Skip to main content
Category

News

ashoup
In Stories, News

Two Fronts of a Continuing Assault: The GOP Finalizes Junk Insurance Plans and Announces Another Repeal Bill

This afternoon, conservative groups announced their latest plan to repeal the Affordable Care Act. Across town the Trump Administration announced a finalized rule on association health plans. In other words, it was just another day in the GOP’s war on Americans’ health care.

NO RAVES FOR REPEAL RETREAD

Wall Street Journal: “The Latest Plan Is One Front Of A Continuing Assault On The ACA By Republicans.” “The latest plan is one front of a continuing assault on the ACA by Republicans and conservatives in the aftermath of the failed previous effort to repeal it. While the Justice Department has asked a court to toss out key provisions of the health law, the 20 GOP state attorneys general in the lawsuit want the court to end the law altogether.” [WSJ, 6/19]

The Hill: “The Plan Eliminates Obamacare’s Essential Health Benefits.” “Experts note that block grants, though, could lead to cuts in health services if they do not grow over time in the way that the current open-ended system does. The plan also eliminates ObamaCare’s essential health benefits, which require plans to cover a range of services like mental health and prescription drugs. Backers argue this would lead to cheaper plans being available.” [The Hill, 6/19]

Los Angeles Times: “The New Approach Would Scrap Many Of The Current Law’s Insurance Protections.” “The new approach would scrap many of the current law’s insurance protections, including its system of guaranteeing coverage to low-income Americans through either Medicaid or subsidized commercial insurance. ‘The proposal would repeal the individual entitlement to premium and cost-sharing reduction subsidies and Medicaid expansion,’ note the authors… Many of the repeal proposals envisioned not only rolling back the current law but restricting federal funding for the entire Medicaid program, which covers more than 70 million low-income Americans.” [Los Angeles Times, 6/19]

Insurance News Net: Plan “Would Eliminate The ACA’s Medicaid Expansion As Well As The Subsidies That Help People Buy Coverage.” “Groups led by the Heritage Foundation, the Galen Institute and former Sen. Rick Santorum, R-Pa., drafted the plan, which will be formally announced Wednesday. It would eliminate the ACA’s Medicaid expansion as well as the subsidies that help people buy coverage. Instead, it would convert that money into block grants for the states… In addition, the plan would eliminate the essential health benefits that plans are required to cover under the ACA.” [Insurance News Net, 6/19]

National Review: “Broadly Speaking, This Is Similar To The Graham-Cassidy Bill.” [National Review, 6/19]

Center On Budget And Policy Priorities: New Proposal “Would Have The Same Severe Effects On Health Insurance Coverage, Access To Care, And Many Americans’ Health And Financial Security As Last Year’s Repeal Bills.”  “The new plan to repeal the Affordable Care Act (ACA) would have the same severe effects on health insurance coverage, access to care, and many Americans’ health and financial security as last year’s repeal bills.  Like them, it would eliminate the ACA’s Medicaid expansion for low-income adults, lead to sharply increased health care costs for millions of moderate-income individual-market consumers — especially older people — eliminate consumer protections that are especially crucial for people with pre-existing health conditions, and cause millions to lose coverage.” [CBPP, 6/19]

Center For American Progress: “Graham-Cassidy 2.0 Could Cut ACA Funding For Coverage By 31 Percent By 2028.” “Although this is a new plan, it merely recycles some of the worst elements of the failed Graham-Cassidy repeal bill—which experts consider the “the most harmful” repeal bill.5 Graham-Cassidy 2.0 would lead to the same disastrous results: Millions of Americans would lose health care coverage; Protections for pre-existing conditions would be decimated; Costs would increase for lower-income, older, and sick Americans; Massive disruption would occur, causing insurers to drop out of marketplaces… Based on the plan’s specifications and the Congressional Budget Office’s (CBO) updated baseline of ACA funding under current law, the Center for American Progress estimates that Graham-Cassidy 2.0 could cut ACA funding for health coverage by 31 percent by 2028 and by 26 percent  from 2022 to 2028.” [CAP, 6/19]

ASSOCIATION HEALTH PLANS PANNED

CNN: “The Move Could Weaken” Consumer Protections “And Make Coverage More Expensive.” “The Trump administration is taking the final step Tuesday in its plan aimed at making health insurance policies cheaper for some small businesses. But the move could weaken some of the Affordable Care Act’s consumer protections for those buying these plans and make coverage more expensive for those who remain on the Obamacare exchanges.” [CNN, 6/19]

Associated Press: “State Regulators Are Concerned About Association Health Plans Because Similar Plans In The Past Had Problems With Financial Solvency And Even Fraud.” “State insurance regulators are concerned about association health plans because similar plans in the past had problems with financial solvency and even fraud. A big concern about Tuesday’s announcement is to what degree state regulators will retain oversight over the Trump administration’s new plans.” [USA Today, 6/19]

New York Times: Plans “Could Drive Up Premiums, Which Have Increased As Mr. Trump And Republicans In Congress Have Undercut Many Elements Of The [ACA].” “But consumer groups, state officials and Blue Cross Blue Shield plans have long opposed such ideas. They say association health plans will tend to attract employers with younger, healthier workers, leaving behind sicker people in more comprehensive, more expensive plans that fully comply with the Affordable Care Act. That could drive up premiums, which have increased as Mr. Trump and Republicans in Congress have undercut many elements of the law, President Barack Obama’s signature domestic achievement.” [NYT, 6/19]

Washington Post: “The Move Could Be Characterized As Sort Of An ‘Obamacare Repeal Plan B.’” “Association plans have been around for years, but the Trump administration is expanding eligibility as a way to provide cheaper options for people to afford health insurance. The move could be characterized as sort of an ‘Obamacare Repeal Plan B’ made up of efforts by Trump appointees to pull back on the law administratively now that Congress has failed to eliminate the ACA.” [Washington Post, 6/19]

Chris Hansen, American Cancer Society: People With Serious Illnesses Like Cancer Could Face ‘Ever-Increasing Premiums For Comprehensive Coverage.” [NYT, 6/19]

Avalere: Rule Will “Increase Premiums As Much As 4 Percent.” “Avalere Health, a Washington D.C.-based consulting firm, predicted 4.3 million people would leave the individual and small-group markets, which would increase premiums as much as 4 percent by 2022. Avalere performed the analysis for America’s Health Insurance Plans, the lobbying group for the health insurance industry.” [USA Today, 6/19]

Wall Street Journal: Due To Plan, “Costs For Consumers Who Buy Their Own Coverage On The Individual Market Are Likely To Rise.” “While premiums for association plans will probably be significantly cheaper, costs for consumers who buy their own coverage on the individual market are likely to rise, analysts say. Those higher premiums are expected to increase the number of Americans without coverage.” [WSJ, 6/19]

