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The GOP Agenda: Worse Care, Higher Costs for Residents at Nursing Homes

Washington, DC — Ahead of the Senate Finance Committee’s hearing on nursing home neglect and abuse tomorrow, it’s important to remember just how the GOP’s health care policies have failed nursing home patients across America. Donald Trump and his Republicans in Congress worked to repeal the Affordable Care Act, block expansion and access to Medicaid, and fell into lock step with the nursing home industry to weaken penalties they may face for harming their own residents. The GOP Agenda has nothing to do with helping those in nursing homes and long-term care facilities–it only seeks to serve industry CEOs and gut access to care so many patients desperately need.

The GOP Agenda: Repeal the Affordable Care Act and Its Protections for People in Nursing Homes

The ACA Expanded Nursing Home Quality-Related Requirements for the First Time Since 1987. “The Affordable Care Act (ACA) is the first comprehensive legislation since the Nursing Home Reform Act, part of the Omnibus Budget Reconciliation Act of 1987 (OBRA ’87), to expand quality of care-related requirements for nursing homes that participate in Medicare and Medicaid and improve federal and state oversight and enforcement…the ACA incorporates the Nursing Home Transparency and Improvement Act of 2009, introduced because complex ownership, management, and financing structures were inhibiting regulators’ ability to hold providers accountable for compliance with federal requirements. The ACA also incorporates the Elder Justice Act and the Patient Safety and Abuse Prevention Act, which include provisions to protect long-term care recipients from abuse and other crimes.” [Kaiser Family Foundation, 1/28/13]

The GOP Agenda: Cutting Access to Nursing Home Care by Slashing Medicaid

Medicaid Pays for Most of the 1.4 Million People in Nursing Homes. “Medicaid pays for most of the 1.4 million people in nursing homes… It covers 20 percent of all Americans and 40 percent of poor adults…A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation.” [New York Times, 6/24/17]

Medicaid Covers 6 in 10 Nursing Home Residents, and Half of Seniors Using Medicaid Long-Term Care Services Were in Nursing Homes. [Kaiser Family Foundation, 6/20/17]

The Trump Administration and Republicans in Congress Pursued ACA Repeal Bill that Would Have Also Slashed Medicaid. “On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid, part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly entitlement.” [New York Times, 6/24/17]

New York Times Headline: “Medicaid Cuts May Force Retirees Out of Nursing Homes” [New York Times, 6/24/17]

Associated Press Headline: “Medicaid cut in GOP health bill worries the nursing home set” [Associated Press, 7/8/17]

Senate GOP Repeal Bill Would Have Cut Medicaid by $2.6 Trillion by Second Decade. “The Congressional Budget Office (CBO) estimates that the Senate Republican health bill’s Medicaid cuts would deepen significantly in the second decade, with the cuts growing from 26 percent in 2026 to 35 percent in 2036, relative to current law. Now, based on CBO estimates and data, the Committee for a Responsible Federal Budget (CRFB) estimates that the Senate bill would cut Medicaid by roughly $2.6 trillion over the second decade (2027-36), on top of Medicaid cuts of $772 billion in the first decade.” [Center on Budget and Policy Priorities, 7/11/17]

The Trump Administration is Looking for Ways to Bypass Congress to Enact Medicaid Block Grants. “The Trump administration is quietly devising a plan bypassing Congress to give block grants to states for Medicaid, achieving a longstanding conservative dream of reining in spending on the health care safety net for the poor…Capping spending could mean fewer low-income people getting covered, or state-designated cutbacks in health benefits.” [Politico, 1/11/19]

In 2018, the Trump Administration Proposed Cutting Medicaid by $1.4 Trillion. “The Administration is proposing to cap federal Medicaid payments to states and to cut federal Medicaid spending by $1.439 trillion – that is trillion with a “t” – over the ten year period 2019 – 2028. That is about 26% of what the Administration projects federal Medicaid spending would otherwise be, and within shouting distance of the $1.455 trillion cost of the tax cuts enacted in December.” [Georgetown Center for Children and Families, 2/12/18]

The GOP Agenda: The Trump Administration Weakened Penalties Against Nursing Homes that Harm Patients at the Request of the Nursing Home Industry

The Trump Administration Scaled Back Fines Against Nursing Homes that Harm Residents, at the Request of the Nursing Home Industry. “The Trump administration is scaling back the use of fines against nursing homes that harm residents or place them in grave risk of injury, part of a broader relaxation of regulations under the president. The shift in the Medicare program’s penalty protocols was requested by the nursing home industry…The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities. [New York Times, 12/24/17]

New Guidelines Intended to Discourage Regulators from Levying Fines, Even When Violations Resulted in Resident’s Death. “The new guidelines discourage regulators from levying fines in some situations, even when they have resulted in a resident’s death. The guidelines will also probably result in lower fines for many facilities.” [Kaiser Health News, 12/31/17]

