Today, in defense of the Trump Administration’s indefensible work requirements that have kicked thousands of people off of their health care, Seema Verma, the Administrator of the Centers for Medicare and Medicaid Services, continued to argue that these requirements help Medicaid enrollees attain “skills they need” and “jobs that are available.”
Say what?
Here’s the truth: 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. Astudy 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 they are better able to seek employment.” In both Ohio and Michigan, having access to health care made iteasier 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.
In Michigan, Medicaid Work Requirements Hurt, Rather Than Help Enrollees’ Ability To Find Work: “The Michigan study 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 they are better able to seek employment.” [Georgetown University Health Policy Institute, 12/15/17]
In Ohio, Health Coverage Made It Easier For The Unemployed To Look For Work: “In studies of adults who gained coverage in Ohio and Michigan under the Affordable Care Act’s Medicaid expansion, 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. [CBPP, 1/11/2018]
WORK REQUIREMENTS ADD ADMINISTRATIVE HURDLES, MAKING IT HARDER FOR PEOPLE WHO ARE ELIGIBLE FOR CARE TO GET IT
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]
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]
Washington, D.C. – Following the announcement by the Centers for Medicare and Medicaid Services that the Trump Administration is slashing navigator funding and pushing enrollment for junk plans that charge people more money for less care, Leslie Dach, campaign chair for Protect Our Care, issued the following statement:
“After keeping one million Americans from gaining coverage by cutting last year’s open enrollment period in half and slashing advertising for affordable plans by ninety percent, the Trump Administration is once again taking quality, affordable health care away from people who need it through its latest act of sabotage. Defunding the navigator program and forcing the navigators who are left to push junk plans on the American people is a shocking and cynical move, even by this Administration’s standards.”
BACKGROUND:
Breaking: Trump Administration Slashes Grants To Help Americans Get Affordable Care Act Coverage. “The Trump administration is eliminating most of the funding for grass-roots groups that help Americans get Affordable Care Act insurance and will for the first time urge the groups to promote health plans that bypass the law’s consumer protections and required benefits. The reduction, the second round of cuts that began a summer ago, will shrink the federal money devoted to groups known as navigators from $36.8 million to $10 million for the enrollment period that starts in November.” [The Washington Post, 7/10/2018].
During The First Open Enrollment Period, 10.6 Million Americans Were Assisted By Navigators. “More than 4,400 Assister Programs, employing more than 28,000 full-time-equivalent staff and volunteers, helped an estimated 10.6 million people during the first Open Enrollment period.” [Kaiser Family Foundation, 7/15/14]
For Months, The Groups That Help People Sign Up For Marketplace Coverage Have Been In Limbo. “Local groups that help people sign up for ObamaCare and Medicaid have yet to hear from the Trump administration about their annual federal funding, leaving many in limbo and fearing the grants could be too small or might not come at all…The organizations typically hear from the federal government in April or early May with information about how much money will be available for grants, when key deadlines are and the expected award date. But several navigators contacted by The Hill said they have received no information from the Centers for Medicare & Medicaid Services..When asked about the navigator grants, a spokesperson for the Department of Health and Human Services (HHS) wrote in an email that HHS did not have any details to share at this time.” [The Hill, 6/20/18]
Dan Derksen, Doctor Who Oversees Navigator Program At University Of Arizona: “At a time when people have more questions, it’s very likely there will be fewer people to help them in person.” [USA Today, 6/21/18]
Last Year’s Cuts Led University Of Florida Navigator Program To Cut Staff. “Jodi Ray, director of Florida Covering Kids & Families navigator group at the University of South Florida, said her organization is bracing for changes. Last year’s cuts forced the Florida group to trim the number of employed navigators. She worries that further cuts and program changes could harm the state’s vulnerable residents who rely on the organization’s services.” [USA Today, 6/21/18]
Karen Egozi, CEO Of The Epilepsy Foundation Of Florida: We’re In The Dark. “We really haven’t gotten any update or any deadline to submit applications or any knowledge at all about what the future is going to bring.” [The Hill, 6/20/18]
Catherine Edwards, Executive Director For The Missouri Association Of Area Agencies On Aging: Administration Has No Incentive To Work With Community Groups. “We know this administration is not friendly to the ACA, and so they have no incentive to involve community-based groups in enrolling people.” [The Hill, 6/20/18]
Shelli Quenga, Director Of Programs For South Carolina-Based Palmetto Project: Restricting Support Is Bad For Consumers. “It’s very unfortunate for the consumer…We know that consumers still need in-person assistance — and especially consumers who are not native English speakers, consumers who are living just above the poverty line who don’t have a lot of experience with making big financial decisions like this that also have long-term implications to their financial future for themselves and their family members.” [The Hill, 6/20/18]
Cutting Funds To Navigator Groups Means They Must Significantly Cut Back On Outreach. “‘We have no expectation of any federal money being available to us,’ said Donna Friedsam, the director of Covering Wisconsin, a navigator program. Her organization received a 42 percent reduction last year because of the funding changes. It previously offered enrollment services in 23 counties, but had to scale down to 12.” [The Hill, 6/20/18]
Trump Administration Considering Cutting Funding For Health Care Navigator Groups. “The Trump administration is considering cutting funding for ObamaCare outreach groups that help people enroll in coverage, sources say. An initial proposal by the administration would have cut the funding for the groups, known as “navigators,” from $36 million last year to $10 million this year. Sources say that proposal now could be walked back, and it is possible funding could remain the same as last year, but it is unclear where the final number will end up.” [The Hill, 6/29/18]
Jodi Ray, Director Of Florida Covering Kids And Families: “Less Resources Means We Have Less Boots On The Ground To Provide That Enrollment Assistance.” [The Hill, 6/29/18]
Washington, D.C. – Today, the Centers for Medicare and Medicaid Services released a trends report about last year’s open enrollment period, which saw decreased enrollment and rising premiums. Protect Our Care Executive Director Brad Woodhouse released the following statement in response:
“Today’s report confirms that Republican sabotage is directly responsible for rising premiums and fewer Americans obtaining health insurance, outcomes which were entirely avoidable. From the day he took office Donald Trump has worked with Congressional Republicans to sabotage the Affordable Care Act, and nowhere was this more evident than last year’s open enrollment period. The Administration cut in half the number of days people could sign up for coverage; reduced the outreach budget by ninety percent; and used funding to boost open enrollment to launch a propaganda campaign against the ACA. All told, these actions reduced enrollment by more than one million people – and as we look toward next year’s open enrollment period, the Trump Administration has already dramatically cut in-person assistance to help people sign up for 2018 health coverage, and we can expect more of the same. Unfortunately, it is the American people who will once again be left to suffer.”
