Fact Sheet: President Trump is Working to Dismantle the ACA Despite Growing Public Approval for the Law

 

In addition to avidly encouraging repeal of the Affordable Care Act (ACA) in Congress, President Trump has stepped up his own aggressive and systematic campaign to sabotage and dismantle the ACA. Despite growing popularity of the ACA, Trump has repeatedly said that the best thing to do is to let the ACA “explode,” and he has done everything in his power to undermine and dismantle the law piece by piece. In fact, he referred to his October 12 executive order that pushes junk insurance policies and will cripple the market as “starting the process” of ACA repeal.

Trump began his sabotage effort immediately upon taking office. Shortly after his inauguration, he issued an executive order directing federal agencies to use their administrative powers to begin dismantling the ACA “to the maximum extent permitted by law.” Then the Department of Health and Human Services (HHS), the agency charged with promoting and enforcing the law, announced that it would stop planned ads for the final week of open enrollment for marketplace health coverage, which experts say reduced final enrollment by more than 400,000 people.

The president is using executive power to dismantle the ACA by forcing premium increases, creating instability in the market, allowing the sale of insurance that doesn’t meet minimum standards, actively interfering with the ability of consumers to sign up for coverage, and rolling back the guarantee of no-cost birth control for 55 million women.

Trump has attacked the health care law in five ways:

  1. Refusing to implement the individual responsibility provision of the ACA. From Day One the administration has said it does not intend to enforce the individual mandate, which is the cornerstone of the ACA because it ensures that everyone participates in the insurance market, which keeps rates lower and encourages competition. Experts and insurers say that failure to enforce the mandate is a major cause of market uncertainty, which, in turn, raises costs for everyone and encourages insurers to leave markets.

  2. Threatening to withhold Cost-Sharing Reduction (CSRs) payments to the insurance companies – and then announcing on October 12, 2017 that he will end these payments. Cost sharing reduction payments are reimbursements to insurance companies that lower costs for about 6 million people who buy insurance on ACA exchanges, making health care more affordable for more people. Insurers and experts agree that this has been a very significant act of sabotage. According to the Congressional Budget Office, CSR uncertainty “may lead insurers to withdraw from the market” (several have in several states) and will increase rates by 20% in 2018 and 25% in 2020, putting health coverage out of reach for million of people. Now that Trump has ended the payments, the departure of insurers from key markets is likely. New York’s attorney general has already announced a likely lawsuit by a coalition of states challenging the decision. Along with lax enforcement of the individual mandate, uncertainty about the CSR payments has already caused significant disruption in otherwise healthy markets. Here’s more background:

    • More than half of all marketplace consumers benefit from CSRs, which go to people with incomes below 250 percent of the poverty line (about $60,000 for a family of four) and reduce their out-of-pocket costs by an average of about $1,100 per person.  To see what percent of enrollees depend on CSRs in your state, see the map here: https://www.cbpp.org/blog/interactive-map-cost-sharing-subsidies-at-risk-under-house-gop-health-bill
    • Under the ACA, insurers must provide health plans with lower deductibles and other out-of-pocket costs to people who qualify for CSRs, and the federal government then reimburses the insurers for the cost of doing so, which is about $7 billion a year. Insurers have to provide these savings regardless of whether they are reimbursed by the federal government, as the law intends.
    • Following the failure of the Senate to pass ACA repeal in July, the Senate’s Committee on Health, Education, Labor and Pensions began a bipartisan effort to address this problem – specifically, they were considering requiring CSR payments for two years. But the committee’s work was scuttled by GOP leadership to make room for the last-ditch effort to push the failed Graham-Cassidy repeal bill in September. This came at a crippling time – September 27 was the final deadlinefor insurers to sign contracts to participate in the federal ACA markets next year. Bipartisan talks in the Senate have started again.
  3. Cutting enrollment and outreach. The administration has sabotaged efforts to inform consumers about the ACA and enroll them in coverage in six ways that are intended to lower enrollment in ACA plans in 2018.

