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ashoup
In News, Statement

Protect Our Care Statement On Approval Of Kentucky Medicaid Waiver

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

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

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

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

ashoup
In News

“Today’s Announcement Isn’t About Work. It Is About Taking Away Health Insurance From Low-Income People”: Responses to the Trump Administration’s Medicaid Announcement

Today, the Trump Administration announced changes to Medicaid, the nation’s largest health insurance program. Issued to mandate work requirements to those receiving Medicaid, the proposed changes jeopardize health care for millions of Americans – nearly all of whom are already working. Responses to this announcement have focused on the amount of unnecessary suffering this could bring about, as well as the vast mistruths the Trump Administration is promoting. Don’t believe us?  Take a look for yourself…

Politico: “Independent studies have shown that most Medicaid enrollees who are eligible to work already do so.” [Politico, 1/11]

Washington Post: “Most health policy experts, including a few noted conservatives, have regarded the government insurance enabling millions of people to afford medical care as a right that should not hinge on individuals’ compliance with other rules.” [Washington Post, 1/11]

Vox: “Republicans argue that requiring work for Medicaid eligibility will lead to better health outcomes, because employment can be linked to improved health and help move people off Medicaid as they make more money. But many Medicaid recipients are already working. If they are not, then they are likely elderly, disabled, retired, sick, or caring for a loved one. These new bureaucratic hurdles could impede some Americans’ ability to access health insurance and the care they need.” [Vox, 1/11]

Los Angeles Times: “Critics of the Trump administration’s approach note that a growing body of evidence shows that Medicaid health coverage is helping many Americans improve their health and their finances, not holding them back, as Verma and other have suggested… There is little evidence that many working-age Medicaid enrollees are choosing the government coverage instead of seeking work.” [Los Angeles Times, 1/11]

CNN: “The Trump administration is about to start letting states require many Medicaid recipients to work for their benefits. But millions of Americans in the health care safety net program already have jobs. Some 60% of working age, non-disabled Medicaid enrollees are working, according to a new report from the Kaiser Family Foundation. That’s about 15 million people. Plus, nearly eight in 10 recipients live in families with at least one worker.” [CNN, 1/11]

Associated Press: “Most who are not working report reasons such as illness, caring for a family member or going to school. Some Medicaid recipients say the coverage has enabled them to get healthy enough to return to work.” [NBC News, 1/11]

Washington Examiner: “A Kaiser Family Foundation brief about work requirements in other programs, such as SNAP and TANF, raised questions about their effectiveness in getting people employed and said states spend a large amount of time and money making sure the requirements are followed.” [Washington Examiner, 1/11]

USA Today: “Health groups and advocates for the poor — including the National Center for Law and Economic Justice and the American Lung Association — dispute Verma’s contention that the Centers Medicare and Medicaid Service has the authority to grant such requests. Courts have said states can’t add additional requirements for Medicaid eligibility that are not in law, the coalition wrote. Some bills offered in Congress address such changes, but haven’t passed yet. ‘Most people on Medicaid who can work, do so,’ the coalition wrote, ‘and for people who face major obstacles to employment, harsh requirements won’t help them overcome them.’” [USA Today, 1/11]

Harold Pollock, University of Chicago: “Medicaid work requirements may hit Trump country hardest. They could hit underemployed early-retirees who now find themselves reliant on Medicaid.. They could hit surprising numbers of people with disabilities — including addiction to opioids — who are covered under the ACA Medicaid expansion but can’t fill the requirements. They could hit hospitals in low-income rural areas that provide services to people who have lost Medicaid and can’t pay.” [Washington Post, 1/11]

Jeff Grogger, University of Chicago: “Medicaid, unlike cash welfare payments, isn’t a disincentive to work, because it doesn’t provide people with funds they’d need to pay rent or buy food, said Jeff Grogger, an urban policy professor at the University of Chicago. He said it’s not clear what problem a Medicaid work requirement would solve, and that there are better ways to help people find jobs or reduce the number of people receiving Medicaid.”

Jeff Grogger, University of Chicago: “It’s not like Medicaid is providing some kind of alternative lifestyle that’s attractive and keeps people out of the workforce. If we had fewer sick people and fewer poor people, that’d lower the Medicaid rolls. Thinking in those terms is more productive.” [Bloomberg, 1/11]

Sara Rosenbaum, George Washington University: “‘It’s like the Wild West. Who knows what will come in the door?’ Sara Rosenbaum, a George Washington University professor who has followed Medicaid policy for decades, said. ‘Everything is couched as ‘you could,’ ‘you might,’ ‘you should think about.’ It’s like winking and nodding throughout the whole thing. They are not saying, ‘These are the limits on what we’ll approve.’” [Vox, 1/11]

Sara Rosenbaum, George Washington University: “There is a breathtaking lack of guardrails. Basically almost anything goes.. There’s really nobody who’s exempt.” [Vox, 1/11]

