June 2018

After Republican Senators Lamar Alexander, Michael Enzi, Rand Paul, Mitch McConnell, Orrin Hatch, John Cornyn, John Thune, Roy Blunt, John Barrasso, Joni Ernst, Chuck Grassley, Ron Johnson, James Inhofe, Deb Fischer, John Boozman, Johnny Isakson, Bill Cassidy, Marco Rubio, Shelley Moore Capito, James Lankford, Steve Daines, Roger Wicker, Tom Cotton, Dan Sullivan, Todd Young, John Kennedy, Richard Shelby, Dean Heller, Richard Burr, and Tim Scott urged the Trump Administration to hurry up and sabotage health care even faster, Protect Our Care Campaign Chair Leslie Dach said:

“At a time when Republican Senators should be standing up to the Trump Administration’s threat to strip protections from 130 million Americans with pre-existing conditions, they are instead urging the Administration to commit more sabotage, faster. Today, 30 Republican senators asked Trump to fast-track an expansion of association health plans, which fail to provide real coverage because they can exclude or limit basic services such as prescription drug coverage, mental health care, and maternity care. Before the Affordable Care Act, this type of plan had a long history of fraud and unpaid claims, and many states still exempt them from key consumer protections. When these plans fail, they leave people who thought they had real coverage out in the cold – which is where millions of Americans will find themselves if the Trump Administration and these irresponsible Senators have their way.”

 

INSURANCE COMMISSIONERS AGREE THAT ASSOCIATION HEALTH PLANS ARE BAD FOR CONSUMERS

National Association of Insurance Commissioners: Association Health Plans Are Bad For Consumers. “AHPs would fragment and destabilize the small group market, resulting in higher premiums for many small businesses…AHPs would be exempt from state solvency requirements, patient protections, and oversight exposing consumers to significant harm.” [NAIC]

Pennsylvania Insurance Commissioner Concerned About Potential For Consumer Harm Under AHPs. “The proposed rule would also loosen existing commonality of interest requirements to allow associations to form simply based on membership in the same trade, industry or profession..If a self funded MEWA were permitted to form in a neighboring state and to sell to Pennsylvania association members under the metro area provision, Pennsylvania regulators would not have the ability to assist a Pennsylvania resident if problems arise with the other state’s association, including claim denials, or, worse yet, in the event of insolvency or fraud.” [PA Insurance Commissioner Jessica Altman, 3/6/18]

California Insurance Commissioner: “The Proposed Rule Is A Perfect Storm Of Bad Ideas.” “The AHPs proposed by this rule will harm consumers by degrading the individual and small group health insurance markets through adverse selection, and will impinge upon states’ rights while opening the door to fraud, insolvency and abuse…The proposed rule in no way limits the ability of states to regulate MEWAs, insurers offering coverage through MEWAs, and insurance producers marketing that coverage to employers. However, the checkered history of MEWAs instructs that unscrupulous actors will try and exploit any change which can be mischaracterized as constituting ERISA preemption.” [CA Insurance Commissioner Dave Jones, 3/6/18]

PATIENT GROUPS, HOSPITALS, AND KEY HEALTH STAKEHOLDERS CONDEMN AHPs

American Cancer Society Cancer Action Network: “We Are Also Concerned About The Proliferation Of AHPs Because Of Their History Of Fraud And Financial Instability.” “For a long time, these products were not traditionally subject to the same state insurance solvency and licensing requirements that allowed regulators to maintain necessary oversight.5 If an AHP lacked the financial resources to pay claims, then enrollees were left with no coverage and high out-of-pocket costs. Even in cases of well-meaning AHP sponsors, insolvencies led to millions of dollars in unpaid claims.” [ACS-CAN, 3/6/18]

American Hospital Association: AHPs “Ultimately Decreas[e] Access To Affordable Coverage.” “We are concerned that this rule fails to protect against discriminatory insurance practices and could contribute to instability in the individual and small group market, ultimately decreasing access to affordable coverage.” [American Hospital Association, 3/6/18]

Coalition Of 118 Patient And Community Organizations Urges Department Of Labor To Reconsider AHPs. “We believe that the proposed changes would negatively impact access to quality, affordable care for consumers, disrupt the individual and small business marketplace, and further strain the limited resources of state regulators…The intent of the President’s executive order was to increase consumer choice while curbing costs, however we believe that AHPs as proposed would invariably weaken the individual and small group markets leading to higher healthcare costs for all; higher premiums for those who stay in the marketplace, and high out of-pocket costs for those who are covered by AHPs for unexpected medical needs.” [Coalition Of 118 Patient And Community Organizations, 3/6/18]

AHPs ARE HOTSPOTS FOR FRAUD IN STATES:

Florida

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]

