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Sabotage Tracker

 

January 2021

  • In an “11th-hour” act of sabotage, the Trump administration approves a proposal in Tennessee that would make the state’s Medicaid program a block grant. Block granting Medicaid funds has been repeatedly rejected by Congress and is seen by health care experts as blatant attempts to gut coverage and kick people off the rolls. 

December 2020

  • The Trump administration finalizes a rule that would allow “grandfathered” health plans to increase out-of-pocket costs for consumers without losing their legacy status. This status exempts health plans from the Affordable Care Act’s consumer protections, like covering essential health benefits.

November 2020

  • In an unprecedented act of sabotage, the Trump administration approves Georgia’s 1332 waiver, which seeks to end the state’s participation in HealthCare.gov with no state-based replacement and instead direct consumers to private brokers and insurers. The Center on Budget and Policy Priorities estimates tens of thousands of Georgians could lose coverage as a result of this waiver. 
  • The Trump administration proposes a rule that would cause most HHS regulations to automatically expire without onerous assessment and review of the regulations. According to the Center on Budget and Policy Priorities, if the SUNSET rule is finalized, “the proposal would divert key resources from responding to COVID-19; wreak havoc on the administration of Medicaid, Medicare, the marketplaces, and other HHS programs; and potentially seriously harm millions of people.”
  • The Trump administration’s proposed Notice of Benefit and Payment Parameters for 2022 encourages states to eliminate healthcare.gov and instead direct people to buy ACA coverage through insurers and private brokers. The proposal also slashes user fees, which traditionally provide funding for key marketplace functions and outreach. Experts warn that, while the Biden administration can reverse these harmful changes, it will take significant time and resources that could be spent on other pressing issues, like responding to the coronavirus pandemic. 

October 2020

  • During his NBC town hall, President Trump once again promises to repeal the Affordable Care Act in a second term: “we would like to terminate” the ACA and “we have a very good chance of doing it.”
  • During an interview with Lesley Stahl on “60 Minutes,” President Trump reaffirms that he wants the Supreme Court to strike down the Affordable Care Act, stating “I hope that they end it.”

September 2020

  • Following the death of Justice Ruth Bader Ginsburg, President Trump selects anti-ACA Judge Amy Coney Barrett as his nominee to the Supreme Court. Barrett has criticized both major rulings that upheld the ACA and vehemently opposed the health care law’s contraception coverage mandate. The court is set to hear California v. Texas, the case seeking to overturn the ACA, on November 10, which could rip coverage away from more than 20 million Americans and eliminate protections for 135 million people with pre-existing conditions in the middle of the pandemic. 
  • Trump confirms his goal of overturning the ACA with Barrett on the court, tweeting “Obamacare will be replaced with a MUCH better, and FAR cheaper, alternative if it is terminated in the Supreme Court. Would be a big WIN for the USA!” 
  • The day after nominating Barrett, Trump calls Obamacare “terrible” and doubles-down on his goal of overturning the law: “‘If we can end Obamacare and come up with a much better health-care system that’s much cheaper and much better, which is what we’ll do.” 
  • The U.S. reaches the grim milestone of 200,000 coronavirus deaths — a direct result of Trump’s failed response to the pandemic.

July 2020

  • The Department of Justice and the state of Arkansas petitions the Supreme Court to reinstate Medicaid work requirements that were previously ruled by the DC Circuit Court of Appeals to be “arbitrary and capricious” while failing to advance the purposes of Medicaid. These burdensome paperwork requirements are particularly dangerous during the coronavirus crisis, where millions of Americans have lost employer-sponsored health coverage. 
  • The Supreme Court rules that the Trump administration may allow a wider range of employers to opt out of the ACA’s requirement to provide contraceptive care because of religious or moral objections. An estimated 70,000 and 126,000 people could lose access to cost-free birth control as a result of Trump broadening the exemption.
  • An investigation by the House Committee on Energy & Commerce reveals enrollment in Trump’s short-term junk plans increased by 600,000 people in 2019. 