Wall Street Journal: “Associations With A Preponderance Of Female Employees Could Be Charged More.” “Women couldn’t be charged more within individual plans, but associations with a preponderance of female employees could be charged more overall, according to the senior Labor Department official. Some critics have said women and older people will pay more, and they’ve said the plans will essentially be able to discriminate against consumers by offering some benefits and omitting others, such as cancer treatments or certain prescriptions.” [WSJ, 6/19]

CNBC: “Health Providers, Insurers And Medical Groups Have Warned That The Plans Could Drive Up Premiums And Make Insurance Unaffordable.” “These insurance plans would not be subject to requirements under the Affordable Care Act, which included mandatory coverage for 10 essential health benefits, such as maternity and newborn care, prescription drug costs and mental health treatment… Health providers, insurers and medical groups have warned that the plans could drive up premiums and make insurance unaffordable for some people by siphoning healthy consumers who want cheaper coverage, leaving behind a pool of sicker patients with higher medical costs in ACA plans.” [CNBC, 6/19]

Vox: AHPs “Are Not Required To Cover All Of The Essential Health Benefits Mandated By The Affordable Care Act.” “Association health plans, the subject of the new rules, do not have to follow the same rules as individual policies sold under Obamacare, meaning they are not required to cover all of the essential health benefits mandated by the Affordable Care Act, like maternity care, an important piece of the law’s protections for people with preexisting conditions.” [Vox, 6/19]

Larry Levitt, Kaiser Family Foundation: “The Clear Intent Of The Executive Order Is To Create A Parallel Insurance Market Exempt From Many Of The Consumer Protections In The Affordable Care Act.” “‘The clear intent of the executive order is to create a parallel insurance market exempt from many of the consumer protections in the Affordable Care Act,’ Larry Levitt at the Kaiser Family Foundation told me last year. ‘This has the potential to siphon off healthy people with skinnier benefits and cheaper premiums, leaving behind a sicker pool of people under ACA plans.’” [Vox, 6/19]

Karen Pollitz, Kaiser Family Foundation: “They Could Have A Destabilizing Effect.” “‘To the extent that these plans develop and serve as a parallel market, that could have a destabilizing effect,’ said Karen Pollitz of the nonpartisan Kaiser Family Foundation, an expert on individual health insurance. Pollitz also served as a consumer protection regulator in the Obama administration. ‘People who think they can get by without those (comprehensive) benefits will look for cheaper premiums,’ she added.” [USA Today, 6/19]

Politico: “Critics Warn The Steps Will Further Destabilize” Insurance Markets. “Critics warn the steps will further destabilize wobbly Obamacare markets by siphoning off younger and healthier customers, who are more likely to favor cheaper plans that cover less. The law’s insurance markets have already been beset by skyrocketing premiums and diminishing competition, problems that are likely to grow worse if the customer base becomes even smaller and sicker.” [Politico, 6/19]

Highmark CEO David Holmberg: Rule Change “Creates A New Set Of Uncertainties.” “Highmark CEO David Holmberg said the health insurer, which is finally making money on Obamacare customers after years of losses, is committed to remaining in the law’s markets in Delaware, Pennsylvania and West Virginia. However, he said the changes coming out of Washington are adding new challenges. ‘We can see a path where we could stabilize this, but we continue to see rule changes,’ Holmberg told POLITICO. ‘That creates a new set of uncertainties.’” [Politico, 6/19]

Families USA: “With Surgical Precision, The Proposed Rule Repeals The Most Important Limitations On AHP Sales.” “With surgical precision, the proposed rule repeals the most important current limitations on AHP sales: Under federal law, AHPs are supposed to be business associations offering insurance plans to their business members… Currently, when small businesses buy plans through an association like the chamber of commerce, those plans still must include the protections that apply to other small groups, and the plans are subject to state and federal oversight. This would all change under the proposed rule. An AHP could be offered by a supposed ‘association’ that does nothing but provide health insurance. That ‘association’s’ membership could be united by just residence in a common geographic area or work in the same trade or industry. While an AHP cannot explicitly exclude people or companies based on health status, health costs, or health conditions, an AHP can use ‘redlining’ to avoid high-cost members, excluding particular geographic areas or lines of work that tend to be associated with high health care expenses.” [Families USA, 6/19]

ashoup
In News, Stories

Seven Things You Should Know About Republicans’ Latest Repeal ‘Plan’

  1. The Republican ‘Plan’ Would Gut Protections For Pre-Existing Conditions, Forcing People To Choose Between Bankruptcy And Staying Alive. The latest Republican repeal plan would repeal key consumer protections, including the guarantee that people with pre-existing conditions can buy coverage at the same price as someone who isn’t sick. Under the repeal plan, states would no longer use single risk pools, meaning those who are sick or at risk of becoming sick could be forced to pay much more. As Loren Adler, the Associate Director of the USC-Brookings Schaeffer Initiative For Health Policy, notes: “The Heritage document attempts to obfuscate this point, but it’s quite clear it would unwind the ACA’s protections for people with pre-existing conditions.”
  2. It Would Let Insurance Companies Charge Older People An Age Tax. Under the Affordable Care Act (ACA), insurance companies are barred from charging older Americans more than three times the amount they charge younger consumers. However, under the Republican plan, insurance companies would once again be allowed to charge older people many times more for the same coverage.
  3. Insurance Companies Could Deny Coverage For ‘Essential Health Benefits,’ Such As Maternity Care, Prescription Drug Coverage, And Treatment For Substance Use Disorders. The new plan would let states waive the requirement that insurance companies cover the ten essential health benefits established by the ACA. Removing these guaranteed benefits would make it harder for Americans to access comprehensive health care. These ten essential health benefits include ambulatory services, emergency services, hospitalization, maternity care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services, laboratory services, preventive services, and pediatric services.
  4.  Millions Would Lose Coverage, Increasing The Number Of Uninsured. The proposal would repeal Medicaid expansion and replace marketplace subsidies with underfunded block grants to states. Under the proposal, 50 percent of the block grants would be spent on private insurance, limiting states’ ability to cover people through Medicaid. These insufficient funds and spending requirements would result in significant coverage losses
  5. Medicaid Expansion Would Disappear. States that expanded Medicaid would lose under the Republican plan. As Larry Levitt, Senior Vice President of the Kaiser Family Foundation, highlights: “Over time, federal funding under the new conservative block grant program would be equalized across states based on the number of low-income residents. States that have not expanded Medicaid under the ACA would be winners. States that have would be losers.” Cuts to Medicaid lead to coverage losses, and threaten the stability of rural hospitals.
  6. Rich Families Get Yet Another Tax Break. The bill would double Health Savings Account (HSA) contribution limits, benefiting families who can afford to contribute thousands of dollars to these tax-deductible accounts. This, from the same party that just passed a $1.5 trillion tax break that disproportionately benefited the wealthy and gave health industry companies billions.
  7. …While Middle-Income Americans Lose Tax Credits That Help Families Afford Coverage. The Republican plan wants to “refocus subsidies” by directing block grants toward the states. As Adler remarks, these cuts target middle-class Americans: “Apparently Heritage also thinks the problem with the ACA is that the middle class [people without] employer coverage get subsidies to purchase health insurance [and] wants to limit that.”
ashoup
In News, Stories

