Research

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.”

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.

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.

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. 

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.

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.

The presumed incoming ranking member on the Senate HELP Committee, Senator Bill Cassidy (R-LA)’s record on health care is as abysmal as they come. Over the years, Cassidy has voted to rip health care coverage from millions of Americans and strip protections from as many as 130 million people with pre-existing conditions, and his own 2017 repeal bill was the worst of the bunch. Senator Cassidy has also opposed provisions before Congress that would lower drug prices, expand coverage, improve care for seniors, and level the playing field for working families. Republicans like Senator Cassidy are completely out of touch with the economic and health worries that keep families up at night as they continue to put industry profits ahead of their constituents. 

Bill Cassidy’s Plan To Repeal The Affordable Care Act Would Leave Tens Of Millions Without Care

After the failure of Donald Trump’s other attempts to repeal the Affordable Care Act, Bill Cassidy partnered with Lindsey Graham and Dean Heller on a proposal that would have radically changed our health care system – ending the Affordable Care Act tax credits and Medicaid expansion and changing them into block grants with dramatically less funding for states. It would have also converted traditional Medicaid into a per capita cap program permanently. This bill aimed to slash coverage, raise costs, eliminate protections for millions of people across America and gut Medicaid. In fact, it was the worst of the repeal bills that were proposed in 2017 and its bad ideas have lingered on for years. 

Cassidy’s Bill Was Worse than Other Repeal Bills 

Analysts Agreed: Every State Would Have Suffered Under Graham-Cassidy Affecting People’s Care. Multiple independent analyses agreed that the Graham-Cassidy repeal bill would have cut federal funding to states. Over time, every state would lose because Graham-Cassidy proposed to zero out its block grants and ratchet down its spending on the Medicaid per capita cap. This meant people would not have access to the financial assistance to help lower their health care bills, and federal Medicaid funding would no longer adjust for public health emergencies, prescription drug or other cost spikes, or other unexpected increases in need. 

Cassidy’s Health Care Plan Cut Care For Millions Of Americans

Under Graham-Cassidy 32 Million Would Lose Health Coverage. As a result of zeroing out block grants for Marketplace tax credits and Medicaid expansion and additional cuts to Medicaid, the Graham-Cassidy bill essentially repealed the Affordable Care Act without replacing it. 

Millions Enrolled Through Medicaid Expansion Would Be Put At Risk. The Graham-Cassidy bill would have eliminated Medicaid expansion, which has helped more than 15 million Americans receive quality, affordable coverage, and put part of its funding into inadequate block grants. The bill would have further punished states that expanded Medicaid by redistributing funds to states that did not expand Medicaid. 

More Than 70 Million Americans with Medicaid Coverage, Including Seniors, People with Disabilities, and Children, Would Be Put At Risk. The Graham-Cassidy bill would have turned traditional Medicaid into a per capita cap, meaning millions who are enrolled in Medicaid would have had their care jeopardized. Medicaid disproportionately helps children, seniors in nursing home care and people with disabilities. A study by Avalere found that Graham-Cassidy would have cut funding for people with disabilities by 15-percent and 31-percent for children by 2036. 

More Than 35 Million Children’s Care Would Be Put At Risk. Millions of children are enrolled in Medicaid and CHIP, whose care could be at risk because of the funding cuts in Graham-Cassidy. 

Cassidy’s Health Care Plan Raised Costs And Ended Protections For People With Pre-Existing Conditions 

Under Graham-Cassidy Premiums Would Have Increased 20 Percent in the First Year. According to the Congressional Budget Office, Graham-Cassidy included provisions that would have raised premiums up to 20 percent in the first year. 

Graham-Cassidy Would Have Raised Costs For People With Pre-Existing Conditions. Graham-Cassidy would have allowed states to let insurance companies once again charge people with pre-existing conditions more, which could have raised costs for more than 130 millions Americans that have a pre-existing condition. For example, an individual with asthma would face a premium surcharge of $4,340. The surcharge for pregnancy would be $17,320, while it would be $142,650 more for patients with metastatic cancer. 

People Over The Age of 50 Would Have Faced An “Age Tax.” The Graham-Cassidy bill would have allowed states to let insurers charge people over 50 high premiums without limits. AARP said, “The Graham/Cassidy/Heller/Johnson bill would result in an age tax for older Americans who would see their health care costs increase under this bill.” AARP estimates that 60-year-old Americans could have paid as much as $16,174 more in higher premiums and out-of-pocket costs in 2020. 

