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CMS Archives — Protect Our Care

CMS Administrator Verma Makes Clear the Administration’s War on Medicaid Expansion is Far From Over

Washington, DC – After CMS Administrator Seema Verma stated in an interview with Politico today that a once-rejected policy of drastically limiting Medicaid expansion is once again “under review,” Protect Our Care executive director Brad Woodhouse released the following statement:

“There’s no limit to the lengths this administration will go to sabotage Medicaid. Administrator Verma’s comments about revisiting the disastrous policy of allowing states to sabotage Medicaid expansion is just the latest step in their war to undermine our health care. From supporting so-called work requirements like those in Arkansas, which have already stripped coverage from 18,000 people, to advocating supporting the outright repeal of Medicaid expansion and calling for over a trillion dollars in cuts in their latest budget block granting – the Trump administration’s opposition to Medicaid is as hostile as it is downright cruel.

“It’s clear as daylight that giving states ‘flexibility’ when it comes to Medicaid expansion is just doublespeak for denying people coverage. No administration has done more to undermine Medicaid, and Administrator Verma’s latest comments underscore their continued desire to gut it.”

Calling BS on CMS: Seema Verma’s Medicaid Spin Is a Bald-Face Lie

Washington, DC — Today, Centers for Medicare & Medicaid Services Administrator Seema Verma gave a speech at the CMS Quality Conference in Baltimore, Maryland where she tried to affirm the administration’s commitment to Medicaid, despite the multiple efforts orchestrated by Verma to sabotage and undermine the program.

In response, Brad Woodhouse, executive director of Protect Our Care, released the following statement:

Seema Verma’s comment today is, plain and simple, a bald-faced lie. This administration has worked against Medicaid at every turn. Indeed, not since Medicaid was signed into law more than 50 years ago has there been an administration or an Administrator more hostile to Medicaid than the Trump administration and Seema Verma. The Trump administration supports so-called work requirements like those in Arkansas which has already ripped coverage away from 18,000 people, opposed Medicaid expansion in states across the country, and advocated for the block granting of Medicaid which is a euphemism for slashing its budget and kicking people off the rolls.

Fortunately, the American people have a different view: Medicaid has never been more popular. The attacks on Medicaid by this administration and its Republican allies led in large part to the defeat of the ACA repeal effort. And, during the 2019 election, voters across the country rejected the Republicans’ sabotage agenda and either expanded Medicaid at the polls or elected pro-Medicaid politicians who promised to do so in office. The truth is, Medicaid is flourishing despite this administration’s efforts to undermine it and no type of Orwellian spin from Administrator Verma can change that.”

“Higher Costs And More People Being Uninsured” How Trump’s Latest ACA Sabotage Targets Consumers

Last week, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Affordable Care Act’s benefit and payment parameters that would raise costs and reduce coverage for millions of Americans. On top of reducing subsidies available to those who purchase health care through the exchange and increasing premiums, the Trump administration’s proposed rule changes would also raise the out-of-pocket maximum for people with employer-sponsored health care.

Here’s what news outlets have to say about the proposed changes:

Axios: Consumers Would Pay More Under New ACA Rules. “Turns out the Trump administration’s big ACA regulation packs a bit more punch than we realized at first. Some of the rule’s technical changes will end up requiring people to pay more for their coverage, while rolling back the cost of federal premium subsidies, my colleague Sam Baker reports…The federal government would end up spending about $900 million less on premium subsidies, according to the proposed regulation. The same change would also slightly loosen limits on out-of-pocket costs. The ACA capped total out-of-pocket spending at $8,000 per year for an individual and $16,000 per year for a family plan.  The Trump proposal would raise those caps by $200 and $400, respectively, according to Brookings’ Matt Fiedler. That change would apply to people who get coverage through their jobs, not just the ACA’s insurance markets.” [Axios, 1/22/19]

Wall Street Journal: Trump’s Proposed ACA Rules Could Lift Costs For Millions Of People. “The Trump administration on Thursday proposed changes that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act, a move that Republicans said is necessary to cut inflated subsidies but Democrats viewed as another GOP effort to sabotage the health law. The proposal, released by the Centers for Medicare and Medicaid Services, would raise the out-of-pocket maximum that people with employer-sponsored coverage pay in 2020. The individual maximum would increase by $200 to $8,200 annually, and the maximum for family coverage would increase by $400, analysts said. The plan would also change a calculation that determines how much people pay if they buy insurance from the ACA exchange and get credits to reduce their monthly premiums. The change could raise premiums next year for many of the roughly 9 million people who get the credit.” [Wall Street Journal, 1/17/19]