In Florida, A Man Pleaded Guilty To Embezzling $700,000 In Premiums From the AHP He Ran in 2004 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 2004, A Florida Woman Was Left With $500,000 In Unpaid Medical Bills While She Was Covered By Association Health Plan. “Joan Piantadosi, a small business owner bought health insurance from Employers Mutual LLC through an association for herself, her family, and her employees. She was left with more than $500,000 in unpaid medical bills for her husband’s treatment during the time she was covered by Employers Mutual LLC. On top of that, her husband needed a liver transplant to live. In her own words, “[W]e were informed that since we lacked insurance coverage, we would have to pay a deposit of $150,000 before my husband could enter the hospital’s Liver Transplant Inpatient program. We simply did not have $150,000 to cover the deposit. Consequently, my husband was removed from the recipient list…We feared, among other things, that my husband might die while we were attempting to deal with the predicament of being uninsured despite having paid premiums to what appeared to be a legitimate health insurer.” [United Hospital Fund, 3/6/18]

Louisiana

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]

Texas

In Texas, Patients Thought They Were Insured Until Told Otherwise In A Moment Of Crisis. “Robert Loiseau, who represented fraud victims in Texas, recalled their shock when they tried to receive care. ‘People bought insurance coverage because it was cheap and seemed to provide them with coverage they needed,’ he said. ‘It had a veneer of legitimacy. But when they went to the doctor, they found out all of a sudden that their insurance company, their perceived insurance company, was in receivership and that they had no coverage.’” [New York Times, 10/21/17]

Between 2001 And 2003, Texas Shut Down 129 Unauthorized Insurance Operations. “In the last two years, the Texas Insurance Department shut down 129 unauthorized insurance companies, affiliates, operators, and their agents whose illegal actions affected more than 20,000 Texans.” [The Commonwealth Fund, August 2003]

New Jersey

In 2002, An AHP Became Insolvent With $15 Million In Outstanding Claims. “For example, when a long-standing AHP in New Jersey that covered 20,000 people became insolvent in 2002, it had $15 million in outstanding medical bills. This left participating businesses and their employees’ claims unpaid even though employers paid premiums to the AHP.” [Commonwealth Fund, 10/10/17]

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 healthplan 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]

South Carolina

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]

Across State Lines: North Carolina, Maryland, And Beyond

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.„ 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 reporton 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]

Last week, the Department of Justice announced that it would aid and abet twenty states in a politically-motivated lawsuit against the Affordable Care Act. Specifically, the DOJ has decided to argue that key consumer protections, including protections for up to 130 million Americans with pre-existing conditions, should end now that Republicans have axed the law’s individual mandate through last year’s tax bill.

Yesterday, groups and experts from all sides, ranging from physicians to legal scholars to small businesses and health insurance companies, joined together to submit amicus briefs highlighting the absurdity and the cruelty of the Trump DOJ’s argument.

Patient groups, physicians, and hospitals emphasize how much the lawsuit could threaten care for people across the country:

• American Cancer Society, American Cancer Society Cancer Action Network, American DIabetes Association, American Heart Association, American Lung Association, and National Multiple Sclerosis Society: “Striking Down These Provisions Would Be Catastrophic And Have Dire Consequences For Many Patients With Serious Illnesses.” Invalidating the ACA in whole or in part “would be devastating for the millions of Americans who suffer from serious illness or have preexisting conditions and rely on those protections under current law to obtain life-saving health care. If either the plaintiffs’ or the administration’s position were adopted by the court, people with serious illness are likely to be denied coverage due to their preexisting conditions or charged such high premiums because of their health status that they will be unable to afford any coverage that may be offered. Without access to comprehensive coverage, patients will be forced to delay, skip, or forego care. Striking down these provisions would be catastrophic and have dire consequences for many patients with serious illnesses.” [American Cancer Society et. al, 6/14/18]

• American Medical Association, The American Academy of Family Physicians, The American College of Physicians, The American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry: “​Invalidating The Guaranteed-issue And Community Rating Provisions—or The ​entire A​CA—would Have A Devastating Impact On Doctors, Patients, And The American Health Care System As A Whole.” “Congress declined to do what the Plaintiffs ask this Court to do for a reason: the consequences of repealing the ACA would be staggering…Plaintiffs’ proposed remedies . . . would strip health care from tens of millions of Americans who depend on the ACA; produce skyrocketing insurance costs; and sow chaos in the nation’s health care system​…The ACA’s ‘nationwide protections for Americans with pre-existing health conditions’ has played a ‘key role’ in allowing 3.6 million people to obtain affordable health insurance. Severing those vital insurance reforms would leave millions without much-needed insurance.” [AMA et. al, 6/14/18]

