Washington DC — According to the newly released transcript of President Trump’s interview with The New York Times, Trump boasted that his Texas lawsuit will “terminate” the Affordable Care Act and that was a political “victory” for him and Republicans in Congress. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:
“President Trump confirmed what we all know to be true: he and Republicans are using the Texas lawsuit to overturn the entire Affordable Care Act – eliminating all the protections for people with pre-existing conditions – with no plans for a replacement. Voters overwhelmingly rejected Trump’s health care repeal and sabotage agenda back in November, yet President Trump and his allies in Congress are dead set on accomplishing through the courts what they couldn’t do legislatively: fully repeal the law, devastate American health care and leave millions of Americans at risk.”
Yesterday, House Oversight Chairman Elijah Cummings kicked off the new Health Care Congress by taking a stand for Americans and standing up to the drug companies. Cummings explained that when these drug companies (some of the most powerful corporations in the world) raise prices suddenly, everyday Americans are “left holding the bill.” That’s why we proposed in our Health Care Agenda that Congress should end price gouging and lower prescription drug prices for all Americans. We look forward to working with this health care Congress as they fight to push our health care system in the right direction.
Washington DC — As reported by health care analyst Charles Gaba, the state-based exchanges have broken an all-time enrollment record despite the Trump administration’s relentless attempts to sabotage access to coverage. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response:
“Millions of Americans rely on the Affordable Care Act for quality coverage and today’s announcement is evidence that the American people want and need coverage through the exchanges despite constant sabotage from the Trump administration. The fact that states who manage their own marketplaces saw record-breaking numbers this year while federal marketplaces saw a substantial decline is all the evidence one needs to prove that President Trump’s repeal-and-sabotage agenda is hurting millions of Americans.”
With Covered California releasing their final, official 2019 Open Enrollment Period data, and the latest updates from New York (which still has 2 days to go) and Massachusetts (which wrapped up last week), I now nearly all 2019 OEP data on hand.
I say nearly all because there are still three numbers missing:
Vermont has yet to release any 2019 enrollment data. This is the 3rd year in a row that they’ve been radio silent. Assuming they’re close to last year (28,763 QHP selections), they should add around 28,000 to the national total.
New York still has 2 days left for people to #GetCovered. I’m going to assume they’ll tack on perhaps 5,000 more people today and tomorrow.
The District of Columbia hasn’t posted any updates since December 11th, which means not only do they still have 2 days for people to sign up, they’re actually missing a whopping 51 days worth of enrollment data. Again, assuming they wrap up close to last year, that should mean another 1,400 or so from DC.
Between the three, I’d expect another ~34,000 QHP selections to be tacked onto the totals below.
However, even without that, the 12 state-based exchanges have collectively broken their all-time record for ACA Open Enrollment, racking up more than 3,018,000 QHP selections this season.
Here’s what that looks like visually…and the contrast between the Federal Exchange and the State-Based Exchanges is dramatic:
After a dramatic enrollment increase in 2015 and a lesser increase in 2016, the 39 states hosted by HC.gov have seen a gradual, steady decline each year since. They closed out the 2019 Open Enrollment Period with 1.3 million fewer people having signed up than at their peak in 2016. Perhaps 200,000 or so of this was due to Louisiana and Virginia expanding Medicaid in recent years, but that does nothing to explain the other 1.1 million drop-off, which is almost certainly due to having the HC.gov marketing & outreach budgets being slashed to the bone, the Open Enrollment Period being cut in half and so forth.
Meanwhile, the 12 states which operate their own full ACA exchanges (and which have their own marketing/outreach budgets) saw less-dramatic increases in 2015 & 2016…but they’ve collectively stayed virtual dead even for every year since then. In fact, when the dust settles on the 2019 Period, I expect the 12 state-based exchanges to reach around 3.05 million QHP selections, which would be 1.5% higher than last year and 1.3% higher than their collective all-time high in 2017.
The fact of the matter is simple: association health plans (AHPs) are not required to cover the essential health benefits put in place by the Affordable Care Act and are allowed to charge people more based on their age, health status, and gender. This means that while AHPs are required to cover people with pre-existing conditions, they can refuse to cover any treatment associated with a pre-existing condition. Because these plans lack consumer protections, plans that do cover essential health benefits could scale back coverage at some point, and consumers wouldn’t know until it was too late. Fundamentally, association health plans open the door to coverage that is not comprehensive and have a long, well-documented history of fraud and abuse.