House GOP Budget Proposal Latest Attack on Americans’ Care

Washington, D.C. – Today, House Republicans released a budget resolution which contains massive health care cuts and paves the way for full repeal of the Affordable Care Act. Protect Our Care Campaign Director Brad Woodhouse released the following statement in response:

“Tomorrow marks the six-month anniversary of the passage of Congressional Republicans’ trillion-dollar tax scam, when Congressional Republicans voted to take health care away from millions of Americans and raise costs on tens of millions more in order to cut taxes for the wealthiest and corporations – but apparently this wasn’t enough, and Congressional Republicans continue to launch almost-daily attacks on Americans’ care. Today’s Republican budget would pave the way for them to repeal the Affordable Care Act, slash Medicare and Medicaid, and drastically cut other health programs when what Americans need is relief from the onslaught of GOP health care sabotage. Enough is enough – it’s time for Republicans to end their war on health care.”

ashoup
In News, Stories

Like Arsonists Coming to Put Out a Forest Fire, These Republicans Are Coming After Your Health Care Again

Washington, D.C. – Tomorrow, Governors Matt Bevin (R-KY) and Phil Bryant (R-MS) will join with former senator Rick Santorum to announce their latest iteration of the GOP’s health care repeal legislation. Bevin has threatened to take health care away from 500,000 Kentuckians if a court strikes down his work requirements, Bryant thinks Americans go to to the doctor because they have “nothing else to do,” and Santorum compared the ACA to apartheid. In anticipation of the event, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“That Washington Republicans have turned to two governors who have actively attempted to prevent citizens of their states from obtaining health care coverage and a former senator who compared the ACA to apartheid tells you all you need to know. The GOP’s latest attempt to repeal the ACA would be just as devastating as previous versions, taking health care away from millions of Americans, remove protections for those with pre-existing conditions, ending Medicaid expansion, and implementing an age tax on seniors, leaving Americans from coast to coast to needlessly suffer the consequences of their vengeance-driven legislation. As Americans continue to say loud and clear: enough is enough – it’s time for the GOP to end its war on health care.”

Here’s a summary of three horrible records on health care:

MATT BEVIN

Matt Bevin Threatens to Take Health Care From 500,000 Kentuckians If Courts Strike Down His Work Requirements.  “Attorneys for Kentucky Gov. Matt Bevin (R) will tell a federal court this Friday that that the governor plans to take his ball and go home if he can’t get his way on Medicaid work requirements, premiums, and other restrictions. Bevin, who campaigned on ending the Medicaid expansion but backed down from that threat once elected, is now arguing that he will scrap the state’s Medicaid expansion if the controversial new rules are struck down by federal courts. Kentucky was the first state in the nation to win permission from the Trump administration to impose the new Medicaid rules, which are expected to throw nearly 100,000 Kentuckians off the program. With at least a dozen other states looking to adopt their own Medicaid work requirements, the outcome of the case could determine the future of the program not only in Kentucky but across the country.” [Talking Points Memo, 6/14/18]

January 2017: Matt Bevin Proposed Repealing The ACA “In Its Entirety” Without Offering Replacement Ideas.  “Kentucky Gov. Matt Bevin is urging GOP leaders in Congress to repeal Obamacare “in its entirety,” including the Medicaid expansion and popular consumer protections. In a Jan. 6 letter to House Republicans, Bevin did not advocate any major replacement ideas. Instead, he said Kentucky should be given ‘maximum flexibility’ to regulate health insurance as the state did before Congress passed the Affordable Care Act in 2010. ‘States understand the unique challenges and demographics of their own populations, so repealing the cumbersome one-size-fits-all’ law will allow states to ‘be nimble’ and develop their own health care solutions, Bevin wrote. ‘Congress should repeal the ACA in its entirety and permit Kentucky to return to regulating the health insurance market under its existing state authority.’” [Cincinnati Enquirer, 1/14/17]

Matt Bevin Dismantled Kentucky’s Successful State Run Health Exchange Leaving Nearly 75,000 Kentuckians To Re-Enroll On The Federal Exchange.  “Kentuckians who’ve purchased health insurance via Kynect will have to re-enroll on the federal exchange starting Nov. 1. The Centers for Medicare and Medicaid Services on Tuesday told Gov. Matt Bevin that all major milestones for the switch had been met. As of this year, 74,640 people were enrolled via the state health care exchange, Kynect. […] In his campaign for governor, Bevin promised to dismantle Kynect and move Kentucky to the federal exchange. He called the state-run exchange ‘redundant’ and said it ‘adds no value.’” [WFPI,10/4/16]

HEADLINE:  “How One U.S. State Is Leading The Charge To Dismantle Obamacare” [Reuters, 5/5/17]

PHIL BRYANT

Phil Bryant Opposed Expanding Medicaid Because Recipients Go To The Doctor Too Often Because They Have “Nothing Else To Do.” “Kaiser Health News: What is the cost to the state of having 17 percent of the population without health insurance? Phil Bryant: I would rather pay extra to Blue Cross [to help cover uncompensated costs for the uninsured], rather than have to raise taxes to pay for additional Medicaid recipients. Medicaid recipients multiply their visits to a physician. It’s clear once someone goes on Medicaid, the number of times they go to a physician doubles, quadruples. KHN: Some experts may argue people new to Medicaid have many health issues they need to address. Bryant: I make the argument that it’s free. It’s free and you have nothing else to do.” [Kaiser Health News, 1/23/13]

Phil Bryant:  Because Of Emergency Rooms “There Is No One Who Doesn’t Have Health Care In America.” “Kaiser Health News: Are there any positive benefits to people being on Medicaid? Phil Bryant: Medicaid was meant to be a temporary [stop]gap for providing you medical treatment while you are looking for a job. Now we are saying, you can have a job and still receive Medicaid. So we have changed the whole dynamic. There is very little incentive for those 940,000 people on Medicaid to find a better job, or to go back to school, or to get [into] a workforce training program because they say: Look, if I go over $33,000,  [I] will lose Medicaid. There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room. There are better ways to deal with people that need health care than this massive new program.” [Kaiser Health News,1/23/13]

Phil Bryant’s Refusal To Expand Medicaid Has Deprived 300,000 Mississippians Of Health Care.  “As Americans across the nation begin to find out what Obamacare has in store for them, many of Mississippi’s most needy will find out the answer is nothing. That is likely the case for William and Leslie Johnson of Jackson County, since the state decided not to expand the Medicaid program for the poor under President Barack Obama’s Affordable Care Act. As a result, nearly 300,000 adults there will fall through the cracks of healthcare reform.” [Reuters, 10/4/13]