Bill Cassidy Is A Relentless Foe Of The Affordable Care Act

As A Member Of The House, Bill Cassidy Voted Against Initial Passage Of The Affordable Care Act And For More Than 50 Repeal Attempts. As a member of the House from 2009-2015, Bill Cassidy was a relentless opponent of the Affordable Care Act, including voting against initial passage of the law and voting for at least 50 Republican attempts to repeal or substantially alter the law. His anti-ACA record continued in the Senate, where he voted for legislation that gutted the Affordable Care Act by eliminating the insurance exchanges and subsidies, and repealing the Medicaid expansion accepted by 30 states in his first year in office. 

2017: Cassidy Voted For All Three Republican Attempts To Repeal The ACA, Endangering Care For Millions Of Americans. In July 2017, Bill Cassidy voted for all three Republican attempts to repeal the Affordable Care Act – “Repeal and Delay,” the Better Care Reconciliation Act, and “Skinny” Repeal. All three would have had devastating impacts on Americans’ care, cutting millions off from coverage. 

• If “Repeal and Delay” had become law, 32 million fewer people would have had health insurance by 2026 and health insurance premiums would have doubled for those in the individual market.
• If BCRA had become law, it would have eliminated coverage for 15 million Americans in 2018 and increased individual premiums by 20 percent
• If “Skinny” repeal had become law, at least 15 million Americans would have lost coverage in 2018, the largest one year increase in US history, and premiums would have gone up by roughly 20 percent

2022: Cassidy’s Vote Against The Inflation Reduction Act, Was A Vote For Higher Health Insurance Premiums for Millions of Americans. Bill Cassidy joined every other Republican in Congress in voting against the Inflation Reduction Act. A record breaking 14.5 million Americans enrolled in an ACA marketplace plan in 2021. Right now, nearly 13 million people, or 89 percent with an ACA plan, are receiving enhanced premium tax credits, making their coverage affordable and accessible. The Inflation Reduction Act saves the average American family $2,400 a year and is extended through 2025. The Inflation Reduction Act ensures families pay no more than 8.5 percent of their income towards coverage. This helps middle and working class families facing excessive premiums or living in high-premium areas.

• Cassidy’s Vote Against The Inflation Reduction Act Was Also A Vote Against Expanding Coverage for Communities of Color. The Center on Budget Policy and Priorities estimates the increased savings continued under the Inflation Reduction Act will cause a sharp decline in the uninsured rate across every racial group, with one in three uninsured Black adults gaining coverage. Health coverage access is imperative to reducing racial disparities in health coverage across the nation and Bill Cassidy and every other Republican in Congress voted against it. 

Bill Cassidy Took Hundreds Of Thousands Of Dollars From Big Pharma And Opposed Efforts To Lower Prescription Drug Prices 

Bill Cassidy Voted To Block Medicare From Negotiating Lower Drug Prices. For nearly 20 years, Medicare has been banned from negotiating the price of prescription drugs for seniors, and Big Pharma has been able to dictate prices while Americans pay three times more for their medications than people in other countries. Bill Cassidy and every other Republican in Congress voted to leave that ban in place by voting against the Inflation Reduction Act. Under the Inflation Reduction Act, Medicare is empowered to negotiate prices for select drugs for Medicare Part D’s 49 million beneficiaries. 

Cassidy Opposed Capping Out-Of-Pocket Spending For Seniors. Bill Cassidy and every other Republican in Congress voted against helping the more than 1.4 million Medicare enrollees who paid more than $2,000 in out-of-pocket costs in 2020. Seniors with serious conditions like cancer, multiple sclerosis, and rheumatoid arthritis will save thousands of dollars on prescriptions under the Inflation Reduction Act, which caps Medicare Part D out-of-pocket costs for prescription drugs at $2,000 per year beginning in 2025. 

Cassidy Voted To Let Big Pharma Keep Raising Prices. The Inflation Reduction Act stops Big Pharma from raising Medicare drug prices faster than the rate of inflation beginning in 2023. For example, Humira, a medication commonly used to treat rheumatoid arthritis, is one of the nation’s highest revenue generating drugs, raking in $21 billion in sales in 2019. AbbVie, Humira’s manufacturer, has hiked the price of Humira 27 times, including in January 2021 when it raised its cost by 7.4 percent. Over the past 20 years, price increases for brand-name drugs in Medicare Part D have risen at more than twice the rate of inflation.

