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Last month, Republicans got a thumping at the polls in large part due to their continued health care repeal-and-sabotage efforts. Health care was the top issue among voters of all backgrounds, who handed Democrats control of the House, flipped seven governors’ mansions, and elected to expand health care, even in deep red states. Unfortunately, Republicans across the country and the Trump Administration didn’t get the memo, and their reckless agenda has continued unabated.

Here’s what they’ve been up to, and how their actions are harming Americans:

1. THE TRUMP ADMINISTRATION’S SABOTAGE OF OPEN ENROLLMENT IS PREVENTING INDIVIDUALS FROM OBTAINING COVERAGE

As open enrollment comes to its conclusion, individuals attempting to obtain coverage for 2019 have once again been harmed by Administration’s rampant sabotage efforts. The Administration slashed the sign-up period in half, cut navigator funding by 84 percent, pushed enrollment for junk plans which charge more money for less care and can deny coverage to people with pre-existing conditions, and again scheduled maintenance during the sign-up period. Taken together, these actions are expected to reduce Americans’ access to care, which national data is bearing out: A recent analysis of the first month of this year’s open enrollment period  found that enrollment was down nearly 13 percent compared to last year.

2. THE TRUMP ADMINISTRATION HAS KICKED THOUSANDS OF AMERICANS OFF THEIR HEALTH INSURANCE

The Trump Administration has doubled down on imposing onerous Medicaid requirements designed to make it even harder for Americans to access health care. On Sunday, the Administration filed a motion to dismiss a lawsuit over its Arkansas-approved waiver, which has kicked more than 12,000 Arkansans off of their health insurance since its approval just three months ago.

Two weeks ago the Administration re-approved a Kentucky waiver containing work requirements, previously rejected by a federal judge who ruled the state failed to consider whether it would “in fact [help furnish] medical assistance to its citizens” and was estimated to kick 95,000 Kentuckians off of their insurance.”

The Administration has approved similar waivers in Indiana, New Hampshire, and Wisconsin, all of which will kick Americans off of their insurance while failing to promote work, as study after study has shown.

3. THE TRUMP ADMINISTRATION IS PUSHING STATES TO ALLOW INSURANCE COMPANIES TO SELL JUNK PLANS THAT CIRCUMVENT CRUCIAL PROTECTIONS AMERICANS DEPEND ON

Last week, the Trump Administration issued new insurance guidance, encouraging states to “tear down pillars” of the Affordable Care Act. This move would allow federal subsidies to be used to purchase junk plans that are not required to cover pre-existing conditions, hospitalization, or prescription drugs. What will this mean?

• Larry Levitt, Senior Vice President of Kaiser Family Foundation: 1332 waiver guidance gives states much the same flexibility as repeal would. [Business Insider, 10/22/18]
• Timothy Jost, Washington and Lee University Law Professor: “Invariably, the coverage is going to be more expensive for people who really need comprehensive coverage.” [Kaiser Health News, 11/29/18]
• American Lung Association: New 1332 waiver guidance “Would further erode patient protections, undermine care for people with lung disease.” [American Lung Association, 11/29/18]
• HuffPost: Rule change “almost certainly means that, overall, people with serious medical problems are likely to have a harder time finding coverage.” [HuffPost, 10/22/18]
• Axios: Administration’s waiver “could add up to one of its most substantive blows yet against the affordable care act.”  [Axios, 10/23/18]

4. THE TRUMP ADMINISTRATION ALSO APPEARS TO BE STEERING MEDICARE BENEFICIARIES TO PRIVATE PLANS

In another potential giveaway to Big Insurance from the Trump Administration, emails sent to Medicare beneficiaries by HHS appear to be steering them to private Medicare Advantage programs, over Medicare. Said Richard S. Foster, formerly the nonpartisan actuary of the Medicare program, told the New York Times the emails sounded “more like Medicare Advantage plan advertising than objective information from a public agency.”

