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Trump Archives — Protect Our Care

The GOP Agenda: Worse Care, Higher Costs for Residents at Nursing Homes

Washington, DC — Ahead of the Senate Finance Committee’s hearing on nursing home neglect and abuse tomorrow, it’s important to remember just how the GOP’s health care policies have failed nursing home patients across America. Donald Trump and his Republicans in Congress worked to repeal the Affordable Care Act, block expansion and access to Medicaid, and fell into lock step with the nursing home industry to weaken penalties they may face for harming their own residents. The GOP Agenda has nothing to do with helping those in nursing homes and long-term care facilities–it only seeks to serve industry CEOs and gut access to care so many patients desperately need.

The GOP Agenda: Repeal the Affordable Care Act and Its Protections for People in Nursing Homes

The ACA Expanded Nursing Home Quality-Related Requirements for the First Time Since 1987. “The Affordable Care Act (ACA) is the first comprehensive legislation since the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), to expand quality of care-related requirements for nursing homes that participate in Medicare and Medicaid and improve federal and state oversight and enforcement…the ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, introduced because complex ownership, management, and financing structures were inhibiting regulators’ ability to hold providers accountable for compliance with federal requirements. The ACA also incorporates the Elder Justice Act and the Patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes.” [Kaiser Family Foundation, 1/28/13]

The GOP Agenda: Cutting Access to Nursing Home Care by Slashing Medicaid

Medicaid Pays for Most of the 1.4 Million People in Nursing Homes. “Medicaid pays for most of the 1.4 million people in nursing homes… It covers 20 percent of all Americans and 40 percent of poor adults…A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.” [New York Times, 6/24/17]

Medicaid Covers 6 in 10 Nursing Home Residents, and Half of Seniors Using Medicaid Long-Term Care Services Were in Nursing Homes. [Kaiser Family Foundation, 6/20/17]

The Trump Administration and Republicans in Congress Pursued ACA Repeal Bill that Would Have Also Slashed Medicaid. “On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly entitlement.” [New York Times, 6/24/17]

New York Times Headline: “Medicaid Cuts May Force Retirees Out of Nursing Homes” [New York Times, 6/24/17]

Associated Press Headline: “Medicaid cut in GOP health bill worries the nursing home set” [Associated Press, 7/8/17]

Senate GOP Repeal Bill Would Have Cut Medicaid by $2.6 Trillion by Second Decade. “The Congressional Budget Office (CBO) estimates that the Senate Republican health bill’s Medicaid cuts would deepen significantly in the second decade, with the cuts growing from 26 percent in 2026 to 35 percent in 2036, relative to current law. Now, based on CBO estimates and data, the Committee for a Responsible Federal Budget (CRFB) estimates that the Senate bill would cut Medicaid by roughly $2.6 trillion over the second decade (2027-36), on top of Medicaid cuts of $772 billion in the first decade.” [Center on Budget and Policy Priorities, 7/11/17]

The Trump Administration is Looking for Ways to Bypass Congress to Enact Medicaid Block Grants. “The Trump administration is quietly devising a plan bypassing Congress to give block grants to states for Medicaid, achieving a longstanding conservative dream of reining in spending on the health care safety net for the poor…Capping spending could mean fewer low-income people getting covered, or state-designated cutbacks in health benefits.” [Politico, 1/11/19]

In 2018, the Trump Administration Proposed Cutting Medicaid by $1.4 Trillion. “The Administration is proposing to cap federal Medicaid payments to states and to cut federal Medicaid spending by $1.439 trillion – that is trillion with a “t” – over the ten year period 2019 – 2028. That is about 26% of what the Administration projects federal Medicaid spending would otherwise be, and within shouting distance of the $1.455 trillion cost of the tax cuts enacted in December.” [Georgetown Center for Children and Families, 2/12/18]

The GOP Agenda: The Trump Administration Weakened Penalties Against Nursing Homes that Harm Patients at the Request of the Nursing Home Industry

The Trump Administration Scaled Back Fines Against Nursing Homes that Harm Residents, at the Request of the Nursing Home Industry. “The Trump administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury, part of a broader relaxation of regulations under the president. The shift in the Medicare program’s penalty protocols was requested by the nursing home industry…The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities. [New York Times, 12/24/17]

New Guidelines Intended to Discourage Regulators from Levying Fines, Even When Violations Resulted in Resident’s Death. “The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.” [Kaiser Health News, 12/31/17]

In November 2017, The Trump Administration Exempted Nursing Homes Violating Certain Rules from Penalties for 18 Months. “In November, the Trump administration exempted nursing homes that violate eight new safety rules from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.” [New York Times, 12/24/17]