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]
Between 2000 and 2002, AHPs Left 200,000 Policyholders with $252 Million In Unpaid Medical Bills. “There have been several documented cycles of large-scale scams. According to the GAO, between 1988 and 1991, multiple employer entities left 400,000 people with medical bills exceeding $123 million. The most recent cycle was between 2000 and 2002, as 144 entities left 200,000 policyholders with $252 million in unpaid medical bills.” [United Hospital Fund, 3/6/18]
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]
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]
STATE INSURANCE OFFICIALS, EXPERTS HAVE WARNED OF SUCH FRAUD UNDER NEW RULES
As Coalition Urges States To Allow AHPs, State Officials Push Back, Warn Of Fraud. “A coalition of business groups wants to ensure that the states aren’t setting up hurdles that will make it difficult for small employers to participate in group health plans established under a new rule by the U.S. Labor Department… [Pennsylvania Insurance Commissioner Jessica Altman] reminded the DOL before the rule was finalized about the history of fraud among past association health plans. She wasn’t the only official in Pennsylvania to oppose the plans. Attorney General Josh Shapiro also pushed back against the rule, joining 11 other attorneys general in a lawsuit against the DOL and the U.S.” [Bloomberg, 9/11/18]
State Insurance Commissioners Want To Know What Restrictions They Can Put On AHPs. “But given the looming sales of AHPs, state regulators want to know as soon as possible what restrictions they can place on the plans. They fear the Trump administration may argue that state regulation is pre-empted by the federal Employee Retirement Income Security Act, which governs self-insured employer health plans…The states that so far have issued new rules or policy statements limiting AHPs are Democratic-led states. But insurance regulators in both red and blue states are nervous about an expansion of AHPs given the long history of fraud and insolvencies involving these types of plans.” [Modern Healthcare, 8/7/18]
Dr. James Madara, CEO of the American Medical Association: Association Health Plans Have Potential To Threaten Health And Financial Stability. “Fraudsters prey upon areas of regulatory ambiguity and may challenge such authority in courts to further delay enforcement, which allows more time to increase unpaid medical claims…Without proper oversight to account for insolvency and fraud, AHPs have the potential to … (threaten) patients’ health and financial security and the financial stability of physician practices and other providers.” [Modern Healthcare, 3/7/18]
Insurance Commissioners Have Had Difficulty Finding Answers On The Ground About Association HealthPlans.“‘We’re asking questions and finding it very difficult to get answers,’ said Washington state Insurance Commissioner Mike Kreidler.” [Politico, 8/6/18]
ASSOCIATION HEALTH PLANS DON’T HAVE TO OFFER 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]
Washington DC — Today, the Ways and Means Committee held a hearing on Protecting Americans with Pre-existing Conditions. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in reaction to today’s committee hearing:
“We congratulate Chairman Neal and House Democrats for kicking off the Health Care Congress with the issue that brought them into the majority – affordable access to health care and, specifically, protecting people with pre-existing conditions from discrimination by insurance companies. It is heartening to hear so many members committed to maintaining and strengthening protections for people with pre-existing conditions. Today’s discussion sends a strong signal that House Democrats are focused on eliminating threats like junk plans and doing more to lower the cost of care for Americans.Voters put Democrats in the majority in the House to protect and improve their care. Democrats understand they have a responsibility to deliver. If today’s hearing is any indication, they have every intention of doing so.”
Washington, DC — Today, Centers for Medicare & Medicaid Services Administrator Seema Verma gave a speech at the CMS Quality Conference in Baltimore, Maryland where she tried to affirm the administration’s commitment to Medicaid, despite the multiple efforts orchestrated by Verma to sabotage and undermine the program.
In response, Brad Woodhouse, executive director of Protect Our Care, released the following statement:
“Seema Verma’s comment today is, plain and simple, a bald-faced lie. This administration has worked against Medicaid at every turn. Indeed, not since Medicaid was signed into law more than 50 years ago has there been an administration or an Administrator more hostile to Medicaid than the Trump administration and Seema Verma. The Trump administration supports so-called work requirements like those in Arkansas which has already ripped coverage away from 18,000 people, opposed Medicaid expansion in states across the country, and advocated for the block granting of Medicaid which is a euphemism for slashing its budget and kicking people off the rolls.
