public health, Trump Administration

The silent killer of the Affordable Care Act

Screen grab from one of the HHS videos used as part of a multi-pronged social media campaign against the ACA.

A new report from the Daily Beast found that the Trump Administration is quietly using taxpayer money to undermine the Affordable Care Act, which remains law despite the Senate’s best efforts.  Tom Price, the Secretary of Health and Human Services, released a series of 23 testimonials videos featuring individuals describing how they have been burdened by the Affordable Care Act (ACA). The videos appeared on YouTube last month and have only accumulated a few hundred views each.

While this may seem like a small spiteful action, the money to produce these videos came from the “consumer information and outreach budget” which is intended to be used for informing the public about the ACA and encouraging enrollment.

In addition to the videos, HHS has pushed a multi-pronged social media campaign against the ACA. Not to mention, one of Trump’s first actions as President was to effectively kill ACA commercials with just 5 days left in Open Enrollment. This resulted in 424,000 less people enrolling in health insurance when compared to enrollments during the same time in the previous year.

This all seems relatively inexpensive, but the Trump Administration requested  $574 million for this specific budget item, though HHS declined to detail how much it has devoted to specific line items.

The true silent killer of the ACA has been reconstruction of the HHS.gov website. The website refuses to refer to the Affordable Care Act by name, replacing it with “the current law.” All info-graphs outlining the benefits of the ACA and key information, such as links to HealthCare.gov and critical enrollment dates, have been removed altogether. The website encourages consumers to use “private sector alternatives” instead of the Health Insurance Marketplaces established under the law.

HHS has also altered the HealthCare.gov website, removing the “Cost and Savings” tab where consumers can find information about where to find prices, if they have to pay penalties, or if they qualify for savings.

Needless to say, the Trump Administration is disregarding its responsibility to administer the Affordable Care Act and is putting significant resources into sabotaging the law through all means necessary. By quietly publishing anti-Affordable Care Act propaganda and removing vital information about the law from government websites, the Trump Administration continues to strip citizens of their rights under the ACA.

Andy Slavitt, former director of the Center for Medicare and Medicaid Services, puts it this way: “you’re not hired into the administration to decide whether you agree with the law you’re asked to execute. That’s not your job… Congress appropriates funds for you to carry out laws that they passed, not to spend those funds on activities that counteract those laws.”

Sydney Idzikowski is an MSW inter at the NC Justice Center

 

NC Budget and Tax Center, public health, Trump Administration

Warning: Last-ditch GOP effort offering $200 billion to buy votes won’t fix unfixable Senate health bill

Earlier this week we reported that the Senate GOP health “repeal without replacement” proposal would do great harm to NC, as it would double the number of uninsured in North Carolina.

Unfortunately, the latest is that in a last-ditch effort to save their bill to repeal the Affordable Care Act (ACA), Senate Republican leaders are reportedly offering $200 billion to win the votes of senators from states that expanded Medicaid under the ACA.

Here’s a brief explanation from the Center on Budget and Policy Priorities:

“This new fund would presumably supplement private coverage for those who gained Medicaid coverage under the expansion but would lose it under the Senate bill.  No senator should fall for it. While $200 billion seems like a lot of money, it’s only 17 percent of the bill’s $1.2 trillion in cuts: $756 billion from Medicaid and $427 billion from subsidies to help low- and moderate-income people buy coverage in the individual market.”

Overall, it is clear that this additional money would do nothing to fix the major and fundamental problems that the bill would create:

  • It would do nothing to offset the Medicaid cuts resulting from the per capita cap, which would affect children, seniors, and people with disabilities in all states.  These cuts would shift ever-increasing costs to states, forcing the states to respond by making ever-deepening cuts in eligibility, benefits, and provider payments.
  • It would do nothing to address the bill’s harm to people with private coverage, including the loss of coverage for millions of people (due largely to sharp cuts in marketplace subsidies), increased costs for those who stay covered, and the loss of access to health care for millions with pre-existing conditions.
  • It would do nothing to address the fact that millions of lower-income marketplace consumers in non-expansion states (like North Carolina) would see their deductibles jump many thousands of dollars under the Senate bill.

No one should be fooled:  The reported $200 billion cannot fix this bill, and does not come close to undoing coverage cuts.

Here’s what would really help, as we stated earlier this week:

“Based on the facts, it is clear that NC’s two U.S. senators should support the idea of starting from scratch with a different, bipartisan approach that leaves Medicaid aside and focus on making real improvements to marketplace stability and affordability.”

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

NC Budget and Tax Center, public health

Senate GOP health “repeal without replacement” proposal would do great harm to NC

By now many have heard that the proposed Senate GOP “repeal and replace” health care bill is dead after some Senate Republicans could not support it. However, the bad news is that Senate Majority Leader Mitch McConnell says they will now pursue a vote to repeal without replacement. McConnell announced last night that the vote— which is expected to fail — will occur next week, at President Trump’s request.

What does this mean for North Carolina? If the Senate proceeds to repeal the ACA without a replacement, the number of uninsured North Carolinians would rise (and double) from 1.1 million to 2.1 million in 2019 alone. Furthermore, Federal government investments on North Carolina’s health care would be reduced by $1.6 billion in 2019, and by $59 billion from 2019 to 2028, because the Medicaid expansion, premium tax credits, and cost -sharing assistance would be eliminated.

This type of negative impact on the state’s most vulnerable and on the state’s budget is dangerous considering we recently reported that North Carolina is not on track to achieve its 2020 health objectives, and that the legislature’s Fiscal Research Division has projected state budget shortfalls of $1.2 billion to $1.4 billion in fiscal years 2019-20 to 2021-22.