• American Hospital Association, Federation of American Hospitals, The Catholic Health Association of the United States, and Association of American Medical Colleges: “A judicial repeal would have severe consequences for America’s hospitals, which would be forced to shoulder the greater uncompensated-care burden that the ACA’s repeal would create.” The relief sought by Texas and its allies “would have devastating consequences, kicking millions of Americans off of coverage and inflicting on them all the harms that come with being uninsured. These harms would fall on the low-income families least able to cope with them. ​And a judicial repeal would have severe consequences for America’s hospitals, which would be forced to shoulder the greater uncompensated-care burden that the ACA’s repeal would create.” [American Hospital Association et. al, 6/14/18]

• Public Health Scholars and the American Public Health Association: “The Foreseeable Public Health Consequences Of The Injunction Are Nothing Short of Catastrophic.” “Without the ACA, the health of millions of Americans would be harmed. Consider the grim analyses of proposed legislation partially repealing the ACA: In 2017, the nonpartisan Congressional Budget Office (“CBO”) assessed the impact of a bill partially repealing the ACA and found (among other things) that it would, in “the first new plan year following enactment of the bill” alone, increase the number of uninsured Americans by 18 million. That number would grow to 27 million after the “year following the elimination of the Medicaid expansion,” and then to 32 million by 2026. Still more is at stake here: Unlike the injunctive relief plaintiffs seek, the bill analyzed by CBO would have staggered its partial repeal of the ACA to avoid catastrophic results. Here, plaintiffs ask the Court to eliminate, as preliminary injunctive relief, a complex statute in its eighth year of implementation—a statute whose repeal through democratic means has been attempted innumerable times but has never succeeded.” [Public Health Scholars et. al, 6/14/18]

• AARP: Before ACA’s Protections, Discrimination Against Those With Pre-Existing Conditions, Age Rating, And Annual And Lifetime Caps Made Accessing Health Care Out Of Reach For Older Adults. “Uninsured pre-Medicare adults faced nearly insurmountable challenges to securing insurance because they were denied coverage based on preexisting conditions or offered costly policies that excluded coverage for needed care. Even without preexisting conditions, insurance premiums for older adults were as much as 11 times greater than their younger counterparts solely based on their age. Even a healthy person who was age 50 to 64 with no preexisting conditions faced markedly higher insurance premium rates than a younger person. Age rating put the cost of insurance out of reach for many pre-Medicare adults. Annual and lifetime caps—which were easily exceeded by treatment for a single illness such as cancer, heart disease, or diabetes—meant that many older adults either went without treatment until they became eligible for Medicare or incurred financially ruinous medical debt.” [AARP, 6/14/18]

Health insurance companies warn that the lawsuit could lead to mass coverage losses:

• America’s Health Insurance Plans: “Abruptly threatening or even cutting off billions of federal dollars that allow individuals to purchase insurance and that fund benefits offered through Medicaid or Medicare would have devastating effects.”“The healthcare system, while constantly evolving, cannot pivot to a new (or, worse yet, non-existent) set of rules without consequences. Abruptly threatening or even cutting off billions of federal dollars that allow individuals to purchase insurance and that fund benefits offered through Medicaid or Medicare would have devastating effects.​ Enjoining enforcement of federal laws like the federally-facilitated marketplaces and the products sold on them would be similarly disruptive.” [AHIP, 6/14/18]

• The Ability Of Millions Of Low-Income, Medically Vulnerable People To Access Necessary Treatments Would Be Cast Into Doubt. “The Medicaid program would likewise experience significant disruptions​. Stopping the funding for individuals made newly eligible for Medicaid under the ACA would harm the 34 states that have chosen to expand their Medicaid programs and potentially disrupt healthcare coverage for the 12 million people added as a result of that expansion​…The coverage of millions of low-income and medically-vulnerable patients—and their ability to receive necessary treatments and prescription drugs—would be cast into doubt. At the same time, state Medicaid programs would see drug costs increase considerably for all enrollees (including children, disabled, and elderly) due to the loss of the ACA’s enhanced prescription drug rebates​.” [AHIP, 6/14/18]

Small businesses and the Service Employees International Union (SEIU) demonstrate how DOJ’s lawsuit would jeopardize Americans’ health while harming the economy:

• Small Business Majority Foundation: “Before the enactment of ACA, this linkage pressured individuals to seek out and then stay put in jobs that provided affordable health insurance—a phenomenon known as ‘job lock’—because people clung to jobs with affordable health coverage even when they might have otherwise chosen to start businesses or pursue more attractive job opportunities with growing small businesses.” Small business owners, their employees, and self-employed individuals have benefited significantly from the many different reforms enacted as part of the Affordable Care Act, especially the creation of the individual marketplaces with tax credits, the optional expansion of Medicaid, and small group market reforms. Millions more working Americans, who are self employed or employees of the Nation’s small businesses, now have health insurance that they would not have had without the Act. The harm they will suffer if the Act is enjoined is just one of many reasons why the public interest is not served by Plaintiffs’ sweeping requested injunction.” [Small Business Majority Foundation, 6/14/18]

