To: Interested Parties
From: Brad Woodhouse, Protect Our Care Campaign Director
Date: October 13, 2017
Re: President Trump’s Deliberate Sabotage of Our Health Care Means He and Republicans in Congress Own The Mess They Created
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This week President Trump and his administration took deliberate actions to sabotage our health care by undermining the insurance markets. On Thursday, President Trump signed an Executive Order that would roll back key protections and result in garbage insurance, raise premiums, reduce coverage and expose millions of Americans again to discrimination based on pre-existing conditions.
Then later that night, his administration announced it would default on payments that help lower people’s out-of-pocket costs known as cost-sharing reductions, or CSRs. The nonpartisan Congressional Budget Office said failure to make these payments would result in higher premiums of 20 to 25 percent, make insurers leave the marketplace, and add nearly $200 billion to the national debt.
Why is he doing this? The answer is clear: out of spite and political games. He failed repeatedly to pass a so-called “repeal and replace” bill through Congress, so now he is purposely sabotaging the markets. This is repeal by another means, pure and simple. As he recently stated at the Values Voters Summit, “It’s step by step by step…And one by one, it’s going to come down.”
President Trump famously said “the best thing we can do…is let Obamacare explode” and “let it be a disaster because we can blame that on the Democrats.” But as his actions this week lay bare, he is not letting Obamacare fail, he is making Obamacare fail, and more people are realizing he and Republicans now own the mess they’ve created.
Take a look at some of the headlines this week after the administration announced it would no longer pay cost-sharing reductions:
- Washington Post: Throwing a bomb into the insurance markets, Trump now owns the broken health-care system
- Washington Post: Trump’s not going to be able to avoid blame for kneecapping Obamacare
- Vox: Trump’s acting like Obamacare is just politics. It’s people’s lives.
- NPR: Trump Administration To End Obamacare Subsidies For The Poor
- Forbes: Trump’s End To Obamacare Subsidies Hurts Patients, Not Insurers
- Bloomberg: Trump Cuts Off Health-Insurer Subsidy, Threatening Obamacare Chaos
Here Are All the Ways the Trump Administration Is Sabotaging Health Care
The Trump administration’s actions this week to sabotage our health care are not the first. Since taking office earlier this year, President Trump, his administration and allies in Congress, have been doing anything and everything they can to undermine our health care. Their intended goals are to make fewer people sign up for coverage either by making coverage so expensive people drop out, or by not giving consumers the tools they need to get covered, and to force insurers out of the marketplace to force it to collapse.
Here is what they have done so far:
- On his first day in office, President Trump signed an Executive Order directing the administration to find any ways they could to unravel the Affordable Care Act.
- For the final days of open enrollment in January 2017, the Trump Administration cut 75% of television advertising and all digital advertising that helped people find out about their health care options- resulting in an estimated 500,000 fewer people getting coverage.
- The Trump administration cut the number of days people could sign up for coverage in half for future enrollment periods, from 90 days to 45 days.
- The Trump administration cut the outreach ad budget by 90 percent, from $100 million to just $10 million. Advertising is a critical way for people to know when and how they can get covered.
- The administration plans to be shutting Healthcare.gov down for part of the day on most Sundays.
- The administration ordered the Department of Health and Human Services’ regional directors to stop participating in open enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell said, “I didn’t call it sabotage…But that’s what it is.”
- The administration has cut in-person assistance and changed the final deadline to sign up.
- The Trump administration essentially rolled back a rule that would allow employers to deny millions of women free access to birth control under the Affordable Care Act.
- The Trump administration for months has threatened to stop funding CSRs, only making the payments on a month-to-month basis. Yesterday, they announced they would not be making the October payment.
- President Trump signed an Executive Order that would roll back key protections and result in garbage insurance, raise premiums, reduce coverage and expose millions of Americans again to discrimination based on pre-existing conditions.
We Pay the Price for Trump’s Sabotage
This may be a political game for President Trump because he wants to get rid of anything President Obama did, but all of us will pay for his spite. As the chair of the Senate Health, Education, Labor and Pension Committee Lamar Alexander (R-TN) said, “Without payment of these cost-sharing reductions, Americans will be hurt.”
We are already seeing this in action. Protect Our Care issued a report last week showing that in at least 20 states, insurers had raised their premiums more than they would have because of President Trump’s threat to withhold CSR payments. Who knows how they will react now that he actually did? Some insurers could try to readjust their rates higher or leave the marketplace altogether.
Experts agree, failing to make these payments will mean higher premiums and will explode the national debt.