Based on the facts, it is clear that NC’s two U.S. senators should support the idea of starting from scratch with a different, bipartisan approach that leaves Medicaid aside and focus on making real improvements to marketplace stability and affordability. We now know that it would not be in North Carolina’s best interest to see the GOP health bill, or elements of it, arise down the line and in other forms.

What would “Repeal without Replace” do?

Sen. McConnell now says that he plans to bring to a vote a version of the 2015 Affordable Care Act (ACA) repeal reconciliation bill that President Obama vetoed. Assuming a similar timeline to the 2015 version, that bill would:

  • Completely end expansion as of Jan. 1, 2020. There would be no phase-out and no statutory option for states to keep their expansions, even if they could afford to do so at regular match.
  • Completely eliminate the ACA’s tax credits and cost sharing subsidies – with no replacement – as of Jan. 1, 2020.
  • Immediately repeal the ACA’s high-income and corporate taxes, cutting taxes for households with incomes over $1 million by over $50,000 per year.
  • Immediately repeal the ACA’s individual and employer mandates.

What would the consequences of “Repeal without Replace” be?

The Congressional Budget Office (CBO) analyzed the consequences of this approach in January 2017, and found: Repealing much of the Affordable Care Act (ACA) would cause 32 million people to lose coverage by 2026 and roughly double premiums in the individual insurance market. Specifically, the report showed:

  • Coverage: 18 million people would lose coverage in 2018, 27 million would lose coverage by the early 2020s, and 32 million would lose coverage by 2026.
  • Individual market premiums: Compared to current law, premiums would be 20-25 percent higher in the first year, 50 percent higher by the early 2020s, and would double by 2026.
  • Individual market stability: By the early 2020s, about half of U.S. population would live in areas with no individual market insurers, increasing to 75 percent by 2026. Essentially, the individual market would collapse in most of the country.

According to the Urban Institute:

“The vast majority of those becoming uninsured would be members of working families (82percent), and more than half (56 percent) would be non-Hispanic whites. The vast majority of adults becoming uninsured would lack college degrees (80 percent).”

Luis A. Toledo is a Public Policy Analyst for the Budget & Tax Center, a project of the North Carolina Justice Center.

Environment, Governor Roy Cooper, public health

“People of NC require your protection”: Gov. Cooper urges EPA to quickly set a safety standard for GenX

Gov. Roy Cooper: Asking the EPA for multiple health studies about GenX

Gov. Roy Cooper sent a letter to EPA Administrator Scott Pruitt today seeking “urgent action to get us answers and solutions” about the health risks of GenX in drinking water. “We need the EPA to move more quickly to finalize its health assessment of GenX and set a maximum contaminant level for it,” Cooper wrote.

GenX is a byproduct of the manufacture of Teflon and non-stick surfaces. Chemours, a spinoff of DuPont, has discharged GenX into the Lower Cape Fear River for decades, but only within the last 18 months have scientists from the EPA and NC State University discovered the chemical in the water. Since then, GenX has been detected at high levels in the drinking water leaving the public utility plants — no traditional treatment method removes it — although the amounts have decreased over the past three weeks since Chemours stopped discharging it into the river. Residents in parts of Brunswick, Pender and New Hanover counties, including the City of Wilmington, presumably have been drinking GenX-contaminated water.

An emerging contaminant, it is not regulated, and thus the EPA has not set a health standard for it. However, last week the state health department set a health goal for GenX of no more than 140 parts per trillion — a drastic reduction from the original 70,000 ppt DHHS had proposed.

The EPA, DuPont and Chemours already agreed to a 2009 consent order requiring the companies to reduce the amount of C8, a chemically similar precursor to GenX, in drinking water of residents living near the Washington Works facility in Parkersburg, W.V. However, as Cooper wrote, Chemours has stated that it believes the order doesn’t apply to the Fayetteville plant. “I ask that the EPA revisit this consent order immediately and modify it to apply to any and all release of GenX.”

 

7-17 Letter to Epa_0 by LisaSorg on Scribd

NC Budget and Tax Center, public health

Latest data: NC will not come close to 2020 health objectives; legislature’s policy failures implicated

One of North Carolina’s goals is “to be one of the healthiest states in the nation.” However, the reality is that our state is not on track to reach this goal anytime soon.

Every 10 years since 1990, North Carolina has set decennial health objectives with the goal of making North Carolina a healthier state. In 2011, the state identified 13 major health focus areas and established 41 objectives and targets to be meet by the year 2020. According to our state’s health improvement plan, “Healthy NC 2020: A Better State of Health”:

“The case for improving the health of individuals throughout the state is strong…the improvement of population health is an important economic development strategy, because health is a form of human capital and as such is a significant “input” into our economic system.”

Unfortunately it appears our state will fall woefully short of achieving the goals outlined in its health improvement plan. Analysis of the latest state data and overall health rankings finds the following:

  • North Carolina is not on track to achieve major health objectives by 2020.

The state is not likely to meet targets for 32 out of 41 health objectives (78 percent) by 2020. At the current pace it would take the state 48 more years (or until the year 2065) to achieve all of its 2020 targets. As a result, 12 out of the 13 (92 percent) state’s major health focus areas are negatively affected and not likely to be successful in achieving the 2020 objectives related to them.

  • North Carolina is worse off in 18 key health objectives compared to nine years ago. In other words, instead of making progress, certain conditions have gotten worse.

Major health objectives in our state that are worse off today compared to nine years ago include: the unintentional poisoning mortality rate; the percentage of individuals aged 12 years and older reporting illicit drug use; the suicide rate; the rate of mental health-related visits to emergency rooms; the percentage of people spending more than 30 percent of their income on rental housing; the percentage of adults who have had permanent teeth removed due to tooth decay or gum disease; the number of critical violations per restaurant/food stand; and the percentage of adults with diabetes. Read more