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January 2020 Recess

Intro: A Health Care Recess

While much of the national focus is being drawn to current events, the number one issue for American families is – and has remained – health care. Just weeks ago, two Republican judges sided with Donald Trump’s lawsuit to overturn the entire Affordable Care Act. The ruling by the 5th Circuit is a win for Republicans and puts the fate of the health care law in the hands of the lower court judge who had already ruled in favor of overturning the law. With the future of health care in limbo, President Trump started the new year by making outlandish lies about “saving” protections for pre-existing conditions, when in reality his administration and Republicans have tried everything they can to destroy the health care law and eliminate these protections for 135 million Americans. 

In contrast, House Democrats have spent the past year passing a landmark bill to lower drug costs, reversing the Trump administration’s sabotage and strengthening protections for Americans with pre-existing conditions.

Given Republicans continued assault on health care,  the President’s blatant lies about his record, and Democratic achievements,  this recess is a perfect opportunity to remind constituents who is on their side and who is on the side of big drug and insurance companies. The contrast could not be clearer: Republicans would rather lie about their records and continuing to sabotage health care, while Democrats actually pass bills to lower costs and improve care.  

This packet provides fact sheets and message guidance on all these issues. If you’d like to work with Protect Our Care in your district, contact Anne Shoup at [email protected].

The Top Ten Ways Trump Has Sabotaged Americans’ Health Care

President Trump lies repeatedly about his health care agenda. While he hopes Americans believe his outrageous claims like how he “saved” protections for pre-existing conditions, in reality, his record is defined by one act of sabotage after another. From trying to eliminate protections for pre-existing conditions, to gutting funding for Medicaid and his allegiance to drug companies over patients, Trump’s agenda has been all about taking health care away and enriching big pharma while they raise costs on Americans. 

Trump recently made one of his most bald-faced lies about how he “saved” protections for pre-existing conditions. That could not be further from the truth. To understand just how disastrous the Trump health care agenda is, and the extent of his lies, here are ten of the most egregious ways he has sabotaged Americans’ health care. 

  1. Trump Won’t Stop Trying To Repeal Our Health Care Law. Trump notoriously tried and failed multiple times to repeal the Affordable Care Act. All of the repeal bills that went through Congress would have caused millions of Americans to lose their health coverage and raised premiums by double digits for millions more. They would have ended Medicaid as we know it, putting the care of children, seniors and people with disabilities at risk.
  2. Trump Is All-In On The Texas Lawsuit, Threatening Health Care For Millions. After failing to repeal the health care law, Trump took his war on America’s health care to a new level and went to court seeking to strike down the entire Affordable Care Act–including protections for pre-existing conditions. If President Trump and Republicans have their way, 20 million Americans will lose their insurance coverage, 135 million Americans with pre-existing conditions will be stripped of their protections, and costs will go up for millions. 
  3. Trump Continues To Stand With Big Pharma As Drug Prices Have Soared. Donald Trump promised that he would lower drug costs, but instead he gave drug companies billions in tax breaks. The year after the tax bill passed, the largest drug companies made $50 billion in profits and subsequently used their savings to invest billions more in stock buybacks for their shareholders. Meanwhile, more than 3,400 drugs saw price increases in the first half of 2019 alone. Trump has rejected common sense reforms, like giving Medicare the power to negotiate for lower prices.  
  4. Trump Has Declared War On Medicaid. Between encouraging states to impose red tape and paperwork requirements and championing work requirements, the Trump administration has worked tirelessly to dismantle Medicaid. After Arkansas imposed the nation’s first so-called work requirements program, more than 18,000 residents lost Medicaid coverage. While these state efforts have been blocked by a federal judge several times, the Trump administration keeps fighting to impose work reporting requirements in Medicaid, appealing federal court rulings that blocked such requirements because they are illegal. Meanwhile, a recent GAO report found that the administrative costs to implement the failed work requirement programs in five states topped $400 million. 
  5. At Least Two Million People Have Lost Coverage Under Trump. Census data revealed the uninsured rate rose for the first time since the implementation of the Affordable Care Act. The rate increased from 7.9% in 2017 to 8.5% in 2018, or by approximately 2 million people. More than one million children lost Medicaid coverage between 2017 and 2019. Health care experts have pointed to a “chilling effect” from Trump-backed policies, including Medicaid work requirements.
  6. Trump’s Budget Would Have Slashed Medicare And Medicaid. Donald Trump’s proposed federal budget in 2019 would cut funding for Medicare by more than $800 billion and repeal the ACA. Additionally, the budget would cut $1.5 trillion from Medicaid, which would result in millions of people losing health coverage, cuts to nursing home care, and cuts to care for children with severe disabilities.
  7. The Trump Tax Scam Gave Hundreds Of Billions To Drug And Insurance Companies With Soaring Profits While Further Eroding Access to Health Care. Trump signed into law a Tax Bill that, among other things, repealed a key provision of the Affordable Care Act that required most people to have health coverage and which is the basis of the Trump-Republican lawsuit seeking to overturn the Affordable Care Act. Additionally, the repeal of the individual mandate contributed to thousands of dollars in increased premiums on the individual market in 2019. 
  8. Health Care Costs Have Skyrocketed Under Trump. Under Donald Trump, health insurance costs have risen faster than people’s wages–to more than $20,000 per year for the average family, making it harder and harder for many Americans to get ahead. 
  9. Trump Cut Open Enrollment Funding, And Instead Funneled People Into Junk Plans That Do Not Include Protections For Pre-Existing Conditions. In 2017, the Trump administration cut 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. The administration also slashed funding for non-profit health navigator groups, that help people shop for coverage, from $36 million to $10 million. CMS has encouraged groups to use the remaining funds to push people to sign up for junk plans that skirt important consumer protections.
  10. Trump’s Policies Promote Discrimination Against Women, People Of Color, And LGBTQ Americans. Since taking office, the Trump administration has taken multiple steps to make it harder for women, people of color, and LGBTQ Americans to access health care. For example, in August 2019, the Trump administration begins enforcing a rule that bars certain federally-funded clinics from referring women for abortions. As a result, the nation’s largest recipient of Title X funds, Planned Parenthood, was forced to exit the program, losing $60 million in funding previously used to provide birth control and reproductive health care services for low-income women. Moreover, experts point to Trump’s immigration policies for having deterred many Latino families from getting coverage, resulting in steep coverage losses, especially for children. Trump has also tried to make it easier for transgender Americans to be discriminated against in health care settings and allow providers’ to refuse patient care on the basis of the provider’s personal beliefs, a move likely to undermine access to care for patients who already face health care disparities. 

