~The GOP Repeal Bill Would Cut Coverage, Raise Costs and Eliminate Protections~
With 3 weeks until the clock runs out on the GOP’s ability to repeal health care through partisan repeal, Republicans are scheming to ram through another secretly drafted plan — but this one might be their worst one yet. Senators have repeatedly promised an open process with “regular order” to allow for expert testimony, debate and amendments before passing a health care repeal, but this scheme was drafted in secret and may be rammed through at the last minute. In fact, Ohio Republican Governor John Kasich said last week that he opposes this plan, calling it an “eleventh hour” attempt at repeal, and in a bipartisan Senate hearing Massachusetts Republican Governor Charlie Baker said the plan would result in “dramatically negative” effects in his state.
Reports about the plan, known as Graham-Cassidy-Heller, suggest that it will include the same draconian cuts to Medicaid as the Senate’s previously introduced Better Care Reconciliation Act by eliminating the enhanced federal funding for the ACA’s Medicaid expansion and turning the remaining program into a block grant. But Graham-Cassidy-Heller would also eliminate the ACA’s marketplace subsidies. In their place, the proposal would give states a block grant that would shrink over time, ending entirely by 2027.
Source: Center on Budget and Policy Priorities, 8/24/17
The nonpartisan Congressional Budget Office has shown that every health care repeal means cutting coverage, increasing costs and gutting protections that people depend on. This is no different. In fact, Maine Republican Senator Susan Collins said she has “a lot of problems” with the way this plan guts Medicaid, and Nevada Republican Governor Brian Sandoval said he has “a problem” with the cuts to health insurance in Nevada.
“Anyone who thinks Republicans have been listening to voters who hated the first 5 health care repeal attempts is sorely mistaken — this latest scheme is even worse,” said Protect Our Care Campaign Director Brad Woodhouse. “Republicans are putting politics over people’s health care and are rushing through this partisan, harmful repeal bill in the final 3 weeks. Doing this puts in jeopardy the bipartisan, open process that’s begun in Senate Health Committee to strengthen our health care system.”
The American people have overwhelmingly rejected health care repeal time and again. In the latest polling from Hart Research released last week, voters have gone from neutral on health care repeal in March of 2017 (45% favor, 48% unfavor) to overwhelmingly opposed in the latest polling (25% favor, 60% unfavor). In fact, an analysis by MIT found the GOP effort to repeal health care to be the most unpopular legislation in 30 years.
KEY FACTS ABOUT GRAHAM-CASSIDY-HELLER
Includes the same cuts to Medicaid And Medicaid Expansion As Other Repeal Bills. This repeal scheme embrace the already-rejected Medicaid cuts in the Senate’s failed health care repeal bill (known as BCRA) with $180 billion in cuts over 10 years — gutting Medicaid coverage for seniors in nursing homes and kids with disabilities. In addition, this would effectively eliminate Medicaid expansion by 2027. [Center on Budget and Policy Priorities, 8/24/17]
Increases Out Of Pocket Costs And Weakens Protections For People With Pre-existing Conditions. As the Center on Budget and Policy Priorities found, “The proposal includes provisions of the Senate Republican leadership bill that would allow states to waive important consumer protections in the individual market. Under these waivers, which would be subject to near-automatic approval by the federal government, insurers could exclude crucial services such as maternity and mental health care from their plans, impose annual and lifetime limits, and dramatically raise deductibles and other out-of-pocket costs. According to CBO, states with about half of the population would take up these damaging waivers. In addition, Senators Cassidy and Graham are reportedly also considering adding to their plan the so-called ‘Cruz amendment,’ which would allow insurers to charge sharply higher premiums to people with pre-existing conditions or deny them coverage altogether.” [Center on Budget and Policy Priorities, 8/24/17]
Allows Insurers To Charge Older People Up To Five Times More For Coverage As Younger People. [Kaiser Family Foundation, 8/1/17]
Reduces And Eventually Eliminates Federal Funding For Tax Credits That Help People Afford Coverage. “Under current law, moderate-income individual market consumers are guaranteed tax credits to help them pay for meaningful coverage meeting certain standards, and low-income adults in expansion states are guaranteed the ability to enroll in Medicaid, which ensures a comprehensive array of benefits and financial protection. The Cassidy-Graham amendment would eliminate these guarantees and allow states to spend their federal funding on virtually any health care purpose. Faced with large federal funding cuts and exposed to enormous risk, most if not all states would be forced to use this ‘flexibility’ to eliminate or cut coverage and financial assistance for low- and moderate-income people.” [Center on Budget And Policy Priorities, 7/27/17]
According to news reports this morning, President Trump is again demanding that Congress deliver on health care repeal, despite the fact that it’s been overwhelmingly rejected by voters and repeated analysis has shown it would cut coverage, increase costs and eliminate protections. The latest vehicle for partisan repeal appears to be the so called Graham-Cassidy-Heller bill, which represents another partisan, secretive repeal effort which will gut coverage, slash Medicaid, raise out-of-pocket costs and weaken or eliminate protections for people with pre-existing conditions.
Senate Republicans have a choice to make: do they embrace the bipartisan committee hearings beginning today that focus on improving our health care system, reducing costs and stabilizing the markets OR do they follow Trump’s demand for another hyper-partisan health care repeal?
OPTION 1:POLITICO: “Trump wants one last Senate push on Obamacare repeal”
OPTION 2: Washington Post: “Senate panel begins bipartisan hearings to try to improve Affordable Care Act”
“The reality is clear: voters have rejected health care repeal because it guts our health care system, rips away coverage and raises costs. Graham-Cassidy-Heller is more of the same,” said Protect Our Care Campaign Director Brad Woodhouse. “Congress should listen to their constituents and reject the secret, partisan road to repeal. The American people expect Congress to work across the aisle and improve our health care system, not succumb to President Trump’s demands for a health care repeal.”