Los Angeles Times: Despite The Government Shutdown, Trump’s Efforts To Gut Obamacare Go Full Speed Ahead. “A good portion of the federal government may be shut down, but you can rest assured that the devoted Obamacare saboteurs at the Department of Health and Human Services are on the job. Late Thursday, they released proposed rule changes for the 2020 health insurance year — and requests for comments on further changes — that will drive up premiums for people on Affordable Care Act health plans, cut subsidies and discourage more Americans from enrolling. The proposals also could raise prescription costs for enrollees and raise costs even for families enrolled in employer plans. Longer-term changes proposed for 2021 and beyond could affect about 2 million ACA enrollees.” [Los Angeles Times, Hiltzik, 1/18/19]

Associated Press: White House Proposes To Increase Affordable Care Act Premiums. “The Trump administration Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue. The roughly 1 percent increase could feed into the Democratic argument that the Trump administration is trying to ‘sabotage’ coverage for millions. The administration said the proposal is intended to improve the accuracy of a complex formula that affects what consumers pay for their premiums. Premiums under the health law were basically stable this year after several sharp annual hikes.”  [Associated Press, 1/17/19]

Politico: CMS Wants To Reduce Obamacare Subsidies Through Formula Change. “The administration is proposing a technical change in the 2020 marketplace rules that is expected to result in less premium assistance for low-income Obamacare customers, POLITICO’s Paul Demko reports…A decrease in financial assistance of $900 million and 100,000 fewer Obamacare customers in 2020 if the proposal is adopted, according to CMS. The agency is justifying the change as a way to reduce big increases in federal subsidies that resulted from the Trump administration’s decision to cut off cost-sharing reduction payments.” [Politico, 1/18/19]

Buzzfeed News: Administration’s Proposed Rule Would “Result In Higher Premiums And More People Being Uninsured.” “The Trump administration revealed this week that it could try to take one more shot at weakening the Affordable Care Act’s individual markets before the end of Trump’s first term. A request for comment on a proposed rule change posted late Thursday contemplates a series of changes that would save the government $1 billion per year or more, but result in higher premiums and more people being uninsured…But now the administration is signaling it may try to end silver loading. Doing this on its own would lead to a major jump in premium costs and could badly destabilize the markets. The administration says it wants to kill silver loading in concert with Congress voting to bring back the old subsidies. However, Congress has so far shown a complete inability to come together to pass a bill to improve the Obamacare markets. The administration did not specifically say it will act without Congress, but it did so with premiums in the past and is asking for feedback on how it should ‘address’ the issue of silver loading.” [Buzzfeed News, 1/18/19]

CMS Proposal is the Trump Administration’s Latest Act Of Health Care Sabotage

The Payment Notice Cuts Premium Tax Credits By $1 Billion Annually, Slashes Coverage, Increases Out-Of-Pocket Costs, And Puts People With Pre-existing Conditions At Risk

 

Last night, the Centers for Medicare & Medicaid Services (CMS) issued the proposed annual Notice of Benefit and Payment Parameters (NBPP) for the 2020 benefit year, which outlines regulatory and financial guidelines applicable to exchange plans. The proposal from CMS would do the following:

  • Cut premium tax credits by $1 billion per year ($900M in 2020 and 2021, $1 billion in 2022 and 2023)
  • Cause 100,000 people to lose marketplace coverage annually starting in 2020
  • Increase annual premiums by $189 for a family of four at 300 percent of poverty
  • Increase the maximum out-of-pocket costs by $400 for a family (from $16,000 without the change to $16,400 with it) and $200 for an individual (from $8,000 annually to $8,200 annually).

“Despite the lessons of the 2018 midterm elections, the Trump administration is continuing its relentless efforts to sabotage health care for millions of Americans,” said Leslie Dach, chair of Protect Our Care. “They want to increase premiums, put protections for people with pre-existing conditions further at risk, and rip affordable coverage from countless Americans. It’s time they start improving our health care and stop ripping it apart.”

Here’s a look at what the Administration’s proposal would mean for people across the country, according to health care experts and CMS itself:

The Payment Notice Means Higher Premiums, Less In Subsides, And A Drop In Enrollment. “The Trump administration estimates that their proposed change to how ACA premium subsidies are calculated would increase consumer premiums by $181 million and decrease marketplace enrollment by 100,000. As a result, the government would save $900 million.” [Larry Levitt, 1/17/19]

The Provisions Of The Payment Notice Would Reduce Americans’ Premium Tax Credits By Roughly $1 Billion Annually, Leading A Family Of Four At 300 Percent Of The Federal Poverty Line To Pay $189 More Annually. As Matt Fielder, Fellow at the USC-Brookings Schaeffer Initiative for Health Policy concludes: “In dollar terms, single person at 300% of FPL would lose $92/year in [premium tax credits]; family of four at 300% of FPL would lose $189/year in [premium tax credits]. Smaller effects at lower income levels and larger effects at higher income levels. In the aggregate, CMS Actuary estimates proposed change would result in $900m less in tax credit payments and 100,000 fewer Marketplace enrollees in 2020.” [Matt Fiedler, 1/17/19]

