October 2017

In one day, between an Executive Order that will de-stabilize the insurance market and cutting off cost-sharing reduction (CSR) payments, President Trump has done what Congress repeatedly refused to — gut American health care. But, in slashing cost sharing reduction payments, not only is Trump out of step with the American people — he is out of step with many in his own party including key Senators, Governors and House members.

Now, the same Republicans who have spoken out in favor of efforts to stabilize the market and continue these payments which keep out of pocket costs low for millions of Americans, must step up and

immediately work to pass legislation to restore cost sharing reduction payments and stabilize the market or the political consequences associated with gutting people’s health care won’t just fall on Trump.

See what Republicans have said is support of continuing cost sharing reduction payments…

REPUBLICAN LEADERSHIP

Senate Majority Leader Mitch McConnell (R-KY): “If My Side Is Unable To Agree On An Adequate Replacement, Then Some Kind Of Action With Regard To The Private Health Insurance Market Must Occur.” “If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,’ McConnell said. ‘No action is not an alternative. We’ve got the insurance markets imploding all over the country, including in this state.” [Washington Post, 7/6/17]

Sen. John Thune (R-SD): “I Hope The President Will Continue To Make Those Payments.” [Kasie Hunt Tweet, 8/1/17]

House Deputy Majority Whip Rep. Tom Cole (R-OK): “Asked If He Thought Congress Should Provide The Money, Mr. Cole Said, ‘My Personal Opinion Is Yes.’” “I don’t think anyone wants to disrupt the markets more than they already are.” Asked if he thought Congress should provide the money, Mr. Cole said, “My personal opinion is yes.” [New York Times, 4/10/17]

REPUBLICAN COMMITTEE CHAIRS

Senate HELP Committee Chairman Lamar Alexander (R-TN): Sen. Alexander “Recommended The Trump Administration Find A Way, Either Through Administrative Action Or Legislation Or A Combination, To Extend Temporary Cost-Sharing Payments Under The Affordable Care Act At Least Through 2018 — And Probably Should Go Ahead And Do It Through 2019.’” He “recommended the Trump administration ‘find a way, either through administrative action or legislation or a combination, to extend temporary cost-sharing payments under the Affordable Care Act at least through 2018 — and probably should go ahead and do it through 2019.’” [Statement, 6/15/17]

Sen. Lamar Alexander (R-TN): “Without Payment Of These Cost-Sharing Reductions, Americans Will Be Hurt.” “‘Without payment of these cost-sharing reductions, Americans will be hurt. Up to half of the states will likely have bare counties with zero insurance providers offering insurance on the exchanges, and insurance premiums will increase by roughly 20%, according to America’s Health Insurance Plans (AHIP).” [Alexander Statement, 8/1/17]

Sen. Lamar Alexander (R-TN): We Should “Approve The Temporary Continuation Of Cost-Sharing Subsidies For Deductibles And Co-Pays.” “‘While we build replacements, we want the 11 million Americans who now buy insurance on the exchanges to be able to continue to buy private insurance. Among the actions that will help are to… approve the temporary continuation of cost-sharing subsidies for deductibles and co-pays.’” [Politico Pro, 1/13/17]

Senate Finance Committee Chair Orrin Hatch (R-UT): “I Think They’re Going To Have To Be Paid.” “I think they’re going to have to be paid.” “You can’t let people be without basic health care.” [Politico, 7/18/17]

House Ways And Means Committee Chairman Kevin Brady (R-TX): “We Should Act Within Our Constitutional Authority Now To Temporarily And Legally Fund Cost-Sharing Reduction Payments As We Move Away From Obamacare.” “We should act within our constitutional authority now to temporarily and legally fund cost-sharing reduction payments as we move away from Obamacare.” “Insurers have made clear the lack of certainty is causing 2018 proposed premiums to rise significantly.” [New York Times, 6/8/17]

