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Health Care Remains Top Issue Heading Into Midterms

To: Interested Parties

From: Brad Woodhouse, Protect Our Care Campaign Director

Date: May 3, 2018

Re: Health Care Remains Top Issue Heading Into Midterms


Throughout the Trump presidency, one issue has consistently stood out as the top priority for voters, critical to how Americans will cast their ballots in the midterm elections: health care.

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

These polls, conducted by nonpartisan news outlets and by research firms from a wide array of ideological backgrounds, have shown consistent results despite asking differently-framed questions amid a turbulent political landscape. Clearly, health care is a dominant issue that will remain potent through the midterm elections, and the consistent partisan trust divide indicates that it should be a major focus for Democratic candidates in virtually every race in the country.

HEALTH CARE REMAINS A TOP ISSUE FOR AMERICAN VOTERS

Throughout 2018, poll after poll has surveyed which issues are top-of-mind for voters and nearly every time health care has been at the top of the list.

For example, a February CNN poll found that health care was voters’ top priority. Among its findings:

  • 83% of voters said health care was extremely important or very important, the highest among all issues.
  • 53% of voters said health care was extremely important, the highest among all issues – a 20% increase from August of 2010, a year when health care played a major factor in midterm elections.
  • 78% of independent voters said health care was important, tied with the economy as their top issue.
  • At least 70% of voters in every demographic category said health care was important – a trend that stretches across gender, age, income level, education level, ideology, and party affiliation.

These results were echoed by a March Pew Research Center survey, which found health care is the number-one pocketbook issue for Americans across all income brackets:

  • More than half of those surveyed said that health care affects their household’s financial situation “a lot,” the only issue which more than half of Americans rated a key economic issue.

  • Health care is “a top household financial issue” across all income levels, with 53% of those earning more than $100,000 and 52% of those earning $30,000 or less saying it has a large effect.

An April HuffPost/YouGov poll found that health care was a top issue for voters, with, 28% of those surveyed listing health care as their top the top issue, leaving the Huffington Post to conclude:

“Heading into the midterm elections, American voters are more likely to say they’re focused about health care than any other issue.”

A March Gallup survey asked Americans about the issues they are most worried about and, 78% of those surveyed named health care as a worry, more than any other issue, leading Newsweek to frame its coverage of the poll, “Health Care Is A Bigger Concern Than Terrorism”:

“Americans are more concerned about health care than they are about terrorism, according to a poll released on Monday. The Gallup survey rated health care as the top concern among Americans, with 55 percent of respondents noting they were “a great deal” concerned about the availability and affordability of health care. Twenty-three percent were “a fair amount” concerned about the topic. It is the fifth year running that health care has topped Gallup’s list of concerns for  Americans. It’s the 13th time overall that the issue has been a top concern. Democrats were more concerned about health care than Republicans, although 39 percent of Republicans still expressed concerns about the issue.”

A survey leaked in March from America First Policies using President Trump’s own pollsters found that health care was the top issue for voters, with 41% saying lowering health care costs should be Congress’ top priority. On the other side of the spectrum, a February poll from Priorities USA also found that independent voters continue to hold major concerns about President Trump’s war on health care:

“Donald Trump’s policies are adding to the economic burdens of average families by raising the cost of health care and driving up insurance premiums. And Trump has broken his promise to crack down on excessive drug prices. Instead, he has given the big drug companies huge tax breaks while allowing them to charge as much as they want, without any controls or negotiation. 60% of voters have major concerns, including 71% among independents.”

HEALTH CARE IS DRIVING DEMOCRATIC SUPPORT

Health care is not just a top concern for voters – it’s also a deciding factor for voters, and drives widespread support of Democrats.

On March 13, voters in Pennsylvania’s eighteenth district went to the polls and selected Conor Lamb over pro-repeal candidate Rick Saccone in a district which had gone for Donald Trump by nearly twenty points. A telephone exit poll of those who cast ballots found that:

  • Health care was a top issue for voters, with 52% listing it as important and only 19% deeming it not important. Among voters who said health care was the most important issue, Lamb beat Saccone 64-36, and among voters who said it was either the most important or a very important issue, Lamb beat Saccone 62-38.
  • On health care, voters said Lamb better reflected their views by 7 points, 45-38. Among independents, that gap widened to 16 points, with 50% saying Lamb’s health care views were more in line with theirs to only 34% for Saccone.
  • Voters were less likely to support Saccone because of the Republican health care agenda. Saccone’s support of the Republican health care agenda made 41% of voters less likely to vote for him and only 28% more likely to support him.