The Rules Would Also Increase The Maximum Out Of Pocket Costs In All Private Insurance Plans, By $200 For Individuals And $400 For A Family. “A technical change proposed by the Trump administration would result in maximum consumer out-of-pocket costs in all private insurance plans going up to $8,200 per person in 2020 instead of $8,000. To be clear, either amount is out of reach for many people.” The rule would also increase the maximum out of pocket costs for families from $16,000 to $16,400. [Larry Levitt, 1/17/19; Centers on Medicare And Medicaid Services, 1/17/19

100,000 People Would Lose Marketplace Coverage Each Year Beginning In 2020. [CMS, 1/17/19]

The Administration Has Also Invited Public Comment On Two Parameters — Eliminating Silver-Loading And Automatic Reenrollment. “One change the Trump administration is inviting comment on could eliminate automatic renewal of ACA marketplace coverage and premium subsidies. This year 1.8 million people were automatically re-enrolled in states using the federal marketplace. Another change the Trump administration is inviting comment on could eliminate “silver loading,” where insurers increased premiums for silver plans to offset the termination of cost-sharing subsidy payments to those insurers by the administration. Prohibiting “silver loading” of premiums in the ACA marketplace would lower government costs, but it would increase out-of-pocket premiums for many subsidized enrollees and also increase premiums for middle-class consumers not eligible for subsidies.” [Larry Levitt, 1/17/19]

Andy Slavitt, Former Head Of CMS: “Undermining Obamacare Is The Only Conceivable Reason To Dismantle [Auto-reenrollment].” “Auto reenrollment is simple. It means that like most employer coverage, if you forget to sign up for coverage, yours won’t get taken away. With auto-reenrollment, you can still reject coverage by not paying the bill. 1.8 million use it every year to keep continuous coverage. What happens if it’s taken away? You forget to sign up by 12/15. Get a cancer diagnosis in January. Not covered. With auto-[reenrollment], covered. It’s already automated, and how people are used to operating. Undermining Obamacare is the only conceivable reason to dismantle this.” [Andy Slavitt, 1/17/19]

The Payment Notice Allows States To Select An Essential Health Benefits (EHB) Package Used By Another State, Making EHBs More Flexible And Making It Easier For States To Not Cover All Of The Needs Of People With Pre-existing Conditions. “In the 2019 Payment Notice, we finalized options for states to select new EHB benchmark plans starting with the 2020 benefit year. Under 45 CFR 156.111, a state may modify its EHB-benchmark plan by: (1) Selecting the EHB-benchmark plan that another state used for the 2017 plan year; (2) Replacing one or more EHB categories of benefits in its EHB-benchmark plan used for the 2017 plan year with the same categories of benefits from another state’s EHB-benchmark plan used for the 2017 plan year; or (3) Otherwise selecting a set of benefits that would become the state’s EHB-benchmark plan.” [CMS, 1/17/19]

Legislators are calling the changes out for what they are: sabotage.

Sen. Ron Wyden (D-OR), Ranking Member Of Senate Finance Committee: “Today’s Proposed Rule Deliberately And Needlessly Increases Premiums And Will Result In Too Many Americans Losing Coverage.” “Trump’s health care sabotage agenda is defined by higher premiums for families and bureaucratic barriers that make it harder to find health coverage. Today’s proposed rule deliberately and needlessly increases premiums and will result in too many Americans losing access to health coverage. It’s no wonder Americans are so fed up with America’s health care system when the Trump administration continues to fan the flames of uncertainty while families pick up the check.” [Wyden Statement, 1/17/19]

Sen. Patty Murray (D-WA), Ranking Member Of The Senate Health, Education, Labor, And Pensions (HELP) Committee: “Even 27 Days Into The Shutdown He Caused, President Trump Has Somehow Found Time To Further Sabotage Health Care For Patients, Families, And Women.” “Even 27 days into the shutdown he caused, President Trump has somehow found time to further sabotage health care for patients, families, and women — this time by proposing what would amount to a health care tax on patients and families across the country. President Trump is hurting families left and right and Democrats are going to keep holding him accountable.” [Murray Statement, 1/17/19

Protect Our Care Reacts to CMS Proposed Payment Notice For 2020

Washington, D.C. – Today, the Centers for Medicaid and Medicare Services (CMS) announced its proposed payment notice for the 2020 coverage year which includes a reduction in tax credits for millions of Americans and is additionally seeking public comments on potential changes to the ACA marketplaces — one which could eliminate the practice of silver loading and one that could eliminate the auto-enrollment of marketplace coverage.  In response, Leslie Dach, chair of Protect Our Care, issued the following statement:

“The proposed reduction in tax credits will raise health care premiums for millions of Americans and result in a minimum of 100,000 people losing their health care and are just another form of Trump administration sabotage.  In addition, any effort to eliminate silver loading or auto-enrollment would be a direct attack on our health care and would raise premiums and threaten coverage for millions. Once again, the Trump administration is sabotaging our health care system and asking the American people to foot the bill.”