In November 2017, The Trump Administration Exempted Nursing Homes Violating Certain Rules from Penalties for 18 Months. “In November, the Trump administration exempted nursing homes that violate eight new safety rules from penalties for 18 months. Homes must still follow the rules, which are intended, among other things, to reduce the overuse of psychotropic drugs and to ensure that every home has adequate resources to assist residents with major psychological problems.” [New York Times, 12/24/17]

In October 2017, the Trump Administration Discouraged CMS Regional Offices from Levying Fines if the Error was a “One-Time Mistake.” “In October, CMS discouraged its regional offices from levying fines, even in the most serious health violations, if the error was a ‘one-time mistake.’ The centers said that intentional disregard for residents’ health and safety or systemic errors should still merit fines.” [Kaiser Health News, 12/31/17]
The Trump Administration Rolled Back Obama Administration Rule Making it Easier for Nursing Home Residents to Sue for Negligence or Abuse. “Another Obama-era regulation is on the Trump administration’s chopping block — this one about nursing homes. The Obama administration’s rule would’ve made it easier for nursing home residents to sue for negligence or abuse. But the Trump administration is proposing to replace that rule. And the new one could make it almost impossible for nursing home residents to get their day in court. That is because new nursing home residents are frequently handed an agreement to go to arbitration instead of suing if something goes wrong.” [NPR, 8/21/17]

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Those Who Know Health Care The Best Say Chad Readler’s Views On It Are The Worst

As the Senate is poised to vote on Chad Readler’s nomination for the Sixth Circuit Court of Appeals, once again Republicans are about to show us where they stand: against Americans with pre-existing conditions and with a Trump administration that is resolved to dismantle the ACA. Readler, who overruled career Justice Department attorneys and filed the brief on behalf of the Trump administration in Texas v. United States arguing in favor of striking down protections for people with pre-existing conditions, is a known health care opponent. From patient groups to doctors, hospitals, and insurance companies, those who know health care the best say that Readler’s position on health care is the worst.

Leading up to the Texas hearing, disease groups, patient groups, doctors and hospitals warned that Readler’s argument to eliminate the Affordable Care Act and its consumer protections would have disastrous consequences:

Joint Statement From Five Disease Groups — American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, and the National Multiple Sclerosis Society: Patients May Be Forced To “Delay, Skip Or Forego Care.” “Should this case be successful, people with cancer, heart disease, diabetes, lung disease and any serious or chronic condition are likely to be denied coverage due to their pre-existing 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. This was often the case before the law took effect and would likely be the same should these essential protections be eliminated…Striking down these provisions would be catastrophic and have dire consequences for many patients with serious illnesses.” [Joint Statement, 6/8/18]

Joint Statement From Six Provider Groups — American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Osteopathic Association, and American Psychiatric Association: “The Elimination Of These Protections Could Result In Millions Of People Facing Limited Access To Health Care Coverage And Higher Cost As A Result Of Insurers Being Allowed To Return To Discriminatory Coverage And Pricing Practices.” “Our organizations, which represent a combined membership of more than 560,000 physician and medical student members are concerned about the Department of Justice’s decision to not defend the constitutionality of existing laws that extend patient protections to individuals in insurance markets as part of Texas v United States. The elimination of these protections could result in millions of people facing limited access to health care coverage and higher cost as a result of insurers being allowed to return to discriminatory coverage and pricing practices…As physicians who provide a majority of care to individuals for physical and mental conditions, we can speak clearly that these insurance reforms and protections are essential to ensuring that the more than 130 million Americans, especially the more than 31 million individuals between the ages of 55 and 64, who have at least one pre-existing condition are able to secure affordable health care coverage.” [Joint Statement on Texas v. United States, 6/9/18]

American Psychiatric Association: “This Decision Could Lead To Insurers Denying Coverage To The 130 Million Americans With Pre-existing Conditions…Is In The Midst Of An Opioid Epidemic And 30% Rise In Suicide Rates.” “This decision could lead to insurers denying coverage to the 130 million Americans with pre-existing conditions. This is harmful to the health of these Americans and is very short-sighted considering the nation is in the midst of an opioid epidemic and 30% rise in suicide rates.” [American Psychiatric Association, 6/8/18]

The Arc: “Another Example Of The Trump Administration’s Intent To Undermine Access To Health Insurance For Millions Of People With Disabilities.” “The actions of the Department of Justice are another example of the Trump Administration’s intent to undermine access to health insurance for millions of people with disabilities by dismantling the Affordable Care Act.  It exposes the Administration’s intent to eliminate critical protections for people with pre-existing conditions who benefit from provisions in the law that assure access to affordable health insurance. The ongoing attempts to dismantle this law highlight a disturbing disregard, by the Trump Administration, for the needs of people with disabilities who rely on the Affordable Care Act for their health and wellbeing.” [The Arc, 6/8/18]

Brain Injury Association of America: People With Pre-Existing Conditions, Like A Brain Injury, Will Likely Lose Access To Essential Treatment And Rehabilitation. “The Justice Department’s position threatens a core piece of the Patient Protection and Affordable Care Act. If the court agrees, people with pre-existing conditions – like brain injury – will likely be forced to pay higher premiums and ultimately lose access to essential treatment and rehabilitation.” [Brain Injury Association of America, 6/8/18]