On April 24, Hiral Tipirneni nearly upset Republican Debbie Lasko in Arizona’s eighth district, a “closer-than-expected” result in a district Donald Trump carried by 21 points. A telephone exit poll of those who cast ballots similarly found that:

  • Health care was a top issue to voters, and these voters favored Tipirneni. Health care was ranked as a top issue for 58% of voters, with only 17% saying it was not that important or not important at all. Among these voters, Tipirneni beat Lesko 65-33.
  • On health care, voters said Tipirneni better reflected their views. Overall, voters said Tipirneni better reflected their views by 2 points, 45-43, over Lesko. Among independents, the gap widened to 30 points, 57-27 in favor of saying Tipirneni.
  • Voters were less likely to support Lesko because of the Republican health care agenda. Lesko’s support of the Republican health care agenda made 40% of voters less likely to vote for her and only 33% more likely to support her.

These were not special occurrences, either. A March 21 PPP poll among voters in battleground states found voters supporting pro-health care candidates and rejecting those favoring repeal:

  • In Arizona, health care is a top issue for 68% of voters, with 21% saying it is the most important issue. In a hypothetical Senate election, Democrat Kyrsten Sinema leads pro-repeal candidate Martha McSally 46-41
  • In Nevada, health care is a top issue for 65% of voters, with 27% saying it is the most important issue. In a hypothetical Senate election, Democrat Jacky Rosen leads pro-repeal Dean Heller 44-39.
  • In Pennsylvania, health care is a top issue for 71% of voters, with 25% saying it is the most important issue. In a hypothetical Senate election, Democrat Bob Casey leads pro-repeal candidate Lou Barletta 54-36.
  • In Tennessee, health care is a top issue for 71% of voters, with 31% saying it is the most important issue. In a hypothetical Senate election, Democrat Phil Bredesen leads pro-repeal candidate Marsha Blackburn 46-41.
  • In Wisconsin, health care is a top issue for 72% of voters, with 25% saying it is the most important issue. In a hypothetical Senate election, Democrat Tammy Baldwin leads pro-repeal candidates Leah Vukmir and Kevin Nicholson 51-39 and 51-38, respectively.

And in November, in what analysts deemed the election most seen as a bellwether for the rest of the country, exit polling from Virginia, where Democrats had their best performance in decades, found health care to be far-and-away the most important issue:

  • Asked whether health care, immigration, gun policy, taxes, or abortion was the most decisive issue, 39% of voters said health care was the issue which mattered most.
  • Among those who selected health care, 77% backed Democrat Ralph Northam.

VOTERS REJECT THE REPUBLICAN HEALTH CARE AGENDA

Ultimately, Americans don’t support or trust the GOP when it comes to health care.

A February PPP poll found Americans placing blame for rising health care costs on President Trump’s sabotage of the law. Among its findings:

  • Over half of voters know Republicans are sabotaging health care, with 51% stating that the Trump administration is actively taking steps that will raise people’s health care costs.
  • 60% of voters want to keep the ACA in place and make fixes as necessary, with just 34% favoring repeal.

This rang true in Pennsylvania’s eighteenth district, with polling showing not just support for Conor Lamb based on his health care stance, but also a rejection of Rick Saccone for his pro-repeal views:

  • Voters in this heavily-Republican district disapproved of the Republican efforts to repeal the Affordable Care Act by 14 points, 53% to 39%.
  • 59% of those surveyed said the Affordable Care Act should be kept in place with fixes made to it as necessary, while just 38% of those surveyed said the best path forward on health care was to repeal the ACA.
  • Among independent voters, the disparity is even wider, with 63% of independent voters opposing the GOP’s health care efforts and just 33% supporting them.

This was also the case in Arizona’s eighth district. Although Tipirneni was not able to pull off the upset, polling showed health care was a boost for her, and once again showed the ACA’s growing popularity:

  • Voters in this heavily Republican district disapproved of the Republican efforts to repeal the Affordable Care Act by 5 points (49% to 44%).
  • Only 41% of voters think the best path forward on health care is to repeal the Affordable Care Act, to 54% who think it should be kept in place with fixes made to it as necessary.

In fact, even the Trump-backed poll finds that voters don’t trust the GOP’s health care agenda. The America First Policies poll also found:

  • By 17 points, voters disapprove of Trump’s “handling of health care and health insurance” with only 38% approving (16% strongly) and 55% disapproving (44% strongly).
  • Among the 41% of voters who say lowering health care costs should be the top priority, 68% want Congress to either leave the Affordable Care Act as it is or work to fix it, with just 31% backing repeal.

And let’s not forget – in direct opposition of the Republican health care agenda, the popularity of the ACA continues to rise:

  • In the PPP poll, approval for the Affordable Care Act 12 was points above water, 47% approval to 35% disapproval, a dramatic reversal from trends before Trump took office.
  • In the PA-18 exit polling, a deeply-red district, 44% of voters supported for the ACA while just 42% opposed it.
  • And in the latest Kaiser tracking poll, 50% of voters expressed their support for the ACA to just 43% who disapproved, reflecting the long-term upward trend of support for the ACA that reached an all-time high in February at 54-42 approve/disapprove.

