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Fact Sheet: The Cost of Sabotage To State & Local Taxpayers


For Each Person Who Becomes Uninsured, Hospitals’ Uncompensated Care Costs Increase By $900. One study, published by the National Bureau of Economic Research, estimated that “each newly uninsured person leads to nearly $900 in uncompensated care costs.” [National Bureau of Economic Research, June 2015]

Coverage Losses Threaten To Reverse Large Drops In Uncompensated Care That Resulted from The Affordable Care Act’s Historic Coverage Gains. “Between 2013 and 2015, as the nationwide uninsured rate fell from 14.5 percent to 9.4 percent (a 35 percent decline), uncompensated care costs as a share of hospital operating expenses fell by 30 percent.” [Center on Budget and Policy Priorities, 5/23/18; see state-by-state estimates in appendix]

Republican Sabotage Will Increase Uninsured By 3 Million In 2019. The nonpartisan Congressional Budget Office now projects that the number of uninsured people will increase by 3 million between 2018 and 2019. Per CBO, this is “mainly because the penalty associated with the individual mandate will be eliminated and premiums in the nongroup market will be higher.” [Congressional Budget Office, 5/23/18]

Using The National Bureau of Economic Research’s Estimate That Uncompensated Care Costs $900 Per Person, Sabotage Could Cost Hospitals $2.7 Billion In 2019. Using the National Bureau of Economic Research’s estimate that each person who loses insurance increases hospitals’ uncompensated care costs by $900, this coverage loss could result in $2.7 billion more uncompensated costs  in 2019. [Congressional Budget Office, 5/23/18]

In Michigan, Uncompensated Care Costs Fell After The State Expanded Medicaid. A University of Michigan study found that the average hospital’s uncompensated care expenses fell nearly 50 percent, from $7.21 million to $3.77 million, after the state expanded Medicaid. More than 90 percent of hospitals in the study saw a decline in uncompensated costs between 2013 and 2015. [University of Michigan, 12/31/16]

In Tennessee, The Reverse Held True; Medicaid Cuts Drove Up Uncompensated Care Costs. In 2005, approximately 4 percent of Tennessee’s non-elderly adult population lost public insurance coverage. Following these cuts, the uncompensated care each hospital provided increased. [National Bureau of Economic Research, June 2015]

When Hospitals Have Uncompensated Costs, Taxpayers Bear The Burden. “Hospitals do get help with the unpaid bills – from taxpayers. The majority of hospitals are non-profits and are exempt from federal, state and local taxes if they provide a community benefit, such as charitable care. Hospitals also receive federal funding to offset some of the costs of treating the poor.” [USA Today, 7/3/17]


19 States Still Refuse To Expand Medicaid, Denying Communities Financial Support. “National, multi-state, and single state studies show that states expanding Medicaid under the ACA have realized budget savings, revenue gains, and overall economic growth. A 2016 study found that growth in state Medicaid spending in expansion states has been lower relative to non-expansion states.” [Kaiser Family Foundation, 3/28/18]

Studies Show That Expanding Medicaid Can Save States Money. “Multiple studies suggest that Medicaid expansion can result in state savings by offsetting state costs in other areas, including state costs related to behavioral health services, crime and the criminal justice system, and Supplemental Security Income program costs. For example, a study on Montana revealed that as Medicaid’s role in financing substance use disorder (SUD) services has grown under the state’s decision to expand Medicaid, federal Medicaid dollars have replaced federal block grant and state dollars previously used to fund services for uninsured Montanans with SUD.” [Kaiser Family Foundation, 3/28/18]

Expanding Medicaid Helps States Save In Uncompensated Care Costs. The Center for Healthcare Research & Transformation at the University of Michigan found that in states that expanded Medicaid, uncompensated care costs decreased from $15.7 billion in 2013 to $9.6 billion in 2015, while costs in non-expansion states remained relatively stable. [Center for Healthcare Research & Transformation, July 2017]

The Trump Administration Is Pushing States To Adopt Medicaid Work Requirements, Which Cost States More Money Than They Save. In April, President Trump signed an executive order directing federal agencies to encourage states to require their residents to work in order to have health insurance through Medicaid. In addition to being widely understood as ways to reduce Medicaid enrollment, establishing such requirements is expected to actually cost taxpayers money:

Estimates From Nine States Show That Implementing Work Requirement Programs Includes Tremendous Costs. “As estimates from nine states implementing or considering such proposals show, projected costs are typically in the tens of millions of dollars per year, with even higher start-up costs for some states. Kentucky plans to spend $186 million in fiscal year 2018 and another $187 million in 2019 to implement its waiver. And a work requirement considered by Pennsylvania’s legislature would have cost $600 million and require 300 additional staff to administer, according to a state official. Effectively, these proposals divert some state and federal dollars from providing health care to creating new bureaucracy.” [Center on Budget and Policy Priorities, 5/23/18]

In Kentucky, Work Requirements Mean The State Will Lose Out On Federal Funding While Saving Taxpayers Relatively Little. “There’s an even more direct way that work requirements don’t make economic sense. According to Kentucky’s own calculations, the Medicaid waiver will reduce the flow of federal funds to the state by nearly $700 million annually by 2021, while reducing state spending, and taxes paid by state residents, much more modestly… By 2021, when the waiver effects are fully in place, Kentucky will forgo about $680 million annually in federal funds. Kentucky residents will benefit very little from lower taxes as a result of this reduced federal spending — 99 percent of any federal savings will accrue to residents of other states (since Kentuckians contribute just 1 percent of all federal income taxes).” [Commonwealth Fund, 4/9/18]

Restricting People’s Access To Medicaid Will Likely Increase Hospitals’ Uncompensated Care Costs. “Coverage losses from eligibility restrictions will increase uncompensated care costs…Because new eligibility restrictions are projected to reverse a meaningful share of the coverage gains under the ACA’s Medicaid expansion, they will likely reverse a significant share of uncompensated care savings as well.” [Center on Budget and Policy Priorities, 5/23/18]

CBO Confirms: GOP Sabotage Is Raising Costs, Reducing Coverage

Yesterday, the nonpartisan Congressional Budget Office released a report detailing the higher costs Americans are facing due to the GOP’s repeal and sabotage campaign. Among its conclusions: premiums will be going up double-digits, 5 million more Americans than originally anticipated will lose health insurance, and these negative consequences are happening because of Republicans’ actions. Here are the key takeaways:

Washington Post: “The Reality Is Republicans Leading Both Chambers And The White House Have Acted In Ways That Could Trigger The Rise Of Premiums.” “The reality is Republicans leading both chambers of Congress and the White House have acted in ways that could trigger the rise of premiums. They’ve repealed the law’s individual mandate, paving the way for healthier people to leave the marketplaces and leave sicker, more expensive patients behind. They’re working to expand leaner plans exempt from ACA coverage requirements. And they haven’t found a way to pay extra subsidies in order to defray extra plan costs for the lowest-income customers.” [Washington Post, 5/24]

CNN: Individual Mandate Repeal “Alone Will Cause Premiums To Be 10% Higher.” “Congress eliminated the penalty associated with Obamacare’s individual mandate as part of its tax reform package last year. This change alone will cause premiums to be 10% higher because fewer healthy people will buy coverage, leaving insurers with a sicker and costlier group of policyholders, the CBO projected.” [CNN, 5/23]

CNBC: “The CBO Also Projects About 5 MIllion More People” Will Be Uninsured, “Up To A Total Of 35 Million People.” “The CBO also projects about 5 million more people under the age of 65 will be uninsured in 2027 than it estimated in September, up to a total of 35 million people… Trump and congressional Republicans tried unsuccessfully to repeal the landmark health law multiple times last year. They managed to repeal the individual mandate, which required most people to have some form of health insurance or pay a tax penalty, as part of the broader tax law it passed in December. The change is slated to go into effect next year. This coupled with higher premiums will cause 3 million more people than previously forecast to be uninsured next year, CBO estimates. Between 2019 and 2028, it expects the number of uninsured people to increase to 35 million.” [CNBC, 5/23]

The Hill: “ObamaCare Premiums Are Expected To Rise An Average Of 15 Percent Next Year, An Increase Largely Due To The GOP’s Repeal Of The Individual Mandate.” “ObamaCare premiums are expected to rise an average of 15 percent next year, an increase largely due to the GOP’s repeal of the law’s individual mandate, according to a Congressional Budget Office (CBO) analysis released Wednesday. The CBO estimates that gutting the requirement that Americans have health insurance or face a tax penalty will contribute to about a 10 percent rise in premiums for 2019, with insurers expected to see healthier people dropping out of the marketplaces, leaving sicker enrollees on the plans.” [The Hill, 5/23]

