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Kentucky Archives — Protect Our Care

Court Ruling Helps Mitch McConnell Rip Away Protections for People with Pre-Existing Conditions

Decision From Federal Judge Means:

Medicaid Expansion is Gone

Protections for Pre-Existing Conditions are Gone

Hundreds of Thousands of Kentuckians Will Lose Health Care

And Mitch McConnell OWNS IT

Washington, D.C. –  On Friday night, conservative U.S. District Judge Reed O’Connor issued his ruling in Texas, et. al. vs. United States, et. al., siding with Republican attorneys general, governors, the Trump Administration, and Senator Mitch McConnell  to overturn the entire Affordable Care Act (ACA). Whether it’s repealing the individual mandate to pay for tax cuts or ramming through partisan repeal legislation, repeal cheerleader Mitch McConnell has done nothing but support the GOP’s efforts to strip coverage from hundreds of thousands of Kentuckians. Brad Woodhouse, executive director of Protect Our Care issued the following statement:

“Like two sides of the same coin, Mitch McConnell and the Trump Administration have worked relentlessly to undermine the Affordable Care Act. Today, they are one step closer to ripping health care away from millions of Kentuckians with pre-existing conditions like cancer, diabetes, or asthma.  If this ruling isn’t overturned, Mitch McConnell will roll back the clock and take Kentuckians back to the days where insurance companies had the power to once again deny, drop, or charge more for coverage. They will once again have the power to impose annual or lifetime limits and charge women and seniors more based on their age and gender. Make no mistake, these actions will hurt hundreds of thousands of Kentuckians.”

BACKGROUND:

Due to Judge O’Connor’s ruling yesterday, Republicans are one step closer to repealing the Affordable Care Act and eliminating key protections, unleashing — as the Trump Administration itself admitted in his court — “chaos” in our entire health care system. Under this ruling:

  • Marketplace tax credits and coverage for 10 million people: GONE.
  • Medicaid expansion currently covering 15 million people: GONE.
  • Protections for more than 130 million people with pre-existing conditions when they buy coverage on their own: GONE.
  • Allowing children to stay on their parents’ insurance until age 26: GONE.
  • Free annual wellness exams: GONE.
  • Ban on annual and lifetime limits: GONE.
  • Ban on insurance discrimination against women: GONE.
  • Contraception with no out-of-pocket costs: GONE.
  • Limit on out-of-pocket costs: GONE.
  • Requirement that insurance companies cover essential benefits like prescription drugs, maternity care, and hospitalization: GONE.
  • Improvements to Medicare, including reduced costs for prescription drugs: GONE.
  • Closed Medicare prescription drug donut hole: GONE.
  • Rules to hold insurance companies accountable: GONE.
  • Small business tax credits: GONE.

What’s at stake for Kentucky:

  • The coverage that 404,000 Kentuckians gained through the ACA by 2015.
  • Protections for 1,795,500 Kentuckians who have a pre-existing health condition.
  • 462,000 Kentuckians who have coverage because of Medicaid expansion.
  • The health care of roughly 31,000 young adults in Kentucky who have coverage because they can stay on their parents coverage until age 26.
  • The nearly 1,884,719 Kentuckians, most of whom have employer coverage, who can access free preventive care at no cost.
  • The 2,326,000 Kentuckians with employer coverage who no longer have to worry about lifetime or annual limits.
  • Seniors’ drug savings — 83,989 Kentucky seniors are saving $100.3 million on drugs in 2017, an average of $1,194 per beneficiary because the ACA closed the Medicare prescription drug donut hole.

Because Judge O’Connor Sided With Republicans, 17.1 Million People Would Lose Their Coverage

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Be Put Back In Charge, Ending Protections For The 130 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 130 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders
  • 17 million children. One in four children, or roughly 17 million, have a pre-existing condition.  This includes 240,400 Kentucky children.
  • 68 million women. More than half of women and girls nationally have a pre-existing condition.
  • 30 million people aged 55-64. 84 percent of older adults, 30.5 million Americans between age 55 and 64, have a pre-existing condition. This includes 412,100 Kentuckians.
  • 1,795,500 Kentuckians have a pre-existing condition.

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Have The Power To Deny Or Drop Coverage Because Of A Pre-Existing Condition

Before the Affordable Care Act, insurance companies routinely denied people coverage because of a pre-existing condition or canceled coverage when a person got sick. If Judge O’Connor rules in favor of Republicans, insurance companies will be able to do this again.

