HHS Archives — Protect Our Care

Secretary Azar Admits That HHS Is Trying To Gut Medicaid Without Congressional Approval

Washington, DC — Today, Health and Human Services (HHS) Secretary Alex Azar answered questions from Senator Bob Casey (D-PA) during a Senate Finance Committee hearing on Trump’s FY20 budget about HHS having direct conversations with various states about block granting Medicaid, all without the approval of Congress. Leslie Dach, chair of Protect Our Care, released the following statement in response:

“The block grants that Secretary Azar and Trump’s Republicans are pushing are just a thinly veiled attempt to slash Medicaid funding and rip away people’s health care, which Americans vehemently oppose. Congress has repeatedly rejected this disastrous idea and so did voters just months ago in November. It’s time for Secretary Azar to come clean with the American people about his true intention to gut Medicaid and take health care away from millions of Americans.”

All-Lies on Azar

Day One of Secretary Azar’s Testimony On the Budget Featured Blame-Shifting and Deceit on Everything from Junk Plans to Trump’s Proposed Cuts to Medicare

Is Congress In for More of the Same Tomorrow?

Washington, DC – In response to today’s dishonest testimony from Health and Human Services Secretary Alex Azar on President Trump’s FY20 budget before the House Energy and Commerce Subcommittee on Health, Protect Our Care executive director Brad Woodhouse released the following statement:

“It’s no surprise that Trump’s HHS Secretary, a former pharmaceutical executive, would refuse to level with the American people at today’s hearing about the administration’s plans to terminate the ACA through the Texas lawsuit, sell junk insurance plans, and slash Medicare and Medicaid by over $2 trillion. Time and again, Secretary Azar refused to answer questions about the Trump budget’s deep cuts to Medicaid and Medicare or provide any evidence for his baseless claim about this administration’s interest in providing protections for people with pre-existing conditions.

“Make no mistake, Alex Azar is President Trump’s Field General in this administration’s war on American health care. Under his watch, the uninsured rate has increased, open enrollment has been sabotaged, junk insurance plans are poised to undermine Americans’ health care and thousands of people in states like Arkansas have lost coverage due to ridiculous (paper) work requirements. While Alex Azar has learned from his boss how to lie his way through direct question, the results of his policies speak for themselves: insurance and drug companies make out like bandits while the American people get the shaft.”

Costs Up, Coverage Down: The Real HHS 2018 Annual Report

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

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

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

  1. Drug companies continue to increase prices while reaping billions of dollars from the Trump tax bill and seeing massive profits. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion — the highest of any publicly traded health care company.  Meanwhile, pharmaceutical companies continue to increase prices. In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills. All in all, nearly 30 drugmakers are expected to raise prices in 2019. One drug industry lobbyist has said that drug companies’ limited concessions are “a calculated risk” summarizing big pharma’s strategy to play the Trump administration: “take these nothing-burger steps and give the administration things they can take credit for.”

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

February 2019

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

January 2019

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

December 2018

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

November 2018

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

October 2018

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

September 2018

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

August 2018

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

July 2018

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

June 2018

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

May 2018

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

April 2018

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

March 2018

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

February 2018

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

January 2018

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

December 2017

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

November 2017

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

October 2017

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

September 2017

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

August 2017

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

July 2017

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

June 2017

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

May 2017

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

April 2017

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

March 2017

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

February 2017

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

January 2017

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

New Trump Rule on Drug Rebates is Just a Gift to Big Pharma

Washington, DC– Yesterday, the Trump administration proposed a rule to the drug rebate system that they falsely claimed would help consumers and lower drug prices. Leslie Dach, chair of Protect Our Care, issued the following statement:

“This administration’s plan  – another multi-billion dollar giveaway to the big drug companies – will raise Medicare premiums with zero guarantees that it will lower costs for patients. Meanwhile, the administration opposes what really needs to happen — end drug company price gouging on everyday drugs like insulin that millions of Americans rely on, and let Medicare directly negotiate with drug companies to truly lower prices. With a former pharmaceutical executive running HHS, it’s no surprise the administration continues to side with big drug companies and ignore the needs of patients and older Americans.”

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.

