Speaker Nancy Pelosi

U.S. House of Representatives

SOTU FACT SHEET – President Trump: Failing Hard-Working American Families on Health Care

February 4, 2020
Blog
President Trump Is Engaged in All-Out Assault on Americans’ Health Care, Especially Protections for People with Pre-Existing Conditions

Leading up to President Trump’s State of the Union on Tuesday night, February 4th, our office is sending out a series of reports entitled “President Trump: Failing Hard-Working American Families,” on President Trump’s record since he took office in 2017 and how his claims match up with reality.  This is one of those reports.

One specific health care issue on which President Trump is failing hard-working families is prescription drug costs.  Earlier today, our office sent out a separate fact sheet on this topic, entitled “President Trump: Failing Hard-Working American Families on Prescription Drug Costs.”


While engaging in the last three years in an all-out assault on Americans’ health care, President Trump has broken every single one of his campaign health care promises.  Not surprisingly, a recent poll by the Kaiser Family Foundation shows Americans disapprove of President Trump’s handling of the Affordable Care Act by 56 to 35 percent and his handling of prescription drug prices by 54 to 30 percent.  

THE FACTS: President Trump Is Actively Working to Destroy Protections for Pre-Existing Conditions and Every Other Protection and Benefit of the Affordable Care Act

REALITY: Actually, President Trump is urging federal courts to strike down every last provision of the health care law, including protections for people with pre-existing conditions.

In addition, the nonpartisan Congressional Budget Office concluded that the “Trumpcare” Repeal and Replace bill, passed by the House, would have gutted pre-existing conditions protections, increased premiums, and led to 23 million Americans losing health coverage.

The facts are that President Trump spent all of 2017 working to end the protections for pre-existing conditions and all of the other protections and benefits of the ACA through his Trumpcare legislation, passed by the House and then blocked in the Senate, to repeal and replace the Affordable Care Act.

Having failed to undo the Affordable Care Act by legislation, President Trump and Republicans have turned to the federal courts and are suing in federal court to strike down every provision of the ACA, including the protections for pre-existing conditions.

Trump/GOP ACA Lawsuit: After Recent Ruling from Fifth Circuit, The Threat Posed by Trump/GOP Lawsuit To Strike Down All Of The ACA, Including Protections For Pre-Existing Conditions, Is Still Very Much Alive

On December 14, 2018, a very conservative federal district court judge in Texas issued a ruling in the Trump/GOP ACA lawsuit, striking down all of the provisions of the ACA, including the protections for people with pre-existing conditions.

  • On the day of the ruling, after spending months telling Americans how much he supported protections for pre-existing conditions, President Trump immediately praised on Twitter the judge’s decision to strike down these protections.  Again, the next day, he spoke to reporters and said the judge’s decision was “Great news for America.” 

The ruling by the federal district judge was then appealed to the Fifth Circuit Court of Appeals.  On December 18, 2019, the Fifth Circuit ruled, 2 to 1, with Republicans against the individual mandate and asked the same conservative judge in Texas, who had previously struck down the entirety of the ACA, to determine next steps, including the possibility of striking down the ACA again. 

Hence, the ruling by the Court of Appeals keeps the threat to pre-existing conditions protections and the other key ACA protections and benefits very much alive.

If the Trump/GOP ACA lawsuit is ultimately successful, it will end protections for people with pre-existing conditions, strip coverage from millions of Americans, put insurance companies back in charge, and force seniors to pay more for prescription drugs, as seen below.

If the Trump/GOP ACA lawsuit ends up being successful in striking down the entirety of the ACA:

GONE:  Protections for 130 million Americans with pre-existing conditions.  The uninsured rate will increase by 65 percent.
GONE:  Medicaid expansion, which covers 17 million people.
GONE:  Nearly 12 million seniors will have to pay more for prescription drugs because the Medicare ‘donut hole’ will be reopened.

GONE:  2.3 million adult children will no longer be able to stay on their parents’ insurance.

GONE:  Insurance companies will be able to charge women 50 percent more than men.

GONE:  Financial assistance that helps 9 million people purchase health care in the marketplace.

GONE:  Key support for rural hospitals.  As Americans lose coverage, already struggling hospitals will be hit even harder as their costs increase.

GONE: Ban on insurance companies having lifetime limits on coverage.

GONE:  Requirements that insurance companies cover prescription drugs and maternity care.

