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Calling BS on CMS: Seema Verma’s Medicaid Spin Is a Bald-Face Lie

Washington, DC — Today, Centers for Medicare & Medicaid Services Administrator Seema Verma gave a speech at the CMS Quality Conference in Baltimore, Maryland where she tried to affirm the administration’s commitment to Medicaid, despite the multiple efforts orchestrated by Verma to sabotage and undermine the program.

In response, Brad Woodhouse, executive director of Protect Our Care, released the following statement:

“Seema Verma’s comment today is, plain and simple, a bald-faced lie. This administration has worked against Medicaid at every turn. Indeed, not since Medicaid was signed into law more than 50 years ago has there been an administration or an Administrator more hostile to Medicaid than the Trump administration and Seema Verma. The Trump administration supports so-called work requirements like those in Arkansas which has already ripped coverage away from 18,000 people, opposed Medicaid expansion in states across the country, and advocated for the block granting of Medicaid which is a euphemism for slashing its budget and kicking people off the rolls.

Fortunately, the American people have a different view: Medicaid has never been more popular. The attacks on Medicaid by this administration and its Republican allies led in large part to the defeat of the ACA repeal effort. And, during the 2019 election, voters across the country rejected the Republicans’ sabotage agenda and either expanded Medicaid at the polls or elected pro-Medicaid politicians who promised to do so in office. The truth is, Medicaid is flourishing despite this administration’s efforts to undermine it and no type of Orwellian spin from Administrator Verma can change that.”

protectourcare
In News

Six Things Azar Conveniently Left Out Of His Op-ed Defending Trump On Drug Pricing

In his new op-ed defending the Trump administration’s failures on drug pricing published in Stat this morning, Secretary Alex Azar rambled about drug pricing without acknowledging any of the ways the Trump administration has time and again protected the rigged system that makes the drug companies even richer, while making people who work for a living pay higher prices for drugs.

  1. Pharmaceutical Companies Have Reaped Billions Of Dollars From The Trump Tax Bill. The Trump tax scam means billions of dollars in tax breaks for pharmaceutical companies. An Axios study found that 21 health care companies collectively expect to gain $10 billion in tax savings during 2018 alone. Most of the tax break windfall for health care companies is going toward share buybacks, dividends, acquisitions and paying down debt. According to Axios, nine pharmaceutical companies are spending a combined $50 billion on new share buyback programs.
  2. The Administration Has Consistently Advocated For The Repeal Of The Affordable Care Act, Including Its Requirement That Insurance Companies Cover Prescription Drugs. After the Trump administration tried and failed to repeal the ACA legislatively, it took to the courts in hopes of eliminating the health law. In 2018, the Justice Department decided not to defend the Affordable Care Act in court against a lawsuit seeking to overturn it. Since, a federal judge has ruled to overturn the law, including its requirement that insurance companies cover patients’ prescription drugs.
  3. One Trump Administration Proposal Would Let Insurance Companies Stop Covering Brand Name Drugs, Which Some Consumers Rely On. Under the proposal, consumers who rely on brand-name prescription drugs when generics are available would face higher costs. Insurance companies would be able to calculate a consumer’s out-of-pocket spending based solely on generic equivalents of brand-name drugs, meaning if a brand name drug had a $25 co-pay associated with it and the generic version had a $5 co-pay, if a consumer paid a $25 co-pay on a brand-name drug the insurance company would only have to include the $5 co-pay associated with the generic in the consumer’s out-of-pocket spending. This means consumers who rely on brand-name drugs have to pay significantly more in out-of-pocket costs to get the medication they need. Advocates, such as Carl Schmid of the AIDS Institute have warned that this proposal “increases the likelihood that people won’t pick up their drugs, won’t take their drugs.”
  4. Trump Installed Big Pharma Executives In Key Administration Posts. The author of op-ed, Alex Azar himself is a former Eli Lily executive. Trump’s appointment of Scott Gottlieb at FDA was described as “music to pharma’s ears.” Other pharma lobbyists writing Trump’s health policy include senior adviser at FDA, Keagan Lenihan, who joined the administration after lobbying for the drug distribution giant McKesson, former Gilead lobbyist, Joe Grogan, who reviews health care regulations at the Office of Management and Budget and is expected to soon lead the White House’s Domestic Policy Council, and Deputy Assistant to the President for Domestic Policy Lance Leggitt, who has lobbied for a variety of drug-industry clients.
  5. 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.”
  6. In The Past Year, Drug Companies Have Seen Massive Profits And Price Increases. Pharmaceutical companies raked in more than $30 billion in profits in the third quarter of 2018, with Pfizer alone bringing in $4.1 billion — the highest of any publicly traded health care company. Of the 19 companies that tallied at least $1 billion of third-quarter profit, 14 were drug companies.  Meanwhile, pharmaceutical companies continue to increase prices. In January 2019 alone, Pfizer and Novartis announced price increases on dozens of drugs, including increasing the cost of a breast cancer medication to $12,000 for 21 pills. All in all, nearly 30 drugmakers are expected to raise prices in 2019. One drug industry lobbyist has said that drug companies’ limited concessions are “a calculated risk” summarizing big pharma’s strategy to play the Trump administration: “take these nothing-burger steps and give the administration things they can take credit for.”
protectourcare
In News

Don’t Be Fooled: Chad Readler Wants to Repeal American Health Care

The Trump administration recently announced the renomination of 51 nominees to the federal bench, including Chad Readler for the Sixth Circuit Court of Appeals. In his role as Acting Assistant Attorney General, Readler overruled career attorneys at the Department of Justice and  filed a brief on behalf of the Trump administration in Texas v. United States arguing in favor of striking down the Affordable Care Act, including its protections for people with pre-existing conditions.