BACKGROUND:
In April, the Trump Administration cut the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
In July, the Trump Administration used funding intended to support health insurance enrollment to launch a multimedia propaganda campaign against the Affordable Care Act.
In August, the Administration cut 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.
In September, the Administration ordered the Department of Health and Human Services’ regional directors to stop participating in Open Enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell says, “I didn’t call it sabotage…But that’s what it is.”
In October, the Trump Administration dramatically cut in-person assistance to help people sign up for 2018 health coverage.
Last week, it was reported that the Trump Administration proposed further massive cuts for health insurance navigators.
Washington, D.C. – This morning at the America’s Health Care Future event hosted by the Washington Post, Centers for Medicare & Medicaid Services Administrator Seema Verma admitted that the uninsured rate will continue to rise under their watch. Protect Our Care Campaign Director Brad Woodhouse released the following statement in response:
“Administrator Verma’s remarks this morning are only the latest example of the Trump Administration demonstrating their total disregard for Americans’ health care. During President Trump’s first year in office, the uninsured rate grew by 3 million – the largest increase since 2008. During President Trump’s second year in office, premiums are expected to increase double-digits across the country. The Trump Administration and Republicans in Congress have carried out a sabotage campaign designed to make the Affordable Care Act fail, and they have succeeded to the detriment of the American people. Administrator Verma’s admitting that the Administration has no plans to stop this suffering is disgraceful. Enough is enough – it’s time for the GOP to end their war on health care.
Washington, D.C. – After Senator Susan Collins (R-Maine) bragged about discussing rising premiums with Centers for Medicare & Medicaid Administrator Seema Verma, Protect Our Care Campaign Director Campaign Chair Leslie Dach released the following statement:
“Senator Collins talking to Administrator Verma about Republican rate hikes is about as much help to working families as two foxes chatting in front of a chicken coop. Senator Collins’ ‘plan’ for lowering premiums was to vote for a TrumpTax bill that raised them by double digits, while Administrator Verma’s ‘plan’ is to sell junk insurance that doesn’t cover essential medical care and allows companies to once again discriminate against people with pre-existing conditions. Last fall, Senator Collins had a clear opportunity to tackle rising premiums, and she missed the boat. She could have voted against the GOP tax bill and kept her promise to pass a bipartisan market stabilization package to undo some of the Trump Administration’s own sabotage. Instead, she did neither. Senator Collins and Seema Verma can discuss rising premiums until the cows come home, but in fact, it’s their policies that got us into this mess in the first place.”
