Trump, Congress Considering More Damaging New Twist on ACA Repeal: Texas Implications

This is a cross-post by Stacey Pogue of Center for Public Policy Priorities

Media reports indicate that President Trump and Congressional Republicans are working to revive their bill to repeal the Affordable Care Act (ACA) with the same harmful provisions plus two new ones. States would be able to opt out of “essential health benefits” and the requirement that health plans not charge people more because they are sick.

This new approach, if adopted, would completely undermine the popular ACA provision ensuring that people with pre-existing conditions can’t be denied coverage. It is meaningless if you are technically offered coverage by an insurer if the plan doesn’t cover your health conditions, or it is sold at an astronomical price that only the wealthiest can afford. This approach will make cheaper, bare-bones coverage available to healthy individuals, but it will prevent people who actually need health care from getting good and affordable coverage.

Essential Health Benefits

“Essential health benefits” are the minimum standards for coverage that must be included in certain types of health insurance – plans sold to small employers and in the “individual market,” – plans sold directly to consumers who do not have job-based coverage.  Essential health benefits include basic and necessary categories of care as: hospitalization; maternity and newborn care; mental health and substance use disorder care; prescription drugs; and emergency room services.

If a state opts out of essential health benefit protections, insurers will once again get to pick and choose what to cover. Insurers will drop comprehensive benefit to help attract the healthiest (and cheapest to cover) customers. Benefits that will most likely be cut back are: maternity services; prescription drugs; mental health and substance use disorder services; rehabilitative care; and pediatric dental and vision care. Families who lack coverage for critical services will once again bear the full financial weight for illness and injury, and many will be unable to afford needed health care.

Before essential health benefit protections were in place, coverage in the individual market was much more limited than job-based coverage.

  • In Texas before the ACA, there were no policies for sale in the individual market that included maternity services and maternity was not always included in small employer plans. The average charge for pregnancy care and delivery for women with private insurance is more than $32,000 for a vaginal birth and $51,000 for a caesarean section without complications. Few families could absorb these enormous costs if insurance failed to include maternity coverage.
  • Mental health coverage also was often excluded, or else very limited. Nationally, before the ACA, 34 percent of individual market consumers did not have coverage for substance abuse services, and 18 percent did not have coverage for mental health services.
  • Nationally, before the ACA, one of five people enrolled in the individual market had no prescription drug coverage, compared with just one in twenty in the employer market.
  • Coverage of rehabilitative services, particularly important to children who need to learn developmentally appropriate skills was often limited before essential health benefit protections.

Community Rating

One of the most popular and well-known provisions of the ACA is that people with pre-existing conditions can’t be denied health coverage. Mentioned less often, but just as important, is that people with pre-existing conditions also cannot be charged more because they are sick. This is called “community rating” in insurance jargon, and it means that everyone pays the average price regardless of health conditions. If the ACA repeal bill ends community rating, it will resurrect a historic form of discrimination. People with pre-existing conditions will be unable to afford premiums, even if they are technically offered a plan.

Access isn’t the same as coverage. You may technically have access to a Ferrari, but that doesn’t mean you can afford to buy one.

In Texas, we know a bit about how dramatically higher prices can climb without community rating. Before the ACA, small employers technically had to be offered a plan even if they had sick employees, but there were few restrictions on how much groups could be charged. The Texas Department of Insurance collected data on both the average per-person premium charged to small employers and the maximum per-person premium charged to small employers. In 2006, insurers generally reported average per-person premiums of $3,000-$4,000, and maximum per-person premiums of $20,000-$30,000. One insurer reported an average per-person premium of $2,700 and a maximum possible per-person premium of $62,000. Our history in Texas shows clearly that a guaranteed “offer” of coverage with no pricing protections is essentially meaningless.

Return to the bad old days

The state options approach being discussed in Congress is a bad deal for Texans. It will place coverage out-of-reach for those who need it most.

Week of Action on ACA Repeal aka NO #Trumpcare

Update: Please RSVP for our Tuesday night conference call, where we’ll discuss ACA repeal

The Affordable Care Act faces a critical repeal vote this Thursday.

This is a do-or-die moment for the ACA. Exactly seven years to the day of the Affordable Care Act becoming law, the House of Representatives will be voting to repeal it and replace it with Trumpcare—a plan that would lead to 24 million Americans losing their health care.

We’ve put together some resources to help you speak with your member of Congress or their staff about the harm ACA repeal will do to Texans.

This week we need to call our members of Congress and demand that they reject Trumpcare.