Fortunately, the American people have a different view: Medicaid has never been more popular. The attacks on Medicaid by this administration and its Republican allies led in large part to the defeat of the ACA repeal effort. And, during the 2019 election, voters across the country rejected the Republicans’ sabotage agenda and either expanded Medicaid at the polls or elected pro-Medicaid politicians who promised to do so in office. The truth is, Medicaid is flourishing despite this administration’s efforts to undermine it and no type of Orwellian spin from Administrator Verma can change that.”
In his new op-ed defending the Trump administration’s failures on drug pricing published in Stat this morning, Secretary Alex Azar rambled about drug pricing without acknowledging any of the ways the Trump administration has time and again protected the rigged system that makes the drug companies even richer, while making people who work for a living pay higher prices for drugs.
Pharmaceutical Companies Have Reaped Billions Of Dollars From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone.Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. According to Axios, nine pharmaceutical companies are spending a combined $50 billion on new share buyback programs.
The Administration Has Consistently Advocated For The Repeal Of The Affordable Care Act, Including Its Requirement That Insurance Companies Cover Prescription Drugs. After the Trump administration tried and failed to repeal the ACA legislatively, it took to the courts in hopes of eliminating the health law. In 2018, the Justice Department decided not to defend the Affordable Care Act in court against a lawsuit seeking to overturn it. Since, a federal judge has ruled to overturn the law, including its requirement that insurance companies cover patients’ prescription drugs.
One Trump Administration Proposal Would Let Insurance Companies Stop Covering Brand Name Drugs, Which Some Consumers Rely On. Under the proposal, consumers who rely on brand-name prescription drugs when generics are available would face higher costs. Insurance companies would be able to calculate a consumer’s out-of-pocket spending based solely on generic equivalents of brand-name drugs, meaning if a brand name drug had a $25 co-pay associated with it and the generic version had a $5 co-pay, if a consumer paid a $25 co-pay on a brand-name drug the insurance company would only have to include the $5 co-pay associated with the generic in the consumer’s out-of-pocket spending. This means consumers who rely on brand-name drugs have to pay significantly more in out-of-pocket costs to get the medication they need. Advocates, such as Carl Schmid of the AIDS Institute have warned that this proposal “increases the likelihood that people won’t pick up their drugs, won’t take their drugs.”
Trump Installed Big Pharma Executives In Key Administration Posts. The author of op-ed, Alex Azar himself is a former Eli Lily executive. Trump’s appointment of Scott Gottlieb at FDA was described as “music to pharma’s ears.” Other pharma lobbyists writing Trump’s health policy include senior adviser at FDA, Keagan Lenihan, who joined the administration after lobbying for the drug distribution giant McKesson, former Gilead lobbyist, Joe Grogan, who reviews health care regulations at the Office of Management and Budget and is expected to soon lead the White House’s Domestic Policy Council, and Deputy Assistant to the President for Domestic Policy Lance Leggitt, who has lobbied for a variety of drug-industry clients.
Trump’s Proposals Always Fall Far Short Of His Promises. President Trump promised that he would allow Medicare to use its buying power to negotiate drug prices directly with suppliers, but after meeting with pharmaceutical executives early in 2017, Trump abandoned that pledge, calling it “price fixing” that would hurt “smaller, younger companies.”
In The Past Year, Drug Companies Have Seen Massive Profits And Price Increases. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion — the highest of any publicly traded health care company. Of the 19 companies that tallied at least $1 billion of third-quarter profit, 14 were drug companies. Meanwhile, pharmaceutical companies continue to increase prices. In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills. All in all, nearly 30 drugmakers are expected to raise prices in 2019. One drug industry lobbyist has said that drug companies’ limited concessions are “a calculated risk” summarizing big pharma’s strategy to play the Trump administration: “take these nothing-burger steps and give the administration things they can take credit for.”
The Trump administration recently announced the renomination of 51 nominees to the federal bench, including Chad Readler for the Sixth Circuit Court of Appeals. In his role as Acting Assistant Attorney General, Readler overruled career attorneys at the Department of Justice and filed a brief on behalf of the Trump administration in Texas v. United States arguing in favor of striking down the Affordable Care Act, including its protections for people with pre-existing conditions.