In October 2017, the Trump Administration Discouraged CMS Regional Offices from Levying Fines if the Error was a “One-Time Mistake.” “In October, CMS discouraged its regional offices from levying fines, even in the most serious health violations, if the error was a ‘one-time mistake.’ The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.” [Kaiser Health News, 12/31/17]
The Trump Administration Rolled Back Obama Administration Rule Making it Easier for Nursing Home Residents to Sue for Negligence or Abuse. “Another Obama-era regulation is on the Trump administration’s chopping block — this one about nursing homes. The Obama administration’s rule would’ve made it easier for nursing home residents to sue for negligence or abuse. But the Trump administration is proposing to replace that rule. And the new one could make it almost impossible for nursing home residents to get their day in court. That is because new nursing home residents are frequently handed an agreement to go to arbitration instead of suing if something goes wrong.” [NPR, 8/21/17]

Protect Our Care and Sen. Sherrod Brown Oppose Trump Judicial Nominees Working to Strip Health Care from Americans

Washington, DC–Today, Protect Our Care partnered with Senator Sherrod Brown of Ohio on a press call to highlight why Chad Readler and Eric Murphy ’s nominations to the Sixth Circuit Court of Appeals would be disastrous for not only Ohioans, but all Americans’ health care. Readler attacked the Affordable Care Act by signing a legal brief refusing to defend the law at the Department of Justice in support of the Texas lawsuit, which would strip millions of their coverage and deny pre-existing condition protections enshrined in the ACA.

“No American should be denied health care because of a pre-existing condition, or because they’re a woman, or because they cannot afford it,” Senator Brown said. “I cannot support nominees who have actively worked to strip Ohioans of their health care rights. Special interests already have armies of lobbyists and lawyers on their side, they don’t need judges in their pockets.”

“Chad 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,” said Brad Woodhouse, executive director of Protect Our Care. “Simply put, a vote for Chad Readler is a vote for full repeal of the Affordable Care Act. Readler tried to sabotage the ACA from within the administration, and if we put him on the court, he will be able to sabotage your care from the bench.The Senate must protect the American people’s health care by denying Chad Readler a lifetime appointment.”

Full press call audio here

Background on Chad Readler:

Readler filed the Trump administration’s brief in Texas V. United States, and his nomination for a judicial seat was announced the same day he filed the brief calling for the ACA’s protections for people with pre-existing conditions to be overturned.

If the Texas ruling is not overturned:

  • 4.8 million Ohioans with pre-existing conditions could lose their coverage
  • Ohioans over age 50 could face a $3,329 age tax
  • 151,026 Ohioans would lose tax credits and have to pay more for coverage in the marketplace
  • 214,338 Ohio seniors would have to pay more for their prescription drugs
  • 717,100 Ohioans could lose their health care due to possible repeal of Medicaid expansion

Court Affirms Speaker Pelosi and Democratic Health Care Champions in Congress’s Fight to Protect Health Care From the Trump Texas Lawsuit

Washington, DC–Yesterday evening, the US Court of Appeals for the Fifth Circuit issued a ruling that allows the United States House of Representatives to intervene in the Texas, et. al. vs. United States, et. al. case which would overturn the Affordable Care Act and its protections for people with pre-existing conditions. Leslie Dach, chair of Protect Our Care, issued a statement in response:

“The Fifth Circuit correctly ruled that House Democrats can defend the American people against the Trump administration’s all out attack on America’s health care. Despite the GOP lies about protecting people with pre-existing conditions, President Trump himself bragged that the Trump Texas lawsuit would ‘terminate’ the ACA. This ruling is just another reminder that Speaker Pelosi and Democratic health care champions in Congress are not going to rest until every attack on our health care is stopped dead in its tracks. The Republican assault on health care needs to end.”

BACKGROUND:

Due to Judge O’Connor’s ruling on December 14th, Republicans are one step closer to repealing the Affordable Care Act and eliminating key protections, unleashing — as the Trump Administration itself admitted in his court — “chaos” in our entire health care system. 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.

Protect Our Care Praises the MORE Health Education Act

Washington, DC— Today, Senators Jeanne Shaheen (D-NH), Gary Peters (D-MI), and Tim Kaine (D-VA) introduced the MORE Health Education Act, which would counter the Trump administration’s sabotage efforts that have diverted funds and slashed health care enrollment advertising and marketing for the Health Insurance Marketplace by 90 percent since the president took office. Brad Woodhouse, executive director of Protect Our Care, issued a statement in support:

“The Trump administration has slashed the outreach and advertising budget for open enrollment in a deliberate act of sabotage – showing they will stop at nothing to undermine the health care law and deny Americans coverage. In November, voters said ‘enough’ with the GOP’s repeal and sabotage agenda and thanks to the leadership of Senator Shaheen and her Democratic colleagues, legislation is being introduced in the House and Senate to put a stop to President Trump’s ongoing efforts to undermine the law – an effort we wholeheartedly support.”  