Ultimately, the message could not be more explicit: voters from all backgrounds and in states across the country are telling the GOP that enough is enough – it’s time for Republicans to end their war on health care and cease their repeal and sabotage agenda. As polls and election results have made clear, if Republicans continue their war on health care and Democrats call them on it, the opposition party will continue to widen its advantage in the midterm elections.

The Republican War on Health Care: First They Sabotaged It, Then They Refused to Fix It, Now they Own It

Republicans Bear 100% of Responsibility for Avoidable Premium Increases Set to Hit Millions of Middle Class Families This Fall

BEFORE PRESIDENT TRUMP’S SABOTAGE, THE MARKETS WERE STABILIZING

Trump White House Today Admits The Marketplaces Were Stabilizing. “After an initial adjustment period, insurers’ financial health, as measured by their stock prices, surpassed earlier levels … While insurers initially incurred losses in the ACA marketplaces as they adjusted to new regulations and a relatively unhealthy risk pool, insurers are now profiting on the individual market as well.” [CEA, 3/18/18]

In 2017, Congressional Budget Office Reports: ACA Market Is Stable. “The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable.”  [Congressional Budget Office, 3/13/17]

In 2017, S&P Global Reports: ACA Market Will Remain Stable So Long As The Trump Administration Is Not “Disruptive.” S&P Global repeatedly reports that “2016 results and the market enrollment so far in 2017 show that the ACA individual market is not in a ‘death spiral.’ However, every time something new (and potentially disruptive) is thrown into the works, it impedes the individual market’s path to stability.” [S&P Global, 4/7/17]

THEN REPUBLICAN REPEAL ATTEMPTS UNDERMINED THE MARKET

Ongoing Republican repeal attempts throughout 2017 created uncertainty that insurance companies said forced them to hike premiums: “Obamacare markets are undergoing a slow-motion meltdown as Republicans stoke a climate of uncertainty while struggling to agree on their own plan for overhauling American health care.” [Politico, 6/8/17]

AND IF THAT WASN’T ENOUGH, PRESIDENT TRUMP STARTED TO SABOTAGE THE MARKETS, WHILE REPUBLICANS ON THE HILL DID NOTHING TO STOP IT

On October 13, 2017, President Trump Ended Cost Sharing Reductions (CSRs), Payments To Insurers That Help Lower Income Americans Afford Health Coverage In The ACA Marketplace. [Washington Post, 10/13/17]

Kaiser Family Foundation: Lack Of CSR Payments Resulted In Surcharge In Premiums Of 7.1 To 38 Percent. “As shown in Table 1, among those insurers that specify the surcharge on silver plans for the discontinuation of CSR payments, the amount of the surcharge ranges from 7.1% to 38%.” [KFF, 10/27/17]

THEN CONGRESS PASSED A TAX CUT FOR THE WEALTHY AND CORPORATIONS THAT ALSO RAISED PREMIUMS AND WILL TAKE COVERAGE AWAY FROM MILLIONS OF PEOPLE

Last December, Congressional Republicans Passed A Tax Bill That Strips 13 Million Of Insurance And Raises Premiums By Double Digits. “The Senate bill’s repeal of the individual mandate (the requirement that most people get health coverage or pay a penalty) would cause 13 million more people to become uninsured, raising the uninsured rate among the non-elderly from 11 percent to about 16 percent, the Congressional Budget Office (CBO) estimates. It also would raise premiums by an average of 10 percent in the individual market by 2027, according to CBO.” [CBPP, 12/8/17]

Urban Institute Predicts Near 20 Percent Premium Increases Next Year And Millions Of Americans Losing Coverage Due To The Repeal Provision In The Tax Law And Trump Sabotage.  According to a study by the non-partisan Urban Institute, Republican health care sabotage is set to artificially inflate premiums by double digits for millions of families this fall. The study forecasts an 18.2% increase in 2019 premiums for Affordable Care Act plans and millions of Americans losing their coverage because the Trump and Congress repealed the individual mandate and the Trump Administration’s proposal to sell junk plans that do not meet ACA requirements. [Urban Institute, 3/14/18]

CONGRESSIONAL REPUBLICANS BROKE THEIR PROMISE TO PASS A STABILIZATION BILL IN 2017

After Being Promised To Have A Stabilization Bill As Part Of The Tax Bill, Sens. Alexander And Collins Issued A Statement Saying They Asked Sen. McConnell To Postpone Stabilization Until 2018. ‘Rather than considering a broad year-end funding agreement as we expected, it has become clear that Congress will only be able to pass another short-term extension to prevent a government shutdown and to continue a few essential programs,’ said the Senators.  ‘For this reason, we have asked Senator McConnell not to offer this week our legislation which independent analysts Avalere and Oliver-Wyman say would reduce premiums by about 20 percent for the 9 million Americans who have no government subsidies to help them buy insurance in the individual market. Instead, we will offer it after the first of the year when the Senate will consider the omnibus spending bill, the Children’s Health Insurance Program reauthorization, funding for Community Health Centers, and other legislation that was to have been enacted this week.’” [Alexander and Collins Statement, 12/20/17]

