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Fact Sheet on Health Repeal in Senate Tax Bill — Rep. Peter Roskam

Spotlight: Rep. Peter Roskam (R-IL)

Senate Republicans passed a tax bill on Friday night that repeals health care to pay for another massive tax break for the wealthiest and corporations. What the repeal of the individual mandate in the Senate bill 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.

The bill passed by the House did not include the repeal of the individual mandate. The House should insist that it stays out. Rep. Peter Roskam (R-IL) has one opportunity left to take a stand against any inclusion of the individual mandate in the final bill which, if passed with the repeal of the individual mandate, would cause 525,000 people to lose coverage in Illinois including 27,600 in Rep. Roskam’s district, raise premiums on middle-class families by $1,940 and impose an age tax of up to $1,400 on older Illinoisans, and cut $970 million in Medicare funds to Illinois all to pay for tax cuts for the wealthy and corporations.

SENATE REPUBLICANS JUST VOTED TO REPEAL HEALTH CARE — RAISING PREMIUMS BY DOUBLE DIGITS FOR MIDDLE CLASS FAMILIES, RIPPING AWAY COVERAGE FOR 13 MILLION AMERICANS, IMPOSING AN AGE TAX ON OLDER AMERICANS AND GUTTING MEDICARE BY $25 BILLION — ALL TO PAY FOR SPECIAL TAX BREAKS FOR MILLIONAIRES AND BIG CORPORATIONS

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]

Center For American Progress: Senate Tax Bill Will Result In 525,000 More Uninsured In Illinois, 27,600 More In Rep. Roskam’s District.[Center for American Progress, 11/16/17, 12/5/17]

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]

Center For American Progress: Marketplace Premiums For A Typical Middle-Class Family In Illinois Will Rise By $1,940 In 2019. [Center for American Progress, 11/16/17]

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 Nationally, And Up To $1,400 In Illinois, 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]

Center For American Progress: Illinois Would See A $970 Million Cut In Medicare Funds. [Center for American Progress, 11/16/17]

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]

PASSING ALEXANDER-MURRAY AFTER VOTING FOR REPEAL IS LIKE INSTALLING GUARDRAILS ON THE HIGHWAY AFTER YOUR CAR HAS GONE OVER THE CLIFF

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.

THE LEADING EXPERTS — PATIENT GROUPS, INSURERS, DOCTORS AND HOSPITALS — AND MORE THAN 2,400 FAITH LEADERS AND THE AMERICAN PEOPLE OPPOSE HEALTH REPEAL

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]

In News

Memo From Andy Slavitt: 3 Reasons Sen. Susan Collins Should Demand Health Repeal be Removed from the GOP Tax Bill

To: Interested Parties

From: Andy Slavitt, Former Acting Administrator for the Centers for Medicare and Medicaid Services

Date: December 5, 2017

Subject: 3 Reasons Sen. Susan Collins Should Demand Health Repeal be Removed from the GOP Tax Bill

Last week, Sen. Susan Collins (R-ME) joined 50 of her Republican colleagues to pass a sneaky health care repeal bill under the guise of tax cuts to the wealthy and corporations. This legislation, if enacted into law, will result in13 million people losing their health coverage, raising premiums by ten percent, forcing higher costs on older Americans to pay more for their care, and jeopardizing Medicare. Here are three reasons why Sen. Collins should reconsider her vote as Congress considers a final bill.

First, This Tax Bill Hurts Mainers’ Health Care, Especially Older Mainers.The Senate tax bill repeals the provision in the Affordable Care Act (ACA) that requires most individuals to have health coverage, the consequences of which would increase the number of uninsured, raise costs and devastate insurance markets. This is why 19 leading patient groups — including the American Heart Association, the American Diabetes Association, and the American Cancer Society; six leading industry groups — including the America’s Health Insurance Plans, the American Academy of Family Physicians, the American Hospital Association, the American Medical Association, the Blue Cross Blue Shield Association and the Federation of American Hospitals; and more than 2,400 faith leaders opposed repealing this provision arguing it would have serious consequences for care, particularly for people with chronic or major health conditions.

One estimate shows in Maine alone, family premiums in the marketplace will increase on average by $2,350 in 2019, and 50,000 Mainers will lose coverage by 2025.

Older Mainers would not be spared. The AARP estimates a 64-year-old will have to pay $1,748 more in premiums because of health repeal, essentially an age tax for people over 50.

In her own words, Sen. Collins expressed concern about including health repeal in the tax bill, calling it the bill’s “biggest mistake.” Last month she said, “The fact is that, if you do pull this piece of the Affordable Care Act out, for some middle-income families, the increased premium is going to cancel out the tax cut that they would get.”

