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Trump administration Archives — Protect Our Care

House Energy & Commerce Committee Continues to Deliver On Their Promise to Americans With More Legislation Designed to Lower Costs, Improve Care, and End Trump Administration’s Sabotage

Democrats, Responding to the Mandate from Voters in November, Introduce Bills to Reverse the Trump Administration’s Harmful Cuts to the Navigator Program, Provide States More Funding to Establish State-Based Marketplaces, and Provide Funding for States to Set Up Their Own Reinsurance Programs

Washington, DC — Today, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing announcing a second round of bills that are aimed at lowering costs, increasing access to care, and blocking the Trump administration’s sabotage of our health care system. The first round of bills considered by the committee would halt the administration’s harmful waivers, roll back junk plans that undermine protections for people with pre-existing conditions and provide insufficient coverage, and restore funding for open enrollment that has been slashed by President Trump in an act of deliberate sabotage.

This set of bills would reverse the Trump administration’s harmful cuts to the navigator program that denied people access to fair and impartial information on enrollment and financial assistance options; provide states more funding to establish state-based marketplaces giving states the ability to tailor the program to meet the particular needs of their residents; and provide funding for states to set up their own reinsurance programs that make health care more affordable for everyone throughout the individual market including those with serious medical conditions.

“Last November, voters rejected the Trump administration and their GOP allies’ repeal and sabotage agenda and scores of Republicans in Congress were shown the door as a result,” said Brad Woodhouse, executive director of Protect Our Care. “Democrats are continuing to turn the page on the willful sabotage by Republicans by doing what the American people asked of them – make health care more affordable and accessible to all. With this set of bills, Democrats are continuing to show us they’re serious about delivering on their promise to voters to lower costs and improve care for all Americans.”

Background

The Health Subcommittee of the Committee on Energy and Commerce will consider the following bills:

H.R. 1425, the “State Health Care Premium Reduction Act” would provide $10 billion annually to states to establish a state reinsurance program or use the funds to provide financial assistance to reduce out-of-pocket costs for individuals enrolled in qualified health plans. The bill also requires the Centers for Medicare and Medicaid Services (CMS) to establish and implement a reinsurance program in states that do not apply for federal funding under the bill.

H.R.1386, the “Expand Navigators’ Resources For Outreach, Learning, And Longevity (ENROLL) Act” would provide $100 million annually for the Federally-facilitated Marketplace (FFM) navigator program. The bill would reinstate the requirement that there be at least two navigator entities in each state and would require the Department of Health and Human Services (HHS) to ensure that navigator grants are awarded to entities with demonstrated capacity to carry out the duties specified in the Affordable Care Act. The bill would also prohibit HHS from considering whether a navigator entity has demonstrated how it will provide information to individuals relating to association health plans or short-term, limited-duration insurance plans.

H.R.1385, the “State Allowance For A Variety Of Exchanges (SAVE) Act” would provide states with $200 million in federal funds to establish state-based Marketplaces. Under current law, federal funds are no longer available for states to set up state-based Marketplaces.  

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

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

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

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

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

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

February 2019

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

January 2019

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

December 2018

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

November 2018

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

October 2018

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

September 2018

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

August 2018

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

July 2018

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

June 2018

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

May 2018

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

April 2018

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

March 2018

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

February 2018

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

January 2018

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

December 2017

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

November 2017

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

October 2017

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

September 2017

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

August 2017

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

July 2017

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

June 2017

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

May 2017

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

April 2017

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

March 2017

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

February 2017

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

January 2017

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

Cost Of Care: Trump Administration Rigs System To Make Drug Companies Even Richer While Americans Pay More

Today, the “Health Care Congress” continues to respond to the will of the voters with a House Ways & Means hearing on the Cost of Rising Prescription Drug Prices. While President Trump repeatedly promises to lower the cost of prescription drugs, Republicans are protecting the rigged system for the drug companies, allowing insurance companies to deny drug coverage to people, and rewarding the drug companies, instead.