Trump Tweeted Early Contender for Lie of the Year With Outrageous Claim About “Saving” Protections for Pre-existing Conditions 

On January 13, the President of the United States made one of his most outlandish lies, tweeting that he “saved” pre-existing condition protections, when in fact he has done everything possible to strip 135 million Americans with pre-existing conditions of their protections. The press quickly debunked President Trump’s claim and reminded Americans of the truth about Trump’s disastrous health care agenda. 

Associated Press: AP FACT CHECK: No, Trump Didn’t Save Preexisting Conditions. “People with preexisting medical problems have health insurance protections because of President Barack Obama’s health care law, which Trump is trying to dismantle. One of Trump’s major alternatives to Obama’s law — short-term health insurance, already in place — doesn’t have to cover preexisting conditions. Another major alternative is association health plans, which are oriented to small businesses and sole proprietors and do cover preexisting conditions.Neither of the two alternatives appears to have made much difference in the market. Meanwhile, Trump’s administration has been pressing in court for full repeal of the Obama-era law, including provisions that protect people with preexisting conditions from health insurance discrimination.” [Associated Press, 1/13/20

New York Times: To the Contrary, Trump Has Tried to Weaken Protections for Pre-Existing Conditions. “President Trump was not in Washington when the Affordable Care Act passed and established a right to health insurance for Americans with pre-existing health conditions. His first legislative priority as president was a bill that would have repealed key parts of Obamacare and weakened such protections. His Justice Department is arguing in court that the entire law should be overturned.” [New York Times, 1/13/20

Washington Post Fact Checker Gave Trump’s Claim That He “Saved” Pre-Existing Conditions Four Pinocchios. “Trump has repeatedly tried to repeal or weaken the ACA, and independent experts have concluded the various plans he supported would have weakened coverage for Americans, especially those with preexisting conditions…This traffic jam of false claims ends up in a crash worthy of Four Pinocchios.” [Washington Post, 1/13/20