4 FACTS About The Latest Health Care Repeal Ploy (Graham-Cassidy-Heller)
I UNPOPULAR. New polling shows 60% of people oppose the GOP’s health care repeal bills while only 25% support it. That’s down from 48% unfavorable, 45% favorable back in March. The GOP health care repeal effort is the most unpopular legislation in over 30 years according to an analysis by MIT professors.
II SECRET. Despite commitments to oppose secretive processes on health care, the proposal still has had No public legislative language, section-by-section analysis or meaningful description; No public Congressional Budget Office estimates; No apparent consultation with experts; and No apparent inclusion of women Senators in the process.
III HARMFUL. The Center on Budget and Policy Priorities found the plan would “cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, increase out-of-pocket costs for individual market consumers, and weaken or eliminate protections for people with pre-existing conditions.”
IV WORSE. The latest analysis found this plan would be worse than the already-rejected health care repeal bills. Vox reports it would be “arguably be more disruptive, not less, to the current health care system. It would let money currently spent on health insurance go toward other programs, providing no guarantee that the Affordable Care Act programs individuals rely on today would continue into the future.”
RE: New Polling on Voters’ Priorities for Healthcare After the Failure of Repeal and Replace
From August 18 to 21, Hart Research Associates completed 1,017 online interviews with a representative national cross section of Americans who voted in the 2016 election. The selfreported presidential vote among the sample is 48% for Hillary Clinton, 45% for Donald Trump, 5% for Gary Johnson, and 2% for Jill Stein. The party identification of the survey respondents is 43% Democrat, 39% Republican, and 18% independent.
Overview
Our recent national survey of 1,017 voters, conducted August 18 to 21, 2017, confirms that the efforts of President Trump and Republicans in Congress to repeal and replace the Affordable Care Act already have put them very far at odds with the public and are a major political vulnerability for them. The poll results also clearly demonstrate that continued efforts by Trump and congressional Republicans to undermine the Affordable Care Act will be deeply unpopular with voters, including many rank-and-file Republican voters. Large majorities of voters recognize that President Trump is trying to make the Affordable Care Act fail and playing politics with people’s healthcare. This behavior is in direct contrast with the priorities of most voters; for example, two-thirds of voters agree that “President Trump and the Republicans in Congress need to put politics aside and take the necessary steps to make sure individuals have access to affordable health insurance under the Affordable Care Act.”
There is widespread disapproval of President Trump’s threats to cut off the funding that helps insurance companies reduce out-of-pocket costs for individuals, and these threats are one of the top sources of concern about Trump’s handling of healthcare. Voters react strongly to the fact that cutting off these funds would increase health insurance premiums for individuals by 19%, as well as to the uncertainty that these threats create for insurers and the resultant possibility that many Americans could be left without affordable healthcare options. If these outcomes occur and there are failures in the Affordable Care Act, voters will blame President Trump and the congressional Republicans who are complicit in his efforts to undermine the ACA. Healthcare stands out as the number-one issue for voters in the 2018 midterm elections, and large majorities say they will be less likely to reelect their senator or congressperson if he/she supports efforts by President Trump to destabilize the health insurance markets and sabotage the Affordable Care Act.
From a political perspective, these poll results underline one clear conclusion: Democrats and progressives should be playing offense on the issue of healthcare, and should keep the issue front and center for voters in the coming weeks and months. This poll and others show that healthcare is a priority voting issue across the electorate, and the threat to healthcare presented by the policies of President Trump and congressional Republicans is a matter of deep personal concern to many voters. There is an obvious high ground in the debate about what should happen next in healthcare policy: voters want a bipartisan effort to keep what works in the Affordable Care Act and make the necessary improvements so it can work better, and they want action to bring more stability to the health insurance markets to keep premiums down and make sure people continue to have affordable healthcare options. If President Trump and congressional Republicans fail on these objectives and outcomes, voters will hold them accountable for that, and Democrats and progressives should be aggressive in shining a spotlight on each and every action by Trump and the Republicans that contributes to higher premiums and greater instability in the healthcare system.
In making these points, Democrats and progressives should:
Remind voters of Trump’s frequent declarations of his intention to let the Affordable Care Act fail and the ways he has followed through on these threats — including his efforts to limit and subvert enrollment;
Blame Trump and congressional Republicans for rising premiums and insurer opt-outs in the health insurance marketplaces, as a direct result of policies and actions designed to promote uncertainty and instability;
Emphasize that Trump is deliberately sabotaging people’s healthcare because of his own egomania, political spitefulness, and personal hostility to the previous administration;
Hold congressional Republicans accountable for supporting Trump’s efforts to destabilize the health insurance markets and sabotage the Affordable Care Act, and for their lack of independence in standing up to these efforts;
Never let voters forget that Trump and the Republicans in Congress see the alternative to the Affordable Care Act as a system that weakens protections for pre-existing conditions, imposes an age tax through higher premiums on people over the age of 50, leaves 16 million to 32 million more Americans uninsured, and eviscerates Medicaid at the expense of children, people with serious disabilities, and people in need of nursing home care;
Remind voters that instead of sabotaging people’s healthcare, the better way is a bipartisan effort to keep what works in the Affordable Care Act and make the necessary improvements so all Americans have access to affordable, quality healthcare.
Discussion of Key Findings
1. The efforts of President Trump and Republicans in Congress to repeal and replace the Affordable Care Act already have put them in a very deep hole with the public on the issue of healthcare.
By 61% to 39%, voters disapprove of the way Donald Trump is handling the issue of healthcare as president — including fully half (50%) who strongly disapprove; only 21% strongly approve. Independent voters disapprove of Trump’s handling of the issue by 40 points (70% to 30%), and one-in-five (20%) Trump voters disapproves as well. Voters volunteer a variety of reasons for disapproving of Trump’s handling of healthcare: Democrats emphasize that Trump just wants to destroy former President Obama’s legacy, while Republicans focus on Trump’s lack of accomplishments on the issue and his failure to come up with a good plan to replace the Affordable Care Act.