Republicans and the Trump administration did do one thing on this issue: America’s largest pharmaceutical companies got a huge huge tax break from the Trump Tax bill and are lining the pockets of shareholders and CEOs while continuing to raise prices for everyday Americans.

The Trump Administration’s Talk is Cheap, But Drug Prices Aren’t…

Health care is prohibitively expensive for many Americans, causing many who have insurance to skip or delay care and prohibiting many who lack insurance from signing up for care.

  • A Protect Our Care poll found that 84 percent of Americans support requiring drug companies to notify the government in advance when they plan to significantly raise drug prices and create a mechanism to identify and stop unjustified increases; 82 percent support allowing Medicare to negotiate directly with drug companies to get lower prices on prescription drugs.
  • 15.5 percent of those who have insurance either skipped or delayed care because of cost or trouble paying bills in 2017.
  • Roughly one in four, or 26.2 percent of non-elderly people struggle with insurance affordability problems.
  • Cost is of particular concern to those in fair or poor health — 46.5 percent of those in fair or poor health are uninsured or have problems affording care despite having coverage. This includes 13.5 percent who are uninsured and 32.9 percent who have insurance but had a problem affording care in the last year.
  • Cost is the most cited reason for being uninsured — 45 percent of uninsured nonelderly adults in 2017 said they were uninsured because the cost is too high.

Americans pay more for drugs than do people in any other country. At $1,208 per capita, people in the U.S. spend more on pharmaceuticals per capita than do people in any other country in the world. British researchers found that U.S. prices were consistently higher than in other European markets, six times higher than in Brazil, and 16 times higher than in the lowest-price country, which was usually India.

Drug Prices Continue to Soar Under Trump. A report by Senate Democrats finds that the prices of the 20 most-prescribed drugs under Medicare Part D have increased substantially over the past five years, rising 10 times faster than inflation. Another report from the Pharmacy Benefits Consultants finds that over the past 14 months, 20 prescription drugs saw list-price increases of more than 200 percent.

Drug companies are engaging in the dangerous practice of price-gouging — pursuing massive profits to the detriment of people who need their medication to survive. In September 2018, Nostrum chief executive Nirmal Mulye defended his choice to raise the price of an antibiotic from $474.75 to $2,392 a bottle, saying he had “moral requirement…to sell the product for the highest price.” In 2017, Mylan, the company that made the EpiPen, came under fire for charging $609 for a box of two devices even though each only contained about $1 worth of the drug epinephrine. Between 2012 and 2016, the price of insulin, which 7.5 million Americans depend on, nearly doubled from $344 to $666.

…Pharmaceutical Companies Are Raking It In…

Pharmaceutical Companies Have Reaped Huge Benefits From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. According to Axios, nine pharmaceutical companies are are spending a combined $50 billion on new share buyback programs. All of the buybacks were announced during or after passage of the tax bill. Some drug companies are also increasing dividends for shareholders, with AbbVie increasing its cash dividend by 35 percent while also announcing a new $10 billion share repurchase program.

Massive Profits And Price Increases. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion — the highest of any publicly traded health care company. Of the 19 companies that tallied at least $1 billion of third-quarter profit, 14 were drug companies.  Meanwhile, pharmaceutical companies continue to increase prices. In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills.  All in all, nearly 30 drugmakers are expected to raise prices in 2019.  

Soaring CEO Pay. According to an Axios study, the CEOs of 70 of the largest U.S. health care companies cumulatively have earned $9.8 billion since 2010. CEOs took home nearly 11 percent more money on average every year since 2010 — far more than the wage growth of nearly all other workers. In 2017 alone, 30 health care executives made a combined $976 million.

…And Republicans Are Making it Worse

Republicans refuse to let Medicare negotiate for lower drug prices. Though 92 percent of Americans support allowing the federal government to negotiate drug prices for Medicare beneficiaries, Republicans refuse to let Medicare negotiate drug prices. A 2018 Senate Homeland Security and Governmental Affairs Democratic Committee report found that Medicare Part D could save $2.8 billion in a single year if it were allowed to negotiate drug prices.

