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ashoup
In Research, Fact Sheet

FACT SHEET: Republicans’ Threats to Medicaid Are A Clear and Present Danger

April marks the 5th annual Medicaid Awareness Month. With Medicaid currently serving over 92 million Americans, the largest enrollment in history, this program has never been more important to the lives of everyday Americans. Medicaid enrollment has increased by 61 percent nationally since 2013 and the program has been proven time and time again to save lives, increase coverage and – in turn – broaden access to needed care, and help reduce racial, rural, and other health disparities. Republican attacks on Medicaid are especially harmful for communities of color, rural Americans, people with disabilities, and low-income families. 

Even with Medicaid serving more Americans than ever before, Republicans across the country have made it their mission to slash its budget by billions. One budget plan offered by an influential former member of the Trump administration would cut over $2 trillion from Medicaid, ending Medicaid expansion entirely and kicking over 21 million Americans off of their health care plans. Whether it’s at the state level where Republican lawmakers in 10 states continue to refuse to expand Medicaid or in Congress where Speaker Kevin McCarthy recently released a plan that would impose work reporting requirements and other burdensome policies for new moms and families, this war on Medicaid will not stop.

By The Numbers

  • Tens of Millions of Americans are at Risk of Losing Vital Parts of Their Health Care if Cuts to Medicaid Are Pushed Through. Over 92 million Americans are currently enrolled in Medicaid. Cuts to Medicaid would surely see considerable reductions in coverage leaving millions potentially uninsured with no pathway to get health coverage.
  • More Than 50 Percent Of Children Could See Significant Reductions in Their Health Coverage. Nationally, 54 percent of American children are covered by Medicaid/CHIP. Slashing Medicaid funding would see many of these children become ineligible for low-cost health insurance with no pathway to finding affordable health care.
  • Funding For Nearly Two-Thirds of Long-Term Residents in Nursing Homes Would Dry Up. Medicaid covers nursing home bills for over 60 percent of residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room can cost over $100,000 annually. Medicaid caps or cuts would see more seniors without the financial resources to afford long-term care.
  • Marginalized Groups Are Disproportionately Harmed by Republican Attacks. Increasing Medicaid access is the single most important action available to expand coverage and reduce racial inequities in the American health care system. The ACA led to historic reductions in racial disparities in access to health care, but racial gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic adults. Cutting Medicaid and repealing the ACA’s Medicaid Expansion would result in coverage loss, and therefore inflame these disparities.
  • Rural Americans Relying on Medicaid Would be Left Behind by Republicans. Nearly 14 million Medicaid enrollees reside in rural areas. Medicaid helps fund rural hospitals, which employ six percent of all employees in rural counties that report having any hospital employment. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2023, over 600 rural hospitals are at risk of closing in the near future.
  • Nearly 45 Percent Of Adults With Disabilities Could See Reduced Health Coverage or Lose Coverage Entirely. Medicaid covers 45 percent of non-elderly adults with disabilities, including adults with physical disabilities, developmental disabilities, and brain injuries. Republican plans could leave many of these people and their families with little support and sometimes even no health coverage at all.
  • Births Currently Covered by Medicaid Could be at Risk. Medicaid covers over 40 percent of births in the United States and Congress recently offered permanent federal funding to states that opt to expand Medicaid coverage to mothers for one year postpartum. All of these gains would be rolled back under Republican plans and maternal mortality, already a dire crisis in this country especially for Black and Indigenous mothers, would only be worsened.
  • Medicaid’s Assistance for Those With Substance Use Disorders Would Substantially Diminish. Nationally, around 12 percent of Medicaid enrollees over 18 have some kind of substance use disorder (SUD) and Medicaid is crucial to building a system of comprehensive substance use care. These interventions have been vital and life saving, with one study finding that around 10,000 lives were saved from fatal opioid overdoses as a direct result of Medicaid expansion alone. Cutting Medicaid, put simply, would increase overdoses and decrease treatment options for thousands of Americans.
  • Over a Quarter of Americans Living With a Serious Mental Health Condition Could See Their Coverage Cut Back. Medicaid is the single-largest payer for mental health services in America, serving 26 percent of all adults living with a serious mental health condition. Expanding Medicaid services, such as behavioral health benefits, also has led to improved access and better outcomes for low-income individuals. Simply having access to Medicaid has shown in some studies to reduce depression rates by over 3 percent among those with chronic health conditions. Capping or cutting Medicaid spending could see these achievements in mental health care rolled back.

Some Republicans Have Proposed Sunsetting Medicaid Programs. Republicans have a long history of targeting Medicaid for spending cuts and these threats have only grown more serious in recent weeks. Senator Rick Scott has famously proposed a budget that sunsets all federal programs, putting Medicaid in particular on the chopping block. Representative Barry Loudermilk called out Medicaid by name when pronouncing that “everything was on the table” when it came to spending cuts. At the same time, Representative Brett Guthrie called for an explicit cap on Medicaid spending, harkening back to the failed ACA replacement bill which led to Republicans losing the House of Representatives when Americans voted in the midterms. Speaker Kevin McCarthy recently released a plan that would impose work reporting requirements and other burdensome policies for new moms and families.

Speaker Kevin McCarthy Has Proposed Strict Work Requirements to Medicaid While Holding Debt Ceiling Deal as Leverage Over the Country. Kevin McCarthy gave up a significant amount of his power in order to take the title of Speaker. As such, it should be no surprise that his Medicaid proposals mirror that of the radical MAGA Freedom Caucus, proposing the addition of strict work requirements to Medicaid in order for eligible Americans to even have access to the program. Studies of states which have implemented work requirements have repeatedly found these barriers increase disenrollment rates, particularly among those with chronic illnesses (which has itself been increasing steadily since 2020). Other studies have found that even Medicaid beneficiaries who do work often struggle with the complex reporting requirements and risk losing coverage even if they fully comply with the work requirements.

The Proposed Vought Budget Plan Will Slash Medicaid and Rip Away Health Care from Millions of Americans. Former Trump budget director Russell Vought has been quietly tasked by House Republicans to craft a budget that will focus on cutting essential programs for millions of Americans. Although the party line is that Republicans want to reduce spending, choosing Vought is an interesting choice considering his direct role under Donald Trump in ballooning the national debt to a state which will weigh down the American economy for decades. Nevertheless, Vought has proposed a wide swath of austerity measures aimed at punishing the poorest and most vulnerable Americans. Vought’s plan would cut over $2 trillion from Medicaid alone and would also repeal the Affordable Care Act, which would end Medicaid Expansion entirely and kick over 21 million Americans off of their health care plans.