Margaret A. Murray, Chief Executive of the Association for Community Affiliated Plans: Anyone Who Has Had “So Much As A Case Of Asthma” Should Be “Deeply Unsettled.” Margaret A. Murray, the chief executive of the Association for Community Affiliated Plans, which represents plans for low-income and vulnerable populations, said that anyone who has bought individual insurance ‘and has had so much as a case of asthma in their past should be deeply unsettled by the choices this administration has made.’” [Washington Post, 6/8/18]

America’s Health Insurance Plans: Administration’s Decision Will Cause Rates To Increase For Older, 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.” [America’s Health Insurance Plans, 6/8/18]

After Judge Reed O’Connor ruled in favor of Readler’s argument,  insurance companies, disease groups, hospitals, and health advocates yet again condemned the position, calling it “misguided and wrong”:

Blue Cross Blue Shield: “We Are Extremely Disappointed In The Court’s Ruling.” “Yesterday’s federal district court ruling in a case challenging the Affordable Care Act is the first step in what we expect will be a lengthy legal process…While we are extremely disappointed in the court’s ruling, we will continue to work with lawmakers on a bipartisan basis to ensure that all Americans can access the consistent, quality health coverage they need and deserve.” [Blue Cross Blue Shield, 12/15/18]

America’s Health Insurance Plans: “The District Court’s Decision Is Misguided And Wrong.” “The district court’s decision is misguided and wrong. This decision denies coverage to more than 100 million Americans, including seniors, veterans, children, people with disabilities, hardworking Americans with low-incomes, young adults on their parents’ plans until age 26, and millions of Americans with pre-existing conditions. We argued in an amicus brief before the court that provisions of the Affordable Care Act (ACA) affecting patients with pre-existing conditions, and those covered by Medicaid and Medicare should remain law regardless of what the court ruled on the individual mandate. Unfortunately, this ruling harms all of these Americans.” [AHIP, 12/14/18]

American Medical Association: “An Unfortunate Step Backward For Our Health System.” “The American Medical Association called the ruling ‘an unfortunate step backward for our health system’ and warned the decision could ‘destabilize health insurance coverage.’ ‘No one wants to go back to the days of 20 percent of the population uninsured and fewer patient protections, but this decision will move us in that direction,’ AMA president Barbara L. McAneny said in a statement.” [CNBC, 12/14/18]

American Federation Of Hospitals: “The Judge Got It Wrong.” “‘The judge got it wrong,’ said Charles N. ‘Chip’ Kahn III, president of the Federation of American Hospitals. ‘This ruling would have a devastating impact on the patients we serve and the nation’s health-care system as a whole. . . . Having this decision come in the closing hours of open enrollment also sows seeds of unnecessary confusion.’” [Washington Post, 12/14/18]

American Hospital Association: “America’s Hospitals And Health Systems Are Extremely Disappointed.” “America’s hospitals and health systems are extremely disappointed with today’s federal district court ruling on the constitutionality of the Affordable Care Act. The ruling puts health coverage at risk for tens of millions of Americans, including those with chronic and pre-existing conditions, while also making it more difficult for hospitals and health systems to provide access to high-quality care…We join others in urging a stay in this decision until a higher court can review it and will continue advocating for protecting patient care and coverage.” [American Hospital Association, 12/14/18]

American Association of Medical Colleges: “This Ruling Puts Millions Of Americans, Including The Most Vulnerable Patients, At Risk.” “Dismantling the ACA will be disastrous for the nation’s health care system. Patients—particularly those with preexisting and complex conditions—require stability and continuity in their care. Without access to affordable meaningful coverage, many would forego or delay necessary medical care. This ruling puts millions of Americans, including the most vulnerable patients, at risk.” [American Association of Medical Colleges, 12/15/18]

Elena Hung, President Of Little Lobbyists: “The Harm Is Done.” “We know the ACA is still the law and nothing changes for now. But the harm is done; you can’t tell us not to worry when our kids’ lives are on the line.” [Elena Hung Twitter, 12/14/18]

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In News

Kaiser Poll Finds That Majority of Americans Support Government Action to Lower Drug Prices While Republicans Refuse to Hold Drug Companies Accountable

GOP-Aligned Group AAN Launches Nearly $3 Million Ad Buy Giving Republicans Political Cover to Protect Drug Companies’ Profits

Washington, DC — Today, the Kaiser Family Foundation released its tracking poll finding that a majority of Americans across political party lines are in favor of policy options aimed at curbing the cost of prescription drugs. The poll found that 86 percent of people want the federal government to negotiate with drug companies to get a lower price on medications for people with Medicare. Meanwhile, American Action Network (AAN), a GOP-aligned group, launched a $2.9 million ad campaign targeting 46 Republican House members and 11 Republican senators, calling for them to resist the calls for the incredibly popular proposal to allow Medicare to negotiate drug prices. Brad Woodhouse, executive director of Protect Our Care, released the following statement on the ad campaign:

“The American people are highly supportive of the policies on the table meant to rein in the soaring costs of prescription drugs, and it’s clear from these new ads that drug companies are running scared. Instead of learning the lesson from the November election and working to lower health care costs and improve coverage for all Americans, GOP groups are carrying water for drug companies by giving Republicans political cover to protect big pharma’s profits. It’s high time for Congress to protect Americans’ pocketbooks instead of drug companies’ bottomline, but unfortunately the Republicans didn’t get the message.”