  • A 2010 congressional report found that the top four health insurance companies denied coverage to one in seven consumers on the individual market over a three year period.
  • A 2009 congressional report found that the of the largest insurance companies had retroactively canceled coverage for 20,000 people over the previous five year period
Conditions That Could Cost You Your Care:

  • AIDS/HIV
  • Alcohol/drug Abuse
  • Cerebral Palsy
  • Cancer
  • Heart Disease
  • Diabetes
  • Epilepsy
  • Kidney Disease
  • Severe Epilepsy
  • Sleep Apnea
  • Pregnancy
  • Muscular Dystrophy
  • Depression
  • Eating Disorders
  • Bipolar Disorder
Jobs You Could Be Denied Coverage Because Of:

  • Active military personnel
  • Air traffic controller
  • Body guard
  • Pilot
  • Meat packers
  • Taxi cab drivers
  • Steel metal workers
  • Law enforcement
  • Oil and gas exploration
  • Scuba divers
Medications That You Could Be Denied Health Care For Taking:

  • Anti-arthritic medications
  • Anti-diabetic medications (including insulin)
  • Anti-cancer medications
  • Anti-coagulant and anti-thrombotic medications
  • Medications used to treat autism
  • Anti-psychotics
  • Medications for HIV/AIDS
  • Growth hormone
  • Medication used to treat arthritis, anemia, and narcolepsy
  • Fertility Medication

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Have The Power To Charge You More

  • More than 100 Million People With A Pre-Existing Condition Could Be Forced to Pay More. An analysis by Avalere finds that “102 million individuals, not enrolled in major public programs like Medicaid or Medicare, have a pre-existing medical condition and could therefore face higher premiums or significant out-of-pocket costs” thanks to the Republican lawsuit to repeal the Affordable Care Act.
  • Insurance Companies Could Charge Premium Surcharges in the Six Figures. If Judge O’Connor sides with Republican lawmakers, insurance companies would be able to charge people more because of a pre-existing condition. The health repeal bill the House passed in 2017 had a similar provision, and an analysis by the Center for American Progress found that insurers could charge up to $4,270 more for asthma, $17,060 more for pregnancy, $26,180 more for rheumatoid arthritis and $140,510 more for metastatic cancer.
  • Women Could Be Charged More Than Men for the Same Coverage. Prior to the ACA, women were often charged premiums on the nongroup market of up to 50 percent higher than they charged men for the same coverage.
  • People Over the Age of 50 Could Face a $4,000 “Age Tax,” Including $3,264 in Kentucky. If Judge O’Connor sides with Republican lawmakers, insurance companies would be able to charge people over 50 more than younger people. The Affordable Care Act limited the amount older people could be charged to three times more than younger people. If insurers were to charge five times more, as was proposed in the Republican repeal bills, that would add an average “age tax” of $4,124 for a 60-year-old in the individual market, including $3,264 in Kentucky, according to the AARP.
  • Seniors Would Have to Pay More for Prescription Drugs. If Judge O’Connor sides with Republican lawmakers, seniors would have to pay more for prescription drugs because the Medicare “donut” hole got reopened. From 2010 to 2016, “More than 11.8 million Medicare beneficiaries have received discounts over $26.8 billion on prescription drugs – an average of $2,272 per beneficiary,” according to a January 2017 CMS report. In Kentucky, 83,989 Kentucky seniors saved $100.3 million on drugs in 2017, an average of $1,194 per beneficiary .

Because Judge O’Connor Sided With Republicans, Insurance Companies Could Have the Power to Limit the Care You Get, Even If You Have Insurance Through Your Employer

  • Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.
  • Reinstate Lifetime and Annual Limits. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage.
  • Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.

Because Judge O’Connor Sided With Republicans, Medicaid Expansion Would Be Repealed

Fifteen million people have coverage through the expanded Medicaid program, including 162,000 in Kentucky.