Bloomberg: “One Reason For The Rising Premiums Is The Actions Of President Donald Trump.” “One reason for the rising premiums is the actions of President Donald Trump. Last year, Trump topped funding for the cost-sharing reduction payments made to insurers under Obamacare to help Americans afford health costs. The non-payment of those subsidies, less enforcement of a rule requiring people to have insurance and limited competition caused insurers to raise their premiums by about 34 percent in 2018, compared to 2017. That increased the cost of the subsidies to the federal government, according to the CBO.” [Bloomberg, 5/23]

Axios: “The Magnitude Of These Increases Stems Largely” From Administrative Actions. “Insurance premiums tend to go up every year, but the magnitude of these increases stems largely from the repeal of the ACA’s individual mandate, the expansion of skimpy short-term plans, and the decision last year to cut off the law’s cost-sharing payments. [Axios, 5/24]

Justine Handelman, Blue Cross Blue Shield Association Vice President: “It Continues To Be Uncertain Times.” “Although the administration hasn’t teed up any new policy announcements lately, senior officials from the Blue Cross Blue Shield Association told reporters yesterday that there’s still reason to be nervous.  It’s too late to help moderate premium hikes for 2019, they said, so they’re focused on 2020. They’re hoping new policies like the change in short-term plans won’t take effect until 2020, so that they won’t upend the market assumptions plans have made for next year.‘It continues to be uncertain times,’ said Justine Handelman, a BCBSA senior vice president.” [Axios, 5/24]

Kris Haltmeyer, Blue Cross Blue Shield Association Vice President: “‘With the repeal of the individual mandate and the failure of Congress to enact stabilization legislation, we are expecting premiums to go up substantially,’ Haltmeyer said… Haltmeyer said the premium increases are ‘related to the loss of the mandate and then underlying medical costs.’ ‘Those two things have the most impact on the rate increases,’ he added.” [The Hill, 5/23]

Nonpartisan Congressional Budget Office Confirms Devastating Impact of Republican Sabotage

After the nonpartisan Congressional Budget Office released a report detailing how Republican actions to sabotage health care will harm health care costs and force millions of Americans off their coverage, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“The nonpartisan Congressional Budget Office just confirmed what Democrats and health care advocates have been warning about for months: Republican sabotage will force next year’s individual market premiums to spike by double digits and leave 3 million more Americans uninsured. According to today’s CBO estimate, average rates will jump 15% this fall, a number that’s on the low end of preliminary filings we’ve seen this month in Virginia, Maryland, Oregon and Vermont. And Republicans will have a hard time hiding from this: CBO says two-thirds of that 15% increase is specifically caused by the Republican tax bill’s repeal of the Affordable Care Act requirement for most people to have health insurance. We tried to warn President Trump and Congressional Republicans, but they refused to listen, and now it’s American families who will pay the price.”

Right-Wing Groups’ Big New Idea on Health Repeal: Let’s Keep Digging

After four right-wing groups urged Congressional Republicans to revive repeal and expand previous bills’ attacks on health care, Protect Our Care Chair Leslie Dach released the following statement:

“For almost a decade, Republicans have been listening to right-wing groups funneling hundreds of millions of dollars into the relentless campaign to repeal health care. Now, these groups are counting on Congressional Republicans to ignore the will of the American people and amp up attacks on Medicaid and the Affordable Care Act. This time, they want an even more destructive bill – one that would slash Medicaid, repeal expansion, and decimate the insurance markets, all while giving insurance and pharmaceutical companies even bigger tax breaks. This would make health coverage far more expensive, kick millions off care, not to mention it would be political suicide for Republicans. It’s time for Jim DeMint and his cronies to get another hobby and give up their obsession with taking away our care.”


Trump Drug ‘Plan’ Could Punish Seniors With Cancer

Washington, D.C. – After new research from Avalere and a CBS News investigation exposed the dangers seniors with cancer could face under the Trump Administration’s drug pricing blueprint, Protect Our Care Campaign Director Brad Woodhouse said:

“The Administration has no answers on how its proposed changes to Medicare would protect seniors from prohibitively high out-of-pocket costs for specialized cancer treatment. This is more proof that the Trump Administration’s drug pricing ‘plan’ is a day late and a dollar short. Americans are already worried enough about rising health care costs; let’s not find new ways for the Trump Administration to make care more expensive.”