Republicans in Congress get poor marks on this issue as well: eight-in-10 (80%) voters disapprove of the way congressional Republicans are handling the issue of healthcare, while only 20% approve. This “disapprove” number includes 91% of Democrats, 81% of independents, and, notably, 68% of Republicans themselves. These marks reflect the public’s dislike for Republicans’ legislative proposals over the course of this year: 60% of voters are unfavorable toward the bills proposed by the Republicans to repeal and replace the ACA, while only 25% are favorable. Among those with a strong opinion, negative attitudes outnumber positive ones by more than seven-to-one (6% very favorable, 43% very unfavorable). Independent voters oppose the GOP bills by a wide margin of 64% to 17%, while more than a third (35%) of Republicans are opposed as well. This represents significant erosion in support since our poll back in May, when voters expressed unfavorable views toward the House version of the Republican healthcare repeal bill (the AHCA) by a much smaller margin, 54% to 40% (with Republicans supportive by 71% to 22%). What’s more, our March poll — conducted at the outset of the healthcare fight — found voters to be essentially split on the issue, with 48% unfavorable and 45% favorable toward the Republicans’ efforts at that point.
2. Large majorities of voters recognize that President Trump is “trying to make the Affordable Care Act fail” and “playing politics with people’s healthcare.” This behavior is in direct contrast with the priorities of most voters.
There is a major disconnect between what voters want President Trump to do now that Congress has failed to repeal and replace the current healthcare law and what they believe he actually is doing, as the following table shows: Hart Research Associates
On a related set of questions, nearly two-thirds (64%) of voters believe it is true that Donald Trump is “undermining the Affordable Care Act” and three-in-five (61%) voters believe that he is actively “trying to make the Affordable Care Act fail.” Additionally, 64% say that Trump is “playing politics with people’s healthcare,” including one-in-four (24%) of his own voters. Along similar lines, a 57% majority believe that the president is “sacrificing people’s healthcare in order to oppose Barack Obama.” And when provided with a list of phrases describing potential actions Trump could take around healthcare, this idea — that Trump would hurt people purely out of his own personal animus toward his predecessor — scores as the most worrisome for voters, with onethird (32%) choosing it as their number-one concern.
Clear majorities of voters see each of the following statements about Trump’s approach to healthcare as true:
Trump is undermining the Affordable Care Act (64% true)
Trump is playing politics with people’s healthcare (64% true)
Trump is trying to make the Affordable Care Act fail (61% true)
Trump is sacrificing people’s healthcare in order to oppose Barack Obama (57% true)
3. There is widespread disapproval of President Trump’s threats to cut off the funding that helps insurance companies reduce out-of-pocket costs for individuals, and these threats are one of the top sources of concern about Trump’s handling of healthcare.
When asked to react to a variety of actions President Trump has taken on healthcare, several elicit widespread disapproval from voters.
He has frequently threatened to cut off the funding that helps insurance companies reduce out-of-pocket costs for individuals, which non-partisan analysis says can raise premiums by 19% (66% disapprove)
He has frequently threatened to cut off the funding that helps insurance companies reduce out-of-pocket costs for individuals, creating uncertainty for insurance companies when calculating next year’s premiums (66% disapprove)
He has cut in half the amount of time when people are able to sign up for health insurance under the Affordable Care Act (65% disapprove)
His budget makes deep cuts in funding for Healthcare.gov — the website people use to sign up for insurance under the Affordable Care Act — knowing that these cuts would make the website less reliable and less easy to use (63% disapprove)
He has publicly said several times that he will let the Affordable Care Act fail — signaling to insurance companies that they cannot rely on the Trump administration and creating uncertainty about what rules they will be operating under (61% disapprove)
Of these different actions taken by President Trump, many voters highlight his threat to cut off the CSR payments as one of the two items causing them the most concern (selected by 47%). Voters also emphasize Trump’s statements about letting the ACA fail as a top concern (selected by 43%), because these statements signal to insurance companies that they cannot rely on his administration and create uncertainty about the rules they will be operating under.
After hearing about what Trump has said and done on healthcare, voters overwhelmingly are convinced that his actions are destructive and will have negative consequences. For example, 70% of voters say it is true that Trump is “actively trying to undermine the Affordable Care Act and taking actions that are destabilizing health insurance markets,” while 65% say it is true that he is trying to “sabotage” the law. And more than three-in-five (61%) respondents concur with the conclusion that “on healthcare, Donald Trump is putting his ego and dislike for Barack Obama ahead of doing what is necessary to ensure that people have access to affordable health insurance” — exactly the petty, politically motivated approach they tell us bothers them the most.
4. After hearing the pros and cons of the issue, voters say by two to one that payments of the cost sharing reductions should continue — notwithstanding the GOP charge that these payments are bailouts of the insurance industry.
In total, we tested eight different arguments in favor of continuing and guaranteeing costsharing reduction payments for the next several years, all of which garnered majorities saying they were convincing — including three that were rated as convincing by 60% or more of voters. On the other side of the coin, we tested three arguments in support of cutting off these payments. Only one of these arguments — that these funds are used to bail out insurance companies so they can make a profit, and taxpayers should not subsidize insurance companies — was rated as convincing by a majority of voters. Fiftyseven percent (57%) of voters felt this was a convincing argument; while 43% said it was just somewhat or not convincing, including a third (32%) of Republicans.
Of the pro-CSR arguments we tested, the statement that “if these funds are cut off, more health insurance companies will decide not to offer health insurance to individuals and many Americans could be left without affordable healthcare options” tested strongly, with 64% saying this is a convincing argument in favor of continuing these payments, including 41% who say it is “very” convincing. Essentially tied was the argument that if these funds are cut off, non-partisan analysts say that premiums for individuals would be 19% higher each year; 63% of voters, including 66% of independent voters, rated this as convincing.
