The Trump administration and Republicans are trying to take credit for stabilizing marketplaces under the Affordable Care Act. They are wrong. Before Trump and Republicans in Congress began its two year war on health care to repeal and sabotage the Affordable Care Act, independent analyses showed the marketplaces were already beginning to stabilize. Their efforts to repeal and sabotage the ACA actually led to higher costs for people, especially because they were undermining protections for pre-existing conditions.

Here are four ways the Republican National Committee gets it wrong in a recent report.

1 – REPUBLICAN REPEAL EFFORTS HAVE RAISED OUR COSTS

The Trump administration and Republicans want to take credit for premiums “getting better.” The truth: the relentless war on health care the Trump administration and Republicans in Congress have waged over the last 18 months have caused costs to increase.

  • 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]

2 – PRIOR TO THE TRUMP ADMINISTRATION, PREMIUM RATES WERE STABILIZING

The Trump administration and Republicans are trying to take credit for a stabilizing marketplace. The truth: the marketplaces were stabilizing before Trump came into office.

  • Before Trump became president, experts predicted ACA marketplaces were stabilizing. Prior to the Trump administration, independent analyses show that the Affordable Care Act was working. Standard’s & Poor said it expected insurers’ performance in the marketplaces to be better in 2016 than in 2015, and 2017 would be better than 2016.
  • Net premiums only increased $1 from 2016 to 2017, before the Trump/GOP sabotage began. In March 2017, the nonpartisan Congressional Budget Office said it anticipated “the market to be stable” under the ACA. The average premium after tax credits increased by $1 dollar, from $100 in 2016 to $101 in 2017.

3 – REPUBLICANS ARE ACTIVELY UNDERMINING PROTECTIONS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

The Trump administration and Republicans tout their new “short-term, limited duration” plans as a way to reduce costs. The truth: Republicans have been actively undermining protections for people with pre-existing conditions.

  • These are junk plans because insurance companies can deny coverage for people with pre-existing conditions and they do not have to cover essential benefits under the ACA, meaning people won’t have the coverage they need when they need it. For example:

Los Angeles Times: Expanding Short-Term Plans Is Opposed By Nearly Every Patient Advocacy Organization In The Country. “Expanding short-term plans also risks driving up costs for Americans with preexisting medical conditions who need more comprehensive benefits…Among the groups that have opposed the Trump administration’s moves are virtually every leading patient advocacy organization in the country, including the American Lung Assn., the American Heart Assn., the Cystic Fibrosis Foundation, the March of Dimes, the National Multiple Sclerosis Society, Susan G. Komen, AARP and the advocacy arm of the American Cancer Society. [LA Times, 8/1/18]

HuffPost: Short-Term Plans Provide Junk Coverage And Drive Up Costs Of Comprehensive Care. “Meanwhile, those seeking out comprehensive plans because they want or need them will discover those policies have gotten more expensive, thanks to the way short-term plans will affect the rest of the insurance market. Some insurance shoppers will have serious, even life-threatening diseases, such as cancer, which will mean their insurance must have a full set of benefits. But those kinds of policies will become more expensive than they can afford. [HuffPost, 8/1/18]

Bloomberg: Cheaper Plans “Can Come At A Cost.” “For some people, though, the cheaper premiums can come at a cost, such as when insurers claim that a cancer treatment shouldn’t be covered because a patient had the disease before buying coverage, as Bloomberg reported in October.” [Bloomberg, 7/31/18]

Short-Term Plans Sometimes Impose Unexpected Rules, Like For Instance Refusing To Cover Hospitalizations During The Weekend.There may be other strange rules. A review of some plan documents from Families USA found an Illinois plan that would cover only hospitalizations beginning during the week — inpatient stays that began on the weekend would not be allowed except in rare circumstances. Some plans had waiting periods for care. Cancer treatment, for example, is not covered in certain plans during the first month a person is enrolled in a plan, and no treatment for illness is covered in the first five days. That’s the kind of detail that might be easy to overlook when signing up for a plan if you aren’t expecting a cancer diagnosis.” [New York Times, 8/1/18]

  • In addition, Republicans in 20 states are suing to overturn the Affordable Care Act and eliminate its protections for people with pre-existing conditions in a Texas district court. The Trump administration is siding with them, not federal law, and asking the judge to specifically overturn the protections that ban insurance companies from denying coverage, or charging more, because of a pre-existing condition.

4 – ALLOWING INSURANCE COMPANIES ACROSS STATE LINES IS A RACE TO THE BOTTOM

The Trump administration and Republicans are pushing a proposal to allow insurance companies to sell across state lines as a way to lower costs. The truth: this would be a race to the bottom for insurance companies to sell from states with the least consumer protections, thus hurting consumers.

  • CBO: Selling Across State Lines Would Result In People Living In States With More Consumer Protections To Be Offered Plans From States That Do Not Have Those Protections. “Under H.R. 2355, CBO expects that individual health insurance would be offered across state lines to individuals in states with relatively expensive coverage mandates and rate-setting rules that permit relatively little variation in the prices an insurer may charge. The insurers offering those policies would be licensed in, and regulated by, states that do not have those characteristics.” [Congressional Budget Office, 9/12/05]
  • Urban Institute: Insurers Would Domicile Firms In States With Lax Regulations And The Least Consumer Protections. “Pre-ACA proposals to permit sales of insurance across state lines would have allowed insurers to take advantage of the regulatory variation across states. The same is true for current proposals to permit such sales while simultaneously repealing all or most of the ACA. Under such a policy scenario, insurers would have powerful financial incentives to domicile firms in states that have little regulation of nongroup insurance markets, such as those without guaranteed issue, those with no limits on premium rating, those permitting liberal use of benefit riders, and so on.” [The Urban Institute, 6/29/16]
  • NAIC: Allowing The Sale Of Insurance Across State Lines Would “Preempt” Consumer Protections In States. “In the same vein, we strongly oppose legislation that would preempt state authority. We continue to see proposals that would preempt state licensing requirements and, thus, consumer protections by allowing sales across state lines by federal edict, without proper discretion for the states to form compacts between themselves. We also see proposals that would preempt state solvency requirements and regulations by creating federally licensed insurance pools called ‘association health plans.’ Such federal actions would strip states of the ability to protect consumers and create competitive markets and should be rejected.” [NAIC Letter to Reps. Walden, Brady, Pallone and Neal, 1/24/17]