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. Indeed, it is even more important now to focus back home on kitchen table issues. The recess is a tremendous opportunity to drive home the contrast between Democrats and Republicans and to highlight Democratic efforts to lower costs, protect people with pre-existing conditions, and stop Republicans’ assault on health care.

Protect Our Care is eager to work with you. During this upcoming recess, our state teams are organizing around three key events happening this fall:

1. House Democrats’ prescription drug bill.
2. The implications of Trump’s Texas lawsuit, which could be decided by the courts at any time.

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].

Message Guidance From Recent Polling

Health care remains the number one issue for the American people and the number one opportunity for Democrats in the 2020 election. Earlier this month, Hart Research’s Geoff Garin completed a national survey of 1,000 voters to assess attitudes and evaluate messaging on health care for Protect Our Care. Here are Protect Our Care’s recommendations for health care messaging based on those results and our overall view of the opportunity ahead.

THE LANDSCAPE AND THE OPPORTUNITY

Health Care is Issue #1. Forty-eight percent (48%) choose health care as one of their top two issues in deciding how they will vote—the same as it was in June 2018. Health care is a dominant issue among independents (55%), seniors (43%), swing voters for Congress (57%), and undecided voters for President (57%).

Democrats Strong, Trump Weak. By 12 points (56-44%), voters trust Democrats more than Republicans on health care. By 14 points (57-43%), voters disapprove of the job Trump is doing on health care—a deficit that expands to 22 points (39-61%) among voters who are undecided for President. Democrats also have strong advantages as the party more likely to expand the number of people with health insurance (+32), ensure affordable coverage for people with pre-existing conditions (+22), and make sure people don’t have health insurance taken away (+20).

Room to Grow on Health Care. Trust for Democrats on health care almost doubles after message testing reveals the Republican agenda and its consequences. From the initial 12-point (56-44%) advantage, the lead grows to 22 points (61-39%), including 8-point growth among independents, 14-point gain with age 50-64, and 16-point gain with non-college white women.

THE BIG THEMES

Addressing the Rising Cost of Health Care. When asked for their top health care priorities, voters pick reducing health insurance premiums and out-of-pocket costs (39% overall, 40% with independents, 41% with swing voters) and cracking down on excessive prescription drug prices (34% overall, 40% with independents, 37% with swing voters). By a 48 to 31 margin, voters want Democrats to focus on these cost issues, as opposed to advancing proposals for major changes in the health care system to achieve universal coverage.

Standing Up Against Drug & Health Insurance Companies. Voters blame drug and insurance companies for high health care costs. And by a 16-point margin, voters trust Democrats more than Republicans to put average people over drug and insurance companies. Voters overwhelmingly support Medicare negotiations for lower prices.

Protecting People with Pre-Existing Conditions and Opposing an Age Tax. These contrasts between Democrats and Republicans remain extremely powerful.

Protecting Medicare. Republican cuts to Medicare spending are unpopular. Voters over the age of 65 put a top priority on protecting Medicare (57%), and voters in small towns and rural areas are more likely than average to prioritize protecting Medicare (44%). Tying Republican Medicare cuts to their need to fund their huge tax giveaway to the wealthy and big corporations is powerful.

BEST POINTS AGAINST DONALD TRUMP

We tested a list of different aspects of Donald Trump’s health care record to see which would cause him the most problems with voters, particularly undecided voters. His proposal to cut the Medicare budget by $800 million, his tax breaks for drug companies while drug prices soar, and the fact that health care costs are rising faster than wages show that the Trump economy is not working for everyday Americans top the list.

Here are the top three messages based on those results:

• Donald Trump’s proposed federal budget would cut funding for Medicare by more than $800 billion
  • 61% Major Doubts About Reelecting Trump /// 60% Major Doubts Among Undecideds For President
• Donald Trump gave the drug companies billions in tax breaks, the largest drug companies made $50 billion in profits, while drug prices for average people continue to soar
  • 60% Major Doubts About Reelecting Trump /// 60% Major Doubts Among Undecideds For President
• Under Donald Trump, health care costs have risen faster than people’s wages—to nearly $20,000 per year for the average family—making it harder and harder for many Americans to get ahead. The Trump economy is not working.
  • 59% Major Doubts About Reelecting Trump /// 59% Major Doubts Among Undecideds For President

BEST FIGHTS TO HAVE WITH REPUBLICANS

Among all the different health care debates that could happen, three contrasts give the biggest advantage to Democrats and are the most important battles for people to see us engaging in. Among Congressional swing voters, the Democrat has an advantage of at least 46 points on all three of these contrasts. These include the debate around Medicare negotiations, the consequences of health care repeal, pre-existing conditions and age tax, and Republican cuts to Medicare. Here are our recommended top messages for a Democrat to deliver:

• I support giving Medicare the power to negotiate with the drug companies to lower drug prices. The Republican favors keeping the current ban that prevents Medicare from negotiating for lower drug prices.
  • (63% more likely to vote for the Democrat, 16% more likely to vote for the Republican).
• Republicans favor repealing the Affordable Care Act (Obamacare) and replacing it with a new law that would eliminate protections for people with pre-existing conditions and allow insurance companies to charge older people five times more for their coverage than younger people. I oppose forcing people with pre-existing conditions and older people to pay much more for their coverage.
  • (62% more likely to vote for the Democrat, 23% more likely to vote for the Republican).
• Republicans favor cutting the amount the federal government spends on Medicare. I oppose cutting funding for Medicare.
  • (58% more likely to vote for the Democrat, 21% more likely to vote for the Republican). 

BEST PROACTIVE AGENDA

We tested to see what voters said their top priorities were for Congress, particularly among swing voters. Here were the top three:

• Reduce health insurance premiums and out-of-pocket costs
  • 39% among all voters // 41% among swing voters
• Protect Medicare for older Americans
  • 36% among all voters // 36% among swing voters
• Crack down on excessive prescription drug prices
  • 34% among all voters // 37% among swing voters

LEAN INTO THE FIGHT OVER PRESCRIPTION DRUGS (HR 3)

The drug price issue is critically important to voters. Cracking down on drug costs is the top priority for 34% of voters—including 40% of independents and 37% of swing voters—and it’s an issue Democrats currently have a 13-point advantage on (47-34%).

Medicare negotiation may be our best single debate to engage in with Republicans. The debate over Medicare negotiations is one that makes people more likely to vote for a Democrat, by 47 points (63-16%). This advantage extends to 62 points (67-5%) with independents, 51 points (59-8%) with undecided voters for Congress, and 45 points (61-16%) with seniors.

Here are the key messages:

Democrats support giving Medicare the power to negotiate with drug companies to lower drug prices. (This language works far better than “supporting giving Medicare the power to negotiate with the drug companies.” This is likely because most voters don’t know a ban exists to begin with.)

• Our bill will mean lower prices for everyone, no matter where they get their insurance.
• Our bill means that Americans will not have to pay more for their medicines than people do in other countries. (97% of Americans agree with us on this, including 74% who agree strongly.)
• Our bill will use the savings we get for the federal government and reinvest them back to provide vision, dental, and hearing benefits for seniors

EFFECTIVE MESSAGING ON TRUMP’S LAWSUIT TO REPEAL THE ACA

The Trump Lawsuit Comes at a Time When the ACA is More Popular Than Ever. Republicans are suing to overturn the ACA when favorability towards the “the Affordable Care Act (aka Obamacare)” is +16 (58-42%) today, up from +8 (54-46%) in January and up—significantly—from -2 (49-51%) in December 2016.

A Debate About the Lawsuit Helps Democrats and Hurts Republicans. The debate over the lawsuit makes people more likely to vote for a Democrat by 29 points (55-26%).

Focus on the Specific Real-Life Consequences of the Lawsuit, not the Affordable Care Act Itself: While the law remains popular, the specific provisions such as protections for pre-existing conditions, coverage for 20 million Americans, and Medicaid expansion are individually much more popular than talking about law as a whole.

Here are the key messages:

The Texas lawsuit to repeal our health care law is the Trump and Republican health care plan. They are trying to do in court what they couldn’t do in Congress. They won’t stop in their efforts to take away affordable, quality health care from American families.

• Protections for over 135 million Americans with pre-existing conditions would be eliminated. Insurance companies could deny them coverage altogether or charge them more.
• 20 million people would lose insurance coverage, increasing the uninsured rate by 65%.
• 12 million seniors would pay more for their prescription drugs.
• If the case is appealed to the Supreme Court: two Trump appointed justices, supported by every Republican in the Senate, would hold the future of your health care in their hands. 

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

House Democrats have put forward 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.

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

Since President Trump was sworn into office, he and Republicans have waged a relentless war on American health care. Against the loud objections of the American people, Trump and his allies have repeatedly tried to repeal and sabotage the health care law in Congress, administratively and in the courts. This strategy was resoundingly rejected by the American people in November when they voted out scores of pro-repeal Republicans and put Democrats in charge of a Health Care Congress.

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 is 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 the Trump-Texas 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-Texas 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 130 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, 17 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.
• An estimated 689,077 veterans would become uninsured by 2026 if the ACA is overturned. Veterans benefited immensely from Medicaid expansion and the ACA’s subsidies for purchasing insurance in the marketplaces. Ultimately, the ACA reduced the number of uninsured veterans by more than one third.
• 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.

Republicans Want To Put Insurance Companies Back In Charge, Ending Protections For The 130 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 130 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

• 17 million children, 68 million women, and 30 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.