Key Findings From the KFF Health Tracking Poll:

  • A Substantial Majority Favor Most Actions That Would Keep Prescription Drug Prices Down. “The vast majority of Americans favor requiring drug companies to include drug list prices in their advertisements (88 percent), making it easier for generic drugs to come to market (88 percent), and allowing the federal government to negotiate with drug companies to get a lower price on medications for people with Medicare (86 percent). All three of these policy proposals are supported by large majorities of Democrats, independents, and Republicans”
  • An Overwhelming Majority (86 Percent) Support Medicare Drug Price Negotiation. 86 percent of those polled support allowing the government to negotiate with drug companies to secure a lower price for people with Medicare.
  • Eight In Ten Americans See Drug Company Profits As A Major Factor Contributing To High Prescription Drug Prices. “The public sees profits made by pharmaceutical companies as a major factor contributing to the price of prescription drugs. At least eight in ten – across party identification – say profits made by pharmaceutical companies are a “major factor” in the price of prescription drugs. This is followed by seven in ten (69 percent) who say the cost of research and development is a “major factor” contributing to the price.”
  • About A Quarter of Those Taking Prescription Drugs Say They Are Difficult To Afford. “Among those currently taking prescription drugs, about one-fourth (24 percent) and a similar share of seniors (23 percent) say it is difficult to afford their prescription drugs, including one in ten saying it is “very difficult.” Three in ten adults ages 50 to 64 report having difficulty affording their prescription medicines (30 percent) compared to about one-fourth of those ages 65 and over with Medicare (23 percent) and one-fifth of those under the age of 50 (21 percent), who take fewer drugs on a regular basis. This group, adults ages 50 to 64, is not yet eligible for Medicare but is more likely to be taking more prescription medicines than other non-Medicare eligible populations.”

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Protect Our Care Releases New Report Detailing the Threats Republican Policies Pose to Rural Health Care in Michigan

Legislation Cosponsored by Senator Gary Peters Would Help Expand Coverage and Benefit Rural Communities, Addressing the Unique Problems Outlined in New Report

Washington, DC — A day after Senator Gary Peters joined a group of senators to introduce the SAME Act, a bill that would benefit rural communities by providing each state expanding its Medicaid program with the same levels of Federal matching funds regardless of when it chooses to expand the program, Protect Our Care released a new report, “A Tough Row to Hoe: How Republican Policies are Leaving Michigan’s Rural Health Care in the Dust.” The report looks at how Republican sabotage of the Affordable Care Act and relentless attacks on Medicaid expansion have done damage to rural residents of the state, who face both a lack of coverage and a lack of care in their communities.  


Read the report here.

“Our report shows how President Trump and his Republican allies in Congress have stopped at nothing to wreak havoc on our health care, resulting in especially devastating impacts in rural America,” said Brad Woodhouse, executive director at Protect Our Care. “Premiums have risen, coverage has been lost, and rural hospitals face constant uncertainty as rural health care is threatened. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and Senator Peters’ leadership on the SAME Act is a major step towards encouraging more states to expand Medicaid and ensuring rural Americans will have access to the health care coverage they so desperately need.”

By The Numbers: Rural Health In Michigan


11 percent of Michiganders living in rural areas are uninsured, compared to 9 percent of Michiganders living in nonrural areas.

Since the Affordable Care Act, the adult uninsured rate has fallen by 11 percent in rural parts of Michigan.

25 percent of Michiganders living in rural areas have health coverage through Medicaid.

The Affordable Care Act led to a $571 million reduction in Michigan uncompensated care costs. Between 2013 and 2015, Michigan hospitals’ uncompensated care costs decreased by $571 million, or roughly 45 percent.

634,300 Michiganders became newly eligible for coverage when Michigan expanded Medicaid.

18 rural hospitals in Michigan are at a high financial risk of closing. This represents roughly 25.4 percent of the state’s rural hospitals.

In Michigan, where lawmakers expanded Medicaid, one rural hospital has closed since 2010. The one hospital that did close did so two years before the state expanded Medicaid:

Cheboygan Memorial Hospital (MI-01, closed in 2012)

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Protect Our Care Releases New Report Detailing the Threats Republican Policies Pose to Rural Health Care in Virginia

Senator Mark Warner’s SAME Act Would Help Expand Coverage and Benefit Rural Communities, Addressing the Unique Problems Outlined in New Report

Washington, DC — A day after Senator Warner introduced the SAME Act, a bill that would benefit rural communities by providing each state expanding its Medicaid program with the same levels of Federal matching funds regardless of when it chooses to expand the program, Protect Our Care released a new report, “A Tough Row to Hoe: How Republican Policies are Leaving Virginia’s Rural Health Care in the Dust.” The report looks at how Republican sabotage of the Affordable Care Act and relentless attacks on Medicaid expansion have done damage to rural residents of the state, who face both a lack of coverage and a lack of care in their communities.  