Governor Matt Bevin Puts Partisanship Over Health of Kentuckians

Washington, D.C. – Days after a federal district court issued a scathing rebuke of the Bevin-Trump Administrations’ Medicaid scheme to impose rigid work requirements that would be impossible for many of those most in need of health care coverage to meet, Governor Bevin announced his Administration would retaliate by immediately cutting 500,000 Kentuckians enrolled in Medicaid off of critical and vision coverage. Brad Woodhouse, executive director of Protect Our Care, released the following statement in response:

“I have only one question for Governor Matt Bevin and President Donald Trump: why are you so hellbent on taking health care away from your constituents? Until the Bevin and Trump administrations teamed up to wage a war on health care, Kentucky was headed in the right direction: insurance coverage and access to quality care were going up — way up. But the GOP’s repeal-and-sabotage agenda is threatening these gains by driving people’s health care premiums up and kicking people off of health insurance by any means necessary, whether through so-called ‘work requirements’ or, now, by politically-motivated fiat.”

BACKGROUND:

Prior to the Bevin and Trump Administrations, Kentucky’s story was a successful case study of how the state and federal governments can work hand-in-hand to improve health care access and outcomes for people:

  • Kentucky experienced the largest uninsured rate drop among low-income adults, all while creating 40,000 jobs and harnessing a $30 billion economic impact.
  • Kentucky’s uninsured rate fell from 16.3% to 7.2% in 2016 following the implementation of Medicaid expansion.
  • Kentucky’s enrollment in Medicaid and CHIP increased 110% between 2013-2017, the largest increased of any state and nearly three-times the national average.
  • Low-wage workers made up the majority of Medicaid-eligible adults who gained coverage under the state’s expansion.
  • Medicaid is viewed favorably by 74 percent of Americans.

###

Federal Court Protects Health Care for 97,000 Kentuckians

Washington, D.C. – Today, a federal district court issued a scathing rebuke of the Trump Administration’s approval of Kentucky’s Medicaid waiver putting health care for up to 97,000 Kentuckians at risk by imposing rigid work requirements that could be impossible for many of the people most in need to meet.  In response, Brad Woodhouse, executive director of Protect Our Care, released the following statement:

“This decision is a victory for the Kentuckians who need affordable health care the most — children, people with chronic health care conditions, and low-wage workers. Nearly 100,000 Kentuckians stood to lose coverage if this mean-spirited law was to take effect. But this fight isn’t over, since Governor Bevin made it plain he’d throw health care for 500,000 Kentuckians overboard if the court didn’t rule in his favor. We call on Governor Bevin to stand down from his crusade against Kentucky families who rely on Medicaid for coverage, and instead turn his focus to the urgent health needs confronting the people of his state, like the tragic opioid crisis.”

Said the Court in its ruling today: “[Secretary Azar] never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders his determination arbitrary and capricious. The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review.”

BACKGROUND:

  • 500,000 Kentuckians could lose coverage if Gov. Bevin ends the state’s Medicaid expansion,  according to Kentucky Health and Family Services Secretary Adam Meier.
  • Low-wage workers made up the majority of Medicaid-eligible adults who gained coverage under the state’s expansion.
  • Those currently covered by Medicaid in Kentucky include:
    • 561,326 children, composing 39 percent of all state Medicaid enrollees;
    • 9,500 veterans and 5,300 spouses of veterans, who gained coverage under expansion;
    • 44 percent of all births in the state;
    • 90,794 elder Americans aged 65 and older, and
    • 161,380 Medicaid enrollees who are disabled or require long-term care.
  • Medicaid is supported by 74 percent of Americans.

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

Washington, D.C. – As preliminary Kentucky rate filings for 2019 individual-market health insurance indicated another round of premium increases due to Washington Republicans’ repeal-and-sabotage agenda, Protect Our Care Executive Director Brad Woodhouse released the following statement:

“For the past year and a half, President Trump and his Republican allies in Congress have engaged in a deliberate, aggressive campaign to undermine health care and now families in Kentucky are being asked to pay the price. Until we stop Washington Republicans’ attacks on health care, experts predict that rates will keep rising by double digits. Washington Republicans should start working on bipartisan solutions to make coverage more affordable, instead of helping their friends in the insurance industry make another buck on the backs of hardworking Kentuckians.”

From the Insurance Companies:

CareSource Kentucky: Rates Going Up Because Of Trump/GOP Repeal Of Individual Mandate. “Additionally, the removal of the individual mandate will increase the overall health risk of the Kentucky marketplace due to plan selection bias. Consumers with the greatest need for health insurance will tend to maintain coverage while healthier consumers may forgoe coverage. Therefore CareSource will require an increase in premiums in order cover the expected increase in claims costs.” [CareSource, June 2019]

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

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

Now, initial rate filings in Kentucky forecast double-digit rate hikes again this fall because of Republican sabotage.

