Alex Azar

Washington, DC — Today, as HHS released its 2018 annual report and Secretary Azar gave a speech on drug pricing, one thing has become clear: the Trump administration does not want the American people to know the real impact of its war on health care — higher costs and less coverage. Leslie Dach, chair of Protect Our Care, issued a statement in response to Azar’s claims in his speech:

“While Secretary Azar is attempting to tout his record at HSS, Americans are suffering from the truth. The administration is  is hiding the real impact of its agenda: drug prices are going up, drug companies are enjoying massive tax giveaways, millions no longer have health insurance because of the administration’s sabotage campaign, and protections for pre-existing conditions are under attack. The claim that President Trump and Secretary Azar’s HHS improved America’s health care is ludicrous. The real story is that costs went up, coverage went down, and the American people lost out.”

Despite what’s in their annual report, we know what their record is:

1. Drug companies continue to increase prices while reaping billions of dollars from the Trump tax bill and seeing massive profits. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. 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.  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. All in all, nearly 30 drugmakers are expected to raise prices in 2019. One drug industry lobbyist has said that drug companies’ limited concessions are “a calculated risk” summarizing big pharma’s strategy to play the Trump administration: “take these nothing-burger steps and give the administration things they can take credit for.”

1. Under Trump, the uninsured rate has risen to its highest levels since the Affordable Care Act took effect. Gallup’s quarterly health survey reveals that the uninsured rate has risen to the highest rate since the Affordable Care Act’s coverage expansion was completed, leaping from 10.8 percent in 2016 to 13.7 percent in 2018 and representing about 7 million more Americans who are now uninsured. A major reason for this increase? Trump’s relentless health care sabotage. Among the factors contributing to this uninsured rate, Gallup cited increased premiums, major cuts to outreach funding and open enrollment, slashed funding to health care navigator groups, and Trump’s hostility to the ACA.
2. Sec. Azar and the Trump administration have expanded access to junk plans that are allowed to discriminate against people with pre-existing conditions. In August, the Trump administration finalized a rule that allows consumers to purchase junk plans with an expanded duration of 364 days, as opposed to the the previously allowed maximum of three months, and renew such plans for up to three years. Since finalizing the rule, the Trump administration has urged navigator groups that help people sign up for coverage to push consumers toward junk plans and has issued guidance urging states to let ACA subsidies be used to purchase these skimpy plans. Junk plans are notoriously ripe for fraud, drive up health care premiums, leave consumers with worse coverage and at risk for bankruptcy.
3. The Trump administration’s health care sabotage means Americans are paying more for premiums than they should. While Azar tries to claim that premiums have stabilized under him, health care analyst Charles Gaba has found that marketplace premiums are roughly 8 percent higher than they would be absent GOP sabotage. With GOP sabotage, premiums increased 2.8 percent in 2019. Absent such sabotage, premiums would have decreased 5.37 percent.
4. The Trump administration has encouraged states to impose onerous Medicaid work requirements designed to kick people off of their health coverage — so far, more than 18,000 have lost coverage in Arkansas alone. In 2017, the Trump administration encouraged states to adopt policies that make it harder for people to access health care through Medicaid. One such way is by requiring Medicaid enrollees to work in order to maintain health coverage through Medicaid. So far, the Trump administration has approved waivers in seven states — AZ, AR, IN, KY, MI, MS, and WI — that will prevent people from being covered through Medicaid unless they meet restrictive requirements. Similar waivers are pending in eight states: AL, OH, OK, SD, TN, UT, and VA. Already, more than 18,000 Arkansans have lost coverage because of these burdensome requirements.
5. Secretary Azar and the Trump administration have engaged in a years-long effort designed to sabotage the Affordable Care Act, going so far as to argue in court that protections for people with pre-existing conditions should be overturned. Trump along with Republican attorneys general and governors have already sued to try to overturn our health care laws in the Texas lawsuit. Just several weeks ago, President Trump boasted that the Affordable Care Act and its protections for people with pre-existing conditions would be “terminated” through the case. A complete list of the administration’s sabotage efforts is below and can be found in our health care sabotage tracker:

February 2019

• Trump predicts the Affordable Care Act will be “terminated” through the Texas lawsuit seeking to overturn the law.
• In an effort to restrict access to information about women’s reproductive health, the Trump administration removes web pages associated with the ACA and its contraceptive coverage from HHS’s Office of Population Affairs website.