Misleading Congress, Azar Denies Reality of Rate Hikes

HHS SECRETARY AZAR: “I really do not believe it will have a significant impact on our risk pool, the repeal of that..I don’t see the premium effect.” [Senate Appropriations Subcommittee hearing, 5/10/18]

EX-HHS SECRETARY TOM PRICE: “There are many, and I am one of them, who believes that that actually will harm the pool in the exchange market because you’ll likely have individuals who are younger and healthier not participating in that market. And, consequently, that drives up the cost for other folks in that market.” [World Health Care Congress speech, 5/1/18]

VIRGINIA INSURANCE COMPANIES: “Both Cigna and CareFirst BlueCross BlueShield cited policies advocated by the Trump administration, including the repeal of ObamaCare’s individual mandate, as part of its justifications for the increases. Cigna is proposing an average premium increase of 15 percent for its 103,264 customers in Virginia, with a range of increases from 6.4 percent to 40 percent. CareFirst is proposing a 64 percent increase for its approximately 4,500 customers in the commonwealth, citing an increase in sicker people entering the marketplace.” [The Hill, 5/4/18]

CONGRESSMAN DON BEYER (D-VA): “Come to Virginia, where premiums will soar by up to 64% because of sabotage by your boss and your agency, and say that again. Maryland too. Have you looked, or talked to actual people?” [Twitter, 5/11/18]

Protect Our Care Outlines Market Stabilization Must-Haves

As Congress begins to shape an omnibus after passing this morning’s spending bill, Protect Our Care Campaign Director Brad Woodhouse released the following statement outlining provisions that bill must include to stabilize the Affordable Care Act’s marketplaces and counteract cost increases caused by the Trump Administration and its Republican allies in Congress’s ongoing sabotage:

“If Congressional Republicans are serious about addressing the mounting mess they have created in the individual insurance market, they need to do far more than they are currently proposing. And the scale of those solutions must match the scope of the problems that Republican sabotage has created.

“While the Affordable Care Act marketplaces have shown remarkable stability in the face of this relentless sabotage, President Trump’s actions have already raised premiums this year, and the Republican tax bill will make things even worse next year by pushing premiums up double digits.

“A truly bipartisan market stabilization plan means making coverage more affordable,  not punishing people with pre-existing conditions, and not including anti-choice restrictions. The American people want affordable, high-quality health care, not even more restrictions on women’s health. And Republicans should not seek to revive high risk pools, failed experiments of the the past which would reverse the Affordable Care Act’s guarantees and once again allow states to segregate people with pre-existing conditions.

“The American people keep saying it loud and clear: enough is enough. It’s time for Republican lawmakers to do the right thing, leave politics at the door, reject their party’s war on health care, and develop real solutions to make coverage more affordable and accessible for more Americans.”

Policymakers Should Craft Reinsurance Proposals to Lower Premiums, Help More People
Center on Budget and Policy Priorities // Sarah Lueck // 2.8.18

The idea of reimbursing health insurers for some costs associated with their highest-cost enrollees, known as reinsurance, is gaining traction as policymakers seek ways to make states’ individual insurance markets more stable and reduce premiums. But some federal reinsurance proposals are likelier than others to reduce premiums, and reinsurance alone won’t help individual market consumers who qualify for subsidized coverage.

Reinsurance defrays insurers’ costs and reduces their risk, so insurers can reduce overall premiums compared to what they’d otherwise charge.

In the House, a bipartisan reinsurance bill from Reps. Ryan Costello and Collin Peterson is reportedly gaining support, including among insurers. It would provide up to $30 billion over three years for the Secretary of Health and Human Services (HHS) to allocate at his discretion. Meanwhile, Sen. Susan Collins is continuing to craft her bipartisan reinsurance bill (co-sponsored by Sen. Bill Nelson), which Senate Majority Leader Mitch McConnell promised to bring to the Senate floor. She’s proposing to make up to $10 billion over two years available to states, which they could then use to secure additional federal funding through waivers that HHS approves to let states experiment with new ways to deliver health care to their residents.

With reinsurance efforts potentially moving forward, policymakers should keep the following in mind:

Reinsurance funds should be targeted at reducing premiums, not diluted by other purposes. The Costello bill would let states use federal reinsurance for a number of purposes, not all of which focus on the individual market or on reducing premiums. For example, states could use the funding for “promoting participation” and “increasing health insurance options” in both the individual and small-group markets, or for promoting access to preventive services (especially dental and vision care) and maternity and newborn care, and preventing and treating mental or substance use disorders. While increasing access to these health services is important, it isn’t directly related to reducing premiums or stabilizing insurance markets. These provisions would probably also let states use federal funds to replace their own spending on activities they would have undertaken anyway — which would have no impact on individual-market premiums at all. The Costello bill also seems to let states create high-risk pools, an idea that House Speaker Paul Ryan has continued to talk up. But past high-risk pools worked by separating people with high-cost health needs into a different pool from less costly people. That approach has been tried and failed, and it shouldn’t be replicated. The Costello bill also includes new, unrelated policy dealing with abortion.