The House Freedom Caucus Budget Proposes Radical Medicaid Cuts. The House Freedom Caucus, to whom Speaker Kevin McCarthy ceded much of his official power as Speaker, has proposed a budget plan which will cut over $3 trillion in non-defense spending taking aim specifically at health care programs like Medicaid. One of the major plans for restructuring the program would be the institution of strict work requirements in order to even access Medicaid. All research on the subject shows that work requirements reduce dramatically the number of people who can access Medicaid. Almost two-thirds, or 62 percent, of those who would lose their Medicaid coverage as a result of work requirements are women, and disproportionately women of color. As well, even though the Freedom Caucus is claiming this is an attempt to cut spending on needless bureaucracy, time and time again Medicaid work requirements end up costing more money to implement and maintain than traditional Medicaid or Medicaid Expansion. Georgia’s new Medicaid work requirements require the state to develop “expensive administrative processes,” estimated to cost upwards of $270 million annually to implement, nearly 3 times more than Medicaid Expansion would cost.

Republicans in 10 States Continue to Fight Against Medicaid Expansion. While Republicans are fighting a war of ideology, the facts are clear, Medicaid expansion saves lives. According to the Center on Budget and Policy Priorities, Medicaid expansion saved the lives of 19,200 older adults aged 55 to 64 between 2014 and 2017. At the same time, 15,600 older adults died prematurely as a result of their state’s decision not to expand the program. A study published in the Journal of Health Economics found that Medicaid expansion reduced mortality in non-elderly adults by nearly four percent. Cancer deaths have dropped more in states that accepted Medicaid coverage under the ACA than in states that have held out, and expansion has also been tied to fewer heart-related deaths. Often Republicans know that Medicaid Expansion would be the best program for their state, but continue to refuse to expand it or, in some states, will try to implement a milquetoast replacement program.

  • Republicans are Leaving Hundreds of Thousands of Georgians Behind With Their Sham Medicaid Waiver. Governor Brian Kemp’s Medicaid waiver program will likely increase coverage for 50,000 Georgians, costing taxpayers around the same amount of money it would cost to adopt Medicaid expansion and cover over 500,000 Georgians. Included in Kemp’s plan are strict work requirements aimed at punishing those who cannot afford health care which will cost taxpayers three times more simply to maintain than expanding Medicaid. Under the Republican waiver plan, almost 300,000 Georgians would have no pathway to any type of health insurance at all. Brian Kemp and Georgia Republicans are willing to leave these Georgians behind in the name of pure ideology.

Texas and Florida Are Cutting Staff While Millions Are At Risk of Losing Medicaid Coverage. Due to the Public Health Emergency (PHE), nearly 3 million Texans and 1 million Floridians were able to access and maintain Medicaid coverage for around three years. As the federal unwinding process begins , these 4 million people will likely see themselves kicked off of Medicaid, through no fault of their own. In 2022 Texas chose to purposefully cut staffing to their Medicaid program, making it even more difficult to enroll or renew coverage. Until April 1, this was not as large of an issue as Americans were protected from being booted off of Medicaid rolls, but now that Medicaid continuous coverage protections have been decoupled from the PHE eligibility for millions of Americans on Medicaid are being put into question. Even for people who are still eligible for Medicaid, the renewal process may be so difficult and burdensome that they cannot receive the coverage, with studies suggesting anywhere between 45 percent and 83 percent of those estimated to lose coverage will lose it purely for administrative reasons. In Florida, Republican lawmakers have made draconian cuts to hospitals specifically treating poor and marginalized Floridians amidst widespread protests from hospitals and staff throughout the state. These cuts have led to worse outcomes and patient care and the already fragile state of many hospitals in the state becoming dire. Since 2005, Florida has seen the 9th most rural hospital closures of any state in the country. Expanding Medicaid would increase funding to these hospitals, increase coverage of Floridians and Texans, and reduce the impacts of the PHE unwinding but both Republicans in Florida and Texas have no plans to move forward with expanding Medicaid programs.

ashoup
In Fact Sheet, Research

FACT SHEET: Braidwood v. Becerra Judge Moves To End Guaranteed Free Preventive Health Care For More Than 150 Million Americans

On March 30, 2023, District Judge Reed O’Connor struck down portions of the Affordable Care Act (ACA) that require insurers to cover lifesaving preventive services without cost sharing. Judge O’Connor invalidated all of the benefits covered under the U.S. Preventive Services Task Force (USPSTF), including lifesaving cancer and heart disease screenings, prenatal care,  pre-exposure HIV treatments, and more.

This lawsuit was initiated and driven by extremist, longtime foes of the ACA, abortion rights, marriage equality, vaccination mandates, and diversity policies—and decided by the same Federal District Court judge whose decision invalidating the entire ACA was reversed by the Supreme Court in 2021. Judge O’Connor’s ruling will once again put Americans at the mercy of insurance companies and employers, who could eliminate the benefits entirely or start charging for them, increasing costs for patients by thousands of dollars a year and creating major obstacles to care. Guaranteed no-cost coverage of preventive services, including screenings for chronic disease, is a key factor in expanding access to these services – which together with actions to address other social and structural determinants of health – and advancing health equity.

The ACA’s requirement that insurers provide services recommended by the USPSTF without cost-sharing guarantees access to dozens of health services with zero out-of-pocket costs. Eliminating costs for these lifesaving screenings and services has transformed how preventive care is delivered, saved countless lives, improved health outcomes, reduced disparities in care, and cut consumer health care costs for more than 150 million Americans. Judge O’Connor’s decision in the Braidwood Management (formerly Kelley) v. Becerra lawsuit ends the requirement that insurance plans cover these lifesaving, no-cost benefits. Here are just some of the preventive services invalidated by Judge O’Connor:

  • GONE – Free, Guaranteed Cancer & Health Screenings. This decision strikes down the ACA requirements that insurers cover screenings for serious health issues including colorectal cancer, lung cancer, hypertension, and prediabetes. 
  • GONE – Free, Guaranteed Mental Health & Substance Use Screenings. This decision strikes down the ACA requirements that insurers cover screenings for depression and anxiety for children and adolescents, as well as depression screenings for adults. This decision also strikes down the requirement that insurers cover screenings for unhealthy alcohol and drug use and tobacco cessation counseling and products. 
  • GONE – Free, Guaranteed PrEP. This decision strikes down the ACA requirements that guarantee access to pre-exposure prophylaxis (PrEP), a drug proven to substantially reduce the risk of contracting HIV. PrEP has been associated with a significant decrease in the number of new HIV diagnoses.

