Fact Sheet: Benefit Cuts in President Trump’s Budget Shift Costs to Families and State Budgets

 

President Trump’s budget claims to address deficit increases partially caused by passage of his $1.5 trillion tax giveaway plan from last year, but the truth is that his 2019 budget just shifts more costs to families and state budgets by making deep cuts to critical healthcare benefits and an array of services, including education, transportation, housing and nutrition.

Cuts to the Affordable Care Act, Medicaid, Medicare and other healthcare programs carry heavy costs to families, businesses and health care providers who depend on federal funding to hire staff, provide services and keep their doors open.

Thanks to the Affordable Care Act, the number of uninsured people fell to a historical low over the last few years, but last year’s efforts to repeal the law and to dismantle Medicaid are already reversing the new trend. President Trump’s proposed FY 2019 budget continues to target the ACA, Medicaid and Medicare for massive cuts, despite the popularity of the programs and the critical role that health care plays in economic security.

  • President Trump’s tax law has already repealed a key provision of the ACA (Affordable Care Act) that will leave over 13 million more people without insurance and increase premiums by $2000.00 annually in order to corporations like Apple, Wells Fargo and Pfizer a permanent 14% tax cut.
  • Although poll after poll shows that the public does not support ACA repeal, the President’s budget blueprint re-affirms his commitment to end the ACA entirely through a proposal that resembles the Graham Cassidy repeal bill that Congress rejected last year. Over 20 million people could lose coverage under this kind of repeal proposal[1].
  • Repeal would also unravel critical protections that affect everyone with private insurance, including rules that stop insurance companies from discriminating against women, people with pre-existing conditions and older people and that require all insurance policies to cover Essential Health Benefits (EHB) like maternal and newborn care, prescription drugs, physical therapy and hospitalization.
  • Despite promises to protect Medicare for seniors, the President’s budget proposes Trump’s plan includes $554 billionin cuts to Medicare, the federal health care program that provides insurance to 55 million Americans over the age of 65 as well as people with disabilities.
  • President Trump’s 2019 budget also cut nearly $1.4 trillion from Medicaid, which provides health care to over 70 million kids, seniors, people with disabilities and working families. Medicaid pays for almost half of all births[2] in the country and is the leading payer of nursing home and home care for seniors.[3]

President Trump’s budget cuts Medicaid through block grants and per-capita-caps would fundamentally end the program as we know it, preventing Medicaid from expanding in critical moments to address epidemics like Zika, the deadly opioid epidemic or the current spread of deadly flu that is killing over four thousand people a week. Cuts to Medicaid would also curtain states’ capacity to respond to natural disasters like last year’s hurricanes, terrorist attacks like 9/11, and economic downturns that can happen at any time.

Medicaid is the largest source of federal funding in nearly every state budget in the country. Trump’s proposal to dismantle Medicaid would drain more and more federal funding from state budgets, leaving states to make up the difference by either taking healthcare away from more people or cutting other benefits like roads or schools to fill the gap.

But Medicaid isn’t the only federal program on the chopping block in President Trump’s budget.

The budget blueprint also slashes $213 billion or about 30% of funding for the SNAP (Supplemental Nutrition Assistance Program) or food stamps, which provides families with the ability to put meals on the table. Over 40 million American families struggle with food insecurity in our country today,[4] including 7 million seniors and 13 million children.

The struggle is often tied to under employment, stagnant wages and the rising cost of food. Between 2012 and 2016, the cost of food increased by 6.1% according to the Consumer Price Index while wages rose by less than 3% over the same period. Only prices for medical care and housing have risen faster than food prices.

  • Nearly 70% of SNAP participants are families with children; nearly a third are households with seniors or people with disabilities.
  • After unemployment insurance, SNAP is most responsive federal program providing additional assistance during economic downturns like the recent recession: 92 percent of SNAP benefits go to households with incomes at or below the poverty line, and 56 percent go to households at or below half of the poverty line (about $10,390 for a family of three in 2018.
  • SNAP kept 8.4 million people out of poverty in 2015, including 3.8 million children.  SNAP lifted 2 million children above half of the poverty line in 2015, according to this same analysis — more than any other program.[5]
  • Hunger and food insecurity among older people is increasing and projected to continue growing. In 2016, SNAP served over 4.7 million families with at least one person aged 60 or older every month. Trump’s budget cuts both SNAP and the Meals on Wheels program that feeds over 2 million aged Americans.