A federal reinsurance program is likely the fastest, most efficient way to mitigate premium increases in 2019. Insurers will have to finalize their decisions about individual-market premiums and about where they will offer plans by this fall, and they’ll begin making decisions well before that. And 2019 is shaping up to be a tough year in the individual market, particularly because the new tax law’s repeal of the Affordable Care Act’s (ACA) individual mandate to have health coverage or pay a penalty will take effect and because plans that don’t meet ACA standards are expected to proliferate under proposed Trump Administration regulatory changes. While a temporary reinsurance program is only a partial fix at best for the premium increases and other harmful effects of these changes, a federal reinsurance program could be implemented more quickly and efficiently than multiple state-level programs. The Collins-Nelson bill relies entirely on states to apply for funding. In a better approach, the Costello bill gives states the option to apply for funding and administer their own programs but includes a safeguard — to establish a federal program if states don’t act fast enough. The Costello bill, however, would also leave the amount that each state would receive up to the HHS Secretary’s discretion, creating unnecessary uncertainty and risk, particularly because the Trump Administration has been more focused on sabotaging the ACA-compliant insurance markets than shoring them up.

Provisions intended to offset reinsurance costs shouldn’t make people worse off. If policymakers seek to offset the federal cost of a reinsurance program through spending cuts or tax increases, those measures should not threaten the health of individuals. They should not, for instance, include cuts in other health care programs or changes that hurt modest-income people or those with pre-existing conditions.

Even well-designed reinsurance doesn’t make health care more affordable for low- or moderate-income people. Reinsurance reduces the sticker price of health insurance — i. e., the overall premiums that insurers charge. That means it benefits individuals and families who don’t qualify for premium tax credits that help low- and moderate-income people afford their insurance through the ACA health insurance marketplaces. That’s because the premium credits limit eligible people’s cost to no more than a given percentage of their incomes, so they pay about the same amount for coverage regardless of the sticker price. Most Americans who are uninsured and eligible for marketplace coverage could qualify for tax credits under current law. But some people who get tax credit — those with incomes up to four times the poverty level, or about $48,000 a year for an individual — also have trouble affording their premiums and out-of-pocket costs. Researchers estimate that modest improvements in the tax credits could meaningfully expand coverage. Increasing the tax credits or cost-sharing reductions (CSRs) for those already receiving them would also help shore up insurance markets and, if paired with reinsurance, broaden the benefits to all individuals and families buying health insurance on their own.

A bill that includes reinsurance funding and would reinstate CSR payments to insurers, such as the Costello bill, also should increase the tax credits or increase cost-sharing subsidies for people. Here’s why: As we and others have explained, the Trump Administration’s decision to halt CSR payments has had the effect of substantially raising tax credits, making coverage more affordable for many moderate-income consumers. (That’s because insurers raised premiums to account for the loss of CSR payments, which boosted the amount of federal premium tax credits available to eligible people.) Restoring CSR payments would reverse the tax credit increases and make coverage more expensive for this group. Thus, a bill funding reinsurance, restoring CSRs, and failing to increase tax credits or cost-sharing subsidies would make coverage more affordable for middle-income consumers but less affordable for many people at lower income levels.


Azar Fails Confirmation Questioning, Refuses to Protect Our Care

Following Alex Azar’s refusal to commit to protecting Americans’ care at this morning’s Senate Finance Committee hearing, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Alex Azar failed the American people at his confirmation hearing today by refusing to signal an end to the Trump Administration’s sabotage and to promise that he would protect our care. Azar showed that we can’t trust him to defend Americans’ coverage by endorsing Republicans’ wildly unpopular proposal to cut Medicaid through block grants. And as a former Big Pharma lobbyist, Azar failed to offer any assurances he would address spiking drug costs with his out-of-touch claim that costs will always go up. If confirmed as Secretary, Azar would be empowered to accelerate the Republican war on health care. Because of Azar’s failure at today’s hearing, Senators must reject his nomination.”