Plus All the Others, from the Washington Post
Trump’s op-ed is full of lies as brazen as any he’s ever told. Here are four things he got wrong – way wrong – on health care.
ONE: TRUMP AND REPUBLICANS WANT TO END PROTECTIONS FOR PRE-EXISTING CONDITIONS
The Trump administration has refused to defend the ACA against a lawsuit brought by conservative leaders in 20 states and even agrees with them that the ACA’s protections for people with pre-existing conditions should be overturned.
Because Of The Affordable Care Act, Insurance Companies Can No Longer Deny Coverage Or Charge More Because Of Pre-Existing Conditions. “Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a ‘pre-existing condition’ — that is, a health problem you had before the date that new health coverage starts.” [HHS]
The ACA Outlawed Medical Underwriting, The Practice That Let Insurance Companies Charge Sick People And Women More. As the Brookings Institution summarizes, “The ACA outlawed medical underwriting, which had enabled insurance carriers to court the healthiest customers while denying coverage to people likely to need costly care. The ACA guaranteed that all applicants could buy insurance and that their premiums would not be adjusted for gender or personal characteristics other than age and smoking.”
The ACA Stopped Companies From Charging Women More Than Men For The Same Plan. The Affordable Care Act eliminated “gender rating,” meaning American women no longer have to pay an aggregated $1 billion more per year than men for the same coverage.
Thanks To The Affordable Care Act, Insurance Companies Can No Longer Drop Coverage Because of Illness. Because of the ACA, insurance companies can no longer rescind or cancel someone’s coverage arbitrarily if they get sick.
If the courts rule in favor of the Republican attorneys general, critical Affordable Care Act protections would vanish overnight, unleashing chaos in our entire health care system. Here is what could be eliminated:
- 17 million more 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, 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 and people over age 50
- Limit on out-of-pocket costs
- Medicaid expansion currently covering 15 million people
- Small business tax credits
- Marketplace tax credits for up to 9 million people
TWO: TRUMP’S “NEW HEALTH INSURANCE OPTIONS” ARE ACTUALLY JUNK PLANS
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 Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]
- 1 in 4 Children 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]
Commonwealth Fund: “Cost Sharing Designs In Short-Term Coverage Leave Members Facing Major, Unpredictable Financial Risk.” “The out-of-pocket maximum for each best-selling plan is higher than that allowed in individual or employer plans under the ACA, when adjusting for the shorter plan duration. When considering the deductible, the best-selling plans have out-of-pocket maximums ranging from $7,000 to $20,000 for just three months of coverage. In comparison, the ACA limits out-of-pocket maximums to $7,150 for the entire year.” [Commonwealth Fund, 8/11/17]
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]
Short-Term Junk Plan Currently Being Sold In Thirteen States Does Not Cover Services For Patients Admitted To Hospital On The Weekend. “That brings us to the short-term plan marketed by UnitedHealth’s Golden Rule subsidiary….To begin with, the Golden Rule plan excludes pregnancy and provides for a lifetime maximum benefit of only $250,000. Remarkably, it won’t cover hospital room, board or nursing services for patients admitted to a hospital on a Friday or Saturday, unless for an emergency or for necessary surgery the next day.” [Los Angeles Times, 4/26/18]
THREE: TRUMP’S HEALTH CARE SABOTAGE IS DRIVING COSTS UP FOR CONSUMERS
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]
FOUR: TRUMP AND REPUBLICANS WANT TO UNDERMINE MEDICARE
Last month, Larry Kudlow, Director of the National Economic Council, confirmed that he has his sights on cutting Medicare. Asked when programs like Social Security and Medicare will be looked at for reforms, Kudlow replied, “Everyone will look at that — probably next year.”
Paul Ryan on Medicare: “It’s the biggest entitlement we’ve got to reform.” Paul Ryan, December 6, 2017: “We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit…Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements…In- think the president is understanding that choice and competition works everywhere in health care, especially in Medicare…This has been my big thing for many, many years. I think it’s the biggest entitlement we’ve got to reform.”
President Trump and Congressional Republicans are targeting Medicare and Medicaid to pay for tax cuts for the wealthiest. Last December, President Trump signed a $1.5 trillion tax bill that disproportionately benefits the wealthy. How do Republicans plan on paying for it? Speaker Ryan’s answer is clear: “Frankly, it’s the health care entitlements that are the big drivers of our debt.” In an attempt to pay for these tax cuts, in April, House Republicans passed a budget amendment that would slash Medicare funding by $537 billion over the next decade.
Congressional Republicans proposed these cuts after passing a budget resolution last year that cut Medicare by $473 billion. The 2018 budget resolution passed by Republicans in December 2017 cut Medicare by $473 billion.
As the cost of drugs skyrocket, President Trump and his Republican allies in Congress will not allow Medicare to negotiate for better prescription drug prices. Under current law, the Secretary of the Department of Health and Human Services (HHS) is explicitly prohibited from negotiating directly with drug manufacturers on behalf of Medicare Part D enrollees. Although it would decrease both federal spending and beneficiaries’ out-of-pocket costs for prescription drugs, a policy allowing the federal government to negotiate drug prices for Medicare beneficiaries was noticeably absent from President Trump’s recent prescription drug announcement.
Congressional Republicans have repeatedly attempted to transform Medicare into a voucher program, which experts warn would lead to the “demise” of the program. Speaker Ryan has spoken about turning Medicare into a voucher system, and in Fall 2017, the Centers for Medicare and Medicaid services filed a Request for Information concerning a shift in a “new direction” for Medicare, which Senate Democrats worried might entail a voucher system. Experts warn, and Republicans including Newt Gingrich acknowledge, that such a shift would lead to the demise of traditional Medicare as premiums increase.
Congressional Republicans repealed several components of the ACA designed to help keep Medicare’s costs down, effectively driving up costs for the program. By repealing the requirement that most people have insurance, Congressional Republicans knowingly voted for a measure expected to increase the number of uninsured. The 2018 Medicare Trustees Report predicts that this increase will increase the share of subsidies paid to hospitals via Medicare. Similarly, by repealing the Independent Payment Advisory Board, Congressional Republicans took away a mechanism that slowed Medicare cost growth.
….BUT DON’T JUST TAKE IT FROM US. NON-PARTISAN FACT CHECKERS ALL AGREE THAT TRUMP IS LYING ABOUT HEALTH CARE
Washington Post On Trump’s OpEd: “Almost Every Sentence Contained A Misleading Statement Or A Falsehood” [Washington Post, 10/10/18]
FactCheck.Org: “Trump Misleads on Preexisting Conditions.” [FactCheck.org, 10/2/18]
FactCheck.Org: Trump’s Claims About Declining Premiums Are “Misleading.” [FactCheck.org, 9/28/18]
Associated Press: Trump “Isn’t Playing It Straight” About Pre-Existing Conditions. [Associated Press, 10/1/18]
PolitiFact: Trump Has Put Pre-Existing Condition Protections “Under Threat By Lawsuit.” [PolitiFact, 9/29/18]
PolitiFact: Trump’s Claims About Democrats And Pre-Existing Conditions Are “Pants On Fire.” [PolitiFact, 10/5/18]
New York Times: “Trump Claims to Protect Pre-Existing Health Conditions. That’s Not What the Government Says.” [New York Times, 9/21/18]