Politico: “Trump’s Claim Monday That He ‘Saved Pre-Existing Conditions’ In Americans’ Health care Is A False One — The Latest Attempt By The President To Distort His Years-Long Record Of Trying To Strike Down The ACAt.” “Trump’s claim Monday that he ‘saved Pre-Existing Conditions’ in Americans’ health care is a false one — the latest attempt by the president to distort his years-long record of trying to strike down the ACA. Backed by then-President Barack Obama and passed by Democrats in Congress in 2010, the landmark health care law included historic protections for millions of Americans with chronic illness and other health conditions.” [Politico, 1/13/20

Vox: Trump Claiming To Be A Defender Of Preexisting Conditions Is Pretty Shameless. “Trump — who in 2017 pushed health care legislation that would’ve resulted in 23 million Americans losing coverage, and whose administration is currently fighting in federal court to strike down the Affordable Care Act (ACA), including its protections for people with preexisting conditions — nonetheless claimed in a tweet attacking Democratic presidential candidate Michael Bloomberg on Monday that ‘I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now’…Trump’s tweet is either a big lie, illustrates his profound confusion about health care policy, or some combination thereof.” [Vox, 1/13/20

The Real Republican Agenda: The Trump-Texas Lawsuit To Overturn The Law, Take Away Your Health Care

Last month, the Fifth Circuit Court of Appeals ruled in favor of the Trump administration and Republicans in Texas vs. United States, striking down as unconstitutional the ACA’s individual mandate and remanding to the lower court judge a final decision on what parts of the ACA should be eliminated – the very judge who has already ruled the entire law unconstitutional. If President Trump and Republicans have their way, 20 million Americans will lose their insurance coverage, 135 million Americans with pre-existing conditions will be stripped of their protections, and costs will go up for millions. 

Trump’s lawsuit means higher costs for worse care

President Trump’s lawsuit to completely overthrow the Affordable Care Act would rip insurance away from millions of Americans, gut protections for pre-existing conditions and raise costs. It would give insurance companies power to charge as much as they want and cover as little as they want, while paying their CEOs more and padding their profits. If Trump overturns health care, it would:

  • Gut protections for every American with a pre-existing condition
  • Hike premiums for millions of Americans
  • No longer allow children the ability to stay on their parents’ health care plan until 26
  • Allow insurance companies to not cover drug costs and to charge women more than men
  • Increase the number of uninsured by 65%
  • Let insurance companies use premiums for unlimited executive bonuses instead of paying for care

Voters loudly rejected health care repeal in 2018, and now Donald Trump is going to court to overrule them. Health care repeal was the #1 issue in the midterms and remains the #1 issue the American people want Congress to address. 

Every Republican owns this lawsuit. Republicans have tried for years to repeal the Affordable Care Act and the Trump administration has actively tried to sabotage it. 18 states led by Republican state officials are supporting Trump’s lawsuit and Republicans in the House voted for it. 

And if that wasn’t enough, Republicans continue their larger war on health care…

In addition to Trump’s lawsuit, the Republican repeal and sabotage agenda raises costs, weakens protections, reduces coverage, and puts drug and insurance company profits first.

  • Trump’s newly proposed budget includes nearly $1 trillion in Medicare cuts and $1.5 trillion in cuts to Medicaid, and repeats his call for repeal of the Affordable Care Act. Trump promised to never cut Medicare and Medicaid when he ran for president.
  • The Trump and Republican tax bill gave hundreds of billions of dollars in tax cuts to insurance and drug companies. Their profits and CEO salaries soar while you pay more. 
  • Republicans continue their relentless sabotage efforts. They want insurance companies to sell you junk plans that don’t cover pre-existing conditions and charge you more when you get sick. And they want to require ridiculous paperwork requirements as a way of kicking you off Medicaid.

Fact Sheet On Trump Lawsuit To Overturn ACA

President Trump is trying to rip apart our health care by going to court to eliminate the Affordable Care Act in its entirety. If the Trump lawsuit is successful, it will strip coverage from millions of Americans, raise premiums, end protections for people with pre-existing conditions, put insurance companies back in charge, and force seniors to pay more for prescription drugs. The result will be to — as the Trump Administration itself admitted in Court — unleash “chaos” in our entire health care system. 

If the Affordable Care Act is struck down:

  • GONE: Protections for 135 million Americans with pre-existing conditions. The uninsured rate will increase by 65 percent. 
  • GONE: Medicaid expansion, which covers 17 million people. 
  • GONE: Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.
  • GONE: 2.3 million adult children will no longer be able to stay on their parents’ insurance. 
  • GONE: Insurance companies will be able to charge women 50 percent more than men.
  • GONE: Financial assistance that helps 9 million people purchase health care in the marketplace.
  • GONE: Key support for rural hospitals. As Americans lose coverage, already struggling hospitals will be hit even harder as their costs increase.
  • GONE: Ban on insurance companies having lifetime caps on coverage.
  • GONE: Requirements that insurance companies cover prescription drugs and maternity care.

