News

“This report is a call for change, yet the Trump Administration delivers more of the same sabotage” said Amanda Harrington

Washington, DC — At the same time as the release of a new report issued by the U.S. Government Accountability Office today finding a vast gulf in access to health care between people who live in states that have expanded Medicaid in contrast with those that have not, the Trump Administration announced that Governor Paul LePage’s former health-obstructer-in-chief Mary Mayhew has been tapped to lead Medicaid and CHIP.

The GAO report puts into sharp view the harm that can be done when officials like Mayhew block Medicaid expansion in their states. Among the report’s findings, low-income adults in states that expanded Medicaid were almost half as likely to have unmet medical needs, more than half as likely to forego medical care due to cost and nearly half as likely to report needing mental health care or prescription medication but not being able to afford it.

Amanda Harrington, spokeswoman for Protect Our Care, issued the following statement in response:

“The new GAO report is not only a call to action for states that haven’t expanded Medicaid yet, it’s a call for change in leadership. Medicaid expansion is front and center in many competitive governor’s races around the country, and this report shows why: Your ability to access medical care when you need it shouldn’t depend on who you are, how much money you make or what your ZIP code is, but unfortunately that’s the reality for far too many Americans living in states that refuse to expand Medicaid.

“Putting Mary Mayhew in charge of the critical Medicaid and CHIP programs, where she will actively be working to block people from the care they need, is just more Republican health care sabotage. Numerous times, Mary Mayhew and Governor Paul LePage have sought to obstruct the will of Mainers by blocking Medicaid expansion — and as this report shows, she did so at great cost to the people in her state.”

ADDITIONAL BACKGROUND

Key Findings from the GAO report, Access to Health Care for Low-Income Adults in States with and without Expanded Eligibility

• An estimated 5.6 million uninsured, low-income adults—those ages 19 through 64—had incomes at or below the income threshold for expanded Medicaid eligibility as allowed under the Patient Protection and Affordable Care Act (PPACA); of these, 3.7 million live in non-expansion states.
• Low-income adults in expansion states were less likely to report having any unmet medical needs compared with those in non-expansion states, and low-income adults who were insured were less likely to report having unmet medical needs compared with those who were uninsured.
• Among the low-income adults who were uninsured, those in expansion states were less likely to report having any unmet medical needs compared with those in non-expansion states.
• Low-income adults in expansion states were more likely to report having a usual place of care to go when sick or needing advice about their health and receiving selected health care services compared with those in non-expansion states.

As Medicaid’s Popularity Grows, It Has Become  a Key Issue in Competitive Governor’s Races

In Ohio, Cordray Blasts DeWine – Who Flip Flopped on Medicaid Expansion. “Cordray also dinged DeWine on Ohio’s Medicaid expansion, which provides health coverage to nearly 700,000 Ohioans. Republican Gov. John Kasich has ‘done some things that are very good for Ohio,’ Cordray said. ‘He had real courage on the Medicaid expansion, bringing that to Ohio and fighting the naysayers in his own party who said, ‘Gee, that’s part of Obamacare.’ And my opponent was part of those naysayers.’ DeWine now says he’ll keep the expansion. But Eck didn’t answer a question asking why, if he favored it, DeWine repeatedly sued to kill the law that made it possible.” [Columbus Dispatch, 9/20/18]

In Wisconsin, Democratic Challenger Targets Walker For Not Taking Federal Medicaid Expansion. “Evers made health care the focus of his only television ad to date, faulting Walker for not taking the federal Medicaid expansion and pointing out that the cost of an average health insurance plan sold on the private market this year in Wisconsin was more expensive than in Minnesota. Walker argues the ad is misleading and health insurance costs will decrease in Wisconsin once a recently approved reinsurance program takes effect.” [Minneapolis Star Tribune, 9/7/18]

In Maine, the Race For Governor Could “End Mediaid Standoff.” “Nearly 60 percent of voters said yes to the ballot initiative last November to approve expansion, but Republican Gov. Paul R. LePage — who is term limited  — has done everything he can to block its implementation, citing concerns over funding. Before it appeared on the ballot, he had vetoed bills to expand Medicaid five times, and now it’s tied up in an ongoing legal battle. Candidates who could follow LePage appear to be more open to implementing the ballot initiative. Democratic gubernatorial candidate Janet Mills has been a vocal supporter of Medicaid expansion. Independent candidates Terry Hayes and Alan Caron have also said they would implement it. The Republican candidate Shawn Moody previously seemed to follow LePage’s lead in opposing expansion, but now says he would implement the law as long as there is funding.” [Washington Post, 10/15/2018]