INVESTIGATION REVEALS: Trump Administration Tries to Rig Health Care Enrollment To Make Coverage Options Secret

Washington DC – This morning, a new Sunlight Foundation investigation revealed that the Trump Administration is sinking to new levels to sabotage the Affordable Care Act. Days before the open enrollment deadline, HHS removed information about ways to apply for coverage on HealthCare.Gov, which may cause confusion and could impede consumers ability to obtain health insurance coverage. According to Sunlight’s investigation, they are directing people to sign up for coverage through enrollment sites run by for-profit companies, and have removed the option of signing up for coverage by mail and phone. Brad Woodhouse, executive director of Protect Our Care, released the following statement in response:

“The Trump administration wants to make it as hard as possible for people to get the health care that they deserve and as easy as possible for the big health insurance companies to profit. Today, that means another round of health care sabotage. That sound you hear is the constant screech of a broken record, but it’s nothing in comparison to the real pain Americans are feeling from the Trump administration’s continued sabotage of our nation’s health care system. This administration’s relentless attacks on open enrollment, which include slashing the open enrollment period, dramatically cutting advertising, and instructing navigators to direct folks to junk plans, is now being punctuated by the removal of information explaining how to apply for coverage, serving no purpose other than to separate individuals from their health care coverage.”

 

In overhaul of HealthCare.gov webpage, information about ways to apply is gone

Sunlight Foundation// Rachel Bergman // December 11, 2018

A side-by-side of a previous version of the “Apply for Health Insurance” page from November 14, 2018, and a new version of the page from November 22, 2018. Snapshots captured by the Internet Archive’s Wayback Machine.

A few weeks after the start of the Open Enrollment period to sign up for Affordable Care Act (ACA) coverage, which runs from November 1 to December 15, 2018, HealthCare.gov’s “Apply for Health Insurance” webpage was altered. Information about two ways to apply is now missing and has been replaced by a new list of application options and links, including a link for “Help On Demand,” a third-party consumer assistance referral system, operated by a for-profit software company, BigWave Systems.

In today’s new report from the Web Integrity Project, we document the overhaul of the “Apply for Health Insurance” page, the portion of the ACA enrollment website that describes different ways consumers can apply for health coverage.

Previously, the page contained a table that listed five ways to apply, with links to pages that provided more information about each option: 1) online (using HealthCare.gov), 2) by phone, 3) with in-person help (from assisters), 4) through an agent or broker, and 5) by mail. Now, the page lists only four options: 1) Find and contact an agent, broker, or assister; 2) Have an agent or broker contact you; 3) Use a certified enrollment partner’s website; and 4) Use HealthCare.gov.

Two of the options — to enroll by phone and by mail — have been completely removed. These removals occurring well into the Open Enrollment period, after consumers may have already visited HealthCare.gov and decided to use one of these methods. The removals may cause confusion and could impede consumers’ ability to obtain health insurance coverage.

The third option, enabling users to get “in-person help” from assisters has been merged with the fourth option, to find an agent and broker. (Although these option were previously listed as distinct options, they both provided a link to the same page.) While the assister community is broad, and includes all individuals or organizations trained to provide free help to consumers and small businesses searching for and enrolling in health coverage, agents and brokers are part of narrower group of this community and usually receive commissions from health insurance companies for each plan they sell.

Some of the added links associated with new options may reflect policy changes at the Centers for Medicare and Medicaid Services (CMS) — the office that manages and funds HealthCare.gov. These policy changes are aimed at making it possible for consumers to bypass HealthCare.gov to find ACA coverage. The added links preceded CMS’s release of new guidance on enhanced direct enrollment, which allows websites of approved third-parties, including agents and brokers, to provide consumers with the same information and capacity to manage their coverage as is available through HealthCare.gov.

The new set of options includes third-party entities in three of the four options, listing agents and brokers twice and linking to information about using partner websites to enroll in coverage.

Specifically, a link listed as part of the new “Have an agent or broker contact you” option directs users to an “exit” webpage, warning “Once you leave HealthCare.gov, you’re subject to the privacy and security policies of the Help On Demand site, operated by BigWave Systems.” Clicking the “Go Now” button from this page directs users to the third-party website. According to CMS, the “Help on Demand” website, which is run by a for-profit, private software company, “connects consumers seeking assistance with Marketplace-registered, state-licensed agents and brokers in their area who can provide immediate assistance with Marketplace plans and enrollments.”

The page linked from the new “Use a certified enrollment partner’s website” option explains that certified partners may include online health insurance sellers, who will show you all the Marketplace coverage plans offered in your area, or insurance companies, whose websites may show you only the Marketplace plans they offer. Some certified partners let you shop for plans on their websites but require you to enroll on HealthCare.gov, and others allow you to shop, enroll, and manage your plan on their own websites, completely separate from HealthCare.gov.

Beyond including new options to use “Health On Demand” and partner websites, the order in which options appear on the page changed. The option to use HealthCare.gov — the website on which the “Apply for Health Insurance” page is hosted — is now last on the list of ways to apply. Before the change, it was listed as the first option. This change, in conjunction with options that direct consumers off of the HealthCare.gov website, demonstrates a de-emphasis by CMS of the very website it manages.