Read the report here.

“Our report shows how President Trump and his Republican allies in Congress have stopped at nothing to wreak havoc on our health care, resulting in especially devastating impacts in rural America,” said Brad Woodhouse, executive director at Protect Our Care. “Premiums have risen, coverage has been lost, and rural hospitals face constant uncertainty as rural health care is threatened. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and Senator Warner’s leadership on the SAME Act is a major step towards encouraging more states to expand Medicaid and ensuring rural Americans will have access to the health care coverage they so desperately need.”

By The Numbers: Rural Health In Virginia


19 percent of Virginians living in rural areas are uninsured, compared to 12 percent of Virginians living in nonrural areas.

Since the Affordable Care Act, the uninsured rate has fallen by 6 percent in rural parts of Virginia.

17 percent of Virginia living in rural areas have health coverage through Medicaid.

The Affordable Care Act led to a $78 million reduction in Virginia uncompensated care costs. Between 2013 and 2015, Virginia hospitals’ uncompensated care costs decreased by $78 million, or roughly 26 percent.

Since expanding Medicaid last fall, almost 200,000 Virginians have signed up for coverage. Since enrollment for Medicaid expansion began in November, nearly 200,000 Virginians have signed up for care. The Robert Wood Johnson Foundation (RWJF) and Urban Institute estimate that that number will continue to increase overtime, ultimately resulting in more than 400,000 people gaining coverage. Virginia’s decision to expand Medicaid is expected to reduce the uninsured rate by 3.3 points — from 14.2 percent to 10.9 percent.

In Virginia, where lawmakers refused to expand Medicaid until last year, two rural hospitals have closed since 2010. These hospitals include:
Pioneer Community Hospital of Patrick County (VA-09, closed in 2017)
Lee Regional Medical Center (VA-09, closed in 2013)
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Protect Our Care Releases New Report Detailing the Threats Republican Policies Pose to Rural Health Care in Alabama

Senator Doug Jones’ SAME Act Would Help Expand Coverage and Benefit Rural Communities, Addressing the Unique Problems Outlined in New Report

Washington, DC — A day after Senator Doug Jones introduced the SAME Act, a bill that would benefit rural communities by providing each state expanding its Medicaid program with the same levels of Federal matching funds regardless of when it chooses to expand the program, Protect Our Care released a new report, “A Tough Row to Hoe: How Republican Policies are Leaving Alabama’s Rural Health Care in the Dust.” The report looks at how Republican sabotage of the Affordable Care Act and relentless attacks on Medicaid expansion have done damage to rural residents of the state, who face both a lack of coverage and a lack of care in their communities.  

Read the report here.

“Our report shows how President Trump and his Republican allies in Congress have stopped at nothing to wreak havoc on our health care, resulting in especially devastating impacts in rural America,” said Brad Woodhouse, executive director at Protect Our Care. “Premiums have risen, coverage has been lost, and rural hospitals face constant uncertainty as rural health care is threatened. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and Senator Jones’ leadership on the SAME Act is a major step towards encouraging more states to expand Medicaid and ensuring rural Americans will have access to the health care coverage they so desperately need.”

By The Numbers: Rural Health In Alabama


19 percent of Alabamians living in rural areas are uninsured, compared to 16 percent of Alabamians living in nonrural areas.

Since the Affordable Care Act, the uninsured rate has fallen by 9 percent in rural parts of Alabama.

24 percent of Alabamians living in rural areas have health coverage through Medicaid.

The Affordable Care Act led to a $112 million reduction in Alabama uncompensated care costs. Between 2013 and 2015, Alabama hospitals’ uncompensated care costs decreased by $112 million, or roughly 18 percent.

314,000 Alabamians could gain coverage if the state were to expand Medicaid. By failing to do so, the Robert Wood Johnson Foundation (RWJF) and Urban Institute estimate that 314,000 Alabamians are being denied coverage through the program. If Alabama were to expand Medicaid, it is estimated that the uninsured rate would drop from 17.5 percent to 12.5 percent.

21 rural hospitals in Alabama are at a high financial risk of closing. This represents roughly 50 percent of the state’s rural hospitals.

In Alabama, where lawmakers refused to expand Medicaid, five rural hospitals have closed since 2010, with a sixth expected to close in March.