5. THE TRUMP ADMINISTRATION HAS CAUSED THE CHILDREN’S UNINSURED RATE TO DRASTICALLY INCREASE FOR THE FIRST TIME IN YEARS

Last week, the Georgetown University Center for Children and Families released a new report on the uninsured rate for children, and for the first time, the number and rate of uninsured children in the United States went up. Trump-GOP health care sabotage are chief among the reasons for the increase.

6. THE TRUMP ADMINISTRATION CONTINUES TO TRY TO END PRE-EXISTING CONDITIONS PROTECTIONS IN COURT, AS PART OF A COORDINATED GOP EFFORT TO REPEAL THE AFFORDABLE CARE ACT AND RIP HEALTH CARE AWAY FROM MILLIONS

Any day now, a conservative federal judge in Texas is expected to rule on a lawsuit filed by a coalition of Republican attorneys general, and supported by the Trump Administration, that is designed to overturn the Affordable Care Act, including its protections for people with pre-existing conditions.

7. WISCONSIN REPUBLICANS ARE TRYING TO DENY THE DULY ELECTED INCOMING DEMOCRATIC GOVERNOR AND ATTORNEY GENERAL THE AUTHORITY TO PULL WISCONSIN OUT THE LAWSUIT TO OVERTURN THE ACA AND END PRE-EXISTING CONDITIONS PROTECTIONS

Despite polls showing health care was the top issue for Wisconsin voters — and that they overwhelmingly favored Democrats on it, propelling them to victory in statewide race — Wisconsin Republicans passed legislation that seeks to deny the duly elected incoming Democratic Governor and Attorney General from withdrawing participation in Walker-Schimel-Trump’s assault on pre-existing conditions in federal court.

8. TRUMP ADMINISTRATION APPROVES FLORIDA’S REQUEST TO RESTRICT RETROACTIVE MEDICAID ELIGIBILITY

Early this week, Florida received federal approval to shorten the amount of time people who sign up for Medicaid have for retroactive eligibility from 90 days to just 30. Critics charge that this change will hurt both patients and providers and that it will limit access to health care services for older patients and people with disabilities.

…MEANWHILE, THE TRUMP ADMINISTRATION GLOSSES OVER ITS RECORD WITH PHONY, FANCY “REPORTS”

A so-called “report” from the Department of Health and Human Services was actually “stuffed with conservative talking points” and “potshots at the Affordable Care Act,” according to Axios, rather than any substantive information about how the Trump administration plans to address the top health care concerns of the American people: lowering the cost of prescription drugs, ending junk insurance plans, funding Medicaid and Medicare and maintaining pre-existing conditions protections.

New Report is More Hot Air As the Trump-GOP War on Health Care Rolls On

Washington, DC – Today, the Trump Administration released a report that is nothing more than a bait-and-switch on health care from an Administration whose primary health care agenda is to take Americans’ coverage away. In response, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“No fancy report is going to change the fact that when it comes to health care, the Trump Administration’s real goals are crystal clear: to erode protections Americans depend on, like those for individuals with pre-existing conditions; to make people pay more money for less coverage; and to do whatever they can to get rid of or dismantle Medicare, Medicaid and the Affordable Care Act.”

Though they’re trying to distract from it, here’s the Trump Administration’s real health care record:

TRUMP AND REPUBLICANS ARE WORKING TO END PROTECTIONS FOR PRE-EXISTING CONDITIONS

If federal courts rule in favor of the Trump Administration and Republican attorneys general, protections for people with pre-existing conditions would vanish overnight, unleashing chaos in our entire health care system.

In addition to going to court to eliminate pre-existing conditions protections, the Trump Administration is urging states to skirt consumer protections in the Affordable Care Act through regulatory waivers.