  • Mississippi Is The Unhealthiest State In The Country.  “It’s time again for the United Health Foundation’s annual state health rankings report, and like last year, Mississippi comes in 50th. Despite being a leader in telehealth and, historically, childhood vaccinations, Mississippi’s high rate of childhood poverty, obesity and cigarette smoking contributes to it being the unhealthiest state in the country, according to the 2017 America’s Health Rankings report. Of the five categories examined in the report, Mississippi ranked overall 50th for one: clinical care. This has to do with Mississippi’s doctor shortage, lack of mental health providers and preventable hospitalizations. The state ranked 49th for behaviors and 44th for community and environment — both in which Louisiana came in last — 47th for policy and 48th for health outcomes. Mississippi has the highest infant mortality rate of any state with 8.8 deaths per every 1,000 live births.” [Jackson Clarion Ledger, 12/12/17]

Phil Bryant Pushed For Passage Of The AHCA.  “Mississippi Gov. Phil Bryant has joined seven other Republican governors in a letter endorsing the GOP plan to repeal and replace former President Barack Obama’s health care law. The Thursday letter to Majority Leader Mitch McConnell and House Speaker Paul Ryan was also signed by the governors of Indiana, Alabama, Idaho, Kanas, Maine, Missouri and Utah. The governors say they support the plan’s more flexible Medicaid program and phased-in transition from Obama’s law. The letter says the plan offers states more freedom on how they use money for Medicaid and allows them to require that participants have a job or go through job training.” [Associated Press, 3/24/17]

RICK SANTORUM

Rick Santorum Compared The ACA To Apartheid.  “Nelson Mandela stood up against a great injustice and was willing to pay a huge price for that, and that’s the reason he is mourned today, because of that struggle that he performed…and I would make the argument that we have a great injustice going on right now in this country with an ever increasing size of government that is taking over and controlling people’s lives, and Obamacare is front and center in that.” [“O’Reily Factor,” Fox News, 12/5/13]

Rick Santorum Claimed That The ACA Made “100 Percent” Of Americans Dependent On The Federal Government And Called It “The Beginning Of The End Of Freedom In America.”  “What we have — what we will go to in a very short period of time, the next two years, a little less than 50 percent of the people in this country depend on some form of federal payment, some form of government benefit to help provide for them. After Obamacare, it will not be less than 50 percent; it will be 100 percent. Now, every single American will be looking to the federal government — not to their neighbor, not to their church, not to their business or to their employer, or to the community or nonprofit organization in their community — will be looking always to those in charge, to those who now say to you that they are the allocator and creator of rights in America. Ladies and gentlemen, this is the beginning of the end of freedom in America. Once the government has control of your life, then they got you.” [Rick Santorum, Election Night Speech, Steubenville, OH, 3/6/12]

Rick Santorum Called The ACA “The Final Death Knell” For America.  “They are fundamentally different than my grandfather. He cared about freedom. He cared about it more than anything else. Didn’t want to be taken care of by Mussolini and told what to do and his kids grow up and march in whatever military and conformity that the fascists were dictating at the time. As I was saying to Jim today earlier, I think we’re at a critical junction of American history right now where that freedom that my grandfather fought for is fundamentally at stake. We are ever-gradually — and not-so-gradually in the last couple of years — edging our way toward the same kind of country that my grandfather left. […] What got me into this race was Obamacare. I’m no history professor like Newt Gingrich, but I am a little bit of a student of history and I’ve seen what that, I believe, final death knell will be to America of having government control that very critical aspect of our life, which is access to the care that we need to stay alive.” [Rick Santorum, Campaign Speech, Waterloo, IA,12/14/11]

Rick Santorum Said That Government-Provided Health Care Is A Plot To Kill Off People Who Don’t Vote The Right Way.  “If we have a system where the government is going to be the principal provider of health care for the country, we’re done. Because then, you are dependent on the government for your life and your health…When Thatcher ran for prime minister she said — remember this, this is the Iron Lady — she said, ‘The British national health care system is safe in my hands.’ She wasn’t going to take on health care, because she knew once you have people getting free health care from the government, you can’t take it away from them. And the reason is because most people don’t get sick, and so free health care is just that, free health care, until you get sick. Then, if you get sick and you don’t get health care, you die and you don’t vote. It’s actually a pretty clever system. Take care of the people who can vote and people who can’t vote, get rid of them as quickly as possible by not giving them care so they can’t vote against you. That’s how it works.” [Rick Santorum, Young Americans for Freedom Convention, Yorba Linda, CA, 12/3/13]

As a reminder, here are the stakeholders who opposed the initial version of Graham-Cassidy:

  • Physicians and Nurses: American Medical Association; American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association, American Psychiatric Association; American College of Physicians; American Nurses Association
  • Patient Groups: ALS Association, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Lung Association, Arthritis Foundation, Cystic Fibrosis Foundation, Family Voices, JDRF, Lutheran Services in America, March of Dimes, National Health Council, National Multiple Sclerosis Society, National Organization for Rare Diseases, Volunteers of America, WomenHeart; More Than 35 Cancer Organizations; 469 Mental Health and Substance Use Disorder Groups; The Arc
  • Hospitals: American Hospital Association; Children’s Hospital Association; Federation of American Hospitals; America’s Essential Hospitals; Catholic Health Association; Kansas Hospital Association; Greater New York Hospital Association; Kaiser Permanente
  • Insurers: America’s Health Insurance Plans; Blue Cross Blue Shield Association; Association for Community Affiliated Plans
  • Consumer Groups: AARP; Consumers Union
ashoup
In News, Statement

Protect Our Care Statement on Latest Republican Repeal Plan

As Republican organizations and leaders release yet another proposal to repeal the Affordable Care Act, Protect Our Care Campaign Director Brad Woodhouse released the following statement:

“Republicans just can’t seem to take a hint. Today, they’re back to push a repackaged version of the same repeal bill that Americans firmly rejected last year. It’s a tired retread of the same old proposals to gut protections for people with pre-existing conditions, impose an age tax on older Americans, and pave the way for huge Medicaid cuts. Despite repeated pleas from the American people, Republicans simply refuse to stop pushing their destructive repeal-and-sabotage agenda, but they have no problem putting power back in the hands of insurance companies, giving hundreds of billions in tax breaks to pharmaceutical companies, and going back on their promises to rein in drug prices. The Republican establishment can come up with a million plans to repeal our health care, but our answer is still the same: NO. Republican politicians should denounce this new effort, end their war on the our health care, and get to work on bipartisan solutions to bring down costs and protect our care.”

ashoup
In Stories, News

Trump Administration, Ignoring 95% of Health Care Groups, Finalizes Association Rule

Washington, D.C. – The Trump Administration just announced new mandates that force weak products that fail to cover critical consumer needs and force costs up for everyone else onto the health insurance markets. Over 95% of health care experts and advocates opposed the change. Protect Our Care Campaign Director Brad Woodhouse released the following statement about these junk plans in response:

“Association health plans fail to provide real coverage because they can refuse to cover critical consumer protections like prescription drug coverage, mental health care, and maternity care, and studies show that these types of plans have a long history of fraud and unpaid claims. These garbage health plans are just the latest Trump Administration attempt to undermine and sabotage our health insurance – sticking Americans with higher costs and chipping away protections for millions and millions of people with pre-existing conditions. The Republican war on health care continues to mean you pay more, you get less.”