Cassidy Has Taken Hundreds Of Thousands Of Dollars From The Pharmaceutical Industry. It is no wonder why Senator Cassidy voted against the Inflation Reduction Act and was so opposed to Build Back Better, which both included historic provisions to rein in pharmaceutical companies and lower the cost of prescription drugs for millions of Americans. Between 2017 and 2022, Cassidy received over $500,000 in contributions from the pharmaceutical industry. 

While President Biden and Democratic lawmakers fought hard to lower health care costs for Americans, Republicans were fighting to keep health care prices high, increase profits for Big Pharma, and pull one over on the American people going into election season. Now, after voting in unison against the Inflation Reduction Act, these same Republican lawmakers are scrambling to change their message and fight to raise health care costs. 

Protect Our Care is continuing to highlight the Inflation Reduction Act’s critical measures to drive down health care costs, reduce prescription drug prices, and combat racial disparities in care. This week, Protect Our Care is focusing on how the bill reduces health care premiums for 13 million families purchasing coverage on the Affordable Care Act (ACA) marketplaces. More information on Protect Our Care’s Inflation Reduction Act theme weeks can be found here. 

Republicans Want Millions of Americans to Lose Access to Health Care. Through this legislation, Democratic lawmakers have continued to make sure that no individuals or families making under around $20,000 and $41,000 respectively will have to pay for any premiums. This has opened up the ACA marketplace to millions of low-income Americans and has allowed a record breaking 14.5 million people to have health care through open enrollment. Republicans have on the other hand released a plan that would raise premiums, end Medicaid as we know it, stop health care subsidies, and repeal not only the Inflation Reduction Act, but the American Rescue Plan and the Affordable Care Act. Just repealing the premium subsidies alone would cause over 3 million people to lose coverage entirely.

Republicans Voted For Increased Health Care Costs For Millions of Americans. Thanks to the American Rescue Plan, passed by President Biden an Democratic lawmakers, the ACA saw an increase of subsidies lowering health care costs for over 13 million Americans. Previously, premiums would cost the average middle class family around 15 percent of their annual income, but these subsidies put a cap of 8.5 percent. The Inflation Reduction Act extended these subsidies through 2025, allowing Americans to continue saving on average $2,400 a year on health care premiums. Every Republican in Congress voted against extending these subsidies and some have vowed to continue the fight to take away these subsidies, thereby raising premiums by thousands for Americans.

Republicans Want Rural Americans to Pay More for Health Care. The subsidies continued under the Inflation Reduction Act allow over 65 percent of rural Americans to have access to zero dollar premium health coverage, and 76 percent are able to find a plan for less than $50 a month. This will work to significantly lower the economic divide between urban and rural Americans and give millions of people who desperately need it access to quality and affordable health care. Every Republican in Congress voted against this relief for rural Americans. 

Republicans Want to Increase Racial Inequities in Health Care. Racial disparities plague the health care system of the United States, but through the subsidies continued under the Inflation Reduction Act, President Biden and Democratic lawmakers are taking steps to significantly reduce them. More than 65 percent of uninsured Black adults and 68 percent of uninsured Hispanic and Latino adults are eligible for zero dollar premium plans. An even greater 75 percent of uninsured Black adults and nearly 80 percent of uninsured Hispanic and Latino adults can access plans for less than $50 a month. Research shows that programs like this, which lower the barriers to access quality and affordable health care, are essential in reducing racial disparities in health. Republicans though would rather spend millions trying to get the Inflation Reduction Act repealed and those responsible for it out of office than allow for more families, no matter their background, to see their health care costs drop across the board. 

Republicans Want to Shut Down the Government Instead of Helping American Families. As Congress returns to session there is one thing on the minds of Republicans, repealing the Inflation Reduction Act, and they will do anything to accomplish this. Key leadership in the Republican Senate, like Rick Scott, have already threatened to shut the government down indefinitely until Biden repeals the Inflation Reduction Act. It doesn’t matter that shutting down the government will cost Americans billions of dollars or that if they succeed millions of Americans will see drastically higher premium rates or lose coverage entirely. Whose interests do Republican lawmakers really have in mind with their constant attempts at sabotaging the Inflation Reduction Act, because it certainly isn’t the American people?