BACKGROUND

The Trump Administration has repeatedly sabotaged the open enrollment process by cutting outreach resources and shortening the enrollment time period.

  • Protect Our Care’s Statement On The Trump Administration’s Sabotage Efforts Harm Open Enrollment

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.

“Higher Costs And More People Being Uninsured” How Trump’s Latest ACA Sabotage Targets Consumers

Last week, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Affordable Care Act’s benefit and payment parameters that would raise costs and reduce coverage for millions of Americans. On top of reducing subsidies available to those who purchase health care through the exchange and increasing premiums, the Trump administration’s proposed rule changes would also raise the out-of-pocket maximum for people with employer-sponsored health care.

Here’s what news outlets have to say about the proposed changes:

Axios: Consumers Would Pay More Under New ACA Rules. “Turns out the Trump administration’s big ACA regulation packs a bit more punch than we realized at first. Some of the rule’s technical changes will end up requiring people to pay more for their coverage, while rolling back the cost of federal premium subsidies, my colleague Sam Baker reports…The federal government would end up spending about $900 million less on premium subsidies, according to the proposed regulation. The same change would also slightly loosen limits on out-of-pocket costs. The ACA capped total out-of-pocket spending at $8,000 per year for an individual and $16,000 per year for a family plan.  The Trump proposal would raise those caps by $200 and $400, respectively, according to Brookings’ Matt Fiedler. That change would apply to people who get coverage through their jobs, not just the ACA’s insurance markets.” [Axios, 1/22/19]

Wall Street Journal: Trump’s Proposed ACA Rules Could Lift Costs For Millions Of People. “The Trump administration on Thursday proposed changes that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act, a move that Republicans said is necessary to cut inflated subsidies but Democrats viewed as another GOP effort to sabotage the health law. The proposal, released by the Centers for Medicare and Medicaid Services, would raise the out-of-pocket maximum that people with employer-sponsored coverage pay in 2020. The individual maximum would increase by $200 to $8,200 annually, and the maximum for family coverage would increase by $400, analysts said. The plan would also change a calculation that determines how much people pay if they buy insurance from the ACA exchange and get credits to reduce their monthly premiums. The change could raise premiums next year for many of the roughly 9 million people who get the credit.” [Wall Street Journal, 1/17/19]

Los Angeles Times: Despite The Government Shutdown, Trump’s Efforts To Gut Obamacare Go Full Speed Ahead. “A good portion of the federal government may be shut down, but you can rest assured that the devoted Obamacare saboteurs at the Department of Health and Human Services are on the job. Late Thursday, they released proposed rule changes for the 2020 health insurance year — and requests for comments on further changes — that will drive up premiums for people on Affordable Care Act health plans, cut subsidies and discourage more Americans from enrolling. The proposals also could raise prescription costs for enrollees and raise costs even for families enrolled in employer plans. Longer-term changes proposed for 2021 and beyond could affect about 2 million ACA enrollees.” [Los Angeles Times, Hiltzik, 1/18/19]

Associated Press: White House Proposes To Increase Affordable Care Act Premiums. “The Trump administration Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue. The roughly 1 percent increase could feed into the Democratic argument that the Trump administration is trying to ‘sabotage’ coverage for millions. The administration said the proposal is intended to improve the accuracy of a complex formula that affects what consumers pay for their premiums. Premiums under the health law were basically stable this year after several sharp annual hikes.”  [Associated Press, 1/17/19]

Politico: CMS Wants To Reduce Obamacare Subsidies Through Formula Change. “The administration is proposing a technical change in the 2020 marketplace rules that is expected to result in less premium assistance for low-income Obamacare customers, POLITICO’s Paul Demko reports…A decrease in financial assistance of $900 million and 100,000 fewer Obamacare customers in 2020 if the proposal is adopted, according to CMS. The agency is justifying the change as a way to reduce big increases in federal subsidies that resulted from the Trump administration’s decision to cut off cost-sharing reduction payments.” [Politico, 1/18/19]