June 2020

  • Trump’s Department of Health and Human Services issues a final rule to weaken the enforcement of the Health Care Rights Law (section 1557 of the ACA), which bans discrimination against LGBTQ Americans and women in health care and insurance coverage. This announcement comes in the middle Pride Month and as the nation continues to battle the coronavirus pandemic. 
  • The Trump administration and Republican attorneys general filed briefs with the Supreme Court in support of California v. Texas, the lawsuit seeking to strike down the ACA. In the briefs, they advocated for ripping away health care from 23 million Americans, eliminating protections for 135 million with pre-existing conditions and raising costs across the board — all in the midst of the coronavirus crisis.

May 2020

  • Trump reiterates his support for overturning the Affordable Care Act during the pandemic, telling reporters, “we want to terminate health care under Obamacare.” Per the Washington Post: “Trump’s declaration caps months of debate within his administration about the best course of action, in which the stakes have only become greater now that the nation’s health-care system is struggling to deal with the spread of the coronavirus, which has killed more than 70,000 Americans.”
  • Trump administration confirms that individuals covered by short-term junk plans will not be eligible for emergency funding to help cover treatment costs if they contract coronavirus, which could leave patients with tens of thousands of dollars in medical bills.

March 2020

  • President Trump doubles down on his support for the Texas lawsuit which would rip coverage away from 20 million and eliminate Medicaid expansion in the midst of the coronavirus pandemic.

January 2020

  • Trump administration continues their quest to sabotage Medicaid by announcing new guidance encouraging states to apply for so-called “block grants” that will gut coverage and kick people off the rolls.
  • Trump threatens to cut federal funding for California unless it drops a state requirement that private health insurers cover abortion.
  • Trump makes clear he is open to slashing benefits for vital programs like Medicare, Medicaid and Social Security during an interview with CNBC at the World Economic Forum.
  • Trump administration proposes rule reversing Obama-era policy that requires faith-based health providers receiving federal funding to inform clients about services they don’t provide for religious reasons and to provide referrals to alternative providers if patients object to their practices.
  • CMS proposes ending automatic re-enrollment for certain low-income ACA exchange enrollees, meaning that those who pay $0 in premiums with the help of tax credits would have to actively update their application during open enrollment or risk losing this essential financial assistance.

December 2019

  • The Fifth Circuit Court of Appeals rules in favor of the Trump administration and Republicans in Texas vs. United States, striking down as unconstitutional the ACA’s individual mandate and remanding to the lower court judge a final decision on what parts of the ACA should be eliminated – the very judge who has already ruled the entire health care law unconstitutional.
  • Reports surface of website glitches during the final day of open enrollment. This is the second known widespread technical problem during the 2020 open enrollment period, with the first preventing an estimated 100,000 people from signing up. After facing public pressure from lawmakers and patient advocates, CMS extended the enrollment deadline, however CMS Administrator Seema Verma did not specify how the agency would ensure the extension was communicated to the public.
  • South Carolina becomes the first non-expansion state to receive federal approval to impose harmful Medicaid work requirements. This proposal targets low-income parents and threatens coverage for an estimated 14,000 residents.

November 2019

  • POLITICO reports that CMS funneled $2.25 million to GOP consultants aligned with Trump. These contractors charged up to $380 per hour to help with Seema Verma’s personal brand and to provide “strategic communications” support traditionally handled by government employees.

October 2019

  • Trump administration announces pilot program that will allow individual market insurers to tie premiums to reaching “health goals,” such as losing weight or lowering blood pressure. Under this program, premiums could vary by more than 30 percent for people who fail to meet these goals, and experts warn that older and sicker people who can’t comply could be priced out of coverage. One law professor described the initiative as a “back door to health-status underwriting.”
  • Trump administration announces new requirement for immigrants to have health insurance in order to obtain visas. Eligible coverage would not include Medicaid or subsidized ACA plans, but it would allow for coverage under short-term junk plans. Among other consequences of this policy, immigrants could be forced to obtain these skimpy plans that don’t actually cover pre-existing conditions.
  • Georgetown University’s Center for Children and Families reports that the number of uninsured children in the U.S. increased by more than 400,000 between 2016 and 2018, reaching a total of more than 4 million children lacking coverage nationwide. The authors said the rise of uninsured children was “due in large part to the Trump Administration’s actions that have made health coverage harder to access and have deterred families from enrolling their eligible children in Medicaid and CHIP.”

