To: Interested Parties

To: Interested Parties

From: Brad Woodhouse, Protect Our Care Campaign Director

Date: September 29, 2017

Re: Trump and Republican Sabotage of Health Care

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

This week witnessed the defeat of the fifth Republican health care repeal attempt, the Graham-Cassidy-Heller-Johnson bill. Every attempt to repeal the Affordable Care Act (ACA) raised premiums and costs, increased the number of people without coverage, allowed insurance companies to gut protections for people with pre-existing conditions, imposed an age tax on older Americans, and ended Medicaid as we know it.

At the same time Republicans threaten to try repeal again in 2018 — despite the public’s repeated rejection of their partisan efforts — the Trump administration and Republicans in Congress are doing everything they can to sabotage our current system.

This memo exposes those sabotage efforts, outlines how this sabotage is already raising people’s costs, and shows how the American people will hold Republicans accountable for their actions.

Republicans are Taking Deliberate Actions to Sabotage Our Health Care

The most used Republican talking point is that Obamacare is “failing,” “imploding,” or “exploding.” President Trump said earlier this year, “the best thing we can do…is let Obamacare explode” and “let it be a disaster because we can blame that on the Democrats.”

These statements are false for two reasons. First, independent analyses show that the Affordable Care Act is working. Standard’s & Poor said it expected insurers’ performance in the marketplaces to be better in 2016 than in 2015, and 2017 would be better than 2016. The nonpartisan Congressional Budget Office said it anticipated “the market to be stable” under the ACA. The average premium after tax credits increased by $1 dollar, from $100 in 2016 to $101 in 2017. Currently, 10.2 million people are signed up for coverage in the marketplaces.

Second, the President’s statements do not accurately reflect reality. Republicans are not “letting” the ACA fail, as though they were just mere onlookers watching it happen. No. They are taking deliberate actions to sabotage the health care system. For example, on day one, the Trump Administration issued an executive order demanding federal agencies begin dismantling the Affordable Care Act without protecting parts that are working and without regard to the damage it would cause. Whatever President Trump’s motivation — personal hostility toward President Obama or simply spitefulness — the result is clear: his administration is making it harder for people to sign up for coverage and taking steps that are raising people’s premiums and destabilizing the marketplace.

Making it Harder for People to Enroll — Meaning Fewer Will Sign Up

The Trump administration is making it much harder for people to enroll in the marketplaces. For the final days of open enrollment in January 2017, the Trump Administration cut 75% of television advertising and all digital advertising that helped people find out about their health care options- resulting in an estimated 500,000 fewer people getting coverage.

Then, the Trump administration announced it was cutting the number of days people could sign up for coverage in half for future enrollment periods, from 90 days to 45 days.

For the open enrollment period that begins on November 1, 2017, the Trump administration already said it was cutting the outreach ad budget by 90 percent, from $100 million to just $10 million. The administration will be shutting Healthcare.gov down for part of the day on most Sundays. Sens. Brian Schatz (D-HI), Elizabeth Warren (D-MA), Cory Booker (D-NJ) and Chris Murphy (D-CT) wrote to the Department of Health and Human Services demanding answers about why this is going to happen.

This week, BuzzFeed News reported that the Trump administration ordered the Department of Health and Human Services’ regional directors to stop participating in open enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell said, “I didn’t call it sabotage…But that’s what it is.”

Add to that cuts to in person assistance, call centers being closed and a new final deadline to sign up.

All of these actions will result in reducing the number of people who sign up in the marketplaces. What this will mean is that those people who do sign up are more likely to be sicker and older, since they have a higher incentive to sign up than younger, healthier people. That in turn will cause premiums to spike. In other words, the Trump administration’s direct actions will be responsible for fewer people signing up for health care and raising premiums for those who do — a clear case of sabotage if there ever was one.

CSRs: Raising Rates and Destabilizing the Marketplace

Another big part of Trump’s sabotage campaign is his repeated threats to stop funding the cost sharing reductions (CSRs), which lower people’s out of pocket costs. The result: an increase in deductibles and out-of-pocket costs for the majority of those covered through the ACA marketplaces. As Sen. Lamar Alexander (R-TN) said, “Without payment of these cost-sharing reductions, Americans will be hurt.”