Here’s a script:

I’m calling to ask Congressman _____ to oppose Trumpcare. According to the CBO, Trumpcare will result in 24 million Americans losing their health care over the next 10 years. It will mean higher premiums for many Americans, worse coverage options, and even millions of people with employer coverage will lose their coverage as a result of this bill. Trumpcare also cuts $880 billion in funding for Medicaid, which will result in 14 million Americans from working families losing their coverage. It does all of this in order to give a major tax cut to the wealthiest Americans, insurance companies, drug companies and other corporations like medical device companies. This is unacceptable.

If the staffer says the CBO score is bad: That is not true. The CBO is a well-respected, nonpartisan office that does cost estimates of major bills to make sure that the public and Members of Congress understand the full impact of bills like Trumpcare. Republicans and Democrats alike have relied on CBO estimates for decades and so there is no reason to believe its analysis is wrong. The CBO score is clear in that millions of Americans will lose coverage because of Trumpcare.

Will Congressman _______ commit, publicly, to voting against Trumpcare?

Use the following to add more local detail to your phone calls and emails:

How many Texans will lose their health insurance by 2026 as a result of Trumpcare, and how much more will it cost them?

Use this interactive map from the Center for American Progress to find out.

How many will lose insurance in your Congressional district by 2026 as a result of Trumpcare?

Download this table from the Center for American Progress to find out.

What’s the true cost of Trumpcare in your Congressional district?

Find your district’s fact sheet in this memo from the Democratic staff of the Committee on Energy and Commerce and the Committee on Oversight and Government Reform on the impact of the potential ACA repeal on each of the 435 congressional districts and the District of Columbia. (These numbers do not agree exactly with the previous table, likely due to differing methodologies.)

How will tax credits change for people in your county?

While some younger people may do slightly better under Trumpcare, costs will skyrocket for Texans in their late fifties and early sixties. Use this interactive map from the Kasier Family Foundation to find out.

If you want a more in-depth exploration from very smart policy wonks of all the horrible things this bill will do, listen to last week’s emergency ACA call with Indivisible, the Center for American Progress, the Center on Budget and Policy Priorities, and Families USA.

Organize a vigil at your member of Congress’ office

Millions of lives hang in the balance. The House vote this coming week is the first step towards enactment of this devastating Trumpcare bill. But you and your Indivisible group have the power to stop this.

Centex Action Network in Waco has organized vigils at Rep. Flores’ office Wednesday and Thursday nights this week, and they invite Indivisible groups from across Texas and the nation to hold their own vigils at their member’s offices this week.

UPDATE: Many more vigils are happening!

Is your group holding a vigil? Let us know and we’ll add it to the community calendar.

CBO Score on repeal is out P.S. we’re all screwed

The Congressional Budget Office score is out, and #Trumpcare will throw 14 million people off insurance by 2018, rising to 24 million by 2026. All for a savings on the deficit  $337 billion over 10 years (which is virtually nothing–the US budget for 2015 was $3.8 TRILLION).
 
Per the CBO:
  • Premiums would rise by 15 to 20 percent in the near term
  • 7 million people would lose their employer coverage
  • Increased deductibles and out-of-pocket costs
  • 25% cut to Medicaid by 2026 (still affects states like Texas that didn’t expand Medicaid)
  • The monthly health insurance premium for a single 64-year-old who makes $26,500 would jump more than 700% (from $1,700 to $14,600)
 
You know what to do! Start making those calls NOW:
 
Sen. Cornyn, 512-469-6034
Sen. Cruz, 512-916-5834
Rep. McCaul, 512-473-2357
Rep. Flores, 512-373-3378
Rep. Smith, 512-912-7508
Rep. Williams, 512-473-8910
Rep. Carter, 512-246-1600
Rep. Doggett, 512-916-5921

Sign Up Now to Take Action on ACA Repeal!

Is health care repeal one of your top concerns? Then we hope to see you at the Capitol on March 6, along with 1000+ other health care activists and advocates!

While ACA repeal or replace or who-knows-what will happen in Congress, much of the implementation will be left to the states, especially with respect to Medicaid. That means we need to get in front of our #txlege members and tell them what Texans need!

If you want to #ProtectOurCare, join Indivisible Austin and the Cover Texas Now coalition on March 6 for the Rally to Protect Health Care + Lobby Day. In addition to the morning rally and press conference, you’ll be able to meet with lawmakers and staff in the afternoon. Austin locals may visit their own lawmakers, or they may join up with groups of concerned citizens from across the state–we’ve got people joining in from Dallas/Fort Worth, San Antonio, Houston, the Rio Grande Valley, and El Paso! RSVP is required to prepare materials and lobby groups.