TRUMP IS PUSHING JUNK PLANS THAT EXCLUDE COVERAGE OF PRE-EXISTING CONDITIONS

Short-Term Plans May Exclude Coverage For Pre-Existing Conditions. “Policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition could be considered pre-existing and so excluded from coverage.” [Kaiser Family Foundation, 2/9/18]

Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits and Prescription Drugs. “Typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways.” [Kaiser Family Foundation, 2/9/18]

Short-Term Junk Plans Can Retroactively Cancel Coverage After Patients File Claims. “Individuals in STLDI plans would be at risk for rescission. Rescissions are retroactive cancellations of coverage, often occurring after individuals file claims due to medical necessity. While enrollees in ACA coverage cannot have their policy retroactively cancelled, enrollees in STLDI plans can.” [Wakely/ACAP, April 2018]

Junk Plans Are Notorious For The Scams They Attract. “Once the new rules were announced, vendors both fraudulent and legitimate adapted to market these short-term plans as the lines between the two became even more blurry. (The plans favored by our scam-happy president are also, unsurprisingly, historically scammy.)…As the administration promised, there are certainly more options, but there’s also not much by way of a filter. Since last summer, the federal budget for ‘insurance navigators’—the people you can call to parse your government-funded options, including Medicare and state healthcare—has been cut by 80%.” [Splinter, 11/21/18]

TRUMP’S HEALTH CARE SABOTAGE IS DRIVING COSTS UP FOR CONSUMERS

Larry Levitt, Senior Vice President Of Kaiser Family Foundation: Premiums Would Be Going Down If Not For Insurance Companies Compensating For Unstable Environment. “ACA premiums are stable for 2019 because they went up so much this year due to an uncertain environment and regulatory actions by the Trump administration. Premiums would be going down a lot if not for repeal of the individual mandate penalty and expansion of short-term plans.” [Levitt, 9/27/18]

Brookings Analysis Estimates That Individual Market Premiums Would Fall By 4.3 Percent In 2019 If Not For GOP Sabotage. [Brookings Institution, 8/1/18]

Health Care Analyst, Charles Gaba Has Calculated That Across The Country, Premiums Will Increase By An Average Of 2.8 Percent In 2019. The average premium increases indicate that premiums nationwide will be 8.1 percent higher than they would have been absent GOP sabotage. [Charles Gaba, Accessed 12/3/18]

TRUMP AND REPUBLICANS WANT TO UNDERMINE MEDICAID AND MEDICARE

President Trump’s FY 2019 budget proposed $1.4 trillion in cuts to Medicaid. In February, President Trump proposed a budget that would have gutted Medicaid by $1.4 trillion.

President Trump and Congressional Republicans are targeting Medicare and Medicaid to pay for tax cuts for the wealthiest. Last December, President Trump signed a $1.5 trillion tax bill that disproportionately benefits the wealthy. In an attempt to pay for these tax cuts, in April, House Republicans passed a budget amendment that would slash Medicare funding by $537 billion over the next decade.

Congressional Republicans proposed these cuts after passing a budget resolution last year that cut Medicare by $473 billion. The 2018 budget resolution passed by Republicans in December 2017 cut Medicare by $473 billion.

Larry Kudlow, Director of the National Economic Council, confirmed that he has his sights on cutting Medicare. Asked when programs like Social Security and Medicare will be looked at for reforms, Kudlow replied, “Everyone will look at that — probably next year.”

As the cost of drugs skyrocket, President Trump and his Republican allies in Congress will not allow Medicare to negotiate for better prescription drug prices. Under current law, the Secretary of the Department of Health and Human Services (HHS) is explicitly prohibited from negotiating directly with drug manufacturers on behalf of Medicare Part D enrollees. Although it would decrease both federal spending and beneficiaries’ out-of-pocket costs for prescription drugs, a policy allowing the federal government to negotiate drug prices for Medicare beneficiaries was noticeably absent from President Trump’s recent prescription drug announcement.  

Congressional Republicans repealed several components of the ACA designed to help keep Medicare’s costs down, effectively driving up costs for the program. By repealing the requirement that most people have insurance, Congressional Republicans knowingly voted for a measure expected to increase the number of uninsured. The 2018 Medicare Trustees Report predicts that this increase will increase the share of subsidies paid to hospitals via Medicare. Similarly, by repealing the Independent Payment Advisory Board, Congressional Republicans took away a mechanism that slowed Medicare cost growth.