Washington, D.C. – Consumer advocates spoke out quickly and loudly after the Trump Administration announced a final Notice of Benefit and Payment Parameters rule for plans offered through the Affordable Care Act’s individual marketplaces that will weaken benefits for millions of Americans, put those with pre-existing conditions at risk, and make it even harder for people to sign up for coverage – all while lining insurance company pockets through reduced review of rate hikes and overhead:
Elected Officials
Senator Ron Wyden (D-OR): “Instead of taking steps to prevent big premium increases this fall, the Trump Administration is watering down your health care and making it harder to get coverage. Projections already showed double digit premiums increases this year due to the Trump Administration’s attacks on families’ health care, and today’s new rules pour gasoline on the fire.” [4/9/18]
Senator Patty Murray (D-WA): “With this new rule, President Trump has issued an open invitation for insurance companies to raise premiums, skirt patient protections, and undermine families’ care. I’m very concerned about what these dramatic, harmful changes in policy could mean for women who don’t want to pay more than men for health care, for people with pre-existing conditions, for those struggling with mental illness and substance use, and for millions of peoples’ health costs. Republicans in Congress should join Democrats in condemning the President Trump’s latest politically-motivated effort to raise families’ costs and create health care chaos.” [4/9/18]
Stakeholders & Experts
Andy Slavitt, Former Acting CMS Administrator: “Andy Slavitt, who was acting CMS administrator during the Obama administration’s final two years, countered that the current administration ‘is making it clear that they’re implementing a law that they have no intention of making succeed.’ Slavitt called the revisions ‘a gift to the insurance companies by finding lots of ways for them to get around the standards Americans have come to expect.’” [Washington Post, 4/9/18]
Sam Berger, Senior Adviser, Center for American Progress: “This rule reduces protections for people with pre-existing conditions, increases the cost of health coverage, and makes it harder for consumers to sign up for coverage. This past year has shown just how much consumers value quality, affordable health care, but rather than encourage awareness, lower prices, and promote market stability, the administration is more concerned with trying to undermine the law. This is just the latest example of the Trump administration putting its ideological crusade against the Affordable Care Act ahead of the health and well-being of the American people.” [4/9/18]
Avalere: “The final NBPP … allows for greater essential health benefit flexibility, which could lead to less generous benefits and worse access for consumers.” [4/9/18]
Matt Eyles, Incoming President and CEO, America’s Health Insurance Plans: “When you think about things like the individual mandate going away, some of the other proposed rules that are being put in place, whether it be around association plans, short-term policies — it’s just still a nasty soup right now that’s brewing… We’re looking ahead to 2019, and it’s not a really great picture right now, but I know a lot of companies are committed to the market.” [Washington Times, 4/10/18]
U.S. PIRG: “Together, these changes will make it easier for health insurance companies to raise rates and reduce the value of health coverage for consumers. This is a big step in the wrong direction.” [4/9/18]
AFT Nurses and Health Professionals: “CMS gives states more power to cut health benefits, more profits to insurance companies, with fewer safeguards for coverage.” [4/10/18]
News Coverage Details Rule’s 529 Pages of Sabotage
Wall Street Journal: “Trump Administration Allows States to Narrow ACA Coverage.” “The Trump administration will give states leeway to winnow down the mandatory health benefits guaranteed to consumers who buy Affordable Care Act insurance plans, under a rule issued Monday… The changes to the ACA plans reflect the administration’s goal of dismantling former President Barack Obama’s signature health law and transferring more health-policy decisions to the states. Democrats and some consumer groups denounced the rule as another effort by the administration to undermine the ACA. They have said that weakening the scope of the benefits offered in ACA plans will hurt consumers by reducing coverage. The new rule will ‘undermine protections for people with pre-existing conditions with a race-to-the-bottom approach that fundamentally undermines the Affordable Care Act’s essential health-benefit coverage guarantee,’ said Brad Woodhouse, campaign director of Protect Our Care, a group that is an advocate for the ACA.” [Wall Street Journal, 4/9/18]
CNN: “The New Rule Is The Latest Effort By The Administration To Undermine The Affordable Care Act.” “The new rule is the latest effort by the administration to undermine the Affordable Care Act. Earlier this year, it proposed rules that would allow insurers to sell short-term insurance plans, which last just under a year but don’t have to comply with Obamacare’s regulations, and to make it easier for small businesses to band together to offer coverage that doesn’t adhere to all of the health reform law’s mandates. Both of these options could have lower premiums, but also cover fewer benefits.” [CNN, 4/9/18]
Health Care Dive: “The Sweeping Rule Is Just The Latest In The Trump Administration’s Steady Chipping Away” At The ACA. “The sweeping rule is just the latest in the Trump administration’s steady chipping away at the landmark health law, which has been coupled with a move to give states more control over their healthcare regulations. The administration cut off cost-sharing reduction payments to insurers in October, sparking backlash from payers. The Republican tax bill last year repealed the individual mandate penalty starting in 2019. And more is on the way. In February, the administration released a proposed rule to expand short-term health insurance availability, bumping up the allowance of coverage to 12 months. It is also promoting association health plans, which aren’t required to meet the EHB requirements or protect people with pre-existing conditions. The ACA requires payers to cover at least 10 specific benefits, including maternity care and prescription drugs.” [Health Care Dive, 4/9/18]
Reuters: “This Could Lead To Less Generous Coverage.” “The Trump administration took additional steps to weaken Obamacare on Monday, allowing U.S. states to relax the rules on what insurers must cover and giving states more power to regulate their individual insurance markets. The Centers for Medicare and Medicaid Services issued a final rule that allows states to select essential health benefits that must be covered by individual insurance plans sold under former President Barack Obama’s healthcare law. The 2010 Affordable Care Act requires coverage of 10 benefits, including maternity and newborn care and prescription drugs. Under the new rule, states can select from a much larger list which benefits insurers must cover. That could lead to less generous coverage in some states, according to Avalere Health, a research and consulting firm. [Reuters, 4/9/18]
