News

Big Pharma Continues to be Big Winner in Trump’s America

Meanwhile, the GOP Slashes Health Care for the Rest of Us

SHOT: A new analysis by the Associated Press, released Monday of last week, showed that drug companies have announced “far more price hikes than cuts,” despite Trump’s promise to take action on prescription drug prices.

CHASER: A new analysis by CNBC, released Friday, showed that big drug companies are “having [their] best quarter in five years.” In fact, on Friday — the very same day that House Republicans passed massive tax cuts for the rich that they plan to pay for by cutting Medicare and Medicaid — big drug and insurance company profits “[surged] to an all-time high.”

Rosendale Changes Tune As New PPP Poll Shows Health Care and Pre-existing Conditions Protections Top Issue to Montana Voters, and Tester Up 4 Points — 49-45 — in Head-to-head

Washington, DC – At the Senate debate in Missoula last night, insurance commissioner Matt Rosendale became the latest Republican to lie to voters about his record on pre-existing conditions protections. Rosendale’s shameful effort to re-write his own record comes on the heels of a new poll from Public Policy Polling (PPP) for Protect Our Care showing that health care is a top issue to voters and that Montanans have “major concerns” with Matt Rosendale’s pro-repeal record. Said Brad Woodhouse, executive director of Protect Our Care, in response to the debate last night:

“Matt Rosendale is not being honest when he says he’s tried to make sure people with pre-existing conditions are always covered. What Matt Rosendale has actually done is work to allow insurance companies to charge you more if you have a pre-existing condition, if they will cover you at all. Rosendale’s health policies are a tough pill for voters to swallow and he knows it – that’s why he’s sugarcoating his record.”

ADDITIONAL BACKGROUND

What Rosendale Said:

“We are making sure people have options. We are making sure that other folks are being held accountable and we are trying to do it at the local level to make sure that pre-existing conditions are always covered.”

What Rosendale Has Done:

Rosendale Repeatedly, Consistently and Enthusiastically Supported Health Repeal Bills That Would Have Gutted Protections for Montanans With Pre-existing Conditions

• Rosendale Supported A Straight Repeal Of The ACA. [KRTV, 7/18/17]
• Rosendale:  “I Won’t Give Up On Repealing And Replacing Obamacare.” [Matt Rosendale for Montana, accessed 8/23/18]
• 2017:  Rosendale Supported Allowing Insurers To Offer Plans That Don’t Cover Pre-Existing Conditions Or Offer Minimum Benefits Mandated By The ACA. “Rosendale said states should be allowed to let health insurers offer less-expensive plans that cover fewer things, instead of the minimum benefits mandated by the ACA. Those products could be priced lower for younger, healthier customers, he said – or people could use non-insurance products for their health coverage, such as agreements with primary-care providers. ‘If you give the consumer the ability to find something that fits their budget, that fits their health-care needs and meets their personal choices, then that will help us start bending the cost curve down,’ Rosendale said. Health insurers and others have said this approach would end up pricing certain people out of the market, such as older, sicker customers. However, Rosendale said the state and federal government can solve that problem by financing a high-risk insurance pool that would offer coverage to these more costly patients.” [KRTV, 7/18/17]

Rosendale Supports Junk Plans, Which Do Not Protect People with Pre-existing Conditions

• Short-Term Plans May Exclude Coverage For Pre-Existing Conditions. “Policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition could be considered pre-existing and so excluded from coverage.” [Kaiser Family Foundation, 2/9/18]
  • As Many As 130 Million Nonelderly Americans, Including 426,000 Montanans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]
  • One in 4 Children, Including 54,000 Montana Children With A Pre-Existing Condition, Would Be Impacted If Insurance Companies Could Deny Or Charge More Because Of A Pre-Existing Condition. [Center for American Progress, 4/5/17]
• Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits. “Typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways.” [Kaiser Family Foundation, 2/9/18]
• Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits –  “for example, many policies cap covered benefits at $1 million or less.” [Kaiser Family Foundation, 2/9/18]
• Short-Term Junk Plans Can Retroactively Cancel Coverage After Patients File Claims. “Individuals in STLDI plans would be at risk for rescission. Rescissions are retroactive cancellations of coverage, often occurring after individuals file claims due to medical necessity. While enrollees in ACA coverage cannot have their policy retroactively cancelled, enrollees in STLDI plans can.” [Wakely/ACAP, April 2018]
• Association Health Plans Allow Insurers 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]