- Congressional Budget Office: Congressional Budget Office says that failure to make these payments would mean people’s health insurance premiums will go up 20 to 25 percent and add nearly $200 billion to the debt over the next decade.
- Center for American Progress: “The Center for American Progress estimates that uncertainty around CSRs and mandate enforcement will raise 2018 premiums for benchmark coverage an extra $1,061 annually for a 40-year-old and $2,491 annually for a 64-year-old.”
- Kaiser Family Foundation: “Benchmark premiums would increase by 19 percent on average if cost-sharing subsidies were unpaid.”
- Urban Institute: “We find that premiums for silver marketplace plans would increase $1,040 per person on average.”
- Urban Institute: “A precipitous drop in insurer participation is even more likely if the cost-sharing assistance is discontinued.”
- Commonwealth Fund: “Eliminating cost-sharing reductions could destabilize insurance markets.”
- Kurt Giesa, Practice Leader, Oliver Wyman Actuarial Consulting: “Our modeling shows that this uncertainty, if it remains, could lead payers to submit rate increases between 28 and 40 percent, and more than two-thirds of those increases will be related to the uncertainty around CSR payments and individual mandate.”
State Insurance Commissioners and Agencies
- Julie Mix McPeak, President-Elect, National Association of Insurance Commissioners and Tennessee State Insurance Commissioner: “I am very fearful that we’ll have insurers make a decision to leave markets as a result of the uncertainty.”
- Teresa Miller, Pennsylvania Insurance Commissioner: “Failing to make payments to insurers for cost-sharing reductions would force insurers to request a statewide average 20.3 percent increase rather than 8.8 percent statewide average that was filed with the department in may.”
- Mike Kreidler, Washington State Insurance Commissioner: “The current federal administration’s actions — such as not committing to reimburse insurers for cost-sharing subsidies and not enforcing the individual mandate — appear focused only on destabilizing the insurance market.”
- Lori Wing-Heier, Director, Alaska Division Of Insurance: “It is expected that health care premiums would jump as high as 20 percent if trump follows through with his threat to cut subsidies.”
- Dave Jones, California State Insurance Commissioner: “President Trump appears on a mission to destroy health-insurance markets by creating instability through his own actions and thereby depriving millions of Americans of health-care coverage.”
- Marguerite Salazar, Colorado’s State Insurance Commissioner: “Commissioner Marguerite Salazar said the Trump Administration threatens the whole market. ‘My fear is it may collapse.’”
- Determination by the Florida Office of Insurance Regulation: “Florida regulators said most of the average rate hike — 31 percentage points [of the 44.7 percent total] — came from standard plans sold on the ACA exchange at Healthcare.gov. Insurers raised rates for those plans due to the political uncertainty that has plagued the healthcare debate, specifically whether the Trump administration will stop paying subsidies that lower out-of-pocket costs for low-income Americans.”
- Eric A. Cioppa, Superintendent, Maine Bureau Of Insurance: “If they don’t get a subsidy, i fully expect double-digit increases for three carriers on the exchanges here.”
Health Care Industry
- U.S. Chamber of Commerce, American Benefits Council, American Hospital Association, Federation of American Hospitals, American Medical Association, American Academy of Family Physicians, BlueCross BlueShield Association, America’s Health Insurance Plans: The most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions (CSRs)…If CSRs are not funded, Americans will be dramatically impacted.”
- National Academy for State Health Policy: “The Federal Government must commit to funding CSR payments in order to lower rates and stabilize carrier participation.”
- Dan Hilferty, President and CEO, Independence Blue Cross: “We firmly believe your coverage will be there for 2018, if the federal government, Congress and president commit to, fund the subsidies during an interim period of time.”
- Kelly Paulk, Vice President, Product Strategy and Individual Markets, Blue Cross Blue Shield of Tennessee: “We have to factor in two significant uncertainties…combining those two factors leads to an average 21 percent rate increase.”
- Danielle Devine, Michigan Director of Operations, Meridian Health Plan: “The political climate continues to make it difficult to price and the uncertainty over the future of the subsidies creates the largest reason for significant rate increases.”
- Rick Notter, Director of Individual Business, Blue Cross Blue Shield of Michigan: “If we don’t have that cost-sharing (subsidy), we have to make up the difference and the only way for us to do that is with a higher rate.”
- Dr. Mario Molina, Former CEO, Molina Healthcare: “The Administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don’t let them fool you.”
- Brad Wilson, CEO, Blue Cross Blue Shield of North Carolina: “The failure of the Administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower.”
Americans Will Rightly Hold Republicans Accountable for Sabotage
President Trump and Republicans in Congress might hope that people will blame President Obama and Democrats for rising premiums and limited choices on the marketplace, but that is not the case. As the Wall Street Journal editorial board wrote, “Republicans run the government and that means they are responsible for what happens in health care.”