 

Let’s be clear, Readler’s anti-health care record speaks for itself:

 

READLER AUTHORED THE TRUMP ADMINISTRATION’S ASSAULT ON THE AFFORDABLE CARE ACT IN TEXAS V. UNITED STATES

Readler Filed The Trump Administration’s Brief In Texas V. United States To Strike Down The ACA.  In his role as Acting Assistant Attorney General, Raedler filed the Trump administration’s brief in Texas V. United States arguing that the court should enter “a declaratory judgment that the ACA’s provisions containing the individual mandate as well as the guaranteed issue and community-rating requirements will all be invalid beginning on January 1, 2019.” [Federal Defendants’ Memorandum in Response to Plaintiffs’ Application for Preliminary Injunction, Texas v. United States of America, 6/7/18]

Readler Was Nominated For A Judicial Seat The Same Day He Filed The Brief Calling For The ACA To Be Overturned.  “If confirmed, Chad A. Readler of Ohio will serve as a Circuit Judge on the U.S. Court of Appeals for the Sixth Circuit.  Chad Readler currently serves as the Principal Deputy and Acting Assistant Attorney General for the Civil Division at the U.S. Department of Justice, a position that he has held since 2017. In that role, Mr. Readler has lead and supervised the Department’s largest litigating division and has actively briefed and argued several cases on behalf of the United States in federal courts across the country.” [White House Press Release, 6/7/18]

  • Readler Was Renominated For The Bench In January 2019.  “Today President Donald J. Trump announced his intent to nominate the following judicial nominees:  […] Chad A. Readler, of Ohio, to be United States Circuit Judge for the Sixth Circuit.” [White House Press Release, 1/22/19]

Republicans And Career DOJ Officials Refused To Have Anything To Do With Readler’s Arguments

Republican Lamar Alexander Called Readler’s Argument “As Far Fetched As Any I’ve Ever Heard.”  “Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, called the Trump administration’s argument against ObamaCare in a court case ‘as far-fetched as any I’ve ever heard.’  The Justice Department (DOJ) wrote in a filing Friday that it would not defend ObamaCare’s protections for people with pre-existing conditions, siding in large part with a challenge to the law brought by a coalition of Republican-led states. The states, and the DOJ, argue that Congress’s repeal of the tax penalty associated with ObamaCare’s individual mandate makes the law’s protections for people with pre-existing conditions unconstitutional Alexander said it wasn’t the intent to take away protections for people with pre-existing conditions when the mandate penalty was repealed late last year. ‘There’s no way Congress is going to repeal protections for people with pre-existing conditions who want to buy health insurance. The Justice Department argument in the Texas case is as far-fetched as any I’ve ever heard,’ Alexander said in a statement late Tuesday evening.” [The Hill, 6/12/18]

A 20 Year Veteran Of The DOJ Resigned In The Wake Of Readler’s Brief.  “A senior career Justice Department official has resigned in the wake of the Trump administration’s move to stop defending a key provision of the Affordable Care Act, a departure that highlights internal frustration generated by the decision, according to people familiar with the matter. Joel McElvain, who has worked at the Justice Department for more than 20 years, submitted his resignation letter Friday, the morning after Attorney General Jeff Sessions notified Congress that the agency will not defend the ACA — the 2010 law known as Obamacare — against lawsuits brought by Republican-led states challenging its requirement that most Americans carry health insurance.” [Washington Post, 6/12/18]

Two Career Attorneys At DOJ Asked To Be Withdrawn From Readler’s Brief.  “Just before the brief was filed, McElvain and two other career attorneys, Eric Beckenhauer and Rebecca Kopplin, filed a motion to withdraw from the case. Asked about the withdrawal of the attorneys, a Justice official said: ‘As is customary, the department decided to sub in a new legal team for a new legal position.’ The official said she was not aware of any indication that the other two attorneys were departing.” [Politico, 6/13/18]

An Ideologically Diverse Group Of  Legal Scholars Said Readler’s Arguments “Violate Basic Black-Letter Principles” Of Law.  “Under these circumstances, a court’s substitution of its own judgment for that of Congress would be an unlawful usurpation of congressional power and violate basic black-letter principles of severability. Yet that is what the plaintiff States and the United States invite this Court to do.” [Brief of Amici Curiae Jonathan H. Adler, Nicholas Bagley, Abbe R. Gluck, Ilya Somin, and Kevin C. Walsh in Support of Intervenors-Defendants’ Opposition to Plaintiffs’ Application for Preliminary Injunction, Texas v. United States of America, 6/14/18]

THE TEXAS CASE PUTS THE HEALTH CARE OF MILLIONS OF AMERICANS AT RISK

Republican officials — supported by the Trump administration in the brief authored by Chad Readler  — in 20 states went to federal court in the northern district of Texas to repeal the Affordable Care Act in its entirety. In a December 2018 ruling, U.S. Northern District Court Judge Reed O’Connor used  the courts to do what Republicans in Congress failed to do legislatively: strike down the Affordable Care Act. If O’Connor’s ruling is not overturned, it will rip coverage from millions of Americans, raise costs, end protections for people with pre-existing conditions, put insurance companies back in charge, and force seniors to pay more for prescription drugs. The result will be to — as the Trump Administration itself admitted in Court — unleash “chaos” in our entire health care system.