Here’s What Health Experts Have Said About The Case

  • A coalition of 16 patient advocacy organizations—led by the American Cancer Society—urged the court not to end guaranteed preventive coverage because it “would be highly disruptive to the health care system and patient care,” noting, “USPSTF’s preventive care recommendations have been adopted and relied on by patients and providers in the health care system for over 12 years…It is a popular provision of the law favored by 62% of Americans.”
  • A coalition of 8 leading medical organizations—led by the American Medical Association—warned that O’Connor’s ruling would “revert to the pre-ACA regulatory regime, where insurers could charge their enrollees…for mammograms, colonoscopies, and other services at will. […] All Americans…will be affected by the confusion that emerges from gutting the ACA’s decade-old preventive-care requirements. Doing so would yield a “confusing patchwork of health plan benefit designs offered in various industries and in different parts of the country,’ making it difficult for ‘patients who have serious medical conditions or are at high risk for such conditions’ to ‘find a plan that fully covers preventive and screening services.’ […] Many will instead decide to forgo basic preventive services entirely.”
  • Twenty-four organizations representing millions of people with or at risk for serious or chronic illnesses released a letter highlighting the need to protect access to preventive services.

What Happens Next

If the federal judiciary allows O’Connor’s ruling to stand, a full reversal of the preventive services requirement would set off a massive disruption in the American health care system with over 150 million Americans at risk of losing access to no-cost preventive care at the end of this year or when they renew their insurance.

It is imperative Judge O’Connor’s ruling be stayed pending appeal. The case will almost certainly be appealed to the 5th Circuit Court of Appeals, and it will eventually end up at the Supreme Court. 

Who Is Behind It? 

The Braidwood Management v. Becerra Plaintiffs Have Repeatedly Sued To Overturn Parts Of The ACA. John Kelley, his wife, and his company, Kelley Orthodontics, filed an earlier and similar class action lawsuit against the ACA’s contraceptive mandate known as DeOtte v. Azar. Another plaintiff, Braidwood Management, owned by Dr. Steven Hotze, was also a plaintiff in DeOtte and has previously brought and lost challenges to other parts of the ACA. In addition to being a plaintiff in previous efforts to overturn the ACA, Hotze is a vocal advocate for multiple far-right conspiracy theories, claiming COVID-19 was an invention of the “deep state,” suggesting equal rights for LGBTQ+ individuals would lead to child molestation, and bankrolling election fraud vigilantism after making false claims regarding voter fraud in the 2020 election. 

The Lead Attorney For The Plaintiffs In Braidwood Management V. Becerra Is One of the Key Authors of SB8, Texas’ Vigilante Anti-Abortion Law. The lead attorney for the plaintiffs is Jonathan Mitchell, “who helped craft the Texas abortion law that was designed to evade judicial review by leaving enforcement to private citizens instead of government officials.”

  • Mitchell Filed Briefs Arguing the Supreme Court Should Overrule its Decisions Protecting Marriage Equality and Invalidating Anti-Sodomy Laws. Mitchell filed a brief in the Dobbs case urging the Supreme Court to overturn Roe v. Wade–and criticized Mississippi for suggesting that the Court could leave in place its 2015 ruling in Obergefell v. Hodges, holding that same-sex couples have the right to marry in all states. He said that Obergefell and Lawrence v. Texas, the 2003 ruling that invalidated all remaining state anti-sodomy laws, “are judicial concoctions, and there is no other source of law that can be invoked to salvage their existence.” Mitchell has also referred to PrEP, a life-saving medication that prevents HIV infection as a drug that would “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” 

The Plaintiffs In Braidwood Management v. Becerra Are Also Represented By The Trump-Aligned America First Legal Foundation. The plaintiffs are “represented by America First Legal Foundation, a nonprofit led by senior members of President Donald Trump’s administration, including Trump senior adviser Stephen Miller.” 

  • America First Legal Has Supported Suits To Overturn Vaccine Mandates And Block “Critical Race Theory.” America First Legal is involved in numerous hot-button conservative legal actions. AFL has supported suits seeking to overturn vaccine mandates and sued companies that have policies to increase diversity in their workforces. The group has also filed suits alleging that pandemic aid for minority farmers is “racist” and trying to force the Biden administration to stop allowing immigrant children into the country.
  • America First Legal Was Established By Former Trump Aide Stephen Miller “To Make Joe Biden’s Life Miserable.” America First Legal was founded by former Trump aide and white nationalist Stephen Miller who was “looking to use it to make Joe Biden’s life miserable.” He was also the architect of the Trump administration’s harshest immigration policies and a supporter of the forced sterilizations committed by ICE in Georgia.

The Judge Ruling on Braidwood Management v. Becerra Is Well-Known For His Anti-Obamacare Beliefs. According to CNN, U.S. District Judge Reed O’Connor is, “a Texas-based judge who has become notorious for his rulings against the Affordable Care Act under the Trump and Obama administrations.” O’Connor — an appointee of President George W. Bush and a former advisor to Sen. John Cornyn on the Senate Judiciary Committee — has issued opinions spanning over a decade that would dismantle key Obamacare provisions and now, with Braidwood Management v. Becerra, has ruled once again to strip Americans of their quality and affordable health care. 

  • Judge O’Connor Has Previously Ruled To Strike Down The Entire ACA, To Overturn Contraceptive Coverage Requirements, To Invalidate Vaccine Mandates, And Limit LGBTQ+ Rights. O’Connor presided over the last major Obamacare challenge to land on the Supreme Court’s doorstep. In that case, O’Connor invalidated the entire ACA — and his decision was overturned by a 7-2 majority that included four of the Supreme Court’s conservative Justices. In addition to the individual mandate case, O’Connor also sided with Obamacare challengers who took aim at the law’s non-discrimination provisions, its contraceptive coverage requirement, and at insurance provider fees imposed on states through the law. He also recently ruled against the military’s Covid-19 vaccine mandate and has in the past issued decisions against policies that expanded LGBT rights. 
  • For Opponents Of The ACA, Judge O’Connor Is “Their Guy.” Describing Judge O’Connor’s string of anti-ACA rulings, John Cogan, a health law professor at the University of Connecticut School of Law said, “There are plaintiffs who simply will not give up, despite years of defeats. They’ve had some successes, but years of defeats, and there’s just no lack of an appetite for continuing litigation. […] The whole approach to challenging the ACA … he’s their guy.” 

Why The Plaintiffs’ Legal Arguments Are Wrong

The plaintiffs make three primary legal arguments – all are wrong. The plaintiffs will likely raise these arguments as the case is appealed.

The Plaintiffs’ First Argument: The law violates the Appointments and Vesting Clauses of the Constitution because members of the United States Preventive Services Task Force (USPSTF), Advisory Committee on Immunization Practices (ACIP), and Health Resources and Services Administration (HRSA) have not been nominated by the President or confirmed by the Senate and, according to the plaintiffs, can “unilaterally determine” the preventive care that must be covered by insurers and plans. 

