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FACT CHECK: Sen. Collins’ Sunday Show Stabilization Deception

Yesterday, Sen. Susan Collins (R-Maine) appeared on CNN’s State of the Union and proceeded to give a version of the events surrounding the GOP stabilization bill failure that do not hold up to scrutiny. Here’s what Sen. Collins said – and what actually happened:

SEN. COLLINS BANKED ON DISINGENUOUS STABILIZATION PROMISE IN EXCHANGE FOR HER VOTE ON ON THE REPUBLICAN TAX BILL

What Collins says now:

When asked on CNN’s State of the Union whether she thought she was lied to to get her vote for the Republican tax bill, Sen. Susan Collins responded, “No, I really don’t.”

What really happened:

Last December, Collins said that a failure to pass stabilization would be a “serious breach of a promise.” When discussing the possibility that stabilization might not become law, Collins said, “I’m counting on the administration to make sure that does not happen…I would consider it a very serious breach of a promise to me.”

MITCH MCCONNELL BROKE HIS PROMISE TO SEN. COLLINS ON STABILIZATION

What Collins says now:

Sen. Collins reiterated that she believes Majority Leader McConnell kept his promise to her: “I had the opportunity just two weeks ago to bring a package to the Senate floor with Lamar Alexander, so the Majority Leader kept his promise to me.”

What really happened:

In Sen. Collins’ own words, she cast a vote to pass the tax bill because she had secured “commitments to pass legislation to help lower health insurance premiums.” She secured a commitment to pass stabilization, not just hold a vote on legislation. Not only did stabilization never pass, but no vote was ever held on Collins’ or Alexander’s health care stabilization package.

REPUBLICANS SABOTAGED EFFORTS TO STABILIZE THE AFFORDABLE CARE ACT

What Collins says now:

Sen. Collins continued to push a false narrative about what happened during stabilization efforts, saying, “Much to my surprise, [stabilization] was blocked actually by Senators on the other side of the aisle.”

What really happened:

In reality, Republicans bear 100% of the responsibility for failing to pass legislation that would stabilize the Affordable Care Act. House Republicans, such as Rep. Tom Cole, went on the record indicating they opposed stabilization: “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.”

The White House then released a list of extreme, deal-breaking demands, including: expanding Hyde restrictions to effectively prohibit all privately-purchased plans from covering abortion; codifying short-term health plans that undermine protections for people with pre-existing conditions; and imposing an age tax that allows insurers to change Americans over age 50 premiums over five times higher than they charge younger people. Republicans were quick to advocate for these changes, adding a partisan poison pill they knew would torpedo bipartisan stabilization efforts.

Even Sen. Collins’ Republican colleagues recognize that they now own the outcome on health care. Sen. Lindsey Graham told Breitbart News, “[Obamacare] is 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.”

In an op-ed she penned for the Portland Press Herald, Sen. Collins herself admitted that price increases were entirely avoidable: “This proposal was the last clear opportunity to prevent these health insurance rate increases, which will be announced Oct. 1. The most frustrating thing about these imminent price increases is that they were entirely avoidable. Much about health care is complicated.”

Final Open Enrollment Numbers Confirm Staying Power of ACA

Washington, D.C. – As the Centers for Medicare and Medicaid Services released the final open enrollment numbers for 2018, which showed that 11.8 million people nationwide bought Affordable Care Act marketplace coverage, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Millions of Americans rely on the Affordable Care Act for quality, affordable coverage, and today’s confirmed enrollment numbers provide clear evidence of the law’s critical importance in American health care. But for over a year, the Trump Administration has been carrying out an unprecedented sabotage campaign designed to undermine the law and make it fail. Nowhere was this more apparent that the Administration’s attacks on open enrollment, which included cutting the advertising budget by 90 percent, halving the enrollment time, and denying help for people trying to get coverage. But the American people rejected this partisan scaremongering, and now we know that 11.8 million people signed up for marketplace coverage, almost matching last year’s total enrollment despite the many obstacles the Trump Administration placed in their way. While this is heartening news, these 11.8 million people and millions more are living in fear that the Republican war on health care will hike their rates and make care prohibitively expensive or unavailable to people with pre-existing conditions.

