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Roundup: Trump Administration Urges States To “Demolish” Basic Structure Of Affordable Care Act

Today, the Trump administration announced its latest effort to sabotage the Affordable Care Act by mounting an unprecedented attack on the ACA’s marketplaces.

Here’s what media, experts, and patient groups had to say:

Washington Post: Trump Administration “Demolishing” Basic Rule Of Affordable Care Act That Federal Subsidies May Only Be Used To Purchase Plans In Federal Marketplace. “The Trump administration is urging states to tear down pillars of the Affordable Care Act, demolishing a basic rule that federal insurance subsidies can be used only for people buying health plans in marketplaces created under the law…The changes go beyond a variety of other steps Trump administration health officials have taken in the past year to weaken the ACA, which the president has opposed vociferously…The new steps go further by undercutting the basic ACA structure of the insurance marketplaces created for those who cannot get affordable health benefits through a job.” [Washington Post, 11/29/18]

American Lung Association: New 1332 Waiver Guidance “Would Further Erode Patient Protections, Undermine Care For People With Lung Disease.” [American Lung Association, 11/29/18]

Wall Street Journal: “The Waivers Have The Potential To Be One Of The Most Decisive Factors In Letting States Go Separate Ways On Health Care.” “The waivers have the potential to be one of the most decisive factors in letting states go separate ways on health care. Some are likely to keep the current system, where premium tax credits go to consumers who buy ACA-compliant plans on the exchanges, while others may upend much of that system altogether.” [Wall Street Journal, 11/29/18]

Larry Levitt, Senior Vice President Of Kaiser Family Foundation: New Guidance Allows States To Offer Subsidies For Plans That Do Not Cover Pre-existing Conditions And Paves Way For States To Increase Subsidies For Higher-income People And Reduce Subsidies For Lower-income People. “The Trump administration has filled in details of ACA waiver guidance, illustrating how states could restructure premium subsidies, including subsidizing lower premium plans that don’t cover pre-existing conditions…Under the new ACA waiver rules, states could restructure premium subsidies so they are based only on age and not by income, increasing subsidies for higher-income people and reducing them for lower-income people.”“ [Larry Levitt, 11/29/18]

Sabrina Corlette, Senior Research Fellow At Georgetown University’s Center On Health Insurance Reforms: It’s “Really Hard To See How Any Of These Concepts (Except Reinsurance) Can Meet The Statutory Guidelines.” [Sabrina Corlette, 11/29/18]

HealthLeaders Media: “Verma Lambastes ACA, Giving States 4 Ways To Bypass It.” [HealthLeaders Media, 11/29/18]

And here’s how legislators reacted:

Democratic Leader Nancy Pelosi: Trump Administration Is “Cynically Working To Make Health Insurance More Expensive And To Leave More Americans Without Dependable Coverage At All.” “The American people just delivered an overwhelming verdict against Republicans’ cruel assault on families’ health care.  But instead of heeding the will of the people or the requirements of the law, the Trump Administration is still cynically working to make health insurance more expensive and to leave more Americans without dependable coverage at all.The Trump Administration is trying to push more Americans into junk insurance plans that do not cover essential health care, leaving families exposed to crushing out-of-pocket costs after an injury or illness.  Meanwhile, Republicans continue to push their monstrous lawsuit to strike down the vital protections for people with pre-existing conditions.” [Democratic Leader, 11/29/18]

Sen. Patty Murray, Ranking Member Of Senate Health, Education, Labor, And Pensions Committee: “The Trump Administration Is Brazenly Warping A Tool Meant To Help States Innovate And Lower Prices So It Can Further Gut Protections For People With Pre-existing Conditions And Drive Up Health Care Costs.” “These new templates are nothing more than a how-to guide for health care sabotage. The Trump administration is brazenly warping a tool meant to help states innovate and lower prices so it can further gut protections for people with pre-existing conditions and drive up health care costs. Congress created these waivers and included guardrails to allow for innovation while making sure people could get high-quality, affordable coverage—however the Trump Administration’s guidance takes us in the opposite direction.” [U.S. Senate Committee On Health, Education, Labor & Pensions, 11/29/18]