Why The Plaintiffs Are Wrong: Congress made a conscious decision to require coverage of preventive services — specifying bodies that utilized well-established standards to guide their decisions — and ensured each entity in question (USPSTF, ACIP, and HRSA) is overseen by federal agencies whose heads have been appointed by the President and who all report to a senior official appointed by the President and confirmed by the Senate (the Secretary of Health and Human Services [HHS]). USPSTF members are appointed by the head of the Agency for Healthcare Research and Quality, who reports to the Secretary of HHS. The HRSA Administrator reports to the Secretary of HHS. The members of ACIP are appointed by the CDC Director who reports to the Secretary of HHS. HRSA is a component of HHS.

The Plaintiffs’ Second Argument: The preventive services provision violates the nondelegation doctrine because it delegates legislative power to the USPSTF, ACIP, and HRSA without providing an “intelligible principle” to guide their exercise of discretion. 

Why The Plaintiffs Are Wrong: Congress required the coverage of evidence-based and preventive services, and it specified bodies that applied well-established standards to guide their decisions. By specifying those bodies, Congress plainly endorsed and incorporated the standards that they utilized, and those standards provide a sufficient “intelligible principle” to limit discretion and govern the recommendations and guidelines that must be covered under the ACA.

The Plaintiffs’ Third Argument: The plaintiffs claim they have religious objections to paying for one of the preventive services mandated by the ACA — PrEP, a drug essential to HIV prevention – and that requiring coverage of this medication is a violation of the Religious Freedom Restoration Act (RFRA).

Why The Plaintiffs Are Wrong: As the Department of Justice explains in its court filings, the plaintiffs have not shown that their religious beliefs are burdened because they failed to prove that the availability of PrEP medications encourages behavior inconsistent with their beliefs or that the PrEP requirement causes an increase in their cost for health insurance. In addition, preventing the spread of HIV, a potentially fatal, infectious disease, is a compelling government interest–which is a separate basis for rejecting the RFRA claim.

ashoup
In News, Report, Research

NEW REPORT: Texas Mifepristone Abortion Case Threatens Entire Drug Approval Process

Read the Report Here.

Washington, DC — Today, Protect Our Care is releasing a report detailing the disastrous implications of the medical abortion lawsuit in Texas aiming to ban the abortion medication mifepristone. A decision to ban mifepristone would threaten millions of women’s access to safe and legal abortions and open the door for the politically-motivated destruction of the entire drug approval process.

Since the Supreme Court’s elimination of the constitutional right to an abortion, anti-abortion activists have ramped up their attacks on remaining protections. This attack in Texas comes at a huge cost, not only to the access to safe abortion care but to the entire U.S. drug approval process. Protect Our Care’s new report outlines the dire consequences of Judge Matthew Kacsmaryk’s potential ruling.  

Protect Our Care Founder Leslie Dach issued the following statement: 

“The medical abortion case being argued today in Texas endangers the health of millions of women and also threatens the entire drug approval process in the United States. If the judge decides to overturn the FDA approval of mifepristone, it would open the door to other politically motivated lawsuits that could result in the banning of critical life-saving drugs relied on by millions. The result would be chaos in our drug approval system and the arbitrary banning of drugs that keep so many of us alive and healthy.”

ashoup
In Fact Sheet, Research

NEW: State Fact Sheets Describe GOP Budget Cuts and Threats to American Health Care

Read the Fact Sheets Here.

Washington DC — Today, Protect Our Care is releasing state-by-state fact sheets to underscore Republicans’ radical plan to raise costs and rip away health care from millions of Americans. Republicans in Congress have set their sights on making massive cuts to the Affordable Care Act (ACA), Medicaid, and Medicare. They are working to throw out protections for pre-existing conditions, repeal the Inflation Reduction Act’s measures to reduce the cost of drugs, make coverage more affordable for nearly 15 million Americans, and gut Medicaid expansion, which covers 20 million people. These cuts would be disastrous for the American people, disproportionately impacting children, rural Americans, people with disabilities, and people of color.

Protect Our Care’s new fact sheets outline the consequences of Republicans’ plans to repeal the ACA and Medicaid expansion. Republicans refuse to give up on this decade-long effort despite the ACA and Medicaid expansion being extremely popular with voters.

These attacks come as more and more Americans rely on the ACA and Medicaid for their health care. President Biden and Democrats in Congress passed the Inflation Reduction Act, which expanded tax credits to help make premiums more affordable for people purchasing coverage on their own. President Biden also made record investments in the Navigator program and eliminated the family glitch, which previously blocked millions of families from receiving coverage under the ACA. As a result, the uninsured rate has reached an all-time low, and a record 16.3 million people have signed up for health care coverage for 2023. 

Protect Our Care Founder Leslie Dach issued the following statement: 

“Republicans have promised to gut the Affordable Care Act and Medicaid. They want to rip away protections for people with pre-existing conditions, raise premiums, and take health insurance away from millions of Americans. If they get their way, health care costs would go through the roof and millions would have nowhere to turn.”

What the Congressional Republican Agenda Means for Americans

Speaker McCarthy and MAGA Congressional Republicans have committed to balance the budget while adding $3 trillion or more to the deficit through tax cuts skewed toward the wealthy and large corporations. As a matter of simple math, that requires trillions in program cuts. Congressional Republicans have yet to disclose to the American people where these cuts will come from. But past Republican legislation, budgets, and litigation, along with recent statements, proposals, and budget plans, provide clear evidence that health care will be on the chopping block for severe cuts. 

Virtually every Republican budget or fiscal plan over the last decade has included repeal of the Affordable Care Act (ACA) and deep cuts to Medicaid. That would mean: higher health care costs for American families; ending critical protections for people with pre-existing conditions; and threats to health care for seniors and people with disabilities, including growing home care waiting lists and worse nursing home care. 

Americans deserve to see congressional Republicans’ full and detailed budget plan, including what it cuts from the ACA and Medicaid, Social Security and Medicare, and other critical programs, and should have the chance to compare it with the President’s budget plan, which he will release March 9. 

ACA repeal would reverse The United States’ progress in getting more Americans health insurance. Since the passage of the Affordable Care Act, monthly enrollment rates for Medicaid have increased by over 59 percentage points—coverage gains that would surely be lost if the ACA and Medicaid expansion is eliminated. 

More than 106 million Americans—about 32 percent of the country—rely on Medicaid and the Affordable Care Act for health coverage. 

In total, over 37 million Americans’ health insurance coverage will be at risk from ACA repeal. This includes over 16,306,448 who have signed up for ACA marketplace coverage for 2023, and over 21,339,037 enrolled in Medicaid expansion coverage available due to the ACA. 

