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Report: President Trump and Republicans in Congress Say That The ACA Is Going To “Explode,” But They Are The Ones Lighting the Fuse

  • President Trump and Republicans in Congress are playing a reckless game with the health of millions of Americans by sabotaging the ACA.
  • President Trump has been trying, since day one of his administration, to undermine the ACA to appease his base.
  • These actions are just another step in a years-long effort by Republicans to sabotage families’ health care in order to score political points.

 

As soon as President Trump took office in January, he set his sights on destroying the Affordable Care Act. Now, as the Republican effort to “replace” the ACA with a bill that takes away health care from more than 24 million Americans and raises costs for millions more, President Trump says that “Obamacare, unfortunately, will explode.”

 

  • On January 20, the day of his inauguration, President Trump signed an executive order giving agencies broad authority to undermine of the ACA with vague instructions.

 

    • This uncertainty has real implications for working families. A recent analysis suggests that the uncertainty Trump has created through efforts to undermine the ACA could increase premiums by $480-$960 annually. [CAP, 4/26/17]

 

  • On January 26, President Trump announced that the Administration would stop planned ads for the final week of open enrollment for marketplace health coverage. [CBPP, 1/31/2017; ThinkProgress, 2/4/2017; CBPP, 2/2017]

 

    • Many of the youngest consumers wait until the end of the enrollment period to buy coverage. Total enrollment this year fell by 4 percent, and pulling the ads contributed to that decrease.

 

    • The HHS Inspector General is now investigating the Trump administration’s decision to cut off these advertisements just as families were making decisions about their health care. [The Hill, 3/24/17]

 

  • On April 14, the Administration finalized its first regulation on health care, billing the rule as “market stabilization.” What the rule really does is:

 

    • Raises premiums, out-of-pocket costs, or both for millions of moderate-income families. [Morning Consult, 3/14/2017; CBPP, 2/15/2017; The Atlantic, 3/29/2017]

 

    • Weakens network adequacy standards, including by reducing the standard for in-network essential community providers such as children’s hospitals, Ryan-White HIV AIDS Providers, and family planning clinics. [Health Affairs, 4/14/17]

 

    • Makes it harder for consumers to get covered by cutting the open enrollment period in half and delaying coverage for people using special enrollment periods. [CBPP, 4/13/17]

 

Here’s what the Trump Administration and Congressional Republicans have planned to sabotage the law in the future:

 

  • Continue delays or completely terminate the cost-sharing subsidies that lower the deductibles, co-pays, and other out-of-pocket costs for individuals with marketplace plans. [New England Journal of Medicine, 1/7/2016; CBO, 3/1/2016]

 

    • House Republicans have waged an all-out war on cost sharing reductions, filing suit against the constitutionality of these subsidies back in 2014 in House v. Burwell. They have continued this suit under the Trump administration and now insurance carriers don’t know how to file their rates for 2018. As a result, Molina threatened to pull out of the marketplace entirely, Anthem questioned whether they would be able to remain in the market, and several state insurance commissioners were forced to delay the deadline for filing premiums. [Business Insider, 4/28/17, CNBC, 4/28/17]

 

    • During the negotiation over the FY2017 omnibus spending bill, the Trump Administration repeatedly flip-flopped on whether it would fund the cost-sharing reductions, causing further chaos in the market.

 

    • One analysis showed that elimination of these subsides would lead to a premium increase of around 19% – these skyrocketing premiums would have a disastrous effect on Americans’ ability to purchase health coverage. [KFF, 4/6/2017]

 

    • A follow-up indicated that failing to make cost-sharing reduction payments would ultimately increase the deficit by $2.3 billion in FY2018 and $31 billion over ten years because premiums would increase, increasing the amount of tax credits provided to low-income enrollees. [KFF, 4/25/17]

 

  • Drive affordable plans and insurers out of the ACA market.

 

    • The Trump Administration and Republican members of Congress are threatening the future of critical cost-sharing subsidies, continuing to push their disruptive and dangerous Trumpcare bill, and sending negative signals about their interest in maintaining the exchanges.

 

    • These steps have created an uncertain and changing legislative and regulatory environment that has already had adverse effects on insurer participation and consumer plan choices for 2016 and 2017. [American Academy of Actuaries, 4/24/2017]

 

The actions this year are just another step in a years-long attempt to sabotage health care for American families to gain political advantage.

 

Let’s look back at some of the Republican attempts to sabotage the ACA since 2010:

 

2010

  • Congressional Republicans campaigned on a promise not to fund any part of the new health reform law. [New York Times, 10/26/2010]

 

2011

  • In January, the House Republicans held their first of more than 50 votes to repeal or undermine health reform. [Politico Magazine, 1/30/2014; TIME, 3/24/2017]

 

  • In April, the House passed Rep. Paul Ryan’s budget, the first of several Republican- budgets that included a repeal of the ACA. [Washington Post, 4/5/2011]

 

  • Later in April, the House passed a repeal of the ACA’s Prevention and Public Health Fund, which was intended to be used for prevention, wellness, and public health activities. [Politico Magazine, 1/30/2014; CRS, 3/21/17; Washington Post, 3/21/2014]

 

  • In April, the House passed a resolution that defunded all of the ACA by passing a resolution that directed the Senate to “take a vote defunding all mandatory and discretionary spending.” [GovTrack, Accessed 4/4/2017]

 

  •  In April, the House passed its version of the Fiscal Year 2012 budget with language to repeal and defund the law. [GovTrack, Accessed 4/4/2017]

 