September 2019

  • Census data reveals the uninsured rate rose for the first time since the implementation of the Affordable Care Act. The rate increased from 7.9% in 2017 to 8.5% in 2018, or by approximately 2 million people. This includes more than one million children losing Medicaid coverage alone. Health care experts pointed to a “chilling effect” from Trump-backed policies, including Medicaid work requirements.

August 2019

  • Trump administration finalizes rule that penalizes legal immigrants for accessing Medicaid. Leading health care organizations said that fear of Trump’s proposal has already resulted in declining participation in health programs and warned that the rule could have catastrophic public health consequences and drive up health care costs for all patients and payers.
  • Trump administration begins enforcing a rule that bars certain federally-funded clinics from referring women for abortions. As a result, the nation’s largest recipient of Title X funds, Planned Parenthood, was forced to exit the program, losing $60 million in funding previously used to provide birth control and reproductive health care services for low-income women.

July 2019

  • New report suggests that a Trump administration immigration proposal could result in millions of children losing health insurance. In addition to blatantly limiting CHIP and Medicaid enrollment, making more immigrants ineligible for government health benefits would likely result in fear and confusion among current enrollees.

June 2019

  • Trump administration announces HRA rule to let employers encourage their employees to buy junk plans that do not cover people with pre-existing conditions. The Brookings Institution warns that this move means older, sicker workers could end up paying higher premiums.
  • After failing to block grant Medicaid legislatively, the White House dodges Congress in order to review plan to overhaul state Medicaid programs through block grants.

May 2019

  • Sunlight Foundation report reveals that “various HHS offices have seemingly gone out of their way to systematically remove references to the ACA,” removing an 85-page website containing information about the potential benefits of the Affordable Care Act.
  • CDC survey finds 1.1 million more Americans lost health insurance coverage in 2018.
  • Trump administration proposes rule change that allows doctors, hospitals, and health care companies to refuse to provide services to LGBTQ people and patients who have had abortions.

April 2019

  • Trump administration keeps fighting to impose work requirements on Medicaid, appealing federal court rulings that blocked such requirements because they are illegal.
  • Change in Administration’s final rule setting for ACA will raise premiums on 7.3 million by cutting tax credits and raise limit on out-of-pocket maximums.
  • Trump: “We got the individual mandate, the absolute worst part of Obamacare eliminated, now we’re going for the rest.”

March 2019

February 2019

  • Trump predicts the Affordable Care Act will be “terminated” through the Texas lawsuit seeking to overturn the law.
  • In an effort to restrict access to information about women’s reproductive health, the Trump administration removes web pages associated with the ACA and its contraceptive coverage from HHS’s Office of Population Affairs website.

January 2019

  • Thanks to GOP sabotage, the uninsured rate surges to the its highest level since 2014. Roughly seven million fewer people are estimated to have health care now than did two years ago.
  • The Centers for Medicare and Medicaid Services (CMS) proposes changes to the ACA’s benefit and payment parameters, reducing subsidies available to those who purchase health care through the exchange, increasing premiums, and raising  the out-of-pocket maximum for people with employer-sponsored health care.
  • In a win for big Pharma, the Trump administration proposes changes to the rebate system that would raise premiums, benefit pharmaceutical companies, and contain no mandate to lower list prices of drugs.
  • The Trump administration announces it will consider allowing states to convert Medicaid to block grant programs, allowing the federal government to cap the amount a state’s Medicaid program can receive.