The shifts in information on the “Apply for Health Insurance” page are not a one off. This report on the overhaul comes on the heels of WIP’s recent report, describing the removal of an assister training guide for Latino outreach. Jodi Ray, who oversees an assister effort as director of Florida Covering Kids & Families at the University of South Florida, told the Washington Post about the importance of these training materials in enabling her work. “If you pull credible resources, make it less accessible, it does make our job more difficult,” said Ray. “You have to know your community, the population, the culture of who you’re trying to reach. If we’re not providing the resources to be able to do that effectively, we’re going to lose that population that needs this more than anyone.”

Indeed, the overhaul of the “Apply for Health Insurance” page and the removal of the Latino outreach training guide come amid an array of Trump administration efforts to undermine the Open Enrollment period. These efforts include cutting the advertising and promotional budget for the ACA last year and multiple budget cuts to federally-funded assister programs.

Through a de-emphasis of HealthCare.gov, the removal of information about some of the simple methods for applying for coverage under the ACA, and the addition of options directing users to insurance sellers outside of the Marketplace, the overhaul of the “Apply for Health Insurance” page reduces access to information and options for obtaining health insurance. This ultimately amplifies the many other efforts by this administration to undermine Open Enrollment and access to health coverage broadly.

More Proof: Trump Administration Targets Latinos In Its Open Enrollment Sabotage

Washington, DC – As part of its efforts to sabotage open enrollment, the Centers for Medicare and Medicaid Services removed a training guide for Latino outreach from a CMS website. This move is just one more part of the Administration’s sabotage efforts, including drastic cuts to outreach efforts and shortening the enrollment time period. Leslie Dach, Chair of Protect Our Care, issued the following statement in response:  

“From day one, Donald Trump has worked to sabotage health care for millions of Americans. Now, the Administration has targeted Latinos by deleting critical information from the HHS website that provides training for navigators as they assist Latino communities during the enrollment period. We all know open enrollment is a critical time for Americans to get the coverage they need. The Affordable Care Act is particularly important to Latinos, who are uninsured at a disproportionately high rate of 22 percent. There is no doubt in my mind that the Trump Administration is taking active steps to harm health care at the expense of the American people.”

 

BACKGROUND:

22 Percent Of Hispanic Americans Are Uninsured. The uninsured rate of Hispanic Americans is 22 percent, more than twice that of white Americans, 9 percent of whom are uninsured.

Between 2016 And 2018, The Trump Administration Has Cut Funding For Groups That Help People Sign Up For Coverage By 84 Percent. After cutting funding for navigator groups that help people sign up for coverage from $63 million in 2016 to $36 million in 2017, the Trump administration made yet another round of cuts in 2018, leaving just $10 million in funding for health navigator groups. Since 2016, Trump has cut navigator funding by 84 percent.

Health Navigators, Like Jodi Ray At The University Of South Florida, Say Cuts To Navigator Programs Prevent Them From Adequately Letting People Know That Open Enrollment Is Happening. Ray said, “We don’t have the people to provide the enrollment assistance nor to do the outreach and marketing to let people know what’s happening.”

This Year, 800 Counties Served By The Federal Marketplace Are Operating Without Any Federally Funded Navigators. This is more than six times as many counties served by the federal marketplace that operated without federally funded navigators in 2016, when 127 counties lacked such a navigator.  

The Trump Administration Wants Navigator Groups To Push Consumers To Sign Up For Junk Coverage That Is Exempt From Covering Prescription Drugs And Hospitalization Instead Of Comprehensive Plans. The Administration announced in July that it would encourage navigator groups to use their remaining funding to push consumers to sign up for junk health plans, which cover few benefits and notorious for the fraud they attract.

In 2017, The Trump Administration Cut The Open Enrollment Advertising budget By 90 Percent. As ABC News summarized, “In 2016, the Centers for Medicare & Medicaid Services spent $100 million on Obamacare advertising and outreach, but for [2017]’s open enrollment period, CMS plans on spending $10 million.” CMS chose not to increase the budget for 2019.

 

A full timeline of the Trump administration’s crusade to sabotage open enrollment is below:

October 2018

  • 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, a move expected to worsen ACA risk pools.
  • Trump administration announces scheduled maintenance on the open enrollment website, preventing people from signing up for coverage on Sundays from 12:00 AM – 12:00 PM.

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

  • 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.

July 2018

  • 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.

December 2017

  • 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.

October 2017

  • The Trump Administration dramatically cuts in-person assistance to help people sign up for 2018 health coverage.

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.

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.