Elliot Fishman, Former CMS Administrator: “You’re going to lose not just the people who don’t meet the requirement but also those who can’t get through the new bureaucratic process.. Our experience over decades of research is that any time you require new documentation, you lose a lot of people who in principle shouldn’t be losing eligibility.” [Talking Points Memo, 1/11]

Elliot Fishman, Former CMS Administrator: “The requirement for Medicaid waivers is that they promote the objectives of the Medicaid program, and not just in the Obama administration, but in every previous administration, that was always understood to mean expanding coverage and strengthening the delivery of medical services. It has never been used to just cut back on coverage, which this is an effort to do.” [Talking Points Memo, 1/11]

Leonard Cuello, National Health Law Program National Policy Director: “Cuello said the argument that work promotes health is ‘totally contorted . . . It’s a little like saying that rain causes clouds. It’s more that people [with Medicaid] get care, which helps them be healthy and makes them able to work.’” [Washington Post, 1/11]

Mary Beth Musucemi, Kaiser Foundation Medicaid and the Uninsured Program Associated Director: This “will penalize individuals by having them lose health coverage, rather than incentivize them, as a voluntary program with adequately funded supportive services necessary to overcome barriers would.” [Washington Post, 1/11]

Mary Beth Musucemi, Kaiser Foundation Medicaid and the Uninsured Program Associated Director: “Conditioning Medicaid eligibility and coverage on work is a fundamental change to the 50 plus year history of the Medicaid program… There is a real risk of eligible people losing coverage due to their inability to navigate this process or miscommunication or other breakdowns in the administrative process.” [The Hill, 1/11]

Joan Alker, Georgetown Center for Children and Families Executive Director: The administration “has the ‘causality backwards’ and ‘you’re more likely to be able to work’ if you have health insurance such as Medicaid in the first place.” [The Hill, 1/11]

Matt Fiedler, Brookings Institution: “Documenting compliance will often not be trivial, and even small hassle costs can discourage people from signing up for insurance coverage… Higher hassle costs will likely cause meaningful reductions in Medicaid coverage even among people who are working.”  [Vox, 1/11]

Eliot Fishman, Families USA Senior Health Policy Director: “Unconscionable and illegal… Today’s announcement isn’t about work. It is about taking away health insurance from low-income people.” [Washington Post, 1/11]

Judy Solomon, Center on Budget and Policy Priorities Vice President for Health Policy:  “It is a very major change in Medicaid that for the first time would allow people to be cut off for not meeting a work requirement, regardless of the hardship they may suffer… There’s never been a work requirement in Medicaid, it’s only been in recent years that states have raised the possibility of having one. Medicaid is a health program that is supposed to serve people who don’t otherwise have coverage.” [NBC News, 1/11]

Judy Solomon, Center on Budget and Policy Priorities Vice President for Health Policy: “Don’t be fooled by the new [CMS] guidance saying will protect people with disabilities. It won’t. While people who get Medicaid because they meet strict Social Security disability criteria are exempt, there are lots of people who are ill or have a disability who get Medicaid. These people including people with cancer, mental illness and substance use disorders, will be subject to the work requirement and have to prove they are exempt with a doctor’s letter or other proof. Many won’t know to do that and some won’t be able to get the paperwork… The consequences will be harsh for many people. Losing critical care they need to stay healthy. This new policy won’t improve health outcomes but worsen them for many people and make it harder for them to work or stay employed.” [Twitter, 1/11]

Suzanne Wikle, Center for Law and Social Policy: “Access to Medicaid makes it easier for people to look for work and obtain employment. A so-called ‘work requirement’ does not support work, but instead puts a critical support for work at risk.” [National Public Radio, 1/11]

Jane Perkins, National Health Law Center Legal Director: “We know the upshot is people are going to be cut off… We are going to sweep in people who are working or trying to get work because they haven’t filled out the necessary paperwork. And cutting off people from Medicaid is certainly not going to improve their health.” [Los Angeles Times, 1/11]

Matt Salo, National Association of Medicaid Directors Executive Director: “This is going to go to court the minute the first approval comes out.” [Washington Post, 1/11]

ashoup
In News

Kicking You While You’re Down: 5 Facts You Need to Know About Medicaid & Why the Trump Administration’s New Proposal Would Hurt People

 

The Trump administration announced that it would allow states to deny Medicaid coverage to some low-income adults if they are not working or have a work-related activity, a move that could affect as many as 22 million people, with the stated goal that it would incentivize people to find a job. The facts speak otherwise. The truth is: the vast majority of people with Medicaid coverage who can work, are working. This policy ignores the reality that many who want to work can’t find a job and kicks people while they are down: targeting people with chronic health conditions, families with a sick child or a parent who needs care, and in particular women. If the goal here is to help people find a job, how does taking away their health care do that? It doesn’t. It only makes it harder. Here are five facts you should know about Medicaid and why the Trump administration’s policy would hurt people.

FACT –  The vast majority of people with Medicaid coverage 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

FACT – About half of working adults on Medicaid work for a small business and industries that typically do not provide health coverage, like farming.