Reuters: “Insurers Could Also Have An Easier Time Raising Their Rates Under The New Rule.” “Insurers could also have an easier time raising their rates under the new rule. Obamacare mandated that premium rate increases of 10 percent or more in the individual market be scrutinized by state regulators to ensure that they are necessary and reasonable. The new CMS rule raises that threshold to 15 percent.” [Reuters, 4/9/18]
CNN: The Rules “Make It Easier For Insurers To Spend Less Of The Premiums They Collect On Policyholders And Put More Toward Profits.” “The rule also allows states to make it easier for insurers to spend less of the premiums they collect on policyholders and put more toward profits and administrative costs. And the administration raised the default threshold that trigger state reviews of insurers’ proposed rate hikes to 15%, up from 10%.” [CNN, 4/9/18]
Washington Post: New Rules “Will Enable States To Allow Future Doctors Visits [Or Cover] Fewer Prescription Drugs.” “One of the most significant changes involves a set of 10 essential health benefits that the ACA requires of health plans sold through the federal insurance marketplace and separate state marketplaces. The new rules will not jettison any of the categories but will enable states to allow fewer doctors visits, for example, or to cover fewer prescription drugs.” [Washington Post, 4/9/18]
Washington Post: “The Government Will No Longer Require That Insurers Provide A Standardized Set Of Benefits, Urged By The Obama Administration As A Way To Help Consumers Comparison Shop.” “In another change, the government is turning over to the 39 states that rely on the federal insurance exchange, HealthCare.gov, responsibility for ensuring that marketplace plans have enough doctors and other providers of care in their networks. Similarly, the government no longer will require that insurers provide a standardized set of benefits, urged by the Obama administration as a way to help consumers comparison shop. [Washington Post, 4/9/18] Washington Post: “In A Sharp Shift, The New Rules Further Weaken The Network Of Consumer Assisters.” “In ways both subtle and substantial, many of the past years’ rules were upgrades to help consumers with prices, benefits and shopping for coverage. Under a change effective in 2016, any insurer wanting to raise its premiums by 10 percent or more has been required to disclose the increase with a justification. Insurers also have had to publish up-to-date lists on drugs, including tiers of coverage and any restrictions on consumers’ ability to get them. The rules for 2017 started a rating system for the number of doctors and other providers in plans’ networks, so that customers could better compare marketplace insurers in areas that offer a choice. In a sharp shift, the new rules further weaken the network of consumer assisters, known as navigators, whose funding the Department of Health and Human Services slashed last year. The rules remove the requirement that every area has at least two navigator groups and that one be local.” [Washington Post, 4/9/18]
Washington Post: Insurers No Longer Must Devote 80 Percent Of Income To Customers’ Care. “In addition, insurers no longer will be required to devote 80 percent of their income to customers’ care, if they can show that a higher profile would improve their financial stability.” [Washington Post, 4/9/18]
The Hill: Ruling Gives Flexibility For States “To Change The Essential Health Benefits.” “Other changes announced Monday include additional flexibility for states to change the Essential Health Benefits, the list of health services that insurance plans must cover.” [The Hill, 4/9/18]
Washington Examiner: New Rules “Ease The Requirements” Plans Must Cover. “The new rules would ease the requirements on the health benefits that plans must cover, as well as quality control. Critics say the new rule will allow insurers to charge higher prices and skirt patient protections… The agency also is changing the requirements for how much money an insurer must provide toward medical services and quality improvement. Obamacare requires insurers to spend 80 percent of the money it takes in from premiums on health costs and quality improvements and 20 percent on administrative overhead or marketing. CMS would allow a state to change that ratio based on certain factors.” [Washington Examiner, 4/9/18]
Associated Press: “One Of The Ways To [Lower Costs] Is By Cutting Back On Benefits.” “The administration is under pressure from Republican-led states to reduce the cost of health insurance for consumers buying their own policies. One of the ways to do that is by cutting back on benefits.” [AP, 4/9/18]
Washington, D.C. – After the Trump Administration finalized “rules of the road” for next year’s Affordable Care Act marketplaces that favor insurance companies over the American people, Protect Our Care Campaign Director Brad Woodhouse released the following statement:
“President Trump and Congressional Republicans have already set the stage for higher prices and more confusion next fall with laws and regulations that undermine the Affordable Care Act marketplaces. Now, the Trump Administration is compounding its attack by encouraging insurance companies to undermine protections for people with pre-existing conditions with a race-to-the-bottom approach that fundamentally undermines the Affordable Care Act’s essential health benefit coverage guarantee. Meanwhile, the Administration is sweetening the deal for insurance companies by loosening restrictions on extreme rate hikes.
“Today’s Trump Administration action will make it even harder for Americans to sign up for coverage next year, with further cuts to local assisters who help families navigate their options and enroll. The Administration’s own data from this year’s enrollment period shows that their cuts to outreach and assistance dampened enrollment – especially among younger and healthier consumers – while states that ran their own marketplaces did not see similar drop-off. Today’s sabotage will compound that problem.
“As we look ahead to this fall’s open enrollment period, when premiums are already expected to spike due to harmful actions by Trump and his Republican Congress, there is simply no excuse for setting rules of the road that allow insurance companies to chip away at benefit quality and hike rates with impunity, while at the same time stripping away resources that help Americans understand their insurance options. This short-sighted, bad-faith rule is yet another brick in the wall that Republicans are building between the American people and access to good, affordable coverage.”
Yesterday, the Trump Administration confirmed that Idaho’s Affordable Care Act end-run is wildly illegal. Even so, CMS encouraged Idaho to explore other ways to sabotage the law.