Nearly 54 million Americans with pre-existing health conditions could lose critical protections. Before the ACA, at least 53,883,000 Americans with pre-existing health conditions could be denied coverage or charged more if they tried to buy individual market health insurance. Republican repeal proposals either eliminate these protections outright or find other ways to gut them. 

Over 25 million Americans could lose protection against catastrophic medical bills. Before the ACA, insurance plans were not required to limit enrollees’ total costs, and almost one in five people with employer coverage had no limit on out-of-pocket costs, meaning they were exposed to tens of thousands of dollars in medical bills if they became seriously ill. 

About 68 million Americans with Medicaid could lose critical services, or could even lose coverage altogether, including over 44,223,975 children. Slashing federal funding for Medicaid will force states to make Medicaid eligibility changes that would make it harder to qualify for, and enroll in, Medicaid coverage. States would also likely consider capping or limiting enrollment.

Medicaid funding could be slashed. Republican budget plans would eliminate the minimum federal Medicaid matching rate (FMAP) for states. Under current law, states with lower relative average per-capita income receive higher matching rates than states with the highest average per-capita income, and no state receives a FMAP that is lower than 50 percent. If the 50 percent floor were eliminated, according to some older estimates, states could see their FMAP fall to as low as 15 percent, forcing Americans to pick up a far greater share of the cost of their Medicaid programs or make substantial cuts to their Medicaid programs. 

Almost 10 million seniors and people with disabilities could receive worse home care, with ballooning wait lists for those still in need. Under a block grant or per-capita cap, there would be fewer dollars available for home care services, an optional benefit in Medicaid. Faced with large federal funding cuts, states would almost certainly ration care. The United States already has over 655,596 people on its home care wait lists so any additional cuts in federal funding will likely cause the state’s existing waitlist to skyrocket. 

Hundreds of thousands of nursing home residents would be at risk of lower-quality care. Over 60 percent of nursing home residents are covered by Medicaid. With large cuts in federal funding, states would be forced to cut nursing home rates to manage their costs, as many states have done during recessions. Research shows that when nursing homes are paid less, residents get worse care. 

ashoup
In Fact Sheet, Research

FACT SHEET: Insurance Companies are Making Billions in Profits on Medicare Advantage

While They Air Television Ads Falsely Scaring Seniors They Are Bragging to Wall Street About Their Profits

The insurance industry and their Republican supporters in Congress are trying to scare seniors into believing the Biden administration is cutting Medicare. Insurance companies claims that they will have to cut benefits or increase premiums for seniors are just plain false. In fact, the Biden administration is proposing to increase spending on Medicare Advantage by $4 billion. And despite their dire advertising, the insurance companies have been busy telling Wall Street they expect Medicare Advantage to drive serious growth for their businesses.

Following Medicare’s Advance Notice payment update and during the industry’s multi-million dollar false advertising campaign, Humana announced they are doubling down on the Medicare Advantage business and only offering government-backed coverage. Humana announced in February 2023 that it will stop providing employer-sponsored commercial coverage as it focuses on bigger parts of its business, like Medicare Advantage. CEO Bruce Broussard said that the exit from employer-sponsored coverage lets Humana focus on its “greatest opportunities for growth.” After the announcement, shares of Humana Inc. climbed more than $4 to $507.91 Thursday.

Earlier in February, Humana shared with investors that they expect Medicare Advantage to drive their expected growth. In a Q4 2022 earnings call, Humana CFO Susan Diamond announced, “Our 2023 outlook reflects top-line growth above 11%, with consolidated revenues projected to be north of $103 billion…driven by growth in…Medicare Advantage.” 

UnitedHealthcare cites growth that is also driven by Medicare Advantage. In a Q4 2022 earnings call, UnitedHealthcare CFO John Rex announced, “Our strong 2023 Medicare Advantage member outlook is consistent with…serv[ing] up to 900,000 more people in ’23 across our individual, group, and dual special needs offerings, our 8th consecutive year of above-market growth.” 

In 2022, UnitedHealthcare showed double-digit revenue increases driven by Medicare Advantage. Their first quarter filing cited revenue growth of 14% in UnitedHealthcare and 19% in Optum. “The increases in revenues were primarily driven by growth in the number of people served through Medicare Advantage…”

We’ve heard these unfounded complaints from the industry before, and experts debunk them.
Mark Miller, who directed MedPAC for over 15 years, states: “This notion and threat thrown about from plans — ‘Touch one of my dollars, and all benefits will disappear’ — based on history and experience, that’s nonsense.” David Meyers, Assistant Professor of Health Services, Policy, and Practice at the Brown University School of Public Health, states: “I’m not really convinced we will see much movement in benefits or premiums with these proposed rules. Supp benefits are a huge marketing tool for plans and they won’t want to get rid of benefits benes like.”

ashoup
In Fact Sheet, Research

FACT SHEET: Insurers Care More About Big Profits Than Serving Dual-Eligible Seniors

The Reality is Medicare Advantage Profits are Through the Roof, Especially for Plans That Serve Dual-Eligible Seniors

People who are on Medicare Advantage are disproportionately Black and Latino. The insurance industry is using this data point to suggest seniors of color will be disproportionately harmed by HHS’s proposed 2024 rate increase of $4 billion for Medicare Advantage plans. In reality, insurers are not doing enough to address the quality of Medicare Advantage plan offerings to these communities and are trying to hold onto their record profits.

Research Shows Plans Offered to Dual-Eligible Seniors are Among the Most Profitable. Medicare Advantage Plans are the most profitable part of the health insurance business by a factor of nearly two. Among Medicare Advantage plans, those that serve dual-eligible seniors are the most profitable. In 2022, MedPAC found that in 2020, special needs plans (SNPs) serving dual-eligible seniors (D-SNPs) had margins of 10.7 percent, and SNPs for enrollees with certain chronic conditions (C–SNPs) had margins of 11.2 percent. Even nonprofit D–SNPs had an average profit margin of 6.4 percent. Medicare Advantage plans have since received payment increases of 4.08% in 2022 and 8.5% in 2023.

Big Insurers are Threatening to Cut Benefits if They Don’t Receive a Larger Payment Increase. An industry-funded study claims Medicare Advantage plans could reduce annual benefits by $540 per senior if they don’t receive a larger payment increase. However, these plans make an average of $1,730 in annual gross margin per senior, so choosing to not invest more in seniors reflects their greed, not a lack of funding from CMS. Former MedPAC staff dismiss the claim that insurers will cut benefits as “nonsense” based on how plans have historically responded to payment updates.  