RSVP NOW

URGENT #txlege Opportunity for Action on Jan. 31

URGENT! TEXAS SENATE FINANCE COMMITTEE HEARING ON HEALTH & HUMAN SERVICES, JANUARY 31, 2017!

UPDATE: We just received word that this hearing will recess sometime around 10:30 am, and will likely reconvene some time after NOON. Please plan your day accordingly if you plan to attend to give testimony.

PLEASE RSVP and plan to join us at the Capitol on Tuesday starting at 9 a.m. in room E1.036!

Texans targeted by drastic cuts to the state’s health and human services (HHS) budget (Article 2) need your support on January 31st!

If you think Texas should have a robust Medicaid program, strong supports for children with special needs, provide services to adults with disabilities so they can work and live full lives, and don’t want the Texas legislature to slash funding, SHOW UP.

Come to the Capitol and show your support for resisting the Senate’s proposed budget. We need folks who can:

  • Attend the hearing and keep the room full to show our support for halting cuts to Medicaid
  • Sign up to give oral testimony (more details to come in comments below)
  • Write and turn in written testimony (more details to come in comments below)
  • Speak with the media about how cuts to the state’s Medicaid budget harm them and/or their families.

BACKGROUND:
The committee is taking public testimony on the HHS section of the Senate Budget put forth by Lt. Gov. Dan Patrick and Sen. Jane Nelson. The Senate budget includes nearly half a billion dollars in cuts to health and human services, which would devastate medical care and services that Texas children and families rely on. The Senate bill also fails to provide funding to cover Medicaid for the full two years of the next budget.

People who will be harmed by these cuts include:

  • Children who get their health insurance through Medicaid
  • People with disabilities
  • Low-income seniors, and
  • Pregnant women

Your presence and your testimony can make a difference for millions of Texans.

Unite against Tom Price – or we all pay the price in future healthcare costs

“We are more alike, my friends,
than we are unalike.”

From Maya Angelou’s “Human Family”

If you’ve been paying attention to the news and social media lately, Angelou’s sentiment about our similarities may seem questionable at the moment. We appear to be a nation deeply divided on the majority of issues. To complicate matters further, the press, the pundits, and the politicians sow even more discontent by perpetually highlighting these divisions. No one seems to be able to agree on how to right the ship and sail on to a more prosperous America for all.

However, one of the things that we are mostly united about is the importance of quality, affordable healthcare for everyone.

  • The Pew Research Center recently published a report concluding that sixty percent of Americans believe that the government “should be responsible for ensuring health care coverage for all Americans, compared with 38% who say this should not be the government’s responsibility.”
  • Additionally, in a poll evaluating healthcare priorities for 2017, the Kaiser Family Foundation (KFF) reports that 67% of Americans believe that lowering out-of-pocket healthcare costs is a top priority for the incoming administration.
  • 61% also think that a reduction in the cost of prescription drugs should be a top priority, according to the same KFF study.

These statistics, along with the growing movement to save the Affordable Care Act, indicate that we are not as divided as it may seem. Constituents in both Aurora, Colorado and Spokane, Washington gained national attention by gathering at public events and demanding answers to their healthcare concerns. Despite this growing unification, the incoming administration continues to push repeal. The Congressional Budget Office reports that the repeal will have the opposite effect of what most of us want – in fact, it will result in the loss of coverage for many and the increase in premiums for all.

Tom Price, Trump’s nominee for the department of Health and Human Services, has been an outspoken critic of the ACA. He even authored a bill devised to repeal it. Of further concern is his voting record and stance on reproductive rights. Mr. Price’s policies do not reflect those of the majority of Americans.

It is vital that we keep the pressure on our elected officials to block these nominations and save the Affordable Care Act. Call John Cornyn , Ted Cruz , and your local representative . If you’re at a loss for words, be sure to use the excellent scripts provided here. If possible, organize a group to meet with your representatives about the serious healthcare issues facing us as Texans.

Kendall Shearman

Audio from #SaveACA Conference Call Available

Thanks to everyone who was able to join the call last night, and to our guest speakers.

This week Congress voted to move forward with the process of instructing Committees — including the House Ways and Means Committee chaired by Texas Congressman Kevin Brady — to begin writing up repeal legislation that would go around the normal Senate filibuster process.
Congressional leaders are still aiming to get the repeal legislation to the President’s desk by February 20th.

Many Texas representatives will play important roles in drafting the repeal legislation. Two committees are responsible for the legislation–Ways & Means and Energy & Commerce. Is your member of Congress on this list?

