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Alabama Archives — Protect Our Care

Protect Our Care Releases New Report Detailing the Threats Republican Policies Pose to Rural Health Care in Alabama

Senator Doug Jones’ SAME Act Would Help Expand Coverage and Benefit Rural Communities, Addressing the Unique Problems Outlined in New Report

Washington, DC — A day after Senator Doug Jones introduced the SAME Act, a bill that would benefit rural communities by providing each state expanding its Medicaid program with the same levels of Federal matching funds regardless of when it chooses to expand the program, Protect Our Care released a new report, “A Tough Row to Hoe: How Republican Policies are Leaving Alabama’s Rural Health Care in the Dust.” The report looks at how Republican sabotage of the Affordable Care Act and relentless attacks on Medicaid expansion have done damage to rural residents of the state, who face both a lack of coverage and a lack of care in their communities.  

Read the report here.

“Our report shows how President Trump and his Republican allies in Congress have stopped at nothing to wreak havoc on our health care, resulting in especially devastating impacts in rural America,” said Brad Woodhouse, executive director at Protect Our Care. “Premiums have risen, coverage has been lost, and rural hospitals face constant uncertainty as rural health care is threatened. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and Senator Jones’ leadership on the SAME Act is a major step towards encouraging more states to expand Medicaid and ensuring rural Americans will have access to the health care coverage they so desperately need.”

By The Numbers: Rural Health In Alabama


19 percent of Alabamians living in rural areas are uninsured, compared to 16 percent of Alabamians living in nonrural areas.

Since the Affordable Care Act, the uninsured rate has fallen by 9 percent in rural parts of Alabama.

24 percent of Alabamians living in rural areas have health coverage through Medicaid.

The Affordable Care Act led to a $112 million reduction in Alabama uncompensated care costs. Between 2013 and 2015, Alabama hospitals’ uncompensated care costs decreased by $112 million, or roughly 18 percent.

314,000 Alabamians could gain coverage if the state were to expand Medicaid. By failing to do so, the Robert Wood Johnson Foundation (RWJF) and Urban Institute estimate that 314,000 Alabamians are being denied coverage through the program. If Alabama were to expand Medicaid, it is estimated that the uninsured rate would drop from 17.5 percent to 12.5 percent.

21 rural hospitals in Alabama are at a high financial risk of closing. This represents roughly 50 percent of the state’s rural hospitals.

In Alabama, where lawmakers refused to expand Medicaid, five rural hospitals have closed since 2010, with a sixth expected to close in March.

These hospitals include:
Georgiana Medical Center (AL-02, will close in March 2019)
Florala Memorial Hospital (AL-02, closed in 2013)
Elba General Hospital (AL-02, closed in 2013)
Chilton Medical Center (AL-06, closed in 2012)
SouthWest Alabama Medical Center (AL-07, closed in 2011)
Randolph Medical Center (AL-03, closed in 2011)

Protect Our Care Praises Effort Led by Senators Mark Warner (D-VA) and Doug Jones (D-AL) to Support Medicaid Expansion

The SAME Act Will Lead to Expansion of Coverage and Benefit Rural Communities

Washington, DC–Today, Senators Mark Warner (D-VA) and Doug Jones (D-AL), among others, introduced the States Achieve Medicaid Expansion (SAME) Act, which would provide each state expanding its Medicaid program with the same levels of Federal matching funds, regardless of when it chooses to expand the program. Brad Woodhouse, executive director of Protect Our Care, praised the legislation in a statement:

“Medicaid expansion has been one of the most successful facets of the Affordable Care Act, providing millions of Americans with the health care coverage they so desperately need. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and has helped rural hospitals keep their doors open. The SAME Act will not only give all states that enacted Medicaid expansion the same funding benefits, it will incentivize more states to follow suit. Under the leadership of Senators Mark Warner and Doug Jones, the SAME Act is a major step toward ensuring better access to care, lowering costs, and keeping rural hospitals open.”

BACKGROUND:

Medicaid Expansion Is A Lifeline To Rural Communities. The Affordable Care Act opened the doors to Medicaid expansion, which has significantly expanded access to health care in rural communities, reduced rural hospitals’ uncompensated care costs, and helped rural health providers keep their doors open by allowing states to expand Medicaid coverage for adults up to 138 percent of the federal poverty line. Medicaid expansion allowed 1.7 million rural Americans to gain coverage who had not previously been eligible.

Following Medicaid Expansion, The Uninsured Rate In Rural Parts Of Expansion States Decreased By A Median Of 44 Percent. In rural states that expanded Medicaid, the uninsured rates dropped significantly after the ACA became law:

  • In Montana, the uninsured rate dropped from 19 to 8.5 percent between 2013 and 2016.
  • In Kentucky, the uninsured rate dropped from 16.3 to 7.2 percent between 2013 and 2016.
  • In Arkansas, the uninsured rate dropped from 17.8 to 9.1 percent between 2013 and 2016.
  • In West Virginia, the uninsured rate dropped from 14.2 to 8.8 percent between 2013 and 2016.

By Reducing Uncompensated Care Costs, Medicaid Expansion Means Hospitals Have Greater Financial Security. Medicaid expansion also drastically reduced the amount of costs that a hospital absorbs for any treatment or service not paid for by an insurer or patient, known as uncompensated care.. The Center on Budget and Policy Priorities finds that “states that expanded Medicaid to low-income adults under the ACA saw both larger coverage gains and larger drops in uncompensated care: a 47 percent decrease in uncompensated care costs on average compared to an 11 percent decrease in states that did not expand Medicaid.” CBPP concludes that these declines in uncompensated care were “almost certainly” the result of the ACA’s coverage gains.

A June 2018 Protect Our Care Analysis Found That The Vast Majority Of Rural Hospital Closures Since 2010 Were In States That Had Refused To Expand Medicaid. Between 2010 and June 2018, 84 rural hospitals closed. The vast majority of those rural hospital closures, 77 percent, occurred in states that refused to expand Medicaid. Nearly 90 percent of the rural hospitals that have closed since 2010 were located in states that refused to expand Medicaid by the time of their closure. Only 10 out of 84 rural hospitals closed in states after they had expanded Medicaid; of hospital closures in states that expanded Medicaid, nine closed before the state expanded the program. Since Protect Our Care’s June report, even more hospitals have closed. The Scheps Center Rural Health Research Program tracks that 97 rural hospitals have closed since 2010.

