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October 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. 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. Senate resolution to reverse the Trump administration’s attacks on protections for people with pre-existing conditions, 
  3. And 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

Polls continue to show health care remains the number one issue for voters. In the past month, the contrast between Democrats and Republicans’ health care priorities makes clear who is on their side. Since returning from their August Recess, Democrats in the House and Senate have moved quickly to put legislation forward to lower the cost of prescription drugs and crack down on Trump administration sabotage. Last week, Speaker Pelosi and House Democrats unveiled the Lower Drug Costs Now Act, a landmark bill that would end the ban on Medicare from negotiating for lower drug prices and impose the strongest-yet enforcement measures to hold big pharma accountable. In the Senate, Democrats have introduced a resolution to reverse the Trump administration’s push for junk insurance plans that don’t cover pre-existing conditions, a key component of the administration’s sabotage agenda to undermine health care. 

As Democrats have advanced proposals that voters in both parties overwhelmingly support, Republicans have dug in deeper on their efforts to sabotage the Affordable Care Act. A decision in the disastrous Texas lawsuit in the Fifth Circuit Court of Appeals is expected in the coming weeks. If the court rules in the administration’s favor, our entire health care system will be overturned stripping health care from 20 million Americans and protections for 130 million Americans with pre-existing conditions as well as costs skyrocketing across the board. 

The contrast is clear: Democrats are following through on their promise to lower drug prices, hold insurance companies accountable for rigging the system and ensure Americans with pre-existing conditions don’t lose their protections. Meanwhile, Republicans have cozied up to big insurance and drug companies while pushing junk insurance to undermine protections for pre-existing conditions all while supporting a lawsuit that would strip health care from millions of Americans. 

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. This plan delivers on the promise Democrats made in 2018 to reduce the cost of drugs and take on the big drug companies but Republicans continue to stand with the drug companies instead. 

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 ends the ban on Medicare negotiating directly with drug companies to lower prescription drug prices. 
  • Not only will those on Medicare benefit from lower drug prices, but the lower prices would apply to anyone purchasing drugs whether or not they are covered by Medicare. 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 reverse the 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 fail to lower prices. 
  • No longer will Americans have to pay double and triple the price for the same prescription drugs as others pay around the world. 

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 could. He refuses to support Medicare negotiations, gave them billions in tax breaks and has put former drug company 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

Making the Senate GOP Choose Sides: The Protect Pre-Existing Conditions Act

In September, Senate Democrats under the leadership of Senator Mark Warner (D-VA) filed a discharge petition to force a vote on the Protect Pre-Existing Conditions Act which would undo the Trump administration’s new junk insurance plans that don’t cover people with pre-existing conditions. A vote on this resolution will make Senate Republicans choose: vote in favor of protecting for the 130 million Americans with pre-existing conditions or continue supporting Trump’s efforts to undermine those protections. 

As Senate Democrats are once again proving they are focused on saving vital protections for the 130 million Americans with pre-existing conditions, Republicans want to send us back to the days when insurance companies could deny coverage or charge more for people with pre-existing conditions – which is exactly what these junk insurance plans do. 

President Trump Wants To Gut Crucial Protections. If He Gets His Way:

  • Protections for people with pre-existing conditions would be essentially meaningless. The American Cancer Society Cancer Action Network said allowing states to waive essential health benefits “could render those protections meaningless” for people with pre-existing conditions.
  • It would be harder for people with pre-existing conditions to get affordable coverage. As Consumers Union stated, allowing states to waive essential health benefits would be “putting meaningful coverage out of reach for many Americans, especially those with chronic and pre existing conditions.”
  • You could pay more for the same coverage. The Trump administration would allow states to adjust the amount of premium tax credits and cost sharing consumers receive to help lower their costs. Without the guardrail to ensure coverage is just as affordable, many consumers could end up paying more for the same care. 
  • Insurers would not have to cover essential benefits, like maternity care. Right now, every insurance plan must cover the 10 essential health benefits. Because states could opt out of covering these basic benefits, insurers would likely only offer policies that covered much less than they do now. The Kaiser Family Foundation found that the benefits most likely to no longer be covered would be maternity care, mental health or substance abuse coverage. 
  • Insurers could reimpose lifetime and annual limits. Allowing states to opt out of the essential health benefits coverage means that insurance companies could once again put lifetime and annual limits on the amount of care you receive. The Center for American Progress estimates that 20 million people with health coverage through their employer would face lifetime limits on coverage, and 27 million would face annual limits.

Polling Confirms That Voters Overwhelmingly Support Protecting Pre-Existing Conditions And Reject Junk Plans:

Pre-Existing Conditions

  • Nearly 70 Percent Of Voters Believe Protections For Pre-Existing Conditions Should Be A “Top Priority” For Congress. [Kaiser Family Foundation, 9/12/19
  • 72 Percent Of Voters Say It Is “Very Important” That The ACA’s Protections For Pre-Existing Conditions Remain In Place. [Kaiser Family Foundation, 7/30/19

Junk Plans

  • 82% Of Republican Voters And 85% Of Voters Overall Support Stopping Health Insurance Companies “From Selling Junk Health Insurance Plans That Do Not Provide Coverage For Essential Medical Treatments And Drugs Or Plans That Discriminate Against People With Preexisting Medical Conditions.” [Hart Research, 1/28/19]
  • 69 Percent Of Voters Support Stopping Insurance Companies From Selling Junk Health Insurance Plans That Do Not Cover Prescription Drug Costs Or Protect People With Pre-Existing Conditions. [Public Policy Polling for Protect Our Care, 5/6/19
  • When Presented With Republican And Democratic Messaging On Junk Plans, Voters Agree With Democrats Over Republicans By A 16-Point Margin (58-42). [Hart Research, 1/28/19]
    • Democrats say: “Democrats who want to make sure that insurance companies actually provide the coverage you need when you get sick and require insurance companies to cover people with preexisting conditions.” Republicans say: “Republicans who want to lower the cost of your health care by eliminating requirements that you need to pay more for insurance coverage than you want or need”

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. 

State-By-State Facts Sheets