Although President Trump often talks about the struggles of working families, his budget cuts the very programs that struggling families depend on to get by in the hardest times. In addition to cutting health care and nutrition assistance, Trump’s budget also cuts housing assistance for low-income people by over $7 billion next year even though rent across the country is historically high and unaffordable for most low wage working people, seniors and many people with disabilities.

  • The cost of rent in the United States has risen by 18% over five years, making housing harder to afford for many. A recent Harvard study noted that over 20 million Americans pay half their income for rent. In states like Texas, Illinois, California, New Jersey, Virginia, Florida, and Georgia, a minimum wage worker would have to work two full time jobs to afford a one bedroom apartment.
  • The proposals in Trump’s budget increases the amount that low income people under 62 years of age would pay for rent from 30% to 35% of total income. Rents would triple for the poorest families resulting in more evictions and more homeless families.
  • The budget also ends the Low Income Home Energy Assistance Program (LIHEAP), which helps households making under 150% of poverty ($30,000 annually for a family of three) pay for heat and utilities, a critical resource during periods of intense cold like this winter’s “polar vortex” and stifling heat.

The Trump budget also includes over $3.6 billion in cuts in public education including Title II—used in part to recruit and retain teachers and support principals—and the 21st Century Learning Centers block grants, which pay for enrichment programs after school that are particularly important for low income children and working parents who lack affordable child care.

  • As the nation recovers from yet another deadly school shooting that resulted in 17 deaths and nearly as many injuries, the Trump budget called for a 36% cuts in the Education Department’s funding for school safety programs including the complete elimination of the Project School Emergency Response to Violence (Project SERV) and Project Prevent Grant programs.
  • The budget also ends loan forgiveness for students who graduate and go into public services, Stafford loans that help young people go to college, and redirects over a billion tax-payer dollars away from the public education system and into private schools.

President Trump’s budget plan takes our country in the wrong direction.

Instead of cuts to health care, the President should keep his promise by protecting Medicaid and Medicare and lowering prescription drug prices.

Instead of cutting food stamps, housing, and education, he should raise the federal minimum wage, which remains at $7.25 an hour even though the cost of living continues to escalate and he should create more opportunities for more young people to attend college and increase their potential for increased earnings.

Finally, instead of the $550 billion more in tax breaks for the rich he includes in this budget—including ending the estate tax for wealthy people who inherit estates included in the proposed budget, the President should make the 1% and corporations pay their fair share of taxes—just like the rest of us–to support investment in our country.

[1] To see how many people in your state have coverage through ACA marketplaces and Medicaid expansion visit: https://www.kff.org/interactive/interactive-maps-estimates-of-enrollment-in-aca-marketplaces-and-medicaid-expansion/

[2] To see what percentage of births in your state are covered by Medicaid, look up your state here: https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[3] To see how many people are covered by Medicaid in your state, download your state fact sheet here: https://www.kff.org/interactive/medicaid-state-fact-sheets/

[4] http://www.feedingamerica.org/research/map-the-meal-gap/2015/2015-mapthemealgap-exec-summary.pdf

[5] More basic information about SNAP is here: https://www.cbpp.org/research/policy-basics-the-supplemental-nutrition-assistance-program-snap

Fact Sheet: Women Pay the Price for Cuts in President Trump’s 2019 Budget

 

On the heels of a massive $1.4 trillion in tax giveaways to the rich and corporations that passed at the end of December, 2017, President Trump this year has proposed a federal budget blueprint that would cut countless critical services that women depend on to support themselves and their families.

The President’s budget proposes over $1.6 trillion in cuts to Medicaid, Medicare, Social Security Disability, repeal of the Affordable Care Act, and billions in cuts to food stamps, housing, public education, and countless other areas of the social safety net that help women and families make ends meet. These cuts create new and unfair burdens for women and particularly for women of color, deepening racial and gender disparities and exacerbating income inequality.

Women, Particularly Women of Color Face Greater Poverty, More Barriers

More and more women are working full time, leading households and raising children alone these days, but wages, benefits and key supports like Paid Family and Medical Leave and affordable child-care have not caught up with women’s increased labor participation and role in the economy.

  • In 2015, about 42% of all households with children under the age of 18 were led by mothers who were the primary income earners, a major increase from 1960 when just 11% of households had mothers who filled the same role.1
  • Women of color have historically worked outside the home at much higher rates than white women. Black mothers currently and historically have had the highest ratesof being the primary or sole breadwinner for their families: 70 percent of black mothers were breadwinners in 2015.[i]
  • Women of color are more likely to be raising children alone compared to white counterparts.

