Talking Points on the Republican Bill to Gut the ACA and Slash Medicaid

One sentence

The Republican bill to gut the Affordable Care Act and slash Medicaid takes health coverage away from millions of Americans – from seniors to children – will force people to pay much, much more for, high-deductible insurance and blows a huge hole in state budgets, while giving massive tax cuts to the very wealthy and drug and insurance corporations. And it defunds Planned Parenthood.

Key Points

  • The Republican bill guts the Affordable Care Act and slashes Medicaid.
  • The Republican bill takes coverage away from millions of Americans by drastically cutting tax credits to buy coverage and by making enormous cuts in state funding for Medicaid.
  • The Republican bill will hike the cost of health insurance for millions of Americans, with the biggest increases for seniors and moderate-income working people.
  • The Republican bill hike premiums by 30% for people with pre-existing conditions if for any reason – such as losing a job – they don’t have coverage for 63 days.
  • The Republican bill pushes people into high-deductible insurance plans and ends the ACA program that limits out-of-pocket costs to many working families.
  • The Republican bill ends Medicaid expansion and slashes state funding for the regular Medicaid program by radically changing the way Medicaid is funded. States will be forced to end coverage and eliminate health care services for seniors, people with disabilities, children and working families.
  • The Republican bill gives huge tax cuts to the wealthiest Americans and to drug, insurance and medical-device companies – it even has a special tax break for health insurance CEOs.
  • The Republican plan defunds Planned Parenthood.

Key Provisions

  • Ends the ACA’s tax credits, which were based on income, starting in 2020 and replaces them with tax credits that only go up with age.
    • Tax credits are reduced to $2,000 for people under 30 to $4,000 for people over 60.
    • Phases out the tax credits for incomes above $75,000.
    • Tax credits are not adjusted by local cost of living.
    • At the same time, allows insurance companies to charge seniors up to 5 times as much as young people – current law is 3 times.
  • Bottom line: most people will get much lower tax credits and so have to pay more themselves for coverage – with moderate-income families, older people, and people who live in high medical cost areas seeing the biggest increases.
  • Immediately eliminates the ACA’s requirement that individuals have insurance coverage and that employers with more than 50 employees pay for coverage.
    • Ending the individual mandate, combined with keeping coverage for pre-existing conditions and lowering tax credits, will start an insurance market death spiral. People who are the sickest will scrape to find a way to buy coverage while others drop out, leading to higher premiums and more people dropping out.
  • Ends Medicaid expansion and cuts coverage for children and adults in Medicaid.
    • Ends Medicaid expansion beginning in 2020, with some transition for people already enrolled.
    • Only requires states to cover children in Medicaid who are under the poverty level, reducing the requirement from 133% of the poverty level.
    • Ends federal funding for adults in Medicaid who are over 133% of poverty.
  • Replaces Medicaid’s funding of actual health spending by capping at a cost per-person, starting in October 2019.
    • Instead of states getting a fixed percentage of payments from the federal government (which varies by state), the federal government would cap the amount that it pays per person at the medical CPI.
    • Capping Medicaid will result in hundreds of billions of dollars in cuts to states.
    • In a public health crisis – the opioid crisis, Zika, etc. – the federal government will not increase funding for state Medicaid programs.
  • Pushes people into high-deductible health plans, through several provisions.
    • Allows insurance companies to sell catastrophic plans, ending the requirement that plans cover a set percentage of medical costs – the ACA’s platinum, gold, silver and bronze plans.
    • Ends the ACA’s plan that limits out of pocket costs for people with moderate incomes.
    • Increases tax benefits of health savings accounts, which are usually high deductible plans that only work if you are rich enough to save money out of your paycheck.
  • Hikes health care costs for people with pre-existing conditions.
    • Insurance companies must charge anyone who has not been insured for 63 days a 30% surcharge on their premiums.
    • Sets up a “Patient and state stability fund,” which can fund state high-risk pools, for people who need costly medical care. The 35-year history of states attempting high-risk pools resulted in high-premiums, high-deductibles and long-waiting lists.
  • Huge tax breaks – $525 billion over 10 years – for the wealthy and for drug, insurance and medical device corporations.
    • Ends the ACA’s taxes on unearned income for people with high incomes. The top 0.1% of households—those with income of at least $3.7 milliona year—would receive a tax cut of about $197,000 in 2017, on average.
    • Ends the ACA’s taxes on insurance, drug and medical device corporations.
    • Even ends an ACA provision that limited insurance companies from writing off high executive salaries.
  • Defunds Planned Parenthood.