A tricky wrinkle in Trump’s Medicare Rx “Blueprint”

CBS News // Walecia Konrad // May 22, 2018

The Trump administration’s “Blueprint” to lower drug prices and reduce patient costs made one thing clear: The government will not directly negotiate with drug companies to secure lower prescription prices. But that doesn’t mean it isn’t proposing changes that would dramatically alter the way Medicare pays for some of the most expensive drugs, and in the process, potentially raise out-of-pocket costs for some of the country’s sickest patients.

A cornerstone of the Trump plan calls for all Medicare drug payments to be consolidated under Medicare Part D, the prescription drug plan for Medicare enrollees administered by private insurers. Under Part D, insurers and middlemen known as pharmacy benefit managers (PBMs) negotiate with drug companies for discounted prices in exchange for the drug companies’ products being included in the PBMs’ list of covered drugs.  

But drugs intravenously administered in physicians’ offices, such as chemotherapy and vaccines, are usually covered as a medical treatment under Medicare Part B. Physicians buy these drugs directly from manufacturers, and Medicare reimburses doctors for the drugs’ average sales price plus 6 percent.

Alex Azar, Health and Human Services secretary and former president of the U.S. division of pharmaceutical giant Eli Lilly (LLY), has been touting the move to consolidate Medicare drug payments during several public appearances since he and President Trump unveiled the Blueprint earlier this month. Azar and other proponents of the plan point out that the 6 percent markup included in Medicare Part B creates incentives for doctors to purchase more expensive drugs to get a higher dollar profit. Better, said Azar, for insurance companies and PBMs in Medicare Part D to negotiate discounts and lower prices.

Pharmaceutical companies are against the idea, partly because they generally are paid more under Part B than Part D. “Bringing negotiation to Part B drugs is such a potent way to bring down prices that PhRMA is already protesting the idea,” Azar said in a recent speech at the American Enterprise Institute in which he referred to the drug industry trade group called Pharmacuetical Research and Manufacturers.

But Azar and others have shed little light on exactly how this change would take place, leaving patients worried about the potential for astronomically higher out-of-pocket costs.  

Sky-high co-pays?

“If they shift Medicare Part B medicines to Medicare Part D without making any changes in the Part D structure, it will have a horrible effect on patients,” said David Mitchell, president and founder of Patients for Affordable Drugs. Mitchell, who’is currently undergoing cancer treatment, noted that he and most cancer patients with Medicare Part B have supplemental insurance that covers out-of-pocket costs, including drug co-pays, incurred under Medicare Part B insurance.

Mitchell points to his own regimen of cancer drugs, which adds up to about $23,000 each time he visits the infusion clinic. He pays $2,100 a year for a supplemental policy that covers his Part B co-payments. Medicare Part D recipients are not eligible to buy supplemental prescription drug insurance.

If his drugs were to fall under Medicare Part D, Mitchell explained that he would quickly pay enough in out-of-pocket co-pays to fall into a category called catastrophic coverage. Once in that category, Mitchell would pay 5 percent of his drug costs, which he estimates would equal about $15,000 in a year’s time. “That’s a completely unaffordable amount,” he said.

An analysis released Monday from health care consultants Avalere Health backs up Mitchell’s point. In 2016, average out-of-pocket costs were about 33 percent higher for Part D-covered new cancer therapies than for those covered in Part B. “Medicare beneficiaries typically have lower out-of-pocket costs in Part B — especially since so many seniors carry supplemental coverage,” said Richard Kane, senior director at Avalere, in a press release. “Any proposal for shifting drugs to Part D needs to account for these differences.”  

Logistical problems

“Having a doctor purchase, mix and handle the infusion of a drug is a completely different medical experience than going to the pharmacy and picking up a bottle of pills,” said Marc Samuels, founder of ADVI Health and former White House health policy adviser for President George H.W. Bush. Cancer treatments and other physician-administered drugs are complicated and personalized, often changing from week to week or even day to day depending on the patient’s reaction to the drugs.  

Patients and physicians are wondering how the actual delivery of drugs would work. “I heard someone say that I’d have to go to the pharmacy to pick up my drugs then bring them to the infusion center,” Mitchell of Patients for Affordable Drugs said. “That isn’t going to work.”

What’s more, Samuels argued that the 6 percent markup that doctors receive under Medicare Part B isn’t as profitable as it may sound.  Doctors purchase these expensive drugs then often have to discard them because the patient has serious side effects or needs a different drug for another reason. “The 6 percent is designed to help cover that cost,” Samuels said.