Sen. Ron Wyden, Ranking Member Of Senate Finance Committee: Trump Administration Has Created “Fast Lane To Flood Health Care Markets With Junk Plans And Quarantine Older Americans And Those With Pre-existing Conditions Apart From Everyone Else.” “The Trump administration has created a fast lane to flood health care markets with junk plans and quarantine older Americans and those with pre-existing conditions apart from everyone else…Section 1332 was created to generate new and better ideas that improve families’ health – the Trump administration’s approach warms over old and bad ideas that increase costs for consumers and lowers the quality of care. Trump’s sabotage crusade continues to deprive working Americans with the health care security they need, and today’s news accelerates America’s slide back to the days when health care was reserved for the healthy and wealthy.” [U.S. Senate Committee On Finance, 11/29/18]

Trump Administration Doubles Down on Health Care Sabotage

In response to new reporting showing that the Trump Administration is once again urging states to skirt important consumer protections in the Affordable Care Act, Leslie Dach, chair of Protect Our Care, issued the following statement:

“In the wake of an election that sent the unmistakable message that Americans want an immediate end to the GOP war on health care, it’s outrageous to see the Trump Administration make one of its boldest acts of sabotage ever. Once again, the Trump Administration wants to deny millions of Americans protections for pre-existing conditions, and guaranteed coverage for women’s health care and cancer treatments. This is the opposite of what the American people said they wanted, and shows Republicans clearly haven’t learned the lesson of the 2018 elections.”

Read more from the Washington Post here.

Trump, GOP War on Health Care Throws Children Under the Bus Study Finds

Washington DC — For the first time in a decade, the number of uninsured children nationwide has increased, up to 5 percent from 4.7 percent in 2016, according to a recent report released by Georgetown University Center for Children and Families. This historic reversal of progress comes on the heels of the Trump Administration’s continued sabotage of health care, plus Republican state officials’ stubborn refusal to expand Medicaid, despite widespread support. In response to the study, Brad Woodhouse, executive director of Protect Our Care, said:

“President Trump has led a Republican war on health care that has claimed many victims, but most shocking and appalling of all is its impact on our nation’s most vulnerable Americans: our children. After decades of progress, last year more than a quarter million more children were uninsured than in 2016 due to President Trump and the GOP’s repeal and sabotage agenda.  This is an outrageous display of the Trump Administration’s total disregard for Americans’ health care. Whether by voting to expand Medicaid or by voting to replace pro-repeal Republicans with health care champions, the American people have made it crystal clear that they don’t want to give up an inch of progress on health care anymore and they are demanding an end to the Republican war on health care.”

 

Key Reasons for the decline in children’s coverage:

Divergent State Policies Have Led To Vastly Different Changes In The Children’s Uninsured Rate Across States — For Instance, The Uninsured Rate For Children Increased At Triple The Rate In States That Did Not Expand Medicaid As It Did In States That Expanded Medicaid. “In previous years, states have moved in similar but not uniform directions, reflecting the many ways state policy decisions can impact eligibility and enrollment in Medicaid and the Children’s Health Insurance Program (CHIP). The absence of significant progress across the country suggests that even states with the best intentions were unable to withstand strong national currents to protect children from losing health coverage…Three-quarters of the children who lost coverage between 2016 and 2017 live in states that have not expanded Medicaid coverage to parents and other low-income adults. The uninsured rates for children increased at almost triple the rate in non-expansion states than in states that have expanded Medicaid.”

Trump And His Republican Allies Have Repeatedly Tried To Repeal And Sabotage The Affordable Care Act And Have Slashed Funding For Outreach. “These national currents include a lengthy and ultimately unsuccessful congressional effort to repeal the Affordable Care Act (ACA) and cap federal Medicaid funding, as well as an unprecedented delay by Congress that allowed CHIP funding to lapse temporarily. In addition, Congress repealed the ACA’s individual mandate and the Trump Administration made numerous efforts to undermine the ACA Marketplaces, including dramatically cutting outreach and enrollment grants and shortening the open enrollment period.