The proof is in the pudding. States that have finalized their rates for 2018 say they raised them even more because of the uncertainty over whether the Trump administration will pay these cost-sharing reductions. Experts agree, failing to make these payments will mean higher premiums and will explode the national debt.

Studies

• Congressional Budget Office: Congressional Budget Office says that failure to make these payments would mean people’s health insurance premiums will go up 20 to 25 percent and add nearly $200 billion to the debt over the next decade.
• Center for American Progress: “The Center for American Progress estimates that uncertainty around CSRs and mandate enforcement will raise 2018 premiums for benchmark coverage an extra $1,061 annually for a 40-year-old and $2,491 annually for a 64-year-old.”
• Kaiser Family Foundation: “Benchmark premiums would increase by 19 percent on average if cost-sharing subsidies were unpaid.”
• Urban Institute: “We find that premiums for silver marketplace plans would increase $1,040 per person on average.”
• Urban Institute: “A precipitous drop in insurer participation is even more likely if the cost-sharing assistance is discontinued.”
• Commonwealth Fund: “Eliminating cost-sharing reductions could destabilize insurance markets.”
• Kurt Giesa, Practice Leader, Oliver Wyman Actuarial Consulting: “Our modeling shows that this uncertainty, if it remains, could lead payers to submit rate increases between 28 and 40 percent, and more than two-thirds of those increases will be related to the uncertainty around CSR payments and individual mandate.”

State Insurance Commissioners and Agencies

• Julie Mix McPeak, President-Elect, National Association of Insurance Commissioners and Tennessee State Insurance Commissioner: “I am very fearful that we’ll have insurers make a decision to leave markets as a result of the uncertainty.”
• Teresa Miller, Pennsylvania Insurance Commissioner: “Failing to make payments to insurers for cost-sharing reductions would force insurers to request a statewide average 20.3 percent increase rather than 8.8 percent statewide average that was filed with the department in may.”
• Mike Kreidler, Washington State Insurance Commissioner: “The current federal administration’s actions — such as not committing to reimburse insurers for cost-sharing subsidies and not enforcing the individual mandate — appear focused only on destabilizing the insurance market.”
• Lori Wing-Heier, Director, Alaska Division Of Insurance: “It is expected that health care premiums would jump as high as 20 percent if trump follows through with his threat to cut subsidies.”
• Dave Jones, California State Insurance Commissioner: “President Trump appears on a mission to destroy health-insurance markets by creating instability through his own actions and thereby depriving millions of Americans of health-care coverage.”
• Marguerite Salazar, Colorado’s State Insurance Commissioner: “Commissioner Marguerite Salazar said the Trump Administration threatens the whole market. ‘My fear is it may collapse.’”
• Determination by the Florida Office of Insurance Regulation: “Florida regulators said most of the average rate hike — 31 percentage points [of the 44.7 percent total] — came from standard plans sold on the ACA exchange at Healthcare.gov. Insurers raised rates for those plans due to the political uncertainty that has plagued the healthcare debate, specifically whether the Trump administration will stop paying subsidies that lower out-of-pocket costs for low-income Americans.”
• Eric A. Cioppa, Superintendent, Maine Bureau Of Insurance: “If they don’t get a subsidy, i fully expect double-digit increases for three carriers on the exchanges here.”