Rosendale Supports High Risk Pools, Which Do Not Protect People with Pre-existing Conditions

• High Risk Pools Typically Had Pre-Existing Condition Exclusions And Limited Benefits. “Many such pools had pre-existing condition exclusion periods, limited benefits, and enrollment limits; all of these characteristics served to reduce the value of the coverage, creating high financial burdens for enrollees and limiting the number of people who could access the coverage.” [Health Affairs, 3/15/16]
• Most State High Risk Pools Had Lifetime And Annual Limits On Coverage.  “Thirty-three pools [out of 35 states] imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.” [Kaiser Family Foundation, 2/22/17]
• High Risk Pools Typically Had Waiting Periods. “There were 35 state high-risk pools before the Affordable Care Act passed. To control costs, they would often do things like charge higher premiums than the individual market. Most had waiting periods before they would pay claims on members’ preexisting conditions, meaning a cancer patient would need to pay premiums for six months or a year before the high-risk pool would cover her chemotherapy treatments.” [Vox, 5/3/17]
  
• High Risk Pools Mean Delayed Or Forgone Care. “Even once they were in a high-risk pool, the high costs and limited benefits prompted some people to delay or forgo care, leading to poorer health outcomes and even more spending. And many families accrued substantial medical debt, even with the coverage.” [Stateline, 2/16/17]

Rosendale is Hiding His Record Because Polls of Montana Voters Show Health Care is a Top Issue and his Repeal Record is Unpopular:

• Fifty-six percent of voters say health care is the most important or a very important issue for them this election.  
• By a 20 point margin, 56-36, Montana voters oppose Republican efforts to repeal the Affordable Care Act and instead want to keep what works and fix what doesn’t.
• Fifty-one percent of voters say the elimination of protections for people with pre-existing conditions, supported by Matt Rosendale, is “a major concern.”
• Montana voters oppose the Trump administration’s lawsuit to eliminate protections for people with pre-existing conditions by a 49 point margin, 65 percent to 16 percent. A majority of Republicans (51 percent) oppose the administration’s lawsuit.
• The survey finds Tester with a strong four point lead over Rosendale (49-45) similar to other surveys which have consistently shown Teste rahead. Six percent of respondents were undecided.

PPP surveyed 594 Montana voters on September 28, 2018.  The margin of error is +/- 4.02%. This poll was conducted by automated telephone interviews.

New Poll Released Ahead of Senator Jon Tester and Matt Rosendale Debate Tonight Finds Health Care a Top Issue for Majority of Voters, and Strong Opposition to Repeal of ACA and Pre-existing Conditions Protections

Tester Up 4 points, 49-45, in Head-to-head

Washington, DC – Tonight, on the heels of a new poll from Public Policy Polling (PPP) for Protect Our Care showing Montanas have “major concerns” with Matt Rosendale’s pro-repeal record, health care champion Senator Jon Tester will debate Matt Rosendale. The poll also shows the importance and power of health care as an issue in a “red” state. Ahead of the debate, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“We know why Matt Rosendale recently started to pay lip service to protections for people with pre-existing conditions – because his voters vehemently oppose ripping those protections away. But the truth is Matt Rosendale has supported Republican bills to eliminate protections for people with pre-existing conditions in the past and his website says he’ll never ‘give up’ on repeal in the future. Rosendale even voted against the Medicaid expansion, which is a lifeline to thousands of Montanans.”  