OVER 95% OF COMMENTERS OPPOSED ASSOCIATION HEALTH PLANS

Not A Single Group Representing Patients, Physicians, Nurses Or Hospitals Voiced Support In The Public Comments. “Altogether, more than 95% — or 266 of 279 — of the healthcare groups that filed comments about the proposed association health plan regulation expressed serious concern or opposed it.” [Los Angeles Times, 5/30/18]

INSURANCE COMMISSIONERS AGREE THAT ASSOCIATION HEALTH PLANS ARE BAD FOR CONSUMERS

National Association of Insurance Commissioners: Association Health Plans Are Bad For Consumers. “AHPs would fragment and destabilize the small group market, resulting in higher premiums for many small businesses…AHPs would be exempt from state solvency requirements, patient protections, and oversight exposing consumers to significant harm.” [NAIC]

Pennsylvania Insurance Commissioner Concerned About Potential For Consumer Harm Under AHPs. “The proposed rule would also loosen existing commonality of interest requirements to allow associations to form simply based on membership in the same trade, industry or profession..If a self funded MEWA were permitted to form in a neighboring state and to sell to Pennsylvania association members under the metro area provision, Pennsylvania regulators would not have the ability to assist a Pennsylvania resident if problems arise with the other state’s association, including claim denials, or, worse yet, in the event of insolvency or fraud.” [PA Insurance Commissioner Jessica Altman, 3/6/18]

California Insurance Commissioner: “The Proposed Rule Is A Perfect Storm Of Bad Ideas.” “The AHPs proposed by this rule will harm consumers by degrading the individual and small group health insurance markets through adverse selection, and will impinge upon states’ rights while opening the door to fraud, insolvency and abuse…The proposed rule in no way limits the ability of states to regulate MEWAs, insurers offering coverage through MEWAs, and insurance producers marketing that coverage to employers. However, the checkered history of MEWAs instructs that unscrupulous actors will try and exploit any change which can be mischaracterized as constituting ERISA preemption.” [CA Insurance Commissioner Dave Jones, 3/6/18]

PATIENT GROUPS, HOSPITALS, AND KEY HEALTH STAKEHOLDERS CONDEMN AHPs

American Cancer Society Cancer Action Network: “We Are Also Concerned About The Proliferation Of AHPs Because Of Their History Of Fraud And Financial Instability.” “For a long time, these products were not traditionally subject to the same state insurance solvency and licensing requirements that allowed regulators to maintain necessary oversight. If an AHP lacked the financial resources to pay claims, then enrollees were left with no coverage and high out-of-pocket costs. Even in cases of well-meaning AHP sponsors, insolvencies led to millions of dollars in unpaid claims.” [ACS-CAN, 3/6/18]

American Hospital Association: AHPs “Ultimately Decreas[e] Access To Affordable Coverage.” “We are concerned that this rule fails to protect against discriminatory insurance practices and could contribute to instability in the individual and small group market, ultimately decreasing access to affordable coverage.” [American Hospital Association, 3/6/18]

Coalition Of 118 Patient And Community Organizations Urges Department Of Labor To Reconsider AHPs. “We believe that the proposed changes would negatively impact access to quality, affordable care for consumers, disrupt the individual and small business marketplace, and further strain the limited resources of state regulators…The intent of the President’s executive order was to increase consumer choice while curbing costs, however we believe that AHPs as proposed would invariably weaken the individual and small group markets leading to higher healthcare costs for all; higher premiums for those who stay in the marketplace, and high out of-pocket costs for those who are covered by AHPs for unexpected medical needs.” [Coalition Of 118 Patient And Community Organizations, 3/6/18]

AHPs ARE HOTSPOTS FOR FRAUD IN STATES

Florida

A Labor Department Lawsuit Revealed An AHP Had Concealed Financial Problems And Left $3.6 Million In Unpaid Claims. “The Labor Department filed suit last year against a Florida woman and her company to recover $1.2 million that it said had been improperly diverted from a health plan serving dozens of employers. The defendants concealed the plan’s financial problems from plan participants and left more than $3.6 million in unpaid claims, the department said in court papers.” [New York Times, 10/21/17]

In Florida, A Man Pleaded Guilty To Embezzling $700,000 In Premiums From the AHP He Ran in 2004 To Help Build A Home For Himself And Was Sentenced To 57 Months In Prison. “A Florida man was sentenced to 57 months in prison after he pleaded guilty to embezzling about $700,000 in premiums from a health plan that he had marketed to small businesses. The Labor Department and the Justice Department said he had used some of the plan premiums to build a home for himself.” [New York Times, 10/21/17]

In 2004, A Florida Woman Was Left With $500,000 In Unpaid Medical Bills While She Was Covered By Association Health Plan. “Joan Piantadosi, a small business owner bought health insurance from Employers Mutual LLC through an association for herself, her family, and her employees. She was left with more than $500,000 in unpaid medical bills for her husband’s treatment during the time she was covered by Employers Mutual LLC. On top of that, her husband needed a liver transplant to live. In her own words, “[W]e were informed that since we lacked insurance coverage, we would have to pay a deposit of $150,000 before my husband could enter the hospital’s Liver Transplant Inpatient program. We simply did not have $150,000 to cover the deposit. Consequently, my husband was removed from the recipient list…We feared, among other things, that my husband might die while we were attempting to deal with the predicament of being uninsured despite having paid premiums to what appeared to be a legitimate health insurer.” [United Hospital Fund, 3/6/18]

Louisiana

In Louisiana, Two People Pleaded Guilty To Using Money From The AHP For Spa Treatments, Diamond Cuff Links, Foreign Travel And Other Personal Expenses. “And in Louisiana, two people pleaded guilty to conspiracy charges after the government found that they had taken money from the medical benefit fund of a trade association and used it to pay for spa treatments, diamond cuff links, evening gowns, foreign travel and other personal expenses.” [New York Times, 10/21/17]

Texas

In Texas, Patients Thought They Were Insured Until Told Otherwise In A Moment Of Crisis. “Robert Loiseau, who represented fraud victims in Texas, recalled their shock when they tried to receive care. ‘People bought insurance coverage because it was cheap and seemed to provide them with coverage they needed,’ he said. ‘It had a veneer of legitimacy. But when they went to the doctor, they found out all of a sudden that their insurance company, their perceived insurance company, was in receivership and that they had no coverage.’” [New York Times, 10/21/17]