After hearing both sides, voters told us by 68% to 32% that they believe these payments should be continued, not cut off. Nearly all (94%) Democrats want to see these payments continued, as do 69% of independents and 38% of Republicans. Sixty-four percent (64%) of white non-college educated women and 41% of non-college educated Trump voters want to see these payments continue, as they are essential to keeping down healthcare costs for everyday people and ensuring access to affordable care.
Furthermore, when informed, nearly half (48%) of voters say that the idea that Trump is “sabotaging people’s healthcare” is one of their top concerns about what he would be doing if he cuts off these payments, and only one-in-five (21%) say that the idea of “sabotage” is not really believable to them as a way of describing what Trump would be doing. (Before learning about the effects of cutting off CSR payments, voters were more likely to see Trump as just playing politics with healthcare — but the additional information makes the idea of “sabotage” both highly concerning and broadly credible.)
5. Continued efforts by Trump and congressional Republicans to undermine the Affordable Care Act will be deeply unpopular with voters, and it is clear that voters will blame Trump and the Republicans for future premium increases and disruptions in the health insurance markets.
In terms of the path forward, 78% of voters agree (seven-to-10 ratings on a zero-to-10 scale) with the statement that “President Trump and the Republicans in Congress should take the necessary steps to make sure the health insurance markets are stable, in order to prevent large increases in insurance premiums,” including three-fourths (75%) of Republicans. Another 68% of voters agree that “President Trump and the Republicans in Congress need to put politics aside and take the necessary steps to make sure individuals have access to affordable health insurance under the Affordable Care Act.” Even in spite of its mentioning the ACA, nearly half (45%) of both Republicans and Trump voters agree with this statement as well.
Encouragingly, the poll indicates that — even if there is not universal agreement that the ACA is working well currently — there is a strong sense of optimism that it can work well with the proper support. In fact, 13% of all voters describe themselves as unfavorable toward the ACA, BUT say they believe it the law has the potential to work well in the future. This important target group is three-fifths female (61%) and is made up largely of Trump voters (69%), 70% of whom do not have a college degree.
Going forward, if there are still problems occurring a year from now in terms of premium increases and insurance companies no longer offering plans under the Affordable Care Act, 83% of voters tell us that Republicans in Congress will bear the responsibility, including 48% who say they will have “a lot” of the responsibility. And 71% believe that President Trump will be responsible, compared with only 51% who say the same about President Obama — suggesting that, despite being known as “Obamacare,” the onus to make the law work is now on the current occupant of the White House and leaders in Congress.
6. Healthcare stands out as the number one issue for voters in the 2018 midterm elections, and large majorities say they will be less likely to reelect their senator or congressperson if he/she supports efforts by President Trump to destabilize the health insurance markets and sabotage the Affordable Care Act.
Nearly six-in-10 (57%) voters chose healthcare as one of their top two most important issues heading into the 2018 elections, far and away the top choice (25 percentage points higher than any other issue) out of a list that spanned topics from the economy and taxes, to education, to immigration, to terrorism and national defense. Healthcare was the number-one choice among self-identified Democrats (71%), independents (58%), and Republicans (42%) alike. The issue is pertinent among key voting blocks, such as white non-college educated women, 53% of whom point to healthcare as one of their top issues, and voters across the 10 states Trump carried in 2016 but in which Democratic senators are defending seats next year (57% of voters in these states picked healthcare, compared to only 32% who picked the economy, their number-two choice).
Finally, this poll suggests that there are indeed electoral consequences to Republicans’ actions (or lack thereof) when it comes to improving the current law and stabilizing healthcare markets: 75% of voters tell us they would be more likely to support their senator or congressperson if he or she “supported a bipartisan effort to bring more stability to the health insurance markets in order to keep premiums down and make sure people continue to have affordable healthcare options,” including 85% of Democrats, 72% of independents, and 65% of Republicans. When framed explicitly in terms of the ACA (“supported a bipartisan effort to keep what works in the Affordable Care Act and make the necessary improvements so it can work better”), 68% of voters are supportive, with even Republican voters more likely to support their representative (47% to 38%). On the other side of the coin, however, voters tell us by 38 points that they would be less likely to vote for someone who “supported efforts by President Trump to destabilize the health insurance markets and sabotage the Affordable Care Act” (22% more likely, 60% less likely).
Washington, DC — Protect Our Care announced today that longtime democratic strategist and former Democratic National Committee (DNC) Communications Director Brad Woodhouse has been appointed Campaign Director for the health care coalition that has worked to stop repeal of health care and protect people’s health care. Leslie Dach, who served as the coalition’s founding Campaign Director will become Campaign Chair, focusing on longer term planning and strategy.
“President Trump continues to deliberately sabotage people’s health care out of his own spitefulness, and we are going to make sure the public is constantly aware of every move this Administration makes until Congressional Republicans stand up and make them stop,” said Woodhouse. “Health care continues to be the number one issue for the American people and we will make sure they have the facts to hold their representatives accountable for playing politics with their health care. I’m honored to lead a coalition devoted to protecting the gains we’ve made in health care for the American people but am daunted at the huge shoes Leslie is leaving me to fill.”
“Protect Our Care will maintain eternal vigilance when it comes to stopping health care repeal, protecting Medicaid, and preventing sabotage,” said Dach. “Brad is the perfect person to make sure that day in and day out we are shining a bright light on any attempt Congress or the Administration are making to harm people’s health care.”
Woodhouse has held leadership roles in multiple prominent progressive and political organizations including as President of Americans United for Change (AUFC), which for over a decade was one of the nation’s leading progressive issue advocacy organizations that was originally created to stop then-President Bush’s plan to privatize Social Security and later was integral in building the infrastructure on the progressive side to pass the Affordable Care Act (ACA). Woodhouse, as AUFC President, was a founding steering committee member of Health Care for America Now (HCAN) which laid the ground work in 2007 and 2008 for a post-Bush Administration push to pass health reform and later played an integral role in passing the ACA during President Obama’s first term.