TRUMP’S HRAs WILL FURTHER ERODE AMERICANS’ ACCESS TO AFFORDABLE HEALTH CARE

Standalone HRAs By Definition Contain An Annual Limit and Are Not Required to Cover Certain Preventive Services. “The ACA requires group health plans to meet certain standards that HRAs can’t meet, specifically the ban on annual and lifetime limits and the requirement to cover certain preventive services at no cost to plan enrollees. (HRAs by definition contain an annual limit on the amount of the employer’s contribution, and they are just accounts that do not cover any benefits.)” [Center on Budget and Policy Priorities, 11/29/17]

Increasing Access To Standalone HRAs Could Incentivize Businesses To Offer Limited Coverage HRAs Instead Of Full Health Coverage. “If the Administration attempts to broaden the availability of such “standalone” HRAs, that would likely prompt fewer businesses to offer health coverage to their employees.  Workers who now have good coverage and substantial contributions from an employer could see those benefits dropped and replaced with an HRA that leaves them paying higher premiums for less comprehensive coverage than what they have today.” [Center on Budget and Policy Priorities, 11/29/17]

HRAs Could Raise Premiums in the Individual Market By Drawing Healthy People Out Of Individual Market. “Depending on the specific proposals, and what employers do in response, HRAs could negatively affect the individual market by moving more high-cost people into that risk pool, raising overall premiums, and leaving other individual-market consumers and the federal government (through the premium tax credit) paying more.” [Center on Budget and Policy Priorities, 11/29/17]

American Cancer Society Cancer Action Network, American Heart Association, America’s Health Insurance plans, Blue Cross Blue Shield Association, Center on Budget and Policy Priorities, Crohn’s & Colitis Foundation, Epilepsy Foundation, Families USA, March of Dimes, The National Multiple Sclerosis Society Are Opposed to Expanding HRAs: “Expanding and extending short-term, limited-duration health plans, increasing enrollment in Association Health Plans (AHPs), and relaxing rules for employer Health Reimbursement Arrangements (HRAs) all increase adverse selection in insurance markets that serve millions of individuals and employers. We are concerned that this could create or expand alternative, parallel markets for health coverage, which would lead to higher premiums for consumers, particularly those with pre-existing conditions. Further, these actions destabilize the health insurance markets that guarantee access to comprehensive health coverage regardless of health status.” [Letter to State Departments of Insurance, 12/14/17]

In response to “one of the boldest steps yet” that the Trump administration has taken to sabotage the Affordable Care Act, media, experts, and policymakers have continued to speak out against the Trump administration’s new 1332 waiver guidance.

Below is a look at what experts are saying:

Sarah Lueck, Senior Policy Analyst At Center On Budget And Policy Priorities: “Potentially What This Guidance And Concept Ideas Are Saying Is: ‘States, You Can Try To Do What Was Rejected In Congress.'” “‘Sarah Lueck, a senior policy analyst at the Center on Budget and Policy Priorities, told me the concepts were reminiscent of some ideas that emerged during the repeal-and-replace debate last year. She said they would allow states to ‘pursue policies that could reduce subsidies available for vulnerable populations, offer inadequate coverage options or leave people with unaffordable coverage…Potentially, what this guidance and concept ideas are saying is: ‘States, you can try to do what was rejected in Congress,’ ‘ Lueck added. ‘But whether it’s the bad ideas from the repeal debate or returning to the pre-ACA-style market, it’s not going to fare as well for people if they have a preexisting condition, if they’re older, low-income — those concerns are very real.’.” [Washington Post, 11/30/18]

Timothy Jost, Washington And Lee University Law Professor: With New Proposal, “Invariably, The Coverage Is Going To Be More Expensive For People Who Really Need Comprehensive Coverage.” “Invariably, the coverage is going to be more expensive for people who really need comprehensive coverage…As soon as any state proceeds to go somewhere with this, there will be legal challenge.” [Kaiser Health News, 11/29/18]