Trump Installed Big Pharma Executives In Key Administration Posts. President Trump installed a former Eli Lily executive, Alex Azar, as his secretary of Health and Human Services and his appointment of Scott Gottlieb at FDA was described as “music to pharma’s ears.” Other pharma lobbyists writing Trump’s health policy include senior adviser at FDA, Keagan Lenihan, who joined the administration after lobbying for the drug distribution giant McKesson, former Gilead lobbyist, Joe Grogan, who reviews health care regulations at the Office of Management and Budget, and Deputy Assistant to the President for Domestic Policy Lance Leggitt, who has lobbied for a variety of drug-industry clients.

Trump’s Proposals Always Fall Far Short Of His Promises. President Trump promised that he would allow Medicare to use its buying power to negotiate drug prices directly with suppliers, but after meeting with pharmaceutical executives early in 2017, Trump abandoned that pledge, calling it “price fixing” that would hurt “smaller, younger companies.” The planned announcement to move some drugs from Medicare Part B, in which pharmaceuticals are purchased and administered by medical providers, to Part D, will do little to restrain the cost of prescription drugs for America’s seniors and falls far short of Trump’s promises.

Because Washington Republicans Repealed The Requirement That Most People Have Insurance And Encouraged People To Sign Up For Junk Plans, 2019 Premiums Are Higher Than They Should Be. Charles Gaba, health care analyst, calculates that individual marketplace premiums are increasing by an average of 2.8 percent nationally. However, Gaba estimates that if not for Republican sabotage, premiums would decrease by an average of 5.4 percent.

The Administration Has Consistently Advocated For The Repeal Of The Affordable Care Act, Including Eliminating The Requirement That Insurance Companies Cover Prescription Drugs. After the Trump administration tried and failed to repeal the ACA legislatively, it took to the courts in hopes of eliminating the health law. In 2018, the Justice Department decided not to defend the Affordable Care Act in court against a lawsuit seeking to overturn it. Since, a federal judge has ruled to overturn the law, including its requirement that insurance companies cover patients’ prescription drugs.

Trump Regime Launches Cover Up Of Its Health Care Sabotage


Washington DC — As reported by the Associated Press, the Trump White House is claiming it has done nothing to “sabotage” the Affordable Care Act. In a report expected to be released today, the Council of Economic Advisers is trying to claim that the administration’s relentless war on Americans’ health care does not constitute “sabotage.” This is blatantly false. Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“We’re just over a month into 2019 but this whopper is already in the running for the lie of the year. The Trump administration’s relentless sabotage of our health care system is well-documented. In November, voters took to the polls and rejected the Republican war on health care, and the fact that this administration is launching a massive cover-up of their sabotage means that they’re already bracing themselves against the wrath of voters in 2020.”

Don’t believe us? Take a look at our sabotage tracker:

February 2019

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

January 2019

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

December 2018

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

November 2018

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

October 2018

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

September 2018

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

August 2018

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

July 2018

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

June 2018

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

May 2018

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

April 2018

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

March 2018

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

February 2018

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

January 2018

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

December 2017

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

November 2017

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

October 2017

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

September 2017

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

August 2017

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

July 2017

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

June 2017

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

May 2017

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

April 2017

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

March 2017

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

February 2017

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

January 2017

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

Anti-Health Care Nominee Chad Readler Is Voted Out Of Committee By Senate Republicans 


Senate Republicans Once Again Turn Their Backs On People With Pre-existing Conditions With Anti-Health Care Vote

Washington DC — Today, on a party-line vote, Republicans on the Senate Judiciary Committee voted to allow Chad Readler’s nomination to the Sixth Circuit Court of Appeals to proceed to the full Senate for debate and a vote. Readler led the effort in the Trump Justice Department to eliminate protections for pre-existing conditions by filing a brief on behalf of the Trump administration in Texas v. United States arguing in favor of striking down the Affordable Care Act’s provisions to prevent insurance companies from denying coverage, or charging more because of a pre-existing condition. In December 2018, U.S. District Court Judge Reed O’Connor ruled in favor of the Republican plaintiffs and said the entire ACA should be struck down. Now, Mitch McConnell is breaking with longstanding Senate norms to jam through this nomination by ignoring the objections of Readler’s home state senator, Sherrod Brown. Leslie Dach, chair of Protect Our Care, issued the following statement:

“A vote for Chad Readler is a vote for full repeal of the Affordable Care Act. His confirmation vote is a litmus test for Republican’s claims to protect people pre-existing conditions and today they failed that test. Readler wants to go back to the days where insurance companies could deny, drop or charge more for coverage and end protections for millions of people with pre-existing conditions. The stakes couldn’t be clearer, the full Senate must stand up for people with pre-existing conditions and block Chad Readler from a lifetime appointment to the court.”

Background:

As Acting Assistant Attorney General, Chad Readler filed a brief on behalf of the Trump administration in Texas v. United States arguing that protections for people with pre-existing conditions under the Affordable Care Act should be struck down. This put the full weight of the Department of Justice behind the Republican war on health care to overturn the entire Affordable Care Act (ACA).  In December, a federal judge ruled in favor of the Republican plaintiffs, striking down the entire ACA. If this ruling is allowed to stand:

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

Back At It Again: Trump Administration Hostile to Medicaid Ignored Rules That Protect Patients


Washington DC — Today, the Los Angeles Times reports that the Trump administration is scrambling to overhaul Medicaid by requiring burdensome work requirements, but are failing to enforce federal rules directing states to analyze the devastating impact such requirements will have on millions of Americans who rely on this life-saving program. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:   

“The actions by this administration are egregious, but unfortunately par for the course considering President Trump has put people in charge of Medicaid who are simply out to destroy it. Failing to enforce rules requiring states to access the impact of Medicaid work requirements shows that the Trump administration doesn’t care who their policies hurt. This is part and parcel to Trump-led Republican sabotage agenda: they oppose Medicaid expansion — which would provide health care coverage to millions more Americans, support so-call ‘block grants” — a euphemism for slashing coverage, and are pushing ‘work requirements’ – which are little more than gotcha paperwork meant to kick eligible people off the rolls. Medicaid is the nation’s largest health insurance program and is more popular today than ever before. These senseless work requirements are already jeopardizing health care for thousands of low-income families — nearly all of whom are already working — and the Trump administration is breaking every rule in the book in their rush to implement it as just another deliberate attack on American health care.”

Background:

IN STATES WHERE SIMILAR RULES HAVE TAKEN EFFECT, THOUSANDS OF PEOPLE HAVE LOST CARE

  • Results from Arkansas confirm that Medicaid work requirements are fundamentally bureaucratic hurdles, threatening access to health coverage for thousands across the state. “A review of monthly data related to the new requirements released by the Arkansas Department of Human Services shows that from September through December 2018, over 18,000 people were disenrolled for failure to comply with the new requirements for three months.” [Kaiser Family Foundation, 1/17/19]
  • This summer, a federal district court blocked Kentucky from imposing similar rules for the negative effects it would have on Kentuckians. Said the court in its ruling, “[Secretary Azar] never adequately considered whether Kentucky HEALTH would in fact help the state furnish medical assistance to its citizens, a central objective of Medicaid. This signal omission renders his determination arbitrary and capricious. The Court, consequently, will vacate the approval of Kentucky’s project and remand the matter to HHS for further review.”
  • In Indiana, 25,000 people with health insurance through Medicaid were dropped from coverage because they were unable to pay their premiums. The Washington Post reported, “About 25,000 adults were disenrolled from the program between its start in 2015 and October 2017 for failure to pay their premiums, according to state reports. Yet, state officials estimate that based on surveys of recipients, about half of those who were disenrolled found another source of coverage, most often through a job…In addition to those who were disenrolled, another 46,000 adults who signed up for Medicaid during 2016 and 2017 were not accepted because they did not pay their initial premium, the state reported.”