If The Texas Ruling Is Not Overturned, 17.1 Million People could Lose Their Coverage

If The Texas Ruling Is Not Overturned, Insurance Companies Could Be Put Back In Charge, Ending Protections For The 130 Million People With A Pre-Existing Condition

  • According to a recent analysis by the Center for American Progress, roughly half of nonelderly Americans, or as many as 130 million people, have a pre-existing condition. This includes:
    • 44 million people who have high blood pressure
    • 45 million people who have behavioral health disorders
    • 44 million people who have high cholesterol
    • 34 million people who have asthma and chronic lung disease
    • 34 million people who have osteoarthritis and other joint disorders
  • 17 million children. One in four children, or roughly 17 million, have a pre-existing condition.
  • 68 million women. More than half of women and girls nationally have a pre-existing condition.
  • 30 million people aged 55-64. 84 percent of older adults, 30.5 million Americans between age 55 and 64, have a pre-existing condition.

If The Texas Ruling Is Not Overturned, Insurance Companies Could Have the Power to Limit the Care You Get, Even If You Have Insurance Through Your Employer

 

  • Insurance Companies Do Not Have to Provide the Coverage You Need. The Affordable Care Act made comprehensive coverage more available by requiring insurance companies to include “essential health benefits” in their plans, such as maternity care, hospitalization, substance abuse care and prescription drug coverage. Before the ACA, people had to pay extra for separate coverage for these benefits. For example, in 2013, 75 percent of non-group plans did not cover maternity care, 45 percent did not cover substance abuse disorder services, and 38 percent did not cover mental health services. Six percent did not even cover generic drugs.

 

 

  • Reinstate Lifetime and Annual Limits. Repealing the Affordable Care Act means insurance companies would be able to impose annual and lifetime limits on coverage.

 

  • Large Employers Could Choose to Follow Any State’s Guidance, Enabling Them Put Annual and Lifetime Limits on Their Employees’ Health Care. Without the ACA’s definition of essential health benefits (EHB) in even some states, states could eliminate them altogether. Large employers could choose to apply any state’s standard, making state regulations essentially meaningless. Because the prohibition on annual and lifetime limits only applies to essential health benefits, this change would allow employers to reinstate annual and lifetime limits on their employees’ coverage.

AT HIS CONFIRMATION HEARING, READLER ATTEMPTED TO DOWNPLAY HIS INVOLVEMENT IN THE BRIEF CALLING FOR THE ACA TO BE STRUCK DOWN  

Readler Denied That He Was The “Primary Author” Of The Brief Calling For The ACA To Be Struck Down.  Mike Lee: Now, as acting assistant attorney general over the Civil Division or as the PDAG were you the primary author of briefs involving some of the cases that have been brought to the public’s attention in connection with your confirmation including the treatment of — in cases involving the treatment of pre-existing conditions under the Affordable Care Act, the separation of unaccompanied alien children from their parents, the so-called Entry Ban DACA litigation or sanctuary cities. Chad Readler: Senator, I wouldn’t call myself the primary author. As the head of the division my name would go on every single brief that the division would file. That could be 20 or 30 briefs a day. Depending on the case I may have had different levels of involvement with the case. I may not have looked at briefs, I may not have, but again it’s tradition at the department that the head of the division goes on every, name, goes on every single brief.” [Senate Judiciary Committee Hearing on Pending Nominations, 10/16/18]

Readler Defended The Brief:  “We Would Not Make An Argument If I Thought It Was Unethical Or Frivolous.”  “Pat Leahy: You do stand by those arguments today that the Affordable Care Act cannot be reasonably defended? Chad Readler: Senator, the position that the attorney general took is that the mandate was unconstitutional and… Leahy: Will you stand by those arguments today? Readler: Senator, it is my position to advocate for the United States. We would not make an argument if I thought it was unethical or frivolous.” [Senate Judiciary Committee Hearing on Pending Nominations, 10/16/18]

Readler On Whether Millions Of People With Pre-Existing Conditions Could Lose Health Coverage If His Position Prevailed:  “The Attorney General Was Clear About What The Legal Position For The Department Would Be. And We’ve Advocated That Position.” “Maisie Hirono:  You’ve been asked a number of questions about your role in Texas versus United States. So if your argument – let me start with the protections of preexisting conditions under the ACA. If your argument on pre-existing condition prevails, would it mean that one in four people who have pre-existing conditions, millions of people in our country including women who have been pregnant possessing the pre-existing condition? Of course, people with asthma, diabetes, cancer. Doesn’t it mean that if your argument prevails that all of these people with pre-existing conditions will either lose their health insurance altogether or have to pay much, much more for health insurance? […] Chad Readler: So senator, healthcare is a very important policy issue in this country. I agree there are a lot of individuals and families facing very serious healthcare conditions. With respect to the legal issues, I’m not a policymaker, but with respect to legal issues in those cases, or in that case, the attorney general was clear about what the legal position for the department would be. And we’ve advocated that position.” [Senate Judiciary Committee Hearing on Pending Nominations, 10/16/18]

protectourcare
In News

Thanks Donald: Trump Sabotage Leads To Highest Uninsured Rate Since 2014

Gallup’s quarterly health survey reveals that the uninsured rate has risen to the highest rate since the Affordable Care Act’s coverage expansion was completed. A major reason for this increase? Trump’s relentless health care sabotage. Take a look for yourself:

Gallup’s Own Release Cites Trump Administration Sabotage In Its Explanation Of The Rising Uninsured Rate: “The Open Enrollment Periods Since 2018 Have Been Characterized By A Significant Reduction In Public Marketing And Shortened Enrollment Periods Of Under Seven Weeks, About Half Of Previous Periods.” Among the factors Gallup cites as playing a role in the increase of the uninsured rate:

  • Increasing Premiums: “One may be an increase in the rates of insurance premiums in many states for some of the more popular ACA insurance plans in 2018 (although most states saw premiums stabilize for 2019).”  [Gallup, 1/23/19]
  • Major Cuts To Open Enrollment: “The open enrollment periods since 2018 have been characterized by a significant reduction in public marketing and shortened enrollment periods of under seven weeks, about half of previous periods.” [Gallup, 1/23/19]
  • Slashed Funding For Navigator groups: “Funding for ACA ‘navigators’ who assist consumers in ACA enrollment has also been reduced in 2018 to $10 million, compared with $63 million in 2016. Overall, after open enrollment in the ACA federal insurance marketplace (i.e., healthcare.gov) peaked in 2016 at 9.6 million consumers, it declined by approximately 12.5%, to 8.4 million in 2019, based on recently released figures.”  [Gallup, 1/23/19]
  • Trump’s Hostility To The ACA: “Other potential factors include political forces that may have increased uncertainty surrounding the ACA marketplace. Early in his presidency, for example, President Donald Trump announced, ‘I want people to know Obamacare is dead; it’s a dead healthcare plan.’ Congressional Republicans made numerous high-profile attempts in 2017 to repeal and replace the plan. Although none fully succeeded legislatively, the elimination of the ACA’s individual mandate penalty as part of the December 2017 Republican tax reform law may have reduced participation in the insurance marketplace in the most recent open enrollment period. Trump’s decision in October 2017 to end cost-sharing reduction could also potentially have affected the uninsured rate.” [Gallup, 1/23/19]

Los Angeles Times: Uninsured Rate Under Trump Surges To Highest Level Since Obamacare Began. “The percentage of American adults without health insurance surged upward in 2018, reaching levels not recorded since before President Trump took office, according to a new national survey that revealed widespread coverage losses over the last two years…The new number represents the highest uninsured rate since the beginning of 2014, when the Affordable Care Act began providing billions of dollars in aid to help low- and middle-income Americans get covered, according to the survey by Gallup. The new report also indicates that some 7 million American adults have likely lost or dropped coverage since 2016…Since taking office, however, Trump has repeatedly attacked the healthcare law and enthusiastically backed a 2017 effort by congressional Republicans to roll it back.” [Los Angeles Times, 1/23/19]

HuffPost: The Uninsured Rate Is The Highest It’s Been In Five Years. “About 7 million fewer Americans had health insurance at the end of last year compared with two years prior, and the share of people who are uninsured is the highest it’s been since 2014, according to a new survey…Since his first day in office, Trump has directed and overseen policies that undermine the health insurance exchanges. The administration has dramatically reduced funding for advertising, marketing and outreach to draw eligible customers to the exchanges during open enrollment and for programs that help consumers navigate the sign-up process. The Republican tax package Trump enacted in 2017 repealed the Affordable Care Act’s fines on people who didn’t obtain health coverage under the law’s individual mandate, freeing people to go uninsured without penalty and causing insurers to increase prices on the assumption that healthier people are less likely to buy coverage in the absence of fines. Perhaps most consequentially, Trump ended payments to health insurance companies serving the lowest-income customers, which led insurers to increase prices to make up for the lost revenue.” [HuffPost, 1/23/19]

Vox: Under Trump, The Number Of Uninsured Americans Has Gone Up By 7 Million. “Certain demographic groups are experiencing a greater loss of coverage than others. Gallup data shows, for example, that Americans who are younger and lower-income have seen a greater decline in insurance coverage than those who are older and wealthier. Women have had insurance rates decline more quickly than men. This trend is especially surprising given that over the same time period, the unemployment rate has been declining. Usually, when more people have jobs, it means more people with access to employer-sponsored health insurance. But even during this period of job growth, America’s uninsured rate keeps climbing.” [Vox, 1/23/19]

Forbes: Uninsured Rate Hits Four-Year High Amid Trump’s Obamacare Attacks. “The rate of Americans without health insurance has ‘risen steadily’ to 13.7% from 10.9% in 2016 , data released Wednesday as part of Gallup’s national “health and well-being index,” which drew from a quarterly data sample of about 28,000 adults…Following his 2016 election, Donald Trump swept into the White House in January of 2017, promising to repeal and replace the ACA, also known as Obamacare. That effort was a failure because the Republican-led Congress of 2017 was unable to repeal the law nor did GOP lawmakers come up with a replacement plan. But the Trump White House has made several policy moves that the Gallup analysis indicates has contributed to fewer people having coverage. ‘The open enrollment periods since 2018 have been characterized by a significant reduction in public marketing and shortened enrollment periods of under seven weeks, about half of previous periods,’ Gallup’s analysis said.” [Forbes, 1/23/19]

CNBC: Rate Of Americans Without Insurance Rises To 4-year High As Trump Weakens Obama Health Law, Gallup Survey Finds. “The percentage of U.S. adults without health insurance reached a four-year high in the last quarter of 2018, but was still well below the peak level seen before Medicaid expansion under the Affordable Care Act in 2014, a new Gallup survey published Wednesday found. The national uninsured rate climbed to 13.7 percent in the fourth quarter of 2018, its highest level since the first quarter of 2014 when the rate reached 13.4 percent, according to data the compiled from Gallup. Women and adults under the age of 35 reported among the highest rates without insurance at 12.8 percent and 21.6 percent, respectively, the survey found.” [CNBC, 1/23/19]