January 2019

• Thanks to GOP sabotage, the uninsured rate surges to the its highest level since 2014. Roughly seven million fewer people are estimated to have health care now than did two years ago.
• The Centers for Medicare and Medicaid Services (CMS) proposes changes to the ACA’s benefit and payment parameters, reducing subsidies available to those who purchase health care through the exchange, increasing premiums, and raising  the out-of-pocket maximum for people with employer-sponsored health care.
• In a win for big Pharma, the Trump administration proposes changes to the rebate system that would raise premiums, benefit pharmaceutical companies, and contain no mandate to lower list prices of drugs.

December 2018

• Hand-picked Federal Judge Reed O’Connor rules in favor of twenty conservative states to overturn the Affordable Care Act, jeopardizing coverage for 17 million people and ripping away the ACA’s vital consumer protections such as protections for people with pre-existing conditions.
• Under the Trump administration’s relentless sabotage, the uninsured rate increases for the first time since 2010. As the Kaiser Family Foundation finds, “In 2017, the uninsured rate reversed course and, for the first time since the passage of the ACA, rose significantly to 10.2% [from 10%].”

November 2018

• Trump administration issues new guidance urging states to “tear down basic pillars of the Affordable Care Act, demolishing a basic rule” that federal subsidies can only be used to purchase ACA-compliant plans. Experts warn against this move, saying it will push affordable, comprehensive care further out of reach for individuals with pre-existing conditions.
• Under the Trump administration, the number of uninsured children grows for the first time in nearly a decade. After a decade of steady decreases in the number of uninsured children, in 2017 the number of uninsured children increased from 3.6 million to 3.9 million.

October 2018

• Republicans appoint Brett Kavanaugh to the Supreme Court. Kavanaugh is known to be hostile to the Affordable Care Act.
• The Trump administration issues guidance that allows federal subsidies to be used to purchase junk plans that can deny coverage to people with pre-existing conditions.

September 2018

• The Trump administration’s Department of Justice joins twenty conservative states in court in opening arguments to argue that the Affordable Care Act’s protections for people with pre-existing conditions should be overturned.
• Nearly 4,600 Arkansans are unable to meet Arkansas’ reporting requirements for the state’s Medicaid work requirements and lose Medicaid coverage.

August 2018

• Trump administration finalizes rule for bare-bones short-term plans that are exempt from key consumer protections, such as the requirement that insurance covers prescription drugs, maternity care, and hospitalization.

July 2018

• CMS halts risk adjustment payments, that enable insurance companies to cover everyone, regardless of whether they are healthy or sick.
• Trump Administration slashes funding for non-profit health navigator groups, that help people shop for coverage, from $36 million to $10 million. CMS encourages groups to use the remaining funds to push people to sign up for junk plans that skirt important consumer protections.
• President Trump nominates Brett Kavanaugh to the Supreme Court. Kavanaugh has previously forced a young woman to continue a pregnancy against her will and has criticized Justice Roberts for upholding the Affordable Care Act’s constitutionality.

June 2018

• Department of Justice takes to the courts to argue that insurance companies should be able to discriminate against as many as 130 million Americans with a pre-existing condition.
• Republican coalition, the Health Policy Consensus Group, released their latest proposal to repeal the Affordable Care Act, which would gut protections for people with pre-existing conditions, let insurance companies charge older people an age tax, and deny key coverage for basic services like maternity care.
• Trump Administration finalizes proposal to expand access to association health plans that skirt key consumer protections.

May 2018

• President Trump boasts about health care sabotage: “We will have gotten rid of a majority of Obamacare.”
• Trump Administration enlists help of former drug lobbyist in writing its drug plan.
• Congressional Republicans try to use annual farm bill to authorize $65 million in taxpayer funding to set up association health plans, which can  exclude prescription drug coverage, mental health care, and maternity care.

April 2018

• House Republicans vote on a balanced budget amendment that would cut Medicaid by $700 billion over ten years, $114 billion in a single year alone.
• Trump Administration limits access to assistance for consumers who want to enroll in marketplace coverage. This change removes the requirement that every area has at least two “navigator” groups to provide consumer assistance and that one be local. Now, just one group could cover entire states or groups of states.

