Republican Sabotage of Our Health Care System

 

EDITOR: Why does the self-styled “pro-life” party want so badly to raise the death rate through more guns and less healthcare? Some think it’s about wealthy elites maintaining political control in the face of sweeping demographic changes. Others think it’s because white nationalists fear immigrants and minorities getting more opportunities. Either way, it’s disgusting and tearing our nation apart.

In the referenced article below, Congressional Democrats describe recent administration executive actions as ACA Sabotage, designed to create a healthcare crisis. Political Genocide may be a more fitting term.

Affordable Care Act SABOTAGE Continues

In the above video, ex-President Obama criticizes Republicans across the nation for blatantly lying about protecting health insurance for people with preexisting conditions. The Washington Post Fact Checker tells us that since his first day in office, President Trump has made 324 false or misleading statements about healthcare (at least as of 10/10/2018). He has also created vast uncertainty in health insurance markets with other sabotage attempts. Here are some examples:

The Trump Administration has refused to commit to making cost-sharing reduction (CSR) payments and failed to commit to enforcing the individual mandate, putting the integrity of the risk pool and affordability of coverage in jeopardy. Trump’s obvious attempts to manufacture a crisis caused uncertainty in the marketplace and prompted insurers to sharply increase premiums for the upcoming plan year, or pull out altogether.

By another executive order in October, Trump allowed associations to offer group insurance plans with skimpy benefits and offer lower cost plans to members nationally across state lines. Trump’s order allows association health plans to be exempted from core Obamacare requirements like coverage of essential health benefits. The “essential” ACA health benefits include hospital care, prescription drugs, maternity care, and mental health. The aim was to broaden the risk pool by preventing insurers from offering cheap plans tailored to young and healthy customers at the expense of older and sicker people. Experts worry this executive order will damage ACA exchangers and result in overall higher costs.

Trump wants to make it easier for businesses to require employees to pay for their own insurance using reimbursements. He also wants to open more loopholes for people to buy insurance outside of ACA markets, attracting younger and healthier people away from current markets. Experts think this will destabilize Obamacare by leaving behind a smaller insurance pool of older and sicker people, resulting in fewer insurers and higher premiums.

Trump’s executive order finally terminates CSR subsidies paid to insurance companies to help people between 100% and 250% of the poverty level pay for the insurance and health care they get through ACA exchanges. Ironically, Trump’s constant threats to terminate CSR subsidies caused uncertainty in insurance markets that exacerbated two problems he blamed on Obamacare – namely, high premiums and the exit of insurers. This intentional sabotage will harm the 7.1 million people, or 58% of Obamacare enrollees, who qualified for subsidies this year.

Signing up for insurance under Obamacare will be a lot harder this year. Trump has shortened the annual open-enrollment period (Now Nov.1 to Dec.15) and announced plans to take HealthCare.gov offline for 12 hours at a time during peek enrollment times, “for maintenance.” He also cut ACA enrollment advertising by 90% and cut funding for Navigator groups who help people navigate the complex enrollment process and pick a plan under the ACA exchanges or Medicaid.

Trump and GOP attacks on Obamacare could come back to bite them politically. Their base sees these attacks as making health care more expensive and more unavailable for many Americans, many of whom are in the red states where Trump won. That’s why they’re lying about what they’ve done and plan to do.

 

A History of Trump Administration Sabotage Efforts

This longer list, summarized from the Center on Budget and Policy Priorities, a nonpartisan research and polity institute (last updated July 2018), highlights Trump’s continued efforts to undermine our healthcare system.

1/20/2017 – Trump issues anti-ACA executive order “directing federal agencies to use their administrative powers begin dismantling the Affordable Care Act ‘to the maximum extent permitted by law.’”

1/26/2017–  The administration announced that it will “stop planned ads for the final week of open enrollment for marketplace health coverage.”

1/31/2017– Even as HealthCare.gov enrollment totals through mid-January exceeded 2016, the final total was slightly less, showing the impact of removing the promotions.