Way & Means:

(D) Lloyd Doggett TX-35 RANKING MEMBER

(R) Kevin Brady TX-8, CHAIR

Ways & Means Health Subcommittee:

(R) Sam Johnson TX-3

(R) Kenny Marchant TX-24

Energy & Commerce

(R) Pete Olson TX-22

(R) Bill Flores TX-17

Energy & Commerce Health Subcommittee

(D) Gene Green TX-29, RANKING MEMBER

(R) Michael Burgess TX-26, CHAIR

Joe Barton TX-6

Additional Texas ACA Resources

Defending Health Care in 2017: What Is at Stake for Texas (FamiliesUSA)

Get Health Insurance Through Your Employer? ACA Repeal Will Affect You, Too (Health Affairs Blog)

Interactive Maps: Estimates of Enrollment in ACA Marketplaces and Medicaid Expansion (Kaiser Family Foundation)

Repealing Federal Health Reform: Economic and Employment Consequences for States (Commonwealth Fund)

You can listen to the call recording here:

The Truth and Consequences of the ACA repeal

During his farewell address, President Obama asked us to remember as we go forward that “…laws alone won’t be enough.  Hearts must change.  If our democracy is to work in this increasingly diverse nation, each one of us must try to heed the advice of one of the great characters in American fiction, Atticus Finch, who said “You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it.”

Essentially, President Obama is asking us to have empathy for one another.

It’s not difficult to empathize with the millions of people who will be affected by the repeal of the Affordable Care Act. Since the Senate’s middle of the night voterama on the morning of January 12th , 2017, which began the repeal of Obamacare, thousands of people have taken to social media ( using the hashtag #SaveACA) and shared the ways in which the ACA has benefited them and what it would mean if it were entirely repealed. Bernie Sanders, as well as other progressives, denounced the repeal as a death sentence for thousands of people per year.

What is more difficult to empathize with is Republican lawmakers’ reckless “repeal and run” attitude towards a program that provides healthcare to many who had limited or non-existent care before now.

As with any new program, the ACA has suffered its share of hiccups and criticisms. One of the main causes for concern among constituencies is how premiums and deductibles rose after Congress passed the ACA. It’s important to understand that one of the reasons this happened is purely political.

When the ACA was passed, Medicaid expansion in the states was intended to be part and parcel of expanding coverage to very low-income people. But many states with Republican leadership declined to expand Medicaid (Texas is the largest state that refused to expand Medicaid).  Likewise, Congress had ample opportunity since the law’s original passage to fix problems that would make the law’s implementation more effective and would positively impact the state insurance marketplaces, but under Republican leadership it has refused.

What is the reported cost to the American taxpayer of this repeal? An estimated $350 billion dollars over the next ten years.

Who does this repeal stand to benefit the most? The wealthiest 400 families in the country. The following graphic illustrates how certain elements of this repeal would stand to benefit those who need no help at all:

Do you disagree with the Republican leaders underhanded tactics in effecting this repeal? Do you think a suitable replacement should be devised before millions of people are left without healthcare insurance? Are you tired of polices that benefit the few while taxing the masses into oblivion?

If you’re in Texas, please call John Cornyn, Ted Cruz, and your district’s representatives. You can access a script in regards to this issue by clicking here. Also, browse this site for other grassroots ways to get involved!

Kendall Shearman

 

*URGENT* #SaveACA Conference Call TONIGHT 7 pm CST

Everyone is invited to join a conference call this evening to discuss critical strategies to oppose the repeal of the Affordable Care Act. Congress began the process of dismantling this law that protects the health and lives of millions of Americans last night.

UPDATE: Tonight’s call will focus on Texas, but the topics and tactics will be useful for anyone interested in advocating to stop repeal and save our healthcare.

Thanks to the Children’s Defense Fund-Texas for convening this informational call!

We’ll be joined by two of Texas’ top healthcare policy advocates at the beginning of the call, and then provide plenty of time for Q&A.

Cheasty Anderson, Health Policy Associate, Children’s Defense Fund-Texas
Melissa McChesney, Healthcare Outreach Coordinator (contractor), Center for Public Policy Priorities

Call-in #: 641-552-9245

PIN: 283674

Simply dial the number above and follow the prompts.

Protest Safety & Verbal Self Defense Training

If you’re gearing up for one of the marches or other actions this month, here’s a good starter guide for Protest Safety (site includes links to more advanced info and a PDF version of the Basic info for printing/sharing).

We also want to offer some training and practice for engaging with our representatives at public events. If you’re interested in a 1-2 hour session that would cover some of the following, please leave a Comment on this post:

  • Grounding and emotional self-regulation techniques for public speaking/civic conflict situations
  • How to take control of the conversation (being rude for the right reasons)
  • Coordinating group action at an event
  • Tactical nonviolence planning essentials

If you have other concerns related to safe engagement, please note those below too, and we’ll try to address them!