Buzzfeed News: Administration’s Proposed Rule Would “Result In Higher Premiums And More People Being Uninsured.” “The Trump administration revealed this week that it could try to take one more shot at weakening the Affordable Care Act’s individual markets before the end of Trump’s first term. A request for comment on a proposed rule change posted late Thursday contemplates a series of changes that would save the government $1 billion per year or more, but result in higher premiums and more people being uninsured…But now the administration is signaling it may try to end silver loading. Doing this on its own would lead to a major jump in premium costs and could badly destabilize the markets. The administration says it wants to kill silver loading in concert with Congress voting to bring back the old subsidies. However, Congress has so far shown a complete inability to come together to pass a bill to improve the Obamacare markets. The administration did not specifically say it will act without Congress, but it did so with premiums in the past and is asking for feedback on how it should ‘address’ the issue of silver loading.” [Buzzfeed News, 1/18/19]

CMS Proposal is the Trump Administration’s Latest Act Of Health Care Sabotage

The Payment Notice Cuts Premium Tax Credits By $1 Billion Annually, Slashes Coverage, Increases Out-Of-Pocket Costs, And Puts People With Pre-existing Conditions At Risk

 

Last night, the Centers for Medicare & Medicaid Services (CMS) issued the proposed annual Notice of Benefit and Payment Parameters (NBPP) for the 2020 benefit year, which outlines regulatory and financial guidelines applicable to exchange plans. The proposal from CMS would do the following:

  • Cut premium tax credits by $1 billion per year ($900M in 2020 and 2021, $1 billion in 2022 and 2023)
  • Cause 100,000 people to lose marketplace coverage annually starting in 2020
  • Increase annual premiums by $189 for a family of four at 300 percent of poverty
  • Increase the maximum out-of-pocket costs by $400 for a family (from $16,000 without the change to $16,400 with it) and $200 for an individual (from $8,000 annually to $8,200 annually).

“Despite the lessons of the 2018 midterm elections, the Trump administration is continuing its relentless efforts to sabotage health care for millions of Americans,” said Leslie Dach, chair of Protect Our Care. “They want to increase premiums, put protections for people with pre-existing conditions further at risk, and rip affordable coverage from countless Americans. It’s time they start improving our health care and stop ripping it apart.”

Here’s a look at what the Administration’s proposal would mean for people across the country, according to health care experts and CMS itself:

The Payment Notice Means Higher Premiums, Less In Subsides, And A Drop In Enrollment. “The Trump administration estimates that their proposed change to how ACA premium subsidies are calculated would increase consumer premiums by $181 million and decrease marketplace enrollment by 100,000. As a result, the government would save $900 million.” [Larry Levitt, 1/17/19]

The Provisions Of The Payment Notice Would Reduce Americans’ Premium Tax Credits By Roughly $1 Billion Annually, Leading A Family Of Four At 300 Percent Of The Federal Poverty Line To Pay $189 More Annually. As Matt Fielder, Fellow at the USC-Brookings Schaeffer Initiative for Health Policy concludes: “In dollar terms, single person at 300% of FPL would lose $92/year in [premium tax credits]; family of four at 300% of FPL would lose $189/year in [premium tax credits]. Smaller effects at lower income levels and larger effects at higher income levels. In the aggregate, CMS Actuary estimates proposed change would result in $900m less in tax credit payments and 100,000 fewer Marketplace enrollees in 2020.” [Matt Fiedler, 1/17/19]

The Rules Would Also Increase The Maximum Out Of Pocket Costs In All Private Insurance Plans, By $200 For Individuals And $400 For A Family. “A technical change proposed by the Trump administration would result in maximum consumer out-of-pocket costs in all private insurance plans going up to $8,200 per person in 2020 instead of $8,000. To be clear, either amount is out of reach for many people.” The rule would also increase the maximum out of pocket costs for families from $16,000 to $16,400. [Larry Levitt, 1/17/19; Centers on Medicare And Medicaid Services, 1/17/19

100,000 People Would Lose Marketplace Coverage Each Year Beginning In 2020. [CMS, 1/17/19]

The Administration Has Also Invited Public Comment On Two Parameters — Eliminating Silver-Loading And Automatic Reenrollment. “One change the Trump administration is inviting comment on could eliminate automatic renewal of ACA marketplace coverage and premium subsidies. This year 1.8 million people were automatically re-enrolled in states using the federal marketplace. Another change the Trump administration is inviting comment on could eliminate “silver loading,” where insurers increased premiums for silver plans to offset the termination of cost-sharing subsidy payments to those insurers by the administration. Prohibiting “silver loading” of premiums in the ACA marketplace would lower government costs, but it would increase out-of-pocket premiums for many subsidized enrollees and also increase premiums for middle-class consumers not eligible for subsidies.” [Larry Levitt, 1/17/19]