2/14/2017– IRS scraps enforcement of individual mandate.

2/15/2017– Allow insurers to offer plans with lower premiums but higher deductibles and out-of-pocket costs than allowed for under the ACA, thus raising overall costs for millions.

3/14/2017– The administration tells governors it will consider waiver proposals that would make it harder for Medicaid beneficiaries to get affordable care and increase the number of uninsured.

3/28/2017– After House Republicans fail to advance another ACA repeal bill, the administration talks of other legislative action that raises uncertainty among insurers and could cause them to raise premiums or pull back from certain markets.

4/12/2017– Trump announces plans to withhold cost-sharing reduction (CSR) subsidy payments to insurers and other rules that would raise consumers’ deductibles and make it harder for people to get insurance.

5/1/2017– Congress fails to include funding for CSRs in the 2017 spending bill, thus risking premium increases, disrupting the insurance marketplace, and endangering coverage of millions of people.

5/2/2017– House Republicans slash CSR subsidies. Even if the bill fails in the Senate, the possible enactment will likely cause insurers to raise premiums and/or exit markets.

5/12/2017– As insurers start filing their 2018 rates, it becomes clear that the Trump sabotage is already taking its toll, because premiums are already higher than they otherwise would be.

5/22/2017– The administration asks for another 90-day delay in a CSR court case that would have allowed payments to continue, forcing uncertainty onto insurers as they set rates, causing those rates to be higher.

5/23/2017– Trump’s budget requests 21% less funding to administer the ACA marketplace in 2018, including cuts to promotional advertising to encourage enrollment.

6/6/2017– Anthem announces plans to exit Ohio’s marketplace, citing uncertainty about CSR subsidies, even though the marketplace itself was doing better than the year before. The move left at least 18 Ohio counties with no insurance competition.

6/8/2017– When asked Tom Price, Health and Human Services (HHS) Secretary, was asked, he refused to say if the administration would fund CSR payments in 2018.

7/22/2017– HHS continued to attach the ACA, removing website content promoting the ACA and releasing dozens of videos featuring people saying the ACA hurt them. HHS also ended contracts with private “navigator” firms who helped people through the enrollment process.

7/28/2017– Senate Republicans held a late night vote in a last ditch effort to pass the American Health Care Act, or AHCA), an ACA repeal and replace bill. The next day Trump threatens to stop paying CSR subsidies, likely causing more insurers to withdraw from markets.

8/31/2017– Just two months before open enrollment was to begin, the administration slashed funding 90% or more for marketplace outreach and 40% for navigator firms, with the obvious intention to reducing the number of people with health insurance.

9/22/2017– Navigator groups are told that it could tale up to 30 days to review approve their revised budgets. Without funding guarantees, many such groups started to cease operation.

9/25/2017– HHS stops staff from its regional offices from participating in insurance enrollment events. It then responds to criticism with false claims that the ACA has failed and is harming people, when it’s their sabotage doing the real harm.

10/6/2017– The administration starts allowing employers to opt-out of covering contraception based on moral or religious objections.

10/12/2017– Trump announced that it will stop making CSR payments to insurers and signs an executive order allowing agencies and associations to offer “skinny” plans without the essential health benefits required by the ACA, including maternity care and mental health treatment.

10/25/2017– HHS Inspector General released a report showing how the administration’s termination of marketplace outreach led to $1.1 million in unrecoverable costs.

10/26/2017– The Centers for Medicare & Medicaid Services (CMS) said it will give states an “unprecedented level of flexibility” in requesting waivers of Medicaid rules, complaining that those rules were not designed for an able-bodied individual.

11/1/2017– When the administration cut the outreach budget by 90% in August, they said spending would focus on low-cost activities like email. But even though the HealthCare.gov database has about 20 million email addresses of enrollees, the administration reduced its email outreach.