Why Alabamians’ Insurance Is Getting Even More Expensive: The Trump Administration and Washington Republicans Keep Sabotaging Health Care

Washington, D.C. – As preliminary Alabama rate filings for 2019 individual-market health insurance indicated premium increases as high as 4 percent due to Washington Republicans’ repeal-and-sabotage agenda, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“For the past year and a half, President Trump and his Republican allies in Congress have engaged in a deliberate, aggressive campaign to sabotage health care and now families in Alabama are paying the price in increased premiums. Costs are going up for hardworking Alabamians, but the Republican tax bill gave insurance companies its record tax breaks and soaring profits. Until we stop Republicans’ war on health care, health care experts predict that rates will keep rising by double digits. Washington Republicans should stand up to the Trump Administration’s sabotage campaign and start working on bipartisan solutions to make coverage more affordable.”

Insurance Companies In Alabama Blame the Trump Administration and Congressional Republicans for Higher Premiums:

Blue Cross Blue Shield Of Alabama: GOP Repeal Of Individual Mandate And Embrace Of Short-Term Plans Driving Up Rates. “The main drivers of the proposed rate changes are as follows: Anticipated changes in the average morbidity… Short‐Term Limited Duration plans, Association Health Plans, and the non‐enforcement of the individual mandate will continue to impact morbidity in 2019. It is expected that those members leaving the ACA Individual market will have lower claims cost than average.” [BCBS, 7/24]

Why Alabamians’ Insurance Is Getting Even More Expensive: The Trump Administration and Washington Republicans Keep Sabotaging Health Care

While spending most of last year trying to repeal the Affordable Care Act (ACA) and waging a war on our health care, President Trump and Republicans in Congress have also used their control of Washington to actively sabotage our health care every chance they get – leading insurance companies to raise premiums for 2018 and 2019  Republicans’ goal is simple: sabotage and undermine the Affordable Care Act, then blame everyone but themselves for the consequences of their actions. President Trump keeps rooting for disaster, saying that “The best thing we can do…is let Obamacare explode” and “Let it be a disaster because we can blame that on the Democrats.

Now, initial rate filings in Alabama are forecasting rate hikes this fall because of Republican sabotage.

Republicans never ended their war on our health care. After Congress failed to repeal the Affordable Care Act, the Trump Administration is aggressively sabotaging our health care system and refusing to work to make coverage better and more affordable.

  • Experts from AARP, the Congressional Budget Office, and a wide range of other nonpartisan organizations agree that Republican actions are forcing up health care costs.
  • Republicans in Congress are supporting the Administration’s many actions to undermine health care, despite widespread opposition from patient and disease groups, doctors, nurses, hospitals, plus health care and consumer advocates.
  • The Trump Administration officials keep rewriting the rules to let big insurance companies cover fewer and fewer services while charging people more and more. The sabotage doesn’t stop there: last year the Administration fired many of the community assisters who help people enroll in health care; this year they are planning more enrollment cuts, making it even harder to sign up for coverage.
  • And now, Republicans are encouraging insurance companies to sell more junk plans that don’t have to cover basic care like hospitalization and prescription drugs, and that are allowed to charge people with pre-existing conditions more or even deny them coverage altogether. In Alabama, no short-term plans available have to cover maternity care, and only 24 percent of plans cover prescription drugs.

This could have been avoided: if Republicans had stopped sabotaging health care, American families wouldn’t be facing another huge increase this fall.

  • Even the Trump Administration has admitted that the Affordable Care Act’s insurance marketplaces had been stabilizing prior to them coming into office.
  • The nonpartisan Congressional Budget Office had predicted only modest rate increases if Republicans hadn’t sabotaged the markets.
  • Even Senate Republicans admitted this fall’s upcoming rate hikes were “avoidable,” but then they torched bipartisan stabilization talks at the last minute, prioritizing partisan politics over their last opportunity to help American families afford health care next year.

The Trump Administration’s sabotage will punish Americans by jacking up premiums again, compounding the damage done last year, when Republican sabotage pushed rates up by a national average of 37 percent, and 19 percent in Alabama.

  • The Republican tax bill’s repeal of a key Affordable Care Act provision and the Trump Administration’s junk plan proposal will increase individual market premiums in Alabama by an average 21.6 percent this fall, according to a recent Urban Institute study.
  • This sabotage-driven rate hike will make the damage Republicans inflicted last year through repeal attempts and sabotage even worse.
  • Higher premiums will mean fewer working families can afford coverage: during the first year of the Trump Administration, millions more Americans joined the ranks of the uninsured – the highest increase since Gallup started tracking the uninsured rate.

Despite Republican sabotage, the Affordable Care Act has improved Alabamians’ care.

  • 170,211 Alabamians signed up for Marketplace coverage this year.
  • Thanks to the Marketplace, Alabama’s uninsured rate fell by 7.7 percent between 2013 and 2016 as Alabamians have gained access to affordable coverage.
  • Before today’s announcement, the Urban Institute predicted that Alabama premiums for 2019 could rise 21.6 percent more because of the Trump Administration’s junk plan proposal and the Republican tax bill’s repeal of a key Affordable Care Act coverage incentive.
  • Even despite sabotage, Affordable Care Act subsidies help keep coverage affordable for 90 percent of Alabama Marketplace consumers, whose average 2018 premium is $70 per month.
  • But because of the Republican sabotage agenda, many middle-income Alabamians could pay hundreds or thousands of dollars more than they would have otherwise.

Alabamians won’t forget that Republicans and the Trump Administration keep forcing up health care costs to score political points.

 

  • Health care costs are a top issue in nearly every major issue-ranked poll in 2018.
  • Voters overwhelmingly trust Democrats over Republicans on health care costs.
  • In poll after poll, voters resoundingly reject President Trump and Congressional Republicans’ repeal-and-sabotage campaign against the Affordable Care Act.