HOUSE REPUBLICANS INDICATED THEY WOULDN’T SUPPORT STABILIZATION

Speaker Ryan Opposed Efforts To Stabilize The ACA Dating Back To October 2017. Last October, Ryan spokesman, Doug Andres, said, “The speaker does not see anything that changes his view that the Senate should keep its focus on the repeal and replace of Obamacare.” [Matt Fuller, Huffington Post Reporter, 10/18/17]

House Conservatives Called Alexander-Murray Stabilization Bill A “Nonstarter.” “House conservatives appear united in opposition to the health care stabilization proposal crafted by Sens. Lamar Alexander and Patty Murray. ‘Right now it’s a nonstarter,’ House Freedom Caucus member Dave Brat said Tuesday during a Conversations with Conservatives press event.” [Roll Call, 10/24/17]

Rep. Tom Cole: “The Idea You’re Going To Vote For Billions Of Dollars To Stabilize A System You Never Supported In The First Place — Pretty Hard To Choke Down.”  “In addition to the dispute over abortion language, GOP lawmakers were reluctant to sign off on provisions that shored up the Affordable Care Act, a law they all opposed. ‘Nobody in that room voted for Obamacare, so the idea you’re going to vote for billions of dollars to stabilize a system you never supported in the first place — pretty hard to choke down,’ said Rep. Tom Cole (R-Okla.).” [Washington Post, 3/19/18]

PRESIDENT TRUMP AND SPEAKER RYAN REPEATEDLY TRIED TO DERAIL STABILIZATION NEGOTIATIONS BY ADDING MORE CONSERVATIVE DEMANDS

September 2017: “House Speaker Paul Ryan And The White House Have Informed Senate Republican Leaders That They Oppose A Bipartisan Plan To Stabilize Obamacare Being Written In The Senate.” “House Speaker Paul Ryan and the White House have informed Senate Republican leaders that they oppose a bipartisan plan to stabilize Obamacare being written in the Senate, according to Trump administration and congressional sources, in a clear bid to boost the Senate’s prospects of repealing the health law.” [Politico, 9/19/17]

March 2018: The White House Released A List Of Conservative, Deal-breaking Demands To Stabilization. In the middle of bipartisan negotiations on stabilization, the White House released a list of its conservative demands, including:

  • Expanding the Hyde abortion language
  • Codifying the Administration’s Short-Term proposal into law that undermine protections for people with pre-existing conditions
  • Expanding Health Savings Accounts (HSAs) that is essentially another tax cut for the wealthy
  • Imposing an age tax on older Americans by letting insurers charge people over 50 five times more than younger people. [White House Document, obtained by Politico, 3/8/18]

The Hill: White House pushes for conservative changes to ObamaCare fix

Politico: White House pitch to bolster Obamacare includes tough trade-offs for Democrats

Wall Street Journal: Trump Administration Pushes Conservative Goals in Health-Care Market Changes

Vox: The White House might have just blown up the last best hope to stabilize Obamacare

Talking Points Memo: White House Demands Threaten Bipartisan Effort To Bring Down Health Premiums

NOW, THE LATEST REPUBLICAN STABILIZATION PLAN THREATENS PRE EXISTING CONDITIONS AND ESSENTIAL HEALTH BENEFITS

           [AARP, 3/21/18]

AND, REPUBLICANS ADDED A  PARTISAN POISON PILL THEY KNEW WOULD TORPEDO BIPARTISAN STABILIZATION NEGOTIATIONS

Statements

Sen. Patty Murray: “They’re Moving Further And Further Away From Their Original Goal.” “We’re not going to give them an expansion of Hyde and say that’s a goal we all agree to…They’re moving further and further away from their original goal, which was to make sure people have lower costs and access.” [Washington Post, 3/8/18]

Sen. Patty Murray: “They Keep Throwing Obstacles In.” “If we would just go back to the basic premise here and do what we all agreed to do, we’d be able to get this done.” [Washington Post, 3/8/18]

Speaker Paul Ryan Refuses To Introduce Stabilization Without Restricting Women’s Access To Health Care. “House Speaker Paul Ryan (Wis.) told his GOP conference at a Tuesday meeting that he wouldn’t bring the measures to the floor without accompanying language known as the Hyde Amendment, ensuring taxpayer dollars can’t go toward plans that cover abortions.” [Washington Post, 3/8/18]