Medicare Advantage Doesn’t Serve Black And Latino Populations Well. Research shows that compared to white seniors, insurers offer plans with lower quality ratings to racial and ethnic minority groups, who enroll in these low-rated plans more frequently than white seniors. Even the top-rated plans perform worse for minority seniors. A December 2022 study found Black seniors enrolled in Medicare Advantage have higher rates of avoidable hospital admissions than white seniors. Furthermore, while Medicare Advantage plans provide additional benefits, a January 2023 GAO report highlights that plans refuse to report the extent to which seniors actually use the supplemental benefits provided by Medicare Advantage plans. 

The Biden Administration is Committed to Advancing Health Equity, Including Through Medicare Advantage. The Biden administration is improving Medicare Advantage for seniors of color by cracking down on deceptive marketing practices, establishing a health equity index in the Star Ratings program that incentivizes the highest quality care for underserved seniors, and strengthening access to behavioral health services by reducing wait times and improving care coordination and network adequacy. These improvements to Medicare Advantage for underserved populations are just one example of the administration’s commitment to advancing health equity stemming from an Executive Order President Biden issued on his first day in office and Health and Human Services’ subsequent Equity Action Plan to institutionalize and sustain a focus on equity over time.

ashoup
In Fact Sheet, Research

FACT SHEET: Inflation Reduction Act Helps Seniors of Color Afford Their Insulin

Thanks to President Biden and Democrats in Congress, the Inflation Reduction Act capped insulin copays at $35 per month for seniors on Medicare. People of color are disproportionately affected by diabetes due to numerous systemic determinants of health that lead to barriers in accessing care. As a result, these communities are more likely to skip, ration, or delay insulin doses when compared to their white counterparts. The intersectionality of race and lack of care in rural areas especially leads to worse health outcomes for people of color. Making insulin more affordable is a lifeline for seniors of all backgrounds and economic status. Protect Our Care is highlighting the importance of lower insulin costs and calling for finishing the job of the Inflation Reduction Act to make the $35 cap universal.

BY THE NUMBERS

  • Deaths related to diabetes are three times more likely among people of color than their white counterparts.
  • More than 12 percent of Black adults, 11.8 percent of Hispanic adults, and 9.5 percent of Asian Americans are diagnosed with diabetes.
  • Black Medicare beneficiaries are twice as likely as white beneficiaries to have health care cost-related challenges. 
  • Americans of color spend upwards of $10,000 a year on diabetes-related costs.

Americans Of Color Are Disproportionately Affected By Diabetes. Over 12 percent of Americans of color experience diabetes due to a combination of genetic, socioeconomic, and environmental risk factors. In 2018, Black Americans were 2.5 times more likely than their white and Hispanic counterparts to be hospitalized due to diabetes complications. Hispanic adults are 50 percent more likely to develop type 2 diabetes over the course of their lifetime than their white counterparts. Racial and ethnic minority populations are also at a higher burden of diabetes-related complications, such as kidney disease, blindness, and worse glycemic control. Despite the higher risk of complications, Americans of color are less likely to receive recommended preventive care and annual screenings, largely as a result of systemic access barriers to this care.

Americans Of Color Skip, Ration, Or Delay Insulin Doses At Higher Rates Than Their White Counterparts. With rates of uninsurance also being highest among people of color, these insulin users are at a higher risk of skipping, rationing, or delaying insulin doses. Nearly 24 percent of Black Americans ration insulin compared to 16 percent of their white and Hispanic counterparts. Black adults also continue to be the hardest hit when it comes to affording their prescription drugs and paying medical bills.

Universal Insulin Copay Caps Will Help Insulin Dependent Americans Of All Ages. While there are 49 million seniors on Medicare who are eligible for the $35 insulin copay cap, 3.2 million were insulin users in 2020. If Congress passes legislation to make the $35 insulin copay cap universal, an additional 21 million insulin users of all ages would benefit, including the nearly 300,000 young people under 20 who are diagnosed with diabetes. 1 in 5 people with private insurance pays more than $35 per month and, for people who are uninsured or have poor coverage, insulin can cost up to $1,000 per month. A striking 14 percent of insulin users spend catastrophic amounts, or at least 40 percent of their income, on insulin.

ashoup
In Fact Sheet, Research

FACT SHEET: Big Drug Companies Have Been Ripping Us Off For Years And Now Are Trying To Protect Their Profits With Scare Tactics, Lobbyists, And Lies

Big drug companies have been ripping us off for years and are now trying to protect their profits with scare tactics and lies. Big drug companies spent over $100 million trying to kill the Inflation Reduction Act, and now they are spending even more to undercut the new law. Their efforts would: (1) increase drug costs and Medicare premiums for seniors by thousands of dollars a year, (2) increase the deficit, and (3) increase drug companies’ profits at the the expense of seniors’ health and financial well-being. 

The Biden-Harris Administration and Congressional Democrats succeeded in enacting legislation that saves lives, lowers prescription drug costs for seniors, and puts thousands of dollars per year back into the pockets of Americans — the greatest health care achievement since the passage of the Affordable Care Act. 

The Inflation Reduction Act:

  1. Caps seniors’ monthly insulin costs at $35 per month.
  2. Provides free recommended vaccinations to seniors.
  3. Caps seniors’ out-of-pocket drug costs at $2,000 per year starting in 2025. 
  4. Prevents price gouging by requiring drug companies to pay rebates to Medicare if they increase their prices faster than inflation.
  5. Gives Medicare the power to negotiate lower drug prices for millions of Americans. 
  6. Reduces the deficit by billions of dollars.

The drug industry is already spending heavily on lobbying to gut the law. Their main focus is undermining negotiations. They want to postpone negotiations for years over the price of some of the most expensive drugs. Currently, small molecule drugs (generally, retail prescription drugs sold in pill form and covered under Part D) are eligible for price negotiation once they have been on the market for 9 years; the drug industry wants to lengthen that period to 13 years to be consistent with biologic drugs, which are more complex to manufacture and are the biggest driver of rising drug spending. 

  • If big drug companies and policymakers desire an even playing field among all drug types, all excessively priced drugs, including biologics, should be aligned with the 9 year negotiation eligibility rule currently in place for traditional small molecule drugs.

If big drug companies get their way, drug costs and premiums will increase for seniors and people with disabilities covered by Medicare. Delaying the eligibility period for Medicare negotiation would reduce the number of drugs eligible for negotiation and prevent some of the highest prices from being lowered. For example, Bristol-Myers Squibb’s atrial fibrillation drug, Eliquis, would not be eligible for lower drug price applicability in 2026 if the drug industry succeeded in rolling back the Inflation Reduction Act. More than 2.6 million seniors would face higher out-of-pocket costs for the drug for an additional four years. Watering down the new law would also lead to higher Medicare premiums.