For now the Trump administration isn’t disclosing any details about how this part of its Blueprint would work. “I’m hoping,” said Mitchell, “we can work with the administration to find a way to allow negotiations to take place without harming patients.”

3 Lies Lamar Alexander Tells About Health Care

As Senator Lamar Alexander takes D.C. Republican politics to Tennessee in a blame-deflecting letter-to-the-editor, Protect Our Care is checking the facts:

“Republicans’ repeated efforts to sabotage the health care system are driving up health care costs across the country, and now Republican Senators who could have protected Americans but chose not to are running scared. For proof, look no further than the top Senate Republican on health care, Lamar Alexander, who just wrote a letter to his hometown paper in a last-ditch attempt to duck responsibility for the pain he’s causing American families. Senator Alexander has developed a history of misleading the public about health care, and once again, his claims just don’t pass the smell test,” said Brad Woodhouse, Campaign Director for Protect Our Care.

LIE 1: That efforts to stabilize health care markets failed because of Democrats. Republican poison pills on reproductive rights are what killed those efforts – full stop. Democrats continue to make overtures to Alexander on stabilization, but in a letter to lobbyists, he unilaterally declared he was walking away from the negotiating table.

LIE 2: That letting Lamar Alexander repeal the Affordable Care Act would have made matters better for anyone. In fact, millions of Americans would have lost their coverage, millions more with preexisting conditions would have faced discrimination from insurance companies, and premiums would have soared.

LIE 3: That Lamar Alexander is a moderate, reasonable or thoughtful voice on health care. His first priority is always repeal, making him no different from far-right Republicans like the Freedom Caucus or the Koch Brothers, who have been pouring millions of dollars into smearing the law for almost a decade. After this spring’s stabilization farce, Lamar Alexander has spent his last shreds of bipartisan credibility, and his letter indicates that people in Tennessee are noticing.


Research Roundup: Studies Show Better Health Care Outcomes, Stronger Household Finances Thanks to Affordable Care Act & Medicaid Expansion

Six new studies highlight the positive impact of the Affordable Care Act is having on health care in America. Three outcomes-focused studies show clear improvements in care for gynecological cancer, head and neck cancer, and serious psychological distress, while two Medicaid Expansion studies find that expanded coverage leads to lower out-of-pocket costs and stabler household finances. Meanwhile, health care reform has entirely closed the demographic coverage gap between Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs) and white Americans.

This new research joins a growing body of work that leads to a simple conclusion: the Affordable Care Act provides measurable benefits for Americans’ health and financial well-being. Here’s a look at the six studies:

Effects of the Affordable Care Act on Young Women With Gynecologic Cancers [Obstetrics & Gynecology, 5/7/18]

This study finds that the ACA’s expansion of access of coverage allowed more young women to catch gynecologic cancer early, improving the likelihood of successful treatment.

  • The study examined nearly 4,000 cases of gynecologic cancer among 21-26-year-old-women and more than 20,000 cases among 27-35-year-old women, comparing those which came about before the ACA and those after its implementation, finding that those with access were more likely to be treated.
  • The study found that prior to the ACA just one in three women between the ages of 19 and 26 were insured, but after its implementation, more than nearly four in five women were covered, helping to account for the diagnoses.
  • The report concluded that, “Young women with gynecologic cancer were more likely to be insured and diagnosed at an early stage of disease.”
  • “This study adds to the evidence of the positive effects of improved coverage through the ACA on young women’s healthcare costs and choices,” noted Dr. Laura Havrilesky, a gynecologist at the Duke University Medical Center, in an editorial published in accordance with the findings.

Changes in Health Insurance Coverage and Barriers to Health Care Access Among Individuals with Serious Psychological Distress Following the Affordable Care Act [Administration and Policy in Mental Health and Mental Health Services Research, 5/12/18]

This study examined mental health outcomes in accordance with the Affordable Care Act, concluding that the ACA has led to better coverage outcomes and increased affordability for non-elderly adults with serious psychological distress (SPD).

  • Examining non-elderly adults with SPD from 2014-2016, the study’s authors found that these adults saw increased coverage and a reduction in the delaying or foregoing of necessary care due to the ACA, and that the law “reduced the odds of an individual with SPD not being able to afford mental health care.”
  • As the study’s authors note, “Mental health care access among racial and ethnic minority populations and people with low income has improved during 2014–2016,” something almost certainly attributable, at least in part, to the ACA

ACA Decreased Non-Insurance Rates Among Patients With Head and Neck Cancer [American Head & Neck Society, 4/19/18]

Another new study finds that in states that expanded Medicaid, patients with head and neck cancer had better health care access.