Headlines

  • Washington Examiner: House Republicans seek anti-abortion protections in Obamacare stabilization bills
  • Huffington Post: Another Obamacare Stabilization Bill Is In Trouble, This Time Because Of Abortion

BY REFUSING TO ADDRESS THEIR OWN SABOTAGE WITH BIPARTISAN STABILIZATION, REPUBLICANS NOW BEAR RESPONSIBILITY FOR THE CONSEQUENCES

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: Republicans “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. [Garin Poll, 9/5/17]

The Alexander-Collins Sham Stabilization Bill

Protect Our Care Campaign Chair Leslie Dach released the following statement on the sham, partisan Alexander-Collins health care stabilization bill:

“The Alexander-Collins legislation should be rejected. It is bad for Americans’ health care. This proposal would result in net coverage losses, higher out-of-pocket costs, and fewer coverage options for many Americans. Despite what Republicans may be publicly saying, Alexander-Collins is not a serious attempt to stabilize the marketplaces. House Republicans admit they oppose stabilization. And Republicans are insisting on a poison pill that would further their war on women’s health. This proposal is a partisan bill designed to fail, and it represents nothing more politics at its worst from elected officials who otherwise have voted to repeal Americans’ health care.”

BACKGROUND

  • The Republican “stabilization” bill includes expansive and restrictive new anti-abortion policy that would have far-reaching consequences for women’s health. Republicans claim they want to apply the existing ‘no federal funding for abortions’ Hyde Amendment to stabilization legislation, but are in fact proposing something entirely new: language that would result in an effective ban on private insurance coverage for abortion, including in plans purchased by private individuals using no federal money, which experts predict would coerce insurance companies into dropping abortion coverage from all plans, both on and off the Marketplace, in order to receive CSRs or reinsurance payments.
  • This proposal would ban a woman from using her own money to buy insurance that covers a medical service the Supreme Court says she has a constitutional right to access and represent a new frontier in Republicans’ war on women’s health. And it’s entirely hypocritical, because the Affordable Care Act was signed into law with restrictions that prohibit insurance companies from using public funds for abortion coverage, with President Obama even having signed an executive order emphasizing that none of its funds can be used to cover abortion services.
  • As Aviva Aron-Dine with the Center on Budget and Policy Priorities explains, the CBO finds that this legislation would result in net coverage losses, with larger losses for moderate-income consumers than gains for middle- and upper-income consumers. Ultimately, this legislation would result in net coverage losses between 500,000 and one million people.
  • Moreover, Aron-Dine notes that the CBO has confirmed that the federal savings from restoring CSRs come from coverage losses, higher premiums, and higher out-of-pocket costs for those with incomes below 400 percent of the federal poverty line, which would result in worse outcomes for consumers between 200 and 400 percent of the poverty line. In fact, the savings would come from a combination of consumers dropping coverage and those maintaining coverage being forced to pay more for doing so.
  • When Republicans’ constituents face double-digit premium increases in the fall because their Congressmen scuttled stabilization, they’ll know exactly who to blame.

Key Quote: ‘Nobody in that room voted for Obamacare, so the idea you’re going to vote for billions of dollars to stabilize a system you never supported in the first place — pretty hard to choke down,’ said Rep. Tom Cole (R-Okla).”

After PA-18 Defeat, GOP Continues to Sabotage Health Care In So-Called Stabilization Bill

Washington, D.C. – Following the major role health care played in Democratic Congressman-elect Conor Lamb’s upset victory in PA-18, studies showing that Republican sabotage and repeal could raise premiums up to 94%, and despite all that, reports of ongoing Republican efforts to sabotage health care in the upcoming Omnibus,  Protect Our Care Campaign Chair Leslie Dach released the following statement:

“Despite Tuesday’s groundbreaking election in Pennsylvania, the clearest wake-up call yet that GOP health care sabotage is an albatross around the neck of anyone who supports it, Congressional Republicans continue to sabotage Americans’ health care, pushing a stabilization package that would not even begin to undo the damage they have done, and launching new attacks on women’s health.

“Because President Trump and his Republican allies in Congress have been trying to repeal and sabotage our health care for over a year, premiums are up twenty percent and millions of Americans have lost their coverage. But instead of addressing the very real damage they have caused in order to lower premiums, Republicans would rather attacks women’s health and encourage insurance companies to offer junk plans that can deny coverage to people with pre-existing conditions.

“Enough is enough. It’s time for the GOP to stop this war on our health care. If President Trump and Congressional Republicans think that grandstanding on a stabilization bill to fix their own wreckage will give them political cover, they are dead wrong.”