• Service Employees International Union (SEIU): “A Decision Striking Down The ACA Not Only Would Strip Health Coverage And Protections From Nearly 30 Million People And Remove Quality Care Incentives For Providers But Also Would Have Catastrophic Economic Consequences.” “Loss of the ACA would cause an enormous surge in the number of uninsured Americans, which would in turn increase the burden of uncompensated medical care costs borne by hospitals and other medical care providers by an estimated $1 trillion between 2019 and 2028. The massive reduction in federal funding would lead to the loss of up to 2.6 million jobs. And because the health care sector accounts for such a large percentage of the overall U.S. economy, eliminating the ACA would result in a $2.6 trillion reduction in total business activity between 2019 and 2023.” [SEIU, 6/14/18]

Law professors and the American Medical Association question the legality of the Justice Department’s argument:

• Law Professors From Both Sides Of The Aisle, Including Jonathan Adler, Ilya Somin, Nicholas Bagley, Abbe Gluck, and Kevin Walsh, Note That Despite Their Different Policy Perspectives, They Agree That DOJ’s Arguments About Severability Are Inconsistent With The Law. “[A] court’s substitution of its own judgment for that of Congress would be an unlawful usurpation of congressional power and violate basic black-letter principles of severability. Yet that is what the plaintiff States and the United States invite this Court to do.​..This time-shifting of congressional intent misapplies severability doctrine. By expressly amending the statute in 2017 and setting the penalty at zero while not making other changes, Congress eliminated any need to examine earlier legislative findings or to theorize about what Congress would have wanted. Congress told us what it wanted through its 2017 legislative actions.” [Jonathan Adler et. al, 6/14/18]

• American Medical Association, The American Academy of Family Physicians, The American College of Physicians, The American Academy of Pediatrics, and the American Academy of Child and Adolescent Psychiatry: DOJ Seeks To “Change The Federal Government’s Health Care Policy Through The Courts.” “The plaintiffs do not seek redress for any real, concrete injury because they have suffered none. They simply seek to change the federal government’s health care policy through the courts, rather than through the legislature.” [AMA et. al, 6/14/18]

 

As preliminary Michigan rate filings for 2019 individual-market health insurance indicated that rates will increase instead of decrease due to D.C. Republicans’ repeal-and-sabotage agenda, after Michiganders were hit with a sabotage-driven average 37% rate hike last year, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“President Trump and his Republican allies in Congress are engaged in a deliberate, escalating campaign to undermine health care, and it’s forcing families in Michigan to pay more again this year when they would have otherwise seen rates actually go down.  Until we stop Republicans’ war on health care, health care experts predict that rates will continue to rise because of President Trump and Congressional Republicans’ actions to undermine the system. It’s time Washington Republicans stand up to the Trump Administration’s sabotage and start working on bipartisan solutions to make coverage more affordable, and stop helping their friends in the insurance industry make another buck on the backs of hardworking Michiganders.”

 

From the Insurance Companies

Blue Cross Blue Shield of  Michigan: “We have included a factor of 5.0% to account for regulatory risk that encompasses known changes to enforcement of the Affordable Care Act’s individual mandate as well as member behavior given the uncertainty of the market.” [6/14/18]

 

Why Michiganders’ Insurance Is Getting More Expensive

While spending most of last year trying to repeal the Affordable Care Act (ACA) and waging a war on our health care, President Trump and Republicans in Congress have also used their control of Washington to actively undermine the Health Insurance Marketplaces every chance they get – leading insurance companies to raise premiums for 2018 and 2019 and, in some cases, forcing them out of the individual market altogether. Washington Republicans’ goal is simple: sabotage and undermine the Affordable Care Act, then blame everyone but themselves for the consequences of their actions. President Trump keeps rooting for disaster, saying that “The best thing we can do…is let Obamacare explode” and “Let it be a disaster because we can blame that on the Democrats.”

Now, initial rate filings in Michigan forecast rate hikes again this fall because of Republican sabotage.

 

Republicans never ended their war on our health care. After Congress failed to repeal the Affordable Care Act, the Trump Administration is aggressively sabotaging our health care system and refusing to work to make coverage better and more affordable.