  • The study analyzed more than 89,000 patients, finding higher coverage rates among both Medicaid enrollees and private insurance, as well as an uninsured rate among diagnoses which decreased nearly 50% after January 2014, in states which expanded Medicaid.
  • The study found that those lacking coverage had an overall survival rate of just 49% compared to 63% among those insured, as well as a a 5-year disease-specific survival rate of just 57% compared to 72% among those insured.

The Effect of the Affordable Care Act Medicaid Expansions on Financial Wellbeing [Journal of Public Economics, 5/7/18]

Another study compiled by employees of the Federal Reserve Bank of Chicago and the University of Illinois, University of Michigan, and Northwestern University found that low-income residents saw better financial outcomes in states which expanded Medicaid.

  • Using credit reporting agency data, the researchers compared the financial outcomes among low-income adults in states which expanded Medicaid and those which did not, determining that Medicaid expansion “significantly reduced d the number of unpaid bills and the amount of debt sent to third-party collection agencies among those residing in zip codes with the highest share of low-income, uninsured individuals.”
  • The study found that Medicaid expansion lowered unpaid balances in collections “by between $65 and $88,” while Medicaid enrollees saw their amount of unpaid balances in collections decrease “by approximately $1,140.”
  • As the authors note: “Our findings suggest that the ACA Medicaid expansions had important financial impacts beyond increasing health care use.”

The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures [Medical Care Research and Review, 5/10/18]

A new analysis from the University of Michigan’s Institute for Social Research finds that Medicaid expansion lowered out-of-pocket medical expenses.

  • The study, conducted by Joelle Abramowitz of the Institute of Social Research, analyzed data from the Current Population Survey Annual Social and Economic Supplement between 2011-2016, finding that those in states which expanded Medicaid saw their medical spending decreases, due to fewer premiums and reduced out-of-pocket medical expenses.
  • The study’s findings “suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals,” as well as suggest “that the expansions were effective in reducing medical out-of-pocket expenditures.”

Health Insurance for Asian Americans, Native Hawaiians, and Pacific Islanders Under the Affordable Care Act [JAMA Internal Medicine, 4/30/18]

Researchers from the Harvard T.H. Chan School of Public Health analyzed the impact of the Affordable Care Act on coverage among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), finding that the ACA closed the uninsured rate gap between AANHPIs and white Americans.

  • Using data from the American Community Survey, the researchers examined the uninsured rate among AANHPIs prior to the ACA and after its implementation, the first study of its kind, finding that unlike other minority groups which saw a decrease in the coverage gap between themselves and white Americans, the coverage gap among AANHPIS was eliminated.
  • Overall, the uninsured rate among AANHPIs dropped 7.3% following the ACA. Among the subgroups of AANHPIs, all saw significant drops: 14.3% among Guamanian or Chamorro, 6.5% among Samoan, and 4.9% among Native Hawaiians, as well as 5.9% among other AANHPIs.
  • “The notable gains in health insurance coverage for AANHPI groups represent valued progress toward health equity,” said senior author Howard Koh, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at Harvard Chan School and Harvard Kennedy School.

The Cost of Sabotage: How Republicans’ Deliberate Actions to Undermine the Affordable Care Act Make Health Care More Expensive for American Families

From his first day in office, President Trump and his Republican allies in Congress have been waging a war on the American health care system, taking deliberate actions to repeal, undermine, and sabotage the Affordable Care Act (ACA).

This is not just some ideological debate of conservatives versus progressives, or Republicans versus Democrats. These efforts have real, negative consequences for millions of American families. And more and more Americans are paying the price, facing higher premiums and out-of-pocket costs or losing coverage altogether.

This week, Protect Our Care will highlight the real, dollars-and-cents costs American families are facing because of Republican health care sabotage.

How Republicans Sabotaged Health Care

Some people may not be aware of all of the deliberate actions the Trump Administration and Republicans have taken over the past 18 months to sabotage our health care. Here are some examples:

  • On his first day in office, President Trump signed an Executive Order directing the administration to identify every way it can unravel the Affordable Care Act.
  • The Trump Administration cut the number of days people could sign up for coverage last year in during open enrollment in half.
  • It cut outreach so people know when to sign up by 90 percent and made dramatic cuts to in-person assistance that help people sign up for coverage.
  • And now, the Trump administration is pushing to allow insurance companies to sell junk plans that roll back key consumer protections in the Affordable Care Act and increase premiums for people seeking any meaningful coverage or who have a pre existing conditions.