  • In December, the House passed a bill (H.R. 3630) that stripped more than $20 billion of funding from the Affordable Care Act, including significantly weakening the Prevention and Public Health Fund. [Politico Magazine, 1/30/2014; New York TIMES, 12/13/2011; Center for American Progress, 1/27/2012]

 

2012

  • In March, the House passed the second consecutive budget that would repeal and defund the ACA. [Politico Magazine, 1/30/2014]

 

  • In July, the House voted again to repeal the ACA ahead of the fall election. [NYTimes, 7/11/2012]

 

  • By the conclusion of the year, the House had voted 34 times to repeal, delay, defund, dismantle the ACA. [Politico Magazine, 1/30/2014]

 

2013

  • The House once again voted to repeal the ACA in May. This marked the 37th vote to repeal the ACA. [NBC News, 5/16/2013]

 

  • At the end of September, days before open enrollment started, the House took several more votes to defund the ACA. [Politico Magazine, 1/30/2014]

 

  • On September 30, House Republican leaders attempted to tie government funding with a one-year delay in enforcement of the individual mandate that required individual to buy health insurance and sent a bill to the Senate with this policy prescription. In the Senate, Republicans insisted upon passing the legislation from the House while Democrats opposed any effort to link the ACA with government funding. This recklessness led to the first government shutdown in 17 years. In response, President Obama said that the shutdown was “entirely preventable if the House [chose] to do what the Senate [had] already done, and that’s the simple act of funding our government without making extraneous and controversial demands in the process.” [Politico Magazine, 1/30/2014; New York Times, 9/30/2013; NPR, 10/17/2013]

 

  • On October 16, the House voted on a bill that would fund the government through January 15, 2014, end the shutdown, and avert the first default in U.S. history. The deal was not “a major bargain,” but rather left “intact all the contentious issues” and set up another policy face-off with next effort to renew government funding. [NPR, 10/16/2013]

 

2014

  • In late March, Republicans held their 51st vote to repeal, undermine, or defund the law. [U.S. News, 3/20/2014]

 

  • On July 30, 2014, the House voted 225-201 to approve H.Res.676, a resolution to move forward with a lawsuit against the Administration. In the suit filed on November 20, 2014, known then as House v. Burwell (and now as House v. Price), the case centers upon the cost-sharing reduction (CSRs) payments paid to insurance companies to reduce the out-of-pocket costs for critical health care services for low-income beneficiaries. As a result of CSRs, more than 7 million Americans who quality based on incomes have saved thousands of dollars on health care and prescription drugs. As of February 2017, the court is holding the case in abeyance after a petition from the Trump Administration. [New York Times, 7/30/2014; USA Today, 11/21/2014; NEJM, 1/7/2016; The Commonwealth Fund, 3/17/2016;  Health Affairs, 2/21/2017]

 

  • In December, Senator Rubio slipped a provision to cap the risk corridor payments as a rider in to a massive appropriations bill. This provision made the risk corridor program revenue neutral, so only contributions collected from insurers could be used to fund payments to the risk corridor program. This “quiet legislative sabotage” was effective in forcing deep cuts in these stabilizing payments, which strained insurance companies, “in (mostly red) states with low incomes and thus poorer health.” [KFF, 8/17/16; New York Times, 12/9/2015]

 

2015

  • On February 3, 2015, in spite of a veto threat from President Obama and lack of clarity amongst Congressional Republicans of how to replace the law, the House of Representatives held its 56th vote since the law’s passage in 2011 to repeal, defund, or undermine the ACA. The first health care repeal vote in the Congress, this vote, like its 55 predecessors, followed party lines. [New York Times, 2/3/2015]

 

  • Republicans in Congress wrote to the Supreme Court in opposition to subsidies for Americans to pay insurance coverage on the exchange, a key component of the ACA.  However, in June, the Supreme Court ruled 6-3 against that recommendation, upholding the subsidies and one of the major tenets of the ACA. The ruling preserved benefits for an estimated 6.4 million Americans. [U.S. News, 6/25/2015; SCOTUS Blog, Accessed 4/6/2017; KFF, 6/25/2015]

 

  • On December 4, 2015, through the process of budget reconciliation, Republicans in the Senate passed a bill repealing the ACA – the first time such a measure was cleared in the Senate chamber and a critical step in getting repeal legislation to the President’s desk. [The Atlantic, 12/4/2015]

 

  • In December, end-of-fiscal year risk corridor payments were supposed to be around $2.9 billion. However, because of the Rubio provision in the 2014 appropriations bill, insurers were reimbursed only around $400 million. As a result, starting in 2015, As a result, starting in 2015, insurance companies, “in (mostly red) states with low incomes and thus poorer health” began to feel the effects of this squeeze. [KFF, 8/17/16; Salon, 3/22/2017]

 

2016

  • On January 6, 2016, the House voted for the 62nd time to repeal, defund, or undermine the ACA, sending repeal legislation to the President’s desk for the first time in their more than 60 attempts. [New York Times, 1/6/2016]

 

  • On February 2, 2016, Republicans failed to overturn President Obama’s veto of its January legislation to repeal the ACA and defund Planned Parenthood. Ironically, the Groundhog Day vote was the 63rd attempt by the House to overturn or undermine the ACA. [Washington Post, 2/2/2016]

 

  • As the Obama Administration drew to a close, experts began to comment on the effects of the 5-year sabotage efforts of Republicans, noting that the few successful legal and legislative efforts to undermine the law, combined with the constant attacks and uncertainty were leading to a decline in insurer participation and consumer choice for ACA participants in 2016. [American Academy of Actuaries, 1/18/2017]

 

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