January 2017

  • 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

Wisconsinites Beware: Trump Administration Approves Walker’s Restrictive Medicaid Waiver

Washington DC – Today CMS approved Wisconsin’s plan to dramatically restrict Medicaid enrollment by taking coverage away from people who do not meet new burdensome work requirements or who cannot afford to pay new burdensome premiums. In response to the announcement, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“Let’s be clear: At a time when Scott Walker is in the political fight of his career — promising over and over again that he’ll protect people with pre-existing conditions — here he is teaming up with Donald Trump to rip health care away from the families who need it the most. Wisconsinites, the vast majority of whom want to ensure people with pre-existing conditions get the coverage they need, must judge Scott Walker by what he does, not what he says. Because despite all his recent talk about protecting people, all he really does is use his power as Governor to put barriers between the hardworking people in his state and the care and coverage they need.”

BACKGROUND

MEDICAID IS A LIFELINE FOR…

…CHILDREN & FAMILIES

  • Nearly 36 Million Children Are Enrolled In Medicaid And CHIP. Roughly 35.7 million children in the United States are enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
  • 38 Percent Of Children In America Are Covered By Medicaid. Nationally, nearly 2 in 5, or 38% of children in America have health insurance through Medicaid.
  • 49 Percent Of Births Are Covered By Medicaid.
  • 17 Percent of Parents Have Health Insurance Through Medicaid.
  • In 2010, Medicaid Kept 2.6 Million Americans Out Of Poverty.

…PEOPLE WITH DISABILITIES

  • Nearly 8.7 million adults enrolled in Medicaid have a disability. Of this group, only 43 percent qualify for social security income.

…SENIORS

  • More than 6.9 million American seniors have Medicaid coverage. 6,920,200 seniors, age 65 and older, are enrolled in Medicaid.
  • Medicaid funds 53 percent of long-term care nationwide. As seniors age, long-term care services become more and more vital, serving half of seniors over age 75 and three in four seniors over age 85.
  • Medicaid covers 6 in 10 nursing home residents. The average annual cost of nursing home care is $82,000 — nearly three times most seniors’ annual income.

…PEOPLE SUFFERING FROM OPIOID USE DISORDER

  • In 2014, Medicaid paid for 25 percent of all addiction treatment nationwide.

IN STATES WHERE SIMILAR RULES HAVE TAKEN EFFECT, THOUSANDS OF PEOPLE HAVE LOST CARE

  • Early results in Arkansas confirm that Medicaid work requirements are fundamentally bureaucratic hurdles, threatening access to health coverage for thousands across the state. “The early results suggest that the incentives may not work the way officials had hoped. Arkansas officials, trying to minimize coverage losses, effectively exempted two-thirds of the eligible people from having to report work hours. Of the remaining third — about 20,000 people — 16,000 didn’t report qualifying activities to the state. Only 1,200 people, about 2 percent of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.” [New York Times, 9/24/18]
  • This summer, a federal district court blocked Kentucky from imposing similar rules for the negative effects it would have on Kentuckians. Said the court in its ruling, “[Secretary Azar] never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders his determination arbitrary and capricious. The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review.”
  • In Indiana, 25,000 people with health insurance through Medicaid were dropped from coverage because they were unable to pay their premiums. The Washington Post reported, “About 25,000 adults were disenrolled from the program between its start in 2015 and October 2017 for failure to pay their premiums, according to state reports. Yet, state officials estimate that based on surveys of recipients, about half of those who were disenrolled found another source of coverage, most often through a job…In addition to those who were disenrolled, another 46,000 adults who signed up for Medicaid during 2016 and 2017 were not accepted because they did not pay their initial premium, the state reported.”

TAKING AWAY SOMEONE’S HEALTH CARE DOES NOT HELP THEM TO WORK

  • Evidence suggests that such work requirements hurt, rather than help enrollees’ ability to find work. A study of Michigan’s Medicaid “illustrates the functional barriers to work that Medicaid beneficiaries face, and many of them result from physical and mental health challenges. This suggests to us that taking away their health coverage means that they are less likely to find work – not more so…a stable source of health coverage such as Medicaid is likely to assist people with their chronic mental and physical health conditions so that they are better able to seek employment.” In both Ohio and Michigan, having access to health care made it easier for the unemployed to find work: “majorities said that gaining health coverage has helped them look for work or remain employed. Losing coverage — and, with it, access to mental health treatment, medication to manage chronic conditions, or other important care — could have the perverse result of impeding future employment.