“The American people don’t want to go back to a time when insurers could deny them health care for having a pre-existing condition or be priced out of the market based on their age, gender, or medical history. The Affordable Care Act is a lifeline for millions of Americans, and Republicans’ continuing attempts to undermine the law are being met with resistance through enrollment, protests, and at the ballot box as the American continue to say: enough is enough – it’s time for Republicans to end their war on our care.”

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.

Iowa Republicans Prioritize Insurance Company Profits Over Iowans’ Health

In response to Iowa Governor Kim Reynolds signing legislation which allows for the sale of association health plans and ‘benefit plans’ which don’t meet Affordable Care Act requirements, Protect Our Care Chair Leslie Dach released the following statement:

“The legislation takes Iowa back to the days when insurance companies could discriminate against people with pre-existing conditions and refuse to cover essential health benefits like maternity care and prescription drugs, paving the way for even higher premiums and further market destabilization. This legislation will allow insurance companies to sell junk plans without proper oversight – precisely the kind of abuses the Affordable Care Act was designed to stop.

BACKGROUND

Protect Our Care [3/30/18]: Association Health Plans Endanger Consumers

Washington Post [4/2/18]Iowa tries another end run around the Affordable Care Act
As a growing number of Republican-led states look for end runs around the Affordable Care Act, Iowa is embracing a strategy that contends not all health plans are actually health insurance. Gov. Kim Reynolds (R) is scheduled Monday to sign into law a bill allowing the century-old Iowa Farm Bureau to collaborate with the state’s dominant insurer to sell “health benefit plans,” which are expected to cost health customers less than ACA coverage because they will not have to comply with federal requirements.

Association Health Plans Endanger Consumers

NATIONALLY, ASSOCIATION HEALTH PLANS HAVE A HISTORY OF FRAUD AND UNPAID CLAIMS

Between 2000 and 2002, AHPs Left 200,000 Policyholders with $252 Million In Unpaid Medical Bills. “There have been several documented cycles of large-scale scams. According to the GAO, between 1988 and 1991, multiple employer entities left 400,000 people with medical bills exceeding $123 million. The most recent cycle was between 2000 and 2002, as 144 entities left 200,000 policyholders with $252 million in unpaid medical bills.” [United Hospital Fund, 3/6/18]

  [GAO, February 2004]

Former Insurance Fraud Investigator: “Fraudulent Association Health Plans Have Left Hundreds Of Thousands Of People With Unpaid Claims.” “Marc I. Machiz, who investigated insurance fraud as a Labor Department lawyer for more than 20 years, said the executive order was ‘summoning back demons from the deep.’ ‘Fraudulent association health plans have left hundreds of thousands of people with unpaid claims,’ he said. ‘They operate in a regulatory never-never land between the Department of Labor and state insurance regulators.’” [New York Times, 10/21/17]

Dr. James Madara, CEO of the American Medical Association: Association Health Plans Have Potential To Threaten Health And Financial Stability. “Fraudsters prey upon areas of regulatory ambiguity and may challenge such authority in courts to further delay enforcement, which allows more time to increase unpaid medical claims…Without proper oversight to account for insolvency and fraud, AHPs have the potential to … (threaten) patients’ health and financial security and the financial stability of physician practices and other providers.” [Modern Healthcare, 3/7/18]

INSURANCE COMMISSIONERS AGREE THAT ASSOCIATION HEALTH PLANS ARE BAD FOR CONSUMERS

National Association of Insurance Commissioners: Association Health Plans Are Bad For Consumers. “AHPs would fragment and destabilize the small group market, resulting in higher premiums for many small businesses…AHPs would be exempt from state solvency requirements, patient protections, and oversight exposing consumers to significant harm.” [NAIC]

Pennsylvania Insurance Commissioner Concerned About Potential For Consumer Harm Under AHPs. “The proposed rule would also loosen existing commonality of interest requirements to allow associations to form simply based on membership in the same trade, industry or profession..If a self funded MEWA were permitted to form in a neighboring state and to sell to Pennsylvania association members under the metro area provision, Pennsylvania regulators would not have the ability to assist a Pennsylvania resident if problems arise with the other state’s association, including claim denials, or, worse yet, in the event of insolvency or fraud.” [PA Insurance Commissioner Jessica Altman, 3/6/18]

