington, Va.” [Wall Street Journal, 7/5/17]

Joe Antos, Health Policy Expert, American Enterprise Institute: People With Chronic Illness “Will End Up Paying More.” “‘Someone with chronic illness, they’re going to end up wanting to buy the more comprehensive coverage,’ says Joe Antos, a health policy expert with the conservative American Enterprise Institute. ‘This means that people with those kinds of illnesses will end up paying more. Even if they receive a federal subsidy, they will likely see higher cost sharing.’ … ‘The people who don’t know something will happen and come down with something, those are the ones at issue,’ Antos argues. ‘It’s not the people who planned ahead and bought the more expensive plan. It’s those who didn’t.’” [Vox, 7/10/17]

Wall Street Journal: “Middle-Income Earners With Pre-Existing Conditions Would Be The Hardest Hit.” “Such a bifurcation likely would mean increased costs for comprehensive plans, analysts said. People receiving the bill’s tax credits would be buffered from the price increases, but those who earn 350% of the poverty level and wouldn’t be eligible for the credits would pay more, they said. Middle-income earners with pre-existing conditions would be the hardest hit.” [Wall Street Journal, 7/5/17]

Larry Levitt, Senior Vice President, Kaiser Family Foundation: Getting Premiums Down “Comes Down To Relaxing Rules That Protect People With Pre-Existing Conditions.” “‘When it gets to crunchtime on these health bills, the discussion comes down to getting premiums down,’ said Larry Levitt, a senior vice president at Kaiser Family Foundation. ‘And that comes down to relaxing rules that protect people with pre-existing conditions.’” [Wall Street Journal, 7/5/17]