  • Nearly half of adults who work and have Medicaid coverage work at businesses with fewer than 100 employees, including 42 percent in businesses with fewer than 50 employees.
  • 40 percent of adults who work with Medicaid coverage work in the the agriculture and service industries.

FACT – The Trump administration’s policy would hurt people with chronic health conditions or taking care of a family member.

  • More than one-third (36 percent) of adults with Medicaid are not working because they are ill or disabled but do not qualify for Supplemental Security Income (SSI).
  • 30 percent of adults on Medicaid without a job report they are taking care of a sick loved one or parent. 15 percent were in school; 9 percent were retired; and only 6 percent could not find work.

FACT – The Trump administration’s work requirement policy would hurt women, particularly women of color.

  • Almost two-thirds, or 62 percent, of those who would lose their Medicaid coverage as a result of work requirements are women, and disproportionately women of color.
  • One reason is women are more likely to be the caregivers for other sick family members, including children, or their parents. And women are more likely to be in jobs that do not provide health coverage.

FACT – The Trump administration’s policy may make it harder for Medicaid enrollees to find a job.

Research from Ohio and Michigan has shown that expanding Medicaid coverage makes it easier to find a job and keep a job. This policy does nothing to help people find work, and it may actually have the opposite effect.

ashoup
In News, Stories

The Plot Against Americans: Bombshell Report Reveals Trump Admin’s Master Strategy to Rip Apart Our Health Care System

WASHINGTON, DC – After Politico released a late-night bombshell report revealing that the Trump Administration left a paper trail of their plans to sabotage health care, Protect Our Care Campaign Chairman Leslie Dach released the following statement:

“President Trump left behind a smoking gun in this newly revealed document, and now Americans can see beyond a shadow of a doubt that the Republican plot to sabotage our care started on Day One of this Administration. This newly revealed document confirms what we knew all along – Republicans never had any plan to improve health care for Americans; they always intended to rip apart affordable coverage and vital insurance protections root and branch. After today, President Trump and Congressional Republicans can no longer deny the truth: from the outset, they were hell-bent on waging a spiteful war against Americans’ health care.”

ashoup
In News

2018 Is the Year of Health Care

To: Interested Parties

From: Brad Woodhouse, Campaign Director, Protect Our Care

Subject: 2018 Is the Year of Health Care

Date: January 2, 2018

In 2017, the Trump administration and Republicans in Congress waged a war on our health care – from ACA repeal to Medicaid cuts to health care sabotage. Under their planned agenda, costs would rise, coverage would fall and millions of Americans would lose protections against abuses from insurance companies.

The story of 2018 is a simple one: it will be the year the politics of health care will haunt Republicans at the polls. Poll after poll shows that health care is the number one issue on voters’ minds and that they strongly oppose the GOP war on health care. Relatedly, the Affordable Care Act is more popular than ever, and more than 8 million people have already signed up for coverage in open enrollment.

Now, some Republicans want to keep their war on health care going.  They do so at their political peril.

The American people see health care as their top issue.

  • 48 percent in a recent Associated Press-NORC poll rated health care as their top concern for 2018, a number double-digits ahead of the second issue, taxes.
  • Health care topped people’s concerns in a POLITICO/Harvard T.H. Chan School of Public Health poll. The number one issue people wanted Congress and President Trump to address was to renew funding for the Children’s Health Insurance Program (CHIP).
  • Health care was the most important issue to people in a recent Economist/YouGov poll (18 percent), followed by Social Security (17 percent).

The American people reject President Trump and Congressional Republicans’ approach to health care.

  • The recent AP/NORC poll had President Trump’s approval/disapproval on health care at 30/70. More voters disapprove of his performance on health than any other issue.
  • According to the November 2017 Kaiser Health Tracking Poll, “The majority of the public (60 percent) – including majorities of Democrats (89 percent) and independents (57 percent) – do not trust President Trump to do what’s best when it comes to health care in this country.”
  • FOX News polling showed only 33% of voters approve of President Trump’s work on health care while 60% disapprove.  

And it will cost Republicans politically if they continue their war on health care, like it did last November.

  • The latest Quinnipiac poll showed 41% of voters as being less likely to vote for a Senator or Member of Congress who backed the GOP’s health care plan with only 19% more likely to support them.
  • Health care was the most important issue for people who voted in the Virginia gubernatorial race in November, more than double any other issue, and Ralph Northam beat Ed Gillespie by 54 points, 77-23, among these voters.
  • In Maine, voters backed a referendum to endorse a key element of the Affordable Care Act by an 18-point margin (59-41), the first time the ACA had ever been on the ballot.

The Affordable Care Act is more popular than it has ever been.