Key Findings from the Protect Our Care-PPP Poll of Montana Voters:

• Fifty-six percent of voters say health care is the most important or a very important issue for them this election.  
• By a 20 point margin, 56-36, Montana voters oppose Republican efforts to repeal the Affordable Care Act and instead want to keep what works and fix what doesn’t.
• Fifty-one percent of voters say the elimination of protections for people with pre-existing conditions, supported by Matt Rosendale, is “a major concern.”
• Montana voters oppose the Trump administration’s lawsuit to eliminate protections for people with pre-existing conditions by a 49 point margin, 65 percent to 16 percent. A majority of Republicans (51 percent) oppose the administration’s lawsuit.
• The survey finds Tester with a strong four point lead over Rosendale (49-45) similar to other surveys which have consistently shown Teste rahead. Six percent of respondents were undecided.

PPP surveyed 594 Montana voters on September 28, 2018.  The margin of error is +/- 4.02%. This poll was conducted by automated telephone interviews.

What Would Rosendale’s Repeal of the Affordable Care Act Mean for Montana?

• Protections for 426,000 Montanans with pre-existing conditions, if they buy coverage on their own
• Improvements to Medicare, including reduced costs for prescription drugs
• Allowing kids to stay on their parents’ insurance until age 26
• Ban on annual and lifetime limits
• Ban on insurance discrimination against women
• Limit on out-of-pocket costs
• Medicaid expansion currently covering 15 million people
• Rules to hold insurance companies accountable
• Small business tax credits
• Marketplace tax credits and coverage for up to 49,000 Montanans.

Rosendale Claims To Support Protecting Coverage For Pre-Existing Conditions, But Supported A Repeal That Would Have Gutted Protections

• Rosendale Supported A Straight Repeal Of The ACA.  “Yet while Daines and Rosendale called for a straight repeal of the ACA, or “Obamacare,” that approach could be a political dead-end as well. […] Daines has never said publicly whether he would have supported the GOP proposal that was pulled Monday night, after two additional Republican senators came out against it. On Tuesday, however, he said it’s time to vote to get rid of ‘Obamacare,’ delay the effective date, and figure out the replacement before that date kicks in. Rosendale agreed, and said two years should be enough time to come up with a replacement.” [KRTV, 7/18/17]
• Rosendale:  “I Won’t Give Up On Repealing And Replacing Obamacare.” “I won’t give up on repealing and replacing Obamacare. Montana families have been devastated with higher premiums and higher deductibles that have made health care completely unaffordable. President Trump has taken important steps to dismantle this disastrous law by removing the individual mandate and removing limits on health plan options. I’ll continue working to expand access and reduce health care costs because we must provide more affordable options and better care to all Montanans while also protecting those with pre-existing conditions.” [Matt Rosendale for Montana, accessed 8/23/18]
• Rosendale Claimed The ACA Was In “A Death Spiral” And “Collapsing Under Its Own Weight.” “Obamacare is in a death spiral. Insurance premiums increased yet again by an average of 25 to 50 percent this year in Montana. As more insurers abandon the Affordable Care Act’s exchange, costs continue to skyrocket across the nation. These trends are unsustainable, and the system is collapsing under its own weight. As I’ve traveled across the state, Montanans have told me that reform is necessary. My role as Commissioner of Securities and Insurance is to advocate for the interests of average Montana insurance customers. I’m committed to fighting for health care policies that expand options, reduce costs, improve access, and respect personal choices.” [Matt Rosendale Op-Ed, Helena Independent Record, 3/20/17]
• 2017: Rosendale Supported A Clean Repeal Bill, Which Would Have Gutted Protections For People With Pre-Existing Conditions.  “Montana’s two U.S. senators split down party lines Tuesday on the GOP’s failed attempts to do a clean repeal of the Affordable Care Act within two years and replace it, with one saying Montana’s current system is in dire straits and the other accusing Republicans of playing politics.  […] Matt Rosendale, the state securities and insurance commissioner, supported the repeal, saying Obamacare has been driving insurance prices up and limiting the choices people have to access health care. ‘It needs to be repealed, and Montana needs the flexibility to develop our own unique solutions to meet the needs of our most vulnerable citizens,’ he said. Rosendale said state lawmakers are ‘capable of crafting made-in-Montana policies to ensure transparency, bring down prices, and protect those with preexisting conditions.’  ‘I’m going to keep fighting for reform because the current system is broken and the people of Montana deserve better,’ Rosendale said.” [Great Falls Tribune, 7/18/17]
• 2017:  Rosendale Supported Allowing Insurers To Offer Plans That Don’t Cover Pre-Existing Conditions Or Offer Minimum Benefits Mandated By The ACA.  “Rosendale said states should be allowed to let health insurers offer less-expensive plans that cover fewer things, instead of the minimum benefits mandated by the ACA. Those products could be priced lower for younger, healthier customers, he said – or people could use non-insurance products for their health coverage, such as agreements with primary-care providers. ‘If you give the consumer the ability to find something that fits their budget, that fits their health-care needs and meets their personal choices, then that will help us start bending the cost curve down,’ Rosendale said. Health insurers and others have said this approach would end up pricing certain people out of the market, such as older, sicker customers. However, Rosendale said the state and federal government can solve that problem by financing a high-risk insurance pool that would offer coverage to these more costly patients.” [KRTV, 7/18/17]