 

 

KEY QUOTES

America’s Health Insurance Plans: Administration’s DOJ Decision Would “Cause Rates To Go Even Higher For Older Americans And Sicker Patients.” “Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules that help those with pre-existing conditions. Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019. Instead, we should focus on advancing proven solutions that ensure affordability for all consumers. [AHIP, 6/8/18]

Associated Press: Administration’s Decision Could “Nudge Premiums Even Higher.” “The Trump administration’s decision to stop defending in court the Obama health law’s popular protections for consumers with pre-existing conditions could prove risky for Republicans in the midterm elections — and nudge premiums even higher.” [CNBC, 6/8/18]

Timothy Jost, Washington & Lee University Law Professor: Administration’s Decision Could Leave Millions Of Americans Facing “Denial Of Coverage Or Higher Premiums.” “Yesterday, the Trump administration’s Department of Justice dropped a bombshell in a rural Texas federal courthouse. The administration stated in a court filing (and also in letters to Congressional leaders) that it would not defend three key provisions of the Affordable Care Act (ACA). If the judge in the case agrees, millions of Americans with preexisting conditions could face denial of coverage or higher premiums.” [Commonwealth Fund, 6/8/18]

Ceci Connolly, Alliance Of Community Health Plans: Administration’s Decision Decision Could Spark Fresh Market Instability. “Ceci Connolly, president of the Alliance of Community Health Plans, called the legal position ‘troubling’ and warned it could spark fresh market instability. ‘At the very least it adds uncertainty at exactly the moment when plans are trying to set rates for next year,’ Connolly said in a statement. ‘At the worst, it could strip away guaranteed coverage for those with pre-existing conditions. We don’t want to return to the days when people who needed the care the most could be turned away because of their health status.’” [Modern Healthcare, 6/8/18]

Fortune: If Administration’s Decision Is Implemented, “There’s A Strong Change Insurers Would Begin Charging Sicker People Significantly More.” “To date, many low-income people have been shielded from those increases since federal subsidies to help pay premiums rise in tandem with the spikes. Middle-class families who don’t qualify for the subsidies are left either swallowing the higher premiums or forgoing coverage. If the protections for people with pre-existing conditions are ultimately shot down, there’s a strong chance insurers would begin charging sicker people significantly more for their coverage while younger and healthier Americans would see lower prices.” [Fortune, 6/11/18]

America’s Health Insurance Plans: Administration’s DOJ Decision Would “Cause Rates To Go Even Higher For Older Americans And Sicker Patients.” “Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules that help those with pre-existing conditions. Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019. Instead, we should focus on advancing proven solutions that ensure affordability for all consumers. [AHIP, 6/8/18]

Associated Press: Administration’s Decision Could “Nudge Premiums Even Higher.” “The Trump administration’s decision to stop defending in court the Obama health law’s popular protections for consumers with pre-existing conditions could prove risky for Republicans in the midterm elections — and nudge premiums even higher.” [CNBC, 6/8/18]

Timothy Jost, Washington & Lee University Law Professor: Administration’s Decision Could Leave Millions Of Americans Facing “Denial Of Coverage Or Higher Premiums.” “Yesterday, the Trump administration’s Department of Justice dropped a bombshell in a rural Texas federal courthouse. The administration stated in a court filing (and also in letters to Congressional leaders) that it would not defend three key provisions of the Affordable Care Act (ACA). If the judge in the case agrees, millions of Americans with preexisting conditions could face denial of coverage or higher premiums.” [Commonwealth Fund, 6/8/18]

Ceci Connolly, Alliance Of Community Health Plans: Administration’s Decision Decision Could Spark Fresh Market Instability. “Ceci Connolly, president of the Alliance of Community Health Plans, called the legal position ‘troubling’ and warned it could spark fresh market instability. ‘At the very least it adds uncertainty at exactly the moment when plans are trying to set rates for next year,’ Connolly said in a statement. ‘At the worst, it could strip away guaranteed coverage for those with pre-existing conditions. We don’t want to return to the days when people who needed the care the most could be turned away because of their health status.’” [Modern Healthcare, 6/8/18]

Fortune: If Administration’s Decision Is Implemented, “There’s A Strong Change Insurers Would Begin Charging Sicker People Significantly More.” “To date, many low-income people have been shielded from those increases since federal subsidies to help pay premiums rise in tandem with the spikes. Middle-class families who don’t qualify for the subsidies are left either swallowing the higher premiums or forgoing coverage. If the protections for people with pre-existing conditions are ultimately shot down, there’s a strong chance insurers would begin charging sicker people significantly more for their coverage while younger and healthier Americans would see lower prices.” [Fortune, 6/11/18]

Former HHS Secretary Tom Price: GOP Actions Responsible For Premium Increases. “President Trump’s former top health official on Tuesday said the Republican tax law would raise the cost of health insurance for some Americans because it repealed a core provision of the Affordable Care Act. Tom Price, Trump’s first secretary of the Department of Health and Human Services, said people buying insurance on government-run marketplaces will face higher prices because the tax law repealed the ACA’s individual mandate. The mandate had forced most Americans to have health coverage or face a financial penalty. ‘There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks within that market,’ Price said at the World Health Care Conference in Washington.” [Washington Post, 5/1/18]

America’s Health Insurance Plans: Republican Sabotage Will “Drive Up The Rate Of Premium Increases.” “Policies that disproportionately draw healthy consumers away from the individual market, like expanding access to short-term plans, will likely have an even more devastating effect on affordability, choice and competition. This will further result in adverse selection, drive up the rate of premium increases, and exacerbate affordability issues for many other people.” [America’s Health Insurance Plans Letter to HHS, 4/20/18]

Cynthia Cox, Kaiser Family Foundation: “In The Absence Of Efforts To Undermine The Market, We Would Be Seeing A Period Of Relatively Small Premium Increases.” “‘In the absence of efforts to undermine the market, we would be seeing a period of relatively small premium increases, driven mostly by the underlying growth in health care costs,’ said Cynthia Cox, the lead author of the Kaiser Family Foundation report. ‘I wouldn’t be surprised if we’re in for another year of double-digit premium increases. And if that does happen, it would be in large part due to policy changes that are happening.’” [Huffington Post, 5/18/18]

