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As President Trump repeats the lie that he is responsible for relatively low premium increases on the Affordable Care Act marketplaces this year, new Kaiser Family Foundation (KFF) analysis says otherwise. The analysis released this morning finds that President Trump has actually caused 2019 premiums to be 16 percent higher than they otherwise would have been absent GOP sabotage. Among the report’s key findings:

• On-exchange consumers’ premiums for 2019 are 16 percent higher than they should be because of GOP sabotage. The key drivers of these higher premiums are policies enacted by the Trump Administration and its Republican allies: “Altogether, on-exchange silver premiums in 2019 are therefore approximately 16% higher than would otherwise be the case if federal CSR payments had continued (the loss of which contributed approximately 10% to silver exchange premiums), the individual mandate penalty were still enforced, and more loosely-regulated plans were not expanding (the latter changes contributed an additional 6% to 2019 rates).”
• The repeal of the individual mandate and the expansion of junk plans has caused 2019 premiums to be  6 percent higher than they should be. Kaiser estimates that the repeal of the individual mandate penalty and the expansion of junk plans (association and short-term plans) will cause consumers to pay 6 percent more than they would absent these actions in their 2019 premiums.
• The administration’s decision to halt cost sharing reduction payments will cause on-exchange consumers to pay 10 percent more than they would have had CSRs not been stopped.
• Even consumers off the ACA exchange will pay 6 percent more because of Republican sabotage. Kaiser found, “Looking ahead to 2019, premiums in much of the country are holding flat or decreasing a bit, but unsubsidized off-exchange consumers on average will nonetheless pay an average of 6% more than they otherwise would have, if it were not for repeal of the individual mandate and expansion of more loosely regulated plans.”

As President Trump prepares to deliver a speech tomorrow at HHS, there can be no doubt he will repeat the lie that he and other Republicans are defenders of pre-existing conditions protections for the 130 million Americans that depend on them for their health and economic security.

“President Trump and Republicans are gaslighting America, all because their deeply unpopular war on health care is totally at odds with what voters want,” said Brad Woodhouse, executive director of Protect Our Care. “Another day, another pack of lies from the GOP.”

Here’s the truth about how Trump has taken a sledgehammer to health care and pre-existing conditions protections, as well as some of the top Republicans aiding and abetting the president in his ongoing war on health care.

ONE: A Republican lawsuit could wipe out protections for people with pre-existing conditions virtually overnight.

Key players: Trump’s Attorney General Jeff Sessions, indicted Texas Attorney General Ken Paxton, Missouri Attorney General Josh Hawley and Scott Walker’s Attorney General Brad Schimel.

TWO: Republicans have expanded junk plans that allow insurers to discriminate against pre-existing conditions and are expected to drive up the cost of care.

Key players: Current HHS Secretary and former drug executive Alex Azar, Montana Insurance Commissioner Matt Rosendale,

THREE: Republicans passed a repeal bill just last summer that would have let insurers go back to discriminating against people with pre-existing conditions.

Key players: Just about every Republican member of Congress, including Kevin Cramer (R-ND), Martha McSally (R-AZ), Jim Renacci (R-OH), Lou Barletta (R-PA), Marsha Blackburn (R-TN), Brian Mast (D-FL), Mario Diaz-Balart (R-FL), Carlos Curbelo (R-FL), Bruce Poliquin (R-ME), Jason Lewis (R-MN), Erik Paulsen (R-MN), Troy Balderson (R-OH), John Culberson (R-TX), Pete Sessions (R-TX), Scott Taylor (R-VA), and David Brat (R-VA).

FOUR: Republicans still want to repeal health care.

Key players: Vice President Mike Pence, Senate Republican Leader Mitch McConnell, House Republican Whip Steve Scalise, Texas Senator Ted Cruz, Wisconsin state Senator Leah Vukmir, Pete Sessions (R-TX), Scott Perry (R-PA), Mike Kelly (R-PA), Keith Rothfus (R-PA), Dave Brat (R-VA).

FIVE: Republicans keep raiding Medicaid, by the hundreds of billions of dollars, in order to pay for tax breaks for the wealthy.

Key players: Trump’s economic chief Larry Kudlow, Senate Republican Leader Mitch McConnell and just about every Republican member of Congress that voted for tax breaks for the wealthiest.

SIX: Many Republicans are restricting access to Medicaid, preventing millions of Americans from receiving life-saving health care.

Key players: Trump’s CMS head Seema Verma, Trump’s Medicaid director Mary Mayhew, Florida Governor Rick Scott, former Massachusetts Governor Mitt Romney, Maine Governor Paul LePage.