House Energy And Commerce Committee Chair Greg Walden (R-WA): “I Will Do Everything I Can To Make Sure The Cost-Sharing Reduction Payments Get Made.” “I will do everything I can to make sure the cost-sharing reduction payments get made, especially this year where they were promised by the federal government under the contracts.” “That’s an obligation not only to insurers but also to the people who took on those plans. We cannot leave them high and dry.” [Bloomberg, 3/30/17]

Senate Homeland Security Committee Chair Ron Johnson (R-WI): The Senate Should “Bite The Bullet And Stabilize Those Markets.” “Sen. Ron Johnson (R-Wis.) has for months called for a bipartisan stabilization bill that would guarantee funding for ObamaCare payments, known as cost-sharing reductions, to insurers. Those payments are key to avoiding premium spikes and keeping insurers in the markets. Johnson said Tuesday that he hopes the GOP can pass something next week, but if not, ‘bite the bullet and stabilize those markets.’” [The Hill, 7/13/17]

OTHER REPUBLICANS

Rep. Ileana Ros-Lehtinen (R-FL): “Cutting Health Care Subsidies Will Mean More Uninsured In My District. @POTUS Promised More Access, Affordable Coverage. This Does Opposite.” [Tweet, 10/12/17]

Rep. Carlos Curbelo (R-FL): “Cost Sharing Reductions Are Critical To Low Income Americans. Congress Should Guarantee Their Funding Through The Appropriations Process.” [Tweet, 10/13/17]

Rep. Tom Reed (R-NY): “If Congress Doesn’t Get It Done The People Who Suffer Are The People Back Home.” “GOP Rep. Tom Reed calls for Congress to fund CSRs. ‘If Congress doesn’t get it done the people who suffer are the people back home.’” [Tweet, 10/13/17]

Rep. Leonard Lance (R-NJ): “Now Congress Must Act And Pass The Problem Solvers Caucus Health Care Plan That…Funds The Cost-Sharing Reduction Program.” “Now Congress must act and pass the Problem Solvers Caucus health care plan that I have endorsed. It funds the cost-sharing reduction program through the congressional appropriations process and implements free-market policies to improve our health care system and lower medical and insurance costs for all.” [Statement, 10/13/17]

Sen. Bill Cassidy (R-LA): “Families Would Be Hurt” If Payments Not Made.” [Sahil Kapur Tweet, 8/1/17]

Sen. Susan Collins (R-ME): “It Really Would Be Detrimental To Some Of The Most Vulnerable Citizens If Those Payments Were Cut Off.” “It would not affect my vote on health care, but it’s an example of why we need to act to make sure that those payments, which are not an insurance company bailout, but rather help people who are very low-income afford their out-of-pocket costs towards their deductibles and their co-pays. And that’s what we need to remember. So, it really would be detrimental to some of the most vulnerable citizens if those payments were cut off. They’re paid to the insurance companies, but the people that they benefit are people who make between 100 percent and 250 percent of the poverty rate. So, we’re talking about low-income Americans who would be devastated if those payments were cut off, though the threat to cut off those payments has contributed to the instability in the insurance market.” [Collins on CNN’s State of the Union, 7/30/17]

Sen. Susan Collins (R-ME): “Very Concerned” About Executive Order And Cutting CSR Funding.” “Susan Collins says she’s ‘very concerned’ with Trump’s new ACA EO and decision to do away with CSRs.” [10/12/17]

Susan Collins: “It Is Absolutely Essential That The CSR Payments Continue.” [Huffington Post’s Matt Fuller Tweet, 8/1/17]

Sen. Lisa Murkowski (R-AK): “The Senate Should Step Back And Engage In A Bipartisan Process To Address The Failures Of The ACA And Stabilize The Individual Markets.” “As I’ve been saying, the Senate should take a step back and engage in a bipartisan process to address the failures of the ACA and stabilize the individual markets. That will require members on both sides of the aisle to roll up their sleeves and take this to the open committee process where it belongs.” [Murkowski Statement, 7/18/17]

Rep. Phil Roe (R-TN): “If We Pull The Subsidies … I Think There Would Be Nobody With A Health Insurance Plan Next Year.” “If we pull the subsidies … I think there would be nobody with a health insurance plan next year.” [Politico, 4/26/17]