Kris Haltmeyer, Blue Cross Blue Shield Association Vice President: “With The Repeal Of The Individual Mandate And The Failure Of Congress To Enact Stabilization Legislation, We Are Expecting Premiums To Go Up Substantially.” Kris Haltmeyer, a vice president at the Blue Cross Blue Shield Association, told reporters that the premium increases were in part due to the repeal of ObamaCare’s individual mandate in the Republican tax reform bill in December. He also cited lawmakers’ failure to pass a bill aimed at shoring up the market, which fell apart earlier this year amid a partisan dispute over abortion restrictions. ‘With the repeal of the individual mandate and the failure of Congress to enact stabilization legislation, we are expecting premiums to go up substantially,’ Haltmeyer said. He estimated that average premium increases nationwide will be in the ‘low teens,’ but that there will be major variation across areas, ranging from the low single digits to up to 70 or 80 percent.” [The Hill, 5/23]

New York Times Editorial Board: “The Administration’s Health Care Sabotage Efforts Have Already Had A Big Impact”: A 30-Percent Premium Increase. “The administration’s health care sabotage efforts have already had a big impact — but not the kind of impact officials promised. Insurance companies raised average premiums for 2018 A.C.A. policies by 30 percent. This has mostly hurt middle-class families who have to pay full freight for health insurance because they make too much money to qualify for subsidies and don’t get coverage through their employer. Few experts were surprised when the Commonwealth Fund found that the percentage of American adults who did not have health insurance jumped to 15.5 percent this year, from 12.7 percent before Mr. Trump took office. Experts say those numbers could climb higher still when the penalty for not having insurance goes away next year.” [NYT, 5/3/18]

Commonwealth Fund: Rollback Of Health Insurance Gains Spurred By “Actions By The Current Administration.” “The marked gains in health insurance coverage made since the passage of the Affordable Care Act (ACA) in 2010 are beginning to reverse, according to new findings from the latest Commonwealth Fund ACA Tracking Survey. The coverage declines are likely the result of two major factors: 1) lack of federal legislative actions to improve specific weaknesses in the ACA and 2) actions by the current administration that have exacerbated those weaknesses. These include the administration’s deep cuts in advertising and outreach during the marketplace open-enrollment periods, a shorter open enrollment period, and other actions that collectively may have left people with a general sense of confusion about the status of the law. Signs point to further erosion of insurance coverage in 2019: the repeal of the individual mandate penalty included in the 2017 tax law, recent actions to increase the availability of insurance policies that don’t comply with ACA minimum benefit standards, and support for Medicaid work requirements.” [Commonwealth Fund, 5/1/18]

Center For American Progress: “Combined, The Recent Tax Law’s Repeal Of The Individual Mandate And The Administration’s Short-Term Plan Rule Will Undermine The Individual Insurance Market And Increase Premiums For ACA-Compliant Coverage.” “Last year, as part of the tax law, Congress eliminated the Affordable Care Act’s individual mandate penalty. Given the mandate’s important role in encouraging healthier people to enroll in the marketplaces, the Congressional Budget Office (CBO) estimates that, in 2019, this will increase average premiums in the individual market by 10 percent. Furthermore, in February 2018, the Trump administration proposed a rule to expand short-term health insurance plans… Along with the repeal of the individual mandate penalty, this expansion of short-term plans will drive up average premiums for ACA-compliant coverage in the individual market. Recent preliminary rate filings in Virginia demonstrate that these actions are contributing to significant premium increases for marketplace coverage in 2019. In fact, some Virginia insurers specifically cited the individual mandate repeal and short-term plan rule as major factors in their rate filings… Combined, the recent tax law’s repeal of the individual mandate and the administration’s short-term plan rule will undermine the individual insurance market and increase premiums for ACA-compliant coverage.” [CAP, 5/18]

New York Times: “Rather Than Trying To Eliminate Obamacare In One Fell Swoop, [Republicans Are] Trying To Undermine It With Multiple Acts Of Sabotage – While Hoping Voters Won’t Realize Who’s Responsible For Rising Premiums And Falling Coverage.” “At the beginning of 2017, Republicans promised to release the kraken on Obamacare — to destroy the program with one devastating blow. But a funny thing happened: Voters realized that repealing the Affordable Care Act would mean taking health insurance away from tens of millions of Americans. They didn’t like that prospect — and enough Republicans balked at the backlash that Obamacare repeal fizzled. But Republicans still hate the idea of helping Americans get health care. So instead of releasing the kraken, they’ve brought on the termites. Rather than trying to eliminate Obamacare in one fell swoop, they’re trying to undermine it with multiple acts of sabotage — while hoping voters won’t realize who’s responsible for rising premiums and falling coverage.” [NYT, 5/8/18]

Washington Post Editorial Board: “The Numbers Suggest That [The ACA’s] Critics’ Sabotage Efforts Are To Blame. “The effects of the president’s underinformed instincts, enabled by the ideologues in his administration, are beginning to show up in some of the numbers, representing real pain that Americans are suffering for Mr. Trump’s deficient leadership… Obamacare critics regularly describe all problems as the inevitable result of a poorly designed law. But the numbers suggest that the critics’ sabotage efforts are to blame. After impressive declines during President Barack Obama’s second term, the fund found that the uninsured rate increased in both of the years Mr. Trump has been in office. During the campaign, Mr. Trump regularly complained that the Affordable Care Act (ACA) left too many Americans uncovered. The result of nearly a year and a half of Mr. Trump’s leadership is 4 million people added to that group.” [Washington Post, 5/8/18]

Horizon Blue Cross Blue Shield of New Jersey: 2018 Premium Increase Was Due To Federal Policy.Three factors connected to federal policy decisions are responsible for 14.7% of the 24.3% total average individual premium increase: Weakened enforcement of the Individual Mandate…Elimination of federal funding for Cost Sharing Reductions (CSR), [and] 2018 reinstatement of Health Insurance Tax…Were it not for the three factors within the control of the Federal Government, Horizon BCBSNJ’s individual premiums would have an average increase of 9.6%.” [Horizon Blue Cross Blue Shield of New Jersey, 10/17/17]

