Dismantling the Affordable Care Act

Four Moves by the Trump Administration to Weaken Obamacare

The Trump administration continues to chip away at the health care law commonly known as Obamacare. 

The full name of the law is the Patient Protection and Affordable Care Act (ACA), and both patient protections and affordability are under attack.

1. Do You Have a Preexisting Condition?

Despite candidate Donald Trump's promises, President Donald Trump is going after protections for people with preexisting conditions.

In February, 20 Republican state attorneys general sued the federal government, saying that the removal of the ACA's individual mandate (see section 3 below)—a change that was tucked away in last year's tax overhaul—has made the whole Affordable Care Act unconstitutional.

The Justice Department has now refused to defend the ACA against this suit, arguing that "the parts of the law guaranteeing coverage to people with health conditions and charging them the same rates should be struck down" along with the individual mandate. (Kaiser Health News, June 8, 2018)

Result: If health insurers are once again allowed to deny coverage to people with preexisting conditions or charge them outlandish rates, those of us who have preexisting conditions will once again be uninsurable on the individual market. (With the Justice Department aligning itself with the ACA's Republican challengers, Democratic state attorneys general will be defending the ACA in court.)

2. Coverage That Doesn't Cover Much

To ensure that health insurance actually provides comprehensive coverage, the ACA established 10 essential health benefits, all of which must be provided to patients without annual caps on the dollars spent.

© Families USA

On June 19, the US Department of Labor issued a rule that will allow policies to be sold that do not have to include these 10 vital benefits and that can once again cap benefits for coverage in these essential areas. These small-group policies will be available to associations covering small businesses or groups of people in the same profession or geographic area. 

Result: While these policies will likely be less expensive, they will not provide comprehensive coverage, potentially leaving people without coverage (or with very limited coverage) for such basics as pregnancy, mental health issues, and prescriptions.

And because healthy people who are currently purchasing health insurance on the state insurance exchanges may head instead for these cheaper but substandard options, the costs for those left in the exchange (who may be less healthy) will likely rise.

3. Removing the Individual Mandate

These developments come on top of earlier moves to remove portions of the ACA that were designed to keep health insurance affordable. To make sure that everyone had coverage, and to keep costs down (the bigger the pool, the lower the premiums and out-of-pocket costs), the ACA included what's known as the individual mandate—a requirement that most Americans either purchase health insurance or pay a fine. (The insurance industry was in full support of this mandate provision.)

Shortly after his inauguration, President Trump issued an executive order that in effect stopped enforcement of the individual mandate, and the Republican tax code overhaul last fall removed it as of January 2019.

Result: The individual mandate made exchange policies more affordable by bringing more, and healthier, people into the exchanges. With fewer and less healthy people in the exchanges, insurers will continue to raise premiums.

And, of course, those who now opt not to carry health insurance have no coverage if an emergency or a health condition should arise. (Which will in turn increase the financial burden on hospitals as the number of unpaid patient bills rises. In health care, everything is connected.)

So, now we are faced with returning to many of the health challenges we faced before passage of the ACA. And there is more . . .

4. Increasing Patients' Share of Medical Costs

President Trump also ended the ACA's cost-sharing reduction payments to insurers, which were federal dollars going to insurance companies (and passed along to hospitals and doctors) to help low-income consumers afford their deductibles and other out-of-pocket costs.

Result: Hospital costs, which are already rising, are expected to increase even further to compensate for the growing inability of low-income patients to cover their deductibles and copays.

Health Security: Marching On & Gaining Ground

At the Health Security for New Mexicans Campaign, we continue our important work to gain support for a different approach to health care coverage. We recently welcomed two new member organizations: Retake Our Democracy and the Santa Fe chapter of Democratic Socialists of America.

Our support is growing—thank you!—but we need your help to ensure that Health Security remains an issue in the 2018 elections. So, please:

• Let candidates know how you feel.

• Get educated about the Health Security Plan. Let us know if you want to take a workshop.

• Spread the word to your friends, neighbors, and coworkers!

In line with that last point, check out our new quarter-page handout—and print out a few to keep with you, in case you meet someone who wants to learn more. Our talking points are also helpful for explaining Health Security to others.

Dana Millen on the Air

Dana Millen at KFUN in Las Vegas, NM, April 2018

Dana Millen, the Campaign's education and outreach coordinator, is a very busy woman.

She presents to groups who are interested in learning about the Health Security Act, updates Campaign member organizations, and runs Health Security bill workshops and speakers' trainings.

Since local people know their own communities best, she reaches out to individual Health Security supporters to help her set up meetings with organizations and community leaders in their cities or towns.

Dana also uses opportunities like radio shows to educate a broader audience. An interview recorded in May for the KSFR (Santa Fe) radio program Retake Our Democracy ran on June 30; you can listen to it here. 