During the campaign to pass the ACA in 2009 and 2010, Woodhouse was a senior adviser and Communications Director at the DNC, where he worked directly with the White House, Organizing for Action (OFA) and Congressional Democrats to pass the law. After leaving the DNC in 2013 and returning to Americans United for Change, Woodhouse and AUFC took the reins of Protect Your Care, an organization which had been established after the ACA was passed to promote and defend the law as it was being implemented. Under Protect Your Care’s banner, Woodhouse ran a field and rapid response communications effort nationally and in nearly a dozen states to push back on the efforts by, among others, the Koch Brothers, to undermine implementation of the law and to discourage people from enrolling in it.
In addition to his role as chair of POC, Dach will be working with the Rockefeller Foundation as a senior advisor, and be engaged in a number of other health care and foundation projects.
For months, the Trump administration has threatened to sabotage people’s health care by canceling cost-sharing-reduction payments, forcing premiums to skyrocket as much as 20% according to the nonpartisan Congressional Budget Office and destabilizing the insurance markets.
As the Senate HELP Committee begins hearings this week on market stabilization, an overwhelming majority of the members of the Committee have already agreed that one of the best ways to stabilize the markets is to stand up against this part of Trump’s planned sabotage.
It’s not just the Senate Democrats, but a majority of the Committee has said they want to follow through on the promised payments to avoid forcing insurance costs to rise even further:
Sen. Lamar Alexander (R-TN), Committee Chair: “Without payment of these cost-sharing reductions, Americans will be hurt.” [Alexander Statement, 8/1/17]
Sen. Lisa Murkowski (R-AK): “As I’ve been saying, the Senate should take a step back and engage in a bipartisan process to address the failures of the ACA and stabilize the individual markets.” [Murkowski Statement, 7/18/17]
Sen. Bill Cassidy (R-LA): “‘Families would be hurt’ if payments not made.”[Tweet, 8/1/17]
Susan Collins (R-ME): “It is absolutely essential that the CSR payments continue.” [Tweet, 8/1/17]
Senator Orrin Hatch (R-UT): “I think we’re going to have to do that.” [Reuters, 7/31/17]
The majority of the Committee agrees: it’s time to move forward, get this done immediately, deliver certainty for markets and stop another rate increase for consumers.
House GOP Ways and Means Committee Chairman Kevin Brady has already endorsed the idea.
Yesterday, a senior Trump Administration official — a mom with two kids — went off the record to discuss the Trump Administration’s commitment to sabotaging the health care system. While claiming to favor stabilizing the insurance markets, the official offered no substance, instead promoting more blatantly false information in what appears to be an attempt to preempt their sabotage. Just how outlandish were the statements made? Take a look for yourself…
STATEMENT: “The administration, the official suggested, will do the minimum necessary to comply with the law, which Mr. Trump has called ‘an absolute disaster’ and threatened to let collapse. ‘I don’t think we can force people to sign up for the program,’ the official said.” [NYT, 8/30/17]
FACT: OBAMACARE IS MORE POPULAR THAN EVER, AND EVEN TRUMP SUPPORTERS WANT THE ADMINISTRATION TO MAKE THE LAW WORK
Kaiser Family Foundation Poll Results: “Only Weeks After Republicans In Congress Failed To Repeal The Landmark Health Reform Law, 52 Percent Of Respondents Hold A Favorable View Of The Affordable Care Act.” “Underscoring the adage that you don’t know what you’ve got until it’s (almost) gone, the popularity of Obamacare is surging. Only weeks after Republicans in Congress failed to repeal the landmark health reform law, 52 percent of respondents hold a favorable view of the Affordable Care Act (ACA), according to a recent Kaiser Family Foundation August poll. That’s up 10 percentage points since June of last year and nearly 20 points since November 2013, when public support for the ACA was at its nadir.” [CBS, 8/30/17]
Kaiser Family Foundation: “Large Majority Of The Public, Including Half Of Republicans And Trump Supporters, Say The Administration Should Try To Make The Affordable Care Act Work.” “After the Senate’s failure to pass legislation to repeal and replace the Affordable Care Act, the latest Kaiser Health Tracking Poll finds that eight in 10 Americans (78%) say President Trump and his administration should do what they can to make the current health care law work. This includes large majorities of Democrats (95%) and independents (80%), as well as about half of Republicans (52%) and President Trump’s supporters (51%).” [KFF, 8/11/17]
STATEMENT: “‘We want people to have access to quality health care,’ the official said. ‘I look at it from a patient perspective. I’m a mom. I’ve got two kids. I’ve got a family. I try to look at health care through that lens. What would I want? What would my family want? I think people want stability in the marketplace.’ ‘We want the health care market, the individual marketplace to function and to function well,’ the official added. ‘It is not functioning, the way it is today.’” [NYT, 8/30/17]
FACT: THE HEALTH CARE SYSTEM IS POISED TO THRIVE AS LONG AS THE SIGNIFICANT UNCERTAINTY INTRODUCED BY THE TRUMP ADMINISTRATION AND REPUBLICANS IN CONGRESS IS REMOVED.