Between 2001 And 2003, Texas Shut Down 129 Unauthorized Insurance Operations. “In the last two years, the Texas Insurance Department shut down 129 unauthorized insurance companies, affiliates, operators, and their agents whose illegal actions affected more than 20,000 Texans.” [The Commonwealth Fund, August 2003]

New Jersey

In 2002, An AHP Became Insolvent With $15 Million In Outstanding Claims. “For example, when a long-standing AHP in New Jersey that covered 20,000 people became insolvent in 2002, it had $15 million in outstanding medical bills. This left participating businesses and their employees’ claims unpaid even though employers paid premiums to the AHP.” [Commonwealth Fund, 10/10/17]

A Health Plan For New Jersey Small Businesses Collapsed With $7 Million In Unpaid Claims. “In another case, a federal appeals court found that a healthplan for small businesses in New Jersey was ‘aggressively marketed but inadequately funded.’ The plan collapsed with more than $7 million in unpaid claims.” [New York Times, 10/21/17]

South Carolina

In South Carolina, A Man Pleaded Guilty To Diverting Nearly $1 Million From An AHP For Churches And Small Businesses, Leaving $1.7 Million In Unpaid Claims. “A South Carolina man pleaded guilty after the government found that he had diverted more than $970,000 in insurance premiums from a health plan for churches and small businesses. ‘His embezzlement and the plan’s consequent failure left behind approximately $1.7 million in unpaid medical claims,’ the Labor Department said.” [New York Times, 10/21/17]

Across State Lines: North Carolina, Maryland, And Beyond

One AHP Scheme Shows How AHPs Can Move From State To State.Families USA chronicled an AHP scheme involving the American Trade Association, Smart Data Solutions, and Serve America Assurance. They found:

  • “Even after one state identifies a problem, the company may continue to operate for years in other states. North Carolina issued a cease and desist order to stop many of the players in this case from selling insurance in 2008.”
  • “But by June 2010, when Maryland issued a cease and desist order, the plans sold by these players had been identified in at least 23 states.„ Estimates of total premiums paid to these companies for unauthorized, unlicensed plans range from $14 million to $100 million.”
  • “This particular scheme operated through associations that went by many different names. (At least one of the players in this case was involved in a previous case concerned with fraudulent insurance sold through an association of employers in 2001-2002.)”
  • “Consumers are often ill-protected when they buy coverage through an association, and the web of relationships among salespeople, associations, administrators, and actual insurers can be difficult for regulators to unravel and oversee. Consumers may be encouraged to join fake associations to buy health insurance so they have an illusion of coverage—and the insurers collect membership dues and premiums while illegally avoiding state oversight).” [Families USA, October 2010]

GAO Report In 1992 Showed Similar AHPs Left At Least 398,000 Participants With More Than $123 Million In Unpaid Claims And More Than 600 Plans In Almost Every State Failed To Comply With State Laws.“Back in 1992, the Government Accountability Office issued a scathing report on these multiple employer welfare arrangements (known as MEWAs; they’re pronounced “mee-wahs”) in which small businesses could pool funds to get the lower-cost insurance typically available only to large employers. These MEWAs, said the government, left at least 398,000 participants and their beneficiaries with more than $123 million in unpaid claims between January 1988 and June 1991. Furthermore, states reported massive and widespread problems with MEWAs. More than 600 plans in nearly every U.S. state failed to comply with insurance laws. Thirty-three states said enrollees were sometimes left without health coverage when MEWAs disbanded…’MEWAs have proven to be a source of regulatory confusion, enforcement problems and, in some instances, fraud,’ the GAO wrote at the time.” [Washington Post, 10/12/17]

ashoup
In News, Stories

Protect Our Care Launches 130 Million Strong Month of Action

Washington, D.C. – The Protect Our Care coalition today launches “130 Million Strong Month of Action,” a campaign to warn Americans about escalating Republican attacks on Affordable Care Act-guaranteed protections for over 130 million Americans with pre-existing conditions. As the Trump Department of Justice asks the courts to take away these protections, the campaign will leverage earned and paid media as well as grassroots advocacy to highlight the true cost of letting insurance companies bring back discrimination.

“There are over 130 million Americans out there with pre-existing conditions who deserve to know that Republicans are trying to let insurance companies take away their coverage,” said Protect Our Care Campaign Director Brad Woodhouse. “The Trump Department of Justice just declared war on people who have a history of diabetes, asthma, or cancer. This month, our coalition of health care advocates will be conducting an aggressive information campaign to make sure people know what’s at stake.”

The campaign launches this morning with a new digital ad targeted to 13 states: Alaska, Arizona, Indiana, Maine, Missouri, Montana, Nevada, North Dakota, Ohio, Pennsylvania, Tennessee, West Virginia, and Wisconsin.

Watch Digital Ad

Protect Our Care is also rolling out 51 fact sheets this morning highlighting the impact residents would face in each state if the Trump Administration wins its case and takes away pre-existing condition protections, and dozens of events are set to take place across the country between now and Independence Day.

ashoup
In Stories, News

Bipartisan Governors Slam Trump Administration For Attempting to Remove Pre-Existing Condition Protections

This afternoon, nine bipartisan governors released a statement slamming the Trump Administration’s decision to argue that protections for Americans with pre-existing conditions are unconstitutional. Protect Our Care Campaign Chair Leslie Dach released the following statement in response:

“The Trump Administration’s decision to argue for discriminating against people with pre-existing conditions has been opposed by everyone from patient groups to doctors – and now you can add nine bipartisan governors to the list. These nine governors – three Republicans, an Independent, and five Democrats –  all recognize the importance of protecting the 130 million Americans with pre-existing conditions and the cruelty of the Administration’s recent actions. These nine bipartisan governors are showing what true leadership looks like – the Administration would do well to follow their lead and reverse their current position.”

ashoup
In News

Rural America Reacts to Protect Our Care & Rural Forward Report On GOP Sabotage

Last week, Protect Our Care and Rural Forward released a new report outlining how Republican policies threaten health care in rural areas. The report was announced at a Capitol Hill press conference with Sen. Bob Casey (D-PA) and Rep. Donald McEachin (VA-04), and state-specific versions of the report were released in thirteen states: Alaska, Arizona, Indiana, Maine, Missouri, Montana, North Dakota, Nevada, Ohio, Pennsylvania, Tennessee, Wisconsin, and West Virginia.

Sen. Bob Casey (D-PA) speaks at the Capitol as the report is released.

Politico Pulse: “Nearly 90 percent of rural hospital closures post-ACA were in states that hadn’t yet expanded Medicaid. That’s according to a new report from Protect Our Care and Rural Forward, which are pro-Obamacare groups. Of the 84 rural hospitals that have closed since 2010, 74 were in states that hadn’t yet opted into the ACA’s Medicaid expansion, stressing their margins… The report lists other pressures on rural hospitals and patients, like the GOP’s push for work requirements in Medicaid. ‘President Trump and his Republican allies are making it harder for people living in rural areas to get the health coverage they need,’ the groups conclude.”