California Insurance Commissioner: “The Proposed Rule Is A Perfect Storm Of Bad Ideas.” “The AHPs proposed by this rule will harm consumers by degrading the individual and small group health insurance markets through adverse selection, and will impinge upon states’ rights while opening the door to fraud, insolvency and abuse…The proposed rule in no way limits the ability of states to regulate MEWAs, insurers offering coverage through MEWAs, and insurance producers marketing that coverage to employers. However, the checkered history of MEWAs instructs that unscrupulous actors will try and exploit any change which can be mischaracterized as constituting ERISA preemption.” [CA Insurance Commissioner Dave Jones, 3/6/18]

PATIENT GROUPS, HOSPITALS, AND KEY HEALTH STAKEHOLDERS CONDEMN AHPs

American Cancer Society Cancer Action Network: “We Are Also Concerned About The Proliferation Of AHPs Because Of Their History Of Fraud And Financial Instability.” “For a long time, these products were not traditionally subject to the same state insurance solvency and licensing requirements that allowed regulators to maintain necessary oversight.5 If an AHP lacked the financial resources to pay claims, then enrollees were left with no coverage and high out-of-pocket costs. Even in cases of well-meaning AHP sponsors, insolvencies led to millions of dollars in unpaid claims.” [ACS-CAN, 3/6/18]

American Hospital Association: AHPs “Ultimately Decreas[e] Access To Affordable Coverage.” “We are concerned that this rule fails to protect against discriminatory insurance practices and could contribute to instability in the individual and small group market, ultimately decreasing access to affordable coverage.” [American Hospital Association, 3/6/18]

Coalition Of 118 Patient And Community Organizations Urges Department Of Labor To Reconsider AHPs. “We believe that the proposed changes would negatively impact access to quality, affordable care for consumers, disrupt the individual and small business marketplace, and further strain the limited resources of state regulators…The intent of the President’s executive order was to increase consumer choice while curbing costs, however we believe that AHPs as proposed would invariably weaken the individual and small group markets leading to higher healthcare costs for all; higher premiums for those who stay in the marketplace, and high out of-pocket costs for those who are covered by AHPs for unexpected medical needs.” [Coalition Of 118 Patient And Community Organizations, 3/6/18]

AHPs ARE HOTSPOTS FOR FRAUD IN STATES:

Florida

A Labor Department Lawsuit Revealed An AHP Had Concealed Financial Problems And Left $3.6 Million In Unpaid Claims. “The Labor Department filed suit last year against a Florida woman and her company to recover $1.2 million that it said had been improperly diverted from a health plan serving dozens of employers. The defendants concealed the plan’s financial problems from plan participants and left more than $3.6 million in unpaid claims, the department said in court papers.” [New York Times, 10/21/17]

In Florida, A Man Pleaded Guilty To Embezzling $700,000 In Premiums From the AHP He Ran in 2004 To Help Build A Home For Himself And Was Sentenced To 57 Months In Prison. “A Florida man was sentenced to 57 months in prison after he pleaded guilty to embezzling about $700,000 in premiums from a health plan that he had marketed to small businesses. The Labor Department and the Justice Department said he had used some of the plan premiums to build a home for himself.” [New York Times, 10/21/17]

In 2004, A Florida Woman Was Left With $500,000 In Unpaid Medical Bills While She Was Covered By Association Health Plan. “Joan Piantadosi, a small business owner bought health insurance from Employers Mutual LLC through an association for herself, her family, and her employees. She was left with more than $500,000 in unpaid medical bills for her husband’s treatment during the time she was covered by Employers Mutual LLC. On top of that, her husband needed a liver transplant to live. In her own words, “[W]e were informed that since we lacked insurance coverage, we would have to pay a deposit of $150,000 before my husband could enter the hospital’s Liver Transplant Inpatient program. We simply did not have $150,000 to cover the deposit. Consequently, my husband was removed from the recipient list…We feared, among other things, that my husband might die while we were attempting to deal with the predicament of being uninsured despite having paid premiums to what appeared to be a legitimate health insurer.” [United Hospital Fund, 3/6/18]