WORK REQUIREMENTS ADD ADMINISTRATIVE HURDLES, MAKING IT HARDER FOR PEOPLE WHO ARE ELIGIBLE FOR CARE TO GET IT

  • Requiring People On Medicaid To Prove They Are Working Adds An Administrative Burden That Is Hardest On Low-Income Americans. “[Administrative hurdles] may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access.  There is also a lot of research about the Medicaid program, specifically, that shows that sign-ups fall when states make their program more complicated.” [New York Times, 1/18/18]
  • Documentation Requirements Increase The Chances That People Will Lose Care, Simply Because They Have Trouble Navigating The Process. “There is a real risk of eligible people losing coverage due to their inability to navigate these processes, miscommunication, or other breakdowns in the administrative process. People with disabilities may have challenges navigating the system to obtain an exemption for which they qualify and end up losing coverage.” [Kaiser Family Foundation, 1/16/18]

THE VAST MAJORITY OF  PEOPLE WITH MEDICAID COVERAGE WHO WHO CAN WORK ARE WORKING

  • 60 percent of nondisabled people with health coverage through Medicaid have a job and are working, including 42 percent working full-time.
  • 51 percent of working adult Medicaid enrollees have full-time jobs year-round, but their salaries are still low enough to qualify for Medicaid coverage, or have Medicaid because their employers do not offer insurance.  
  • Nearly 80 percent of nondisabled people with Medicaid coverage live in a family where at least one person is working, including 64 percent working full-time. The other adult family member may not be working because they have caregiving or other responsibilities at home.
  • A state by state breakdown can be found HERE

SOTU PREVIEW: Five Ways The Trump Administration Has Continued To Sabotage Americans’ Health Care Since The Midterms

In November, voters took to the polls and sent a clear message to GOP leaders: end the Republican war on health care. National exit polls showed health care was the top issue to voters, and exit polls of competitive districts found Democrats had an eight point advantage on health care, 52 to 44 percent. Thirty-three members of Congress who voted to repeal the ACA lost their seats.

Despite voters’ clear rejection of the GOP sabotage agenda, President Trump has continued to ruthlessly target Americans’ health care. Here’s a look at five ways he has ignored the will of the American people and taken aim at health care since this fall’s midterm elections:

  1. Just Last Week, President Trump Admitted That He Supports The Goal Of The Lawsuit Led By Republican Attorneys General And Governors To Completely “Terminate” The Affordable Care Act. Trump predicted the Affordable Care Act would be “terminated” through the Texas lawsuit seeking to overturn the law. In December, cherry-picked Federal Judge Reed O’Connor ruled in favor of twenty conservative states to overturn the Affordable Care Act, jeopardizing coverage for 17 million people and ripping away the ACA’s vital consumer protections such as protections for people with pre-existing conditions.
  2. In January, Experts Blamed Trump Administration Sabotage for Driving The Uninsured Rate To Its Highest Level Since The Implementation Of The Affordable Care Act In 2014. Thanks to GOP sabotage, the uninsured rate surged to its highest level since 2014. Roughly seven million fewer people are estimated to have health care now than did two years ago.
  3. In Its Notice Of Benefit And Payment Parameters, The Centers For Medicare And Medicaid Services Actually Proposed Changes That Would Make Consumers Pay More. The Centers for Medicare and Medicaid Services’ (CMS) proposed changes to the ACA’s benefit and payment parameters would reduce premium tax credits by $1 billion per year, cause 100,000 people to lose marketplace coverage starting in 2020, increase annual premiums, and increase the out-of-pocket maximum for people with employer-sponsored health care.
  4. The Trump Administration Just Gave PhRMA a Big Win After The Pharmaceutical Industry Spent $280 Million On Lobbying In 2018. In a win for big Pharma, the Trump administration proposed changes to the rebate system that would raise premiums, benefit pharmaceutical companies, and contain no mandate to lower list prices of prescription drugs.
  5. After The Midterm Elections, The Trump Administration Urged States To Allow Federal Subsidies To Be Used To Purchase Junk Plans That Discriminate Against People With Pre-existing Conditions. The Trump administration issued new guidance urging states to “tear down basic pillars of the Affordable Care Act, demolishing a basic rule” that federal subsidies can only be used to purchase ACA-compliant plans. Experts warn against this move, saying it will push affordable, comprehensive care further out of reach for individuals with pre-existing conditions.