Rep. Kevin Cramer (R-ND): “As Long As It’s [The Subsidies] Are Part Of The Law Of The Land, It’s Our Job To Appropriate The Money.” “As long as it’s [the subsidies] are part of the law of the land, it’s our job to appropriate the money.” [Politico, 4/5/17]

GOVERNORS, INCLUDING REPUBLICANS

National Governors Association: “The Federal Government Should Fully Fund The Cost-Sharing Reductions (CSRs) For The Remainder Of CY 2017 And CY 2018.” “The federal government should fully fund the cost-sharing reductions (CSRs) for the remainder of CY 2017 and CY 2018 and offer long-term certainty about the future of CSRs.” [NGA, 6/20/17]

Govs. Kasich, Hickenlooper, Sandoval, Wolf, Walker, McAuliffe, Edwards, Bullock: Trump Administration Should Make CSR Payments And Congress Should Explicitly Appropriate Funds Through 2019. “The Trump Administration should commit to making cost sharing reduction (CSR) payments. The National Association of Insurance Commissioners (NAIC), National Governors Association, and United States Chamber of Commerce have identified this as an urgent necessity…Also, Congress should put to rest any uncertainty about the future of CSR payments by explicitly appropriating federal funding for these payments at least through 2019. This guarantee would protect the assistance working Americans need to afford their insurance, give carriers the confidence they need to stay in the market, increase competition, and create more options for consumers.” [Letter, 8/31/17]

Asa Hutchinson, Governor of Arkansas: Calls Trump’s Threat To Withdraw Cost-Sharing Payments “Very Problematic.” “However, Hutchinson says he does have concerns about President Trump’s threat to withdraw cost-sharing from insurance companies if no healthcare bill is passed. Cost-sharing creates a healthcare fund that covers co-payments and deductibles for low-income enrollees. ‘That would be very problematic. That is like withdrawing one little element of the Affordable Care Act… without having a comprehensive reform,’ said Hutchinson.” [Arkansas Public Radio, 8/4/17]

Govs. McAuliffe And Baker On Behalf Of The Health And Human Services Committee, National Governors Association: “A First Critical Step In Stabilizing The Individual Health Insurance Marketplaces Is To Fully Fund CSRs For The Remainder Of Calendar Year 2017 Through 2018.” “The Administration has the opportunity to stabilize the health insurance market across our nation and ensure that our residents can continue to access affordable health care coverage. A first critical step in stabilizing the individual health insurance marketplaces is to fully fund CSRs for the remainder of calendar year 2017 through 2018. This is a necessary step to stabilize the individual marketplaces in the short term as Congress and the Administration address long-term reform efforts.” [NGA, 8/2/17]

Govs. Hickenlooper, Bullock, Sandoval, Hogan, Wolf, Edwards, McAuliffe, Baker, Kasich, And Scott: Instead Of Pursuing Health Care Repeal, “We Ask Senators To Work With Governors On Solutions To Problems We Can All Agree On: Fixing Our Unstable Insurance Markets.” “Instead, we ask senators to work with governors on solutions to problems we can all agree on: fixing our unstable insurance markets. Improvements should be based on a set of guiding principles, which include controlling costs and stabilizing the market, that will positively impact the coverage and care of millions of Americans, including many who are dealing with mental illness, chronic health problems, and drug addiction.” [Letter, 7/26/17]

Govs. Kasich, Bullock, Hogan, Edwards, Walker, Hickenlooper, Baker, Wolf, Scott, McAuliffe, And Sandoval: “Congress Should Work To Make Health Insurance More Affordable By Controlling Costs And Stabilizing The Market.” “Congress should work to make health insurance more affordable by controlling costs and stabilizing the market, and we are pleased to see a growing number of senators stand up for this approach.” [Letter, 7/18/17]

Patient groups, hospitals, doctors, industry experts, consumer groups, teachers and faith leaders have all come out against President Trump’s latest effort to sabotage our health care through Executive Order.

As eighteen patient groups wrote, “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.”