WORK REQUIREMENTS ADD ADMINISTRATIVE HURDLES, MAKING IT HARDER FOR PEOPLE WHO ARE ELIGIBLE FOR CARE TO GET IT

  • Requiring People On Medicaid To Prove They Are Working Adds An Administrative Burden That Is Hardest On Low-Income Americans. “[Administrative hurdles] may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access.  There is also a lot of research about the Medicaid program, specifically, that shows that sign-ups fall when states make their program more complicated.” [New York Times, 1/18/18]
  • Documentation Requirements Increase The Chances That People Will Lose Care, Simply Because They Have Trouble Navigating The Process. “There is a real risk of eligible people losing coverage due to their inability to navigate these processes, miscommunication, or other breakdowns in the administrative process. People with disabilities may have challenges navigating the system to obtain an exemption for which they qualify and end up losing coverage.” [Kaiser Family Foundation, 1/16/18]

THE VAST MAJORITY OF  PEOPLE WITH MEDICAID COVERAGE WHO WHO CAN WORK ARE WORKING

  • 60 percent of nondisabled people with health coverage through Medicaid have a job and are working, including 42 percent working full-time.
  • 51 percent of working adult Medicaid enrollees have full-time jobs year-round, but their salaries are still low enough to qualify for Medicaid coverage or have Medicaid because their employers do not offer insurance.  
  • Nearly 80 percent of nondisabled people with Medicaid coverage live in a family where at least one person is working, including 64 percent working full-time. The other adult family member may not be working because they have caregiving or other responsibilities at home.
  • A state by state breakdown can be found HERE

Trump Administration Deals Devastating Blow to Pre-existing Conditions Coverage & Other Health Insurance Protections

This is yet another blatant example of their repeal and sabotage agenda, and proof of their ongoing war on America’s health care,” says Leslie Dach

 

Washington, DC – In response to a new federal policy issued today that waters down the guardrails that ensure health insurance plans sold in states that are seeking approvals of “1332 waivers” provide the full range of benefits and the cost-sharing protections in the Affordable Care Act, Leslie Dach, chair of Protect Our Care, issued the following statement:

“The hypocrisy of Republicans rolling back protections for pre-existing conditions at a time when their candidates are campaigning as defenders of health care is outrageous. This is yet another blatant example of their repeal and sabotage agenda, and proof of their ongoing war on America’s health care.”

 

ADDITIONAL BACKGROUND:

Kaiser Family Foundation’s Larry Levitt Calls The Rule Out Today An “End Run” Around the ACA. Here is what 1332 waivers without appropriate guardrail protections could mean for consumers:

  • 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. 1332 waivers 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. According to the Brookings Institution, the result would be “that no one in a state’s individual market that waived EHBs would have access to comprehensive coverage. Insurers would likely sell separate policies for benefits not covered in their core plan offerings, but these supplemental policies would be subject to tremendous adverse selection, leading to very high premiums and enrollment almost exclusively by those with pre-existing conditions.” For example, a woman who purchases a separate insurance rider for maternity care would have to pay $17,320 more, according to the Center for American Progress. For states that no longer required substance use disorders or mental health to be covered, coverage for drug dependence treatment could cost an extra $20,450.
  • 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. Moreover, as the Center on Budget and Policy Priorities notes, this would even impact people with coverage from their employer: “The ACA’s prohibition on annual and lifetime limits is tied to the definition of Essential Health Benefits. Thus, repeal of Essential Health Benefit standards could make this protection meaningless, putting almost all Americans with private health insurance coverage — not just those with individual or small-group market coverage — at risk.” 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.

REALITY CHECK: ACA Marketplaces Experiencing Widespread Premium Increases Due to GOP Sabotage

Washington, D.C – On the heels of President Trump’s widely panned and highly deceptive health care op-ed, CMS issued a similarly misleading press release in a transparent effort to conceal how the Trump Administration has raised health care costs. Leslie Dach, chair of Protect Our Care, released the following statement in response:

 

“Another day, another set of lies from the Trump Administration, desperate to hide the truth about how they’ve jacked up health care costs for Americans. Here’s the simple truth: People buying health insurance in America today are paying more for it than they should because of the relentless sabotage campaign by the Trump Administration and its Republican allies in Congress and the states. People who are seeing substantial premium increases are paying more than they should and the people seeing small rate decreases should be paying even less. The fact that Americans are paying more because of Trump’s sabotage when insurance companies are getting massive tax breaks and their profits and CEO salaries are soaring — and projected to skyrocket even further — is outrageous, and underscores why millions are fed up with this Republican war on health care and preparing to take this anger out at the polls.”

 

FACT: ACROSS THE BOARD, AMERICANS ARE PAYING MORE DUE TO TRUMP ADMINISTRATION’S SABOTAGE CAMPAIGN

 

Brookings Analysis Estimates That Individual Market Premiums Would Decrease If Not For GOP Sabotage. Among its key findings:

  • Estimates That Average Premium Would Fall By 4.3 Percent In 2019 In Stable Policy Environment. “I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment.” [Brookings Institution, 8/1/18]
  • Insurance Companies’ Revenues Will Far Exceed Their Costs In 2018. “I project that insurers’ revenues in the ACA-compliant individual market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and 2016. The estimated 2018 margin also far exceeds insurers’ margins in the pre-ACA individual market. ” [Brookings Institution, 8/1/18]
  • Absent Republican Sabotage, Average Premiums For ACA-Compliant Plans Would Likely Fall In 2019. “In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for 3 2019. Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers’ costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs.” [Brookings Institution, 8/1/18]