In 2014, 40 percent of births were to unmarried mothers.1 And in 2013, 72 percent of all black women who gave birth and 53 percent of Latinas who gave birth were unmarried. Comparatively, 29 percent of white women who gave birth in 2013 were unmarried.1

Despite increased participation in the workforce, women still earn less than men and are more likely to be poor, particularly as they age, than men are. Women are also less likely to have benefits like health care and pensions on the job and women accumulate less wealth over their lifetimes than men.

  • More than one in eight women, nearly 16.3 million, lived in poverty in 2016. Poverty rates were particularly high for Black women (21.4 percent), Latinas (18.7 percent) and Native women (22.8 percent).
  • Black women working full time, year round typically make only 63 cents for every dollar paid to their white, non-Hispanic male counterparts, Latinas make 54 cents compared to white men, Native Hawaiian and Pacific Islander women it is 59 cents, and for Native women it is 57 cents.[ii]
  • Families headed by single mothers (35.6 percent) were 5.4 times more likely than married couple families to live in poverty. Poverty rates were higher for Black women who head families (38.8 percent) and Latinas who head families (40.8 percent).[iii] Nearly six in ten poor children (59.5 percent) lived in female-headed families in 2016.[iv]
  • Never-married women without children who work full time also make less money than non-Hispanic white men on average: they are typically paid 76 cents for every dollar.

Women & Women of Color Would Struggle More Under Trump’s Budget

Because women and women of color in particular are more likely to be poor and increasingly likely to be raising children as heads of household, they depend on social safety net programs like SNAP, housing assistance and public education to help make ends meet, particularly in tough economic downturns.

Trump’s budget makes dramatic cuts in these programs including $213 billion or about 30% of funding for the SNAP (Supplemental Nutrition Assistance Program) or food stamps, which provides women with the ability to put meals on the table for their families.

  • Nearly 70% of SNAP participants are families with children, 92% of SNAP benefits go to households with incomes at or below the poverty line, and 56 percent go to households at or below half of the poverty line (about $10,390 for a family of three) in 2018.
  • SNAP kept 8.4 million people out of poverty in 2015, including 3.8 million children.
  • Women make up two thirds of the elderly poor. SNAP is a critical program for addressing increasing hunger among older Americans. In 2016, SNAP served over 4.7 million families with at least one person aged 60 or older every month.

In addition to cutting health care and nutrition assistance, Trump’s budget also cuts housing assistance for low-income people by over $7 billion next year even though rent across the country is historically high and unaffordable for most low wage working people, seniors and many people with disabilities.

  • Poverty and lack of affordable housing are the main causes of homelessness.[v] Women are more likely to be poor in almost every state and have fewer resources to contribute toward increased rent.[vi]
  • The proposals in Trump’s budget increase the amount that low-income people under 62 years of age would pay for rent from 30% to 35% of total income. Rents would triple for the poorest families resulting in more evictions and more homeless families. Families with children are the fastest growing segment of the homeless population.[vii]

Health care cuts to the Affordable Care Act and Medicaid in the Trump budget would devastate women, particularly women of color who already face health disparities and barriers to coverage and care.

Medicaid: The President’s budget proposal would end Medicaid as we know it, cutting $1.4 trillion out of the program in order to address the swollen deficit created by the $1.4 trillion tax law that President Trump passed last year. Most of the tax cuts under the new tax law go to the wealthiest 1% and corporations, who will see a permanent 14% tax cut in their corporate tax bills. Women, who depend on Medicaid more than men for their own healthcare and for their families, would bear the brunt of these changes.[viii]

  • Nearly 40 million women of all ages depend on Medicaid for their healthcare, from family planning services to prenatal and maternal care to long-term care for aging people.8
  • Women are themajority of Medicaid enrollees; in fact, two-thirds of adults with Medicaid coverage are women.
  • Due to discriminatory systemic barriers,women of color disproportionately comprise the Medicaid population, with 30 percent of Black women and 24 percent of Hispanic women enrolled in Medicaid, compared to 14 percent of white women.
  • Medicaid covers more women’s health services than any other health insurance program. Medicaid is the largest source of coverage for reproductive health care in the country, covering nearly half of all births in the United States and 75 percent of family planning services.[ix]

ACA Repeal: Last year, President Trump repealed a key provision of the ACA in his tax bill, leaving 13 million more people without insurance and increasing premiums by $2000 a year for some families in order to pay for permanent tax breaks for corporations like Apple, Wells Fargo and Pfizer Pharmaceuticals in the tax plan. His budget proposal would repeal the rest of the Affordable Care Act through a measure similar to the Cassidy Graham bill that Congress already rejected last year and that would have taken coverage from 20 million people if enacted.