Axios: “Gallup’s Quarterly Health Surveys Tell A Pretty Clear Story, Which It Attributes To The Trump Administration’s Handling Of The ACA.” “The number of Americans without health insurance has been creeping higher throughout the Trump administration, and it’s now the highest it’s been since the Affordable Care Act’s coverage expansion took effect in 2014, according to Gallup’s latest survey…Women, lower-income households and young people saw the biggest coverage losses, according to Gallup…Gallup’s quarterly health surveys tell a pretty clear story, which it attributes to the Trump administration’s handling of the ACA.” [Axios, 1/23/19]

protectourcare
In News

New KFF Health Tracking Poll: More Trouble for Sabotage & Repeal Republicans

The 2018 midterms were a referendum on health care and voters rejected the sabotage and repeal approach of Donald Trump and Republicans in Congress.

According to the new Kaiser Family Foundation Health Tracking poll, opposition continues to grow against Republicans for putting the needs of their health insurance contributors ahead of the needs of people who work for a living.

TWO KEY FINDINGS FROM THE KFF HEALTH TRACKING POLL

  • People reject Trump’s lawsuit to overturn ACA. By 10 points (41-51%), voters disapprove of the right-wing TX judge backing the Trump administration’s lawsuit to overturn the Affordable Care Act. When people hear that the Trump administration lawsuit means “people with pre-existing conditions may have to pay more for coverage or could be denied coverage,” they shift to opposing it by 39 points (25-64%)
  • People want action to protect coverage for those with pre-existing conditions, lower the cost of prescription drugs, and protect consumers against surprise medical bills. 82% of voters say it’s either extremely (54%) or very important (28%) that this Congress take action to lower prescription drug costs. 73% say it’s either extremely (46%) or very important (27%) that this Congress take action to protect coverage of those with pre-existing conditions. 70% of voters say it’s either extremely (43%) or very important (27%) that Congress work to protect people with health insurance from surprise high out-of-pocket medical bills.
protectourcare
In News

BREAKING: Trump Renominates Anti-Health Care Chad Readler for the Sixth Circuit

Washington DC —  Yesterday, the Trump administration announced the renomination of 51 nominees, including Chad Readler for the Sixth Circuit Court of Appeals. In his role as Acting Assistant Attorney General, Readler overturned the career attorneys at the Department of Justice and made the decision not to defend the Affordable Care Act. He filed a brief on behalf of the Trump administration in Texas v. United States arguing in favor of striking down the Affordable Care Act, including its protections for people with pre-existing conditions. Now, Mitch McConnell is breaking with longstanding Senate norms to jam through this nomination by ignoring the objections of Readler’s home state senator, Sherrod Brown. Leslie Dach, chair of Protect Our Care, released the following statement:

“Let’s be clear: A vote for Chad Readler is a vote for full repeal of the Affordable Care Act. His confirmation vote is the litmus test that will show everyone where each Senate Republican stands on protecting people with pre-existing conditions. 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. The stakes couldn’t be clearer, the Senate must stand up for people with pre-existing conditions and block Readler from a lifetime appointment to the court.”

 

Background:

As Acting Assistant Attorney General, Chad Readler filed a brief on behalf of the Trump administration in Texas v. United States arguing that the Affordable Care Act is unconstitutional. This put the full weight of the Department of Justice behind the Republican war on health care to overturn the entire Affordable Care Act (ACA).  If this ruling is allowed to stand:

  • Marketplace tax credits and coverage for 10 million people: GONE.
  • Medicaid expansion currently covering 15 million people: GONE.
  • Protections for more than 130 million people with pre-existing conditions when they buy coverage on their own: GONE.
  • Allowing children to stay on their parents’ insurance until age 26: GONE.
  • Free annual wellness exams: GONE.
  • Ban on annual and lifetime limits: GONE.
  • Ban on insurance discrimination against women: GONE.
  • Contraception with no out-of-pocket costs: GONE.
  • Limit on out-of-pocket costs: GONE.
  • Requirement that insurance companies cover essential benefits like prescription drugs, maternity care, and hospitalization: GONE.
  • Improvements to Medicare, including reduced costs for prescription drugs: GONE.
  • Closed Medicare prescription drug donut hole: GONE.
  • Rules to hold insurance companies accountable: GONE.
  • Small business tax credits: GONE.
Sean England
In Statement, News

Protect Our Care Statement On Gallup Poll Showing The Uninsured Rate Jumping To The Highest Level In 5 Years

YEARS OF REPUBLICAN SABOTAGE RESULTS IN THE FEWEST PEOPLE COVERED SINCE THE PASSAGE OF THE ACA, HURTING WOMEN, LOWER-INCOME HOUSEHOLDS, AND YOUNG PEOPLE THE MOST

Washington DC — Today, according to a new Gallup Health and Wellbeing-Index, about 7 million fewer people had health care in 2018 compared to the previous year. The uninsured rate has steadily increased during the Trump administration from a low of 11 percent in 2016, the lowest since the passage of the Affordable Care Act (ACA). The rate was 14 percent in the last quarter of 2018. Brad Woodhouse, executive director of Protect Our Care, released the following statement:

“Years of Trump administration and Republican sabotage of the ACA continues to take its toll. The Trump administration regularly claims it’s making health care better, but the proof is in the pudding — he’s sabotaging the system and ripping coverage away from millions of families.  And Trump’s sabotage hits women, lower income households, and young people especially hard.