Later that year, the Republican tax bill raised premiums by 10 percent, when they repealed the ACA’s individual mandate – the requirement that most people have health coverage.  That same bill gave hundreds of billions in tax breaks to the wealthy and big corporations, and resulted in huge profits and made CEOs and shareholders richer. Insurance companies got a 40% tax break.

Republicans in Congress repeatedly tried to pass a bill to repeal the Affordable Care Act and slash Medicaid. These bills would have ripped away coverage from tens of millions of people, raised costs for families by double digits, imposed an age tax on older Americans, cut Medicaid by more than $800 billion and weakened protections for people with pre-existing conditions. Those efforts failed, but they were successful in injecting uncertainty into the market that caused insurance companies to raise rates.

Sabotage Means American Families Face Higher Costs, Coverage Loss

Higher Costs
For proof that Republican sabotage is raising costs on American families, just ask the insurance companies. This spring, insurance companies are announcing their initial planned rate hikes for next year. And just like last year, they want to raise premiums by double digits, because of Republican sabotage. America’s Health Insurance Plans (AHIP) said that Trump Administration and Republican policies will “drive up the rate of premium increases, and exacerbate affordability issues for many other people.” The CEO of CareFirst Blue Cross Blue Shield said the marketplaces are “materially worse” under the Trump Administration because of its deliberate actions to undermine the system.

Here are examples from states where insurance companies’ initial rate hikes requests have been made public:

  • In Oregon, insurance companies want to raise rates by double digits – up to 14.3%. One insurance company cited “continued lack of funding for cost sharing reduction plans” as one of the factors for the increase.
  • In Vermont, insurance companies also want to significantly raise rates. One company cited “recent federal legislation [that] also eliminated the penalty associated with the individual mandate. As a result, it is expected that a number of healthy individuals will choose to forgo coverage and leave the single risk pool.”
  • In Maryland, insurance companies want to raise rates as high as 91 percent. As Kaiser Permanente said, “These proposed rates reflect the expected costs of providing coverage for these members, including the impact of eliminating the individual mandate penalty.”
  • In Virginia, insurance companies want to raise rates as high as 64 percent. Factors behind the rate request include “elimination of the Individual Mandate penalties” and “anticipated changes to regulations regarding Short Term Medical and Association Health Plans.”

In fact, a new analysis shows that because of two new Republican policies, encouraging junk plans and repealing the individual mandate, average individual-market premiums will increase by $1,013 next year. That compounds the damage done last year, insurance companies charged families $102 more per month in premiums, attributing the increases to the initial round of Trump Administration sabotage.

Fewer Americans Covered
A four-year trend of health coverage gains has been reversed under the Trump Administration. 3.2 million Americans lost coverage during the first year of the Republican war on health care, and millions more stand to lose their insurance over the coming years.

During President Trump’s first year in office, the national uninsured rate rose for the first time since Affordable Care Act implementation. Gallup reports that the national uninsured rate spiked by 1.3 percentage points to 12.2 percent in 2017, with 17 states experiencing statistically significant increases:

  • West Virginia (4.2 percent), New Mexico (3.8 percent), Iowa (3.3 percent), Hawaii (3.3 percent), Arizona (2.6 percent), Colorado (2.2 percent), Florida (1.4 percent), Illinois (1.6 percent), Indiana (1.5 percent), Missouri (2.1 percent), New York (1.2 percent), North Carolina (1.4 percent), South Carolina (2.1 percent), Texas (1.6 percent), Utah (2.1 percent), Washington (1.5 percent), and Wisconsin (2.1 percent).

Americans Agree: Republicans Are To Blame For Sabotaging Health Care

Recent polling confirms that the American people see Republicans’ actions for what they are: sabotage. A poll conducted last September found that 61 percent of voters believed President Trump was “trying to make the Affordable Care Act fail,” and 64 percent of voters said Trump is “playing politics with people’s health care.” The poll also found that the American people seriously disapprove of how Republicans in Congress are treating health care: 80 percent of voters disapprove while only 20 percent approve.

In a February poll, Public Policy Polling found that more than half of voters nationally (51 percent), said that they thought that the Trump Administration was actively taking steps that will hurt people’s health care and raise costs.