Rosendale Opposed Expanding Medicaid in Montana

Rosendale Voted Against Expanding Medicaid.  [SB 405, 4/18/15]

• Thanks to the Medicaid expansion that Rosendale opposed, 58,100 Montana residents have gained coverage. 46 percent of Montana’s children rely on Medicaid coverage. Eliminating the Medicaid expansion would devastate Montana’s ability to address the opioid crisis as one in four adults battling addiction nationwide are covered through Medicaid.

Today, Secretary of Health and Human Services Alex Azar made yet another desperate attempt to hide the dirty truth about the Trump Administration’s new policies to expand junk health plans, cut Medicaid enrollment by pushing for burdensome work requirements, and sabotage health care at every turn. Said Leslie Dach, chair of Protect Our Care, in response:

“Today’s appearance officially makes Secretary Azar Donald’s Trump latest snake oil salesman. The simple fact is that Trump and Azar’s policies will kick people off their health insurance, allow insurance companies to sell junk insurance policies that discriminate against people with pre-existing conditions, charge women and older people higher premiums and kick people off when they get sick. What’s worse, the GOP relentless war on health care has raised health care costs for millions while giving billions in tax breaks to drug and insurance companies.”

Here’s the truth about the “stabilizing marketplace” Azar wrongly takes credit for:

Larry Levitt, Senior Vice President Of Kaiser Family Foundation: Premiums Would Be Going Down If Not For Insurance Companies Compensating For Unstable Environment. “ACA premiums are stable for 2019 because they went up so much this year due to an uncertain environment and regulatory actions by the Trump administration. Premiums would be going down a lot if not for repeal of the individual mandate penalty and expansion of short-term plans.” [Levitt, 9/27/18]

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

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

Health Care Analyst, Charles Gaba Has Calculated That Across The Country, Premiums Will Increase By An Average Of 3.3 Percent In 2019. The average premium increases indicate that premiums nationwide will be 7.6 percent higher than they would have been absent GOP sabotage. [Charles Gaba, Accessed 9/27/18]

Here are the facts about Trump-Azar’s junk insurance plans:

JUNK PLANS HURT PEOPLE WITH COVERAGE IN THE ACA MARKETPLACES.

• Healthy people will leave the individual market for these plans, causing everyone else’s premiums to go up. As the Center on Budget and Policy Priorities notes, these plans will divide the market between those who are sick and those who are healthy: “Short-term plans would be most likely to attract healthier people, leading to premium increases for ACA-compliant plans and destabilizing individual insurance markets across the nation. “

JUNK PLANS MAKE COMPREHENSIVE HEALTH CARE MORE EXPENSIVE.