Read what the rest had to say here…

PATIENT GROUPS

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]

HOSPITALS

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]

DOCTORS

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]

INDUSTRY EXPERTS

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]

CONSUMER GROUPS

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]

TEACHERS

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]

FAITH LEADERS

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]

As was just announced, California will impose an average 12.4 percent surcharge on health care premiums for the benchmark silver plan offered through Covered California because of efforts by President Trump and Republicans in Congress to sabotage our health care by threatening to withhold cost-sharing reduction payments. While they have been unable to repeal the health care law, they have been doing everything they can to sabotage the marketplace by:

• Threatening to defund the law’s mandatory cost-sharing-reduction payments, which the nonpartisan Congressional Budget office said would increase rates by 20% in 2018 and 25% in 2020.
• Slashing 90% of the funding to let people know when and how they can sign up for coverage.
• Prohibiting Regional Directors from the Department of Health and Human Services from participating in efforts to help people enroll in coverage during open enrollment.
• Shutting down HealthCare.gov during critical hours.
• Cutting the number of days people can sign up for coverage in half.
• On the first day of this administration, President Trump signed an Executive Order demanding that agencies dismantle as much of the law as they can.

Now people are facing the consequences.

“Everyone with the benchmark plan who gets a bill from their insurer for higher health care costs next year can thank President Trump and Republicans in Congress for the sabotage that led to this,” Protect Our Care Campaign Director Brad Woodhouse said. “Their repeated threats, uncertainty and sabotage of our health care system is taking a toll on real people’s lives in California. Your health care bills next year should say ‘brought to you by Donald Trump.’”

EXPERTS AND INSURANCE COMMISSIONERS AGREE THAT TRUMP’S SABOTAGE IS RAISING COSTS:

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.” [Center for American Progress, 8/16/17]

Kaiser Family Foundation: “Benchmark Premiums Would Increase By 19 Percent On Average If Cost-Sharing Subsidies Were Unpaid.” [KFF, 4/6/17]

Urban Institute: “We Find That Premiums For Silver Marketplace Plans Would Increase $1,040 Per Person On Average.” [Urban Institute, 1/16]

Commonwealth Fund: “Eliminating Cost-sharing Reductions Could Destabilize Insurance Markets.” [Commonwealth Fund, 4/28/17]

Urban Institute: “A Precipitous Drop In Insurer Participation Is Even More Likely If The Cost-sharing Assistance Is Discontinued.” [Urban Institute, 12/6/16]

Julie Mix Mcpeak, President-Elect Of The 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.” [New York Times, 8/7/17]

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.” [Press Release, 7/31/17]

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.” [Statement, 6/19/17]

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.” [Fairbanks News-Miner, 8/14/17]

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.” [Wall Street Journal, 6/27/17]

Marguerite Salazar, Colorado’s State Insurance Commissioner: “Commissioner Marguerite Salazar Said The Trump Administration Threatens The Whole Market. ‘My Fear Is It May Collapse.’” [Los Angeles Times, 5/18/17]

Craig Wright, Chief Actuary, Florida Office of Insurance Regulation: “If The Subsidies Are Not Funded, Carriers Would Face The Prospect Of Large Financial Losses.” [New York Times, 8/7/17]

Eric A. Cioppa, Superintendent Of The Maine Bureau Of Insurance: “If They Don’t Get A Subsidy, I Fully Expect Double-Digit Increases For Three Carriers On The Exchanges Here.” [New York Times, 6/4/17]

National Academy for State Health Policy: “The Federal Government Must Commit To Funding CSR Payments In Order To Lower Rates And Stabilize Carrier Participation.” [Letter from State-based Marketplace Directors, 8/30/17]

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.” [CNN, 7/19/17]

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.” [Blog Post, 6/30/17]

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.” [Crain’s Detroit Business, 6/14/17]

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.” [Detroit Free Press, 6/14/17]

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.” [U.S. News & World Report, 5/30/17]

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.” [Washington Post, 5/26/17]

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.” [Oliver Wyman, 6/14/17]