Let’s be clear, Readler’s anti-health care record speaks for itself:
READLER AUTHORED THE TRUMP ADMINISTRATION’S ASSAULT ON THE AFFORDABLE CARE ACT IN TEXAS V. UNITED STATES
Readler Filed The Trump Administration’s Brief In Texas V. United States To Strike Down The ACA. In his role as Acting Assistant Attorney General, Raedler filed the Trump administration’s brief in Texas V. United States arguing that the court should enter “a declaratory judgment that the ACA’s provisions containing the individual mandate as well as the guaranteed issue and community-rating requirements will all be invalid beginning on January 1, 2019.” [Federal Defendants’ Memorandum in Response to Plaintiffs’ Application for Preliminary Injunction, Texas v. United States of America,6/7/18]
Readler Was Nominated For A Judicial Seat The Same Day He Filed The Brief Calling For The ACA To Be Overturned. “If confirmed, Chad A. Readler of Ohio will serve as a Circuit Judge on the U.S. Court of Appeals for the Sixth Circuit. Chad Readler currently serves as the Principal Deputy and Acting Assistant Attorney General for the Civil Division at the U.S. Department of Justice, a position that he has held since 2017. In that role, Mr. Readler has lead and supervised the Department’s largest litigating division and has actively briefed and argued several cases on behalf of the United States in federal courts across the country.” [White House Press Release,6/7/18]
Readler Was Renominated For The Bench In January 2019. “Today President Donald J. Trump announced his intent to nominate the following judicial nominees: […] Chad A. Readler, of Ohio, to be United States Circuit Judge for the Sixth Circuit.” [White House Press Release, 1/22/19]
Republicans And Career DOJ Officials Refused To Have Anything To Do With Readler’s Arguments
Republican Lamar Alexander Called Readler’s Argument “As Far Fetched As Any I’ve Ever Heard.” “Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, called the Trump administration’s argument against ObamaCare in a court case ‘as far-fetched as any I’ve ever heard.’ The Justice Department (DOJ) wrote in a filing Friday that it would not defend ObamaCare’s protections for people with pre-existing conditions, siding in large part with a challenge to the law brought by a coalition of Republican-led states. The states, and the DOJ, argue that Congress’s repeal of the tax penalty associated with ObamaCare’s individual mandate makes the law’s protections for people with pre-existing conditions unconstitutional Alexander said it wasn’t the intent to take away protections for people with pre-existing conditions when the mandate penalty was repealed late last year. ‘There’s no way Congress is going to repeal protections for people with pre-existing conditions who want to buy health insurance. The Justice Department argument in the Texas case is as far-fetched as any I’ve ever heard,’ Alexander said in a statement late Tuesday evening.” [The Hill,6/12/18]
A 20 Year Veteran Of The DOJ Resigned In The Wake Of Readler’s Brief. “A senior career Justice Department official has resigned in the wake of the Trump administration’s move to stop defending a key provision of the Affordable Care Act, a departure that highlights internal frustration generated by the decision, according to people familiar with the matter. Joel McElvain, who has worked at the Justice Department for more than 20 years, submitted his resignation letter Friday, the morning after Attorney General Jeff Sessions notified Congress that the agency will not defend the ACA — the 2010 law known as Obamacare — against lawsuits brought by Republican-led states challenging its requirement that most Americans carry health insurance.” [Washington Post,6/12/18]
Two Career Attorneys At DOJ Asked To Be Withdrawn From Readler’s Brief. “Just before the brief was filed, McElvain and two other career attorneys, Eric Beckenhauer and Rebecca Kopplin, filed a motion to withdraw from the case. Asked about the withdrawal of the attorneys, a Justice official said: ‘As is customary, the department decided to sub in a new legal team for a new legal position.’ The official said she was not aware of any indication that the other two attorneys were departing.” [Politico, 6/13/18]
An Ideologically Diverse Group Of Legal Scholars Said Readler’s Arguments “Violate Basic Black-Letter Principles” Of Law. “Under these circumstances, 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.” [Brief of Amici Curiae Jonathan H. Adler, Nicholas Bagley, Abbe R. Gluck, Ilya Somin, and Kevin C. Walsh in Support of Intervenors-Defendants’ Opposition to Plaintiffs’ Application for Preliminary Injunction, Texas v. United States of America,6/14/18]
THE TEXAS CASE PUTS THE HEALTH CARE OF MILLIONS OF AMERICANS AT RISK
Republican officials — supported by the Trump administration in the brief authored by Chad Readler — in 20 states went to federal court in the northern district of Texas to repeal the Affordable Care Act in its entirety. In a December 2018 ruling, U.S. Northern District Court Judge Reed O’Connor used the courts to do what Republicans in Congress failed to do legislatively: strike down the Affordable Care Act. If O’Connor’s ruling is not overturned, it will rip coverage from millions of Americans, raise costs, end protections for people with pre-existing conditions, put insurance companies back in charge, and force seniors to pay more for prescription drugs. The result will be to — as the Trump Administration itself admitted in Court — unleash “chaos” in our entire health care system.