CEO of CareFirst Blue Cross Blue Shield: Things Are “Materially Worse” Under Trump. “Continuing actions on the part of the administration to systematically undermine the market and make it almost impossible to carry out the mission…If continued efforts at the federal level undermine the marketplaces, I would think the board would have to examine what they would want — that’s very much on their mind.” [Washington Post, 5/1/18]

Lindsey Graham: Republicans “Own The Outcome” On Health Care. “Sen. Graham told Breitbart News, ‘In October, premiums are going up. Obamacare cannot be fixed. It’s going to continue to collapse, and then, we own the outcome. By repealing the individual mandate, which is a step forward in the eyes of the public, we own the issue. We have a responsibility to do something about the collapsing Obamacare system. I believe that we’re going to get blamed more than Democrats because we stopped trying to repeal Obamacare, and to suggest that we don’t own it is just simply politically naive.’ Graham continued, ‘It can hurt us in 2018. It can hurt by our base feeling like we betrayed them. It can hurt us from people suffering from Obamacare, like we don’t have a solution. It will energize Democrats. It can undercut everything we did on the tax cut side.’” [Breitbart, 2/6/18]

Rep. Charlie Dent: “We, The Republican Party…Own” Health Care Now. “Rep. Charlie Dent (R-Pa.) argued Friday that President Trump was ‘ill-advised’ to end key ObamaCare payments, warning that the GOP now ‘owns’ whatever happens to ObamaCare. ‘I think the president is ill-advised to take this course of action because … we, the Republican Party, will own this,’ Dent, a key House moderate who is retiring from Congress at the end of his term, said on CNN. Asked about Trump’s previous comments blaming problems with ObamaCare on former President Barack Obama, Dent pointed out that Republicans currently control the White House and have majorities in both chambers of Congress. ‘Barack Obama is a former president. President Trump is the president and he’s a Republican, and we control the Congress,’ Dent said. ‘So we own the system now. We’re going to have to figure out a way to stabilize this situation … This is on us.’” [The Hill, 10/13/17]

Washington Post: “The Pottery Barn Rule Comes To Mind: You Break It, You Own It.” “This is not ‘letting’ Obamacare fail. Many nonpartisan experts believe that these active measures are likely to undermine the pillars of the 2010 law and hasten the collapse of the marketplaces. The Pottery Barn rule comes to mind: You break it, you own it. Yes, the plate you just shattered had some cracks in it. But if you dropped it on the ground, the store is going to blame you.” [Washington Post, 10/13/17]

Washington Post: “Trump’s Not Going To Be Able To Avoid Blame For Kneecapping Obamacare.” [Washington Post, 10/13/17]

“After Months Of Pinning The Blame For Obamacare’s Shortcomings On Democrats And Watching His Own Party Fail To Act, President Donald Trump Just Took Ownership Of A Struggle That’s Consumed Republicans For Seven Years.” “After months of pinning the blame for Obamacare’s shortcomings on Democrats and watching his own party fail to act, President Donald Trump just took ownership of a struggle that’s consumed Republicans for seven years. Trump’s decision late Thursday to end government subsidies to insurers to help lower-income Americans afford to use their coverage under the Affordable Care Act was the most drastic step he’s taken to undermine his predecessor’s signature achievement. It also lobbed a live bomb into the laps of Republicans lawmakers 13 months before congressional elections after he publicly berated the party’s Senate leadership for being unable to keep a longstanding promise to repeal the law.” [Bloomberg, 10/13/17]

The American People Agree: President Trump And Congressional Republicans Are Playing Politics With People’s Health Care.  A poll conducted last September found that 61 percent of voters believed President Trump was “trying to make the Affordable Care Act fail,” and 64 percent of voters said Trump is “playing politics with people’s health care.” The poll also found that the American people seriously disapprove of how Republicans in Congress are treating health care: 80 percent of voters disapprove while only 20 percent approve. [Hart Research, 9/5/17]

Medicaid Expansion, Junk Plan Bans, and a Law to Shore Up the Marketplace: the ACA Has a Banner Week in the States

While congressional Republicans and their cheerleaders, like former U.S. Senator Rick Santorum, are on the verge of making another run at health care repeal, legislators and everyday citizens in states across the country this week took actions to expand health care access and shore up their marketplaces. Here’s what happened this week, from Virginia to California:

In Virginia, the state Senate joined with the House of Delegates, sending a measure to expand Medicaid to Gov. Ralph Northam to sign into law. The expansion will extend health insurance to 400,000 Virginians.

Richmond Times-Dispatch: Virginia Set To Expand Medicaid As Senate And House Back Budget Deal. “Six years after the U.S. Supreme Court left the decision to states on whether to expand their Medicaid programs under the Affordable Care Act, Virginia is about to extend health care coverage to hundreds of thousands of Virginians without it… [Republican State Senators Ben Chafin and Jill Vogel] defended their decisions as necessary to invest in core public services, while expanding health coverage to people who need it and the hospitals that provide it. ‘I came to the conclusion that ‘no’ just wasn’t an answer anymore,’ he said.” [Richmond Times-Dispatch, 5/31]

In New Jersey, the legislature acted to stabilize the state’s insurance marketplace by implementing a state-level individual mandate, following in the footsteps of Maryland, which passed stabilization measures last month. Congressional Republicans repealed the federal mandate in December’s tax bill, which, combined with the Trump Administration’s short-term plan regulations, had been projected to increase premiums in New Jersey by nearly 11%.

NJ.com: Phil Murphy Signs Law Protecting Obamacare From Trump With N.J. Mandate To Have Health Insurance. “Gov. Phil Murphy on Wednesday signed a law preserving a critical yet controversial part of the Affordable Care Act that President Donald Trump’s administration repealed last year… State Sen. Joseph Vitale, D-Middlesex, one of the prime sponsors of the law, said keeping the mandate ‘was needed to maintain a foundation for the insurance market and to allow the success of the ACA to continue.’ Trump’s actions ‘will usher in an era of higher health insurance costs for everyone and lower health coverage rates. We want to protect New Jersey from the negative impact,’ said state Sen. Troy Singleton, D-Burlington, also a sponsor. About 800,000 people obtained insurance coverage under the law — 500,000 through Medicaid and about 300,000 through a commercial plan.” [NJ.com, 5/30]

In Illinois, the state legislature is expected to implement a six-month limit on the Administration’s proposed short-term junk plans, restoring them to their original intention and protecting Illinoisans’ health and the state’s insurance marketplace. The move follows similar legislative actions in Hawaii and California, which is considering banning short-term plans entirely.