These hospitals include:
Georgiana Medical Center (AL-02, will close in March 2019)
Florala Memorial Hospital (AL-02, closed in 2013)
Elba General Hospital (AL-02, closed in 2013)
Chilton Medical Center (AL-06, closed in 2012)
SouthWest Alabama Medical Center (AL-07, closed in 2011)
Randolph Medical Center (AL-03, closed in 2011)
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Protect Our Care Praises Effort Led by Senators Mark Warner (D-VA) and Doug Jones (D-AL) to Support Medicaid Expansion

The SAME Act Will Lead to Expansion of Coverage and Benefit Rural Communities

Washington, DC–Today, Senators Mark Warner (D-VA) and Doug Jones (D-AL), among others, introduced the States Achieve Medicaid Expansion (SAME) Act, which would provide each state expanding its Medicaid program with the same levels of Federal matching funds, regardless of when it chooses to expand the program. Brad Woodhouse, executive director of Protect Our Care, praised the legislation in a statement:

“Medicaid expansion has been one of the most successful facets of the Affordable Care Act, providing millions of Americans with the health care coverage they so desperately need. Medicaid expansion has been particularly crucial to expanding access to health care in rural communities and has helped rural hospitals keep their doors open. The SAME Act will not only give all states that enacted Medicaid expansion the same funding benefits, it will incentivize more states to follow suit. Under the leadership of Senators Mark Warner and Doug Jones, the SAME Act is a major step toward ensuring better access to care, lowering costs, and keeping rural hospitals open.”

BACKGROUND:

Medicaid Expansion Is A Lifeline To Rural Communities. The Affordable Care Act opened the doors to Medicaid expansion, which has significantly expanded access to health care in rural communities, reduced rural hospitals’ uncompensated care costs, and helped rural health providers keep their doors open by allowing states to expand Medicaid coverage for adults up to 138 percent of the federal poverty line. Medicaid expansion allowed 1.7 million rural Americans to gain coverage who had not previously been eligible.

Following Medicaid Expansion, The Uninsured Rate In Rural Parts Of Expansion States Decreased By A Median Of 44 Percent. In rural states that expanded Medicaid, the uninsured rates dropped significantly after the ACA became law:

  • In Montana, the uninsured rate dropped from 19 to 8.5 percent between 2013 and 2016.
  • In Kentucky, the uninsured rate dropped from 16.3 to 7.2 percent between 2013 and 2016.
  • In Arkansas, the uninsured rate dropped from 17.8 to 9.1 percent between 2013 and 2016.
  • In West Virginia, the uninsured rate dropped from 14.2 to 8.8 percent between 2013 and 2016.

By Reducing Uncompensated Care Costs, Medicaid Expansion Means Hospitals Have Greater Financial Security. Medicaid expansion also drastically reduced the amount of costs that a hospital absorbs for any treatment or service not paid for by an insurer or patient, known as uncompensated care.. The Center on Budget and Policy Priorities finds that “states that expanded Medicaid to low-income adults under the ACA saw both larger coverage gains and larger drops in uncompensated care: a 47 percent decrease in uncompensated care costs on average compared to an 11 percent decrease in states that did not expand Medicaid.” CBPP concludes that these declines in uncompensated care were “almost certainly” the result of the ACA’s coverage gains.

A June 2018 Protect Our Care Analysis Found That The Vast Majority Of Rural Hospital Closures Since 2010 Were In States That Had Refused To Expand Medicaid. Between 2010 and June 2018, 84 rural hospitals closed. The vast majority of those rural hospital closures, 77 percent, occurred in states that refused to expand Medicaid. Nearly 90 percent of the rural hospitals that have closed since 2010 were located in states that refused to expand Medicaid by the time of their closure. Only 10 out of 84 rural hospitals closed in states after they had expanded Medicaid; of hospital closures in states that expanded Medicaid, nine closed before the state expanded the program. Since Protect Our Care’s June report, even more hospitals have closed. The Scheps Center Rural Health Research Program tracks that 97 rural hospitals have closed since 2010.

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Protect Our Care and Sen. Sherrod Brown Oppose Trump Judicial Nominees Working to Strip Health Care from Americans

Washington, DC–Today, Protect Our Care partnered with Senator Sherrod Brown of Ohio on a press call to highlight why Chad Readler and Eric Murphy ’s nominations to the Sixth Circuit Court of Appeals would be disastrous for not only Ohioans, but all Americans’ health care. Readler attacked the Affordable Care Act by signing a legal brief refusing to defend the law at the Department of Justice in support of the Texas lawsuit, which would strip millions of their coverage and deny pre-existing condition protections enshrined in the ACA.

“No American should be denied health care because of a pre-existing condition, or because they’re a woman, or because they cannot afford it,” Senator Brown said. “I cannot support nominees who have actively worked to strip Ohioans of their health care rights. Special interests already have armies of lobbyists and lawyers on their side, they don’t need judges in their pockets.”

“Chad Readler wants to go back to the days where insurance companies could deny, drop or charge more for coverage and end protections for millions of people with pre-existing conditions,” said Brad Woodhouse, executive director of Protect Our Care. “Simply put, a vote for Chad Readler is a vote for full repeal of the Affordable Care Act. Readler tried to sabotage the ACA from within the administration, and if we put him on the court, he will be able to sabotage your care from the bench.The Senate must protect the American people’s health care by denying Chad Readler a lifetime appointment.”

Full press call audio here

Background on Chad Readler:

Readler filed the Trump administration’s brief in Texas V. United States, and his nomination for a judicial seat was announced the same day he filed the brief calling for the ACA’s protections for people with pre-existing conditions to be overturned.