December 2018

  • Cherry-picked Federal Judge Reed O’Connor rules in favor of twenty conservative states to overturn the Affordable Care Act, jeopardizing coverage for 17 million people and ripping away the ACA’s vital consumer protections such as protections for people with pre-existing conditions.
  • Under the Trump administration’s relentless sabotage, the uninsured rate increases for the first time since 2010. As the Kaiser Family Foundation finds, “In 2017, the uninsured rate reversed course and, for the first time since the passage of the ACA, rose significantly to 10.2% [from 10%].”

November 2018

  • Trump administration issues new guidance urging states to “tear down basic pillars of the Affordable Care Act, demolishing a basic rule” that federal subsidies can only be used to purchase ACA-compliant plans. Experts warn against this move, saying it will push affordable, comprehensive care further out of reach for individuals with pre-existing conditions.
  • Under the Trump administration, the number of uninsured children grows for the first time in nearly a decade. After a decade of steady decreases in the number of uninsured children, in 2017 the number of uninsured children increased from 3.6 million to 3.9 million.

October 2018

  • Republicans appoint Brett Kavanaugh to the Supreme Court. Kavanaugh is known to be hostile to the Affordable Care Act.
  • The Trump administration issues guidance that allows federal subsidies to be used to purchase junk plans that can deny coverage to people with pre-existing conditions.

September 2018

  • The Trump administration’s Department of Justice joins twenty conservative states in court in opening arguments to argue that the Affordable Care Act’s protections for people with pre-existing conditions should be overturned.
  • Nearly 4,600 Arkansans are unable to meet Arkansas’ reporting requirements for the state’s Medicaid work requirements and lose Medicaid coverage.

August 2018

  • Trump administration finalizes rule for bare-bones short-term plans that are exempt from key consumer protections, such as the requirement that insurance covers prescription drugs, maternity care, and hospitalization.

July 2018

  • CMS halts risk adjustment payments, that enable insurance companies to cover everyone, regardless of whether they are healthy or sick.
  • Trump Administration slashes funding for non-profit health navigator groups, that help people shop for coverage, from $36 million to $10 million. CMS encourages groups to use the remaining funds to push people to sign up for junk plans that skirt important consumer protections.
  • President Trump nominates Brett Kavanaugh to the Supreme Court. Kavanaugh has previously forced a young woman to continue a pregnancy against her will and has criticized Justice Roberts for upholding the Affordable Care Act’s constitutionality.

June 2018

  • Department of Justice takes to the courts to argue that insurance companies should be able to discriminate against as many as 130 million Americans with a pre-existing condition.
  • Republican coalition, the Health Policy Consensus Group, released their latest proposal to repeal the Affordable Care Act, which would gut protections for people with pre-existing conditions, let insurance companies charge older people an age tax, and deny coverage for basic services like maternity care.
  • Trump Administration finalizes proposal to expand access to association health plans that skirt key consumer protections.

May 2018

  • President Trump boasts about health care sabotage: “We will have gotten rid of a majority of Obamacare.”
  • Trump Administration enlists help of former drug lobbyist in writing its drug plan.
  • Congressional Republicans attempt to use annual farm bill to authorize $65 million in taxpayer funding to set up association health plans, which can  exclude prescription drug coverage, mental health care, and maternity care.

April 2018

  • House Republicans vote on a balanced budget amendment that would cut Medicaid by $700 billionover ten years, $114 billion in a single year alone.
  • Trump Administration limits access to assistance for consumers who want to enroll in marketplace coverage. This change removes the requirements that every area has at least two “navigator” groups to provide consumer assistance and that one be local. Now, just one groupcould cover entire states or groups of states.

March 2018

  • Republicans sabotage efforts to pass a bipartisan bill that would have stabilized Affordable Care Act marketplaces by insisting the bill restrict access to abortion.

February 2018

  • The Trump Administration announces that it will expand access to short-term health plans that do not have to comply with key consumer protection provisions required by the Affordable Care Act.
  • Urban Institute calculates that repeal of the individual mandate and expansion of short term plans will increase individual market premiums by an average 18.2 percent in 2019.
  • Trump Administration releases budget that calls for the Affordable Care Act to be replaced by Graham-Cassidy, in a move that experts predict would reduce health coverage for 32 million Americans.