Second, This Bill Jeopardizes Medicare. This tax bill jeopardizes Medicare funding and therefore the guarantee for senior health care. The Congressional Budget Office said budgetary rules would trigger $25 billion in Medicare cutsas a result of the tax bill the Senate passed, which would result in a $120 million cut for Maine next year alone. Sen. Collins said she received a “personal commitment” from Senate Majority Leader Mitch McConnell (R-KY) that these Medicare cuts would not happen. McConnell and House Speaker Ryan said Congress previously waived these rules in the past, so there is no reason why they would not in the future.

But here is a reason: Republicans are already talking about the need to cut Medicare and Social Security to deal with the $1.5 trillion this tax bill adds to the national debt. On the chopping block: Medicare and Social Security. Speaker Paul Ryan (R-WI) recently said, “we’ve got a lot of work to do in cutting spending.” Sen. Marco Rubio (R-FL) was more explicit, saying, “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.”

Third, Sen. Collins’ Proposed Fixes To Health Repeal Won’t Undo The Harm Of Health Repeal, Even If They Do Pass. Sen. Susan Collins agreed to vote for the tax bill after getting assurances from Senate Majority Leader Mitch McConnell to consider two pieces of legislation she believes would mitigate some of the damage caused by repealing the ACA’s requirement most people have health insurance: the so-called Alexander-Murray and Collins-Nelson bills. However, they won’t work to undo the damage of increasing the number of uninsured, raising costs and destabilizing the markets. Here is why.

The Alexander-Murray bill temporarily funds cost-sharing reduction (CSR) payments that help lower people’s deductibles and other out-of-pocket costs. But that assumed that the marketplaces would not be upended by repealing the individual mandate. Passing Alexander-Murray after repealing health care is akin to installing guardrails on the highway after your car has gone over the cliff. The Congressional Budget Office concluded Alexander-Murray in light of health repeal would essentially be a fig leaf, writing, “the effects on premiums and the number of people with health insurance coverage would be similar.” Plus, the funding for Alexander-Murray would only help lower premiums for silver plan holders in 2019, according to the Center on Budget and Policy Priorities. What about people who chose other types of plans? Their premiums still go up 10 percent. What about after 2019? Premiums go up.

Next, the Collins-Nelson bill would temporarily fund a reinsurance program to mitigate the devastating impacts of health repeal. As the Center on Budgetfound, “Pairing mandate repeal with the Collins-Nelson bill, or a similar approach, thus would not change the fact that repealing the mandate would drive up uninsured rates. That would weaken access to care, health, and financial security for millions of people. It would also substantially raiseuncompensated care costs, which would ultimately be borne by providers, other health care consumers, and taxpayers.”

There Is No Guarantee These Bills Sen. Collins Is Proposing Will Become Law. A close reading of Senate Majority Leader Mitch McConnell’s assurances to Sen. Collins, coupled with past statements from Republican Leaders, raises serious doubts about whether the proposed legislation she wants would become law.

House Republicans have been very reluctant to consider the Alexander-Murray bill. Speaker Paul Ryan has not committed to passing it as part of the tax bill, and he previously opposed it. House conservatives called it a “nonstarter.” President Trump has been all over the map on this issue, from supporting to opposing to again supporting — so who knows what he would do.

Rep. Mark Meadows (R-NC), the chair of the influential House Freedom Caucus objected to passing the Collins-Nelson bill as part of the tax deal.

On ABC’s This Week, Sen. McConnell explained the assurances he gave Sen. Collins:

I’ve committed to Senator Collins to offer Alexander Murray and another bill that she and Senator Nelson from Florida are offering to one of these year-end bills that we’ll be doing in the next couple of weeks. The president is committed to signing it. And we intend to keep our commitment.

So, McConnell is only committing to offering the bills, not guaranteeing they will be included in must-pass legislation. He only mentions President Trump is committed to signing it, but fails to mention anything about the House.

The negative consequences this tax bill has to people’s health care is just one of long list of reasons why Sen. Collins should reconsider her vote as Congress considers a final proposal. There is still time for her to change her mind. We hope she does.

In News, Administration, Capitol Hill

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.

In News, Capitol Hill

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”
In News, Fact Sheet

Health Care Sabotage Tracker

January 2020

  • Trump administration continues their quest to sabotage Medicaid by announcing new guidance encouraging states to apply for so-called “block grants” that will gut coverage and kick people off the rolls.
  • Trump threatens to cut federal funding for California unless it drops a state requirement that private health insurers cover abortion.
  • Trump makes clear he is open to slashing benefits for vital programs like Medicare, Medicaid and Social Security during an interview with CNBC at the World Economic Forum.
  • Trump administration proposes rule reversing Obama-era policy that requires faith-based health providers receiving federal funding to inform clients about services they don’t provide for religious reasons and to provide referrals to alternative providers if patients object to their practices.