“President Trump and his allies in Congress must stop their partisan war on health care before they rip coverage away from millions more. Our focus should be on lowering costs and helping more people get coverage, but Republicans insist on taking us backwards – the exact approach voters rejected in November.  It’s past time for Congress to step in and put the brakes on Trump’s health care sabotage because millions of Americans are paying the price with less coverage and higher costs.”

protectourcare
In News

“Higher Costs And More People Being Uninsured” How Trump’s Latest ACA Sabotage Targets Consumers

Last week, the Centers for Medicare and Medicaid Services (CMS) proposed changes to the Affordable Care Act’s benefit and payment parameters that would raise costs and reduce coverage for millions of Americans. On top of reducing subsidies available to those who purchase health care through the exchange and increasing premiums, the Trump administration’s proposed rule changes would also raise the out-of-pocket maximum for people with employer-sponsored health care.

Here’s what news outlets have to say about the proposed changes:

Axios: Consumers Would Pay More Under New ACA Rules. “Turns out the Trump administration’s big ACA regulation packs a bit more punch than we realized at first. Some of the rule’s technical changes will end up requiring people to pay more for their coverage, while rolling back the cost of federal premium subsidies, my colleague Sam Baker reports…The federal government would end up spending about $900 million less on premium subsidies, according to the proposed regulation. The same change would also slightly loosen limits on out-of-pocket costs. The ACA capped total out-of-pocket spending at $8,000 per year for an individual and $16,000 per year for a family plan.  The Trump proposal would raise those caps by $200 and $400, respectively, according to Brookings’ Matt Fiedler. That change would apply to people who get coverage through their jobs, not just the ACA’s insurance markets.” [Axios, 1/22/19]

Wall Street Journal: Trump’s Proposed ACA Rules Could Lift Costs For Millions Of People. “The Trump administration on Thursday proposed changes that could raise health insurance costs for millions of Americans who get coverage on the job or receive subsidies under the Affordable Care Act, a move that Republicans said is necessary to cut inflated subsidies but Democrats viewed as another GOP effort to sabotage the health law. The proposal, released by the Centers for Medicare and Medicaid Services, would raise the out-of-pocket maximum that people with employer-sponsored coverage pay in 2020. The individual maximum would increase by $200 to $8,200 annually, and the maximum for family coverage would increase by $400, analysts said. The plan would also change a calculation that determines how much people pay if they buy insurance from the ACA exchange and get credits to reduce their monthly premiums. The change could raise premiums next year for many of the roughly 9 million people who get the credit.” [Wall Street Journal, 1/17/19]

Los Angeles Times: Despite The Government Shutdown, Trump’s Efforts To Gut Obamacare Go Full Speed Ahead. “A good portion of the federal government may be shut down, but you can rest assured that the devoted Obamacare saboteurs at the Department of Health and Human Services are on the job. Late Thursday, they released proposed rule changes for the 2020 health insurance year — and requests for comments on further changes — that will drive up premiums for people on Affordable Care Act health plans, cut subsidies and discourage more Americans from enrolling. The proposals also could raise prescription costs for enrollees and raise costs even for families enrolled in employer plans. Longer-term changes proposed for 2021 and beyond could affect about 2 million ACA enrollees.” [Los Angeles Times, Hiltzik, 1/18/19]

Associated Press: White House Proposes To Increase Affordable Care Act Premiums. “The Trump administration Thursday announced proposed rule changes that would lead to a modest premium increase next year under the Affordable Care Act, potentially handing Democrats a new presidential-year health care issue. The roughly 1 percent increase could feed into the Democratic argument that the Trump administration is trying to ‘sabotage’ coverage for millions. The administration said the proposal is intended to improve the accuracy of a complex formula that affects what consumers pay for their premiums. Premiums under the health law were basically stable this year after several sharp annual hikes.”  [Associated Press, 1/17/19]

Politico: CMS Wants To Reduce Obamacare Subsidies Through Formula Change. “The administration is proposing a technical change in the 2020 marketplace rules that is expected to result in less premium assistance for low-income Obamacare customers, POLITICO’s Paul Demko reports…A decrease in financial assistance of $900 million and 100,000 fewer Obamacare customers in 2020 if the proposal is adopted, according to CMS. The agency is justifying the change as a way to reduce big increases in federal subsidies that resulted from the Trump administration’s decision to cut off cost-sharing reduction payments.” [Politico, 1/18/19]

Buzzfeed News: Administration’s Proposed Rule Would “Result In Higher Premiums And More People Being Uninsured.” “The Trump administration revealed this week that it could try to take one more shot at weakening the Affordable Care Act’s individual markets before the end of Trump’s first term. A request for comment on a proposed rule change posted late Thursday contemplates a series of changes that would save the government $1 billion per year or more, but result in higher premiums and more people being uninsured…But now the administration is signaling it may try to end silver loading. Doing this on its own would lead to a major jump in premium costs and could badly destabilize the markets. The administration says it wants to kill silver loading in concert with Congress voting to bring back the old subsidies. However, Congress has so far shown a complete inability to come together to pass a bill to improve the Obamacare markets. The administration did not specifically say it will act without Congress, but it did so with premiums in the past and is asking for feedback on how it should ‘address’ the issue of silver loading.” [Buzzfeed News, 1/18/19]

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In News

Protect Our Care Releases Agenda for The Health Care Congress: Lowering Cost, Expanding Coverage, Strengthening Consumer Protections

After Election Decided on Health Care, Leading Advocacy Group Launches Health Care Agenda and Campaign to Pass It

Washington DC — For over a year, health care has been the dominant issue for Americans of all backgrounds, and the millions of Americans across the country who went to the polls in the 2018 midterms to voice their outrage over the Republican war on health care confirmed it.  The mandate is clear: voters elected a “Health Care Congress” to lower costs and improve care. Today, Protect Our Care is releasing a comprehensive agenda for congressional action: The Health Care Congress: Cost, Coverage, Consumer Protections and kicking off a campaign in states and congressional districts across the country to pass it.