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

  • Experts from AARP, the Congressional Budget Office, and a wide range of other nonpartisan organizations agree that Republican actions are forcing up health care costs.
  • Republicans in Congress are supporting the Administration’s many actions to undermine health care, despite widespread opposition from patient and disease groups, doctors, nurses, hospitals, plus health care and consumer advocates.
  • The Trump Administration officials keep rewriting the rules to let big insurance companies cover fewer and fewer services while charging people more and more. The sabotage doesn’t stop there: last year the Administration fired many of the community assisters who help people enroll in health care; this year they are planning more enrollment cuts, making it even harder to sign up for coverage.
  • And now, Republicans are encouraging insurance companies to sell more junk plans that don’t have to cover basic care like hospitalization and prescription drugs, and that are allowed to charge people with pre-existing conditions more or even deny them coverage altogether. In Kentucky, no short-term plans available have to cover maternity care, and only 37 percent of plans cover prescription drugs.

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

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

The Trump Administration’s sabotage will punish Americans by jacking up premiums again, compounding the damage done last year, when Republican sabotage pushed rates up by a national average of 37 percent, and 50 percent in Kentucky.

  • The Republican tax bill’s repeal of a key Affordable Care Act provision and the Trump Administration’s junk plan proposal will increase individual market premiums in Kentucky by an average 18.7 percent this fall, according to a recent Urban Institute study.
  • This sabotage-driven rate hike will make the damage Republicans inflicted last year through repeal attempts and sabotage even worse.
  • Higher premiums will mean fewer working families can afford coverage: during the first year of the Trump Administration, millions more Americans joined the ranks of the uninsured – the highest increase since Gallup started tracking the uninsured rate.

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

  • 89,569 Kentuckians signed up for Marketplace coverage this year.
  • Thanks to the Marketplace and Medicaid expansion, Kentucky’s uninsured rate fell by 9.1 percent between 2013 and 2016 as Kentuckians have gained access to affordable coverage.
  • Before today’s announcement, the Urban Institute predicted that Kentucky premiums for 2019 could rise 18.7 percent more because of the Trump Administration’s junk plan proposal and the Republican tax bill’s repeal of a key Affordable Care Act coverage incentive.
  • Even despite sabotage, Affordable Care Act subsidies help keep coverage affordable for 76 percent of Kentucky Marketplace consumers, whose average 2018 premium is $124 per month.
  • But because of the Republican sabotage agenda, many middle-income Kentuckians could pay hundreds or thousands of dollars more than they would have otherwise.

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

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

KEY QUOTES

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Backlash Against Proposed Medicaid Cuts Continues

As national backlash to the Trump Administration’s attacks against Medicaid continued, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“We continue to stand against the Trump Administration’s illegal plan to force people off their coverage. The American people want Congressional Republicans to stop stacking the deck against working Americans and for Congress to preserve Medicaid for generations to come.”

Kentucky Rushes to Remake Medicaid as Other States Prepare to Follow

New York Times // Abby Goodnough // February 10, 2018

LOUISVILLE, Ky. — With approval from the Trump administration fresh in hand, Kentucky is rushing to roll out its first-in-the-nation plan to require many Medicaid recipients to work, volunteer or train for a job — even as critics mount a legal challenge to stop it on the grounds that it violates the basic tenets of the program.

At least eight other Republican-led states are hoping to follow — a ninth, Indiana, has already won permission to do so — and some want to go even further by imposing time limits on coverage.

Such restrictions are central to Republican efforts to profoundly change Medicaid, the safety net program that has provided free health insurance to tens of millions of low-income Americans for more than 50 years. The ballooning deficits created by the budget deal that President Trump signed into law Friday and the recent tax bill are likely to add urgency to the party’s attempts to wring savings from entitlement programs.

House Speaker Paul D. Ryan, Republican of Wisconsin, said Thursday that addressing entitlement spending is “what you need to do to fully deal with this debt crisis,” though Senator Mitch McConnell, the Republican majority leader from Kentucky, said he has ruled out doing so this year.

As Kentucky pushes forward, many who work with the poor are worried that the thicket of new documentation requirements in Medicaid will be daunting for low-income people, who may have little education and struggle with transportation, paying for cellphone minutes and getting access to the internet. Not only that, they note, but the new rules will add the type of administrative costs and governmental burdens that Republicans tend to revile.