Louisiana

In Louisiana, Two People Pleaded Guilty To Using Money From The AHP For Spa Treatments, Diamond Cuff Links, Foreign Travel And Other Personal Expenses. “And in Louisiana, two people pleaded guilty to conspiracy charges after the government found that they had taken money from the medical benefit fund of a trade association and used it to pay for spa treatments, diamond cuff links, evening gowns, foreign travel and other personal expenses.” [New York Times, 10/21/17]

Texas

In Texas, Patients Thought They Were Insured Until Told Otherwise In A Moment Of Crisis. “Robert Loiseau, who represented fraud victims in Texas, recalled their shock when they tried to receive care. ‘People bought insurance coverage because it was cheap and seemed to provide them with coverage they needed,’ he said. ‘It had a veneer of legitimacy. But when they went to the doctor, they found out all of a sudden that their insurance company, their perceived insurance company, was in receivership and that they had no coverage.’” [New York Times, 10/21/17]

Between 2001 And 2003, Texas Shut Down 129 Unauthorized Insurance Operations. “In the last two years, the Texas Insurance Department shut down 129 unauthorized insurance companies, affiliates, operators, and their agents whose illegal actions affected more than 20,000 Texans.” [The Commonwealth Fund, August 2003]

New Jersey

In 2002, An AHP Became Insolvent With $15 Million In Outstanding Claims. “For example, when a long-standing AHP in New Jersey that covered 20,000 people became insolvent in 2002, it had $15 million in outstanding medical bills. This left participating businesses and their employees’ claims unpaid even though employers paid premiums to the AHP.” [Commonwealth Fund, 10/10/17]

A Health Plan For New Jersey Small Businesses Collapsed With $7 Million In Unpaid Claims. “In another case, a federal appeals court found that a health plan for small businesses in New Jersey was ‘aggressively marketed but inadequately funded.’ The plan collapsed with more than $7 million in unpaid claims.” [New York Times, 10/21/17]

South Carolina

In South Carolina, A Man Pleaded Guilty To Diverting Nearly $1 Million From An AHP For Churches And Small Businesses, Leaving $1.7 Million In Unpaid Claims. “A South Carolina man pleaded guilty after the government found that he had diverted more than $970,000 in insurance premiums from a health plan for churches and small businesses. ‘His embezzlement and the plan’s consequent failure left behind approximately $1.7 million in unpaid medical claims,’ the Labor Department said.” [New York Times, 10/21/17]

Across State Lines: North Carolina, Maryland, And Beyond

One AHP Scheme Shows How AHPs Can Move From State To State. Families USA chronicled an AHP scheme involving the American Trade Association, Smart Data Solutions, and Serve America Assurance. They found:

  • “Even after one state identifies a problem, the company may continue to operate for years in other states. North Carolina issued a cease and desist order to stop many of the players in this case from selling insurance in 2008.”
  • “But by June 2010, when Maryland issued a cease and desist order, the plans sold by these players had been identified in at least 23 states.„ Estimates of total premiums paid to these companies for unauthorized, unlicensed plans range from $14 million to $100 million.”
  • “This particular scheme operated through associations that went by many different names. (At least one of the players in this case was involved in a previous case concerned with fraudulent insurance sold through an association of employers in 2001-2002.)”
  • “Consumers are often ill-protected when they buy coverage through an association, and the web of relationships among salespeople, associations, administrators, and actual insurers can be difficult for regulators to unravel and oversee. Consumers may be encouraged to join fake associations to buy health insurance so they have an illusion of coverage—and the insurers collect membership dues and premiums while illegally avoiding state oversight).” [Families USA, October 2010]