12/22/2017– Trump signed a trillion-dollar tax bill into law, primarily for wealthy individuals and corporations, repealing the ACA’s individual mandate starting in 2019 to help pay for it. Without the mandate, fewer healthy people will sign up for insurance, likely increasing premiums by 10%, according to the Congressional Budget Office. The CBO also estimated that 13 million people would become uninsured as a result. [Harvard Medical School researchers have found a 25% higher risk of mortality for the uninsured compared with the insured.]

1/5/2018– The administration announced plans to dramatically broaden enrollment in “skinny” Association Health Plans (AHPs). The plan could hurt the individual insurance market and devastate small-group markets. It allows AHPs to treat small businesses self-employed people as a larger group for negotiating purposes but exempts them from many consumer protections that were in place with the ACA, including the requirement to cover essential health benefits. (3/2019: Judge strikes down this plan.)

1/11/2018– CMS issues guidance allowing states to block some low-income adults from getting Medicaid if they’re not working.

1/12/2018– HHS approves Kentucky’s Medicaid waiver, making it the first state to require the recipients to work. The waiver includes many other harmful provisions that will jeopardize low-income residents.

1/19/2018– CMS rescinds 2016 Medicaid guidance giving beneficiaries a choice of provider. The worry now is that states may restrict women covered by Medicaid from choosing a provider offering contraception or other women’s health services, like Planned Parenthood.

2/1/2018– HHS approves Indiana’s Medicaid waiver, allowing it to impose a work requirement.

2/20/2018– The administration proposed rules to expand the use of short-term insurance plans as an alternative to plans with more stringent plans under the ACA. This would allow “skimpy” plans to operate alongside of comprehensive plans, likely exposing consumers to coverage gaps and higher costs.

4/9/2018– CMS announces new rules that reduce insurer accountability and consumer transparency, weaken benefit standards, and add new barriers for people wanting to enroll in health plans. Under the ACA, insurers were required to spend at least 80% of premiums on medical care rather than marketing expenses and executive pay.

6/7/2018– The Department of Justice (DOJ) files a legal brief declining to defend the constitutionality of the ACA in a suit brought by 20 states. In Texas v. United States, the states assert that the entire ACA must be struck down because of conflicts between the Preexisting Conditions coverage requirement and the Individual Mandate requirement, a provision that was declared unconstitutional in an earlier case.

6/19/2017– The Labor Department issues rules to increase enrollment in the association plans (AHPs) that lack ACA coverage requirements. The rules would also allow insurers to charge higher rates for older people or based on gender or occupation. Men, for example, may be seen as less expensive since they don’t get pregnant.

7/7/2018– CMS announced that risk adjustment transfers may be delayed. Risk adjustment is “a federal program that transfers revenues from insurers that enroll a healthier-than-average group of consumers to those that enroll a sicker-than-average group.” It’s meant to reduce the incentive to cherry-pick the healthiest customers and leave others behind, but this announcement adds more uncertainty to the market that will drive up consumer costs.

7/10/2018– CMS slashed funding for the navigator program and consumer outreach to just $10 million for the 34 states relying on HealthCare.gov to administer their ACA marketplaces.

11/8 UPDATE– Republicans abandon the fight to repeal and replace Obama’s health care law — Let’s hope that now we can get down to the business of fixing what was wrong with Obamacare, restoring the damage done from eight years of Republican sabotage, extending affordable healthcare to every American as a human right, and cutting per-capita costs by half to match what so many other advanced nations pay for their superior outcomes and longevity. Because doing that will save our nation over $1.5 $2 trillion every year, it should not matter if costs are buried in premiums and copays, or included in the taxes we pay. To begin that repair and reform process, we need a better understanding of “Why American Healthcare is So Expensive” in the first place.

12/14 UPDATE– Judge Reed O’Connor, a partisan Texas federal judge, took it upon himself to declare Obamacare unconstitutional. After Trump’s tax plan removed the individual mandate penalty, Texas led a 20-State lawsuit arguing that without the mandate the entire ACA must be struck down. O’Connor agreed and gave Republicans a gift that likely won’t survive the appeals process. But if the US Supreme Court were to uphold it, the impact would be severe.