    • First, the administration cut the open enrollment period in half, reducing it to six weeks (November 1-December 15) from twelve last year (November 1, 2016 – January 31, 2017).
    • Second, it slashed advertising for open enrollment by 90% from $100 to $10 million. This advertising is the only way many consumers will learn about enrollment.
    • Third, it slashed funding for local ACA “navigators”, workers who are essential to helping people sign up for coverage, by 41%. Navigators play a critical role in what can be a complicated process.
    • Fourth, the administration announced that it will shut down the enrollment website for 12 hours nearly every Sunday during the open enrollment period. Many people who work during the week wait until the weekend, when they have more time, to sign up for their health care. HHS says this is for “maintenance outages.”
    • Fifth, HHS issued a directive forbidding its ten regional directors from helping with state-based enrollment activities, a standard part of their job in years past since the agency is supposed to promote and enforce the law. This is a key part of the Trump sabotage campaign – ceaselessly attack and refuse to enforce the ACA, creating problems that can then be blamed on the law and Obama’s administration.
    • Lastly, according to the New York Times, HHS has even removed important links from its website, including information about how people could get care through their ACA plans. HHS has also been using official videos and its press office to smear the ACA, promote repeal, and cause consumer confusion.
  4. Ending critical preventive benefits for women. The Trump administration issued a sweeping new rulethat guts the federal requirement that employers include birth control coverage in their health insurance plans. The decision will impact more than 55 million women who have access to birth control without co-payments because of the contraceptive coverage provision under the ACA. In 2013 alone, the mandate saved women $1.4 billion on birth control. Specifically, the order allows any employer, not just religious ones, to raise religious or “moral” objections to birth control and refuse to pay for it for employees. This is a significant departure from the original rule which allowed exemptions for religious employers only (such as churches or catholic hospitals).

  5. Loosening rules for insurance companies, rolling back consumer protections, and allowing the sale of bare-bones policies outside the ACA marketplaces. The administration issued an executive order on October 12, 2017 that allows the sale of junk health insurance and is designed to lure healthy consumers from the individual market in an effort to trigger its collapse. The executive order includes three changes.

    • First, it would expand the use of “short-term” policies from 90 days or less to up to one year. These plans are completely exempt from the ACA’s rules and standards. That means that insurance companies can go back to refusing coverage for people with pre-existing conditions, charging them more for their coverage, and selling bogus plans that don’t include essential health benefits like maternity care, mental health and prescription drugs that are required for plans sold in the ACA marketplaces. These plans could even have life-time and annual benefit caps. Unsuspecting consumers may buy these plans thinking they have good coverage, only to find out they have insurance that’s not worth the paper it’s printed on.
    • Second, it expands the role of so-called “association health plans” in a way that allows plans formed by associations to bypass existing rules for insurance companies (like consumer protections and essential health benefits) that cover other health insurance plans under the ACA. Currently such plans are treated as small business plans and are covered by the ACA. This will allow association plans to systematically cherry pick young, healthy consumers and pull them out of the existing individual health insurance market, which will transform the market into an insurance pool dominated by older and sicker people. That means that rates will skyrocket, insurers will flee, and ultimately the entire private health insurance market could collapse. This would likely make coverage fundamentally unaffordable for middle-class consumers not eligible for the ACA’s tax credits.
    • Third, it expands the use of Health Reimbursement Arrangements, which are employer-funded accounts that reimburse employees for health care expenses, such as deductibles and co-payments. While this sounds good, this change would allow employers to use HSAs to pay premiums – currently not allowed by law – which would create an incentive for employers to stop providing insurance for their employees. Instead they could offer pre-tax dollars – but probably not enough for coverage. This would push sicker patients into the individual market while pulling out healthier consumers, some of whom may purchase the newly available short-term plans. This provision is another way to trigger the collapse of the market.

President Trump and Republicans in Congress have tried all year to repeal the ACA, to dilute the rules it creates for insurance companies, to strip away mechanisms that make coverage affordable in the marketplaces and to roll back the expansion of Medicaid in the 32 states and District of Columbia where it has been implemented and brought the number of people without health coverage to a historic low in our country.

Despite the fact that Congress has failed to repeal the law, largely because of public outcry, President Trump is continuing the repeal efforts through new channels. His sabotage of the law will result in some of the same outcomes we would’ve have seen as consequences of repeal: higher costs, less coverage, and fewer rules that protect consumers from insurance company abuses.

For a timeline of Trump and GOP sabotage, the Center on Budget and Policy Priorities has a dedicated web page, “Sabotage Watch: Tracking Efforts to Undermine the ACA.”