In Michigan, Candidates Gretchen Whitmer (D) And Bill Schuette (R) Spar Over Medicaid Expansion. “As attorney general, Schuette joined at least nine lawsuits fighting the Affordable Care Act. In a 2017 fundraising mailer, he said he opposed the law, ‘including the ‘free’ federal Medicaid dollars from Obama that leave Michigan taxpayers on the hook for more!’ ‘He has been the chief advocate against Healthy Michigan in our state ever since we started the bipartisan negotiations on it,” Whitmer told The Detroit News. ‘The biggest threat to health care in Michigan is Bill Schuette.’ But the Medicaid expansion program is threatened by declining federal aid, Schuette notes. The federal government fully funded the Medicaid expansion program the first three years, but the state began paying a share in 2017 and will be required to cover 10 percent of the costs by 2020. By then, it’s estimated to cost the state roughly $380 million a year.” [Detroit News, 9/18/19]

In Georgia, Democratic Candidate Stacy Abrams Has Said The First Thing She Would Do Is Expand Medicaid. “Democratic candidate Stacey Abrams has said the first thing she would do as governor is expand Medicaid. That’s the decision each state can make to give more low-income people access to health care. States receive federal funding for it, though they, too, have to pay into the program. ‘And you’ll hear me talk about this ad nauseam because it’s the only answer to Georgia’s challenges,’ Abrams said at a health care policy press conference Monday. ‘We have an uncompensated care rate of $1.7 billion.’…Republican Gov. Nathan Deal has refused to expand the program in Georgia, and Republican candidate Brian Kemp said he wouldn’t expand it either. ‘Government programs that aren’t working now are not a reason to give them more money,’ Kemp said at an event last week. Kemp said, instead, he favors opening up the private sector market to more competition to lower health care costs.” [WABE, 9/12/18]

In Alabama, Democratic Challenger Walt Maddox Is Running On Medicaid Expansion. “The Democratic nominee began the tour in Tuscaloosa where he is mayor. Describing himself as the only candidate in the race talking about the state’s “big problems”, Maddox is running on a platform of establishing a state lottery to fund education programs and expanding Medicaid. Standing with his wife, Stephanie and his two children, Maddox said the race is about ensuring the state’s children have opportunities.” [Associated Press, 9/17/18]
In Florida, Andrew Gillum is running on Medicaid Expansion, with polling showing Floridians want to expand Medicaid. “According to new data from the left-leaning think tank Data for Progress, an estimated 65 percent of Florida voters support expanding Medicaid across the state — and, amazingly, voters in every legislative or congressional district from the Keys all the way up to the Panhandle support the idea.” [Miami New Times, 5/25/18]

In Tennessee, Karl Dean is running on Medicaid Expansion, with polls showing voters support it strongly. “The poll, conducted by Mason-Dixon Polling & Research in April, showed 63 percent support Medicaid expansion with the use of federal funds to 21 percent against and 16 percent undecided.” [Nashville Tennessean, 5/7/18]

As Republicans continue to cover up their repeated votes to eliminate and gut coverage for pre-existing conditions, several are claiming that “high risk pools” are the answer. The reality is that high risk pools have never worked to protect people with preexisting conditions — every time they have been tried, they have failed. Here’s why.

HIGH RISK POOLS IMPOSE HIGH PREMIUMS & DEDUCTIBLES …

Premiums For Coverage In High Risk Pools Were As Much As 200 Percent Higher Than The Average Rate But Covered Less Care. “High-risk pool enrollees faced substantially higher premiums than people in the normal individual market, often by as much as 150 percent to 200 percent, although some pools did offer subsidies to low-income enrollees…And stunningly, the overwhelming majority of state high-risk pools actually refused to pay for services associated with a patient’s pre-existing conditions in the first months of their enrollment.” [Center for American Progress, 2/16/17]