  • Pew Research Center: “Today, more Americans say the 2010 health care overhaul has had a mostly positive than mostly negative effect on the country (44% versus 35%), while 14% say it has not had much effect. Overall support for the health care law also has grown since last year. Currently, 56% of the public approves of the law while 38% disapproves, according to a new national survey by Pew Research Center, conducted Nov. 29-Dec. 4.”
  • A Public Policy Poll for Protect Our Care found that 57% say they approve of the Affordable Care Act to just 36% who say they disapprove – a 21 point gap. This is up 5 points from a September poll done for Save My Care, where approval was 54/38.
ashoup
In Statement, News

Protect Our Care Statement On Trump Administration Proposed Rule to Sabotage Health Care Markets

In response to the Trump administration’s proposed rule to expand association health plans,, which will gut protections and raise costs for people with pre-existing conditions and further destabilize the marketplace, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Just days after passing a tax bill that throws 13 million people off health insurance and raises premiums by double digits, the Trump Administration has resumed their war on our health care,” said Woodhouse. “Now they want to let insurance companies sell plans that gut protections and charge more for people with pre-existing conditions. This proposed rule attacks the protections most supported by Americans, and is opposed by leading patient and insurance groups. It’s only the latest act of sabotage from a president who wants to raise your costs and take away your coverage. Only Donald Trump could give America this kind of New Year’s present. Unfortunately, it is the American people who will suffer.”

FACT SHEET: ASSOCIATION HEALTH PLANS

ASSOCIATION HEALTH PLANS ALLOW PROVIDERS TO CHERRY PICK HEALTHIER PEOPLE, RAISING COSTS ON PEOPLE WITH PRE-EXISTING CONDITIONS AND DESTABILIZING THE MARKET

Tim Jost: “It Will Destroy The Small-Group Market…We’ll Be Back To Where We Were Before The Affordable Care Act.” “The result could in many cases be that these new association health plans would be considered large employers when it comes to health insurance. Large employers are not subject to the same rules as individual or small-group plans under Obamacare. Most notably, they do not have to cover all of the law’s essential health benefits or meet the requirement that insurance cover a minimal percentage of a person’s medical bills.If that change were made, association health plans would be freed to craft skimpier (and cheaper) health plans that appeal only to businesses with younger and healthier employees. Small businesses left in Obamacare’s marketplace would likely face higher costs and fewer options as the market became less attractive to insurers. ‘It will destroy the small-group market,’ Tim Jost, a law professor at Washington and Lee University who generally supports Obamacare, told me before the order was signed. ‘We’ll be back to where we were before the Affordable Care Act.’” [Vox, 12/29/17]

Georgetown Center on Health Insurance Reforms: Prior To ACA, AHPs Would Set Up Headquarters In A State With Fewer Regulations And Market To States With More Regulations. “Additionally, AHPs would often set up headquarters in one state with limited regulatory oversight and market policies to businesses and consumers in other states with more robust regulation, thereby bypassing those states’ more protective rating and benefit standards.” [Georgetown Center on Health Insurance Reforms, December 2017]

Deep Banerjee, S&P Global Ratings: “No One Healthy Is Now Going To Sign Up In The ACA Risk Pool, Because They Have This Cheaper Option.” “With associations, health care providers can effectively choose the most desirable participants, allowing the healthy to make the switch to save money — and potentially shutting out the less healthy. ‘No one healthy is now going to sign up in the ACA risk pool, because they have this cheaper option,’ Deep Banerjee, a health care analyst at S&P Global Ratings said.” [UPI, 10/12/17]

ASSOCIATION HEALTH PLANS WOULD ALLOW PROVIDERS TO GUT CONSUMER PROTECTIONS AND MAKE IT HARDER TO PURCHASE COMPREHENSIVE COVERAGE

Katherine Hempstead, Robert Wood Johnson Foundation: “The Easier You Make It Not To Buy Comprehensive Coverage, The Harder You Make It Buy Comprehensive Coverage.” [New York Times, 10/11/17]

Vox: Association Health Plans Could Allow Groups To Act As Large Employers Which Do Not Have To Cover Essential Benefits Under The ACA. “The result could in many cases be that these new association health plans would be considered large employers when it comes to health insurance. Large employers are not subject to the same rules as individual or small-group plans under Obamacare. Most notably, they do not have to cover all of the law’s essential health benefits or meet the requirement that insurance cover a minimal percentage of a person’s medical bills.” [Vox, 10/12/17]

Treating Association Health Plans Like Large Employers Would Exempt Them From Guaranteeing Essential Health Benefits And Allow Them To Charge People Based On Health Status And Gender. Treating Association Health Plans like large-employers would exempt them from key consumer protections under the Affordable Care Act. Large employers do not have to offer plans with the Essential Health Benefits like maternity care, prescription drug coverage or mental health and substance abuse services. Insurers for large employers can also charge more based on health status and gender. [Georgetown Center on Health Insurance Reforms, December 2017]