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

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

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

NEW NYT Interview, Trump Reveals Goal of Texas Lawsuit: “Terminate” Health Care

Washington DC — According to the newly released transcript of President Trump’s interview with The New York Times, Trump boasted that his Texas lawsuit will “terminate” the Affordable Care Act and that was a political “victory” for him and Republicans in Congress. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:

“President Trump confirmed what we all know to be true: he and Republicans are using the Texas lawsuit to overturn the entire Affordable Care Act – eliminating all the protections for people with pre-existing conditions – with no plans for a replacement. Voters overwhelmingly rejected Trump’s health care repeal and sabotage agenda back in November, yet President Trump and his allies in Congress are dead set on accomplishing through the courts what they couldn’t do legislatively: fully repeal the law, devastate American health care and leave millions of Americans at risk.”

Breaking: State-based Exchanges Break Enrollment Record

Washington DC — As reported by health care analyst Charles Gaba, the state-based exchanges have broken an all-time enrollment record despite the Trump administration’s relentless attempts to sabotage access to coverage. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:

“Millions of Americans rely on the Affordable Care Act for quality coverage and today’s announcement is evidence that the American people want and need coverage through the exchanges despite constant sabotage from the Trump administration. The fact that states who manage their own marketplaces saw record-breaking numbers this year while federal marketplaces saw a substantial decline is all the evidence one needs to prove that President Trump’s repeal-and-sabotage agenda is hurting millions of Americans.”

 

BREAKING: State-based exchanges collectively break all-time enrollment record!

ACA Signups // Charles Gaba // January 30, 2019

 

 

With Covered California releasing their final, official 2019 Open Enrollment Period data, and the latest updates from New York (which still has 2 days to go) and Massachusetts (which wrapped up last week), I now nearly all 2019 OEP data on hand.

I say nearly all because there are still three numbers missing:

  • Vermont has yet to release any 2019 enrollment data. This is the 3rd year in a row that they’ve been radio silent. Assuming they’re close to last year (28,763 QHP selections), they should add around 28,000 to the national total.
  • New York still has 2 days left for people to #GetCovered. I’m going to assume they’ll tack on perhaps 5,000 more people today and tomorrow.
  • The District of Columbia hasn’t posted any updates since December 11th, which means not only do they still have 2 days for people to sign up, they’re actually missing a whopping 51 days worth of enrollment data. Again, assuming they wrap up close to last year, that should mean another 1,400 or so from DC.

Between the three, I’d expect another ~34,000 QHP selections to be tacked onto the totals below.

However, even without that, the 12 state-based exchanges have collectively broken their all-time record for ACA Open Enrollment, racking up more than 3,018,000 QHP selections this season.

Here’s what that looks like visually…and the contrast between the Federal Exchange and the State-Based Exchanges is dramatic:

  • After a dramatic enrollment increase in 2015 and a lesser increase in 2016, the 39 states hosted by HC.gov have seen a gradual, steady decline each year since. They closed out the 2019 Open Enrollment Period with 1.3 million fewer people having signed up than at their peak in 2016. Perhaps 200,000 or so of this was due to Louisiana and Virginia expanding Medicaid in recent years, but that does nothing to explain the other 1.1 million drop-off, which is almost certainly due to having the HC.gov marketing & outreach budgets being slashed to the bone, the Open Enrollment Period being cut in half and so forth.
  • Meanwhile, the 12 states which operate their own full ACA exchanges (and which have their own marketing/outreach budgets) saw less-dramatic increases in 2015 & 2016…but they’ve collectively stayed virtual dead even for every year since then. In fact, when the dust settles on the 2019 Period, I expect the 12 state-based exchanges to reach around 3.05 million QHP selections, which would be 1.5% higher than last year and 1.3% higher than their collective all-time high in 2017.