Health Care Industry

• U.S. Chamber of Commerce, American Benefits Council, American Hospital Association, Federation of American Hospitals, American Medical Association, American Academy of Family Physicians, BlueCross BlueShield Association, America’s Health Insurance Plans: The most critical action to help stabilize the individual market for 2017 and 2018 is to remove uncertainty about continued funding for cost sharing reductions (CSRs)…If CSRs are not funded, Americans will be dramatically impacted.”
• National Academy for State Health Policy: “The Federal Government must commit to funding CSR payments in order to lower rates and stabilize carrier participation.”
• Dan Hilferty, President and CEO, Independence Blue Cross: “We firmly believe your coverage will be there for 2018, if the federal government, Congress and president commit to, fund the subsidies during an interim period of time.”
• Kelly Paulk, Vice President, Product Strategy and Individual Markets, Blue Cross Blue Shield of Tennessee: “We have to factor in two significant uncertainties…combining those two factors leads to an average 21 percent rate increase.”
• Danielle Devine, Michigan Director of Operations, Meridian Health Plan: “The political climate continues to make it difficult to price and the uncertainty over the future of the subsidies creates the largest reason for significant rate increases.”
• Rick Notter, Director of Individual Business, Blue Cross Blue Shield of Michigan: “If we don’t have that cost-sharing (subsidy), we have to make up the difference and the only way for us to do that is with a higher rate.”
• Dr. Mario Molina, Former CEO, Molina Healthcare: “The Administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don’t let them fool you.”
• Brad Wilson, CEO, Blue Cross Blue Shield of North Carolina: “The failure of the Administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower.”

Americans Will Rightly Hold Republicans Accountable for Sabotage

President Trump and Republicans in Congress might hope that people will blame President Obama and Democrats for rising premiums and limited choices on the marketplace, but that is not the case. As the Wall Street Journal editorial board wrote, “Republicans run the government and that means they are responsible for what happens in health care.”

An April 2017 Kaiser Health tracking poll found that 64 percent of Americans, including ⅔ of independents and a majority of Republicans, said they would blame Republicans and President Trump for any future problems with health care and the Affordable Care Act (ACA) going forward. The same poll found that 74 percent want Trump and his Administration to do what they can to make the current law work — that includes 8 in 10 independents and over half of Republicans.

Moreover, a recent poll by Hart Research Associates found that “nearly two-thirds (64%) of voters believe it is true that Donald Trump is ‘undermining the Affordable Care Act’ and three-in-five (61%) voters believe that he is actively ‘trying to make the Affordable Care Act fail.’ Additionally, 64% say that Trump is ‘playing politics with people’s healthcare,’ including one-in-four (24%) of his own voters. Along similar lines, a 57% majority believe that the president is ‘sacrificing people’s health care in order to oppose Barack Obama.’”

Clearly, they are not fooling anybody. Take a look at some of the headlines this week after state’s announced their finalized insurance rates for next year:

• Bloomberg: Obamacare Rates Rise in Markets Unsettled by Trump
• USA Today: Obamacare rates soar as White House refuses to make long term commitment to subsidies
• NBC News: Obamacare Repeal Failed, but the Damage Is Already Done

Stand Up to Sabotage

All of us need to play a role in standing up to the Trump administration and Republicans in Congress sabotaging our health care. Here are a few ways:

1. Demand Bipartisan Talks and Action to Stabilize the Health Care Market: Republicans and President Trump have injected uncertainty into the health care market by pursuing secretive, partisan repeal and by refusing to commit to paying CSRs. A bipartisan deal to pay CSRs was nearly in place until Republican leaders and President Trump pulled the plug so they could again try to ram through partisan repeal in the form of Graham-Cassidy. It’s now on Republicans to return to the table and pass a stabilization bill immediately; unfortunately, a lot of the damage has already been done and they will hold the bag for higher premiums, lost coverage and higher debt.
2. Demand Republicans Stand Up to Trump’s Sabotage of Open Enrollment and Shine a Light on What It Means: Republicans need to stand up to and speak out against the Administration’s effort to sabotage open enrollment and do their part to help get their constituents enrolled. Everyone must continue to shine a spotlight on every action (or inaction) along the way of the Trump Administration which undermines Open Enrollment through rapid response press, events in states, online activism and paid advertising so that we can hold people accountable.
3. Hold Republicans Accountable: We should let lawmakers know that if they are not going to stand up to the Trump administration’s sabotage, they are complicit in it. We should be making our voices heard at town hall meetings and calls to our Representatives. We need to expose these sabotage efforts, demand answers and use every tool at our disposal, protests, ads and other forms of activism to hold Republican lawmakers accountable for participating in or turning a blind eye to sabotage.