Today, six new Public Policy Polling Surveys in battleground states find that Americans will blame Republican sabotage for health insurance rate hikes:

  • In Arizona, 55 percent of voters say they will hold Republicans in Washington responsible if rates increase, compared to just 29 percent who said they would not. A plurality (49 percent) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act.
  • In Indiana, 49 percent of voters say they will hold Republicans in Washington responsible if rates increase, compared to just 20 percent who said they would not. A plurality (48 percent) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act.
  • In Missouri, 59 percent of voters say they will hold Republicans in Washington responsible if rates increase, compared to just 25 percent who said they would not. A plurality (47 percent) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act.
  • In Montana, 55 percent of voters say they will hold Republicans in Washington responsible if rates increase, compared to just 32 percent who said they would not. A plurality (47 percent) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act.
  • In Nevada, 56 percent of voters say they will hold Republicans in Washington responsible if rates increase, compared to just 32 percent who said they would not. A majority (55 percent) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act.
  • In Wisconsin, 59 percent of voters say they will hold Republicans in Washington responsible if rates increase, compared to just 31 percent who said they would not. A majority (53 percent) say they believe Washington Republicans and President Trump have been trying to undermine and sabotage the Affordable Care Act.

In short, while Republicans keep pushing their destructive repeal-and-sabotage agenda, more and more American families are paying the price.


New Rule Would Put Donald Trump Between Women And Their Doctors

Washington, D.C. – After the Trump Administration proposed to dramatically accelerate its attacks on women’s care, Protect Our Care Communications Director Marjorie Connolly released the following statement:

“Today’s rule would put Donald Trump between women and their doctors, and it signals a new phase in the Republican war on women’s health. By banning providers from giving women all the facts about their options and restricting them from getting any services at all from essential community health providers, including Planned Parenthood, this rule is designed to threaten women’s health care providers and restrict access to care. Courts blocked a similar proposal in the Reagan era, but now President Trump has gotten a record number of anti-choice judges confirmed, meaning this rule poses an even worse threat to women’s health than it did in the 80s. The Trump-Pence administration continues to pursue a radical anti-women’s health agenda, but today’s proposal will only strengthen the resolve of the millions of women who have been marching against these attacks since Day One.”

BACKGROUND: The Republican War on Women’s Care

Stacking Federal Courts With Anti-Choice Judges: The next generation of American women will face a growing threat posed by an increasingly anti-choice federal judiciary. Twelve of Trump’s judicial nominees were appointed to circuit courts during his first year – more than any other first-year president in American history.

Allowing States To Defund Clinics That Offer Abortion Care: Before today’s proposal, in early 2017, Trump signed a bill allowing states to withhold Title X family planning funds from health care providers that offer abortion-related care. Thirteen states used to withhold the Title X money from abortion providers before the Obama administration blocked them. (Because of the Hyde Amendment, federal funds can’t be used to pay for abortions, so the Title X money went to other health services at those clinics.) The legislation allows them to withhold the funds again and redirect them to providers that don’t offer abortion care.

House Farm Bill Becomes Latest Vehicle for Republicans’ War on Health Care

As the U.S. House prepares to vote on a farm bill that continues Republicans’ push to encourage subpar health plans, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“By including a provision encouraging association health plans, the House farm bill has become the latest vehicle for Republican attacks on health care and people with pre-existing conditions. The bill authorizes $65 million in taxpayer funding to set up association health plans, which can  exclude prescription drug coverage, mental health care, and maternity care. When these plans fail, they leave people who thought they had real coverage out in the cold. Hardworking Americans shouldn’t bet the farm on association health plan coverage.”


The National Association of Insurance Commissioners has warned that association health plans “provide inadequate benefits and insufficient protection to consumers” and “threaten the stability of the small group market.”

Subpar coverage and a lack of pre-existing condition protections pose a particularly large risk for agricultural workers because of the dangers of the profession. According to the U.S. Occupational Safety and Health Administration, the injury rate for agricultural workers is over 40 percent higher than the national workplace injury rate overall.

And as Roger Johnson, president of the National Farmers Union (NFU), wrote during last year’s repeal drive: “The Medicaid expansion has proven especially beneficial to rural communities, where the rate of enrollment is higher than in urban America, and the ACA’s system of tax credits and premium subsidies helps young farmers access insurance while enabling established farmers to maintain consistent coverage.”