In 2017, Every County Will Have An Insurer Participating In The Health Insurance Marketplace. [Kaiser Family Foundation, 8/18/17]
Standard & Poor: “Every Time Something New (And Potentially Disruptive) Is Thrown Into The Works, It Impedes The Individual Market’s Path To Stability.” The U.S. ACA individual market shows signs of improvement, as most insurers’ 2016 results were better than 2015 results. But the market is still developing and will need a couple more years to reach target profitability. 2016 results and the market enrollment so far in 2017 show that the ACA individual market is not in a ‘death spiral.’ However, every time something new (and potentially disruptive) is thrown into the works, it impedes the individual market’s path to stability.” [S&P, 4/7/17]
Kaiser Family Foundation: “Policy Uncertainty Has The Potential To Destabilize The Individual Market Generally.” “While the market on average is stabilizing, there remain some areas of the country that are more fragile. In addition, policy uncertainty has the potential to destabilize the individual market generally. Mixed signals from the Administration and Congress as to whether cost sharing subsidy payments will continue or whether the individual mandate will be enforced have led to some insurers to leave the market or request larger premium increases than they would otherwise.” [KFF, 8/10/17]
STATEMENT: “‘What we’re seeing with some of the programs is you’re spending a lot of money on it, but the idea of these programs is to sign people up,’ the official said. ‘And if you’re giving them a grant and they’re only signing up a few people, then we’re actually wasting money there when we’re spending thousands of dollars to sign up one person. That doesn’t make any sense.’” [NYT, 8/30/17]
FACT: NEARLY 8 IN 10 AMERICANS WANT THE TRUMP ADMINISTRATION TO MAKE THE ACA WORK AND THE ROLE OF NAVIGATORS IS INTEGRAL TO THAT
Kaiser Family Foundation: “Large Majority Of The Public, Including Half Of Republicans And Trump Supporters, Say The Administration Should Try To Make The Affordable Care Act Work.” “After the Senate’s failure to pass legislation to repeal and replace the Affordable Care Act, the latest Kaiser Health Tracking Poll finds that eight in 10 Americans (78%) say President Trump and his administration should do what they can to make the current health care law work. This includes large majorities of Democrats (95%) and independents (80%), as well as about half of Republicans (52%) and President Trump’s supporters (51%).” [KFF, 8/11/17]
Bipartisan Group Of Eight Governors: “The Federal Government Should Continue To Fund Outreach And Enrollment Efforts That Encourage Americans To Sign Up For Insurance.” “First and foremost, encouraging younger, healthier people to enroll in insurance and educating Americans about the importance of coverage can help improve the risk pool. The federal government should continue to fund outreach and enrollment efforts that encourage Americans to sign up for insurance. Many states invest in similar efforts, and all states need the federal government’s support to maximize participation from younger, healthier people.” [Letter, 8/31/17]
Brendan Riley, North Carolina Justice Center: “It Seems Pretty Clear The Administration Is Trying To Undermine Enrollment In Order To Destabilize The Individual Market And Score Political Points.” “This is a sort of death by a thousand cuts,” said Brendan Riley, a health policy analyst with the North Carolina Justice Center, an antipoverty group. “It seems pretty clear the administration is trying to undermine enrollment in order to destabilize the individual market and score political points.” [Wall Street Journal, 8/9/17]
Jessie Menkens, Alaska Primary Care Association: “Menkens And Others Say They Believe The Navigator Groups Are More Important Than In Years Past, Given The Lack Of Commitment From The Trump Administration To Promoting Healthcare.gov.” Menkens and others say they believe the navigator groups are more important than in years past, given the lack of commitment from the Trump administration to promoting Healthcare.gov. “There is a lot of noise coming from Washington, and it is our job to try to cut through that and provide factual and relatable information,” Menkens said. [Washington Post, 8/8/17]
STATEMENT: “When asked if the administration would continue paying the subsidies to insurance companies to aid low-income people, the official said that ‘you still had double-digit rate increases’ when the Obama administration provided the subsidies, known as cost-sharing reduction payments.” [NYT, 8/30/17]
FACT: PREMIUMS WENT UP $1 FROM 2016–2017 AFTER TAX CREDITS AND INSURANCE COMPANIES ARE JACKING UP RATES TO COMPENSATE FOR THE UNCERTAINTY THE TRUMP ADMINISTRATION HAS CREATED AROUND CSR PAYMENTS
CBO: 20–25 Percent Premium Increase, Nearly $200 Billion Cost to Taxpayers, Coverage Losses, Market Uncertainty If Trump’s Cancels Health Care Payments. “Premiums for a popular type of individual health care plan would rise sharply, and more people would be left with no insurance options if President Donald Trump makes good on his threat to stop “Obamacare” payments to insurers, the Congressional Budget Office says. The nonpartisan number crunchers also estimated that cutting off payments that now reduce copays and deductibles for people of modest incomes would add $194 billion to federal deficits over a decade. That head-scratching outcome is because a different Affordable Care Act subsidy would automatically increase as premiums jump, more than wiping out any savings.” [Associated Press, 8/16/17]
Larry Levitt, Kaiser Family Foundation: “Ending The Payments To Insurers Would Introduce More Chaos Into An Unsettled Market, And Perversely End Up Costing The Federal Government More In The End.” “‘Ending the payments to insurers would introduce more chaos into an unsettled market, and perversely end up costing the federal government more in the end,’ said Larry Levitt of the Kaiser Family Foundation, a nonpartisan group that found similar results.” [Associated Press, 8/16/17]
Brad Wilson, CEO, Blue Cross Blue Shield Of NorthCarolina: “The Failure Of The Administration And The House To Bring Certainty And Clarity By Funding CSRs Has Caused Our Company To File A 22.9 Percent Premium Increase, Rather Than One That Is Materially Lower.” “The failure of the administration and the House to bring certainty and clarity by funding CSRs has caused our company to file a 22.9 percent premium increase, rather than one that is materially lower. That will impact hundreds of thousands of North Carolinians.” [Washington Post, 5/26/17]