March 2018

• Republicans sabotage efforts to pass a bipartisan bill that would have stabilized Affordable Care Act marketplaces by insisting the bill restrict access to abortion.

February 2018

• The Trump Administration announces that it will expand access to short-term health plans that do not have to comply with key consumer protection provisions required by the Affordable Care Act.
• Urban Institute calculates that repeal of the individual mandate and expansion of short term plans will increase individual market premiums by an average 18.2 percent in 2019.
• Trump Administration releases budget that calls for the Affordable Care Act to be replaced by Graham-Cassidy, in a move that experts predict would reduce health coverage for 32 million Americans.

January 2018

• The Trump Administration announces that it will support states that impose onerous work requirements on Americans covered by Medicaid, and approves Kentucky’s worst-in-the-nation waiver the next day.
• The Trump Administration announces a move to allow providers to discriminate by allowing them to deny patient care for almost any reason.
• The Trump Administration makes plans to announce even more exemptions from the requirement people have health coverage before this provision is repealed altogether.

December 2017

• The Trump Administration proposes a rule to expand association health plans, which would gut consumer protections, raise costs for people with pre-existing conditions and further destabilize the insurance markets.
• Congressional Republicans pass their tax scam, which doubles as a sneaky repeal of the Affordable Care Act  by kicking 13 million people off of their insurance and raising premiums by double digits for millions more.

November 2017

• Republicans refuse to move forward on the bipartisan Alexander-Murray bill to address the CSR crisis even though it had a filibuster-proof majority in the Senate.

October 2017

• The Trump Administration takes direct aim at birth control by rolling back a rule that guaranteed women access to contraception. (A court has since questioned the legality of the action.)
• President Trump signs an Executive Order to roll back key consumer protections that will result in garbage insurance, raise premiums, reduce coverage and again expose millions of Americans to discrimination based on pre-existing conditions.
• The Trump Administration dramatically cuts in-person assistance to help people sign up for 2018 health coverage.
• After threatening for months to stop funding cost-sharing reduction payments (CSRs) that help lower deductibles and out-of-pocket costs, the Trump Administration stops the payments altogether. The CBO finds that failing to make these payments will increase premiums by 20% and add nearly $200 billion to the debt.

September 2017

• The Administration orders the Department of Health and Human Services’ regional directors to stop participating in Open Enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell says, “I didn’t call it sabotage…But that’s what it is.”

August 2017

• The Administration cuts the outreach advertising budget for Open Enrollment by 90 percent, from $100 million to just $10 million – which resulted in as many as 1.1 million fewer people getting covered.

July 2017

• The Trump Administration uses funding intended to support health insurance enrollment to launch a multimedia propaganda campaign against the Affordable Care Act.
• President Trump, again, threatens to end cost-sharing reduction payments.

June 2017

• Senate Republicans embark on a monthslong failed attempt to pass BCRA, Skinny Repeal and Graham-Cassidy, all repeal bills that would have caused millions of Americans to lose their health coverage and raised premiums by double digits for millions more. They would have ended Medicaid as we know it, putting the care of children, seniors and people with disabilities at risk.

May 2017

• House Republicans vote for and pass a health care repeal bill that would cause 23 million people to lose coverage and gut protections for people with pre-existing conditions. It would have imposed an age tax and allowed insurers to charge people over 50 five times more for coverage and ended Medicaid as we know it, putting the care of seniors, children and people with disabilities in jeopardy.

April 2017

• The Trump Administration cuts the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
• In an effort to convince Democrats to negotiate a repeal of the Affordable Care Act, President Trump threatens to cut off cost-sharing reduction payments (CSRs) that help low-income marketplace customers pay for out-of-pocket costs.

March 2017

• The Trump Administration sends a letter to governors encouraging them to submit proposals which include provisions such as work requirements that make it harder for Medicaid beneficiaries to get affordable care and increase the number of people who are uninsured.

February 2017

• The Trump Administration proposes a rule to weaken Marketplace coverage and raise premiums for millions of middle-class families.

January 2017

• On his first day in office, President Trump signs an Executive Order directing the administration to identify every way it can unravel the Affordable Care Act.
• Also on January 20th, the Department of Health and Human Services begins to remove information on how to sign up for the Affordable Care Act.
• The Trump Administration pulls funding for outreach and advertising for the final days of 2017 enrollment. This move is estimated to have reduced enrollment by nearly 500,000.