Andy Slavitt, Former Head Of CMS: “Undermining Obamacare Is The Only Conceivable Reason To Dismantle [Auto-reenrollment].” “Auto reenrollment is simple. It means that like most employer coverage, if you forget to sign up for coverage, yours won’t get taken away. With auto-reenrollment, you can still reject coverage by not paying the bill. 1.8 million use it every year to keep continuous coverage. What happens if it’s taken away? You forget to sign up by 12/15. Get a cancer diagnosis in January. Not covered. With auto-[reenrollment], covered. It’s already automated, and how people are used to operating. Undermining Obamacare is the only conceivable reason to dismantle this.” [Andy Slavitt, 1/17/19]

The Payment Notice Allows States To Select An Essential Health Benefits (EHB) Package Used By Another State, Making EHBs More Flexible And Making It Easier For States To Not Cover All Of The Needs Of People With Pre-existing Conditions. “In the 2019 Payment Notice, we finalized options for states to select new EHB benchmark plans starting with the 2020 benefit year. Under 45 CFR 156.111, a state may modify its EHB-benchmark plan by: (1) Selecting the EHB-benchmark plan that another state used for the 2017 plan year; (2) Replacing one or more EHB categories of benefits in its EHB-benchmark plan used for the 2017 plan year with the same categories of benefits from another state’s EHB-benchmark plan used for the 2017 plan year; or (3) Otherwise selecting a set of benefits that would become the state’s EHB-benchmark plan.” [CMS, 1/17/19]

Legislators are calling the changes out for what they are: sabotage.

Sen. Ron Wyden (D-OR), Ranking Member Of Senate Finance Committee: “Today’s Proposed Rule Deliberately And Needlessly Increases Premiums And Will Result In Too Many Americans Losing Coverage.” “Trump’s health care sabotage agenda is defined by higher premiums for families and bureaucratic barriers that make it harder to find health coverage. Today’s proposed rule deliberately and needlessly increases premiums and will result in too many Americans losing access to health coverage. It’s no wonder Americans are so fed up with America’s health care system when the Trump administration continues to fan the flames of uncertainty while families pick up the check.” [Wyden Statement, 1/17/19]

Sen. Patty Murray (D-WA), Ranking Member Of The Senate Health, Education, Labor, And Pensions (HELP) Committee: “Even 27 Days Into The Shutdown He Caused, President Trump Has Somehow Found Time To Further Sabotage Health Care For Patients, Families, And Women.” “Even 27 days into the shutdown he caused, President Trump has somehow found time to further sabotage health care for patients, families, and women — this time by proposing what would amount to a health care tax on patients and families across the country. President Trump is hurting families left and right and Democrats are going to keep holding him accountable.” [Murray Statement, 1/17/19

Protect Our Care Reacts to CMS Proposed Payment Notice For 2020

Washington, D.C. – Today, the Centers for Medicaid and Medicare Services (CMS) announced its proposed payment notice for the 2020 coverage year which includes a reduction in tax credits for millions of Americans and is additionally seeking public comments on potential changes to the ACA marketplaces — one which could eliminate the practice of silver loading and one that could eliminate the auto-enrollment of marketplace coverage.  In response, Leslie Dach, chair of Protect Our Care, issued the following statement:

“The proposed reduction in tax credits will raise health care premiums for millions of Americans and result in a minimum of 100,000 people losing their health care and are just another form of Trump administration sabotage.  In addition, any effort to eliminate silver loading or auto-enrollment would be a direct attack on our health care and would raise premiums and threaten coverage for millions. Once again, the Trump administration is sabotaging our health care system and asking the American people to foot the bill.”

Here We Go Again: Trump Tries To End Medicaid As We Know It

Washington, D.C. — New reporting from Politico indicates that the Trump administration is trying to roll back protections for life-saving health care by ending Medicaid as we know it. Even in the midst of a federal government shutdown, President Trump is still working overtime to sabotage health care for millions by devising a plan that would impose limits on Medicaid spending. Leslie Dach, chair of Protect Our Care issued the following statement in response:

“By now, it should be abundantly clear that Donald Trump and his Republican allies will stop at nothing to rip apart our health care. While hundreds of thousands of Americans are going without their paychecks, the Trump administration is adding insult to injury by working to end Medicaid as we know it. Make no mistake, bypassing Congress to turn Medicaid into a block grant program would put the care of millions of children, families, and seniors who rely on the program at severe risk. Enough is enough. It’s time for Trump to call-off his relentless war on Medicaid.”