If the Texas ruling is not overturned:

  • 4.8 million Ohioans with pre-existing conditions could lose their coverage
  • Ohioans over age 50 could face a $3,329 age tax
  • 151,026 Ohioans would lose tax credits and have to pay more for coverage in the marketplace
  • 214,338 Ohio seniors would have to pay more for their prescription drugs
  • 717,100 Ohioans could lose their health care due to possible repeal of Medicaid expansion
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Defiant Drug Company CEOs Offer Up the Same Old Excuses and No Answers for Their Massive Price Hikes

Washington, DC — Today, the CEOs and top executives from seven of the largest drug companies testified before the Senate Finance Committee. The big drug companies have seen billions in profits while Americans have seen the costs of their medications soar. They reaped billions of dollars from the Trump tax scam bill and used it for stock buybacks, enriching their already wealthy investors and CEOs. Headline after headline demonstrates that drug companies are jacking up the prices of vital medications, proving that their commitment to freeze drug prices last year was all political posturing.

Merck’s Ken Frazier admitted as much in the hearing stating, “We have lowered list prices in the past and found it creates a financial disadvantage for the company and it doesn’t get us more volume because of the incentives in the system.”

“The American people deserve answers from these CEOs but instead today they got the same old excuses,” said Brad Woodhouse, executive director of Protect Our Care. “It’s crystal clear that these drug companies won’t follow through on their rhetoric about making prescription drugs more affordable for the American people because it would cut into their record profits.  Senator Menendez said today that if drug companies don’t take meaningful action on their own to reduce prices then policy makers will do it for them. After today’s pathetic display by drug company executives the time for policy makers to act has clearly arrived.”

Background:

Watch Senator Menendez question CEOs on the Trump tax scam here.

Big Drug Companies Raked in Billions of Profits Last Year and Paid Their CEOs Millions…

Pharmaceutical Company2018 Profit ($ Billion)Stock Buybacks Since the 2017 GOP Tax Cut[1]CEOCEO Pay[2]Ratio of CEO Compensation to Median Employee Salary[3]
Pfizer$11.1[4]$10 billionAlbert Bourla$27.9 million313:1
Merck$6.22[5]$10 billionKen Frazier$17.6 million215:1
Johnson & Johnson$15.3[6]$5 billionAlex Gorsky$29.8 million452:1
Sanofi$4.9[7]—Oliver Brandicourt$11.1 million[8]—
Bristol-Meyers$4.9[9]$5 billion[10]Giovanni Caforio$18.7 million169:1
AbbVie$5.7[11]$15 billionRick Gonzalez$22.6 million144:1
AstraZeneca$2.2[12]—Pascal Soriot$12.3 million[13]—

AstraZeneca CEO Pascal Soriot Complained That Despite His $12 Million Salary He Was “The Lowest Paid CEO In The Whole Industry” Which Was “Annoying To Some Extent.” “Soriot, who heads AstraZeneca, has a penchant for going off message — and making headlines when he does…he groused to a reporter at London’s The Times earlier this year that despite his $12 million salary he was ‘the lowest-paid CEO in the whole industry,’ which he added was ‘annoying to some extent.’” [Stat, 2/21/19]

…All While Raising Prices on 1,000 Drugs for YOU

Nearly 30 Pharmaceutical Companies Are Raising Prices on Consumers This Year Alone.Pharmaceutical companies continue to increase prices. In January 2019 alone, drugmakers raised prices on nearly 490 prescription drugs. Johnson & Johnson raised prices on around two dozen drugs, and 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. 

CBS News: “Big Pharma ushers in new year by raising prices of more than 1,000 drugs” [CBS News, 1/2/19]

Reuters: “Big Pharma returning to U.S. price hikes in January after pause” [Reuters, 12/20/18]

Nostrum CEO Mulye: “I Think It Is A Moral Requirement to Make Money When You Can .. To Sell The Product For The Highest Price.” “Last month, Nostrum Laboratories, a small Missouri-based drugmaker, more than quadrupled the price of a bottle of nitrofurantoin from $474.75 to $2,392, according to Elsevier’s Gold Standard drug database. Nitrofurantoin is an antibiotic used to treat bladder infections…In an interview, Nirmal Mulye, Nostrum chief executive, said he had priced the product according to market dynamics, adding: “I think it is a moral requirement to make money when you can . . . to sell the product for the highest price.” [Financial Times, 9/11/18]

Mylan Chairman Coury Responds to Critics After Mylan Charged More Than $600 per Box of the EpiPen When It Only Contained $1 Worth of Ephinephrine: They Ought to Go Copulate with Themselves. “In meetings, the executives began warning Mylan’s top leaders that the price increases seemed like unethical profiteering at the expense of sick children and adults, according to people who participated in the conversations…At one gathering, executives shared their concerns with Mylan’s chairman, Robert Coury. Mr. Coury replied that he was untroubled. He raised both his middle fingers and explained, using colorful language, that anyone criticizing Mylan, including its employees, ought to go copulate with themselves.” [New York Times, 6/4/17]