 

Fact Sheet: Trump Sabotage – How Trump is Working to Undermine the ACA

 

In addition to avidly encouraging repeal of the Affordable Care Act (ACA) in Congress, President Trump has run an aggressive campaign to sabotage and undermine the ACA everyday he’s been in office. Failing to repeal the law at least five times, Trump has repeatedly said that the best thing to do is to let the ACA “explode,” and he has done everything in his power to make that happen.

Trump began his sabotage effort immediately upon taking office. Shortly after his inauguration, he issued an executive order directing federal agencies to use their administrative powers to begin dismantling the ACA “to the maximum extent permitted by law.” Then the Department of Health and Human Services (HHS), the agency charged with promoting and enforcing the law, announced that it would stop planned ads for the final week of open enrollment for marketplace health coverage, which experts say reduced final enrollment by more than 400,000 people.

Trump’s campaign to undermine the ACA has involved three major areas of sabotage.

  1. Sabotaging the individual mandate. From Day One the administration has said it does not intend to enforce the individual mandate, which is the cornerstone of the ACA because it ensures that everyone participates in the insurance market, which keeps rates down and encourages competition. Experts and insurers say that failure to enforce the mandate is a major cause of market uncertainty, which, in turn, will cause rates to go up and insurers to leave markets.
     
  2. Sabotaging the insurance markets by threatening to withhold the Cost-Sharing Reduction (CSRs) payments to the insurance companies. Insurers and experts agree that this has been the most significant act of sabotage. According to the Congressional Budget Office, CSR uncertainty “may lead insurers to withdraw from the market” (several have in several states) and will increase rates by 20% in 2018 and 25% in 2020. Along with lax enforcement of the individual mandate, uncertainty about the CSR payments has caused significant disruption in otherwise healthy markets. Here’s the background:
     
    • About 6 million people — more than half of all marketplace consumers — benefit from CSRs, which go to people with incomes below 250 percent of the poverty line (about $60,000 for a family of four) and reduce their out-of-pocket costs by an average of about $1,100 per person.
    • Under the ACA, insurers must provide health plans with lower deductibles and other out-of-pocket costs to people who qualify for CSRs, and the federal government then reimburses the insurers for the cost of doing so, which is about $7 billion a year. Insurers have to provide these savings regardless of whether they are reimbursed by the federal government, as the law intends.
    • In 2016, House Republicans filed a lawsuit saying that the Obama administration could not make CSR payments because a glitch in the ACA did not technically appropriate the funding, although the law clearly spells out the program and payments. While the judge ruled in favor of the plaintiffs, the court said the administration could continue making the payments while the case is appealed, which the Obama administration did. Instead of continuing to appeal the decision and making clear that they would continue to make the payments to insurers, the Trump administration has repeatedly threatened to withhold the payments. It’s been playing a game of chicken, making the payments on a month-to-month basis at the last minute, while threatening each month to not make them at all. This has fueled premium increases for 2018, since insurers have to set rates based on the assumption that the CSR payments will not continue to be made.
    • Following the failure of the Senate to pass ACA repeal in July, the Senate’s Committee on Health, Education, Labor and Pensions began a bipartisan effort to fix this problem – specifically, they were considering requiring CSR payments for two years. But the committee’s work was scuttled by GOP leadership to make room for the last-ditch effort to push the failed Graham-Cassidy repeal bill in September. This came at a crippling time – September 27 was the final deadlinefor insurers to sign contracts to participate in the federal ACA markets next year.
  3. Sabotaging enrollment and outreach. The administration has sabotaged efforts to inform consumers about the ACA and enroll them in coverage in five ways. Combined, these actions could have a significant impact on the number of people who enroll in 2018.
    • First, the administration cut the open enrollment period in half, reducing it to six weeks (November 1-December 15) from twelve last year (November 1, 2016 – January 31, 2017).
    • Second, it slashed advertising for open enrollment by 90% from $100 to $10 million. This advertising is the only way many consumers will learn about enrollment.
    • Third, it slashed funding for local ACA “navigators” by 41%, workers who are essential to helping consumers select their insurance coverage. Navigators play a critical role in what can be a complicated process.
    • Fourth, the administration announced that it will shut down the enrollment website for 12 hours nearly every Sunday during the open enrollment period. HHS says this is for “maintenance outages.” However, there is no justification for this level of maintenance.
    • Lastly, HHS issued a directive that its ten regional directors were not to participate in or help with state-based enrollment activities, as has been the case in years past, further distancing the agency from the law it’s supposed to promote and enforce. An HHS statement on this says it all: “Obamacare has never lived up to enrollment expectations despite the previous administration’s best efforts. The American people know a bad deal when they see one and many won’t be convinced to sign up for ‘Washington-knows-best’ health coverage that they can’t afford.” This sums up the principle behind the Trump sabotage campaign – ceaselessly attack and refuse to enforce the law and then blame the law if and when it has problems they have helped to create.