Kelly Paulk, Vice President, Product Strategy And Individual Markets, Blue Cross Blue Shield Of Tennessee: “We Have To Factor In Two Significant Uncertainties…Combining Those Two Factors Leads To An Average 21 Percent Rate Increase.” “Our 2017 rates are allowing us to earn a margin (profit) for the first time in four years and would have enabled us to propose only a small increase for 2018 to cover expected changes in medical and operating costs. However, we have to factor in two significant uncertainties — whether the federal government will fund cost-sharing reductions for low-income members and how the risk pool will change if the coverage mandate is not enforced … Combining those two factors leads to an average 21 percent rate increase.” [Blog Post, 6/30/17]
Dr. Mario Molina, Former CEO, Molina Healthcare: “Don’t Let [The Administration And Republicans In Congress] Fool You.” “The administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don’t let them fool you.” [U.S. News & World Report, 5/30/17]
CMS: Premiums For The Benchmark Plan Increased By Only $1 After Tax Credits Between 2016–2017. [CMS, 3/17/17]
STATEMENT: “An administration official refused to offer a target for 2018 signups Wednesday, saying too many factors could affect how to set that target, chief among them high prices for Obamacare next year. ‘It is hard to say that we can get to this target or that target because there are so many things going on in the market,’ said the official, speaking on background.” [Washington Examiner, 8/30/17]
FACT: HHS HAS RELEASED ENROLLMENT PROJECTIONS AND PREDICTIONS FOR EACH OPEN ENROLLMENT PERIOD SINCE THE FIRST
The Secretary of HHS Released Projections — On The Record And The Methodology Behind It — For The 2015, 2016, And 2017 Open Enrollment Periods Ahead Of Open Enrollment. [HHS, 11/10/14, 10/15/15, 10/19/16]
DISASTER AT HOME: Graham-Cassidy-Heller Would Devastate States, Destroy People’s Health Care
In a desperate attempt to satisfy President Trump, Sens. Graham, Cassidy and Heller have slapped together a health care repeal bill that would be devastating to their own constituents’ health care. Louisiana alone stands to lose a whopping $2.3 billion and Nevada $250 million under a bill that is as bad as full repeal by all accounts.
Just look at the headlines for how it’s playing across the country and in the Senators’ home states…
Nevada Independent: Nevada could lose $250 million under Graham-Cassidy-Heller proposal, new report says
New Orleans Gambit: Report: Cassidy-Graham health care plan could cost Louisiana $2.3 billion in health care funding
New Mexico Public Radio: Report: Cassidy-Graham Bill Would Deeply Cut Health Coverage Funding for New Mexico
Middletown Press: Report: Connecticut would be hit hard by ACA repeal
CT Mirror: New Obamacare replacement plan would hurt CT, report says
Fiscal Times: The GOP Has One Last Health Care Plan. It Would Also Cause Millions to Lose Coverage
Inside Health Policy: CBPP: Graham-Cassidy Block Grant Would Cut Funds To 42 States By 2026
The Kaiser Family Foundation now confirms that 3,006 of the 3,007 counties in the United States have Affordable Care Act marketplace plans for next year. The one county that doesn’t, Ohio’s Paulding County, serves 334 people.
Republicans keep saying that many people will not have access to health care plans and make discredited claims about a non-existent death spiral. The claims have been debunked by the nonpartisan Congressional Budget Office and now by the facts in the 2018 coverage map from Kaiser Family Foundation.
Unfortunately, that hasn’t stopped the lies. Just last night, GOP Speaker Paul Ryan again made these debunked claims.
New Reports, Polling Data and Continued Public Backlash Show Republican Sabotage the Wrong Approach
GOP AGENDA: SABOTAGE, UNCERTAINTY AND REPEAL CAUSE PREMIUMS TO RISE
President Trump and Republicans in Congress ran their campaigns promising to lower health care premiums and reduce costs. But it’s now clear that every part of their health care agenda will actually raise them significantly.
At the same time Republicans in Congress kept looking for legislative ways to repeal health care, the Trump administration injected uncertainty into the marketplaces by undermining implementation of the law by repeatedly threatening to default on payments that help lower out of pocket costs and deductibles, and proudly declaring its goal was to let the marketplaces fail. The Congressional Budget Office and Kaiser Family Foundation found that this sabotage and uncertainty will increase premiums by 20% and add almost $200 billion to the federal deficit. The Center for American Progress estimated that Trump’s threats alone will raise premiums as much as $2,500 next year. But that’s apparently not enough for this administration as they continue to pursue a repeal agenda in Congress and seem fully committed to sabotaging open enrollment — potentially denying millions of Americans access to affordable health coverage.
Read more about the GOP efforts to increase health care costs here.
AFTER VOTING TO INCREASE PREMIUMS AND CUT HEALTH COVERAGE, REPUBLICANS CONTINUE TO FACE ANGRY CONSTITUENTS AT HOME
Both the House and Senate are home for August recess, and many Republicans are facing a not-so-warm welcome. 49 Republican Senators and 217 Republican House Members voted to repeal health care — threatening health coverage for millions, gutting protections for people with pre-existing conditions and increasing premiums for American families. Their constituents are showing up at every town hall to demand an explanation or holding their own ‘empty chair’ town halls for those who refuse to talk to their constituents. Republicans who voted to take away people’s health care are facing major blowback back home and people across the country are going to continue to hold them accountable.
Sen. Maria Cantwell Hosts “Friendly” Town Hall In Audience With “Many Of The Same Faces” Who Angrily Questioned Rep. Cathy McMorris Rodgers Over Health Care Last Week.
STUDY: REPUBLICAN ACTIONS IN HEALTH CARE ARE “EXTRAORDINARILY UNPOPULAR”
A new study of 27 national polls published in the New England Journal of Medicine found that while Republican and Democratic voters’ opinions on specific policies varied widely on health care, 72 percent of the public strongly stated that the number of people covered by Medicaid should not decline. As Jacob Leibenluft of the Center on Budget and Policy Priorities pointed out, the “Combination of activism, loss aversion, increased attention to issue have really shifted whole health care debate in less than a year.”