ASSOCIATION HEALTH PLANS HAVE A HISTORY OF FRAUD AND UNPAID CLAIMS

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

2017: Labor Department Filed A Suit Against An AHP For 300 Employers In Washington State Alleging The AHP Had Charged Employers More Than $3 Million In Excessive Fees And Violating Its Fiduciary Duty By Using Assets For Personal Interests. “The problems are described in dozens of court cases and enforcement actions taken over more than a decade by federal and state officials who regulate the type of plans Mr. Trump is encouraging, known as association health plans. In many cases, the Labor Department said, it has targeted ‘unscrupulous promoters who sell the promise of inexpensive health benefit insurance, but default on their obligations.’ In several cases, it has found that people managing these health plans diverted premiums to their personal use. The department filed suit this year against an association health plan for 300 small employers in Washington State, asserting that its officers had mismanaged the plan’s assets and charged employers more than $3 million in excessive ‘administrative fees.’ Operators of the health plan violated their fiduciary duty by using its assets ‘in their own interest,’ rather than for the benefit of workers, the government said.” [New York Times, 10/21/17]

2016: A Labor Department Lawsuit Revealed An AHP Had Concealed Financial Problems And Left $3.6 Million In Unpaid Claims. “The Labor Department filed suit last year against a Florida woman and her company to recover $1.2 million that it said had been improperly diverted from a health plan serving dozens of employers. The defendants concealed the plan’s financial problems from plan participants and left more than $3.6 million in unpaid claims, the department said in court papers.” [New York Times, 10/21/17]

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

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

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

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

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

  • “Even after one state identifies a problem, the company may continue to operate for years in other states. North Carolina issued a cease and desist order to stop many of the players in this case from selling insurance in 2008.”
  • “But by June 2010, when Maryland issued a cease and desist order, the plans sold by these players had been identified in at least 23 states.2 „ Estimates of total premiums paid to these companies for unauthorized, unlicensed plans range from $14 million to $100 million.”
  • “This particular scheme operated through associations that went by many different names. (At least one of the players in this case was involved in a previous case concerned with fraudulent insurance sold through an association of employers in 2001-2002.”
  • “Consumers are often ill-protected when they buy coverage through an association, and the web of relationships among salespeople, associations, administrators, and actual insurers can be difficult for regulators to unravel and oversee. Consumers may be encouraged to join fake associations to buy health insurance so they have an illusion of coverage—and the insurers collect membership dues and premiums while illegally avoiding state oversight).” [Families USA, October 2010]

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

KEY STAKEHOLDERS CAME OUT AGAINST PRESIDENT TRUMP’S EXECUTIVE ORDER ON AHPS SAYING THEY WOULD DESTABILIZE THE MARKETS, RAISE COSTS AND GUT PROTECTIONS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Crohn’s And Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Lutheran Services In America, March Of Dimes, Muscular Dystrophy Association, National Health Council, National Multiple Sclerosis Society, National Organization For Rare Disorders, United Way Worldwide, Volunteers Of America, Womenheart: “This Order Has The Potential To Price Millions Of People With Pre-Existing Conditions And Serious Illnesses Out Of The Individual Insurance Market And Put Millions More At Risk.” “This order has the potential to price millions of people with pre-existing conditions and serious illnesses out of the individual insurance market and put millions more at risk through the sale of insurance plans that won’t cover all the services patients want to stay healthy or the critical care they need when they get sick…Together, these actions would likely split the market between those who need the comprehensive benefits provided under current law and those who are currently healthy and can gamble with substandard coverage. Siphoning off healthy people into risky, low-value plans, could leave millions of Americans with chronic or serious illnesses in an unsustainable insurance pool with rising premiums and fewer choices. It could also leave those who are healthy seriously underinsured when they face an unexpected health crisis.” [Letter, 10/12/17]

American Cancer Society Cancer Action Network: “Health Care Changes Could Leave Millions Of Cancer Patients And Survivors Unable To Access Meaningful Coverage.” “Today’s executive order jeopardizes the ability of millions of cancer patients, survivors and those at risk for the disease from being able to access or afford meaningful health insurance. Exempting an entire set of health plans from covering essential health benefits like prescription drugs or specialty care and allowing expansion and renewability of bare-bones short-term plans will split the insurance market. If younger and healthier people leave the market, people with serious illnesses like cancer will be left facing higher and higher premiums with few, if any, insurance choices.  Moreover, those who purchase cheap plans are likely to discover their coverage is inadequate when an unexpected health crisis happens leaving them financially devastated and costing the health care system more overall.” [ACS CAN, 10/12/17]

American Hospital Association: “These Provisions Could Destabilize The Individual And Small Group Markets, Leaving Millions Of Americans Who Need Comprehensive Coverage To Manage Chronic And Other Pre-Existing Conditions.” “Today’s Executive Order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections…In addition, these provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions, as well as protection against unforeseen illness and injury, without affordable options.” [AHA, 10/12/17]

American Medical Association: “The Executive Order’s Proposal To Expand Access To Association Health Plans And Allow Short-Term Plans To Cover Longer Time Periods May Weaken Important Patient Protections And Lead To Instability In The Individual Health Insurance Market.” “The AMA supports patient choice and promoting market competition, and supports the concept of association health plans. We have concerns, however, the Executive Order’s proposal to expand access to association health plans and allow short-term plans to cover longer time periods may weaken important patient protections and lead to instability in the individual health insurance market.” [AMA, 10/12/17]