• Experts from AARP, the Congressional Budget Office, and a wide range of other nonpartisan organizations agree that Republican actions are forcing up health care costs.
• Republicans in Congress are supporting the Administration’s many actions to undermine health care, despite widespread opposition from patient and disease groups, doctors, nurses, hospitals, plus health care and consumer advocates.
• Just last week, the Trump Administration’s Department of Justice launched an unprecedented attack on Americans with pre-existing conditions, which has drawn widespread condemnation from prominent health care advocacy groups, patient and provider groups, and insurance company associations.
• The Trump Administration officials keep rewriting the rules to let big insurance companies cover fewer and fewer services while charging people more and more. The sabotage doesn’t stop there: last year the Administration fired many of the community assisters who help people enroll in health care; this year they are planning more enrollment cuts, making it even harder to sign up for coverage.
• And now, Republicans are encouraging insurance companies to sell more junk plans that don’t have to cover basic care like hospitalization and prescription drugs, and that are allowed to charge people with pre-existing conditions more or even deny them coverage altogether. In Michigan, no short-term plans available have to cover maternity care, and only 44 percent of plans cover prescription drugs.

 

This could have been avoided: if Republicans had stopped sabotaging health care, American families wouldn’t be facing another huge increase this fall.

• Even the Trump Administration has admitted that the Affordable Care Act’s insurance marketplaces had been stabilizing prior to them coming into office.
• The nonpartisan Congressional Budget Office had predicted only modest rate increases if Republicans hadn’t sabotaged the markets.
• Even Senate Republicans admitted this fall’s upcoming rate hikes were “avoidable,” but then they torched bipartisan stabilization talks at the last minute, prioritizing partisan politics over their last opportunity to help American families afford health care next year.

 

The Trump Administration’s sabotage will punish Americans by jacking up premiums again, compounding the damage done last year, when Republican sabotage pushed rates up by 37 percent in Michigan.

• The Republican tax bill’s repeal of a key Affordable Care Act provision and the Trump Administration’s junk plan proposal will increase individual market premiums in Michigan by an average 12.2 percent this fall, according to a recent Urban Institute study.
• This sabotage-driven rate hike will make the damage Republicans inflicted last year through repeal attempts and sabotage even worse.
• Higher premiums will mean fewer working families can afford coverage: during the first year of the Trump Administration, millions more Americans joined the ranks of the uninsured – the highest increase since Gallup started tracking the uninsured rate. 

Despite Republican Sabotage, the Affordable Care Act Has Improved Michiganders’ Care.

• 293,940 Michiganders signed up for Marketplace coverage this year.
• Thanks to the Marketplace and Medicaid expansion, Michigan’s uninsured rate fell by 4.8 percent between 2013 and 2016 as Michiganders have gained access to affordable coverage.
• Before today’s announcement, the Urban Institute predicted that Michigan premiums for 2019 could rise 12.2 percent more because of the Trump Administration’s junk plan proposal and the Republican tax bill’s repeal of a key Affordable Care Act coverage incentive.
• Even despite sabotage, Affordable Care Act subsidies help keep coverage affordable for 83 percent of Michigan Marketplace consumers, whose average 2018 premium is $127 per month.
• But because of the Republican sabotage agenda, many middle-income Michiganders could pay hundreds or thousands of dollars more than they would have otherwise. 

Michiganders Won’t Forget That Republicans And The Trump Administration Keep Forcing Up Health Care Costs To Score Political Points.

• Health care costs are a top issue in nearly every major issue-ranked poll in 2018.
• Voters overwhelmingly trust Democrats over Republicans on health care costs.
• In poll after poll, voters resoundingly reject President Trump and Congressional Republicans’ repeal-and-sabotage campaign against the Affordable Care Act.

 

 

KEY QUOTES

America’s Health Insurance Plans: Administration’s DOJ Decision Would “Cause Rates To Go Even Higher For Older Americans And Sicker Patients.” “Zeroing out the individual mandate penalty should not result in striking important consumer protections, such as guaranteed issue and community rating rules that help those with pre-existing conditions. Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019. Instead, we should focus on advancing proven solutions that ensure affordability for all consumers. [AHIP, 6/8/18]

Associated Press: Administration’s Decision Could “Nudge Premiums Even Higher.” “The Trump administration’s decision to stop defending in court the Obama health law’s popular protections for consumers with pre-existing conditions could prove risky for Republicans in the midterm elections — and nudge premiums even higher.” [CNBC, 6/8/18]

Timothy Jost, Washington & Lee University Law Professor: Administration’s Decision Could Leave Millions Of Americans Facing “Denial Of Coverage Or Higher Premiums.” “Yesterday, the Trump administration’s Department of Justice dropped a bombshell in a rural Texas federal courthouse. The administration stated in a court filing (and also in letters to Congressional leaders) that it would not defend three key provisions of the Affordable Care Act (ACA). If the judge in the case agrees, millions of Americans with preexisting conditions could face denial of coverage or higher premiums.” [Commonwealth Fund, 6/8/18]