Republican Repeal Bills Were “Extraordinarily Unpopular.” “Overall, only approximately one in four of the respondents (24%) approved of the congressional Republican plan (or plans, since they include both the plan that passed in the House and the proposals put forth in the Senate) to repeal and replace the ACA, whereas 56% disapproved. Fully one in five respondents did not have an opinion.”
72 Percent Of The Public — Across Party Lines — Opposed Medicaid Coverage Losses, Contrary To The Effect Of The Republican Health Care Repeal Bills. “A majority of the public preferred to keep the number of people covered by Medicaid the same as it is now (72%), whereas 22% wanted to reduce the number receiving Medicaid to what it was before the ACA, reducing government spending and taxes…On most specific policy issues in the debate, Republicans and Democrats disagreed, but there is one major exception. The two parties’ adherents agree that the number of people covered by Medicaid should not be reduced in any replacement bill.”
The Public Favored Providing Tax Credits To At Least The Same Number Of People Who Receive Them Today Rather Than Reducing Them, As The GOP Bills Would Have Done. “A majority of the general public did not favor changing the law so that it either provided financial assistance for the purchase of health insurance to fewer persons or reduced the number of people to be covered by Medicaid. When asked about the extent of coverage to be provided by a replacement plan, 57% of the public as a whole preferred to provide financial assistance to purchase insurance to the same number of people as the ACA does now, whereas approximately one third preferred to provide assistance to somewhat fewer people (22%) or a lot fewer people (12%) but save taxpayer money.”
Allowing Insurance Companies To Discriminate Against People With Pre-Existing Conditions And Sell Health Plans With Fewer Benefits Were Deeply Unpopular. “Approximately one third of the public (35%) believed that insurers should be allowed to offer health plans that cover fewer benefits than currently required…On the issue of ending federal health insurance regulatory protections for people who have preexisting medical conditions, less than one fourth of the public believed that insurers should be allowed to charge more for people with preexisting conditions (24%).”
“The Public Became More Supportive Of The Principle That The Federal Government Should Ensure Coverage For Them.” “Finally, the most important change over time was not the increase in public approval of the ACA, but rather the increase in overall support for universal coverage. When confronted with millions of people losing coverage, the public became more supportive of the principle that the federal government should ensure coverage for them.”
FROM: Leslie Dach, Protect Our Care Campaign Director
RE: GOP AGENDA — Sabotage, Uncertainty and Repeal Cause Premiums to Rise
DATE: August 17, 2017
President Trump and Republicans in Congress ran their campaigns promising to lower health care premiums and reduce costs. But it’s now clear that every part of their health care agenda will actually raise them significantly.
At the same time Republicans in Congress kept looking for legislative ways to repeal health care, the Trump administration injected uncertainty into the marketplaces by undermining implementation of the law by repeatedly threatening to default on payments that help lower out of pocket costs and deductibles, and proudly declaring its goal was to let the marketplaces fail. The Congressional Budget Office and Kaiser Family Foundation found that this sabotage and uncertainty will increase premiums by 20% and add almost $200 billion to the federal deficit. The Center for American Progress estimated that Trump’s threats alone will raise premiums as much as $2,500 next year. But that’s apparently not enough for this administration — they continue to pursue a repeal agenda in Congress and seem fully committed to sabotaging open enrollment — potentially denying millions of Americans access to affordable health coverage.
Here are the ways the GOP’s efforts increase health care costs:
SABOTAGE
The new analysis from the nonpartisan Congressional Budget Office makes clear that if the Trump administration cancels payments of cost-sharing-reductions, payments that help lower out of pocket costs and deductibles, it will raise premiums by 20 percent next year and by 25 percent in 2020 — while costing taxpayers nearly $200 billion more. The Kaiser Family Foundation found similarly that it would mean a 19% increase nationally.
President Trump: “Without The Payments, Obamacare Is Gone, Just Gone”: “The president told the Wall Street Journal on Wednesday that not only would such a move cause Obamacare to ‘die,’ it could also be used to force Democrats to negotiate on repealing the health-care law altogether. ‘Without the payments, Obamacare is gone, just gone,’ Trump said.” [ Washington Post, April 14, 2017]
The GOP Chairman of the Senate Health Committee, Lamar Alexander, said: “Without payment of these cost-sharing reductions, Americans will be hurt.”
2. UNCERTAINTY
According to both Kaiser Family Foundation and the Congressional Budget Office, premiums are ALREADY increasing because of the uncertainty in the health care markets caused by the Trump administration and Republicans in Congress just even threatening to cancel cost sharing reduction payments and not enforcing the law. Insurers are jacking up rates in anticipation that this sabotage continues. The Center for American Progress estimated that this uncertainty will raise premiums as much as $2,500 next year.
As the Associated Press reported, “Actions by the Trump administration are triggering double-digit premium increases on individual health insurance policies purchased by many people, according to a nonpartisan study.” This recent study from the Kaiser Family Foundation exposed the latest potential victims of the Trump Administration’s sabotage of our health care — middle class Americans whose premiums would skyrocket.
In addition, CBO echoed this point in its recent report:
“In an analysis using a preliminary version of updated projections of spending to subsidize health insurance purchased through the marketplaces that will be published soon, CBO and JCT find most of the results to be similar to those discussed here. The main exception is this: Premiums under the policy would rise by a smaller amount in 2018 — as the updated projections incorporate some increase in premiums next year as a result of current uncertainty about future CSR payments. “
3. REPEAL
It’s not just uncertainty and sabotage that raise costs, it’s also the Republican agenda of repealing health care. Every alternative Republicans in Congress proposed would lead to higher health care costs.
American families can’t afford higher health care costs so it’s worth pointing out that every part of the Republican agenda leads to higher costs and less coverage: paying more for less. Costs are going up simply because Republicans are playing politics and, in the case of Trump and his Administration, due to intentional efforts to sabotage the current law. As the Wall Street Journal editorial board wrote, “Republicans run the government and that means they are responsible for what happens in health care.”
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