Trump’s Punitive Immigration Policy Deter Children From Enrolling In Medicaid And CHIP. “Finally, one-quarter of all children under 18 living in the United States have a parent who is an immigrant. Several policies targeting immigrant communities are likely deterring parents from enrolling their eligible children in Medicaid or CHIP despite the fact that most of these children are U.S. citizens.

“All of these changes in the national political and policy realm mark a sharp reversal after many years of successful efforts to reduce the uninsured rate for children and families.”

Protect Our Care Urges Congress to Back Democratic Nominee For Speaker

Washington DC — Following today’s overwhelming vote in the House Democratic caucus, Protect Our Care issued the following statement congratulating Nancy Pelosi on being the Democratic nominee for Speaker of the U.S. House of Representatives. In 2018, Democrats won more seats and by a larger vote margin than at any point since Watergate and it was fueled by a health care focused campaign. The Republican nominee for Speaker is Kevin McCarthy, who has voted multiple times to repeal health care and roll back protections for millions of Americans.  

“Protect Our Care is proud to stand with and congratulate Nancy Pelosi on being selected by her colleagues to be the Democratic nominee for the next Speaker of the House,” said Leslie Dach, chair of Protect Our Care. “Leader Pelosi led the Democratic wave that ended Republican control of the House and today she was resoundingly picked to be the Democratic Nominee for Speaker. With today’s vote, the House of Representative is on track to have an experienced, pro-health care leader at the helm. Pelosi’s hard-work has made way for millions of Americans to gain quality health care coverage through the Affordable Care Act (ACA) and defeat Republicans repeal-and-sabotage agenda. Members of Congress who want to stand up for health care, ought to back the Democratic nominee for Speaker as Republicans offer a warmed-over version of the same repeal agenda that voters just rejected.”

“With impeccable discipline, Leader Pelosi made health care the number one issue in the midterms and voters responded – flipping as many as 40 seats held by pro-repeal Republicans,” said Brad Woodhouse, executive director of Protect Our Care. “Make no mistake, the American people took to the polls this election to make their voices heard and overwhelmingly voted for pro-health care Democrats. The Democratic nominee for Speaker of the House is a pro-health care leader with a proven track record of getting results. The Republican nominee for Speaker will do nothing but continue the Trump Administration’s repeal-and-sabotage agenda that fails hard-working Americans every day. The choice could not be more clear.”

NEW: 4 Key Points – Kaiser Post Election Poll Shows Voters Reject GOP War on Health Care and Want Congress and States to Act

The regular Kaiser Family Health Tracking Poll today gives another post-election confirmation that Republicans repeal and sabotage agenda for health care has been rejected by the American people.

See for yourself.

Four Key Points:

  1. The Affordable Care Act is viewed favorably by 53 percent of people – a 13 point margin. It’s the largest level of support for the ACA since after the 2010 election.
  2. 87 percent of people said it’s important (65 percent very important) to protect prohibitions against health insurance companies denying coverage because of people’s medical history.
  3. If Trump’s lawsuit to overturn protections for people with pre-existing conditions succeeds, 70 percent of people want their state to re-establish the protections.
  4. For people who live in states that haven’t yet expanded Medicaid, 59 percent of people support expansion and only 34 percent oppose it.

New Poll: Trump Administration’s Sabotage Efforts Harm Open Enrollment  

Washington DC — The Kaiser Family Foundation released its November tracking poll and found that the Trump Administration’s ongoing sabotage campaign is preventing the American people from signing up for coverage. This isn’t surprising given the Trump Administration’s repeated sabotage of the open enrollment process by cutting outreach resources and shortening the enrollment time period. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:

“The fact that people do not know they have until December 15th to sign up for coverage is another proof point in the Trump Administration’s sabotage of the Affordable Care Act. We all know open enrollment is a critical time for Americans to get the coverage they need. But Donald Trump and Republicans continue to do nothing to get the word out. We must redouble our efforts to let Americans know they only have until December 15th to sign up for coverage. In many cases, premiums are lower this year, making plans more affordable for millions of families across the nation. People who need insurance should sign up for coverage on HealthCare.gov before the December 15th deadline.”