• Repealing the individual mandate and loosening short-term plan rules drive up premiums for everyone who needs comprehensive care. The Congressional Budget Office estimates that repealing the individual mandate will increase premiums by 10 percent annually for the next decade, and a report by Wakely Consulting Group estimates that short-term plans alone will cause premiums to increase by 1.4 percent in 2019.

JUNK PLANS MAKE IT HARDER FOR PEOPLE TO FIND COMPREHENSIVE COVERAGE.

• Azar could be right if you don’t have a pre-existing condition, aren’t a woman or person over fifty, don’t need maternity care or prescription drug coverage, and will never have to use the hospital over the weekend. Junk plans are allowed to discriminate against people with pre-existing conditions by dropping or denying coverage, charge women more, impose annual limits on care, and exclude basic coverage, like hospitalization, prescription drug coverage, and maternity care. In an analysis of short-term plans conducted by the Kaiser Family Foundation, no short-term plans studied covered maternity care, 62 percent did not cover substance abuse treatment, and 71 percent did not cover outpatient prescription drug services. One plan won’t cover expenses if someone is admitted to a hospital on a Friday or Saturday.

Tennessee’s Own Insurance Commissioner, Julie Mix McPeak, Joined a Chorus of State Officials Warning Against Junk Plans. “‘We have to really make sure consumers know what they’re purchasing, and they’re aware of what’s covered and what’s not covered,’ Mix McPeak said. ‘The last thing we need is for consumers to have surprise bills.'” [The Hill, 8/12/18]

Here are the facts about Trump-Azar’s Medicaid work requirements:

TAKING SOMEONE’S HEALTH CARE AWAY DOES NOT HELP THEM TO WORK.

• However, evidence suggests that such work requirements hurt, rather than help enrollees’ ability to find work. A study of Michigan’s Medicaid “illustrates the functional barriers to work that Medicaid beneficiaries face, and many of them result from physical and mental health challenges. This suggests to us that taking away their health coverage means that they are less likely to find work – not more so…a stable source of health coverage such as Medicaid is likely to assist people with their chronic mental and physical health conditions so that they they are better able to seek employment.” In both Ohio and Michigan, having access to health care made it easier for the unemployed to find work: “majorities said that gaining health coverage has helped them look for work or remain employed. Losing coverage — and, with it, access to mental health treatment, medication to manage chronic conditions, or other important care — could have the perverse result of impeding future employment.

ALREADY, ARKANSAS’ WORK REQUIREMENTS ARE NOT FUNCTIONING THE WAY THE STATE HAD SUPPOSEDLY HOPED THEY WOULD.

• Early results in Arkansas confirm that Medicaid work requirements are fundamentally bureaucratic hurdles, threatening access to health coverage for thousands across the state. “The early results suggest that the incentives may not work the way officials had hoped. Arkansas officials, trying to minimize coverage losses, effectively exempted two-thirds of the eligible people from having to report work hours. Of the remaining third — about 20,000 people — 16,000 didn’t report qualifying activities to the state. Only 1,200 people, about 2 percent of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.” [New York Times, 9/24/18]

WORK REQUIREMENTS ARE SO DANGEROUS, THAT DOCTORS WORRY THEY WILL HAVE TO DECIDE BETWEEN “DOING HARM TO PATIENTS” AND “PROVIDING INACCURATE ASSESSMENTS.”

• New England Journal Of Medicine: Medicaid Work Requirements Put Doctors In Difficult Position.  As outlined in the New England Journal of Medicine, “Along with creating new administrative burdens and costs for physicians and enrollees, work requirements may oblige physicians to be involved in determining whether patients maintain or lose insurance coverage. This expectation places physicians’ responsibility to provide honest documentation in stark tension with their primary obligation to serve patients’ interests. Without explicit state guidance on health circumstances that qualify patients for exemptions, physicians may face an ethical dilemma when choosing between two objectionable options: doing harm to patients and providing inaccurate assessments.”