American Academy of Actuaries Point To Trump Administration Sabotage As Drivers Of 2019 Premium Increases. “Key drivers of 2019 premium changes include…Recent legislative and regulatory changes, including the elimination of the individual mandate penalty, the pending expanded availability of short-term limited duration plans and association health plans, and whether changes are made regarding how insurers are instructed to load premiums to account for cost-sharing reduction subsidies.” [American Academy of Actuaries, 6/13/18]

 

American Enterprise Institute Says Deregulating the Individual Market will not Lower Overall Health Costs. “When these proposed rules are made final, which is likely to occur in the coming months, many middle-class consumers will be able to exit the ACA-regulated markets for less expensive options. But overall costs will not decline. Insurers will simply shift higher premiums onto those who remain in the current market, which in turn will mean the federal government will pay higher subsidies for those eligible for premium assistance.” [American Enterprise Institute, 4/26/18]

 

FACT: TRUMP CAN’T TAKE CREDIT FOR STABILIZATION THAT WAS HAPPENING BEFORE HE CAME INTO OFFICE — AND ON A BETTER TRACK BEFORE HIS REPEAL-AND-SABOTAGE CAMPAIGN

 

Larry Levitt, SVP for Health Reform at Kaiser Family Foundation: Before Republican Sabotage, The Individual Marketplaces Were Stabilizing. “With insurers now mostly profitable in the ACA individual insurance market, I would have expected single-digit premium increases for 2019 reflecting health-cost growth…With repeal of the individual mandate and expansion of short-term plans, double-digit hikes are now likely.” [Rampell, Washington Post, 5/14/18]

  • Larry Levitt, SVP for Health Reform at Kaiser Family Foundation: If Not For Republican Sabotage, Premium Increases Would Be Modest.If not for actions by Congress and the Trump administration, we’d be looking at very modest premium increases for next year.” [Larry Levitt, 5/17/18]

Analysis By The Kaiser Family Foundation Confirms what Experts Have Been Saying For Months, Before Sabotage Took Affect, The Individual Market Was Stabilizing. “Annual results from 2017 suggest the individual market was stabilizing and insurers in this market were regaining profitability. Insurer financial results through 2017 – after the Administration’s decision to stop making cost-sharing subsidy payments and before the repeal of the individual mandate penalty in the tax overhaul goes into effect – showed no sign of a market collapse.” [Kaiser Family Foundation, 5/17/18]

Kaiser Family Foundation: “Absent any policy changes, it is likely that insurers would generally have required only modest premium increases in 2018 and in 2019 as well.” [Kaiser Family Foundation, 5/17/18]

Between 2016 and 2017, Premiums Increased At A Much Faster Pace Than Claims Did. “Driving recent improvements in individual market insurer financial performance are the premium increases in 2017 and simultaneous slow growth in claims for medical expenses. On average, premiums per enrollee grew 22% from 2016 to 2017, while per person claims grew only 5%.” [Kaiser Family Foundation, 5/17/18]

 

FACT: CMS IS CHERRY PICKING. THEY IGNORE GIANT RATE INCREASES AND ONLY CITE THE AVERAGE OF SILVER PLANS BECAUSE, OVERALL, PLANS ARE GOING UP BY AN AVERAGE OF THREE PERCENT THIS YEAR (ON TOP OF 30 PERCENT INCREASES LAST YEAR)

In citing the decrease that some Tennesseans will experience next year, CMS completely neglects to mention that other Tennesseans will see increases as high as 10.84 percent on top of last year’s 36 and 21 percent rate hikes. Health insurance experts and analysts blame GOP sabotage.

 

Charles Gaba, Health Care Analyst: Tennessee Premiums Would Have Dropped By 23 Percent If Not For GOP Sabotage. “Regardless, the net effect of all this is that Tennessee premiums are now expected to drop by around 11.1% overall instead of 5.7%…but they still would have dropped even further (around 23% by my estimates) if not for ACA sabotage factors.” [ACASignups, 8/22/18]

Julie Mix McPeak, President of National Association of Insurance Commissioners and TN Insurance Commissioner: GOP Sabotage Could Raise Premiums Yet Again For Next Year. “Obamacare premiums for 2019 would go up 5 percent to 10 percent on top of rate increases that were previously expected because of uncertainty raised by the Trump administration’s suspension of payments among insurers to cover sick enrollees. That is what Tennessee Insurance Commissioner Julie Mix McPeak told me in an interview about the impact of the Department of Health and Human Services’ July 7 announcement that it was suspending $10.4 billion in transfer payments among insurers due to a ruling in February by the U.S. District Court for the District of New Mexico.” [Bloomberg Law, 7/20/18]

 

FACT: ON HIS FIRST DAY IN OFFICE, PRESIDENT TRUMP SIGNED AN EXECUTIVE ORDER DIRECTING THE ADMINISTRATION TO IDENTIFY EVERY WAY IT CAN UNRAVEL THE AFFORDABLE CARE ACT

 

…and he’s been sabotaging our health care each day since.