BACKGROUND

THE GOP HAS ATTEMPTED TO SABOTAGE AMERICANS’ HEALTH CARE AT EVERY TURN

From the moment that Donald Trump and Congressional Republicans took power, they’ve done everything they can to repeal and sabotage Americans’ health care. Now they’re claiming they want to stabilize the marketplaces and lower premiums. This false rhetoric is merely the latest ploy from Republicans who have seen the writing on the wall – Americans are furious about the Republican repeal-and-sabotage agenda.

For the better part of a year, President Trump and his Republican allies in Congress tried to repeal the Affordable Care Act legislatively, striving to kick 32 million Americans off of their coverage and returning to the days when insurers had the power to choose who to deny coverage to by removing protections for those with pre-existing conditions.

When this failed, they doubled down on their administrative sabotage, carrying out a closed-door campaign to undermine the law through administrative actions. These included cancelling cost-sharing reduction (CSR) payments designed to lower premiums; using funding for coverage enrollment to launch a propaganda campaign against the law; and attempting to gut open enrollment by reducing the advertising budget by 90% percent, costing an additional 1.1 million people coverage.

These repeal-and-sabotage attempts culminated in December, when the GOP voted to get rid of the individual mandate in their tax scam, ripping insurance away from ten million people and raising premiums double-digits for millions more in order to finance a tax cut for the wealthiest Americans and corporations.

In the time since, President Trump and his allies in Congress have promoted short-term health policies, which neglect key consumer protection provisions such as protections for those with pre-existing conditions and coverage mandates for essential benefits like maternity care; they have supported association health plans (AHPs), which raise costs for people with pre-existing conditions and further destabilize the insurance markets; and they have encouraged states to promote plans which violate the law, promoting and end-run around the ACA despite such procedures being labeled “wildly illegal.”

A study from the Urban Institute found that this sabotage will result in an increase in individual market premiums by an average of 18.2 percent for 2019.

THE GOP HAS REFUSED TO ACT ON MEASURES TO ACTUALLY STABILIZE THE MARKETS

What the GOP has not done through all of this, however, is undertake a genuine effort to actually stabilize the marketplaces.

Following the collapse of the legislative repeal bills in July, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) began holding hearings on stabilization, bringing in insurance commissioners, governors, and health care experts of both parties. The GOP refused to act on their recommendations, however, instead pivoting to yet another attempt to repeal the ACA through the Graham-Cassidy legislation.

After Graham-Cassidy, which would have kicked twenty million Americans’ off of their insurance and raised premiums double-digits went down in flames, the GOP went through yet another charade on stabilization, refusing to move forward on the bipartisan Alexander-Murray bill to address stabilization despite it having a filibuster-proof majority in the Senate.

A STABILIZATION BILL MUST ACTUALLY STABILIZE THE MARKETPLACE

Now, the GOP says it wants to support stabilization measures. Where was this in the winter, when notices of skyrocketing premiums were going out across the country? Where was this in the fall, when experts were on Capitol Hill lamenting the damage being done to the marketplace? Where was this in the summer, when advocates were begging the GOP to do something rather than push forward yet another repeal bill?

Congressional Republican efforts to undo the damage they and President Trump have caused are wholly insufficient and often turn to failed ideas like high risk pools, which will leave Americans with higher costs and worse coverage. Any bill to stabilize the insurance marketplaces and reverse Republican-caused sabotage must:

  • Expand affordability by increasing the value of premium tax credits and cost-sharing reduction protections;
  • Ensure cost sharing protections fulfill their original purpose of improving affordability and Basic Health Plans are fully funded in order to protect coverage levels;
  • Apply the consumer protections of the Affordable Care Act – such as guaranteed issue, community rating, protections for preexisting conditions – to short term duration plans and protect the essential health benefits from being undermined;
  • Provide for a national meaningful reinsurance program that reduces current premium levels and stabilizes the market;
  • Adequately fund outreach and enrollment efforts;
  • Reject bringing back high-risk pools and Association Health Plans; two failed experiments that would have a destabilizing effect on the marketplace by incentivizing healthier individuals to leave the ACA compliant market, thereby negatively affecting the risk pool and increasing premiums; and
  • Reject punitive and duplicative new anti-choice restrictions on health centers.

Many of the above provisions are included in the recent bills introduced in the Senate by Senator Tammy Baldwin (D-WI) and in the House by Reps. Frank Pallone (D-NJ), Richard Neal (D-MA), and Bobby Scott (D-VA). If Republicans in Congress truly care about stabilization, they will work with Democrats to adopt these provisions and implement a bipartisan, common-sense package to lower premiums and expand coverage options. Anything else is just crocodile tears from elected officials more worried about partisan politics than about Americans’ health.