Here’s a roundup of reactions to the Trump Administration’s continuing bad faith on protecting Idahoans’ health care:
Idaho Statesman: “With Some Modifications, The Noncompliant Plans Could Be Turned Into Short-term Plans For Customers.”
“Verma said her agency was sympathetic to Idaho officials’ concerns, and said President Trump is ‘committed to doing everything in his power to increase competition, choice, and access to lower-priced, high-quality health care options for all Americans.’ ‘As you know, the Patient Protection and Affordable Care Act (PPACA) is failing to deliver quality health care options to the American people and has damaged health insurance markets across the nation, including Idaho’s,’ Verma wrote, noting that premium rates for coverage through the Idaho health insurance exchange have increased by more than 91 percent from 2014 to 2018, while insurance companies continue to incur losses. Verma also outlined some options that she believes Idaho could legally take under a recently proposed federal rule. That rule would expand the availability of short-term, limited duration health insurance by allowing consumers to buy short-term plans that would cover them for just under a year. She said that with some modifications, the noncompliant plans could be turned into short-term plans for customers.” [Idaho Statesman, 3/8/18]
Sen. Ron Wyden: “While They Claim To Be Upholding The Law, They Are Explicitly Inviting Idaho And Other States To Sell Short-term, Junk Insurance — The Exact Opposite Of The Protections Put In Place By The Affordable Care Act.”
“ObamaCare supporters were pleased but not overly impressed by the CMS move. ‘The Trump administration is talking out of both sides of their mouth,’ said Sen. Ron Wyden (D-Ore.). ‘While they claim to be upholding the law, they are explicitly inviting Idaho and other states to sell short-term, junk insurance — the exact opposite of the protections put in place by the Affordable Care Act.’” [The Week, 3/8/18]
New York Times: “Verma Said That Idaho Had Other Options And Could Perhaps Achieve Much Of What It Wanted To Do Under A Regulation Proposed Last Month By Mr. Trump.”
“While rejecting the Idaho plan in its current form, Ms. Verma encouraged the state to keep trying, and she suggested that ‘with certain modifications,’ its proposal might be acceptable… Ms. Verma said that Idaho had other options and could perhaps achieve much of what it wanted to do under a regulation proposed last month by Mr. Trump.” [New York Times, 3/8/18]
Washington Post: “‘We Sincerely Appreciate Your Dedication To The People Of Idaho And Your Efforts To Address The Damage Caused By The [ACA],” Said The Letter.”
“The four-page letter to Idaho Gov. C. L. “Butch” Otter (R) and Cameron, made public early Thursday evening, straddles the Trump administration’s antipathy for the ACA with its need to enforce the sprawling 2010 health-care law that is a path to insurance coverage for millions of Americans. ‘We sincerely appreciate your dedication to the people of Idaho and your efforts to address the damage caused by the [ACA],” said the letter, signed by CMS Administrator Seema Verma. The letter said the president is eager to give states ‘as much flexibility as possible under the law to address the unique needs of their health insurance markets.’” [Washington Post, 3/8/18]
Rep Frank Pallone: “The Administration Continues Its Many Efforts To Undermine The Law And Chip Away At Its Protections, Including By Encouraging Idaho To Sell Junk Plans In Another Way.”
“Democrats cheered the Trump administration’s decision, but they still criticized other actions HHS has taken in recent months to weaken the law. ‘Make no mistake, however, while this is the right decision, the Administration continues its many efforts to undermine the law and chip away at its protections, including by encouraging Idaho to sell junk plans in another way,’ said Rep. Frank Pallone of New Jersey, the top Democrat on the House Energy and Commerce Committee.” [Politico, 3/8/18]
Talking Points Memo: “Verma Notes In The Letter That Enforcing The ACA Is ‘Certainly Not Our Preference.”
“Verma notes in the letter that enforcing the ACA is “certainly not our preference,” and encourages Idaho to find ways within the letter of the law to accomplish the same goals. She specifically advises the state to look into creating short-term health insurance plans—which recently received the Trump administration’s blessing to be sold in violation of the ACA’s regulations. [TPM, 3/8/18]
Bloomberg: “The White House Has Suggested To Congress That People Should Be Able To Renew Short-term Plans Without Being Subject To Medical Underwriting, The Process By Which Insurers Can Exclude Or Charge More For Pre-Existing Conditions.”
“Idaho’s proposal has put the Trump administration in a position it has found itself in before: charged with upholding a law it wants to get rid of, and that it has taken active steps to dismantle. Verma left open the possibility that plans like the state was proposing could be sold in a different form. If they were offered as short-term policies instead of annual coverage, they might be allowable, she said. The administration has pushed short-term plans as a way to offer consumers less expensive, less comprehensive options. In her letter to Idaho authorities, Verma said that ‘with certain modifications, these state-based plans could be legally offered’ as short-term plans. The White House has suggested to Congress that people should be able to renew short-term plans without being subject to medical underwriting, the process by which insurers can exclude or charge more for pre-existing conditions.” [Bloomberg, 3/8/18]
CNN: “Verma [Said] That She Wanted To Work With Idaho And Other States To Repair The ‘Damage’ Caused By The Affordable Care Act.”