Ceci Connolly, Alliance Of Community Health Plans: Administration’s Decision Decision Could Spark Fresh Market Instability. “Ceci Connolly, president of the Alliance of Community Health Plans, called the legal position ‘troubling’ and warned it could spark fresh market instability. ‘At the very least it adds uncertainty at exactly the moment when plans are trying to set rates for next year,’ Connolly said in a statement. ‘At the worst, it could strip away guaranteed coverage for those with pre-existing conditions. We don’t want to return to the days when people who needed the care the most could be turned away because of their health status.’” [Modern Healthcare, 6/8/18]

Fortune: If Administration’s Decision Is Implemented, “There’s A Strong Change Insurers Would Begin Charging Sicker People Significantly More.” “To date, many low-income people have been shielded from those increases since federal subsidies to help pay premiums rise in tandem with the spikes. Middle-class families who don’t qualify for the subsidies are left either swallowing the higher premiums or forgoing coverage. If the protections for people with pre-existing conditions are ultimately shot down, there’s a strong chance insurers would begin charging sicker people significantly more for their coverage while younger and healthier Americans would see lower prices.” [Fortune, 6/11/18]

Former HHS Secretary Tom Price: GOP Actions Responsible For Premium Increases. “President Trump’s former top health official on Tuesday said the Republican tax law would raise the cost of health insurance for some Americans because it repealed a core provision of the Affordable Care Act. Tom Price, Trump’s first secretary of the Department of Health and Human Services, said people buying insurance on government-run marketplaces will face higher prices because the tax law repealed the ACA’s individual mandate. The mandate had forced most Americans to have health coverage or face a financial penalty. ‘There are many, and I’m one of them, who believes that that actually will harm the pool in the exchange market, because you’ll likely have individuals who are younger and healthier not participating in that market, and consequently that drives up the cost for other folks within that market,’ Price said at the World Health Care Conference in Washington.” [Washington Post, 5/1/18]

America’s Health Insurance Plans: Republican Sabotage Will “Drive Up The Rate Of Premium Increases. “Policies that disproportionately draw healthy consumers away from the individual market, like expanding access to short-term plans, will likely have an even more devastating effect on affordability, choice and competition. This will further result in adverse selection, drive up the rate of premium increases, and exacerbate affordability issues for many other people.” [America’s Health Insurance Plans Letter to HHS, 4/20/18]

CEO of CareFirst Blue Cross Blue Shield: Things Are “Materially Worse” Under Trump. “Continuing actions on the part of the administration to systematically undermine the market and make it almost impossible to carry out the mission…If continued efforts at the federal level undermine the marketplaces, I would think the board would have to examine what they would want — that’s very much on their mind.” [Washington Post, 5/1/18]

Lindsey Graham: Republicans “Own The Outcome” On Health Care. “Sen. Graham told Breitbart News, ‘In October, premiums are going up. Obamacare cannot be fixed. It’s going to continue to collapse, and then, we own the outcome. By repealing the individual mandate, which is a step forward in the eyes of the public, we own the issue. We have a responsibility to do something about the collapsing Obamacare system. I believe that we’re going to get blamed more than Democrats because we stopped trying to repeal Obamacare, and to suggest that we don’t own it is just simply politically naive.’ Graham continued, ‘It can hurt us in 2018. It can hurt by our base feeling like we betrayed them. It can hurt us from people suffering from Obamacare, like we don’t have a solution. It will energize Democrats. It can undercut everything we did on the tax cut side.’” [Breitbart, 2/6/18]

Rep. Charlie Dent: “We, The Republican Party…Own” Health Care Now. “Rep. Charlie Dent (R-Pa.) argued Friday that President Trump was ‘ill-advised’ to end key ObamaCare payments, warning that the GOP now ‘owns’ whatever happens to ObamaCare. ‘I think the president is ill-advised to take this course of action because … we, the Republican Party, will own this,’ Dent, a key House moderate who is retiring from Congress at the end of his term, said on CNN. Asked about Trump’s previous comments blaming problems with ObamaCare on former President Barack Obama, Dent pointed out that Republicans currently control the White House and have majorities in both chambers of Congress. ‘Barack Obama is a former president. President Trump is the president and he’s a Republican, and we control the Congress,’ Dent said. ‘So we own the system now. We’re going to have to figure out a way to stabilize this situation … This is on us.’” [The Hill, 10/13/17]