American Academy Of Actuaries: “These Effects Could Include Tilting The Market In Favor Of Entities With Weaker Benefits Or Solvency Standards And Weakening The Protections For Consumers With Pre-Existing Health Conditions.” “‘Creating exemptions from the Affordable Care Act (ACA) insurance market rules can have far-reaching and unintended effects,’ said Academy Senior Health Fellow Cori Uccello. ‘These effects could include tilting the market in favor of entities with weaker benefits or solvency standards and weakening the protections for consumers with pre-existing health conditions.’” [AAA, 10/12/17]

Small Business Majority: “These Changes Would Be Bad For Small Businesses And Their Employees Because They Could Lead To Higher Premiums, Unbalanced Risk Pools And Lower-Quality Insurance.” “We are extremely disappointed this administration continues to undermine the Affordable Care Act (ACA), as evidenced today when President Trump signed an executive order allowing insurance companies to sell health insurance products across state lines and making it easier for groups to establish association health plans (AHPs). These changes would be bad for small businesses and their employees because they could lead to higher premiums, unbalanced risk pools and lower-quality insurance. While President Trump’s order would make it easier for a few select small businesses with younger and/or healthier employees to purchase association health plans that might be cheaper in other states, the tradeoff is that this would result in the emergence of parallel insurance markets for small businesses, leading to major spikes in premiums for small firms that remain in the small-group market.” [SBA, 10/12/17]

Consumers Union: “Executive Order On Health Plans Destabilizes Insurance Markets, Hurts Consumers, Drives Up Costs.” “While this executive order claims to help improve consumers’ access to affordable care, it would have the exact opposite effect. Allowing insurers to sell substandard association health plans that aren’t required to cover basic services and benefits will further fragment and destabilize the insurance markets as a whole. This action splits the market into two, pitting the healthy against those with preexisting conditions and life-threatening illnesses — but ultimately both groups lose in this new scheme.” [Consumers Union, 10/12/17]

American Federation Of Teachers: [Donald Trump] “Is Ignoring The Rule Of Law, Refusing To Compromise, And Doing An End-Run Around Congress In Order To Strip People Of Their Healthcare.” “Donald Trump owns the unwinding of the Affordable Care Act. He is ignoring the rule of law, refusing to compromise, and doing an end-run around Congress in order to strip people of their healthcare. Millions of Americans will be worse off because of his actions. This is an ongoing pattern of the Trump administration’s callous sabotage of Obamacare, and it will cause real harm to American families, leading to increased premiums and loss of coverage for those most in need of healthcare and flooding markets with cheap, limited ‘junk’ insurance.” [AFT, 10/12/17]

NETWORK Lobby: “The Trump Administration Continues To Do As Much As Possible To Destabilize The American Healthcare System, Increase Costs For Families, And Prevent People From Accessing The Care They Need.” “The Trump Administration continues to do as much as possible to destabilize the American healthcare system, increase costs for families, and prevent people from accessing the care they need. Today’s executive order is the latest attack on our healthcare, following a long line of attempts to repeal and cripple the ACA. This executive order will drive up premiums for many—especially middle-class families and people with pre-existing conditions—to further undermine the ACA. It is morally reprehensible to hurt people through unjust policies for political gain.” [Statement, 10/12/17]

KENTUCKY’S EXPERIMENT WITH ASSOCIATION HEALTH PLANS SHOW THE NEGATIVE IMPACTS THEY COULD HAVE

Kentucky Experiment Showed AHPs Destabilize The Market And Caused Insurers To Leave Individual Market Or Not Sell New Policies Subject To Higher Standards. “In 1994, Kentucky passed a set of health insurance reforms (for the individual and small-group markets) that were very similar to the ACA’s market reforms.  These included a requirement for insurers to accept all applicants regardless of their health status, restrictions on exclusions of pre-existing health conditions, and a requirement that premiums be set without regard to health status, claims experience, or gender.  Premium variations for age, family size, and geographic factors were limited, and plan benefits were standardized.  Insurers in the state resisted the reforms and lobbied to repeal parts of it. In 1996, Kentucky’s legislature passed legislation that repealed many of the market reforms.  Crucially, the law exempted associations of employers or individuals from the premium-rating and benefits requirements, a loophole that allowed associations to sell coverage under a much weaker regulatory scheme.  In part because healthy individuals could buy association plans, the risk of adverse selection against the reformed individual market increased.  Nearly all insurers left Kentucky’s individual market or declined to sell new policies that were subject to the stronger rating and benefits standards.  In 1998, the Kentucky legislature passed a bill that repealed many of the state’s remaining health insurance reforms.” [Center on Budget and Policy Priorities, 11/29/17

ashoup
In News, Statement

Protect Our Care Statement On Federal Open Enrollment Numbers

In response to the news that 8.8 million people signed up for health insurance on the federal marketplace, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“A day after Republicans repealed a key provision of the Affordable Care Act and declared the law ‘dead,’ the results of open enrollment made clear the ACA is very much alive and demonstrated just how out of touch the GOP’s priorities are,” said Woodhouse. “More than 2 million new customers signed up for ACA coverage. The Affordable Care Act is working, and people’s lives are improving because of it. Despite widespread sabotage by the Trump Administration, including cutting the open enrollment period in half and dramatically slashing the advertising budget, these numbers prove that people want and need the affordable, quality health coverage the ACA provides, they rely on it for health and financial peace of mind and any further attempts at sabotage will be met with severe resistance. It’s time for the GOP to abandon efforts to take away people’s health care.”