Thanks To The Republican Lawsuit, 20 Million People Could Lose Their Coverage

  • According to the Urban Institute, 19.9 million people could lose coverage by repealing the Affordable Care Act, meaning the number of uninsured Americans would increase from 30.4 million to 50.3 million, representing a leading to a 65 percent increase in the uninsured rate. As the uninsured rate swells, so will the amount of uncompensated care, which Urban predicts will grow by at least 82 percent.
  • States  would lose important federal health care funding — an estimated reduction of $135 billion in the first year. The Urban Institute estimates that a full repeal of the ACA would reduce federal spending on Medicaid/CHIP care and Marketplace subsidies by $135 billion, or 34.6 percent in the first year.
  • Millions of children could lose their coverage. Almost three million children nationwide gained coverage thanks to the ACA.  If the law is overturned, many of these children will lose their insurance.
  • The percentage of people gaining health insurance under the ACA was higher for Latinos than for any other racial or ethnic group in the country. According to a study from Families USA, 5.4 million Latinos would lose coverage if the lawsuit succeeds in overturning the ACA.  

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 135 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 135 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders
  • More than 17 million children, 68 million women, and 32 million people aged 55-64 have a pre-existing condition.

Republicans Want To Give Insurance Companies The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. Now insurance companies have license to do this again. 

  • A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three year period. 
  • A 2009 congressional report found that the of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period
  • An analysis by Avalere finds that “102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs” if the Trump-GOP lawsuit is successful.

Republicans Want To Give Insurance Companies The Power To Charge You More, While Their Profits Soar

  • 138 Million Americans  Could Once Again Have To Pay For Preventive Care. Because of the ACA, health plans must cover preventive services — like flu shots, cancer screenings, contraception, and mammograms – at no cost to consumers. This includes nearly 138 million Americans, most of whom have employer coverage.
  • Premium Surcharges Can Once Again Be In The Six Figures. Thanks to the Republican lawsuit, insurance companies can charge people more because of a pre-existing condition. The House-passed repeal bill had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
  • Women Can Be Charged More Than Men For The Same Coverage. Prior to the ACA, women, for example, were often charged premiums on the nongroup market of up to 50 percent higher than they charged men for the same coverage. 
  • People Over The Age of 50 Can Face A $4,000 “Age Tax.” Thanks to the Republican lawsuit, insurance companies can charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, according to the AARP.
  • Nine Million People In The Marketplaces Will Pay More For Coverage. Thanks to the Republican lawsuit, consumers no longer have access to tax credits that help them pay their marketplace premiums, meaning roughly nine million people who receive these tax credits to pay for coverage will have to pay more.
  • Seniors Will Have To Pay More For Prescription Drugs. Thanks to the Republican lawsuit, seniors will have to pay more for prescription drugs because the Medicare “donut” hole got reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 Centers on Medicare and Medicaid Services report.

Republicans Want To Give Insurance Companies The Power To Limit The Care You Get, Even If You Have Insurance Through Your Employer

  • Reinstate Lifetime and Annual Limits On 109 Million Privately Insured Americans. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage for those insured through their employer or on the individual market.
  • Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.
  • Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.

Republicans Want To End Medicaid Expansion

  • Seventeen Million People Enrolled Through Medicaid Expansion Could Lose Coverage.
  • Access To Treatment Would Be In Jeopardy For 800,000 People With Opioid Use Disorder. Roughly four in ten, or 800,000 people with an opioid use disorder are enrolled in Medicaid. Many became eligible through Medicaid expansion.
  • Key Support For Rural Hospitals Would Disappear, leaving hospitals with $9.6 billion more in uncompensated care.  

House Democrats’ Bold Plan: The Lower Drug Costs Now Act 

In December, House Democrats passed an aggressive plan to reduce the price of drugs for every American family — taking on the drug companies, leveling the playing field so Americans don’t pay more than other countries for their medicines, and ending the rigged system that keeps drug company profits and prices high. Too many American families are staying up at night worrying about rising prescription drug prices and choosing between getting their medication and paying their rent. The big drug companies have spent billions to rig the system so they keep prices high and profits going up, but that ends with this bill. 