In 2017, the FDA approved Marathon Pharmaceuticals’ request to charge $89,000 for a drug, a 6,000% price increase. “A drug company has brought a drug that has been available as a generic elsewhere in the world for decades at a shockingly inflated price…Yet a pharmaceutical company in Deerfield, Ill., has gotten approval from the U.S. Food and Drug Administration to sell deflazacort (snazzy brand name: Emflaza). The company, Marathon Pharmaceuticals, is charging a list price of $89,000 – a 6,000% price increase.” [Forbes, 2/10/17]

In 2015, Martin Shkreli hiked the price of a life saving drug by 5,000% overnight, from $13.50 a pill to $750, when it reportedly only cost $1 to make. “Shkreli, a former hedge fund manager and entrepreneur, earned his unflattering nickname by raising the cost of the drug from $13.50 per pill to $750 per pill. After a Bloomberg reporter suggested it cost around $1 to make, Shkreli acknowledged the drug cost ‘very little money’ to make.” [HuffPost, 3/9/18]

Meanwhile, Drug Companies Reaped Billions from The GOP Tax Cut

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. [Axios, 3/5/18]

Since 2017, Pharmaceutical Companies Have Announced $73 Billion in Share Buybacks.“Collectively, drug companies have announced nearly $73 billion in share buybacks since the tax law passed in December 2017, according to Americans for Tax Fairness. Stock buybacks mostly enrich the already wealthy, including CEOs: the wealthiest 10% of American households own 84% of all corporate shares, the top 1% own 40%. About one-half of households own no stock.” [Americans for Tax Fairness, 1/8/19]

Don’t Be Fooled: Big Drug Companies Promises to Lower Costs are “Nothing-Burger Steps”

Pharmaceutical Company Lobbyist On So-Called Concessions to the Trump Administration: They Are a “Calculated Risk” And “Nothing-Burger Steps.” “The gestures turned out to be largely symbolic — efforts to beat Trump at his own game by giving him headlines he wants without making substantive changes in how they do business. The token concessions are ‘a calculated risk,” said one drug lobbyist. ‘Take these nothing-burger steps and give the administration things they can take credit for.’” [Politico, 8/3/18]

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.” The planned announcement to move some drugs from Medicare Part B, in which pharmaceuticals are purchased and administered by medical providers, to Part D, will do little to restrain the cost of prescription drugs for America’s seniors and falls far short of Trump’s promises.

[1] Americans For Tax Fairness, 1/8/19

[2] Data for FY2017, Bloomberg, 2/22/19

[3] Data for FY2017, Bloomberg, 2/22/19

[4] Pfizer Fourth Quarter And Full Year 2018  Results,” Pfizer, 1/29/19

[5] SFGate, 2/5/19

[6] 2018 Fourth Quarter Results, Johnson & Johnson, 1/22/19

[7] Converted from 4.3 billion euro; The Pharma Letter, 2/7/19

[8] Converted from 9.8 million euro for FY2017; Bloomberg, Accessed 2/22/19

[9]  Fourth Quarter And Full Year Financial Results, Bristol-Myers Squibb, 1/24/19

[10] “Bristol-Myers Squibb expects to execute an accelerated share repurchase program of up to approximately $5 billion, subject to the closing of the transaction, market conditions and Board approval,” Bristol-Myers Squibb, 1/3/19

[11]Fourth Quarter And Full Year 2018 Results, Abbvie, 1/25/19

[12] Market Screener, Accessed 2/22/19

[13] Converted from 9.4 million GBP for FY2017; Bloomberg, Accessed 2/22/19


protectourcare
In News

Sen. Brown & Protect Our Care To Call For Opposition To Trump Nominees Who Worked To Strip Ohioans Of Health Care Rights

Trump Nominees Chad Readler and Eric Murphy will get Floor Vote in Coming Weeks

Readler Supported Efforts to Allow Insurance Companies to Deny Coverage for People with Pre-Existing Conditions; Murphy has Worked to Restrict Women’s Access to Health Care

WASHINGTON, D.C. – Tomorrow, U.S. Sen. Sherrod Brown (D-OH) and health advocates from Protect Our Care will host a news conference call where they will call on members of the Senate to oppose the nominations of Chad Readler and Eric Murphy to serve on the Sixth Circuit Court of Appeals. Both Readler and Murphy have proven too extreme for Ohio, with combined records of working to roll back health care protections and strip Ohioans’ of their rights. Readler has taken a leading role in the Trump Administration’s efforts to undermine the ACA, filing an anti-ACA Justice Department brief in the multi-state lawsuit that recently resulted in one federal court’s ruling that the entire ACA should be struck down. Brown opposed both nominees when they were first announced by President Trump last year and continues to oppose their nominations today.

WHO:  

U.S. Sen. Sherrod Brown (D-OH)
Brad Woodhouse, Executive Director for Protect Our Care
Health care advocates, Susan Hyde and Maya Zimmerman Brown

WHAT:    

News Conference Call Urging Senate Opposition to two Trump nominees, Chad Readler and Eric Murphy

WHEN:

Tomorrow, Tuesday, Feb. 26, 2019 at 2:30 p.m.

RSVP:

Email [email protected] to RSVP and receive call-in information


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