ashoup
In News

The Facts Are In: Despite ACA Popularity, The Trump Administration’s Sabotage Will Deny Affordable Health Coverage to Large Numbers of Americans

This is what health care sabotage looks like.

As open enrollment ends tomorrow, people are starting to notice that the Trump Administration’s extensive sabotage – shortening the enrollment period, eliminating outreach and TV  advertising, cutting funding for navigators – means less people will get health care coverage than would have otherwise.

See for yourself …

Washington Post: ACA Enrollment “Almost Sure To Fall Short In The End Because Of A Compressed Enrollment Season.”  

Kaiser Family Foundation: ‘If not for the pronouncements of its death, and steps taken to hobble it, the ACA marketplace would actually seem, well, alive,’ Larry Levitt, senior vice president of the Kaiser Family Foundation said.

NBC News: “The Total Number Is Likely To Fall Short Of Last Year, Which Featured Both A Longer Enrollment Period And A Far More Robust Outreach Campaign.”

Huffington Post: “Another Reason Experts Expect An Enrollment Decline Is The Trump Administration’s Management Of The Program, Which Has Included Neglect And Outright Sabotage.”

Reuters: “The Trump Administration Has Worked Hard To Undercut” Enrollment.

The Hill: “The Trump administration’s abbreviated enrollment period has left advocates acknowledging the numbers are almost surely going to be lower than the 9.2 million who signed up on HealthCare.gov at the end of the last open enrollment season.”

Bloomberg BNA: “Major Changes Made By The Trump Administration – Such As Cutting Funding For Outreach – Are Making It Challenging To Get As Many People Signed Up This Year.”

Sean England
In Fact Sheet, Research

Protect Our Care Fact Sheet on Health Repeal in Senate Tax Bill

Senate Republicans just passed a tax bill that repeals your health care to pay for another massive tax break for the wealthiest and corporations. What this means is simple: while the wealthy and corporations get a tax break, middle-class families will get double digit premium increases, 13 million people will lose their coverage, older Americans will get an age tax and $25 billion in Medicare funding will be cut.

SENATE REPUBLICANS JUST VOTED TO REPEAL HEALTH CARE — RAISING PREMIUMS BY DOUBLE DIGITS FOR MIDDLE CLASS FAMILIES, RIPPING AWAY COVERAGE FOR 13 MILLION AMERICANS, IMPOSING AN AGE TAX ON OLDER AMERICANS AND GUTTING MEDICARE BY $25 BILLION — ALL TO PAY FOR SPECIAL TAX BREAKS FOR MILLIONAIRES AND BIG CORPORATIONS

Congressional Budget Office: Republican Tax Bill Will Result In 13 Million More Uninsured People. “The number of people with health insurance would decrease by 4 million in 2019 and 13 million in 2027.” [CBO, 11/8/17]

CBO: Average Premiums Will Increase By 10 Percent In Most Years Of The Next Decade Due To The Republican Tax Bill. “Average premiums in the nongroup market would increase by about 10 percent in most years of the decade (with no changes in the ages of people purchasing insurance accounted for) relative to CBO’s baseline projections.” [CBO, 11/8/17]

CBO: Healthier People Less Likely To Purchase Health Coverage, Raising Costs For Everyone Else. “Those effects would occur mainly because healthier people would be less likely to obtain insurance and because, especially in the nongroup market, the resulting increases in premiums would cause more people to not purchase insurance.” [CBO, 11/8/17]

AARP: Premiums For People Over 50 Would Increase Up To $1,500 Because Of Health Care Repeal In The Republican Tax Bill. “The Tax Cuts and Jobs Act as reported by the Senate Finance Committee on Nov. 16, 2017 includes a new provision that would both reduce health care coverage and increase costs for millions of Americans. Older adults ages 50–64 would be at particularly high risk under the proposal, facing average premium increases of up to $1,500 in 2019 as a result of the bill.” [AARP, 11/21/17]

CBO: Republican Tax Bill Would Trigger A $25 Billion Cut To Medicare. “Without enacting subsequent legislation to either offset that deficit increase, waive the recordation of the bill’s impact on the scorecard, or otherwise mitigate or eliminate the requirements of the PAYGO law, OMB would be required to issue a sequestration order within 15 days of the end of the session of Congress to reduce spending in fiscal year 2018 by the resultant total of $136 billion. However, the PAYGO law limits reductions to Medicare to four percentage points (or roughly $25 billion for that year), leaving about $111 billion to be sequestered from the remaining mandatory accounts.” [CBO, 11/14/17]