Protect Our Care Calls Out Josh Hawley’s Crusade Against Care Statewide

“If the myriad mailers didn’t make it clear, the big blue bus parked near the Country Club Plaza should have: Health care is dominating [the election],” says Kansas City Star

Protect Our Care’s nationwide bus tour arrived in Missouri this week to sound the alarm about Republicans’ ongoing efforts to repeal protections for people with pre-existing conditions. Events in Kansas City, Springfield and St.Louis were headlined by former secretary of health and human services Kathleen Sebelius, Neera Tanden, CEO of the Center for American Progress Action Fund, state Representative Crystal Quade and attorneys Sharice Davids and Cort VanOstran. Residents and health care advocates joined them to detail the numerous ways in which Republicans have attacked health care, specifically calling on Attorney General Josh Hawley, Congressman Kevin Yoder, Congressman Billy Long and Congresswoman Ann Wagner to end their attacks on health care.

“Instead of protecting people with pre-existing conditions, politicians like Attorney General Josh Hawley and Congressman Kevin Yoder have joined the assault against them – forcing millions of families across Missouri and Kansas to live in fear of their coverage being taken away,” said Secretary Sebelius. “These Republicans have tried every trick in the book to let insurance companies go back to discriminating against people based on their medical histories. I’ve seen first-hand the lifesaving impact these protections have had, and today people across the heartland are standing up, speaking out and calling on Republicans to stop this harmful war on health care once and for all.”

“The war on health care has already taken a devastating toll on families and communities – driving up premiums, shuttering rural hospitals, and forcing people with pre-existing conditions to live in fear of once again being denied coverage,” said Neera Tanden. “Today we’re here to sound the alarm: the Trump administration and its GOP allies need to stop siding with insurance companies and start putting the people of Missouri first.”

In Kansas City, Paul Washington discussed his fears for his son, who was diagnosed with cancer, if protections for pre-existing conditions are removed. Beth Partin, a cancer survivor, shared how protections in the ACA allow her to afford regular screening and preventative care. Joe Tilleray, a college student from Overland Park, spoke about life with cystic fibrosis. Laura Roberson, whose son was diagnosed with cerebral palsy, detailed the impact of the GOP’s sabotage efforts on her family.

In St. Louis, Elinor Simmons discussed being diagnosed with stage 3 cancer, and her concerns that the war on health care will put her coverage at risk. Teresa Johnson, the mother of a child with Down Syndrome and other serious health conditions, shared how Senator Claire McCaskill helped him get the care he needed at home. And Dr. Pam Gronemeyer, a pathologist, talked how health care is a human right.

In Springfield, Cheyenne Mauzy shared her fears for her son who was diagnosed with a rare blood disorder and the impact if protections for pre-existing conditions are removed. John Mihalevich provided his perspective as a retired doctor on the impact of the state legislature’s failure to expand Medicaid and the devastation that has caused in rural communities.

After Missouri, Care Force One travels to Tennessee, Virginia, North Carolina and Georgia. You can view all the upcoming stops here.

“To get serious about opioids, Republicans need to stop their assault on Medicaid, quit pushing the sale of junk plans and end their relentless war on our health care,” says Leslie Dach

Washington DC – This week, President Trump and Congressional Republicans continue their campaign of deception, attempting to cloak themselves as caring about health care when instead they have waged a war on the Affordable Care Act and Medicaid. While the Trump administration claims the legislation they are signing will address the opioid epidemic sweeping the nation, their recent calls for cuts to Medicaid — which pays for one-fifth of all substance abuse treatments nationwide — and continual expansion and promotion of junk plans without substance use disorder coverage tells another story. Leslie Dach, chair of Protect Our Care, issued the following statement in response:

“Let’s be clear, President Trump and his Republicans are doing more to undermine efforts to address the opioid crisis than they doing to help those Americans who are suffering. In reality, Trump and his allies are undermining the fight against the opioid crisis by raiding Medicaid for hundreds of billions of dollars in cuts in order to pay for tax cuts for the wealthy and by making it easier for insurance companies to sell junk plans without mental health or substance use disorder treatment coverage. To get serious about opioids, Republicans need to stop their assault on Medicaid, quit pushing the sale of junk plans and end their relentless war on our health care.”  