GAO Report In 1992 Showed Similar AHPs Left At Least 398,000 Participants With More Than $123 Million In Unpaid Claims And More Than 600 Plans In Almost Every State Failed To Comply With State Laws. “Back in 1992, the Government Accountability Office issued a scathing report on these multiple employer welfare arrangements (known as MEWAs; they’re pronounced “mee-wahs”) in which small businesses could pool funds to get the lower-cost insurance typically available only to large employers. These MEWAs, said the government, left at least 398,000 participants and their beneficiaries with more than $123 million in unpaid claims between January 1988 and June 1991. Furthermore, states reported massive and widespread problems with MEWAs. More than 600 plans in nearly every U.S. state failed to comply with insurance laws. Thirty-three states said enrollees were sometimes left without health coverage when MEWAs disbanded…’MEWAs have proven to be a source of regulatory confusion, enforcement problems and, in some instances, fraud,’ the GAO wrote at the time.” [Washington Post, 10/12/17]

Kaiser Poll Confirms Public Support for Affordable Care Act

This morning, on the 8th anniversary of the Affordable Care Act’s signing, the Kaiser Family Foundation’s March Health Tracking Poll finds that the law’s popularity remains above water, with half of Americans having a favorable opinion. The poll also confirms that Americans want Congress to improve the law, not to repeal it, with 63% saying Republicans in Congress should focus their efforts on improvements and only 32% supporting repeal.

“Today’s tracking poll confirms that after eight years, the Affordable Care Act has stood the test of time and is now woven into the fabric of the American health care system. Two-thirds of the public want to see the law improved and strengthened. Unfortunately, just this week, Republicans in Congress continued to ignore Americans’ desire to improve health care by refusing to pass bipartisan stabilization legislation to undo some of the rate hikes President Trump has caused with his relentless sabotage of the Affordable Care Act. It’s time for Republicans to listen to their constituents, who want Congress to put the partisan fight over the Affordable Care Act in the rearview mirror once and for all, and start working on bipartisan fixes and improvements. And it’s time for President Trump to face up to the facts and stop his Administration’s ongoing sabotage of our health care system,” said Protect Our Care Campaign Director Brad Woodhouse.

Protect Our Care on Eighth Anniversary of the Affordable Care Act: We Won’t Go Back

On the eighth anniversary of the Affordable Care Act being signed into law, Protect Our Care Campaign Chair Leslie Dach released the following statement:

“Eight years after the Affordable Care Act became law, twenty million people have gained coverage; the uninsured rate has been cut in half; and out-of-pocket spending has fallen double digits while medical bankruptcies are becoming more and more rare. Because of the ACA, insurers can no longer deny coverage to the one-in-four Americans with a pre-existing condition or drop coverage due to a yearly or lifetime limit; plans must cover essential health benefits; women cannot be charged more than men; and young adults can stay on their parent’s plan until age 26.

“Today, not only is the ACA more popular than ever, but health care has become a driving factor in elections across the country. The two times Medicaid expansion was on the ballot, in Maine and Oregon, it won overwhelmingly, and voters have cited health care as a top issue, powering Democratic victories in Virginia, New Jersey, Alabama, Wisconsin, and Pennsylvania. And despite almost a decade of attacks on the law, the American people are more united than ever in favor of expanding access to health care.

“Despite all this, Trump Administration and Congressional Republicans continue their relentless repeal-and-sabotage campaign, raising premiums and out of pocket costs for millions including demanding an age tax for older Americans, taking away protections for people with pre existing conditions, and gutting Medicaid.

“The past eight years have shown just how much progress has been made in the American health care system, and the past year has made clear just how much Americans value the quality, affordable care provided by the ACA. The Affordable Care Act made health care in America immensely better, and we won’t go back.”

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).”

President Trump Ignores Real Opioid Solutions

Washington, D.C. – Today, President Trump spoke in New Hampshire about the opioid crisis. Protect Our Care Campaign Director Brad Woodhouse released the following statement in response:

“Heavy with rhetoric and short on solutions, President Trump’s speech today in New Hampshire was more of the same from a White House more committed to politicizing the opioid crisis than ending it. The Trump Administration has relentlessly attacked and sabotaged Medicaid, proposing to cut funding by hundreds of billions for the program that pays for one-fifth of all substance abuse treatment nationwide, and for two successive years has proposed a 95% cut to the Office of National Drug Control Policy, charged with coordinating the federal response to the nation’s raging opioid crisis.

“If the White House truly cared about combating the opioid epidemic, they would be calling for every state that hadn’t expanded Medicaid to do so. That they’re not tells you all you need to know.”