If The Texas Ruling Is Not Overturned, 17.1 Million People could Lose Their Coverage
According to the Urban Institute, 17.1 million people would lose coverage in the first year by repealing the Affordable Care Act, leading to a50 percent increase in the uninsured rate.
If The Texas Ruling Is Not Overturned, Insurance Companies Could Be Put Back In Charge, Ending Protections For The 130 Million People With A Pre-Existing Condition
According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 130 million people, have a pre-existing condition. This includes:
44 million people who have high blood pressure
45 million people who have behavioral health disorders
44 million people who have high cholesterol
34 million people who have asthma and chronic lung disease
34 million people who have osteoarthritis and other joint disorders
17 million children. One in fourchildren, or roughly 17 million, have a pre-existing condition.
68 million women. More than half of women and girls nationally have a pre-existing condition.
30 million people aged 55-64. 84 percent of older adults, 30.5 million Americans between age 55 and 64, have a pre-existing condition.
If The Texas Ruling Is Not Overturned, Insurance Companies Could Have the Power to Limit the Care You Get, Even If You Have Insurance Through Your Employer
Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.
Reinstate Lifetime and Annual Limits. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage.
Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.
AT HIS CONFIRMATION HEARING, READLER ATTEMPTED TO DOWNPLAY HIS INVOLVEMENT IN THE BRIEF CALLING FOR THE ACA TO BE STRUCK DOWN
Readler Denied That He Was The “Primary Author” Of The Brief Calling For The ACA To Be Struck Down. Mike Lee: Now, as acting assistant attorney general over the Civil Division or as the PDAG were you the primary author of briefs involving some of the cases that have been brought to the public’s attention in connection with your confirmation including the treatment of — in cases involving the treatment of pre-existing conditions under the Affordable Care Act, the separation of unaccompanied alien children from their parents, the so-called Entry Ban DACA litigation or sanctuary cities. Chad Readler: Senator, I wouldn’t call myself the primary author. As the head of the division my name would go on every single brief that the division would file. That could be 20 or 30 briefs a day. Depending on the case I may have had different levels of involvement with the case. I may not have looked at briefs, I may not have, but again it’s tradition at the department that the head of the division goes on every, name, goes on every single brief.” [Senate Judiciary Committee Hearing on Pending Nominations, 10/16/18]
Readler Defended The Brief: “We Would Not Make An Argument If I Thought It Was Unethical Or Frivolous.” “Pat Leahy: You do stand by those arguments today that the Affordable Care Act cannot be reasonably defended? Chad Readler: Senator, the position that the attorney general took is that the mandate was unconstitutional and… Leahy: Will you stand by those arguments today? Readler: Senator, it is my position to advocate for the United States. We would not make an argument if I thought it was unethical or frivolous.” [Senate Judiciary Committee Hearing on Pending Nominations, 10/16/18]
Readler On Whether Millions Of People With Pre-Existing Conditions Could Lose Health Coverage If His Position Prevailed: “The Attorney General Was Clear About What The Legal Position For The Department Would Be. And We’ve Advocated That Position.” “Maisie Hirono: You’ve been asked a number of questions about your role in Texas versus United States. So if your argument – let me start with the protections of preexisting conditions under the ACA. If your argument on pre-existing condition prevails, would it mean that one in four people who have pre-existing conditions, millions of people in our country including women who have been pregnant possessing the pre-existing condition? Of course, people with asthma, diabetes, cancer. Doesn’t it mean that if your argument prevails that all of these people with pre-existing conditions will either lose their health insurance altogether or have to pay much, much more for health insurance? […] Chad Readler: So senator, healthcare is a very important policy issue in this country. I agree there are a lot of individuals and families facing very serious healthcare conditions. With respect to the legal issues, I’m not a policymaker, but with respect to legal issues in those cases, or in that case, the attorney general was clear about what the legal position for the department would be. And we’ve advocated that position.” [Senate Judiciary Committee Hearing on Pending Nominations, 10/16/18]