THE FACTS: President Trump & the GOP Have Been Sabotaging Americans’ Health Care – Increasing Americans’ Health Care Costs

Here is an overview of just some of the acts of sabotage of Americans’ health care by President Trump and Congressional Republicans since January 20, 2017 – which have raised Americans’ health care costs.

  • Executive Order Undermining Health Care on First Day: From his very first day in office, President Trump has worked to sabotage Americans’ health care, including issuing an executive order on the first day urging agencies to take steps to undermine the ACA.
  • To Depress Enrollment, Slashed Open Enrollment Period in Half:  In February 2017, President Trump made it harder for people to sign up for coverage by cutting the open enrollment period in half – from three months to six weeks.
  • Passed GOP Bill to Repeal and Replace ACA, Which Would Have Significantly Increased Premiums:  On May 4, 2017, House GOP passed the “Trumpcare bill,” the GOP bill to repeal and replace the ACA.  According to the CBO, the bill would increase premiums by 20 percent, lead to 23 million more Americans being uninsured, remove protections for pre-existing conditions, and implement an age tax.  
  • Slashed Funding for Advertising/Outreach about Enrollment by 90 Percent and Funding for Navigators by 41 Percent for 2018:  On August 31, 2017, President Trump also made it harder for people to sign up for coverage by slashing funding for public outreach about open enrollment by 90 percent.  He also slashed funds for Navigators who assist individuals to sign up for coverage from $63 million in 2017 to $36 million in 2018 – a cut of 41 percent. 
  • Stopped Federal Cost Sharing Payments, Increasing Premiums by 20 Percent in 2018:  On October 12, 2017, President Trump suddenly terminated the key ACA payments that help reduce out-of-pocket costs for individuals.  CBO stated that this action would increase gross premiums by 20 percent in 2018 and by 25 percent a year in 2020 and beyond.  Although many people in the Marketplaces are protected from this increase, the action significantly increases costs for the 15 percent not receiving subsides.
  • Added Elimination of Individual Mandate Penalty to GOP Tax Scam Bill, Resulting in Increasing Premiums by 10 Percent A Year and 13 Million Losing Coverage:  In December 2017, President Trump pushed for this provision to be included.  According to CBO, the elimination of the penalty will result in 13 million more uninsured Americans and premium increases of 10 percent a year.
  • Slashed Funding for Navigators Even Further for 2019:  In 2017, the Trump Administration had slashed funding for Navigators from $63 million in 2017 to $36 million in 2018.  Then, on July 10, 2018, the Trump Administration slashed the funding once again, cutting it from $36 million in 2018 to only $10 million in 2019. Hence, over a period of just two years, Navigator funding was cut from $63 million to $10 million – a cut of 84 percent. 
  • Issued A Final Rule Promoting Junk Plans for Individuals, Increasing Premiums for People with Pre-Existing Conditions:   On August 1, 2018, the Trump Administration issued a final rule encouraging individuals to purchase Junk Plans which don’t provide essential coverage and exclude people with pre-existing conditions.  These plans are projected to have a dramatic impact on undermining the protections for people with pre-existing conditions.
  • Issued Guidance on Section 1332 Waivers Allowing States to Drastically Weaken ACA’s Consumer Protections:  On October 22, 2018, the Trump Administration issued guidance on Section 1332 waivers, allowing states to drastically weaken ACA’s consumer protections and allowing states to even use federal premium tax credits to subsidize consumers enrolled in junk plans.  This guidance is also projected to have a dramatic impact on undermining the protections for people with pre-existing conditions.
  • Conservative Judge Struck Down the ACA In Its Entirety, In The Lawsuit Brought by President Trump and the Republicans:    On December 14, 2018, in Texas vs. U.S., a very conservative federal district court judge struck down all of the provisions of the ACA as unconstitutional, although the ruling was stayed pending appeal.  Overriding precedent, the Trump Administration’s Justice Department refused to defend the law of the land – the ACA – in court.  Democrats have appealed this outrageous ruling to the Fifth Circuit Court of Appeals.  
  • Issued A Final  Rule for Marketplaces for 2020 That Makes It Harder for Consumers to Compare Plans:  On April 18, 2019, the Trump Administration issued the final rule for 2020 Marketplaces that, among other things, would allow third party websites to enroll people directly, which could make it harder for consumers to compare plans and to get the information they need to pick a plan that meets their needs.
  • Federal Court of Appeals Ruling in Trump ACA Lawsuit Keeps the Threat to Pre-Existing Conditions Protections and Other Key ACA Benefits Alive:  Most recently, on December 18, 2019, the Fifth Circuit Court of Appeals ruled, 2 to 1, with Republicans against the individual mandate and asked the same conservative judge in Texas, who had previously struck down the entirety of the ACA, to determine next steps, including the possibility of striking down the ACA again. 