The Republican Plan to Slash Medicaid and Wreck State Budgets

Topline Message

Already worried about your family’s health care? Now President Trump and Republicans in Congress say they will slash $1 trillion to states for Medicaid, robbing health security for 74 million American working families, children, seniors and people with disabilities. They want to pass the buck to states to throw seniors out of nursing homes, take health care away from working families and jeopardize the lives of Americans with disabilities. Their plan will wreck state budgets, and take away the jobs of millions of Americans who care for our families in hospitals, health centers, doctors’ offices and in our homes.

Talking Points

  • If Trump and the Republicans slash Medicaid funding for states, millions of seniors will be thrown out of nursing homes, American families will be slammed with crushing health care costs for their parents, children and people with disabilities will go without needed care. Huge costs will be shifted to state governments and millions of health care providers will lose their jobs.
  • Capping Medicaid will cut federal funding to states for Medicaid by $1 trillion, so that states will either have to raise taxes, cut school funding or cut Medicaid coverage for the children, working families, seniors and people with disabilities who rely on Medicaid for their health care.
  • There is only one reason that Trump and the Republicans want to make what the New York Times called a “radical change” in Medicaid – to slash federal funding for health care. For 50 years, our federal government has guaranteed that it will pay for Americans in each state who need care at the cost of providing that care. Under the Republican plan, the federal government would provide a fixed amount that doesn’t keep up with rising costs. Bottom line: families and state governments would be forced to pay more and lose life-saving health care.

Governors respond to the claim that the Republican plan will increase state “flexibility.”

  • Republican Massachusetts Governor Charlie Baker: “We are very concerned that a shift to block grants or per capita caps for Medicaid would remove flexibility from states as the result of reduced federal funding.”
  • Democratic Louisiana Governor John Bel Edwards: “… flexibility would really mean flexibility to cut critical services for our most vulnerable populations, including poor children, people with disabilities and seniors in need of nursing home and home-based care.”

Key Facts

  • 74 million Americans rely on Medicaid each year including 33 million children. (Link includes data for each state)
  • Half (46%) of Medicaid spending is on long-term care for seniors and people with disabilities.
  • Republicans propose a total of $2 trillion in cuts to Medicaid over the next decade: $1 trillion through block grants and $ trillion through repeal of the ACA.
  • Medicaid provides essential care for women throughout their lives—from family planning and maternal health services to nursing home care. Medicaid finances nearly half of all births in the U.S., accounts for 75% of all publicly-funded family planning services, and accounts for half (51%) of all long-term care spending, which is critical for many frail elderly women.
  • Medicaid is there for all Americans. Of people who rely on Medicaid: 41% are White, 25% are Latino and 22% are African American. (Link includes data for each state).
  • Small businesses rely on Medicaid to provide health coverage to 6.1 million small business owners and employees[1]. ()
  • There are two ways that Republicans propose to radically change Medicaid:
    • Medicaid “block grants” provide a fixed amount of money to each state, which does not increase when more people need Medicaid and does not depend on how much each state health care costs go up.
    • Medicaid “per-capita” cap would give states a fixed amount of money for each person enrolled in Medicaid that would not increase based on how much each state’s cost of providing health care goes up.

[1] Based on U.S. Census Bureau’s 2016 Current Population Survey with small businesses defined as those with fewer than 50 employees.

Talking Points and Q & A for Don’t Take My Health Care December Events

Topline messages:

  • We are here today to tell President-elect Trump and the Republicans, don’t take away our health care. Don’t take away my health care, my friend’s health care, my daughter’s Medicaid, my father’s Medicare.
  • Trump and Congressional Republicans are trying to take away our health coverage, hike our costs and put us at the mercy of private health insurance corporations. Their plans would take coverage away from every family in America – working families, children, seniors, people with disabilities – everyone who today or in the future will rely on the Medicare, Medicaid and the Affordable Care Act.
  • Even before the new President is sworn in, the Republicans are trying to jam through Congress a plan that would take away health care from more than 30 million people with no plan to replace that health care or make sure that people don’t lose benefits their families depend on.
  • The Republican plan would put the Wall Street health insurance companies back in charge of our health care and take us back to the days when they could discriminate against people with pre-existing conditions, deny coverage for any reason and raise rates at will.
  • Repealing the Affordable Care Act is just the first step. The Republican crusade against health care would also slash funding for Medicaid and trade guaranteed benefits in Medicare for skimpy private insurance vouchers with huge out-of-pocket expenses for seniors and big limits on choice of doctors and hospitals.