ADDITIONAL BACKGROUND

MEDICAID GIVES STATES MORE RESOURCES TO ADDRESS THE OPIOID EPIDEMIC

Medicaid Is Part Of The Solution To Curbing Opioid Epidemic. “Medicaid is the most powerful vehicle available to states to fund coverage of prevention and treatment for their residents at risk for or actively battling opioid addiction….The greatest opportunity to address this crisis is in those states that have elected to expand Medicaid, given the greater reach of the program, additional tools available, and the increased availability of federal funds.” [State Health Reform Assistance Network, July 2016]

Thanks To Medicaid Expansion, The Uninsured Rate For Opioid-Related Hospitalizations Dropped In Expansion States. “In Medicaid expansion states, the uninsured rate for opioid-related hospitalizations plummeted by 79 percent, from 13.4 percent in 2013 (the year before expansion implementation) to 2.9 percent in 2015.  The decline in non-expansion states was a much more modest 5 percent, from 17.3 percent in 2013 to 16.4 percent in 2015.” [Center on Budget and Policy Priorities, 2/28/18]

Just This Week, An Associated Press Study Affirmed That “Medicaid Expansion States Had A Running Start On The Opioid Crisis.” “In states that expanded Medicaid, the insurance program already covers addiction treatment for nearly everyone who is poor and needs it. Medicaid allows states to go beyond the basics with the grant money, while non-expansion states have to fill in for basic needs with fewer dollars, said Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health. In effect, Medicaid expansion states had a running start on the opioid crisis, while states without the extra Medicaid funding hastened to catch up…States that did not expand Medicaid spent $2,645 per patient on opioid addiction treatment on average. Expansion states spent $1,581 per patient for treatment. States that did not expand Medicaid spent $1,170 per person served on recovery support services. Expansion states spent $446 per person served on recovery.” [Associated Press, 10/22/18]

(Center on Budget and Policy Priorities, 2/28/18)

In States Without Medicaid Expansion, Grant Funds Are Spent At A Faster Rate.  An analysis of state use of opioid grant money found states that have expanded Medicaid spend the grant funds at a slower pace than non-expansion states, because Medicaid already covers addiction treatment for the low-income population, allowing the state to direct the grant money to invest in new infrastructure. Non-expansion states spent 71 percent of their grant money in the first year, compared to 59 percent spent by expansion states. [AP, 10/22/18]

Medicaid Expansion Has Improved Access To Substance Treatment Services. “Evidence also suggests that Medicaid expansion improved access to substance use treatment services more broadly. After expanding Medicaid, Kentucky experienced a 700 percent increase in Medicaid beneficiaries using substance use treatment services.  Use of treatment services rose nationally as well; one study found that expanding Medicaid reduced the unmet need for substance use treatment by 18.3 percent.” [Center on Budget and Policy Priorities, 2/28/18]

Medicaid Helps Make Buprenorphine And Naloxone, Drugs Used To Treat Opioid Use Disorder, Affordable. “These data are consistent with other evidence that Medicaid expansion is improving access to care for people with opioid use and other substance use disorders. Medicaid makes medications like buprenorphine and naloxone, which are prescribed to combat opioid use disorders, affordable for beneficiaries.“ [Center on Budget and Policy Priorities, 2/28/18]

JUNK PLANS HURT PEOPLE WITH OPIOID USE DISORDER

Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits, Like Mental Health Treatment. “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 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]

• As Many As 130 Million Nonelderly Americans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]
• One in 4 Children Would Be Impacted If Insurance Companies Could Deny Coverage Or Charge More Because Of A Pre-existing Condition. [Center for American Progress, 4/5/17]
  

Junk Plans Mean Higher Premiums For People With Pre-Existing Conditions. “By promoting short-term policies, the administration is making a trade-off: lower premiums and less coverage for healthy people, and higher premiums for people with preexisting conditions who need more comprehensive coverage.” [Washington Post, 5/1/18]

Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits –  “for example, many policies cap covered benefits at $1 million or less.” [Kaiser Family Foundation, 2/9/18]

REPUBLICANS PLEDGE TO SLASH HEALTH CARE TO PAY FOR THEIR TAX CUTS FOR THE WEALTHY:

Last week, Mitch McConnell Blamed Medicare, Medicaid and Social Security for the massive increase in the debt, calling for cuts. Senate Majority Leader Mitch McConnell blamed “bipartisan reluctance” to reform federal entitlement programs for the rising federal deficit, which the Treasury Department said Monday reached $779 billion in 2018.  “There’s been a bipartisan reluctance to tackle entitlement changes because of the popularity of those programs,” McConnell told Bloomberg News. “Hopefully at some point here, we’ll get serious about this.”

Last month, 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.”

Paul Ryan on Medicare: “It’s the biggest entitlement we’ve got to reform.” Paul Ryan, December 6, 2017: “We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit…Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements…In- think the president is understanding that choice and competition works everywhere in health care, especially in Medicare…This has been my big thing for many, many years. I think it’s the biggest entitlement we’ve got to reform.”

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. How do Republicans plan on paying for it? Speaker Ryan’s answer is clear: “Frankly, it’s the health care entitlements that are the big drivers of our debt.” 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.