THE FACTS: As A Result of The Trump/GOP Sabotage, Since Trump Became President the Rate of Uninsured Is Now Going Up For The First Time Since 2010

A report by Kaiser Family Foundation on the uninsured, which was issued on December 13, 2019, found that the number and rate of uninsured has gone up under President Trump, after years and years of the uninsured rate dropping since the Affordable Care Act was enacted in 2010.

Specifically, the report finds:

  • After the number of uninsured nonelderly Americans reached a height of 46.5 million in 2010, the year the Affordable Care Act was enacted, it then declined every single year between 2010 and 2016 – with 19.8 million nonelderly Americans gaining coverage during that period.  Similarly, the uninsured rate steadily dropped from 17.8 percent in 2010 to an historic low of 10.0 percent in 2016.
  • However, since the inauguration of President Trump, the number of uninsured and the uninsured rate are now once again rising – with 1.2 million more nonelderly uninsured in 2018 than in 2016.  Similarly, the uninsured rate is on an upward trajectory, growing from 10.0 percent in 2016 to 10.4 percent in 2018.

THE FACTS: After Promising As A Candidate “No Cuts” To Medicare, President Trump Has Proposed Medicare Cuts In His Budgets And Says He Is Open To Medicare Cuts After The 2020 Election

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”  [Candidate Donald Trump’s Interview with Daily Signal, May 21, 2015]

“I was the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare and Medicaid.”  [Tweet by Candidate Donald Trump, May 7, 2015]

REALITY:

  • Despite his campaign promises, President Trump’s budgets have proposed cuts in Medicare.  For example, in his FY 2020 budget, President Trump proposed a cut in Medicare of $500 billion over 10 years.
  • Also, in an interview with CNBC on January 22, President Trump opened the door to cuts in Medicare and other entitlement programs after the 2020 election.  As the New York Times reported, “Asked in an interview with CNBC if cuts to entitlements would ever be on his plate, Trump answered yes.  ‘At some point they will be, Mr. Trump said. … ‘At the right time, we will take a look at that.’  Mr. Trump suggested that curbing spending on Medicare, the government health care program for the elderly, was a possibility. ‘We’re going to look.’”

THE FACTS:  After Promising As A Candidate “No Cuts” to Medicaid, Trump Has Been Consistently Assaulting Medicaid and His New Illegal Block Grant Scheme Would Now Gut Medicaid

“I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”  [Candidate Donald Trump’s Interview with Daily Signal, May 21, 2015]

“I was the first and only potential GOP candidate to state there will be no cuts to Social Security, Medicare and Medicaid.”  [Tweet by Candidate Donald Trump, May 7, 2015]

REALITY:

  • Despite his campaign promises, President Trump’s budgets have proposed substantial cuts in Medicaid.  For example, in his FY 2020 budget, President Trump proposed a cut of $1.5 trillion in Medicaid over 10 years. 
  • Also, on January 30, 2020. the Trump Administration unveiled its radical, illegal Medicaid block grant proposal.  Under this plan, states would have broad authority to limit Medicaid spending for certain low-income residents. This Medicaid block grant plan is the most audacious step yet by the Trump Administration to roll back Medicaid – opening the door for states to cut Medicaid, including Medicaid benefits.  This remaking of Medicaid would lead to spending cuts and fewer benefits – likely leading to millions losing coverage.
  • The impacts of this Medicaid block grant program, if taken up by a number of states, could have an enormous impact over time.  Some key points about the possible impacts of the radical, illegal Medicaid block grant proposal include:
    • As AARP has said, “Letting states cap funding in the Medicaid program could put at risk the health coverage for millions of vulnerable Americans.  Capping the program’s program funding structure and limiting benefits and services could leave millions without the coverage and care they need.”
    • Millions of Americans could be affected by these block grants. The millions of low-income adults without children who obtained coverage under the ACA’s Medicaid expansion could be included under a block grant.  In addition, a state could decide to include certain pregnant women and low-income parents because their coverage is not mandated by federal law. 
    • States joining this block grant program would be able to make new cuts to their Medicaid benefits, including which prescription drugs are covered, and to impose new out-of-pocket costs on enrollees.  For example, states could change what kinds of co-pays Medicaid enrollees are required to pay.