Sen. Marco Rubio (R-FL): Republicans Need To Cut Medicare Next To Pay For Tax Cuts. “‘I analyze this very differently than most,’ Rubio told the crowd. ‘Many argue that you can’t cut taxes because it will drive up the deficit. But we have to do two things. We have to generate economic growth which generates revenue, while reducing spending. That will mean instituting structural changes to Social Security and Medicare for the future,’ the senator said.” [Financial Advisor Magazine, 11/30/17]

Center On Budget And Policy Priorities: “Senate Tax Bill Would Add 13 Million To Uninsured To Pay For Tax Cuts Of Nearly $100,000 Per Year For The Top 0.1 Percent.” “The savings from eliminating the mandate would come entirely from reducing health coverage. For example, the federal government would spend less on premium tax credits because fewer people would sign up for marketplace coverage, less on Medicaid because fewer people would enroll, and less on the tax exclusion for employer-sponsored health insurance because fewer employees would enroll in job-based coverage. These savings are what let Senate leaders make their full corporate rate cut permanent…The benefits of corporate rate cuts go overwhelmingly to high-income households.” [CBPP, 11/15/17]

PASSING ALEXANDER-MURRAY AFTER VOTING FOR REPEAL IS LIKE INSTALLING GUARDRAILS ON THE HIGHWAY AFTER YOUR CAR HAS GONE OVER THE CLIFF

CBO: Passing Alexander-Murray After The Repeal Of The Individual Responsibility Provision Would Not Undo The Damage. “In your letter of November 21, 2017, you asked about the combined effects of simultaneously passing the BHCSA and legislation that would repeal the requirement that most U.S. citizens and noncitizens who lawfully reside in the country have health insurance meeting specified standards. Specifically, you asked if legislation that combined the provisions would change the agencies’ previous estimates of the number of people with insurance coverage or premiums in the nongroup insurance market. In the estimate for the BHCSA, the agencies wrote that, relative to the Summer 2017 baseline, the legislation would not substantially change the number of people with health insurance coverage, on net.” [CBO, 11/29/17]

There Is No Guarantee Alexander-Murray Would Pass The House, Let Alone Become Law. There is no guarantee Alexander-Murray would pass the House, let alone become law. Speaker Ryan dodged questions about its fate in the House. House conservatives called it a “nonstarter.” And President Trump has been all over the map on this issue his word cannot be trusted.

THE LEADING EXPERTS — PATIENT GROUPS, INSURERS, DOCTORS AND HOSPITALS — AND MORE THAN 2,400 FAITH LEADERS AND THE AMERICAN PEOPLE OPPOSE HEALTH REPEAL

American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, And 16 More Leading Patient Groups: People With “Serious Health Care Needs” And With Pre-Existing Conditions “May Not Be Able To Afford Coverage.” “Many individuals with serious health care needs, including patients with chronic or major health conditions, who by definition, have a pre-existing condition, may not be able to afford coverage.” [The Hill, 11/28/17]

America’s Health Insurance Plans, American Academy Of Family Physicians, American Hospital Association, American Medical Association, Blue Cross Blue Shield Association, Federation Of American Hospitals: Leading Industry Groups Warn Of “Serious Consequences” Should The Mandate Be Repealed. “As providers of healthcare and coverage to hundreds of millions of Americans, we are committed to assuring everyone has access to a range of high quality, affordable coverage options so they can access the care they need, regardless of pre-existing conditions. To achieve this critical goal, we are urging you to maintain the individual mandate unless and until Congress can enact a package of reforms to adequately assure a balanced risk pool and prevent extraordinary premium increases.” [Letter, 11/14/17]

More Than 2,400 Faith Leaders: “That The Number Of Uninsured Individuals Would Increase By 13 Million By 2025…Violates Our Faith Teaching.” “The individual mandate is critical to keeping individual market coverage affordable and keeping the individual market stable. By repealing the individual mandate, legislation will cause catastrophic losses in health coverage. The CBO estimates that the number of uninsured individuals would increase by 13 million by 2025, which violates our faith teaching.” [Letter, 11/29/17]

Sean England
In Statement

Protect Our Care Statement on Senate Passage of Motion to Proceed

In response to the Senate voting to proceed on the GOP tax bill, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Senate Republicans, with the enthusiastic support of President Trump, just voted to advance a bill that would rip away health coverage from 13 million people, raise premiums on millions more, impose an age tax on older Americans and slash Medicare by $25 billion,” said Woodhouse. “They are doing so to give tax breaks to golf resorts, private jet owners, the idle rich and multi-national corporations, all while raising taxes on the middle class. This bill is beyond terrible policy — it will devastate the lives of millions. This sneaky health care repeal scam is opposed by a coalition of nineteen leading patient groups and more than 2,400 faith leaders, as well as the vast majority of Americans. As this bill moves forward in the Senate, we will hold Members accountable for repealing the health care of the American people to give tax breaks to billionaires and big corporations.”

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