“This agenda is rooted in the voices of millions of Americans who took to the polls demanding affordable health care with strong protections for people with pre-existing conditions,” said Leslie Dach, chair of Protect Our Care. “Health care was the dominant issue in the 2018 midterms and is the number one issue voters want Congress to fix in 2019. Americans want common-sense solutions that lower costs of drugs, stop surprise medical bills, and end junk insurance plans. Americans want Republicans to stop putting the interests of drug and insurance companies above the people’s interest. Now is the time to roll back Republican sabotage and move forward.”

“This agenda outlines how Americans in overwhelming numbers rejected the war on health care being waged by President Trump and his Republican allies,” said Brad Woodhouse, executive director of Protect Our Care. “The Republican repeal and sabotage agenda, that has defined the Republican party for almost a decade, cost them scores of seats during the midterm election and paved the way for Democrats to protect our care. Now as we enter this new ‘Health Care Congress,’ Protect Our Care is poised to hold Republicans accountable, both in DC and in their home districts, all while promoting our own agenda. Voters sent a clear message in November, now we must remain focused on health care to expand coverage, increase protections and make care affordable.”

We hope the policy prescriptions outlined in this agenda will serve as the blueprint for action in 2019. Protect Our Care will distribute this agenda to every member of Congress and will launch campaigns in states and congressional districts across the country to get it passed. Employing the same tactics it used to defeat repeal, Protect Our Care will conduct events, stage protests, host town hall meetings, engage grassroots activists and mount digital and paid advertising campaigns in support of this health care agenda and the efforts of health care champions in the House and Senate to pass it.

Read the full report here. A summary of the agenda from the report can be found below.

 

Do Everything Possible to Overturn the Federal Court Decision that Struck Down the Affordable Care Act

  • Oppose the Texas ruling by a conservative federal judge in the Northern District of Texas that overturned the entire Affordable Care Act by passing a Senate Resolution to similar to the House measure that authorizes the House legal counsel to intervene in the lawsuit and oppose the Republican attorneys general, governors, and Trump Administration who are continuing the war on health care through the courts.

End the War on People with Pre-Existing Conditions

  • Stop insurance companies from selling junk health insurance that allows them to deny quality, affordable coverage to people with pre-existing conditions.  These kinds of short term plans should be limited to three-months with no option for renewal.
  • Guarantee protections for pre-existing conditions and essential health benefits. Require all health plans to cover the “essential health benefits” included in the law, ensure guaranteed issue and community rating, and prohibit insurance companies from imposing lifetime and annual limits on the amount of care a patient can receive.

Lower Costs

  • Lower the costs of prescription drugs. Pass legislation to allow Medicare to negotiate drug prices for all beneficiaries; end price gouging by requiring drug manufacturers to give notice and justify significant price increases; and require transparency of rebate amounts.
  • End surprise medical bills. 57 percent of Americans have received a surprise bill. Too many  people go to a hospital or Emergency Room that is in their network, but get billed for services provided out-of-network, subjecting them to huge bills, as much as six figures. Congress should pass legislation to end surprise medical bills and limit the amount a provider can charge to a negotiated rate.  
  • Expand financial assistance by expanding the eligibility for premium tax credits above 400 percent of the federal poverty limit and increase the size of the tax credit for all income brackets.
  • Expand services before deductibles, examples would include three primary care visits and one specialist visit that are not subject to a plan’s deductible.

End Republican Sabotage

  • Fully support Open Enrollment by restoring funding to the pre-Trump levels and making all information about ways to sign up for coverage easily accessible for everyone.
  • Oppose waivers that undermine the ACA and allow states to skirt key provisions of the law.

Strengthen Medicaid and Medicare

  • Improve Medicare’s affordability by adding an out-of-pocket maximum after which beneficiaries would be protected from additional costs; including prescription drugs in the limit on out-of-pocket spending; adding coverage for vision, hearing, and dental; and making cost-sharing more affordable.
  • Extend and increase federal funding for Medicaid expansion.

Conduct Oversight on Trump Administration Actions that Undermine The Affordable Care Act

  • Topics to conduct oversight on include the Trump Justice Department’s decision not to defend all of the Affordable Care Act in federal court, cuts to outreach and navigator funding, rules opening the door to junk insurance, 1332 guidance that allows federal funds to be used to purchase skimpy health plans, relationships between Administration political appointees and regulated industries, the administration’s push to encourage states to impose work requirements on Medicaid coverage, drug prices and pharmaceutical profits.
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In News

Wisconsin Governor Fights Back Republicans Attempts To Weaken Protections For Pre-existing Conditions

Washington DC —  Republicans in the Wisconsin Senate are attempting to pass new legislation that falsely claims to ensure protections for people with pre-existing conditions continue, despite their efforts to invalidate them in federal court. Leslie Dach, chair of Protect Our Care issued the following statement in response:

“Republicans efforts in Wisconsin to push a bill that allows lifetime limits and annual caps on health care coverage is a travesty. Calling this bill any sort of ‘protection’ for people with pre-existing conditions is a fraud. Governor Evers rightly pledged to fully defend his constituents who have pre-existing conditions by vowing to oppose any legislation that rolls back protections for Wisconsinites. Let’s be clear: AB 1 would roll back the clock on vital protections and take Wisconsin back to the days where insurance companies could write the rules.”