Deductibles For High Risk Pool Enrollees Were Well Above Maximum Allowed By ACA. ”Fourteen states had plans with deductibles of $10,000 per year or higher, substantially greater than the current maximum $7,150 deductible for catastrophic plans in the marketplaces. Thirty states imposed maximum lifetime limits; others had annual coverage limits as low as $75,000 per year.” [Commonwealth Fund, 3/29/17]

  Source: Commonwealth Fund, 3/24/17

… COST TAXPAYERS MORE …

Despite High Premiums, High Risk Pools Could Still Cost The American People Over $90 Billion Annually. “The U.S. Department of Health and Human Services (HHS) recently estimated that up to 17,875,000 people with preexisting conditions were uninsured in 2010. Had all of them been covered by high-risk pools, the cost would have been $194.8 billion in 2010 dollars, with premiums covering only $103.3 billion. Thus, states and the federal government would have needed to find $91.5 billion in additional funding to cover them all—much more than the up to $10 billion per year in federal assistance to states recently proposed by congressional Republicans.” [Commonwealth Fund, 3/29/17]

An Analysis Of High Risk Pools Under The ACHA Finds Such Pools Would Cost The Government Between $37 and $56 Billion Annually. “Government costs for supporting the high-risk pool using ACA-like coverage and subsidies would range from $37 to $56 billion in 2020 and $437 to $656 billion over 10 years (2020–2029), depending upon the eligibility rules used.” [The Urban Institute, May 2017]

Even Conservatives Estimated High Risk Pools Would Cost $15-$20 Billion Annually. “For comparison, conservative experts James Capretta and Tom Miller have estimated that $15 billion to $20 billion per year, or $150 billion to $200 billion over 10 years, would be needed to fully finance high-risk pools even if they covered only 2 million to 4 million people.” [Center For American Progress, 2/16/17]

Premiums For High Risk Pool Coverage Paid Just 53 Percent Of Program Costs. “Premiums ranged from 125 percent to 200 percent of average premiums in the individual market, yet covered only about 53 percent of claims and administrative costs nationally (Wisconsin allowed premiums up to 200 percent of average).” [Commonwealth Fund, 3/29/17]

… AND RESTRICT COVERAGE

High Risk Pools Typically Had Pre-Existing Condition Exclusions And Limited Benefits. “Many such pools had pre-existing condition exclusion periods, limited benefits, and enrollment limits; all of these characteristics served to reduce the value of the coverage, creating high financial burdens for enrollees and limiting the number of people who could access the coverage.” [Health Affairs, 3/15/16]

Most State High Risk Pools Had Lifetime And Annual Limits On Coverage.  “Thirty-three pools [out of 35 states] imposed lifetime dollar limits on covered services, most ranging from $1 million to $2 million. In addition, six pools imposed annual dollar limits on all covered services while 13 others imposed annual dollar limits on specific benefits such as prescription drugs, mental health treatment, or rehabilitation.” [Kaiser Family Foundation, 2/22/17

High Risk Pools Typically Had Waiting Periods. “There were 35 state high-risk pools before the Affordable Care Act passed. To control costs, they would often do things like charge higher premiums than the individual market. Most had waiting periods before they would pay claims on members’ preexisting conditions, meaning a cancer patient would need to pay premiums for six months or a year before the high-risk pool would cover her chemotherapy treatments.” [Vox, 5/3/17]

High Risk Pools Mean Delayed Or Forgone Care. “Even once they were in a high-risk pool, the high costs and limited benefits prompted some people to delay or forgo care, leading to poorer health outcomes and even more spending. And many families accrued substantial medical debt, even with the coverage.” [Stateline, 2/16/17]

HIGH RISK POOL = MORE PEOPLE UNINSURED

Limited Coverage And High Costs Cause People To Remain Uninsured. “Some patients also delayed care to save money, exacerbating their health conditions, and only entered the pools when their conditions became emergencies.” [Stateline, 2/16/17]

CMS: One-Third Of Uninsurable Were Unable To Afford High Risk Pool Coverage. A 2004-05 study by the Center for Medicare and Medicaid Services found that “nationally, high-risk pool premiums are above 25 percent of family income (i.e., are unaffordable) for 10 percent of all individuals, 18 percent of the uninsured, and 29 percent of the uninsurable. By these standards, almost one-third of the uninsurable are unable to afford high-risk pool coverage…” [CMS, Health Care Financing Review, Winter 2004-2005]