December 2019

  • The Fifth Circuit Court of Appeals rules in favor of the Trump administration and Republicans in Texas vs. United States, striking down as unconstitutional the ACA’s individual mandate and remanding to the lower court judge a final decision on what parts of the ACA should be eliminated – the very judge who has already ruled the entire health care law unconstitutional.
  • Reports surface of website glitches during the final day of open enrollment. This is the second known widespread technical problem during the 2020 open enrollment period, with the first preventing an estimated 100,000 people from signing up. After facing public pressure from lawmakers and patient advocates, CMS extended the enrollment deadline, however CMS Administrator Seema Verma did not specify how the agency would ensure the extension was communicated to the public. 
  • South Carolina becomes the first non-expansion state to receive federal approval to impose harmful Medicaid work requirements. This proposal targets low-income parents and threatens coverage for an estimated 14,000 residents.

November 2019

  • POLITICO reports that CMS funneled $2.25 million to GOP consultants aligned with Trump. These contractors charged up to $380 per hour to help with Seema Verma’s personal brand and to provide “strategic communications” support traditionally handled by government employees.

October 2019

  • Trump administration announces pilot program that will allow individual market insurers to tie premiums to reaching “health goals,” such as losing weight or lowering blood pressure. Under this program, premiums could vary by more than 30 percent for people who fail to meet these goals, and experts warn that older and sicker people who can’t comply could be priced out of coverage. One law professor described the initiative as a “back door to health-status underwriting.”
  • Trump administration announces new requirement for immigrants to have health insurance in order to obtain visas. Eligible coverage would not include Medicaid or subsidized ACA plans, but it would allow for coverage under short-term junk plans. Among other consequences of this policy, immigrants could be forced to obtain these skimpy plans that don’t actually cover pre-existing conditions.
  • Georgetown University’s Center for Children and Families reports that the number of uninsured children in the U.S. increased by more than 400,000 between 2016 and 2018, reaching a total of more than 4 million children lacking coverage nationwide. The authors said the rise of uninsured children was “due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP.”

September 2019

  • Census data reveals the uninsured rate rose for the first time since the implementation of the Affordable Care Act. The rate increased from 7.9% in 2017 to 8.5% in 2018, or by approximately 2 million people. This includes more than one million children losing Medicaid coverage alone. Health care experts pointed to a “chilling effect” from Trump-backed policies, including Medicaid work requirements.

August 2019

  • Trump administration finalizes rule that penalizes legal immigrants for accessing Medicaid. Leading health care organizations said that fear of Trump’s proposal has already resulted in declining participation in health programs and warned that the rule could have catastrophic public health consequences and drive up health care costs for all patients and payers.
  • Trump administration begins enforcing a rule that bars certain federally-funded clinics from referring women for abortions. As a result, the nation’s largest recipient of Title X funds, Planned Parenthood, was forced to exit the program, losing $60 million in funding previously used to provide birth control and reproductive health care services for low-income women.

July 2019

  • New report suggests that a Trump administration immigration proposal could result in millions of children losing health insurance. In addition to blatantly limiting CHIP and Medicaid enrollment, making more immigrants ineligible for government health benefits would likely result in fear and confusion among current enrollees.

June 2019

  • Trump administration announces HRA rule to let employers encourage their employees to buy junk plans that do not cover people with pre-existing conditions. The Brookings Institution warns that this move means older, sicker workers could end up paying higher premiums.
  • After failing to block grant Medicaid legislatively, the White House dodges Congress in order to review plan to overhaul state Medicaid programs through block grants.

May 2019

  • Sunlight Foundation report reveals that “various HHS offices have seemingly gone out of their way to systematically remove references to the ACA,” removing an 85-page website containing information about the potential benefits of the Affordable Care Act.
  • CDC survey finds 1.1 million more Americans lost health insurance coverage in 2018.
  • Trump administration proposes rule change that allows doctors, hospitals, and health care companies to refuse to provide services to LGBTQ people and patients who have had abortions.

April 2019

  • Trump administration keeps fighting to impose work requirements on Medicaid, appealing federal court rulings that blocked such requirements because they are illegal.
  • Change in Administration’s final rule setting for ACA will raise premiums on 7.3 million by cutting tax credits and raise limit on out-of-pocket maximums.
  • Trump: “We got the individual mandate, the absolute worst part of Obamacare eliminated, now we’re going for the rest.”

March 2019

February 2019

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

January 2019

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

December 2018

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

November 2018

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

October 2018

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

September 2018

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

August 2018

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

July 2018

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

June 2018

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

May 2018

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

April 2018

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

March 2018

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

February 2018

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

January 2018

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

December 2017

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

November 2017

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

October 2017

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

September 2017

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

August 2017

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

July 2017

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

June 2017

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

May 2017

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

April 2017

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

March 2017

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

February 2017

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

January 2017

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