BACKGROUND:

What Policies Would Actually Ensure Pre-existing Conditions Are Protected?

  1. Guaranteed Issue and Community Rating: Forbids insurance companies from denying coverage based on health status or charging more.
  2. Essential Health Benefits: Required coverage benefits that help consumers with common health needs and prevent insurers from cutting benefits to lower costs.
  3. Prohibitions On Lifetime And Annual Limits: Prevents insurance companies from saying a consumer has maxed out their benefits in a given year.
  4. Prohibitions On Pre-existing Condition Exclusions: Insurance companies must not be able to sell coverage that can exclude coverage for certain conditions, such as cancer, diabetes, or asthma.

WISCONSIN REPUBLICANS’ BILL FAILS THIS TEST

The language of the bill does nothing to prevent insurance companies from reinstating annual and lifetime limits that insurers use to restrict the amount of coverage someone can use.

The bill does not preserve the Affordable Care Act’s essential health benefits, essentially allowing insurers to sell plans exempt from covering basic services like maternity care, hospitalization, and prescription drugs.

Absent these protections, an insurance company could sell coverage to a cancer patient but refuse to cover their hospitalization or prescription drugs and drop their coverage once they reach their lifetime limit.

The bill does nothing to withdraw Wisconsin’s support for the Texas lawsuit that would eliminate the Affordable Care Act and its current protections for people with pre-existing conditions.

 

MILLIONS OF WISCONSINITES AT RISK

2,435,700 Wisconsinites Live With A Pre-Existing Condition. About one in two Wisconsinites, 51 percent, lives with a pre-existing condition. [Center for American Progress, 4/5/17]

1,187,000 Wisconsin Women And Girls Have A Pre-Existing Condition. Approximately 1,187,000 women and girls in Wisconsin live with a pre-existing condition. [Center for American Progress and the National Partnership For Women and Families, June 2018]

308,100 Wisconsin Children Already Have A Pre-Existing Condition. Roughly 308,000 Wisconsinites below age 18 live with a pre-existing condition. [Center for American Progress, 4/5/17]

616,900 Older Wisconsinites Live With A Pre-Existing Condition. 616,900 Wisconsin adults between the ages of 55 and 64 live with at least one pre-existing condition, meaning attacks on these protections significantly threaten Wisconsinites approaching Medicare age. [Center for American Progress, 4/5/17]

 

THE AFFORDABLE CARE ACT OUTLAWED DISCRIMINATION BASED ON PRE-EXISTING CONDITIONS — GOP LAWSUIT TO OVERTURN THE LAW BRINGS DISCRIMINATION AGAINST PRE-EXISTING CONDITIONS BACK

Because Of The Affordable Care Act, Insurance Companies Can No Longer Deny Coverage Or Charge More Because Of Pre-Existing Conditions. “Under current law, health insurance companies can’t refuse to cover you or charge you more just because you have a ‘pre-existing condition’ — that is, a health problem you had before the date that new health coverage starts.” [HHS]

The ACA Outlawed Medical Underwriting, The Practice That Let Insurance Companies Charge Sick People And Women More. As the Brookings Institution summarizes, “The ACA outlawed medical underwriting, which had enabled insurance carriers to court the healthiest customers while denying coverage to people likely to need costly care. The ACA guaranteed that all applicants could buy insurance and that their premiums would not be adjusted for gender or personal characteristics other than age and smoking.”

The ACA Stopped Companies From Charging Women More Than Men For The Same Plan. The Affordable Care Act eliminated “gender rating,” meaning American women no longer have to pay an aggregated $1 billion more per year than men for the same coverage.

Thanks To The Affordable Care Act, Insurance Companies Can No Longer Rescind Coverage Because of Illness. Because of the ACA, insurance companies can no longer rescind or cancel someone’s coverage arbitrarily if they get sick.

 

HEALTH CARE WAS THE TOP ISSUE FOR WISCONSIN VOTERS

A Public Policy Polling election day survey of Wisconsin voters found that health care was the top issue for voters in the state and that they overwhelmingly favored Democrats on it, propelling Tony Evers to victory.

  • 68% of voters said that health care was either a very important issue or the most important issue to them. Those voters supported Evers over Scott Walker 65-33.
  • When asked to name the single issue most important to them in 2018, a plurality (27%) picked health care. Among those voters who said health care was their single most important issue in the election, Evers defeated Walker by a whopping 89-7 margin.
  • Evers especially had an advantage over Walker when it came to the issue of who voters trusted more to protect people with pre-existing conditions. 50% preferred Evers to protect pre-existing conditions to only 41% who preferred Walker.
  • Scott Walker’s support for the Republican health care repeal agenda hurt him badly. Only 32% of voters said his support for repeal made them more likely to vote for him, while 47% said it made them less likely to support him.
  • An overwhelming majority of Wisconsinites want to see the Affordable Care Act stay in place – 62% think it should be kept with fixes made to it as necessary, compared to only 32% of voters who support repealing it.
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