Seniors reject drug companies’ argument that negotiation threatens innovation. AARP’s 2023 survey of their 38 million members re-affirms that Republican and Democratic voters reject the drug industry’s argument that lower prices will kill innovation. 

  • Only 23% think it will have a negative impact on innovation. 
  • 72% believe high drug prices are a result of price gouging by the drug industry.

The drug industry claims that Medicare negotiation will hurt innovation are false. CBO estimates that over the next 30 years, FDA will approve about 1,285 drugs, about 15 fewer drugs than would come to market without the negotiation program. Furthermore, experts agree that the U.S. market will always be the most generous payer and, thus, will continue to provide huge incentives and rewards for true innovation.

The Medicare Drug Price Negotiation Program is designed to reward innovation. The new law gives drug companies at least nine years to recoup their research and development investments and earn profits before becoming eligible for Medicare negotiation. Recent research shows that cancer drugs recover their research and development costs within five years, allowing ample time for drug makers to earn high returns on valuable therapies. Moreover, the argument that drug makers need to set prices high to cover research and development costs is not supported by the evidence  – research shows no correlation between a drug’s price and its research and development costs. For decades, big drug companies have made massive profits by introducing “me too” drugs that don’t provide significant new clinical benefits. Over 60% of the drugs listed on the World Health Organization’s list of essential medicines are me-too drugs. Congress designed the Medicare Drug Price Negotiation program to reward and incentivize true innovation by requiring CMS to consider “unmet medical needs” and a drug’s comparative effectiveness and benefits over other similar drugs, encouraging drug manufacturers to invest bringing truly innovative therapies to market. 

Without Medicare savings from negotiation, Congress couldn’t afford the cost of the bill’s other drug benefits. The Medicare Drug Price Negotiation and Prescription Drug Inflation Rebate Programs reduce some of drug companies’ outrageous profits, and use those savings to deliver better benefits to seniors like lower premiums, a $2,000 out-of-pocket cap, a $35 cap on insulin costs, and free recommended vaccines. Weakening negotiation would undermine these benefits and add to the deficit. 

ashoup
In Fact Sheet, Research

FACT SHEET: Big Insurers and the GOP Are Spreading Falsehoods About the Biden Administration and Medicare

The Reality is Spending for Medicare Advantage is Going Up, Medicare Advantage Profits are Through the Roof, and Evidence of Fraud By Insurance Companies is Widespread

The insurance industry and their Republican supporters in Congress are trying to scare seniors into believing the Biden administration is cutting Medicare. In fact, the Biden administration is proposing to increase spending on Medicare Advantage by $4 billion. The Biden administration is also standing up to long term insurance company fraud and abuse in Medicare Advantage. Their efforts will improve the quality of Medicare Advantage plans – particularly for people struggling to make ends meet. It will also strengthen program integrity, and save the Medicare Trust Fund over $15 billion. 

Big Insurers and the GOP Falsely Claim That the Administration Is Cutting Medicare Advantage, but It’s an Over $4 Billion Increase. On February 1, the Centers for Medicare and Medicaid Services (CMS) proposed a 1.03% increase in its 2024 Advance Notice with Proposed Payment Updates for Medicare Advantage. CMS’s proposed payment increase translates to around $4 billion additional dollars for Medicare Advantage in 2024. This follows two years of even larger payment increases of 8.5% for 2023 and 4.08% for 2022. Medicare Advantage payments to insurers translate to the highest gross margins of any insurance product. Politifact rated a tweet from Senator Tom Cotton that said President Biden is proposing cuts to Medicare Advantage as “false.” The proposed changes to Medicare Advantage are not cuts but instead, aim to solidify the program’s integrity and payment accuracy. 

Republicans Are On The Record Promising To Cut Medicare. Republicans have been working for years to cut Medicare. Senator Rick Scott has proposed “sunsetting” all federal legislation, including Medicare, every five years and subjecting it to congressional reapproval. Senator Ron Johnson would go even further and subject Medicare to the annual appropriations process. Dozens of House Republicans have proposed using the upcoming debt limit debate to force cuts to Medicare and Social Security and just last year the influential Republican Study Committee released a budget that included radical changes to Medicare and Social Security, including raising the eligibility age. 

Republicans Care More About The Profits Of The Insurance Industry Than They Care About America’s Seniors. Some of the same Republicans who have proposed cuts to Medicare are now rushing to defend the insurance industry’s Medicare Advantage profits. Republican Study Committee Chair Rep. Kevin Hern has repeatedly called the administration’s proposed Medicare Advantage payment plan a “cut” that will “slash” Medicare and the “first step” to forcing all Americans into a Medicare for All plan. One of Hern’s top financial backers is the insurance industry. Senators Tom Cotton and Steve Daines have also toed the insurance industry line by attacking the Biden administration’s plan to strengthen Medicare advantage and improve the quality of the program. 

The Administration’s Stewardship Of The Medicare Program Will Save The Medicare Trust Fund Over $15 Billion. Auditing Medicare Advantage plans and recouping overpayments is a commonsense way to preserve Medicare Trust Fund dollars for seniors who rely on Medicare, not greedy corporations. The Biden administration’s policies protect Medicare solvency. 

Medicare Advantage Drives Massive Insurance Industry Profits. A 2020 report from Fierce Healthcare found that the top health insurers raked in $35.7 billion in profits over the course of 2019 due to the growth of Medicare Advantage – six out of seven major insurers saw “notable growth” in their Medicare Advantage enrollment. 

  • Humana Made Billions In Profits In 2022 Driven By Medicare Advantage: In the third quarter of 2022, Humana reported nearly $1.2 billion “largely due to growth in its Medicare Advantage health plans and lower than expected medical expenses.” Medicare Advantage plans form a large share of Humana’s business, and the company projects it will add another 625,000 members to its Medicare Advantage plan in 2023, 13.7% higher compared with 2022. 
  • Medicare Advantage Plans Are The Most Profitable Part Of The Health Insurance Business: A 2023 Kaiser Family Foundation study found that of the four private health insurance markets, the Medicare Advantage market has the highest gross margins, averaging $1,730 per enrollee per year in 2021.  Average gross margins — the average amount by which premium income exceeds yearly claims costs for each covered person — are considered a critical benchmark for insurer financial performance. The average gross margin for the Medicare Advantage market was about double the gross margins of the other three markets, pegged at $689 per covered person in the group market, $745 per covered person for the individual market, and $768 in Medicaid Managed Care.