Dana has a master's degree in public health and a PhD in interdisciplinary studies, with a focus on public policy and leadership. She worked for the Campaign from 2003 to 2012 and returned in 2017, after spending 5 years as manager of the New Mexico Department of Health's Comprehensive Cancer Program with the Chronic Disease Prevention and Control Bureau in Albuquerque. Earlier in her career, she spent 7 years as a community health developer in rural communities in southern New Mexico.

Mini Handout (For All Occasions!)

At our statewide meeting at the end of April, several people requested a smaller, more concise Health Security handout—something they could print out and give to interested friends or colleagues, or pass out at an event. So we put together this two-sided, quarter-page mini handout:

To print out at home, click here. For best results, print out "actual size" rather than "fit to page." And remember, it's double-sided!

If you're printing out multiple copies at a print or copy shop, and the shop is doing the cutting, click here for a version without cutting guidelines. 

Debut in Los Alamos

Our mini handout had its public debut in Los Alamos, where Health Security supporters Tyler Taylor, Susan Gisler (pictured below), and Galen Gisler (pictured below) put together a Health Security table at Chamberfest. 

April 28 Statewide Meeting

(Photo courtesy of Malcolm Panthaki)

Report on the April 28 Statewide Meeting in Albuquerque

Executive Committee chair Max Bartlett and Executive Committee member Maury Castro opened the meeting, which was packed with supporters from around the state.

Attendees appreciated morning appearances by several candidates for governor and lieutenant governor, all of whom expressed their support for Health Security. 

Michelle Lujan Grisham spoke in the early morning, and Jackie Apodaca and other representatives from Jeff Apodaca's campaign were introduced a little later in the day. Candidate for lieutenant governor Sen. Howie Morales, who (along with Sen. Carlos Cisneros) sponsored the Health Security Act in the Senate, addressed the crowd in the morning, as did Rick Miera, who is also running for lieutenant governor. 

While the Campaign is a nonpartisan organization and does not get involved in campaigns for political office, we welcome candidates' support for the Health Security Act. We're excited to see that Health Security is an important issue for these candidates! 

Our first scheduled speaker was Rev. David Rogers of First Christian Church in Carlsbad, who urged attendees to take action and to get involved to make Health Security happen.

Rev. David Rogers (photo courtesy of Willard Hunter)

Next up was a discussion of the Campaign's unique strategy, with Max Bartlett, Executive Committee Chair; Mary Feldblum, Executive Director; and Dana Millen, Education and Outreach Coordinator. 

They emphasized that the Health Security Act has been developed over many years by listening to New Mexicans across the state and by coming up with solutions to the problems they raised regarding setting up our own health care plan. Dana also noted that few people know that we worked with Sen. Jeff Bingaman to ensure that the Affordable Care Act included waivers for state innovation, an important provision that is still in place today.

Mary Feldblum, Executive Director; Max Bartlett, Executive Committee Chair; and Dana Millen, Education and Outreach Coordinator

Rep. Debbie Armstrong, who (along with Rep. Bobby Gonzales) sponsored the Health Security Act in the House in 2017 and plans to do so again in 2019, then took the microphone--we actually had a sound system this time!--to talk about the path to Health Security. 

She emphasized that even after passage, Health Security will take time to implement, and she noted that there are interim solutions being proposed--like a Medicaid buy-in option--that could help people in the meantime.

Rep. Debbie Armstrong (photo courtesy of Malcolm Panthaki)

After Rep. Armstrong spoke, Rep. Gail Chasey, Sen. Bill Soules, and Sen. Liz Stefanics joined her for a panel discussion on the importance of talking to candidates about Health Security and letting them know why you personally support it--tell your story! In addition to talking to candidates, they noted that a good way to spread the word about Health Security is through the groups and organizations that you belong to. There was also time for the audience to ask panel members questions.

Rep. Gail Chasey, Rep. Debbie Armstrong, moderator Mary Feldblum, Sen. Bill Soules, and Sen. Liz Stefanics

In the afternoon, a panel of experienced Health Security supporters and organizers gave their advice, and meeting participants had another chance to ask questions and offer suggestions.

John Mezoff, MD; Mitch Rekow, Albuquerque Teachers Federation; moderator Dana Millen; Roberto Roibal, CWA and SouthWest Organizing Project; and Lorie MacIver, RN, National Union of Hospital and Health Care Employees District 1199

Some ideas from attendees:

• Create a "speakers bureau" of people who are able to present on and speak knowledgeably about Health Security
• Set up meetings/presentations to and with a variety of groups
• Get the word out through tabling at other events
• Develop a brochure and/or other brief materials that supporters can download from the website and hand out to interested individuals (We're working on this!) [UPDATE: click here for a quarter-page handout.]

Thank you to everyone who came! So much wonderful energy!  