On a recent rainy Monday, Bill Wagner, who runs primary care clinics in poor neighborhoods here, listened tensely as a state health official explained how the state would enforce the complex and contentious new rules.

The 20 hours a week of work, job training or volunteering? Ten regional work force boards will monitor who complies, said the official, Kristi Putnam.

The monthly premiums of $1 to $15 that many will now owe? The managed care companies that contract with the state will collect them.

The “rewards dollars” that many will need to earn to get their teeth cleaned or their vision checked? They’ll be tracked through a new online platform, where Medicaid recipients will also be expected to upload their work, volunteer or training hours.

“I know it sounds a little bit complicated,” Ms. Putnam conceded as the group meeting with her, which has overseen efforts to enroll Louisville residents in health insurance in the Obamacare era, jotted notes. Someone heaved a sigh.

After four years of signing up thousands of people for coverage under the health law’s expansion of the Medicaid program, Mr. Wagner told the room, “We’re shifting our focus from helping people gain coverage to helping people keep it.”

The rationale of Gov. Matt Bevin and other supporters is that Medicaid was created for the most vulnerable citizens — those who aren’t only poor, but pregnant, elderly, children or disabled — and that for everyone else, working or otherwise engaging in their community will provide dignity and better health. About 500,000 Kentuckians have joined the Medicaid rolls under the Obamacare expansion, and the state estimates some 350,000 will be subject to the new work rules.

While the work requirement is unprecedented in the history of Medicaid, Mr. Wagner and others say they’re just as concerned about other new rules that will be confusing and hard to follow. For example, many adults who don’t pay their small premiums can be locked out of Medicaid for six months, unless they complete a financial or health literacy course. Others will lose access to dental and vision care.

Critics of the plan point to Indiana, which dropped about 25,000 adults from its Medicaid program from 2015 through 2017 for failing to pay premiums there. About half found other coverage, according to state surveys, typically through a job.

Mark Lee Coleman, a diabetic who was visiting a busy clinic run by Family Health Centers, the nonprofit network that Mr. Wagner heads, one recent morning, had heard next to nothing about the new rules. He needed refills on his medications; his blood sugar level had climbed so high without them that he risked falling into a diabetic coma. But first Mr. Coleman needed help figuring out why his Medicaid coverage had been canceled late last year, even before the new rules kicked in.

A counselor at the clinic called the state Medicaid office and found out Mr. Coleman, 49, had forgotten to report a change in income last July, when he switched from a higher-paying job at an Amazon warehouse to a less physically demanding job as a parts driver for Pep Boys, the automotive chain. After she helped him email a pay stub to the office, his coverage was set to be reinstated within a few days.

Once Kentucky’s new rules take effect this spring and summer, Mr. Coleman will also have to report a monthly tally of his work hours to keep his coverage.

Matt and Sarah Burress, and their children, at home in Mount Washington, Ky. Mr. Burress, who owns a small lawn care business and doesn’t work all winter, wonders how the new rules would affect seasonal, self-employed workers. Credit Aaron Borton for The New York Times
He now works 20 hours a week, but he has neuropathy, a numbness and tingling in his hands and feet, and sometimes has trouble walking. Should he cut back his hours, he’d either have to try to get classified as “medically frail,” which would exempt him from the work rule, or lose his coverage.

He hasn’t thought all that through yet. In concept, though, he supports work requirements — as do most voters, polls have found.

“That’s not bad, to tell you the truth,” he said. “If you’re working, that’s good for your health.

As he spoke, he gulped water from a bottle he kept refilling — his extreme thirst a sign of his health crisis. Kara Peers, a case worker at Family Health Centers, tried to gauge what other challenges he and his wife and four children might be facing that could interfere with his ability to manage his disease.

“What about food, sir?” she asked.

“Ah, we’re kind of low,” he replied.

“Utilities — are you able to pay the bill?”

“It can be tough.”

He left with a month’s worth of medications — three for diabetes, one for high blood pressure, paid for by the clinic — and the reassurance that his Medicaid would soon be reinstated. Melissa Mather, the communications director at Family Health Centers, said she worried that patients like him, who already stumble over Medicaid’s paperwork requirements, will be more lost under the new rules. She and Mr. Wagner are also worried about their homeless patients, who will be subject to the rules unless they meet the federal definition of “chronically homeless” and get an exemption.