Washington Post: “The Pottery Barn Rule Comes To Mind: You Break It, You Own It.” “This is not ‘letting’ Obamacare fail. Many nonpartisan experts believe that these active measures are likely to undermine the pillars of the 2010 law and hasten the collapse of the marketplaces. The Pottery Barn rule comes to mind: You break it, you own it. Yes, the plate you just shattered had some cracks in it. But if you dropped it on the ground, the store is going to blame you.” [Washington Post, 10/13/17]

Washington Post: “Trump’s Not Going To Be Able To Avoid Blame For Kneecapping Obamacare.” [Washington Post, 10/13/17]

“After Months Of Pinning The Blame For Obamacare’s Shortcomings On Democrats And Watching His Own Party Fail To Act, President Donald Trump Just Took Ownership Of A Struggle That’s Consumed Republicans For Seven Years.” “After months of pinning the blame for Obamacare’s shortcomings on Democrats and watching his own party fail to act, President Donald Trump just took ownership of a struggle that’s consumed Republicans for seven years. Trump’s decision late Thursday to end government subsidies to insurers to help lower-income Americans afford to use their coverage under the Affordable Care Act was the most drastic step he’s taken to undermine his predecessor’s signature achievement. It also lobbed a live bomb into the laps of Republicans lawmakers 13 months before congressional elections after he publicly berated the party’s Senate leadership for being unable to keep a longstanding promise to repeal the law.” [Bloomberg, 10/13/17]

The American People Agree: President Trump And Congressional Republicans Are Playing Politics With People’s Health Care. A poll conducted last September found that 61 percent of voters believed President Trump was “trying to make the Affordable Care Act fail,” and 64 percent of voters said Trump is “playing politics with people’s health care.” The poll also found that the American people seriously disapprove of how Republicans in Congress are treating health care: 80 percent of voters disapprove while only 20 percent approve. [Hart Research, 9/5/17]

 

Washington, DC – After Florida Governor Rick Scott made one of the most outrageous and out-of-touch comments to date about the Trump Department of Justice’s new salvo in Republicans’ war on pre-existing condition protections, Protect Our Care Campaign Director Brad Woodhouse issued the following statement:

“Rick Scott served as a key advisor to the Trump administration’s repeal push last summer that would have gutted protections for the 130 million Americans with pre-existing conditions — including nearly eight million Floridians. After failing to repeal the law in Congress, the Trump Administration just took their latest and most dangerous step yet to repeal and sabotage our care, asking the courts to repeal of the Affordable Care Act’s protections for people with preexisting conditions – and as usual, Rick Scott refuses to stand up for the people in harm’s way.  

“Rick Scott’s ally, Florida Attorney General Pam Bondi, is one of the leaders of this dangerous anti-Affordable Care Act lawsuit. If the Trump DOJ and Pam Bondi win their case, protections for Americans with pre-existing conditions will disappear overnight, and insurance companies will once again be allowed to deny overage or  stick people with exorbitant medical bills. Asked for comment on providing affordable access to health care for those with pre-existing conditions, Scott implied that these people don’t deserve to have coverage, saying: ‘We’ve got to reward people for caring for themselves.’ This heartless comment is a new low point in Rick Scott’s long history of undermining health care for millions of Americans.”

RICK SCOTT HELPED DESIGN REPUBLICAN REPEAL EFFORTS THAT WOULD JEOPARDIZE ACCESS TO CARE FOR UP TO 130 MILLION AMERICANS WHO HAVE A PRE-EXISTING CONDITION

HEADLINE:  “Florida’s Rick Scott Says He’s Helping Trump Craft Replacement Health Care Plan.” [McClatchy, 1/18/17]

Rick Scott Was An Advisor To The Trump Administration On Plans To Repeal The ACA.  “ Kicking off a series of meetings with incoming Trump administration officials, Gov. Rick Scott said Wednesday he hopes to help them devise a less costly alternative to Obamacare. Scott said he’s talking with Donald Trump every week or two while working closely with Rep. Tom Price, the president-elect’s choice to run the government agency that oversees Medicaid, Medicare and the landmark 2010 health-insurance law.” [McClatchy, 1/18/17]

Rick Scott Continued To Push For Repeal Even After It Failed In The Senate. “Gov. Rick Scott, whose political career is largely defined by opposition to the Affordable Care Act, still wants Republicans to repeal the federal health care law despite their apparent failure to do so. ‘Floridians simply cannot afford the high taxes and mandates of Obamacare. This law needs to be repealed,’ Scott spokeswoman Kerri Wyland said in an emailed statement.  […] Since November, Scott has written four op-eds stressing the urgency of repealing Obamacare. ‘There is absolutely no question that Obamacare must be repealed immediately so Americans can actually afford to purchase health insurance,’ Scott wrote.” [Orlando Sentinel, 7/18/17]