Gallup’s quarterly health survey reveals that the uninsured rate has risen to the highest rate since the Affordable Care Act’s coverage expansion was completed. A major reason for this increase? Trump’s relentless health care sabotage. Take a look for yourself:
Gallup’s Own Release Cites Trump Administration Sabotage In Its Explanation Of The Rising Uninsured Rate: “The Open Enrollment Periods Since 2018 Have Been Characterized By A Significant Reduction In Public Marketing And Shortened Enrollment Periods Of Under Seven Weeks, About Half Of Previous Periods.” Among the factors Gallup cites as playing a role in the increase of the uninsured rate:
Increasing Premiums: “One may be an increase in the rates of insurance premiums in many states for some of the more popular ACA insurance plans in 2018 (although most states saw premiums stabilize for 2019).” [Gallup, 1/23/19]
Major Cuts To Open Enrollment: “The open enrollment periods since 2018 have been characterized by a significant reduction in public marketing and shortened enrollment periods of under seven weeks, about half of previous periods.” [Gallup, 1/23/19]
Slashed Funding For Navigator groups: “Funding for ACA ‘navigators’ who assist consumers in ACA enrollment has also been reduced in 2018 to $10 million, compared with $63 million in 2016. Overall, after open enrollment in the ACA federal insurance marketplace (i.e., healthcare.gov) peaked in 2016 at 9.6 million consumers, it declined by approximately 12.5%, to 8.4 million in 2019, based on recently released figures.” [Gallup, 1/23/19]
Trump’s Hostility To The ACA: “Other potential factors include political forces that may have increased uncertainty surrounding the ACA marketplace. Early in his presidency, for example, President Donald Trump announced, ‘I want people to know Obamacare is dead; it’s a dead healthcare plan.’ Congressional Republicans made numerous high-profile attempts in 2017 to repeal and replace the plan. Although none fully succeeded legislatively, the elimination of the ACA’s individual mandate penalty as part of the December 2017 Republican tax reform law may have reduced participation in the insurance marketplace in the most recent open enrollment period. Trump’s decision in October 2017 to end cost-sharing reduction could also potentially have affected the uninsured rate.” [Gallup, 1/23/19]
Los Angeles Times: Uninsured Rate Under Trump Surges To Highest Level Since Obamacare Began. “The percentage of American adults without health insurance surged upward in 2018, reaching levels not recorded since before President Trump took office, according to a new national survey that revealed widespread coverage losses over the last two years…The new number represents the highest uninsured rate since the beginning of 2014, when the Affordable Care Act began providing billions of dollars in aid to help low- and middle-income Americans get covered, according to the survey by Gallup. The new report also indicates that some 7 million American adults have likely lost or dropped coverage since 2016…Since taking office, however, Trump has repeatedly attacked the healthcare law and enthusiastically backed a 2017 effort by congressional Republicans to roll it back.” [Los Angeles Times, 1/23/19]
HuffPost: The Uninsured Rate Is The Highest It’s Been In Five Years. “About 7 million fewer Americans had health insurance at the end of last year compared with two years prior, and the share of people who are uninsured is the highest it’s been since 2014, according to a new survey…Since his first day in office, Trump has directed and overseen policies that undermine the health insurance exchanges. The administration has dramatically reduced funding for advertising, marketing and outreach to draw eligible customers to the exchanges during open enrollment and for programs that help consumers navigate the sign-up process. The Republican tax package Trump enacted in 2017 repealed the Affordable Care Act’s fines on people who didn’t obtain health coverage under the law’s individual mandate, freeing people to go uninsured without penalty and causing insurers to increase prices on the assumption that healthier people are less likely to buy coverage in the absence of fines. Perhaps most consequentially, Trump ended payments to health insurance companies serving the lowest-income customers, which led insurers to increase prices to make up for the lost revenue.” [HuffPost, 1/23/19]