Rep. Donald McEachin (D-VA) speaks following the release of the report.

SEMO Times of Missouri: “A report compiled and released by Protect Our Care, a pro-Affordable Care Act coalition, found that 90 percent of rural hospitals that have closed since 2010 have been in states that had not expanded Medicaid at the time of the hospital’s closure. Of the 84 rural hospitals that have closed since 2010, four have been in Missouri. SoutheastHEALTH Center of Reynolds County, Parkland Health Center–Weber Road in Farmington, Sac-Osage Hospital in Osceola, and Twin Rivers Regional Medical Center in Kennett — which closed June 11, 2018 — have all closed in the last four years.”

In Wisconsin, health care advocates held a press conference standing up to GOP health care sabotage.

Indiana Public Media: “Numerous groups warn these changes will have a ripple effect.  Kate Shepard is with Protect Our Care Indiana. ‘The result is increased premiums for everyone,’ Shepard says, ‘even those people who are not buying their insurance through the actual marketplace.’ Protect Our Care released a new report that finds people in rural Indiana could be impacted most. Shepard says Hoosiers have benefited from the law.”

Johnson City Press of Tennessee: “According to Tennessee State University student and Protect My Care organizer Jacob Huss, [rural] residents face unique challenges when it comes to health care access. ‘Rural residents often have to travel long distances for a doctor’s visit and have fewer options when choosing a health care provider. Rural communities also face economic challenges and that can make it much more difficult for residents just to frankly afford their health care,’ Huss said. ‘Many can’t rely on employer-based coverage because it isn’t always offered, especially in a field like agriculture, which so many people rely on directly or indirectly in rural areas.’ While there is a need for health care among many rural Tennesseans, Huss said many state Republicans’ refusal to expand the program has much to do with their opposition to the Affordable Care Act. ‘Since they aren’t able to repeal it, they are sabotaging it,’ Huss said.”

Key findings from the report:

  • Rural hospitals are especially at risk because of Republicans’ health care sabotage agenda, which rural communities often depend on for both primary and specialized health care services. Since 2010, 84 rural hospitals have closed. The vast majority, 90 percent, were in states that had refused to expand Medicaid at the time of the hospital’s closure.
  • The ACA and its Medicaid expansion have been crucial in supporting rural communities: following the ACA’s implementation, the uninsured rate in rural areas dropped from 17 percent in 2013 to 12 percent in 2015. The ACA has expanded access to health care to nearly 1.7 million rural Americans, and Medicaid covers nearly 24 percent of rural Americans, 45 percent of rural children, 15 percent of rural seniors, and 51 percent of rural births.
  • As of 2016, 673 rural hospitals were at risk of closing. If Congressional Republicans continue their attacks on Medicaid and the ACA, the financial stability of these hospitals will remain at risk, and millions of rural Americans will face further barriers to accessing the care they need.
ashoup
In News

GOP Senators to Trump: Sabotage Health Care Faster

After Republican Senators Lamar Alexander, Michael Enzi, Rand Paul, Mitch McConnell, Orrin Hatch, John Cornyn, John Thune, Roy Blunt, John Barrasso, Joni Ernst, Chuck Grassley, Ron Johnson, James Inhofe, Deb Fischer, John Boozman, Johnny Isakson, Bill Cassidy, Marco Rubio, Shelley Moore Capito, James Lankford, Steve Daines, Roger Wicker, Tom Cotton, Dan Sullivan, Todd Young, John Kennedy, Richard Shelby, Dean Heller, Richard Burr, and Tim Scott urged the Trump Administration to hurry up and sabotage health care even faster, Protect Our Care Campaign Chair Leslie Dach said:

“At a time when Republican Senators should be standing up to the Trump Administration’s threat to strip protections from 130 million Americans with pre-existing conditions, they are instead urging the Administration to commit more sabotage, faster. Today, 30 Republican senators asked Trump to fast-track an expansion of association health plans, which fail to provide real coverage because they can exclude or limit basic services such as prescription drug coverage, mental health care, and maternity care. Before the Affordable Care Act, this type of plan had a long history of fraud and unpaid claims, and many states still exempt them from key consumer protections. When these plans fail, they leave people who thought they had real coverage out in the cold – which is where millions of Americans will find themselves if the Trump Administration and these irresponsible Senators have their way.”

 

INSURANCE COMMISSIONERS AGREE THAT ASSOCIATION HEALTH PLANS ARE BAD FOR CONSUMERS

National Association of Insurance Commissioners: Association Health Plans Are Bad For Consumers. “AHPs would fragment and destabilize the small group market, resulting in higher premiums for many small businesses…AHPs would be exempt from state solvency requirements, patient protections, and oversight exposing consumers to significant harm.” [NAIC]

Pennsylvania Insurance Commissioner Concerned About Potential For Consumer Harm Under AHPs. “The proposed rule would also loosen existing commonality of interest requirements to allow associations to form simply based on membership in the same trade, industry or profession..If a self funded MEWA were permitted to form in a neighboring state and to sell to Pennsylvania association members under the metro area provision, Pennsylvania regulators would not have the ability to assist a Pennsylvania resident if problems arise with the other state’s association, including claim denials, or, worse yet, in the event of insolvency or fraud.” [PA Insurance Commissioner Jessica Altman, 3/6/18]

California Insurance Commissioner: “The Proposed Rule Is A Perfect Storm Of Bad Ideas.” “The AHPs proposed by this rule will harm consumers by degrading the individual and small group health insurance markets through adverse selection, and will impinge upon states’ rights while opening the door to fraud, insolvency and abuse…The proposed rule in no way limits the ability of states to regulate MEWAs, insurers offering coverage through MEWAs, and insurance producers marketing that coverage to employers. However, the checkered history of MEWAs instructs that unscrupulous actors will try and exploit any change which can be mischaracterized as constituting ERISA preemption.” [CA Insurance Commissioner Dave Jones, 3/6/18]

PATIENT GROUPS, HOSPITALS, AND KEY HEALTH STAKEHOLDERS CONDEMN AHPs

American Cancer Society Cancer Action Network: “We Are Also Concerned About The Proliferation Of AHPs Because Of Their History Of Fraud And Financial Instability.” “For a long time, these products were not traditionally subject to the same state insurance solvency and licensing requirements that allowed regulators to maintain necessary oversight.5 If an AHP lacked the financial resources to pay claims, then enrollees were left with no coverage and high out-of-pocket costs. Even in cases of well-meaning AHP sponsors, insolvencies led to millions of dollars in unpaid claims.” [ACS-CAN, 3/6/18]

American Hospital Association: AHPs “Ultimately Decreas[e] Access To Affordable Coverage.” “We are concerned that this rule fails to protect against discriminatory insurance practices and could contribute to instability in the individual and small group market, ultimately decreasing access to affordable coverage.” [American Hospital Association, 3/6/18]