Chicago Tribune: Illinois Groups Push To Restrict Short-term Insurance, As Trump Administration Seeks To Expand It. “Dozens of Illinois advocacy groups, under the umbrella of the Protect Our Care Coalition, are supporting a bill that would impose a six-month limit on the use of short-term insurance plans — coverage originally meant to serve as a stopgap for consumers between health insurance plans, such as people changing jobs who can’t afford continued coverage under a previous employer’s plan or students taking a semester off school… Short-term plans can leave consumers in a lurch because they often don’t cover things like maternity care, pre-existing conditions, mental health or prescription medications. In addition to the six-month time limit, the bill would require warnings about what the plans do not cover to be read aloud to consumers buying the plans or featured on websites where they’re sold. The state Senate on Friday unanimously passed the bill.” [Chicago Tribune, 5/25]

Speaking of Medicaid expansion, Utah and Idaho both advanced ballot measures to expand Medicaid, too:

The Hill: Medicaid Expansion Qualifies For Ballot In Utah. “A measure to expand Medicaid under ObamaCare in Utah will appear on the ballot in November after it was certified as having enough signatures. Liberal groups hailed the announcement from the state’s lieutenant governor as they hope to make the deep-red state the 33rd to expand the health insurance program for the poor under the health law. Medicaid expansion would extend coverage to about 150,000 people in the state.” [The Hill, 5/30]

Associated Press: Medicaid Expansion Moves Closer To Possible Referendum. “A Medicaid expansion proposal has passed the signature threshold, officials confirmed on Thursday, but said further review is needed before it gets on the November ballot. Ada County Chief Deputy Clerk Phil McGrane says county clerks across the state have verified roughly 58,000 signatures that organizers submitted earlier this month.” [US News & World Report, 5/24]

In Maine, the Bangor Daily News Editorial Board called for the legislature to fund the state’s Medicaid expansion, which passed overwhelmingly in a referendum last fall:

Bangor Daily News: Lawmakers Must Fund Medicaid Expansion, Which Is The Law, ‘Not A Suggestion.’ “By expanding Medicaid, Maine will make insurance coverage available to as many as 80,000 Mainers. These are people who work but can’t afford health insurance or their employer doesn’t offer it. They are not poor enough or do not have a disability to qualify for Medicaid without an expansion. Under the Affordable Care Act, the federal government covers 90 percent of the cost. Maine is estimated to receive more than $525 million per year for a state investment of about $55 million annually, beginning in 2021, the first full year of implementation. Expanding Medicaid means thousands of Mainers who don’t have insurance will be able to access preventative care, vaccinations, addiction treatment, counseling and other needed care. It will also help stabilize the state’s hospitals, many of which are struggling financially.” [Bangor Daily News, 5/31]

And in Alabama, Jim Carnes, Policy Director of Alabama Rise, eloquently made the case for Medicaid expansion in an op-ed published by the Anniston Star:

Anniston Star: Expanding Medicaid Would Improve Alabama’s Health, Budgets And Economy. “The new Urban Institute report estimates that 314,000 Alabamians would enroll in Medicaid if Alabama extended eligibility to low-income workers. That would mean an additional $1.54 billion in federal funding surging into Alabama’s economy each year under the 9-to-1 federal match rate. It also would mean rural hospitals – like the one in Jacksonville that announced in May that it plans to close – would no longer be bleeding red ink through services to uninsured patients… In any other industry, the prospect of such gains would have political candidates of all stripes blowing trumpets and leading parades. And those other economic development plans wouldn’t have the added advantage that this one brings: giving people a new lease on life by helping them get the health care they need. Isn’t it time we broke the partisan gridlock on the coverage gap? Isn’t it time we demanded that anyone seeking to lead our state offer a vision of a healthier Alabama – and a path to getting there?” [Anniston Star, 5/29]

So while President Trump continued peddling lies about health care in Washington, D.C., states across the country continued the work of expanding health care access to hundreds of thousands of Americans. The ACA remains the law of the land, and its staying power shows it has become woven into the fabric of our nation’s health care system.

In Alabama, Health Care Wins Again

Doug Jones’ shocking win in Alabama might have changed the political landscape, but when one compares his victory to those on Election Day last month, there’s at least one striking similarity: health care. In November, candidates up and down the ballot in Virginia and Maine, Georgia and New Hampshire, ran on the expansion of health care and won. In Alabama, Doug Jones was deemed a “proud supporter of Obamacare,” loudly rejected GOP attempts to repeal and replace the Affordable Care Act and made funding the Children’s Health Insurance Program the first policy mentioned in his victory speech. In short, despite the swirl of other issues, in Alabama, health care won again.

Health Care Was A Top Issue In The Election. “Using Google data, we can see the top-searched issue in almost every Alabama county when it comes to the U.S. Senate race in Alabama. The data covers five topics: immigration, crime, sexual harassment, abortion and healthcare… Healthcare follows crime in the list of most-searched topics in Alabama’s Senate race. That’s especially true in Marengo County, where a whopping 62 percent of Senate-related searches have to do with healthcare… There are four counties where Senate-related searches are evenly divided between crime and healthcare.” [AL.com, 11/29/17]

Doug Jones Was Labeled A “Proud Supporter Of Obamacare.” “Alabama Democratic Senate candidate Doug Jones argued at a rally over the past weekend that ‘We’ve got to quit playing political football’ over whether to repeal Obamacare. Jones’ Republican competitor Judge Roy Moore said that he will ‘vote to repeal Obamacare.’ … The Roy Moore campaign has continued to label Doug Jones a ‘proud supporter of Obamacare.’ [Breitbart, 12/11/17]