The tracking poll showed that:

  • Only one in four Americans know the deadline to sign up for coverage during open enrollment.
  • The poll shows 77 percent of Americans said either they did not know, refused to answer, or gave the wrong date for the open enrollment deadline.
  • Only three in ten people who would buy coverage reported hearing or seeing information about how to do so in the past 30 days

 

BACKGROUND:

Between 2016 And 2018, The Trump Administration Has Cut Funding For Groups That Help People Sign Up For Coverage By 84 Percent. After cutting funding for navigator groups that help people sign up for coverage from $63 million in 2016 to $36 million in 2017, the Trump administration made yet another round of cuts in 2018, leaving just $10 million in funding for health navigator groups. Since 2016, Trump has cut navigator funding by 84 percent.

Health Navigators, Like Jodi Ray At The University Of South Florida, Say Cuts To Navigator Programs Prevent Them From Adequately Letting People Know That Open Enrollment Is Happening. Ray said, “We don’t have the people to provide the enrollment assistance nor to do the outreach and marketing to let people know what’s happening.”

This Year, 800 Counties Served By The Federal Marketplace Are Operating Without Any Federally Funded Navigators. This is more than six times as many counties served by the federal marketplace that operated without federally funded navigators in 2016, when 127 counties lacked such a navigator.  

The Trump Administration Wants Navigator Groups To Push Consumers To Sign Up For Junk Coverage That Is Exempt From Covering Prescription Drugs And Hospitalization Instead Of Comprehensive Plans. The Administration announced in July that it would encourage navigator groups to use their remaining funding to push consumers to sign up for junk health plans, which cover few benefits and notorious for the fraud they attract.

In 2017, The Trump Administration Cut The Open Enrollment Advertising budget By 90 Percent. As ABC News summarized, “In 2016, the Centers for Medicare & Medicaid Services spent $100 million on Obamacare advertising and outreach, but for [2017]’s open enrollment period, CMS plans on spending $10 million.” CMS chose not to increase the budget for 2019.

A full timeline of the Trump administration’s crusade to sabotage open enrollment is below:

October 2018

  • 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, a move expected to worsen ACA risk pools.
  • Trump administration announces scheduled maintenance on the open enrollment website, preventing people from signing up for coverage on Sundays from 12:00 AM – 12:00 PM.

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

  • 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.

July 2018

  • Trump Administration limits access to assistance for consumers who want to enroll in marketplace coverage. This change removes the requirement that every area has at least two “navigator” groups to provide consumer assistance and that one be local. Now, just one group could cover entire states or groups of states.

December 2017

  • 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.

October 2017

  • The Trump Administration dramatically cuts in-person assistance to help people sign up for 2018 health coverage.

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.

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.

January 2017

  • 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.

Statement From Leslie Dach, Chair of Protect Our Care On Problem Solvers Proposals Ahead Of The House Democratic Caucus Leadership Election

Washington DC — In a statement released on Monday by members of the Problem Solvers, a caucus of nine House Democrats outlined its threat to withhold support for Leader Pelosi’s nomination for Speaker. The caucus stated its proposals would “help spur immediate action on health care, immigration and infrastructure.” Leslie Dach, chair of Protect Our Care issued the following statement:

“The way to protect and improve health care isn’t by making demands that were drawn up by a group that includes Republicans who voted to repeal health care — many of whom were defeated by Democrats just a few weeks ago. The way to truly protect and improve health care is by placing the Member of Congress whose leadership gave us the Affordable Care Act and led the blue wave that will protect us going forward in the Speaker’s chair. Let’s take the fight to the opponents of affordable health care — not its champions.”