3/26/2019 UPDATE– Trump said he wants all of Obamacare overturned by the courts and then promised some sort of great healthcare system replacement, with no specifics of course.

It’s Not Just Me, or the mainstream press, Saying This

Analysis by the nonpartisan Congressional Budget Office has shown that every Republican House and Senate bill to replace Obamacare would (1) increase overall costs significantly and (2) cause tens of millions of people to lose health insurance coverage. Sabotage can be even worse, and Congressional Democrats have weighed in on that issue.

Democratic members of the House Committee on Energy and Commerce, and the Senate Committee on Health, Education, Labor and Pensions, recently released a report warning that Republican actions are causing uncertainty in health insurance markets that is resulting in higher premiums and insurers pulling out. A Manufactured Crisis: Trump Administration and Republican Sabotage of the Health Care System is summarized here with quotes from insurance companies and regulators across nearly 20 states.

EXECUTIVE SUMMARY (full text, but without the citations)

“The best thing politically is to let Obamacare explode.” (President Donald Trump in an interview with The Washington Post, 5/24/17)

The Trump Administration dedicated its first six months in office to sabotaging the health care system for partisan gain, threatening to reverse years of progress that have reduced the uninsured rate to historic lows. These destructive efforts by the Administration are causing uncertainty for insurers, which is resulting in significantly higher premiums for consumers.

Perhaps even more egregiously, President Trump and Congressional Republicans are using this manufactured crisis to justify their efforts to pass Trumpcare, which will cut taxes for the wealthiest Americans and special interests while cutting nearly $1 trillion in funding from Medicare and Medicaid. Trumpcare will result in tens of millions more uninsured and impose higher costs on working families, including older adults and individuals with pre-existing conditions. Republicans claim that “Obamacare is in a total death spiral,” as a justification for passing this tax cut bill masquerading as a health bill. But they cannot pretend they are acting to improve the health care system while they are actively working to undermine it.

This report provides an overview of the emerging evidence of the damage that the Trump Administration and Congressional Republicans have inflicted on the individual market. It provides a preliminary analysis of the impact of the Trump Administration’s actions and the impact of legislative uncertainty on premiums and stability in the marketplace, by analyzing the insurance rate filings to date. It will be updated as additional information becomes available.

THE TRUMP ADMINISTRATION’S EFFORTS TO UNDERMINE FAMILIES’ HEALTH CARE

“Why the hell would we?” (President Donald Trump, on making CSP payments, 5/19/17)

Since President Trump assumed office in January 2017, his Administration has repeatedly acted to sabotage the health care system. On his first day in office, President Trump signed an Executive Order that directed the Secretary of Health and Human Services and the heads of government agencies to defer, delay, or waive certain provisions of the Affordable Care Act (ACA), creating vast uncertainty in the marketplace. Since then, his Administration has refused to commit to making cost-sharing reduction (CSR) payments [to insurers] and failed to commit to enforcing the individual mandate. These cynical attempts to manufacture a crisis have caused uncertainty in the marketplace and have prompted insurers to sharply increase premiums for the upcoming plan year. …

SELECTED QUOTES

• “There now is clear evidence that this uncertainty is undermining the individual insurance market for 2018 and stands to negatively impact millions of people.” (the American Medical Association (AMA), America’s Health Insurance Plans (AHIP), Blue Cross Blue Shield Association (BCBSA), and others, 5/19/17)

• “The vast majority of this has been caused by the current administration and by Congress, not by the ACA.” (Community Health Choice, Texas)

• “The continued uncertainty caused by fluctuating directions from Washington could have a disastrous impact on the individual health insurance market in 2018.” (Colorado Insurance Commissioner)

• “The most immediate drivers of instability are the weakening of the individual mandate, the uncertain status of funding for the cost sharing reductions and the absence of funding for overall market stabilization measures.” (Pennsylvania Insurance Commissioner and five insurance companies)

• “If the federal government’s full CSR funding commitments are in jeopardy, we believe that the viability of the exchange market is in immediate jeopardy of failing.” (Molina Healthcare of Washington, Inc.)