Doug Jones: “I Am Disturbed About Repeated Repeal Efforts.” “On his campaign website, he declares that ‘health care is a right’ and praised former President Barack Obama’s Affordable Care Act.
‘I am disturbed about repeated efforts to repeal the bill or weaken it, leaving as many as 32 million more Americans without insurance, driving up rates for others and likely leading to the closure of more rural health care facilities vital in many regions of Alabama. That is a nonstarter,’ Jones says on his website.” [CNN, 11/27/17]

Doug Jones: Repeal And Replace “Not Something That’s Workable.” “As he emphasized his concern over the national health care debate, Jones made clear that eliminating Obamacare is not the solution. And voters, he said, shouldn’t be led into thinking that it is. ‘Repeal and replace is a political slogan,’ Jones said. ‘It’s not something that’s workable.’ After Republican politicians promised voters they would replace Obamacare once President Obama left office, they have failed so far to do so. Jones said the Affordable Care Act needs to be improved and that’s where the energy should be spent – not on doing away with it altogether.” [AL.com, 12/5/17]

Doug Jones Made Clear He Opposed Repealing The ACA, Pledged To “Fix” Health Care. “Democratic Senate candidate Doug Jones released a new TV campaign ad on Monday, focusing on his pledge to help ‘fix’ the problems in health care while attacking Republican opponent Roy Moore. ‘If it’s broken, fix it,’ Jones said as the ad begins. ‘Health care, it’s broken. You know it and I know it. But Roy Moore’s grandstanding and extreme views will do nothing to fix it and his policies will take us back to the past.’ … Jones also said he opposes abolishing the Affordable Care Act, better known as Obamacare, but said there are problems within the national health care law that need to be repaired.” [AL.com, 11/6/17]

Doug Jones Attacked Roy Moore Over The CHIP Program. “Democratic Senate nominee Doug Jones has accused Republican nominee Roy Moore of refusing to support renewal of the Children’s Health Insurance Program (CHIP), which provides insurance to about 150,000 children in the state. ‘Alabamians need leaders who will place a priority on improving the health care of all citizens, children and seniors,’ the Jones campaign said in a statement Wednesday.” [Montgomery Advertiser, 11/3/17]

Health Care Was The First Policy Jones Brought Up In His Victory Speech. “Jones thanked the volunteers who ‘knocked on 300,000 doors’ and made ‘1.2 million phone calls’ on his behalf, and said he’s ready to go to Washington to work on health care, particularly funding the Children’s Health Insurance Program (CHIP).” [The Week, 12/12/17]

Doug Jones Called On Congress To Re-Authorize CHIP “Before I Get Up There.” “So I – I have a challenge. I have a challenge to my future colleagues in Washington. Don’t wait on me… Take this opportunity, in light of this election, and go ahead and fun that CHIP program before I get up there. Put it aside and let’s do it for those million kids and 150,000 here in Birmingham.” [New York Times, 12/12/17]

Protect Our Care Statement On GOP Tax Scam Following Doug Jones Victory

#DelayforDoug

Washington, D.C. – Following Doug Jones’ historic victory in Alabama and the continued insistence of GOP leadership to ram their tax scam through and ignore the will of the people, Protect Our Care Campaign Director Brad Woodhouse issued the following statement:

“If the GOP attempts to jam their tax scam through in the aftermath of this election without allowing Doug Jones to be sworn in and the people of Alabama to be heard, they will make this colossal political miscalculation for themselves even worse,” said Woodhouse. “The Republicans wrote their tax bill, including their sneaky health care repeal, in secret, without any hearings or true debate, and passed it in the middle of the night – and the American people overwhelmingly opposed it even before last night’s political earthquake.

“Now, after the voters of Alabama made their preference clear, the GOP seems prepared to ignore the will of the people – all to rip health care away from 13 million people and raise premiums double digits for tens of millions more to give tax breaks to the wealthiest and big corporations. Majority Leader McConnell should commit to delaying final consideration of the tax bill until Doug Jones is seated. If he doesn’t, Jeff Flake, who supported Jones, and Susan Collins, who already has reservations about the bill, should compel him to do so with their votes.”

The Ghosts of Christmas Past

Republican Senators Called for Delaying Health Care Votes Until Scott Brown Was Seated, And Senate Democrats Agreed

#DelayforDoug

When voters flipped a long-time Democratic seat in the overwhelmingly Democratic state of Massachusetts, the next steps were clear: Republicans demanded a delay in important legislation until the will of the voters could be heard and Democrats agreed.

Last night, in the overwhelmingly Republican state of Alabama, the will of the people was heard when they flipped a long-time Republican seat in favor of a Democrat, Senator-elect Doug Jones..

Will Republicans be so anxious to pass their sneaky health care repeal and give their donors a Christmas present that they’ll over rule the vote that just took place, or will they follow precedent, process and regular order and delay a vote on this tax scam until the people of Alabama can be heard?

HERE IS WHAT REPUBLICANS WERE SAYING…

Sen. Mitch McConnell (R-KY): “I Think That Means There Will Be No More Health Care Votes In The Senate Prior To The Swearing In Of Scott Brown, Whenever That May Be.” “‘I think the message of the moment is that the American people, all across the country, are asking us, even in the most liberal state, Massachusetts, to stop this healthcare bill,’ McConnell said. ‘I think that means there will be no more health care votes in the Senate prior to the swearing in of Scott Brown, whenever that may be,’ the top Senate Republican added.” [The Hill, 1/20/10]

  • Sen. Mitch McConnell (R-KY): “I Think The Majority Has Gotten The Message: No More Gamesmanship Here, No More Lack Of Transparency.” “I think the majority has gotten the message: no more gamesmanship here, no more lack of transparency, let’s honor the wishes of the people of Massachusetts and move forward with policy.” [Politico, 1/20/10]

Sen. John McCain (R-AZ): “The People Of Massachusetts Have Spoken For The Rest Of America: Stop This Process, Sit Down In Open And Transparent Negotiations, And Let’s Begin From The Beginning.” “So here we are, and now the rumors are that they will jam this proposal through the House of Representatives and then bypass what has always been the normal legislative process. They should not do that. The American people have spoken. The people of Massachusetts have spoken for the rest of America: Stop this process, sit down in open and transparent negotiations, and let’s begin from the beginning.” [Sen. McCain Floor Speech, 1/20/10]