Sabrina Corlette, Senior Research Fellow At Georgetown University’s Center On Health Insurance Reforms: Latest Recommendations Continue A ‘Trend’ In The Trump Administration To ‘Break Up The Basic Framework Of The ACA. “‘What would happen is those products … will attract healthier, younger enrollees, leaving a smaller and sicker pool in the ACA-compliant plans,’ Corlette said. She thinks that this will lead to one of two consequences that could harm people with preexisting illnesses. ‘You’re an insurance company and you’re saying, ‘Okay, I can either offer these noncompliant options, get all the healthy people and subsidies to boot, or I can offer these ACA plans and get all the sick people.’ What are you going to do?,’ Corlette said. ‘You’re going to drop the ACA plans and offer these noncompliant plans. Or you can keep offering your ACA-compliant plans and jack up the price.’ Corlette said the latest recommendations continue a ‘trend’ in the Trump administration to ‘break up the basic framework of the ACA…They’ve been punching holes in the ACA’s minimum floor of protections for a while now,” she said. “I would say that this latest 1332 guidance and concepts is just part of that general push by the administration to sort of fray that basic national standard of protections and requirements.’” [Washington Post, 11/30/18]

University Of Michigan Law Professor Nicholas Bagley Warns That Trump’s Suggested Waivers May Not Be Legally Sound. “Would a future waiver be vulnerable? You bet…The ACA says that a state waiver must provide coverage at least as comprehensive as what the ACA provides. A state waiver that means loads of sick people won’t be able to get coverage, or won’t be able to get affordable coverage, shouldn’t pass muster.” [HuffPost, 11/30/18]

How the media is continuing to cover the new guidelines:

HuffPost: Trump Administration Announcement Carries On “Crusade Against ‘Obamacare’ That Voters Seemed To Reject Soundly In This Month’s Midterm Elections.” “The Trump administration just made it easier for states to rewrite some of the Affordable Care Act’s insurance rules, carrying on with a crusade against “Obamacare” that voters seemed to reject soundly in this month’s midterm elections…And among the 1332 waiver models that CMS published on Thursday was a prototype in which people could use federal tax credits to pay for alternative insurance options that exclude key benefits, like full prescription coverage or inpatient psychiatric care, and aren’t generally available to people with pre-existing conditions…Consumers who buy the plans can still face crushing medical bills if they get injured or sick and require treatment the policies don’t cover. Meanwhile, people who need or want more comprehensive coverage can end up paying more for their policies because the insurers who sell them have to raise premiums when healthier customers flock to the skimpier plans. A major goal of the Affordable Care Act was to avoid these problems ― or, at the very least, to mitigate them. By encouraging enrollment into these less-comprehensive plans, experts warned Thursday, the administration was all but certainly making it more difficult for the law to function as intended.” [HuffPost, 11/30/18]

Washington Post: Trump Administration Is Providing States With “Roadmap” For How They Can Sidestep Parts Of ACA. “The Trump administration is providing states with a roadmap for how they can sidestep parts of the Affordable Care Act in the name of giving more power back to the states. But critics fear the move will undermine key consumer protections established by the 2010 health-care law.” [Washington Post, 11/30/18]

CNN: “The Trump Administration Is Laying Out For States How They Can Use Their Sweeping New Powers To Overhaul — And Likely Undermine — Obamacare.” “The Trump administration is laying out for states how they can use their sweeping new powers to overhaul — and likely undermine — Obamacare…It’s the latest move by the Trump administration to weaken the Affordable Care Act from the inside after the collapse of Republican efforts to repeal it altogether, this time by targeting the subsidies, which are considered crucial to keeping insurance markets working well. The new waiver powers could widen the divide in health care coverage among the states, which the Affordable Care Act sought to unify with nationwide standards for benefits and assistance. Red states may seek to provide greater access to alternative plans, while blue states could try to bolster their Obamacare markets.” [CNN, 11/29/18]

New York Times: New Policy “Upends A Premise Of The Affordable Care Act.” “The new policy outlined by the administration on Thursday upends a premise of the Affordable Care Act: that federal subsidies can be used only for insurance that meets federal standards and is purchased through public marketplaces, also known as insurance exchanges. Under the new policy, states could use federal subsidies to help people pay for employer-sponsored insurance. Consumers could combine federal funds with employer contributions to buy other types of insurance.” [New York Times, 11/29/18]