    Talking about what they want to do to ACA, Medicare and Medicaid:

  • Repealing the Affordable Care Act means 30 million people will lose their coverage and health insurance costs will soar even higher, going back to the days when health the big insurance corporations denied our care.
  • The Republican plan would wreak havoc on the insurance market and hurt everyone with private insurance. They plan to tax the health care people get at work and insurance companies would shift the cost of 30 million people new uninsured people back to the rest of us.
  • Their plan would also shift billions in prescription drug costs to the elderly. Seniors and people with disabilities would be left to fend for themselves and forced to choose between their medicine and other basic necessities like rent and food.
  • Trump and Republicans in Congress want to cut $1 trillion from state funding from Medicaid, taking coverage away from working families, children, seniors and people with disabilities and wrecking state budgets.
  • The Republican plan hurts hospitals and jeopardizes the jobs of millions of health care providers. It would force many hospitals to cut back services and others to close.
  • Trump and Republicans in Congress want to replace guaranteed Medicare benefits with a skimpy voucher to buy private insurance. It would take away Medicare’s guarantee of going to the doctor or hospital you want, without paying a huge amount more for health care.What should happen:
  • President Trump and Congress need to work together to strengthen our health care to make it work better for everyone, not tear the whole thing down with no plan to make sure families can keep their health care
  • We can’t afford health care chaos. We need to protect Medicaid and Medicare. We need quality, affordable health care every family can count on.
  • Instead of repealing the Affordable Care Act, improve it: lower premiums, lower deductibles, better choice of doctors and hospitals.

Strengthen the Affordable Care Act, Medicare and Medicaid so that every American has the security of reliable, affordable health coverage.

Questions and Answers on Republican Plans to Take Away Our Health Care

Q. When are Republicans planning to repeal Obamacare?

A. The Republican leadership in Congress says they want to vote to repeal the Affordable Care Act early in January, and put that bill on President Trump’s desk as soon as he’s in office January 20th. But Republican’s haven’t come up with a replacement for the 30 million people who will lose their health care coverage. That’s why some Republicans are starting to have second thoughts about rushing into repeal.

Q. Won’t Republicans replace Obamacare with something else, something they say is better?

A. Republicans have never been able to agree on a “replacement” and every replacement plan they’ve come up with actually makes things worse: takes away coverage from millions of Americans, causes huge increases in deductibles, allows insurance companies to deny coverage to people with pre-existing conditions and taxes employees with health coverage. That’s why some Republicans are getting cold feet and may put off the replacement for 2-3 years. But it’s reckless and dangerous to repeal the law without a replacement and families will face dire consequences if Republicans throw out the Affordable Care Act and then take their time with a new plan. In the meantime, with all the rules gone, health insurance corporations will hike premiums even more than now – and not just for those on Obamacare, but for millions of people who buy private insurance on their own.

Q. Republicans say that a Medicaid block grant will put more control in the hands of state governments, where it belongs.

A. A Medicaid block grant is not about state control – states already run Medicaid now – it’s about gutting the Medicaid program by cutting $1 trillion of federal funding to states for Medicaid. Less money to states for Medicaid means taking away coverage and higher costs for the 73 million working people, seniors, and people with disabilities who rely on Medicaid for their health care. It will wreck state budgets as states try to make up the difference and it will force cuts to other programs like education and roads as states find themselves less and less able to balance the budget. Community and rural hospitals that depend on Medicaid the most will have to cut back or close, jeopardizing millions of health care jobs.

Q. Republicans say that Medicare will go bankrupt unless it’s reformed.

A. That’s one of the big Republican lies. Medicare isn’t going bankrupt. In fact, Medicare has a much better record of controlling health insurance costs than private insurance, which inflates costs to make more profit. Unlike Medicare, Insurance companies pay CEOs millions of dollars in salaries, waste money on marketing instead of health care and overpay for prescription drugs. The Republicans plan would bankrupt seniors and people with disabilities on Medicare and enrich the health insurance corporations. Replacing guaranteed benefits in Medicare with a skimpy voucher for private health insurance would result in much higher costs to seniors, particularly if you want to keep Medicare’s guarantee of choosing your own doctor or hospital.

Q. What has President-elect Donald Trump said about his plans for health care?

A. On the campaign trail, Trump repeatedly said that it was a bad idea to make changes to Medicaid, Medicare and Social Security—the three programs that Americans depend upon most universally for health care and

security. Yet Trump’s choice to head the agency in charge of the Affordable Care Act, Medicare and Medicaid, Rep. Tim Price from Georgia, is a leader in the Congressional fight to repeal Obamacare, slash Medicaid and privatize Medicare. Every American family should be frightened about what that means for their health care.