“This is a very, very big concern from my perspective — talking about the complexity of these changes when a lot of the folks we deal with have lives that are in chaos already,” she said.

For now, there are more questions than answers, as state workers like Ms. Putnam hustle to iron out all the details, let alone explain them. Like Mr. Carter, Sarah and Matt Burress got Medicaid under the Affordable Care Act after going uninsured for years. The coverage may have saved Mr. Burress’s eyesight — though only 29, he was diagnosed with advanced glaucoma when he went for a routine eye check shortly after becoming insured in 2015.

Now he’s worried about keeping his coverage because he runs his own small lawn care business, working irregular hours with a hiatus that lasts all winter.

“We haven’t heard how it will work for seasonal self-employed workers,” said Ms. Burress, who works part time as an office manager. “Do his clients have to say, ‘Yeah, he mowed my grass this week?’ Part of it feels like they’re trying to catch you, by burying people in paperwork and making it a huge inconvenience.”

She added that she and her husband plan to remain on Medicaid only until his business starts turning a profit. “This was never meant to be our permanent fix,” she said, not the “dead-end entitlement trap” that Mr. Bevin rails against.

Most people on Medicaid do work, research has found; Those who don’t often are disabled, even though they may not qualify for Social Security Disability Insurance. Sheila Penney, 54, has cycled in and out of jobs for years with chronic depression and anxiety that started when she lost her father at 16. She has worked as a package handler, a boat reservations manager and even a health insurance enrollment counselor, helping patients at Family Health Centers sign up for Medicaid back in 2014.

But she has not worked at all for the last two years, focusing instead on getting her mental health problems under control and relying on her mother to pay her rent. Now she’s a plaintiff in a lawsuit filed last month to stop Kentucky’s new requirements from taking effect. With Medicaid, she is able to go weekly to a therapist and monthly to a psychiatric nurse practitioner who adjusts her medication, she said.

“I’m wanting to go back to work, but if I was told, ‘You have to go back,’ I do think that would step up my anxiety,” Ms. Penney said. “Volunteering would be less pressure, but you would still want to be consistent and reliable.”

Caring full time for a child or other family member can also count toward the work requirement, as can going to school full time, though neither will apply to Ms. Penney.

She expects she will find a way to pay the new premiums she’ll owe under the plan — $4 a month — but predicts it will mean going without other necessities at times. (She is poor enough under the new rules that if she fails to pay them, she will lose access to dental and vision coverage but not be dropped from coverage altogether.)

“I was at the store yesterday, looking in my wallet and going, ‘Do I have enough money for dog food?” she said. “The thought of taking on even one more expense feels overwhelming.”

For Kimberly Dandridge, who overcame breast cancer and addiction to crack cocaine earlier in her life, Medicaid is a bridge while she works toward a job that comes with benefits. Ms. Dandridge, 53, works 30 hours a week as an administrative assistant, and said she would have no trouble meeting the premium and work requirements — but could relate to those who might.

“I remember there was a time I was just down, in the gutter, so low and broken,” she said. “If people like that need medical attention, just let them get it.”

 

Protect Our Care Statement On Approval Of Kentucky Medicaid Waiver

In response to the news that the Trump Administration granted the approval of Kentucky’s waiver to implement work requirements for Medicaid recipients, Protect Our Care Campaign Director Brad Woodhouse issued the following statement:

“Today’s move from Republicans marks not just a shift in policy, but a shift in the fundamental decency of the United States. Medicaid has long been a lifeline for millions of hard-working Americans – our parents and grandparents, siblings and children. After more than fifty years and nine bipartisan administrations, it is Donald Trump who will cut Americans off from their health care.

“Despite the rhetoric pushed by this Administration and Republicans in Congress, the simple truth is that the majority of those covered by Medicaid who can work are working, largely in low-wage jobs or industries that don’t provide health care, and those who are not working overwhelmingly have chronic health conditions or are taking care of a sick family member. In Kentucky, where nearly 50 percent of all births are covered under Medicaid and nearly 10,000 veterans received the health care they deserve through Medicaid expansion, 20,000 people stand to lose coverage. This decision harms the most vulnerable among us, and abandons the next generation born into circumstances beyond their power.

“Changing Medicaid will do nothing to help Americans find jobs. It will merely take away their health care. It’s a cruel, short-sighted policy, and every Republican who goes along with it should be ashamed.”