Slate: “The New Guidance Is Just The Latest Step In The Trump Administration’s Long Quest To Dismantle Much Of Obamacare Through Executive Fiat.” “One of the administration’s suggestions is to restructure the law’s insurance subsidies, which help low and middle-income Americans pay their monthly premiums, so that they’re tied to age instead of income. (This would effectively give more help to high-earners and less to low-earners). Another is to let people spend those subsidies on cheap health plans that don’t meet all of Obamacare’s coverage requirements. (This would likely drive up costs for some people who needed more comprehensive coverage). It’s not clear that these sorts of changes would hold up in court. But if they did, such moves would likely undercut Obamacare’s consumer protections, including for Americans with pre-existing conditions. The new guidance is just the latest step in the Trump administration’s long quest to dismantle much of Obamacare through executive fiat.” [Slate, 11/29/18]

Kaiser Health News: Experts Predict Ideas Would Foster Parallel Market, Drive Up Premiums For Those Who Remain In ACA Plans. “Still, coupled with other ongoing efforts by the Trump administration to gut Obamacare, policy experts predict the ideas would further foster a parallel market of cheaper, less robust coverage that could draw younger or healthier consumers, but drive up premiums for those who remain in ACA market plans.” [Kaiser Health News, 11/29/18]

Axios: “This Is One Of The Administration’s Most Significant Anti-ACA Moves To Date — If It Works.” “This is one of the administration’s most significant anti-ACA moves to date — if it works. States that ask for everything they’re now allowed to, and get it, could set up an insurance market that looks a lot different from what the ACA envisioned.” [Axios, 11/30/18]

BuzzFeed News: Administration’s Guidance Is “One Of The Boldest Steps Yet” Trump Has Taken To Sabotage ACA. “It is one of the boldest steps yet taken by the Trump administration to take down the building blocks of the Affordable Care Act despite the law remaining on the books…The Obama administration had taken the opposite approach. While it allowed for people to have insurance plans outside of the ACA’s regulations in certain circumstances, the individual markets were bolstered because only regulated plans qualified for subsidies. Since taking office, Trump has encouraged the proliferation of skimpier off-market plans. With ACA repeal off the table for now, this has become the foremost health policy fight in Washington.” [BuzzFeed News, 11/29/18]

The Independent: After Failing To Dismantle The ACA, The Trump Administration Is Now Offering States Suggestions On How To Undermine It. “The federal government has issued suggestions to help states undermine the waiver system of Obamacare, helping to weaken the implementation of the act. Donald Trump and the republican administration tried and failed to completely dismantle the Affordable Care Act, also known as Obamacare, soon after Mr Trump was sworn in as president. However, the administration is now helping states apply for alternative types of insurance, which could ultimately undermine Obamacare.” [The Independent, 11/29/18]

And how policymakers are responding:

Reps. Frank Pallone And Richard Neal, Top Democrats On House Energy And Ways And Means Committees: “We Are Concerned That This Guidance Is Unlawful, Will Raise Costs For Older And Vulnerable Americans, And Will Eliminate Protections For Individuals With Pre-existing Conditions.” “The interpretation disregards both the plain text of the statute, as well as the congressional intent behind Section 1332, which was to allow states to innovate to expand coverage, affordability, and comprehensive benefits. Having ‘access’ to coverage is not the same thing as having coverage, and the Administration’s attempt to read ‘access’ into the statute is transparently motivated by an ideological opposition to the benefits and protections afforded by the ACA.” [Letter To Sec. Azar, 11/29/18]

In response to new reporting showing that the Trump Administration is once again urging states to skirt important consumer protections in the Affordable Care Act, Leslie Dach, chair of Protect Our Care, issued the following statement:

“In the wake of an election that sent the unmistakable message that Americans want an immediate end to the GOP war on health care, it’s outrageous to see the Trump Administration make one of its boldest acts of sabotage ever. Once again, the Trump Administration wants to deny millions of Americans protections for pre-existing conditions, and guaranteed coverage for women’s health care and cancer treatments. This is the opposite of what the American people said they wanted, and shows Republicans clearly haven’t learned the lesson of the 2018 elections.”

Read more from the Washington Post here.