Most Large Insurers In The Medicare Advantage Program Have Been Accused Of Padding Their Profits With Fraud. A 2022 New York Times review of dozens of fraud lawsuits, inspector general audits, and investigations by watchdogs showed how major health insurers have exploited Medicare Advantage to inflate their profits by billions of dollars. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. The insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment. Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance, and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud. The fifth company, CVS Health, which owns Aetna, told investors its practices were being investigated by the Department of Justice.

  • Insurers May Use Medicare Advantage To Pad Their Bottom Line By Disguising Profits As Costs. A 2022 report from the Brookings Institution indicated the five major insurers providing Medicare Advantage plans – UnitedHealthcare, Humana, Aetna, Kaiser Permanente, and Elevance Health (formerly Anthem) – are padding their bottom lines by disguising profits as costs. Insurers are able to do this because profits accrued through related businesses are not regulated by medical loss ratio (MLR) requirements. In certain cases, spending on related businesses can reach more than 70%, the report noted. The top 5 companies have related businesses, including pharmacy benefit managers (PBMs), post-acute providers, hospitals, and physician practices. “In each case, the prices charged to the Medicare Advantage plan can have a material effect on where profits and costs appear,” the report said. “This creates potential to move earnings outside the reach of regulations.”
  • Senate Report Finds Insurers Engage In Deceptive Marketing Practices. A November 2022 report by Senate Finance Committee Chair Ron Wyden found insurers used deceptive marketing practices to enroll seniors and seniors’ complaints to CMS doubled between 2020 and 2021. 

The Biden Administration Is Reining In Insurance Company Excess And Fraud And Protecting Medicare From Corporate Profiteering. CMS should be applauded for protecting the Medicare Trust Fund from being raided by greedy corporations. Medicare Advantage has been a cash cow for big insurance companies, and CMS’s stewardship of Medicare Advantage reflects a commitment to good governance and improving the quality of the program for seniors who choose Medicare Advantage. In finalizing new changes to the Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program and through the annual payment update, CMS is restarting standard program integrity activities like those they conduct with other Medicare and Medicaid programs, holding insurers accountable and strengthening the integrity of the Medicare Advantage program. Medicare Advantage plans now administer nearly half of the Medicare program and receive more than $420 billion in payments per year. No risk adjustment overpayments have been collected from Medicare Advantage organizations since 2007, despite audits that show seniors’ medical records do not consistently support the diagnosis reported by their insurer. 

Overpayments To Medicare Advantage Plans Lead To Higher Premiums For Traditional Medicare And Disproportionately Hurt Rural Seniors. When Medicare Advantage sponsors are overpaid, premiums for seniors with traditional Medicare increase. In effect, fee-for-service Medicare enrollees subsidize Medicare Advantage enrollees. Americans residing in rural areas are less likely to have access to Medicare Advantage, so are disproportionately hurt by overpayments to these plans.

Medicare Advantage Doesn’t Serve Black And Latino Populations Well. People who are on Medicare Advantage are disproportionately Black and Latino. However, research shows that compared to white seniors, insurers offer plans with lower quality ratings to racial and ethnic minority groups, who enroll in these low-rated plans more frequently than white seniors. Even the top-rated plans perform worse for minority seniors. And, even irrespective of plan ratings, Medicare Advantage doesn’t always serve seniors of color better. A December 2022 study found Black seniors enrolled in Medicare Advantage have higher rates of avoidable hospital admissions than white seniors. Furthermore, while Medicare Advantage plans provide additional benefits, a January 2023 GAO report highlights that plans refuse to report the extent to which seniors actually use the supplemental benefits provided by Medicare Advantage plans. The Biden administration is improving Medicare Advantage for seniors of color by cracking down on deceptive marketing practices and strengthening access to behavioral health services by reducing wait times and improving care coordination and network adequacy. These improvements to Medicare Advantage for underserved populations are just one example of the administration’s commitment to advancing health equity stemming from an Executive Order President Biden issued on his first day in office and Health and Human Services’ subsequent Equity Action Plan to institutionalize and sustain a focus on equity over time.

ashoup
In Fact Sheet, Research

FACT SHEET: Universal $35 Insulin Copay Cap Will Benefit Millions Of Americans

Congressional Republicans Stripped Universal $35 Insulin Cap From the Inflation Reduction Act

At the State of the Union, President Biden called for capping insulin costs for every American, not just people on Medicare. Since January 1, more than 3.2 million insulin users on Medicare have been eligible for a $35 insulin copay cap thanks to the Inflation Reduction Act. However, an additional 21 million insulin users, who are not on Medicare, were blocked from receiving these same benefits because of Republicans in Congress. Protect Our Care is highlighting the importance of lower insulin costs over the next two weeks and calling for finishing the job of the Inflation Reduction Act to make the $35 cap universal. 

BY THE NUMBERS

  • 21 million insulin users would benefit from a universal $35 insulin cap.
  • Nearly 1 in 5 adults skip, ration, or delay insulin doses to save money.
  • 23.2 Percent of Black Americans ration insulin compared to 16 percent of their white and Hispanic counterparts. 
  • A month’s worth of insulin costs over $1,000 on average.
  • A universal insulin cap is overwhelmingly supported by 88 percent of Americans.

Over 20 Million Americans Would Benefit From A Universal $35 Insulin Copay Cap. While there are 49 million seniors on Medicare who are eligible for $35 insulin copay cap, 3.2 million were insulin users in 2020. If Congress passes legislation to make the $35 insulin copay cap universal, an additional 21 million insulin users of all ages would benefit. 1 in 5 people with private insurance pay more than $35 per month and, for people who are uninsured or have poor coverage, insulin can cost up to $1,000 per month. A striking 14 percent of insulin users spend catastrophic amounts, or at least 40 percent of their income, on insulin.

Americans Of Color Disproportionately Skip, Ration, Or Delay Insulin Doses Compared To Their White Counterparts. Americans of color are more likely than their white counterparts to experience diabetes due to biological, socioeconomic, and environment risk factors. With rates of uninsured also being highest among people of color, these insulin users are at a higher risk of skipping, rationing, or delaying insulin doses. Nearly 24 percent of Black Americans ration insulin compared to 16 percent of their white and Hispanic counterparts.

Data For Progress Finds Strong Support For Capping Insulin Copays. An overwhelming 88 percent of Americans, including 87 percent of Republicans, support Congress taking action to cap insulin copays for those with private insurance at $35 per month.

Republicans Prevented A Universal Insulin Cap From Passing Under The Inflation Reduction Act. In August 2022, during the negotiation phases of the Inflation Reduction Act,  Republicans stripped the universal insulin cap from the final language of the bill. In a country where 80 percent of diabetics have had to go into debt in order to pay for insulin, this type of action by Republicans reeks of the influence of Big Pharma.

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