Seema Verma and Donald Trump Continue to Hide Behind Lies As Americans Continue to Worry About their Care

“Instead of a super secret so-called contingency plan which no one actually believes exists, just end the lawsuit,” said Brad Woodhouse.

Washington, D.C. – In response to CMS Administrator Seema Verma telling the Washington Examiner that the Trump Administration has a secret “contingency plan” should their lawsuit to upend the American health care system go through, Brad Woodhouse, executive director of Protect Our Care, released the following statement:

“The best contingency plan for protecting American health care – and especially for those with pre-existing conditions – is for the Administration to withdraw its support for this disastrous lawsuit and instead defend the law of the land. The American people have made their voices loud and clear: they support the Affordable Care Act, they want people with pre-existing medical conditions to be protected from discrimination by insurance companies, and they oppose any and all GOP efforts to undermine their health care. Instead of a super secret so-called contingency plan which no one actually believes exists, just end the lawsuit.”

 

THE CLAIM:

CMS Chief Seema Verma Claims That She And The Trump Administration Have A Contingency Plan If The Trump-GOP Lawsuit To End Protections For Pre-existing Conditions is successful [Washington Examiner]:

Seema Verma told reporters that “we do have contingency plans” if the healthcare law is struck down — specifically the provision aimed at ensuring people with pre-existing conditions, such as cancer or diabetes, have access to coverage.

But Chief Seema Verma declined to describe the backup plan, saying that “it wouldn’t be appropriate to share details because it may or may not be needed.”

 

THE REALITY:

If Judge Reed O’Connor rules in favor of the 20 Republican state officials and Trump’s Department of Justice, Seema Verma and Donald Trump will own the consequences to the American people. And those consequences are serious. Critical Affordable Care Act protections could vanish overnight, unleashing — as the Trump Administration itself admitted — “chaos” in our entire health care system.

  • 17 million people could lose their coverage in a single year, leading to a 50 percent increase in the uninsured rate
  • Protections for 130 million people with pre-existing conditions, their own, could end.
  • Medicaid expansion, currently covering 15 million Americans, could vanish.
  • Improvements to Medicare, including reduced costs for prescription drugs, would be eliminated.
  • Children would no longer be allowed to stay on their parents’ insurance until age 26
  • Ban on annual and lifetime limits? Gone.
  • Ban on insurance discrimination against women and people over age 50? Nope.
  • Limits on out-of-pocket costs? Eliminated.
  • Small business tax credits? Done.
  • Marketplace tax credits for up to 9 million people? Not anymore.

Back To Business: Drug Prices Continue To Rise Under Trump

Washington, DC — Just days following the midterm elections that gave Democrats control of the House of Representatives, the Wall Street Journal reports that Pfizer will resume jacking up prices while the Trump administration continues its repeal-and-sabotage agenda. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:

“To no one’s surprise, now that the election is over, it’s back to business as usual for the drug companies, President Trump, and the Republicans who will allow them to charge consumers whatever they want for life-saving and sustaining prescription drugs. Not two weeks ago, voters delivered the House of Representatives to Democrats and elected scores of other Democrats to public office on the issue of health care — all in a repudiation of the Republicans’ repeal and sabotage agenda and their failure to do anything to address the high cost of prescription drugs.  Republicans might be living by the adage that they are going to dance with the one who brought them, but if they fail to work with the new Democratic majority in the House to address drug prices they may just be dancing their way out of office in two years time.”

 

BACKGROUND:

Wall Street Journal: Pfizer To Raise Prices On 41 Drugs In January. “Pfizer plans to raise the list prices of 41 of its prescription drugs, or 10 percent of its portfolio, in January, according to a person familiar with the matter. The plans mean Pfizer would resume its practice of raising drug list prices after the company rolled back some increases in July under criticism from President Trump.” [Wall Street Journal, 11/16/18]