January 2018

  • The Trump Administration announces that it will support states that impose onerous work requirements on Americans covered by Medicaid, and approves Kentucky’s worst-in-the-nationwaiver the next day.
  • The Trump Administration announces a move to allow providers to discriminate by allowing them to deny patient care for almost any reason.
  • The Trump Administration makes plans to announce even more exemptions from the requirement people have health coverage before this provision is repealed altogether.

December 2017

  • The Trump Administration proposes a rule to expand association health plans, which would gut consumer protections, raise costs for people with pre-existing conditions and further destabilize the insurance markets.
  • Congressional Republicans pass their tax scam, which doubles as a sneaky repeal of the Affordable Care Act  by kicking 13 million people off of their insurance and raising premiums by double digits for millions more.

November 2017

  • Republicans refuse to move forward on the bipartisan Alexander-Murray bill to address the CSR crisis even though it had a filibuster-proof majority in the Senate.

October 2017

  • The Trump Administration takes direct aim at birth control by rolling back a rule that guaranteed women access to contraception. (A court has since questioned the legality of the action.)
  • President Trump signs an Executive Order to roll back key consumer protections that will result in garbage insurance, raise premiums, reduce coverage and again expose millions of Americans to discrimination based on pre-existing conditions.
  • The Trump Administration dramatically cuts in-person assistance to help people sign up for 2018 health coverage.
  • After threatening for months to stop funding cost-sharing reduction payments (CSRs) that help lower deductibles and out-of-pocket costs, the Trump Administration stops the payments altogether. The CBO finds that failing to make these payments will increase premiums by 20% and add nearly $200 billion to the debt.

September 2017

  • The Administration orders the Department of Health and Human Services’ regional directors to stop participating in Open Enrollment events. Mississippi Health Advocacy Program Executive Director Roy Mitchell says, “I didn’t call it sabotage…But that’s what it is.”

August 2017

  • The Administration cuts the outreach advertising budget for Open Enrollment by 90 percent, from $100 million to just $10 million – which resulted in as many as 1.1 million fewer people getting covered.

July 2017

  • The Trump Administration uses funding intended to support health insurance enrollment to launch a multimedia propaganda campaign against the Affordable Care Act.
  • President Trump, again, threatens to end cost-sharing reduction payments.

June 2017

  • Senate Republicans embark on a monthslong failed attempt to pass BCRA, Skinny Repeal and Graham-Cassidy, all repeal bills that would have caused millions of Americans to lose their health coverage and raised premiums by double digits for millions more. They would have ended Medicaid as we know it, putting the care of children, seniors and people with disabilities at risk.

May 2017

  • House Republicans vote for and pass a health care repeal bill that would cause 23 million people to lose coverage and gut protections for people with pre-existing conditions. It would have imposed an age tax and allowed insurers to charge people over 50 five times more for coverage and ended Medicaid as we know it, putting the care of seniors, children and people with disabilities in jeopardy.

April 2017

  • The Trump Administration cuts the number of days people could sign up for coverage during open enrollment by half, from 90 days to 45 days.
  • In an effort to convince Democrats to negotiate a repeal of the Affordable Care Act, President Trump threatens to cut off cost-sharing reduction payments (CSRs) that help low-income marketplace customers pay for out-of-pocket costs.

March 2017

  • The Trump Administration sends a letter to governors encouraging them to submit proposals which include provisions such as work requirements that make it harder for Medicaid beneficiaries to get affordable care and increase the number of people who are uninsured.

February 2017

  • The Trump Administration proposes a rule to weaken Marketplace coverage and raise premiums for millions of middle-class families.

January 2017

  • On his first day in office, President Trump signs an Executive Order directing the administration to identify every way it can unravel the Affordable Care Act.
  • Also on January 20th, the Department of Health and Human Services begins to remove information on how to sign up for the Affordable Care Act.
  • The Trump Administration pulls funding for outreach and advertising for the final days of 2017 enrollment. This move is estimated to have reduced enrollment by nearly 500,000.
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