  • Thanks to the ACA, the number of working-age women (ages 19–64) without health insurance fell by almost half from 2010 to 2016, from 19 million to 11 million. Women with insurance are more likely to get preventive care like cancer screenings, routine treatment for disease and illness, including mental health treatment, and are less likely to incur medical debt or unpaid medical bills that threaten their economic security.
  • Low income women have made particularly large gains across race: uninsured rates for women making with incomes below 200 percent of the federal poverty level ($23,760 for an individual or $48,600 for a family of four), fell from 34 percent in 2010 to 18 percent in 2016.[x]
  • Between 2013 and 2015, 5.1 million women of color ages 18–64 gained health insurance coverage, a growth rate of about 18 percent. Coverage for women of color ages 18–64 grew at nearly twice the rate as women overall thanks to ACA and Medicaid expansion.[xi]
  • The ACA created critical protections that stopped insurers from refusing to cover certain services or charged women more for coverage and services. Before the ACA, for instance, millions of women didn’t have insurance coverage for maternity care or other basic care. Without insurance, a vaginal birth can cost$30,000 and a C-section can cost $50,000 in out-of-pocket expenses.
  • Repealing the ACA would allow insurance companies to opt out of providing Essential Health Benefits (EHB) like maternity coverage, prescription drug coverage, and mental health services, forcing women to pay more and creating an insurmountable barrier for poorer women and for women of color, particularly Black women who already have a much higher risk of complications and die at over three times the rate of white women in child-birth.[xii] Black women are 49% more likely than whites to deliver prematurely and black babies are twice as likely as white babies to die before their first birthday.[xiii]
  • The increased costs of care would disproportionately impact women, particularly women of color, given the inequitable incomes and resources for women. This is particularly true for the15 million households — disproportionately led by Black and Latina women — where women are the head of households.
  • Repealing the ACA also rolls back advances in addressing health disparities which result in worse health outcomes for people of color across all income, education level and coverage status. Both increases in coverage and affordability and specific reforms to dismantle structural racism in the healthcare system are critical to achieve equity.

President Trump’s proposed budget lays out a vision for the country that will hurt everyone, but no one will be more hurt than women, particularly women of color, who already face the greatest barriers and systemic discrimination in every sector. The Trump budget strips away every safety net resource and benefit that increases economic security and opportunity for women in order to pay for tax breaks for the rich and corporations and deepens the economic, racial and gender inequity that has already held our country back for too long.

[i] https://www.americanprogress.org/issues/women/reports/2016/12/19/295203/breadwinning-mothers-are-increasingly-the-u-s-norm/

[ii] https://nwlc.org/resources/the-wage-gap-the-who-how-why-and-what-to-do/

[iii] https://nwlc.org/resources/nwlc-resources-on-poverty-income-and-health-insurance-in-2016/

[iv] https://nwlc.org/resources/women-and-poverty-state-state/

[v] http://www.nationalhomeless.org/factsheets/families.html

[vi] www.kff.org/other/state-indicator/adult-poverty-rate-by-gender/?currentTimeframe=0&sortModel=%7B”colId”:”Location”,”sort”:”asc”%7D

[vii] http://www.nationalhomeless.org/factsheets/families.html

[viii] https://www.cbpp.org/research/health/medicaid-works-for-women-but-proposed-cuts-would-have-harsh-disproportionate-impact

[ix] To see how many births are financed by Medicaid in your state see: https://www.kff.org/medicaid/state-indicator/births-financed-by-medicaid/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[x] http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/aca-helped-women-gain-insurance-and-access

[xi] To see state by state numbers on increased coverage for women of color: https://nwlc-ciw49tixgw5lbab.stackpathdns.com/wp-content/uploads/2017/02/WOC-Health-Coverage-by-State-3.pdf

[xii] https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html

[xiii] https://www.marchofdimes.org/materials/premature-birth-report-card-united-states.pdf

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.