The Barrasso Bill: Less Choices, Worse Outcomes, More Repeal and Sabotage

Washington, D.C. – In response to Sen. John Barrasso’s (R-WY) introduction of the latest Republican ACA repeal and sabotage bill, the Improving Choices in Health Care Coverage Act, which would codify the expansion of the Trump Administration’s proposed short-term, junk insurance plans, Protect Our Care Campaign Director Brad Woodhouse release the following statement:

“This legislation is nothing more than the GOP’s latest attack against Affordable Care Act, and it should be dead on arrival in the Senate. A permanent embrace of junk insurance plans would once again allow insurers to discriminate against those with pre-existing conditions and re-implement lifetime caps, eliminate essential health benefits, allowing maternity care and substance abuse treatment to be denied, and leave Americans holding the bill – often running into the hundreds of thousands of dollars.

“Like the many GOP sabotage legislative efforts before it, the Barrasso bill must be rejected. Congressional Republicans should instead be work with their Democratic counterparts to come up with commonsense, bipartisan solutions which actually stabilize the marketplace and provide relief to Americans. Enough is enough – it’s time for the GOP to end their war on health care.”

New Poll: Health Care Far-And-Away Top Issue Among Voters

A new poll from CNN finds that health care remains voters’ top priority, with 83% of those surveyed listing it as either extremely or very important, the highest percentage recorded in the poll dating back to 2002. The new numbers echo Protect Our Care/Hart Research polling conducted last month.

Key CNN results include:

  • 83% of voters said health care was extremely important or very important, the highest among all issues.
  • 53% of voters said health care was extremely important, the highest among all issues – a 20% increase from the CNN/USA Today/Gallup poll conducted in August of 2010, when health care supposedly dominated the midterm elections.
  • 78% of independent voters said health care was important, which tied with the economy as their top issue.
  • At least 70% of voters in every demographic category said health care was important – a trend that stretches across gender, age, income level, education level, ideology, and party affiliation.

“No matter how much the GOP wishes health care would go away, results like today make clear that this is the top issue for American voters,” said Protect Our Care Campaign Director Brad Woodhouse. “Health care is energizing voters of all backgrounds, the majority of whom are furious about the GOP’s sabotage attempts, and Republicans only have themselves to blame. Enough is enough: it’s time for Republicans to end their war on health care.”

Just last week, Save My Care launched a national “Enough is Enough” ad campaign with a six-figure national TV and digital ad buy. The campaign encourages Americans to call on Congress to end the partisan war on health care.

Republican Sabotage Set to Spike Next Year’s Premiums Nationwide

As a new Urban Institute study pulls the alarm on dramatic double-digit rate hikes set to hit states because of President Trump and Congressional Republicans’ sabotage, which includes allowing the sale of junk plans that can discriminate against people with pre-existing conditions and the TrumpTax’s repeal of the individual mandate, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Today’s bombshell report shows the high price Americans will pay for Republican health care sabotage, which is set to artificially inflate premiums by double digits for millions of families this fall. Health care advocates warned President Trump over and over about the devastating economic toll his sabotage would take on American families, and now we have the numbers to prove it. This report shows that Republican sabotage is set not only to spike premiums, but also to drive millions of Americans off real coverage, leaving them underinsured or uninsured, meanwhile increasing federal spending by billions.

“Even though much of the damage is done, Trump and his Republican allies in Congress still have time to work with Democrats on a bipartisan stabilization bill to moderate these premium spikes, but that window of time is closing quickly as insurance companies start to lock in premiums for the fall. It’s past time for Republicans in Congress to stand up to Trump’s partisan war on health care and start cooperating with Democrats to protect our care.”

Find a summary of state-by-state impacts here.

Polling Roundup: The ACA Has Achieved Lasting Popularity & Republicans Have Been Hurt by Sabotage

Four polls over six weeks have reached the same conclusion: the Affordable Care Act has achieved lasting popularity, the electorate is aware of and angry about Republican health care sabotage, and these factors are making health care voters’ top priority. Here’s what the numbers say:

Last week, Public Policy Polling released its first national poll of the year, contrasting the rising popularity of the Affordable Care Act with the blame being leveled on President Trump’s sabotage:

  • Approval for the Affordable Care Act is 12 points above water (47% approval to 35% disapproval), a dramatic reversal from trends before Trump took office.
  • Over half of voters know Republicans are sabotaging health care, with 51% believing the Trump Administration is actively taking steps that will raise people’s health care costs.

Also last week, a Priorities USA memo found that President Trump’s handling of health care remains vastly unpopular, especially among independent voters:

  • On the policy of health care, Donald Trump has a 34/46 favorable/unfavorable message.
  • On his handling of drug pricing, 60% of voters have major concerns, including 71% among independents.

These two polls come on the heels of a January Washington Post/ABC News poll which asked Americans about the policies taking precedent during President Trump’s time in office and found that Americans are most united in opposition to the GOP’s health care agenda:

  • Asked if keeping “Obamacare” was a good thing for the country, 57 percent of respondents said yes – a significantly higher percentage than any other policy. Meanwhile, just one policy was underwater: the Republican tax scam, which kicked millions of people off of their insurance and was opposed 46% – 34%.