Throughout the life of the ACA, the GOP has fought its implementation and sought to undermine it in multiple ways, including opposing state efforts to expand Medicaid. Currently, 32 states and the District of Columbia have expanded Medicaid, while 19 states have not. Five million Americans would gain coverage in 2017 if these 19 states expanded Medicaid under the ACA, which provides 90% federal reimbursement to states for the costs of expansion.

Fact Sheet: Trump’s First 100 Days – A Record of Broken Promises on Health Care

 

Tomorrow marks Donald Trump’s first 100 days as President. When it comes to health care, Trump’s first 100 days have been about breaking every single promise he made on his way to the White House.

For starters, Trump said, “We’re going to have insurance for everybody.” But that’s not true. Under the House Republican bill that Trump supports, 52 million Americans will be without insurance in 2026.

Trump also said that, “there will be no cuts to Social Security, Medicare & Medicaid,” but the GOP plan will cut $880 billion from Medicaid alone.

Trump’s counselor Kellyanne Conway said: “We don’t want anyone who currently has insurance to not have insurance.” But the Republican repeal bill would take health care away from 24 million people.

Tom Price, Trump’s Secretary of Health and Human Services, said that “nobody will be worse off financially” after the Republicans in Congress repeal Obamacare. But rates will go up 15-20% in the first two years, and costs will skyrocket for older Americans. For example, a 64-year-old man making $26,500 a year would see his health costs increase nearly $13,000, thanks to a dramatic reduction in the tax credits people will receive to buy coverage in the Obamacare marketplace.

Here’s the good news – Trump and the Republicans in Congress also promised to repeal the ACA back in January. Trump even vowed to repeal the ACA on “day one” of his presidency. But they still haven’t been able to repeal the law because of the public uprising against the Republican plan.

Over the April recess period, for example, Republicans went home to their districts and were overwhelmed by support for Obamacare. Thousands turned out at town halls, the ACA is at its most popular ever, and the Republican bill has the support of only 17 percent of Americans.

They came back this week with the MacArthur amendment, which makes minor changes to the existing proposal and basically makes a bad bill worse. The latest deal would:

  • Allows insurance companies to charge people with pre-existing conditions more for their health coverage. The Trump/GOP proposal guts the protection against health insurers hiking premiums for people with pre-existing conditions.
  • Lets insurers sell barebones insurance that doesn’t cover essential health services and caps coverage. This would allow insurance companies to refuse to cover hospitals, doctors, prescriptions, lab tests, mental health, maternity and newborn care, preventive care, and substance abuse. There’s a reason these are called “essential health benefits” in the existing law. Eliminating essential health benefits also eliminates the prohibition on health insurance companies putting annual or lifetime limits on how much they pay for your care.
  • Cuts coverage while turning over $600 billion in tax breaks to the wealthiest households making over $250,000 a year, and the insurance industry and prescription drug companies.

The Republicans want to go backwards – way backwards – back to the days when we were all at the mercy of the big insurance companies, the days when you could lose your coverage because you got sick, be denied coverage altogether because you had a health care condition, or be forced to pay higher premiums for coverage because you actually needed health care.

The extreme Members of the Freedom Caucus who want total repeal of the ACA and radical changes in Medicaid endorsed the MacArthur Amendment, even though the Republican repeal plan still wrecks Americans’ health care and hurts their own constituents.

That means that in the first 100 days, Trump and the Republicans have done nothing to improve the ACA, make health care more affordable, or protect Medicaid and Medicare. In fact, the only health care they have protected is their own since the MacArthur proposal would exempt Members of Congress from any adverse impacts that their repeal bill would inflict on the rest of us.