As Evidenced By Wisconsin’s Health Insurance Risk-Sharing Plan (HIRSP), High Risk Pools Offer Less Protection For Fewer People Than Does The Affordable Care Act.“HIRSP, which covered people with pre-existing health conditions before the Affordable Care Act, was one of the largest and most successful so-called high-risk pools in the country. But at its peak it covered only an estimated 24,000 people, and those were people who could afford health insurance. ‘It didn’t begin to catch all the people who needed it,’ said Pollitz of the Kaiser Family Foundation. Mahaffey echoed Pollitz’s assessment. ‘If you bring HIRSP back, it may help a small segment of the population,’ she said, ‘but nowhere near what the Affordable Care Act is serving.’” [Milwaukee Journal Sentinel, 9/20/18]

HIGH RISK POOLS HAVE BEEN TRIED & FAILED

States Sharply Restricted Enrollment In High-Risk Pools, Resulting In Only About Five Percent Of Those Eligible For High Risk Pools To Enroll In 2008. “States sharply restricted enrollment, set premiums further above what many families could afford, and/or scaled back coverage (such as by cutting benefits, raising deductibles and other cost sharing, imposing waiting periods for coverage of pre-existing conditions, and establishing lifetime dollar limits on benefits). Only 226,000 people in 35 states were enrolled in high-risk pools in 2011, on average.  In 2008, only about 5 percent of those estimated to be eligible for those high-risk pools (because they had a chronic condition and were uninsured) were enrolled.” [Center on Budget and Policy Priorities, 11/17/16]

California High Risk Pool Led To Waiting Lists, High Premiums, And Lifetime Limits. “For example, California’s high-risk pool imposed a shorter-than-average, three-month waiting period before enrollees could receive treatment for pre-existing conditions—but also imposed a $75,000 annual limit on benefits along with a $750,000 lifetime limit. In addition, the state capped enrollment, resulting in long waiting lists of people unable to enroll; at the same time, the pool’s high premiums proved difficult for enrollees to afford, leading some to drop out.” [Center for American Progress, 2/16/17]

Premiums in Florida’s High Risk Pool Were Twice The Normal Rate. “Many states starved high-risk pools of cash. Florida’s contained only about 200 people in 2011. Premiums were commonly twice the normal rate. Many states had enrolment caps, meaning that even people willing to fork over were not guaranteed coverage.” [The Economist, 1/16/17]

In Wisconsin, “Cancer Doesn’t Wait” For High Risk Pool Waiting Periods. “The benefit waiting periods used by Wisconsin’s and other states’ high-risk pools are a big concern for patient advocates and provider groups. ‘A six-month exclusionary period is a serious issue,’ said Dr. Len Lichtenfeld, deputy chief medical officer for the American Cancer Society, who also testified at the House hearing. ‘Cancer doesn’t wait.’” [Modern Healthcare, 2/13/17]

In Utah, High Risk Pools Were Limited In Size, And Offered Sub-Par, Delayed Coverage. “Stevenson said only 3,000 people signed up for Utah’s risk pool plan while 200,000 Utahns are signed up for insurance through Obamacare. ‘Utah’s past high risk pool plan had many limitations too,’ he said. People with pre-existing conditions had to wait six months before using their coverage. Pregnant women had a 10 month waiting period before they had any coverage for them or their baby. ‘The measure of success for a program is how many people it helps and if you are only covering 3,000 people and leaving tens of thousands uninsured, I don’t think that’s a good thing to go back to,’ he said.” [CBS KUTV, 3/9/17]

High Risk Pools Mean Higher Costs, Higher Uninsured, And Less Coverage. “The reality is that high-risk pool coverage was prohibitively expensive and there is little evidence to suggest that the existence of such pools made coverage less costly for others in the individual insurance market. Without substantially more federal funding than currently proposed, these facts are not likely to change. People with preexisting conditions may have “access” to coverage, but most will not be able to afford it and those who can will face limited benefits and extremely high deductibles and out-of-pocket payments.” [Commonwealth Fund, 3/29/17]

Washington, DC – Last night, Leah Vukmir continued to desperately conceal her record of siding with big insurance over Wisconsinites in need of quality and affordable health care in her second debate against longtime health care leader, Senator Tammy Baldwin. Brad Woodhouse, executive director of Protect Our Care, issued the following statement in response to Vukmir’s claims during the debate:

“I will dunk a basketball over Lebron James before Leah Vukmir tells the truth about health care. Once again, Leah Vukmir repeated the lie that she’d protect people with pre-existing conditions, which has been called out by factcheckers before. The thing to know about Leah Vukmir is that she’s sided with insurance companies over ordinary Wisconsinites every chance she’s gotten, whether by supporting junk insurance plans that don’t have to cover pre-existing conditions or prescription drugs or maternity care, or by voting to let big insurance companies deny coverage of cochlear implants for children.”