Rick Scott Urged Repeal Of The ACA On “Day One” Of The Trump Administration.  “Florida Gov. Rick Scott (R) is ramping up pressure on Republicans in Congress to aggressively and immediately pursue a repeal of ObamaCare, despite any politically damaging effects. Scott said he made the case for a swift, full repeal of the healthcare law during a meeting Tuesday with Rep. Tom Price (R-Ga.), President-elect Donald Trump’s pick to lead the Department of Health and Human Services. ‘I want to have a repeal as quickly as we can get it done. Day one would be nice for me,’ Scott told reporters outside a downtown Washington, D.C., building being used by Trump’s transition team.” [The Hill, 12/13/16]

Rick Scott Called The AHCA “Way Better Than Obamacare” And Said He Would Do “Everything I Can” To Pass It.   “Gov. Rick Scott said Thursday the failed GOP health care bill was ‘way better than Obamacare’ and that he remains optimistic President Trump and Congress can get it done. ‘I’m going to do everything I can,’ Scott told Tampa Bay Times reporter Steve Contorno after an event in Tampa . ‘I talked to Secretary Price at HHS. I’ve been working with HHS to get more flexibility in our Medicaid program so we can provide care that our taxpayers can afford. I’m going to keep working with the president and vice president and I’m optimistic something will happen.’  ‘The House bill was way better than Obamacare,’ said Scott.” [Tampa Bay Times, 3/30/17]

REPUBLICAN REPEAL BILLS GUTTED PROTECTIONS FOR PRE-EXISTING CONDITIONS

The AHCA Allowed A Surcharge For People With Pre-Existing Conditions. The American Health Care Act would have allowed states to eliminate community rating, meaning insurers would be able to charge people with pre-existing conditions more. This surcharge could have been in the tens of thousands of dollars and even six figures: up to $4,270 for asthma, $17,060 for pregnancy, $26,180 for rheumatoid arthritis and $140,510 for metastatic cancer.

Graham-Cassidy Would Raise Costs For People With Pre-Existing Conditions. Graham-Cassidy would allow states to let insurance companies once again charge people with pre-existing conditions more, which could raise costs for up to 7,810,300 Floridians that have a pre-existing condition. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320, while it would be $142,650 more for patients with metastatic cancer.

NOW RICK SCOTT IS DODGING QUESTIONS ABOUT TRUMP’S LAWSUIT TO UNDO PROTECTIONS FOR PEOPLE WITH PRE-EXISTING CONDITIONS

HEADLINE: “Scott Mum On Trump’s Attack On Pre-existing Condition Provision” [Politico, 6/11/18

Florida’s Attorney General Joined The Suit To Undo Protections For People With Pre-Existing Conditions.  “[Florida Attorney General Pam Bondi signed on this year to the lawsuit challenging the Affordable Care Act. The litigation gained new urgency last week after the Trump administration said it would not defend key portions of the law. Whitney Ray, a spokesman for Bondi, said the attorney general believes people with pre-existing conditions should have access to coverage. ‘But Congress must act in accordance with the U.S. Constitution when addressing the issue,’ Ray said in a written statement.” [WUSF, 6/14/18]

June 13:  Rick Scott Refused To Say Whether He Supported Trump’s Lawsuit.  “Gov. Rick Scott would not directly say Wednesday whether he supports a Trump administration move that critics say could wipe away health care protections for pre-existing conditions — a cornerstone of Obamacare — while saying he believes such protections are needed.” [Tampa Bay Times, 6/13/18]

June 11: Scott Refused To Criticize The Trump Administration Lawsuit.  “Gov. Rick Scott said he supports insurance coverage for pre-existing conditions, but he declined on Monday to criticize the Trump administration’s court effort to gut the provision from Obamacare. The Trump administration on Thursday sided with conservative states seeking to do away with the Affordable Care Act’s ban on insurers charging people more or denying them coverage based on pre-existing conditions. Though the action to further attack Obamacare in the courts generated significant publicity and could affect as many as seven million Floridians, Scott said he didn’t know enough about it to comment fully. ‘I don’t know much about that court case and I heard — somebody just said — that the president tweeted something or did something about that,” Scott said at an event in South Florida on Monday.’” [Politico, 6/11/18]

Rick Scott On Care For People With Pre-existing Conditions:  “We’ve Got To Reward People For Caring For Themselves.”  “‘I believe that if you have a pre-existing condition, you need to still be able to get health care, so it’s very important to me,’ Scott told reporters in Tallahassee. ‘I think everybody ought to be able to get health care insurance. I do believe that you’ve got to start working to fix the law and that law caused our premiums to skyrocket. But I don’t believe in grand bargains, I believe in incrementally trying to make change. We’ve got a lot more competition … We’ve got to reward people for caring for themselves.’” [Tampa Bay Times, 6/13/18]