“However, Verma did say that she wanted to work with Idaho and other states to repair the ‘damage’ caused by the Affordable Care Act. She suggested that Idaho could legally implement many of its proposals through short-term health insurance plans, which don’t have to adhere to all of Obamacare’s rules. The Trump administration is on course to allow insurers to offer these plans for up to a year, rather than just three months.” [CNN, 3/8/18]
Modern Health Care: “Secretary Alex Azar Told Insurers Thursday That The Trump Administration Will Do What It Can ‘Within The Law’ To Let Insurers Offer More Affordable Plans That Don’t Meet ACA Requirements.”
“The Trump administration on Thursday unexpectedly shot down Idaho’s effort to let insurers sell health plans that don’t comply with the Affordable Care Act’s coverage mandates, thwarting conservative efforts to unravel the law’s consumer protections directly for now. But CMS Administrator Seema Verma indicated that Idaho and other states could achieve the same goal by refashioning such noncompliant health plans as short-term products, which the administration would allow under a controversial proposed rule. HHS Secretary Alex Azar told insurers Thursday that the Trump administration will do what it can ‘within the law’ to let insurers offer more affordable plans that don’t meet ACA requirements. In a letter to Idaho Republican Gov. Butch Otter and state Insurance” [Modern Health Care, 3/8/18]
Washington Times: Verma: “This Is Certainly Not Our Preference.”
“‘If a state fails to substantially enforce the law, the Centers for Medicare & Medicaid Services (CMS) has a responsibility to enforce these provisions on behalf of the State,’ Ms. Verma added. ‘This is certainly not our preference.’ She said Idaho, with some tweaks, might be able to offer similar plans under Mr. Trump’s bid to offer short-term plans for up to a year. There is a GOP effort to codify this change and let people renew these plans, setting up a parallel market for healthier people that could siphon valuable enrollees from Obamacare’s exchanges.” [Washington Times, 3/8/18]
Business Insider: Verma: Idaho’s Attempt “Was Admirable.”
“Verma said that while Idaho’s desire to bring down costs — the stated reason for the policy — was admirable, it was also illegal. ‘CMS is committed to working with states to give them as much flexibility as permissible under the law to provide their citizens the best possible access to healthcare,’ Verma said.” [Business Insider, 3/8/18]
The Hill: “Verma’s Letter Offered Alternatives To The State.”
“Verma’s letter offered alternatives to the state, including embracing a Trump administration move to allow different kinds of cheaper, skimpier insurance plans, known as short-term plans.” [The Hill, 3/8/18]
Vox: “The CMS Letter Did Include A Caveat That Provides Some Consolation To Republican Officials – In Washington And Boise – Who Want To Unwind Obamacare.”
“It is a victory for the rule of law, given how openly Idaho was defying the ACA. But the CMS letter did include a caveat that provides some consolation to Republicans officials — in Washington and in Boise — who want to unwind Obamacare. The state could conceivably tweak its proposal, Verma noted, to align with the Trump administration’s own proposed regulations to expand short-term insurance plans — which also do not have to comply with the ACA’s insurance regulations. It would be a back door to achieve the same end (providing an escape hatch from Obamacare for healthier customers, one that is likely to lead to higher premiums for those left behind in the law’s markets) and would be more clearly in line with the administration’s agenda.” [Vox, 3/8/18]
CMS’s New Criteria for State Changes to Medicaid will Deny Coverage to Hundreds of Thousands of Americans
Washington, D.C. — The Centers for Medicare and Medicaid Services (CMS) announced today new criteria for considering requests from states to make changes to their Medicaid programs, dropping the previous requirement that such changes must “increase and strengthen” health coverage for low-income Americans and instead encouraging proposals that place new hurdles to coverage like drug tests and work requirements. CMS Administrator Seema Verma, whose agency’s mission is to help Americans access health coverage through Medicare, Medicaid, CHIP and the Health Insurance Marketplace, said in a statement that the goal of covering more people is a “hollow victory of numbers.” This, despite the fact that on its own website homepage CMS promotes that it’s efforts cover 100 million Americans.
Protect Our Care Campaign Director Brad Woodhouse blasted the changes and Verma’s offensive comparison of people gaining access to health care with “hollow” “numbers.”
“The Trump Administration has once again shown that it will stop at nothing in its zeal to sabotage American health care even if it means harming hundreds of thousands of people and resorting to offensive, right-wing stereotypes about low-income Americans in the process,” said Woodhouse. “CMS is supposed to help people get health coverage, but today it offensively called coverage goals a ‘hollow victory of numbers,’ an Orwellian statement from the agency charged with administering Medicare, Medicaid, CHIP and the Health Insurance Marketplace. These changes are shameful, harmful and wreak of the kind of right-wing rhetoric and policy choices that for decades have demeaned and stereotyped people who need health care but can’t afford it. Hundreds of thousands of Americans will lose coverage as a result of these changes — not because they don’t need, deserve or qualify, but because Donald Trump and Republicans want a talking point for their right-wing base. They should be ashamed.”
These changes are the opposite of the message Americans sent to Congress in defeating one effort after another to repeal the Affordable Care Act, which was to improve and expand coverage rather than repeal it. Republican efforts to slash Medicaid and end Medicaid expansion were especially unpopular as countless Americans shared stories of how important access to Medicaid was to them and their families.