Congressional Republicans Voted to Slash An Additional $1.3 Trillion From Medicaid and other Health Care Programs. The 2018 budget resolution passed by Republicans in December 2017 cut non-Medicare health programs, most notably Medicaid, by $1.3 trillion, a 20 percent cut over the course of 10 years, increasing to a 29.3 percent cut by 2027.

“Trump’s ‘October Surprise’ is to prove once and for all that Republicans don’t care about protecting people with pre-existing conditions or making health care more affordable,” says Brad Woodhouse

Washington, DC – One year ago — after the American people rose up to defeat health care repeal — the Trump Administration issued an executive order outlining three ways that it would circumvent the will of the public and roll back health care protections in the Affordable Care Act. Today, the Trump administration has checked all three things off its list: this summer, it eased restrictions on junk plans (association health plans, or AHPs, and short-term health plans, or STLDIs); yesterday it made it easier for states to allow insurance companies to sell junk plans, and today it announced it has expanded health reimbursement arrangements (HRAs), over the overwhelming opposition of health care experts and advocates. In response, Brad Woodhouse, executive director of Protect Our Care, issued the following statement:

“It’s the trifecta of health care sabotage: not satisfied with just undermining protections for people with pre-existing conditions or pushing junk plans for individuals, now the Trump Administration is working to undermine comprehensive employer coverage, as well. Trump’s ‘October Surprise’ is to prove once and for all that Republicans don’t care about protecting people with pre-existing conditions or making health care more affordable. If we know one thing to be true, it’s that the GOP’s ongoing war on America’s health care isn’t slowing down — in fact, it’s on overdrive as long as they have power.”

EXPANSION OF 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]

1332 WAIVERS WITHOUT APPROPRIATE GUARDRAILS MAKES IT EASIER FOR INSURANCE COMPANIES TO SELL JUNK PLANS

• Protections for people with pre-existing conditions would be essentially meaningless. The American Cancer Society Cancer Action Network said allowing states to waive essential health benefits “could render those protections meaningless” for people with pre-existing conditions.
• It would be harder for people with pre-existing conditions to get affordable coverage. As Consumers Union stated, allowing states to waive essential health benefits would be “putting meaningful coverage out of reach for many Americans, especially those with chronic and pre-existing conditions.”
• You could pay more for the same coverage. 1332 waivers allow states to adjust the amount of premium tax credits and cost-sharing consumers receive to help lower their costs. Without the guardrail to ensure coverage is just as affordable, many consumers could end up paying more for the same care.
• Insurers would not have to cover essential benefits, like maternity care. Right now, every insurance plan must cover the 10 essential health benefits. Because states could opt out of covering these basic benefits, insurers would likely only offer policies that covered much less than they do now. The Kaiser Family Foundation found that the benefits most likely to no longer be covered would be maternity care, mental health or substance abuse coverage. According to the Brookings Institution, the result would be “that no one in a state’s individual market that waived EHBs would have access to comprehensive coverage. Insurers would likely sell separate policies for benefits not covered in their core plan offerings, but these supplemental policies would be subject to tremendous adverse selection, leading to very high premiums and enrollment almost exclusively by those with pre-existing conditions.” For example, a woman who purchases a separate insurance rider for maternity care would have to pay $17,320 more, according to the Center for American Progress. For states that no longer required substance use disorders or mental health to be covered, coverage for drug dependence treatment could cost an extra $20,450.
• Insurers could reimpose lifetime and annual limits. Allowing states to opt out of the essential health benefits coverage means that insurance companies could once again put lifetime and annual limits on the amount of care you receive. Moreover, as the Center on Budget and Policy Priorities notes, this would even impact people with coverage from their employer: “The ACA’s prohibition on annual and lifetime limits is tied to the definition of Essential Health Benefits. Thus, repeal of Essential Health Benefit standards could make this protection meaningless, putting almost all Americans with private health insurance coverage — not just those with individual or small-group market coverage — at risk.” The Center for American Progress estimates that 20 million people with health coverage through their employer would face lifetime limits on coverage, and 27 million would face annual limits.

JUNK PLANS HURT PEOPLE WITH PRE-EXISTING CONDITIONS PROTECTIONS

Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits. “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 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]

• As Many As 130 Million Nonelderly Americans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17]
• One in 4 Children Would Be Impacted If Insurance Companies Could Deny Coverage Or Charge More Because Of A Pre-existing Condition. [Center for American Progress, 4/5/17]
  

Junk Plans Mean Higher Premiums For People With Pre-Existing Conditions. “By promoting short-term policies, the administration is making a trade-off: lower premiums and less coverage for healthy people, and higher premiums for people with preexisting conditions who need more comprehensive coverage.” [Washington Post, 5/1/18]

Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits –  “for example, many policies cap covered benefits at $1 million or less.” [Kaiser Family Foundation, 2/9/18]