Coalition Of 118 Patient And Community Organizations Urges Department Of Labor To Reconsider AHPs. “We believe that the proposed changes would negatively impact access to quality, affordable care for consumers, disrupt the individual and small business marketplace, and further strain the limited resources of state regulators…The intent of the President’s executive order was to increase consumer choice while curbing costs, however we believe that AHPs as proposed would invariably weaken the individual and small group markets leading to higher healthcare costs for all; higher premiums for those who stay in the marketplace, and high out of-pocket costs for those who are covered by AHPs for unexpected medical needs.” [Coalition Of 118 Patient And Community Organizations, 3/6/18]

AHPs ARE HOTSPOTS FOR FRAUD IN STATES:

Florida

A Labor Department Lawsuit Revealed An AHP Had Concealed Financial Problems And Left $3.6 Million In Unpaid Claims. “The Labor Department filed suit last year against a Florida woman and her company to recover $1.2 million that it said had been improperly diverted from a health plan serving dozens of employers. The defendants concealed the plan’s financial problems from plan participants and left more than $3.6 million in unpaid claims, the department said in court papers.” [New York Times, 10/21/17]

In Florida, A Man Pleaded Guilty To Embezzling $700,000 In Premiums From the AHP He Ran in 2004 To Help Build A Home For Himself And Was Sentenced To 57 Months In Prison. “A Florida man was sentenced to 57 months in prison after he pleaded guilty to embezzling about $700,000 in premiums from a health plan that he had marketed to small businesses. The Labor Department and the Justice Department said he had used some of the plan premiums to build a home for himself.” [New York Times, 10/21/17]

In 2004, A Florida Woman Was Left With $500,000 In Unpaid Medical Bills While She Was Covered By Association Health Plan. “Joan Piantadosi, a small business owner bought health insurance from Employers Mutual LLC through an association for herself, her family, and her employees. She was left with more than $500,000 in unpaid medical bills for her husband’s treatment during the time she was covered by Employers Mutual LLC. On top of that, her husband needed a liver transplant to live. In her own words, “[W]e were informed that since we lacked insurance coverage, we would have to pay a deposit of $150,000 before my husband could enter the hospital’s Liver Transplant Inpatient program. We simply did not have $150,000 to cover the deposit. Consequently, my husband was removed from the recipient list…We feared, among other things, that my husband might die while we were attempting to deal with the predicament of being uninsured despite having paid premiums to what appeared to be a legitimate health insurer.” [United Hospital Fund, 3/6/18]

Louisiana

In Louisiana, Two People Pleaded Guilty To Using Money From The AHP For Spa Treatments, Diamond Cuff Links, Foreign Travel And Other Personal Expenses. “And in Louisiana, two people pleaded guilty to conspiracy charges after the government found that they had taken money from the medical benefit fund of a trade association and used it to pay for spa treatments, diamond cuff links, evening gowns, foreign travel and other personal expenses.” [New York Times, 10/21/17]

Texas

In Texas, Patients Thought They Were Insured Until Told Otherwise In A Moment Of Crisis. “Robert Loiseau, who represented fraud victims in Texas, recalled their shock when they tried to receive care. ‘People bought insurance coverage because it was cheap and seemed to provide them with coverage they needed,’ he said. ‘It had a veneer of legitimacy. But when they went to the doctor, they found out all of a sudden that their insurance company, their perceived insurance company, was in receivership and that they had no coverage.’” [New York Times, 10/21/17]

Between 2001 And 2003, Texas Shut Down 129 Unauthorized Insurance Operations. “In the last two years, the Texas Insurance Department shut down 129 unauthorized insurance companies, affiliates, operators, and their agents whose illegal actions affected more than 20,000 Texans.” [The Commonwealth Fund, August 2003]

New Jersey

In 2002, An AHP Became Insolvent With $15 Million In Outstanding Claims. “For example, when a long-standing AHP in New Jersey that covered 20,000 people became insolvent in 2002, it had $15 million in outstanding medical bills. This left participating businesses and their employees’ claims unpaid even though employers paid premiums to the AHP.” [Commonwealth Fund, 10/10/17]

A Health Plan For New Jersey Small Businesses Collapsed With $7 Million In Unpaid Claims. “In another case, a federal appeals court found that a healthplan for small businesses in New Jersey was ‘aggressively marketed but inadequately funded.’ The plan collapsed with more than $7 million in unpaid claims.” [New York Times, 10/21/17]

South Carolina

In South Carolina, A Man Pleaded Guilty To Diverting Nearly $1 Million From An AHP For Churches And Small Businesses, Leaving $1.7 Million In Unpaid Claims. “A South Carolina man pleaded guilty after the government found that he had diverted more than $970,000 in insurance premiums from a health plan for churches and small businesses. ‘His embezzlement and the plan’s consequent failure left behind approximately $1.7 million in unpaid medical claims,’ the Labor Department said.” [New York Times, 10/21/17]

Across State Lines: North Carolina, Maryland, And Beyond

One AHP Scheme Shows How AHPs Can Move From State To State.Families USA chronicled an AHP scheme involving the American Trade Association, Smart Data Solutions, and Serve America Assurance. They found:

  • “Even after one state identifies a problem, the company may continue to operate for years in other states. North Carolina issued a cease and desist order to stop many of the players in this case from selling insurance in 2008.”
  • “But by June 2010, when Maryland issued a cease and desist order, the plans sold by these players had been identified in at least 23 states.„ Estimates of total premiums paid to these companies for unauthorized, unlicensed plans range from $14 million to $100 million.”
  • “This particular scheme operated through associations that went by many different names. (At least one of the players in this case was involved in a previous case concerned with fraudulent insurance sold through an association of employers in 2001-2002.)”
  • “Consumers are often ill-protected when they buy coverage through an association, and the web of relationships among salespeople, associations, administrators, and actual insurers can be difficult for regulators to unravel and oversee. Consumers may be encouraged to join fake associations to buy health insurance so they have an illusion of coverage—and the insurers collect membership dues and premiums while illegally avoiding state oversight).” [Families USA, October 2010]

GAO Report In 1992 Showed Similar AHPs Left At Least 398,000 Participants With More Than $123 Million In Unpaid Claims And More Than 600 Plans In Almost Every State Failed To Comply With State Laws.“Back in 1992, the Government Accountability Office issued a scathing reporton these multiple employer welfare arrangements (known as MEWAs; they’re pronounced “mee-wahs”) in which small businesses could pool funds to get the lower-cost insurance typically available only to large employers. These MEWAs, said the government, left at least 398,000 participants and their beneficiaries with more than $123 million in unpaid claims between January 1988 and June 1991. Furthermore, states reported massive and widespread problems with MEWAs. More than 600 plans in nearly every U.S. state failed to comply with insurance laws. Thirty-three states said enrollees were sometimes left without health coverage when MEWAs disbanded…’MEWAs have proven to be a source of regulatory confusion, enforcement problems and, in some instances, fraud,’ the GAO wrote at the time.” [Washington Post, 10/12/17]

Close Menu