Next Steps

Everyone who came to the statewide meeting left with a personal list of actions they are going to take to help get Health Security passed in 2019. (Thank you, everyone!)

If you weren't able to attend the meeting, here are some ideas. Let us know what you're able to do to help!

Statewide Meeting Agenda

Statewide Strategy Meeting, Saturday, April 28, 2018

For a printable version, click here.

A Light Legislative Session

March 7 was the last day for the governor to sign—or veto—bills passed by the 2018 legislature, bringing this year’s legislative season to a close. What happened regarding health care reform this session? In a nutshell, not much.

• While there were concerns about major cuts to Medicaid, the Medicaid budget survived in relatively reasonable shape.
   
• We were watching two health-care-related memorials—which, unlike bills, do not need the signature of the governor and do not have the force of law.
   
  • HM9/SM3, which passed the house and the senate, asks the Legislative Health and Human Services Committee to explore the economic feasibility of a Medicaid buy-in option. Such an option would allow low-income, uninsured New Mexicans who are not eligible for Medicaid to purchase coverage administered by Medicaid.
     
  • SM7, which passed the senate, requested the Superintendent of Insurance to convene a task force that would examine options to strengthen the increasingly fragile individual insurance market. The memorial pointed out that congressional and presidential actions to weaken the Affordable Care Act have led to a 34% increase in individual health insurance premiums in New Mexico for the 2018 plan year.
     
• Senator Jeff Steinborn’s 2017 bill requiring agencies to engage in bulk purchasing of drugs was not found to be relevant to this budget session and therefore was not able to be heard. The bill, which passed both houses in 2017, was vetoed by the governor last year.

Health care costs and coverage issues clearly remain major concerns, and they have emerged as campaign issues for this election cycle.

With the 2018 session behind us, we’re gearing up for the elections—as well as for the 2019 legislative session, when Health Security will be introduced.

Your participation at our statewide strategy meeting is important. Please plan to join us in Albuquerque on April 28!

Attacks on Obamacare Not Over

The Affordable Care Act—Still Vulnerable to Attack

While the latest attempt* to repeal and replace the Affordable Care Act (Obamacare) has been abandoned, Republican efforts to dismantle the ACA are unfortunately far from over.

First, there are many ways to sabotage the ACA without an outright repeal. In fact, one of President Trump’s first actions in office was an executive order intended to stop enforcement of the individual mandate—the ACA’s requirement that everyone either have health insurance or pay a fine.

And the president’s unwillingness to commit to paying ACA subsidies to insurers (so-called cost-sharing reduction payments) has contributed to a 36% to 41% increase in premiums for next year’s policies available through New Mexico’s insurance exchange (Albuquerque Journal, 09/21/17).

As people drop coverage because they can no longer afford it, or because they think they will no longer have to pay a penalty if they are uninsured, the insurance exchanges set up under the ACA will become even less sustainable.

Second, the push to repeal continues. Even though outright repeal is dead for the moment, Republicans in Congress are already preparing for their next attempt to kill off the ACA. 

—Washington Post, 09/28/17

Sen. Graham, co-sponsor of the failed Graham-Cassidy repeal bill, said earlier this week, "We are coming back to this after taxes" (USA Today, 09/26/17). Some members of Congress apparently don’t want to wait that long. As Congress moves to tackle tax reform, there is talk of continuing with ACA repeal efforts as part of the tax reform process. (See this Politico article for more details.)

This fixated effort to virtually destroy Medicaid and throw millions into the ranks of the uninsured will not stop. Even the united opposition of the insurance industry, hospitals, doctors and nurses, and advocacy organizations like AARP has not put a damper on this desire to follow through with what was promised for seven years—the repeal of Obamacare.

* The Center on Budget and Policy Priorities put together a summary of exactly what the Graham-Cassidy bill would have done—from rolling back the Medicaid expansion to dramatically weakening protections for people with preexisting conditions.

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On the home front, there continues to be growing interest in Health Security. Our basic flyer is a great handout for friends and colleagues who want more information.

And if you belong to an organization (social, professional, political, or activist!) please let them know about Health Security. We are always happy to give a presentation, and working through organizations is often the most efficient and effective way to reach a new audience.

Guess Who Supports Large Health Risk Pools?

We don’t know whether the disastrous Senate efforts to “repeal and replace Obamacare” are really, really dead. Like zombies, bills can resurface.

What intrigues us is that those opposed to the Senate bill have come from a very diverse range of organizations: the American Medical Association, the American Hospital Association, AARP, unions, many advocacy groups, and (hold your breath) the insurance industry!

The insurance industry has been surprisingly public and vocal in its opposition to the Republican proposals to allow insurance companies to offer cheap, bare-bones policies and to abolish the individual and employer mandates to purchase insurance. (And, of course, they oppose all the proposed reductions in federal dollars for Medicaid and for subsidizing the policies bought by individuals on the state-based insurance exchanges—dollars that end up in their pockets!)