Bloomberg: Pharma Earnings Reveal “Trump’s Most Visible Efforts To Strong-arm Them On Prices Hasn’t Caused Much Pain.” “Earnings are now in at most of the biggest pharmaceutical firms, and one thing is clear from their results: One of President Donald Trump’s most visible efforts to strong-arm them on prices hasn’t caused much pain. Pfizer Inc. was called out by Trump in a July tweet over mid-year price increases the drug giant pushed through on a number of its medicines, and the public shaming prompted the company to roll back the increases. That was followed by appeasement from other big pharma firms including Merck & Co., Novartis AG and Roche Holding AG. It’s been obvious from the start that these moves were cosmetic. Roche, for example, promised to forego further price increases this year only after it had already enacted hikes on some of its biggest sellers. But the earnings reports are further proof that efforts intended to mollify the president didn’t involve much if any sacrifice.” [Bloomberg, 10/31/18]

In October, Pfizer Announced That It Would Return To “Business As Normal,” Raising Prices Despite Trump Pressure. “Pfizer CEO Ian Read said the company will return to ‘business as normal’ on its drug pricing in January, after agreeing to hold off on price increases earlier this year following pressure from President Trump…Trump has touted his efforts to get drug companies to hold off on price increases. Fighting high drug prices has been a major focus of his presidency. Pfizer, though, affirmed on Tuesday that the price increases could return in January, given that the agreement only lasted until then.” [The Hill, 10/30/18]

Does Cory Gardner Want to Be the Next Mike Coffman?

Washington, D.C. – This morning, the Denver Post highlighted a new post-election poll showing health care as the top issue for independent voters in Colorado, who overwhelmingly backed Democrats. Brad Woodhouse, executive director of Protect Our Care, released the following statement in response:

“This poll makes it crystal clear that independent Coloradans supported Democrats because of their consistent fight against the Republican repeal-and-sabotage agenda. Health care was a top issue among these voters, who sent Jared Polis to the governor’s mansion and sent pro-repeal Mike Coffman home. It’s time for Sen. Cory Gardner to listen to his constituents and renounce his Party’s relentless attacks on health care by opposing the Trump-GOP lawsuit to strike down the protections millions of Coloradans depend on. If not, he should enjoy his final two years in the Senate.”

FROM THE POLL:

Health Care Was A Top Issue In The Governor’s Race For Unaffiliated, With Unaffiliated Voters Heavily Backing Democrat Jared Polis. “Overwhelmingly, the top two issues that were important to unaffiliated voters and influenced their vote for Governor and the state legislature were education and healthcare. 59% of respondents said they voted for Jared Polis and 25% voted for Walker Stapleton, for a Polis win margin of 34%. Among male unaffiliated voters the Polis win margin was 24 points (53% to 29%) and among unaffiliated women it was 45 points (65% to 20%).” [Magellan Strategies, accessed 11/15/18]

Unaffiliated Voters Support The Democratic Party Due To Their Policies Which “Help People,” With Health Care At The Top Of The List. “What unaffiliated voters like about the [Democratic] Party is their support for affordable healthcare, public education, economic fairness, fighting income inequality and being ‘socially conscious’ on issues like the environment. The common theme in the positive comments is that Democrats promote policies that ‘help people’.” [Magellan Strategies, accessed 11/15/18]

Unaffiliated Voters Who Opposed Republican Walker Stapleton Cited His Dismissal Of Health Care As One Of The Reasons Why. “The primary reasons unaffiliated voters voted against Walker Stapleton were his support for Donald Trump and his policies, and an impression that he was a ‘liar,’ ‘dishonest’ and ‘untrustworthy.’ Some respondents also said they disagreed with his policy priorities, and that he cared more about immigration than education and healthcare.” [Magellan Strategies, accessed 11/15/18]

CO-06: Jason Crow “Assailed” Mike Coffman Over His Vote For Sneaky Repeal. “Crow assailed Coffman for voting for the GOP tax measure that revoked tax penalties for those who don’t buy health insurance. It was a key provision of former President Barack Obama’s health care law, which Crow defended as a first step toward his goal of universal health care. Coffman was booed at town halls last year for insisting that the health law be repealed, though he eventually voted against the GOP effort.” [Denver Post, 11/7/18]