ADDITIONAL BACKGROUND

What Vukmir Said:

“I will fall in front of a truck before I let people go without coverage for pre-existing conditions.”  [WISC TV, 10/13/2018]

What Vukmir Has Done:

Vukmir “Supports Full Repeal Of Obamacare. Period.” “Leah understands why people are upset with Republicans who promised to repeal Obamacare and didn’t deliver. She supports full repeal of Obamacare. Period. And she won’t stop pushing for full repeal in Congress.” [LeahVukmir.com, accessed 6/12/18]

Though Leah Vukmir claims she supports protections for people with pre-existing conditions, she has turned her back on Wisconsinites at every opportunity to do so.

• Vukmir refuses to stand against a lawsuit designed to end protections for people with pre-existing conditions. This summer, the Trump Administration refused to defend against a lawsuit brought by twenty conservative states aimed at overturning the Affordable Care Act and its protections for people with pre-existing conditions. Leah Vukmir refuses to speak against this lawsuit, instead calling it a “necessary step.”

• Vukmir refuses to take action at the state level against the Trump administration’s junk plan and association plan rules that let insurance companies discriminate against people with pre-existing conditions. This summer, the Trump Administration finalized a junk plan rule and an association plan rule that allow insurance companies to discriminate against people with pre-existing conditions. Experts warn that these moves will only increase the cost of comprehensive care, ultimately making it even harder for people with pre-existing conditions to get the care they need. Twenty-one states have taken or are taking action to limit the harmful effects of these junk plans, but Vukmir refuses to do the same for Wisconsin.

Vukmir Says High Risk Pools Would Be Her ‘Solution’ to Cover People With Pre-existing Conditions if the Affordable Care Act is Repealed. The statement itself acknowledges that she would give insurance companies back the power to deny coverage based on pre-existing conditions. Here are some other problems with high risk pools:

• High Risk Pools Typically Had Pre-Existing Condition Exclusions And Limited Benefits. “Many such pools had pre-existing condition exclusion periods, limited benefits, and enrollment limits; all of these characteristics served to reduce the value of the coverage, creating high financial burdens for enrollees and limiting the number of people who could access the coverage.” [Health Affairs, 3/15/16]

• High Risk Pools’ Limited Coverage And High Costs Cause People To Remain Uninsured. “Some patients also delayed care to save money, exacerbating their health conditions, and only entered the pools when their conditions became emergencies.” [Stateline, 2/16/17] Wisconsin’s previous high risk pool only covered 25,000 people, with estimates showing 2.4 million Wisconsinites live with pre-existing conditions.

• Premiums For Coverage In High Risk Pools Were As Much As 200 Percent Higher Than The Average Rate But Covered Less Care. “High-risk pool enrollees faced substantially higher premiums than people in the normal individual market, often by as much as 150 percent to 200 percent, although some pools did offer subsidies to low-income enrollees…And stunningly, the overwhelming majority of state high-risk pools actually refused to pay for services associated with a patient’s pre-existing conditions in the first months of their enrollment.” [Center for American Progress, 2/16/17]

• Despite High Premiums, High Risk Pools Could Still Cost The American People Over $90 Billion Annually. “The U.S. Department of Health and Human Services (HHS) recently estimated that up to 17,875,000 people with preexisting conditions were uninsured in 2010. Had all of them been covered by high-risk pools, the cost would have been $194.8 billion in 2010 dollars, with premiums covering only $103.3 billion. Thus, states and the federal government would have needed to find $91.5 billion in additional funding to cover them all—much more than the up to $10 billion per year in federal assistance to states recently proposed by congressional Republicans.” [Commonwealth Fund, 3/29/17]