• “This uncertainty adds more unpredictability to the rate process and introduces an uneasy level of market volatility, compromising the ability to set adequate rates responsibly.” (Anthem Blue Cross and Blue Shield of Connecticut)

• “With the unknown of cost-sharing-reductions funding … we have great uncertainty for what insurers will be participating in the market and where rates could land for 2018.” (Utah Department of Insurance)

• “[CareFirst] tacked an extra 15 percent onto its premiums because it does not expect the Trump administration to enforce the individual mandate.” (Chet Burrell, Chief Executive of CareFirst)

• “Without enforcement of the coverage mandate, membership is expected to drop, with the healthier individuals more likely to forego coverage. This will drive up the average cost of health care for the individual market.” (Harvard Pilgrim Health Care, Maine)

• “Failure to enforce the penalty for not having health insurance could result in total premium increases of more than 28 percent, and up to 350,000 consumers who would otherwise get coverage likely going uninsured in 2018.” (Covered California)

CONCLUSION (full text)

Republicans are undertaking concerted efforts to sabotage the health care system by introducing instability into the individual insurance market. By choosing not to make CSR payments, providing unclear direction about enforcement of the individual mandate, and generally creating uncertainty about the future of our health care system, the Trump Administration is forcing insurers to raise premiums for the 2018 plan year. These actions are threatening to make health care inaccessible and unaffordable for millions of Americans.

In defending Republicans’ attempts to jam Trumpcare through Congress, Senate Majority Leader Mitch McConnell recently said, “Doing nothing is not an option.” Yet independent experts agree that the individual market would be stable if not for the Trump Administration’s sabotage.

President Trump and Congressional Republicans are manufacturing instability in the marketplace as a false pretense for passing a major tax cut for the wealthy and special interests. This cynical effort is being paid for with draconian cuts to the health care system, and on the backs of millions who need access to affordable coverage. Both President Trump and Congressional Republicans should be held responsible for these cynical and destructive actions.

WHAT’S THEIR UNSPOKEN MOTIVE? Harvard Medical School studies of mortality rates among people without health insurance have shown that up to 20% would die unnecessarily as a result. How can Trump and his GOP allies justify causing tens of millions of Americans to lose their health insurance from Obamacare repeal or sabotage? How can they justify allowing over one million to die as a result? Is that what has come from their hatred of President Obama? I think the answers are both racial and political. See my article on Politics and the Modern Killing Fields.

Religious and Association Plans

There’s a religious loophole that lets healthy families avoid paying penalties for not buying insurance. But this loophole puts them at increased risk and puts the rest of the nation at risk too. In an executive order, Trump has allowed healthy individuals to buy into association and faith-based alternatives by agreeing to help others pay their unexpected healthcare costs.

These religious and association agreements aren’t really insurance, and they lack federal protection or oversight. They can deny membership to anyone with preexisting conditions, may not cover birth control or other (prevention) services mandated by the ACA, and they usually have yearly or lifetime payment caps. So if you unfortunately get an expensive illness or injury and are permanently disabled from a car accident or gun shot, then you’ll still face bankruptcy from the cost after easily exceeding the caps. If you rely instead on indigent care in the expensive ER, you’ll force up healthcare costs for everyone nationwide, even for healthy people.

You see, the whole idea of insurance is to spread risk over a wide audience, but taking the healthy people out of the insurance pool makes it more expensive to treat the rest, and that can cause the entire system to collapse. That’s Trump’s stated objective.

Where is the “great healthcare” Trump promised? I’m still waiting.

It’s Time for Medicare for All