And all of these polls follow a Hart Research memo which found that health care is the number one issue among voters, far exceeding anything else in terms of driving voting preferences. A majority of those surveyed expressed strong disapproval for the health care policies pushed by the GOP:

  • “Healthcare far exceeds any other issue as an important driver of voting preferences, with over half of all voters identifying healthcare as one of their top priorities in the 2018 congressional elections, with 54% of those surveyed choose health care as one of the two issues that will be the most important to them in deciding how to vote for Congress.”
  • Healthcare is the most frequently cited priority among Democrats (68%), independents (54%), and Republicans (38%). It is particularly important to African-American voters (66%) and to white women voters, whether they are college graduates (62%) or non-college graduates (59%).

One poll can be an outlier, or two a coincidence, but four polls in six weeks independently highlighting the importance of health care and the contrast between the Affordable Care Act’s popularity and the GOP’s sabotage show just how important this issue is to the American people. From coast to coast, constituents are making their view abundantly clear: it’s time for the GOP to stop its war on health care, and there will be significant consequences should President Trump and Congressional Republicans fail to heed this advice.

Protect Our Care Calls On Azar to Stand Up for Idahoans’ Coverage

After HHS Secretary Alex Azar dodged questions posed by the House Ways and Means Committee about an Idaho insurance company that intends to sell plans that violate Affordable Care Act minimum quality standards and protections for people with pre-existing conditions, saying “I’m not aware that our opinions or views have been solicited,” Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Dodging the question won’t cut it: Secretary Azar needs to stand up and protect health care for the people of Idaho by stopping the state’s illegal plan to allow pre-Affordable Care Act coverage. This morning we learned that Blue Cross Idaho is trying to take Idahoans back to the days of coverage caps, when people with insurance still lived one illness or injury away from bankruptcy. Even worse, the company is planning to charge people higher premiums based on their medical history, bringing Idaho back to the days when insurers could discriminate against people with pre-existing conditions like asthma or cancer. Medical bankruptcy and coverage denials are exactly the kind of insurance company abuses the Affordable Care Act was designed to stop, and it has done so with popular provisions that most Republicans claim to support. Now, it’s time for Secretary Azar to stand up for the people of Idaho and enforce the law that’s designed to protect their care.”

Ignoring Obamacare Rules, Idaho ‘Freedom’ Plans Come With Limits

Bloomberg // Zachary Tracer // February 14, 2018

After Idaho’s Republican governor promised to find creative ways to get around Obamacare, one health plan in the state plans to offer skimpy coverage that may violate many of the law’s protections for patients.

Blue Cross of Idaho said Wednesday that it will offer insurance plans that don’t comply with some Affordable Care Act requirements. The plans, branded as “Freedom Blue” coverage, have limits on annual medical spending and will charge sicker people higher premiums or deny them coverage in some cases — policies specifically forbidden by the 2010 law.

The move sets up a potential conflict with the federal government. While President Donald Trump has said he opposes the law and has taken steps to undermine it, the administration will have to decide whether to enforce legal requirements that remain on the books.

“Both in terms of federal penalties and in terms of potential private lawsuits, they are taking on tremendous liabilities here,” said Tim Jost, an emeritus professor at the Washington and Lee University School of Law who has been critical of efforts to unwind the law. “What they’re doing is completely illegal. It’s kind of jaw-dropping.”

Trump’s Secretary of Health and Human Services, Alex Azar, said during a Senate hearing last year that he’d uphold the ACA as long as it remains law. Azar is testifying before Congress Wednesday. The department didn’t immediately respond to a request for comment.

Ways Around Law

In early January, Idaho Governor Butch Otter directed the state’s insurance regulator to find “creative ways” for health insurers in the state to offer more affordable coverage. Otter said the state planned to use flexibility offered by the Trump administration in an executive order, and that it had authority to do so. The insurance regulator issued guidelines for the plans later that month.

“The door is open for states to pursue our own reasonable solutions,” Otter said. “We believe Idaho will lead the way in states taking back control of their insurance markets.”

“Our Freedom Blue plans bring more choices and lower prices to consumers,” Blue Cross Idaho Chief Executive Officer Charlene Maher said in a statement.

The plans have a $1 million annual per-person limit to how much care the insurer will pay for. Some also don’t have to cover services like maternity care, and can charge more to people who are sicker after asking them extensive questions about their health.

While such policies were banned by the Affordable Care Act, Idaho plans to use the law as a backstop. If individuals end up with medical expenses that exceed the $1 million limit in the non-Obamacare plans, Idaho will require insurers to help them move into ACA plans, which don’t have limits on medical spending.

 

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.”