  • The plan gives Medicare the power to negotiate with drug companies for lower drug prices.
  • Not only will those on Medicare benefit from lower drug prices, but the lower prices would apply to anyone purchasing drugs no matter how they are insured. Prices would go down for those who get insurance from employers and buy it directly from insurance companies. Whether you’re a child with asthma, a teen with diabetes or a young parent with a rare illness, this bill will bring drug prices down for everyone. 
  • This plan will stop unjustified price gouging for thousands of medications, including insulin, and require drug companies to lower their prices or pay a penalty. 
  • Drug companies would be penalized if they keep the system rigged and their prices high. 
  • No longer will drug companies be allowed to charge Americans double and triple the price for the same prescription drugs as others pay around the world. 

Nonpartisan analysis from the CBO and CMS Office of the Actuary confirms the bill will reduce drug prices by up to 55% and save patients and taxpayers hundreds of billions of dollars over the next few years. 

  • Newly-released analysis from the nonpartisan Congressional Budget Office and the CMS Office of the Actuary the bill confirm it will reduce negotiated drug prices by as much as 55 percent – saving patients an estimated $158 billion over the next few years and decreasing deficits by $345 billion. 

Republicans continue to stand with the drug companies, and oppose the key elements of this plan to reduce drug prices.

  • President Trump has stood with the big drug companies whenever he can. He refuses to support giving Medicare the power to negotiate with drug companies for lower drug prices, gave drug companies billions in tax breaks and has put former drug executives in charge of his health care policy.
  • Republicans gave nearly $100 billion in tax breaks to the biggest drug companies just last year.
  • Big drug company supporters have already started funding secret groups to attack this plan. 
  • Republicans have voted, repeatedly, to let health insurance plans stop covering any of the costs of prescription drugs.
  • Senate Republicans voted against Medicare negotiations in the Senate Finance Committee last month.

Drug Prices Are Soaring Under Trump

Drug Prices In 2019 Surged Compared To The Year Before. With Hikes At 5 Times Inflation — “More Than 3,400 Drugs Have Boosted Their Prices In The First Six Months Of 2019.” “Price hikes on prescription drugs are surging in 2019, despite vows from the Trump administration to rein in pharmaceutical costs. So far in 2019, more than 3,400 drugs have boosted their prices, a 17% increase compared with the roughly 2,900 drug price increases at the same time in 2018, according to a new analysis by Rx Savings Solutions, a consultant to health plans and employers. The average price hike for those 3,400 drugs stands at 10.5%, or about 5 times the rate of inflation, the study found.” [CBS News, 7/1/19]

AARP Analysis Found Specialty Drug Prices Have Grown More Than Three Times Faster Than Inflation. “The prices of widely used specialty prescription drugs grew more than three times faster than general inflation in 2017…The new report found that the average annual price for a single specialty drug used on a chronic basis is now nearly $79,000, compared to $27,824 in 2006.” [AARP, 6/25/19

Insulin Costs Have Tripled Over The Past Decade. As costs continue to rise, as many as one in four of the 7.5 million Americans dependent on insulin are skipping or skimping on doses.

Despite Tough Rhetoric, Trump And His Republican Allies Continue To Block Meaningful Reform.

Trump And His Republican Allies Continue To Block Medicare Negotiation For Lower Drug Prices. Even though 86 percent of Americans support allowing the federal government to negotiate drug prices for Medicare beneficiaries, Republicans refuse to allow Medicare to negotiate. A 2018 Senate Homeland Security and Governmental Affairs Democratic Committee report found that Medicare Part D could save $2.8 billion in a single year if it were allowed to negotiate drug prices. 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 recently blocked by Senate Republicans.

And Don’t Forget, The Trump Tax Bill Gave Drug Companies Billions Of Dollars In Tax Breaks.

  • Pharmaceutical Companies Reaped Huge Benefits From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expected to gain $10 billion in tax savings during 2018 alone. Most of the tax break for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. According to Axios, nine pharmaceutical companies are spending a combined $50 billion on new share buyback programs. 
  • Despite Massive Profits From Tax Bill, Pharma Continued To Raise Prices. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion – the highest of any publicly traded health care company. Of the 19 companies that tallied at least $1 billion of third-quarter profit, 14 were drug companies. Meanwhile, pharmaceutical companies continue to increase prices. In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills. 

For more on Trump’s broken promises on drug pricing, click here


State-By-State Facts Sheets