Republican Sabotage of Our Health Care System

U.S. Congress sealDemocrats in the House Committee on Energy and Commerce and the Senate Committee on Health, Education, Labor, and Pensions recently released a report warning that Republican actions are causing uncertainty in health insurance markets that is resulting in higher premiums and insurers pulling out.

A Manufactured Crisis: Trump Administration and Republican Sabotage of the Health Care System is summarized here with quotes from insurance companies and regulators across nearly 20 states.

EXECUTIVE SUMMARY (full text, but without the citations)

The best thing politically is to let Obamacare explode. (President Donald Trump in an interview with The Washington Post, 5/24/17)

The Trump Administration dedicated its first six months in office to sabotaging the health care system for partisan gain, threatening to reverse years of progress that have reduced the uninsured rate to historic lows. These destructive efforts by the Administration are causing uncertainty for insurers, which is resulting in significantly higher premiums for consumers.

Perhaps even more egregiously, President Trump and Congressional Republicans are using this manufactured crisis to justify their efforts to pass Trumpcare, which will cut taxes for the wealthiest Americans and special interests while cutting nearly $1 trillion in funding from Medicare and Medicaid. Trumpcare will result in tens of millions more uninsured and impose higher costs on working families, including older adults and individuals with pre-existing conditions. Republicans claim that “Obamacare is in a total death spiral,” as a justification for passing this tax cut bill masquerading as a health bill. But they cannot pretend they are acting to improve the health care system while they are actively working to undermine it.

This report provides an overview of the emerging evidence of the damage that the Trump Administration and Congressional Republicans have inflicted on the individual market. It provides a preliminary analysis of the impact of the Trump Administration’s actions and the impact of legislative uncertainty on premiums and stability in the marketplace, by analyzing the insurance rate filings to date. It will be updated as additional information becomes available.


Why the hell would we? (President Donald Trump, on making CSP payments, 5/19/17)

Since President Trump assumed office in January 2017, his Administration has repeatedly acted to sabotage the health care system. On his first day in office, President Trump signed an Executive Order that directed the Secretary of Health and Human Services and the heads of government agencies to defer, delay, or waive certain provisions of the Affordable Care Act (ACA), creating vast uncertainty in the marketplace. Since then, his Administration has refused to commit to making cost-sharing reduction (CSR) payments [to insurers] and failed to commit to enforcing the individual mandate. These cynical attempts to manufacture a crisis have caused uncertainty in the marketplace and have prompted insurers to sharply increase premiums for the upcoming plan year. …


  • “There now is clear evidence that this uncertainty is undermining the individual insurance market for 2018 and stands to negatively impact millions of people.” (the American Medical Association (AMA), America’s Health Insurance Plans (AHIP), Blue Cross Blue Shield Association (BCBSA), and others, 5/19/17)
  • “The vast majority of this has been caused by the current administration and by Congress, not by the ACA.” (Community Health Choice, Texas)
  • “The continued uncertainty caused by fluctuating directions from Washington could have a disastrous impact on the individual health insurance market in 2018.” (Colorado Insurance Commissioner)
  • “The most immediate drivers of instability are the weakening of the individual mandate, the uncertain status of funding for the cost sharing reductions and the absence of funding for overall market stabilization measures.” (Pennsylvania Insurance Commissioner and five insurance companies)
  • “If the federal government’s full CSR funding commitments are in jeopardy, we believe that the viability of the exchange market is in immediate jeopardy of failing.” (Molina Healthcare of Washington, Inc.)
  • “This uncertainty adds more unpredictability to the rate process and introduces an uneasy level of market volatility, compromising the ability to set adequate rates responsibly.” (Anthem Blue Cross and Blue Shield of Connecticut)
  • “With the unknown of cost-sharing-reductions funding … we have great uncertainty for what insurers will be participating in the market and where rates could land for 2018.” (Utah Department of Insurance)
  • “[CareFirst] tacked an extra 15 percent onto its premiums because it does not expect the Trump administration to enforce the individual mandate.” (Chet Burrell, Chief Executive of CareFirst)
  • “Without enforcement of the coverage mandate, membership is expected to drop, with the healthier individuals more likely to forego coverage. This will drive up the average cost of health care for the individual market.” (Harvard Pilgrim Health Care, Maine)
  • “Failure to enforce the penalty for not having health insurance could result in total premium increases of more than 28 percent, and up to 350,000 consumers who would otherwise get coverage likely going uninsured in 2018.” (Covered California)

CONCLUSION (full text)

Republicans are undertaking concerted efforts to sabotage the health care system by introducing instability into the individual insurance market. By choosing not to make CSR payments, providing unclear direction about enforcement of the individual mandate, and generally creating uncertainty about the future of our health care system, the Trump Administration is forcing insurers to raise premiums for the 2018 plan year. These actions are threatening to make health care inaccessible and unaffordable for millions of Americans.

In defending Republicans’ attempts to jam Trumpcare through Congress, Senate Majority Leader Mitch McConnell recently said, “Doing nothing is not an option.” Yet independent experts agree that the individual market would be stable if not for the Trump Administration’s sabotage.

President Trump and Congressional Republicans are manufacturing instability in the marketplace as a false pretense for passing a major tax cut for the wealthy and special interests. This cynical effort is being paid for with draconian cuts to the health care system, and on the backs of millions who need access to affordable coverage. Both President Trump and Congressional Republicans should be held responsible for these cynical and destructive actions.

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