Sen. Susan Collins (R-ME): “Brown’s Election Also Reflects ‘The Fact That So Many People Are Appalled At The Process By Which The Health Care Bill Was Negotiated Behind Closed Doors, Rammed Through The Senate With Limited Debate And Amendments, And Riddled With Special Deals To Garner Votes.’” “Republican Sen. Susan Collins said Brown’s victory ‘is an indication that voters in Massachusetts, indeed a majority of Americans, do not support unfettered, one-party rule in Washington.’ Brown’s election also reflects ‘the fact that so many people are appalled at the process by which the health care bill was negotiated behind closed doors, rammed through the Senate with limited debate and amendments, and riddled with special deals to garner votes,’ Collins said in a statement issued Tuesday evening.” [Bangor Daily News, 1/20/10]

  • Sen. Susan Collins (R-ME): “Collins Said Congress And The White House Should ‘Start From Scratch’” After Scott Brown’s Election. “Collins said Congress and the White House should ‘start from scratch’ and draft a new health care bill that would reduce health care costs and include provisions such as insurance market reforms, the ability to purchase insurance across state lines, and tax breaks for small businesses.” [Bangor Daily News, 1/20/10]

Sen. John Cornyn (R-TX): “I Hope That This Will Usher In A New Era Of Transparency And Willingness To Work Together Rather Than Sort Of Special Sweetheart Deals Cut Behind Closed Doors.” “And so I hope that this will usher in a new era of transparency and willingness to work together rather than sort of special sweetheart deals cut behind closed doors that cause so much concern in the health care bill and elsewhere. And let me just say that the health care bill is a very important part of what was debated and decided yesterday in this election, but it’s not all that was decided. The American people sent a very clear message through the voters of Massachusetts of their concern about the spending and the debt and the government intervention in their lives in ways that limits their freedoms and opportunities in the future of their children and grandchildren.” [Press Conference, 1/20/10]

Sen. Lamar Alexander (R-TN): We Should “Work Together, Step By Step, To Re-Earn The Trust Of The American People.” “Now that the people have spoken in Massachusetts, we should abandon these arrogant notions of trying to turn our entire health care system upside down all at once and, instead, set a clear goal of reducing health care costs and then work together, step by step, to re-earn the trust of the American people–an approach Republican Senators urged exactly 173 different times on the floor of the Senate during last year.” [Floor Remarks, 1/20/10]

Sen. Bob Corker (R-TN): “With The Election Results In A State Like Massachusetts, I Hope My Colleagues On The Other Side Of The Aisle Will Be Convinced To Go Back To The Drawing Board.” “With the election results in a state like Massachusetts, I hope my colleagues on the other side of the aisle will be convinced to go back to the drawing board on the issue of health care reform.” [Press Release, 1/19/10]

Sen. Lindsey Graham (R-SC): “This Is The Result Of A Bill Done Behind Closed Doors.” “‘This is the result of a bill done behind closed doors,’ Graham said, adding 111,000 South Carolina seniors have Advantage plans. ‘We cannot take away Medicare Advantage for 49 states and give it to one because you want his vote.’ Meanwhile, Graham said the Obama administration tried to push a bill through that isn’t bipartisan and that the Massachusetts race illustrates the nation’s desire to go back to the drawing board on reform. He issued a warning that any effort to pass a bill through the Senate will result in ‘holy hell.’ ‘It will be almost impossible for us to work together on other matters there are very important to the country,’ he said.” [Greenville News, 1/18/10]

Sen. Chuck Grassley (R-IA): “I Think It Is Almost An Indication That There Ought To Be Some Pause And To Step Back And Review What’s Been Going On For The Last Year.” “‘I think it is almost an indication that there ought to be some pause and to step back and review what’s been going on for the last year,’ Grassley said during his weekly telephone news conference. ‘And then, after that pause, if there’s a decision to go ahead, obviously that decision’s going to be on a bipartisan basis.’” [Daily Nonpareil, 1/21/10]

Sen. John Thune (R-SD): “The Democrats’ Partisan, Back-Room Approach To Writing A Health Care Bill Has … Been Thoroughly Rejected, As Last Night’s Results Make Clear.” “The Democrats’ partisan, back-room approach to writing a health care bill has … been thoroughly rejected, as last night’s results make clear,” Thune said in a statement. “It is now time to start over on a bipartisan approach and find solutions to lowering costs and improving care.” [Capital Journal, 1/20/17]

…AND SENATE DEMOCRATS AGREED NOT TO TAKE ANY FURTHER ACTION UNTIL BROWN WAS SEATED

Then-Senate Majority Leader Harry Reid (D-NV): “We’re Going To Wait Until The New Senator Arrives Until We Do Anything More On Health Care.” “Senate Majority Leader Harry Reid said Wednesday that there is no firm commitment for Democrats to rush a health care bill through Congress this year. ‘First of all, we’re not going to rush into anything,’ he said. ‘We’re going to wait until the new senator arrives until we do anything more on health care.’” [Politico, 1/20/10]

Sen. Jim Webb (D-VA): “I Believe It Would Only Be Fair And Prudent That We Suspend Further Votes On Health Care Legislation Until Senator-Elect Brown Is Seated.” “In many ways the campaign in Massachusetts became a referendum not only on health care reform but also on the openness and integrity of our government process.  It is vital that we restore the respect of the American people in our system of government and in our leaders.   To that end, I believe it would only be fair and prudent that we suspend further votes on health care legislation until Senator-elect Brown is seated.” [Sen. Webb Statement, 1/19/10]

Protect Our Care: Alabama Election Changed Political Landscape, Republicans Must Delay Vote on GOP Tax Plan Until Doug Jones is Sworn In

Washington, DC – Following the historic victory of Doug Jones in the Alabama special election for U.S. Senate, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Doug Jones’s victory in the Alabama Senate race is a political earthquake, and before Republicans make matters even worse for themselves by voting on a tax scam that rips away health care from millions of Americans, they must allow Doug Jones to be sworn in and force every Republican Senator to decide if they want to be the deciding vote on a bill that devastates American health care to give tax breaks to billionaires and big corporations.”