Vox: Under Trump, The Number Of Uninsured Americans Has Gone Up By 7 Million. “Certain demographic groups are experiencing a greater loss of coverage than others. Gallup data shows, for example, that Americans who are younger and lower-income have seen a greater decline in insurance coverage than those who are older and wealthier. Women have had insurance rates decline more quickly than men. This trend is especially surprising given that over the same time period, the unemployment rate has been declining. Usually, when more people have jobs, it means more people with access to employer-sponsored health insurance. But even during this period of job growth, America’s uninsured rate keeps climbing.” [Vox, 1/23/19]
Forbes: Uninsured Rate Hits Four-Year High Amid Trump’s Obamacare Attacks. “The rate of Americans without health insurance has ‘risen steadily’ to 13.7% from 10.9% in 2016 , data released Wednesday as part of Gallup’s national “health and well-being index,” which drew from a quarterly data sample of about 28,000 adults…Following his 2016 election, Donald Trump swept into the White House in January of 2017, promising to repeal and replace the ACA, also known as Obamacare. That effort was a failure because the Republican-led Congress of 2017 was unable to repeal the law nor did GOP lawmakers come up with a replacement plan. But the Trump White House has made several policy moves that the Gallup analysis indicates has contributed to fewer people having coverage. ‘The open enrollment periods since 2018 have been characterized by a significant reduction in public marketing and shortened enrollment periods of under seven weeks, about half of previous periods,’ Gallup’s analysis said.” [Forbes, 1/23/19]
CNBC: Rate Of Americans Without Insurance Rises To 4-year High As Trump Weakens Obama Health Law, Gallup Survey Finds. “The percentage of U.S. adults without health insurance reached a four-year high in the last quarter of 2018, but was still well below the peak level seen before Medicaid expansion under the Affordable Care Act in 2014, a new Gallup survey published Wednesday found. The national uninsured rate climbed to 13.7 percent in the fourth quarter of 2018, its highest level since the first quarter of 2014 when the rate reached 13.4 percent, according to data the compiled from Gallup. Women and adults under the age of 35 reported among the highest rates without insurance at 12.8 percent and 21.6 percent, respectively, the survey found.” [CNBC, 1/23/19]
Axios: “Gallup’s Quarterly Health Surveys Tell A Pretty Clear Story, Which It Attributes To The Trump Administration’s Handling Of The ACA.” “The number of Americans without health insurance has been creeping higher throughout the Trump administration, and it’s now the highest it’s been since the Affordable Care Act’s coverage expansion took effect in 2014, according to Gallup’s latest survey…Women, lower-income households and young people saw the biggest coverage losses, according to Gallup…Gallup’s quarterly health surveys tell a pretty clear story, which it attributes to the Trump administration’s handling of the ACA.” [Axios, 1/23/19]
The 2018 midterms were a referendum on health care and voters rejected the sabotage and repeal approach of Donald Trump and Republicans in Congress.
According to the newKaiser Family Foundation Health Tracking poll, opposition continues to grow against Republicans for putting the needs of their health insurance contributors ahead of the needs of people who work for a living.
People reject Trump’s lawsuit to overturn ACA. By 10 points (41-51%), voters disapprove of the right-wing TX judge backing the Trump administration’s lawsuit to overturn the Affordable Care Act. When people hear that the Trump administration lawsuit means “people with pre-existing conditions may have to pay more for coverage or could be denied coverage,” they shift to opposing it by 39 points (25-64%)
People want action to protect coverage for those with pre-existing conditions, lower the cost of prescription drugs, and protect consumers against surprise medical bills. 82% of voters say it’s either extremely (54%) or very important (28%) that this Congress take action to lower prescription drug costs. 73% say it’s either extremely (46%) or very important (27%) that this Congress take action to protect coverage of those with pre-existing conditions. 70% of voters say it’s either extremely (43%) or very important (27%) that Congress work to protect people with health insurance from surprise high out-of-pocket medical bills.
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