 

 

 

 

 

 

 

 

 

 

Fact Sheet: The Republican Health Care Repeal Plan is a Bad Bill Getting Worse

 

The Republican proposal to repeal the ACA and make permanent cuts to Medicaid is so bad it’s already failed to get enough support to even get a vote in the House. In addition to taking coverage from 24 million people by 2026, raising costs for almost everyone, and shifting burdens to state budgets, the proposal:

  • Allows insurance companies to charge people with pre-existing conditions more for their health coverage. The Trump/GOP proposal guts the protection against health insurers hiking premiums for people with pre-existing conditions.
  • Lets insurers sell barebones insurance that doesn’t cover essential health services and caps coverage. This would allow insurance companies to refuse to cover hospitals, doctors, prescriptions, lab tests, mental health, maternity and newborn care, preventive care, and substance abuse. There’s a reason these are called “essential health benefits” in the existing law. Eliminating essential health benefits also eliminates the prohibition on health insurance companies putting annual or lifetime limits on how much they pay for your care.
  • Cuts coverage while turning over $600 billion in tax breaks to the wealthiest households making over $250,000 a year, and the insurance industry and prescription drug companies.

The updated deal called the MacArthur amendment makes minor changes to the existing proposal that basically makes a bad bill worse.

  • The Republicans want to go backwards – way backwards – back to the days when we were all at the mercy of the big insurance companies, the days when you could lose your coverage because you got sick, be denied coverage altogether because you had a health care condition, or be forced to pay higher premiums for coverage because you actually needed health care.
  • The ACA ended the biggest insurance industry abuses, including discrimination based on age, gender and health status. These are the protections that the Trump administration and Republicans in Congress would make optional in this bill.
  • The MacArthur amendment does nothing to lower the cost of premiums, out-of-pocket costs, and prescription drugs for consumers, or to guarantee people with pre-existing conditions affordable coverage, or to stop the $600 billion in tax breaks for the rich and insurance companies in the repeal bill.

The Bill STILL Wrecks Health Care for American Families

Just like the bill that didn’t have enough support to pass in March, the latest GOP proposal would take health care away from 24 million people, slash Medicaid, and raise health care costs for all families in order to give $600 billion in tax cuts to the very wealthy and the big insurance and drug companies. It will blow a hole in state budgets so the wealthiest 400 Americans can get a tax break of $7 million a year. It will allow companies to charge older people five times as much as younger consumers and increase costs for people in their 50s and 60s by thousands of dollars a year.

Fact Sheet: Trump/GOP Pushing Again to Take Away Our Care

Newest Horror – No More Protections for People with Pre-Existing Conditions!

Trump, Pence and Ryan are doing everything they can to bring their plan to destroy our health care. In order to win the votes of the extreme right they are now planning to allow insurance companies to charge whatever they want to people with pre-existing conditions and to sell junk health insurance.

As the New York Times health insurance analyst wrote: “…the proposed changes would effectively cast the Affordable Care Act’s pre-existing conditions provision aside.”

HERE’S WHAT WE KNOW ABOUT THE LATEST REPUBLICAN PLAN:

Allows insurance corporations to charge people with pre-existing conditions whatever the want. The Trump/GOP proposal guts the protection against health insurers hiking premiums for people with pre-existing conditions.

Barebones insurance that doesn’t require any coverage. Allows insurers to not cover hospitals, doctors, prescriptions, lab tests, mental health, maternity and newborn care, preventive care, and substance abuse. There’s a reason these are called essential health benefits.

Allows insurance companies to cap how much they pay for your care. Eliminating essential health benefits also eliminates the prohibition on health insurance companies putting annual or lifetime limits on how much they pay for your care.

Higher Premiums for People Who Actually Need Health Care: Health insurance companies will sell barebones plans which leave off basic coverage at a low price and hike the prices of coverage that covers care people actually need, with the biggest hikes for people who have had any medical care.

AND IT STILL TAKES HEALTH COVERAGE AWAY FROM 24 MILLION PEOPLE, HIKES INSURANCE PREMIUMS, HITS PEOPLE IN THEIR 50s and 60s the HARDEST AND SLASHES MEDICAID BY $880 BILLION.

TELL YOUR MEMBER OF CONGRESS TO PROTECT OUR CARE.