Yesterday, a senior Trump Administration official — a mom with two kids — went off the record to discuss the Trump Administration’s commitment to sabotaging the health care system. While claiming to favor stabilizing the insurance markets, the official offered no substance, instead promoting more blatantly false information in what appears to be an attempt to preempt their sabotage. Just how outlandish were the statements made? Take a look for yourself…
STATEMENT: “The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called ‘an absolute disaster’ and threatened to let collapse. ‘I don’t think we can force people to sign up for the program,’ the official said.” [NYT, 8/30/17]
FACT: OBAMACARE IS MORE POPULAR THAN EVER, AND EVEN TRUMP SUPPORTERS WANT THE ADMINISTRATION TO MAKE THE LAW WORK
Kaiser Family Foundation Poll Results: “Only Weeks After Republicans In Congress Failed To Repeal The Landmark Health Reform Law, 52 Percent Of Respondents Hold A Favorable View Of The Affordable Care Act.” “Underscoring the adage that you don’t know what you’ve got until it’s (almost) gone, the popularity of Obamacare is surging. Only weeks after Republicans in Congress failed to repeal the landmark health reform law, 52 percent of respondents hold a favorable view of the Affordable Care Act (ACA), according to a recent Kaiser Family Foundation August poll. That’s up 10 percentage points since June of last year and nearly 20 points since November 2013, when public support for the ACA was at its nadir.” [CBS, 8/30/17]
Kaiser Family Foundation: “Large Majority Of The Public, Including Half Of Republicans And Trump Supporters, Say The Administration Should Try To Make The Affordable Care Act Work.” “After the Senate’s failure to pass legislation to repeal and replace the Affordable Care Act, the latest Kaiser Health Tracking Poll finds that eight in 10 Americans (78%) say President Trump and his administration should do what they can to make the current health care law work. This includes large majorities of Democrats (95%) and independents (80%), as well as about half of Republicans (52%) and President Trump’s supporters (51%).” [KFF, 8/11/17]
STATEMENT: “‘We want people to have access to quality health care,’ the official said. ‘I look at it from a patient perspective. I’m a mom. I’ve got two kids. I’ve got a family. I try to look at health care through that lens. What would I want? What would my family want? I think people want stability in the marketplace.’ ‘We want the health care market, the individual marketplace to function and to function well,’ the official added. ‘It is not functioning, the way it is today.’” [NYT, 8/30/17]
FACT: THE HEALTH CARE SYSTEM IS POISED TO THRIVE AS LONG AS THE SIGNIFICANT UNCERTAINTY INTRODUCED BY THE TRUMP ADMINISTRATION AND REPUBLICANS IN CONGRESS IS REMOVED.
In 2017, Every County Will Have An Insurer Participating In The Health Insurance Marketplace. [Kaiser Family Foundation, 8/18/17]
Standard & Poor: “Every Time Something New (And Potentially Disruptive) Is Thrown Into The Works, It Impedes The Individual Market’s Path To Stability.” The U.S. ACA individual market shows signs of improvement, as most insurers’ 2016 results were better than 2015 results. But the market is still developing and will need a couple more years to reach target profitability. 2016 results and the market enrollment so far in 2017 show that the ACA individual market is not in a ‘death spiral.’ However, every time something new (and potentially disruptive) is thrown into the works, it impedes the individual market’s path to stability.” [S&P, 4/7/17]
Kaiser Family Foundation: “Policy Uncertainty Has The Potential To Destabilize The Individual Market Generally.” “While the market on average is stabilizing, there remain some areas of the country that are more fragile. In addition, policy uncertainty has the potential to destabilize the individual market generally. Mixed signals from the Administration and Congress as to whether cost sharing subsidy payments will continue or whether the individual mandate will be enforced have led to some insurers to leave the market or request larger premium increases than they would otherwise.” [KFF, 8/10/17]
STATEMENT: “‘What we’re seeing with some of the programs is you’re spending a lot of money on it, but the idea of these programs is to sign people up,’ the official said. ‘And if you’re giving them a grant and they’re only signing up a few people, then we’re actually wasting money there when we’re spending thousands of dollars to sign up one person. That doesn’t make any sense.’” [NYT, 8/30/17]
FACT: NEARLY 8 IN 10 AMERICANS WANT THE TRUMP ADMINISTRATION TO MAKE THE ACA WORK AND THE ROLE OF NAVIGATORS IS INTEGRAL TO THAT
Kaiser Family Foundation: “Large Majority Of The Public, Including Half Of Republicans And Trump Supporters, Say The Administration Should Try To Make The Affordable Care Act Work.” “After the Senate’s failure to pass legislation to repeal and replace the Affordable Care Act, the latest Kaiser Health Tracking Poll finds that eight in 10 Americans (78%) say President Trump and his administration should do what they can to make the current health care law work. This includes large majorities of Democrats (95%) and independents (80%), as well as about half of Republicans (52%) and President Trump’s supporters (51%).” [KFF, 8/11/17]