We want to alert you to a fascinating letter addressed to the Senate majority and minority leaders (Sens. Mitch McConnell and Chuck Schumer) and signed by two large insurance associations: America’s Health Insurance Plans and the Blue Cross Blue Shield Association.

Talking about Sen. Ted Cruz’s “Consumer Freedom Option” in the Republicans’ Better Care Reconciliation Act (the bill prior to the “Skinny Repeal” bill that failed last Friday), the letter states that offering bare-bones policies, “is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market.”

Their explanation as to why a bill with this provision is “unworkable” is based on a principle that is fundamental to the success of the Health Security Plan: large risk pools. In the letter, they refer to a recent report from the American Academy of Actuaries. The report succinctly explains the benefits of large risk pools:

Basically, pooling those with higher costs with those who are healthy results in spreading out the costs. “In general, the larger the risk pool, the more predictable and stable the premiums can be.”

The key to a stable risk pool, then, is not separating the healthy and the not-so-healthy into two separate pools. Such a separation (which the bare-bones policies allowed under the “Consumer Freedom Option” would permit) will inevitably result in higher premiums for the sick and those with pre-existing conditions.

Since what is being proposed by the Senate Republicans is a voluntary system (no more mandates to purchase insurance), many of the healthy will choose not to purchase insurance. Others will purchase the cheap, bare-bones policies. Those who have greater medical needs will have no choice but to remain in more expensive plans with more comprehensive coverage.

If an insurance pool, even a large one, attracts a disproportionate number of individuals with costly medical conditions, premiums will be higher than if that risk pool included an “average population.”

Does this not sound like a justification for the NM Health Security Plan? With almost all New Mexicans covered under one plan, the risk would be shared. And, under Health Security, premiums would be based on income, not health status.

No one is immune from a potential health disaster due to illness or an accident. Therefore, sharing the risk is the core concept of insurance.

It does not take a brainy economist or actuary (or a brain surgeon!) to understand that premiums will be more “predictable and stable” under such a system.

A large risk pool—like the Health Security Plan's—would also simplify life for the state’s health care providers and hospitals, which currently have to deal with so many plans with different copays, deductibles, and covered services.

What Have We Been Up To Lately?

Our Work Continues

While we've been keeping abreast of what's been happening at the national level, our work is right here in New Mexico. Exactly what have we been doing since the legislative session ended in March? Take a look below.

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Presentations and meetings with groups around the state—newly active groups, religious groups, provider groups, neighborhood groups.

Want to arrange a presentation to your group? Let us know.

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Bill workshops in Albuquerque, Las Cruces, and Santa Fe

A bill workshop in Santa Fe, hosted by DSA Santa Fe and held at YouthWorks.

At our bill workshops, people learn how to navigate through the Health Security Act to find answers to their questions. These workshops are a chance to really delve into the details that participants want to know about. They also give attendees experience reading and understanding legislative language.  

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Statewide strategy meeting in Albuquerque

Health Security supporters came from as far away as Española and Taos to the north; Gallup to the west; and Silver City, Hillsboro, Las Cruces, and Roswell to the south for this one-day event. Santa Fe, Placitas, Albuquerque, Corrales, and Belen were also represented!

Participants introduce themselves at the beginning of the statewide meeting.

The statewide meeting started off with inspirational words from Pastor Roger Powers of St. Andrew Presbyterian Church, who spoke about the moral imperative of providing health care and the need to pass this legislation. 

Next up was an interview of Health Security Act sponsor Rep. Debbie Armstrong, conducted by none other than Max Bartlett, the Campaign’s chair. Debbie shared her insights about the 2017 legislative session.

Sen. Bill Tallman speaks from the legislative panel.

After her interview, Debbie was joined by three other legislators—Rep. Joanne Ferrary and Sens. Jerry Ortiz y Pino and Bill Tallman—for a panel (moderated by Campaign executive director Mary Felblum) that focused on next steps and effective ways to move the Health Security Act forward. 

Bill Jordan, of New Mexico Voices for Children, then spelled out the current health care situation, both in the state and nationally.

One of the afternoon breakout groups.

After lunch, breakout groups came up with action priorities for the next year, and those who were newer to the Health Security Plan had a chance to learn more about this paradigm-shifting approach.

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Growing Support

Our email list and our membership continue to grow: new member organizations in 2017 include New Mexico Voices for Children, Street Safe New Mexico, and the Northern New Mexico Central Labor Council.

In addition, the New Mexico Medical Society recently passed a resolution to encourage private foundations to fund a financial analysis of the Health Security Plan.

Help Health Security gain even more support by talking to your friends, neighbors (and anyone else you meet!) about this New Mexican solution.