An April 2017 Kaiser Health tracking poll found that 64 percent of Americans, including ⅔ of independents and a majority of Republicans, said they would blame Republicans and President Trump for any future problems with health care and the Affordable Care Act (ACA) going forward. The same poll found that 74 percent want Trump and his Administration to do what they can to make the current law work — that includes 8 in 10 independents and over half of Republicans.
Moreover, a recent poll by Hart Research Associates found that “nearly two-thirds (64%) of voters believe it is true that Donald Trump is ‘undermining the Affordable Care Act’ and three-in-five (61%) voters believe that he is actively ‘trying to make the Affordable Care Act fail.’ Additionally, 64% say that Trump is ‘playing politics with people’s healthcare,’ including one-in-four (24%) of his own voters. Along similar lines, a 57% majority believe that the president is ‘sacrificing people’s health care in order to oppose Barack Obama.’”
Republicans Can Stand Up to Trump’s Sabotage — Will They?
President Trump doesn’t get to have the final word on this — the courts, Congress and the American people will have the opportunity to be heard as well. For starters, many Republicans in Congress are on the record supporting these cost-sharing reduction payments. Will they stand up to the Trump administration to keep premiums from skyrocketing and adding $200 billion to our debt? Neither Congress nor the American people stood by for that failed legislative effort and there is no reason to stand by now and allow a president to sabotage the American health care system out of spite and pure politics.
- Senate Majority Leader Mitch McConnell (R-KY): “If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur…No action is not an alternative. We’ve got the insurance markets imploding all over the country, including in this state.”
- Senate HELP Committee Chairman Lamar Alexander (R-TN): “Without payment of these cost-sharing reductions, Americans will be hurt.”
- Senate Finance Committee Chair Orrin Hatch (R-UT): “I think they’re going to have to be paid.”
- Sen. John Thune (R-SD): “I hope the President will continue to make those payments.”
- Senate Homeland Security Committee Chair Ron Johnson (R-WI): The Senate should “bite the bullet and stabilize those markets.’”
- Sen. Bill Cassidy (R-LA): “Families would be hurt.”
- Sen. Susan Collins (R-ME): “So, it really would be detrimental to some of the most vulnerable citizens if those payments were cut off. They’re paid to the insurance companies, but the people that they benefit are people who make between 100 percent and 250 percent of the poverty rate. So, we’re talking about low-income Americans who would be devastated if those payments were cut off, though the threat to cut off those payments has contributed to the instability in the insurance market.”
- Sen. Susan Collins (R-ME): “Susan Collins says she’s ‘very concerned’ with Trump’s new ACA EO and decision to do away with CSRs.”
- Sen. Lisa Murkowski (R-AK): “As I’ve been saying, the Senate should take a step back and engage in a bipartisan process to address the failures of the ACA and stabilize the individual markets.”
- House Deputy Majority Whip Rep. Tom Cole (R-OK): [On making CSR payments] “My personal opinion is yes.”
- House Ways And Means Committee Chairman Kevin Brady (R-TX): “We should act within our constitutional authority now to temporarily and legally fund cost-sharing reduction payments as we move away from Obamacare.”
- House Energy And Commerce Committee Chair Greg Walden (R-WA): “I will do everything I can to make sure the cost-sharing reduction payments get made, especially this year where they were promised by the federal government under the contracts…That’s an obligation not only to insurers but also to the people who took on those plans. We cannot leave them high and dry.”
- Rep. Phil Roe (R-TN): “If we pull the subsidies … I think there would be nobody with a health insurance plan next year.”
- Rep. Kevin Cramer (R-ND): “As long as it’s [the subsidies] are part of the law of the land, it’s our job to appropriate the money.”
- Rep. Ileana Ros-Lehtinen (R-FL): “Cutting Health Care Subsidies Will Mean More Uninsured In My District. @POTUS Promised More Access, Affordable Coverage. This Does Opposite.”
- Rep. Carlos Curbelo (R-FL): “Cost Sharing Reductions Are Critical To Low Income Americans. Congress Should Guarantee Their Funding Through The Appropriations Process.”
- Rep. Leonard Lance (R-NJ): “Now Congress must act and pass the Problem Solvers Caucus health care plan that I have endorsed. It funds the cost-sharing reduction program through the congressional appropriations process and implements free-market policies to improve our health care system and lower medical and insurance costs for all.”
- Rep. Tom Reed (R-NY): “If Congress doesn’t get it done the people who suffer are the people back home.”