Bipartisan Group Of Eight Governors: “The Federal Government Should Continue To Fund Outreach And Enrollment Efforts That Encourage Americans To Sign Up For Insurance.” “First and foremost, encouraging younger, healthier people to enroll in insurance and educating Americans about the importance of coverage can help improve the risk pool. The federal government should continue to fund outreach and enrollment efforts that encourage Americans to sign up for insurance. Many states invest in similar efforts, and all states need the federal government’s support to maximize participation from younger, healthier people.” [Letter, 8/31/17]
Brendan Riley, North Carolina Justice Center: “It Seems Pretty Clear The Administration Is Trying To Undermine Enrollment In Order To Destabilize The Individual Market And Score Political Points.” “This is a sort of death by a thousand cuts,” said Brendan Riley, a health policy analyst with the North Carolina Justice Center, an antipoverty group. “It seems pretty clear the administration is trying to undermine enrollment in order to destabilize the individual market and score political points.” [Wall Street Journal, 8/9/17]
Jessie Menkens, Alaska Primary Care Association: “Menkens And Others Say They Believe The Navigator Groups Are More Important Than In Years Past, Given The Lack Of Commitment From The Trump Administration To Promoting Healthcare.gov.” Menkens and others say they believe the navigator groups are more important than in years past, given the lack of commitment from the Trump administration to promoting Healthcare.gov. “There is a lot of noise coming from Washington, and it is our job to try to cut through that and provide factual and relatable information,” Menkens said. [Washington Post, 8/8/17]
STATEMENT: “When asked if the administration would continue paying the subsidies to insurance companies to aid low-income people, the official said that ‘you still had double-digit rate increases’ when the Obama administration provided the subsidies, known as cost-sharing reduction payments.” [NYT, 8/30/17]
FACT: PREMIUMS WENT UP $1 FROM 2016–2017 AFTER TAX CREDITS AND INSURANCE COMPANIES ARE JACKING UP RATES TO COMPENSATE FOR THE UNCERTAINTY THE TRUMP ADMINISTRATION HAS CREATED AROUND CSR PAYMENTS
CBO: 20–25 Percent Premium Increase, Nearly $200 Billion Cost to Taxpayers, Coverage Losses, Market Uncertainty If Trump’s Cancels Health Care Payments. “Premiums for a popular type of individual health care plan would rise sharply, and more people would be left with no insurance options if President Donald Trump makes good on his threat to stop “Obamacare” payments to insurers, the Congressional Budget Office says. The nonpartisan number crunchers also estimated that cutting off payments that now reduce copays and deductibles for people of modest incomes would add $194 billion to federal deficits over a decade. That head-scratching outcome is because a different Affordable Care Act subsidy would automatically increase as premiums jump, more than wiping out any savings.” [Associated Press, 8/16/17]
Larry Levitt, Kaiser Family Foundation: “Ending The Payments To Insurers Would Introduce More Chaos Into An Unsettled Market, And Perversely End Up Costing The Federal Government More In The End.” “‘Ending the payments to insurers would introduce more chaos into an unsettled market, and perversely end up costing the federal government more in the end,’ said Larry Levitt of the Kaiser Family Foundation, a nonpartisan group that found similar results.” [Associated Press, 8/16/17]
Brad Wilson, CEO, Blue Cross Blue Shield Of NorthCarolina: “The Failure Of The Administration And The House To Bring Certainty And Clarity By Funding CSRs Has Caused Our Company To File A 22.9 Percent Premium Increase, Rather Than One That Is Materially Lower.” “The failure of the administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower. That will impact hundreds of thousands of North Carolinians.” [Washington Post, 5/26/17]
Kelly Paulk, Vice President, Product Strategy And Individual Markets, Blue Cross Blue Shield Of Tennessee: “We Have To Factor In Two Significant Uncertainties…Combining Those Two Factors Leads To An Average 21 Percent Rate Increase.” “Our 2017 rates are allowing us to earn a margin (profit) for the first time in four years and would have enabled us to propose only a small increase for 2018 to cover expected changes in medical and operating costs. However, we have to factor in two significant uncertainties — whether the federal government will fund cost-sharing reductions for low-income members and how the risk pool will change if the coverage mandate is not enforced … Combining those two factors leads to an average 21 percent rate increase.” [Blog Post, 6/30/17]
Dr. Mario Molina, Former CEO, Molina Healthcare: “Don’t Let [The Administration And Republicans In Congress] Fool You.” “The administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don’t let them fool you.” [U.S. News & World Report, 5/30/17]
CMS: Premiums For The Benchmark Plan Increased By Only $1 After Tax Credits Between 2016–2017. [CMS, 3/17/17]
STATEMENT: “An administration official refused to offer a target for 2018 signups Wednesday, saying too many factors could affect how to set that target, chief among them high prices for Obamacare next year. ‘It is hard to say that we can get to this target or that target because there are so many things going on in the market,’ said the official, speaking on background.” [Washington Examiner, 8/30/17]
FACT: HHS HAS RELEASED ENROLLMENT PROJECTIONS AND PREDICTIONS FOR EACH OPEN ENROLLMENT PERIOD SINCE THE FIRST
The Secretary of HHS Released Projections — On The Record And The Methodology Behind It — For The 2015, 2016, And 2017 Open Enrollment Periods Ahead Of Open Enrollment. [HHS, 11/10/14, 10/15/15, 10/19/16]
