As health insurance companies begin submitting requests to raise premiums on individual markets drastically in 2019, Democrats see an opportunity to go on offense against President Donald Trump and Republicans over the Affordable Care Act after years of playing defense on behalf of President Barack Obama’s signature accomplishment.
“When those rates go up and coverage goes down, it’s important to remember President Trump and congressional Republicans are fully responsible for the significantly higher premiums and millions fewer people insured,” Senate Minority Leader Chuck Schumer, D-N.Y., told reporters last week.
Protect Our Care, a coalition dedicated to preserving the ACA and opposing the GOP health care agenda, launched a campaign Tuesday to highlight proposed insurance rate increases and heap responsibility for them onto the Trump administration in advance of the November midterm elections.
A “Rate Watch” website, paid media, and coordinated educational efforts will aim to link high preliminary health insurance premiums to Trump’s policies as they are announced in the months ahead.
“Families in every state in the nation are scared by the fallout of Washington Republicans’ repeal-and-sabotage war on health care, and with Rate Watch, we’re holding Republicans responsible for what they’ve done,” said Protect Our Care Campaign Director Brad Woodhouse in a statement. “Every health care expert is confirming what ex-Secretary Tom Price just admitted: Republicans are responsible for hiking people’s premiums.”
He was referring to recent comments by former Trump Secretary of Health and Human Services Tom Price at the World Health Care Congress acknowledging that eliminating the ACA’s individual mandate to purchase insurance as part of the GOP’s tax reform legislation raised costs.
"There are many, and I am one of them, who believes that that actually will harm the pool in the exchange market because you'll likely have individuals who are younger and healthier not participating in that market," Price said.
Rate requests filed in Virginia and Maryland last week appear to validate that prediction. While a couple of Virginia insurers are actually proposing slightly lower rates, others are seeking double-digit increases as high as 64 percent. Health care analyst Charles Gaba estimated the average requested increase in the state is around 13 percent.
In Maryland, the average requested increase is 30 percent. CareFirst BlueCross BlueShield is seeking an 18.5 percent increase for HMO members and a 91.4 percent increase for PPO plans. Kaiser Permanente requested a 37.4 percent increase for its HMO plans.
Maryland Insurance Commissioner Alfred Redmer told reporters he believes the marketplace is in a “death spiral,” and CareFirst and Kaiser both cited the elimination of the individual mandate as exacerbating premium increases. Redmer is hopeful the federal government will approve a waiver for the state to establish a reinsurance fund to stabilize the market.
Insurers in other states are so far seeking less dramatic premium hikes. In Vermont, average proposed increases fell between 7 and 11 percent.
Rates announced in May and June are only preliminary, and they will not be finalized until October. In the meantime, state insurance commissioners may try to get the numbers down or changing circumstances in the markets could lead insurers to reduce their requests.
“There’s some negotiation there and the insurance commissioners have a number of tools to manage costs, but they’re limited in what they can do to negotiate those prices down,” said William Custer, director of the Center for Health Services Research at Georgia State University.
Final rates will vary widely by state and by insurer, but many of the millions who purchase insurance on the individual markets are likely to learn their rates will skyrocket in 2019 weeks before the midterm elections. Democrats blame Trump for that and they expect voters will too.
“On his first day in office, President Trump signed an Executive Order to undermine the health care system – no matter the consequences – and he’s been rooting for it to fail ever since. Now, people who work for a living are going to pay the price,” Woodhouse said.
Signaling their intent to capitalize on the issue, Senate Democrats released a report last week accusing Trump and Republicans of “health care sabotage.”
“Trumpcare is very much alive today—and patients and families are paying the price,” the report stated, listing steps Trump has taken to undermine the markets and recounting his many past statements promising “insurance for everybody” and “something far better for the people.”
Schumer held a press conference with Sen. Patty Murray (D-Wash.) and Sen. Ron Wyden (D-Ore.) last Tuesday to trumpet the report’s findings in front of a poster with Price’s quote on it.
“We Democrats are going to be relentless in making sure the American people exactly understand who is to blame for the rates,” Schumer said. “The Republicans control the Senate, the House, the presidency. When the rates go up, especially after all their actions, it’s on their back and they know it.”
Health care experts say policy changes driven by the Trump White House and Republicans in Congress are causing insurance rates to rise for those who continue to rely on the Obamacare markets, even if they provide flexibility and lower costs for others.
“Since the Trump administration began, they have worked backwards in removing some of the programs that increase enrollment and more importantly increase enrollment among better-risk individuals,” Custer said.
By reducing marketing funds, refusing to continue paying cost-sharing subsidies to insurers, zeroing out the individual mandate penalty, and encouraging the use of short-term and association health plans that do not meet Obamacare benefit requirements, the Trump administration has made it easier and less expensive for healthy consumers to opt out of the ACA marketplaces.
“When you only attract sicker people, you have higher claims costs and higher premiums,” Custer said.
A report issued by America’s Health Insurance Plans earlier this year cited the elimination of the individual mandate and new federal regulations that “could destabilize the risk pool” as two of three major factors contributing to higher premiums for 2019. It also suggested reinstating cost-sharing subsidies as a means to mitigate the increases.
Republicans contend changes they implemented have increased consumer choice and enabled some families to stop paying for insurance coverage they do not need and cannot afford. They point to years of rapidly rising costs on the exchanges under Obama and argue the system was already falling apart when Trump took office.
“Make no mistake: this is solely caused by Obamacare,” Sen. John Cornyn, R-Texas, tweeted Monday in response to Schumer’s complaints about proposed rate increases in Vermont.
According to Custer, though, the markets appeared likely to stabilize last year after some particularly steep adjustments in 2017 rates, but the Trump administration’s policies promptly injected uncertainty into insurers’ plans.
“It’s impossible to prove a counter-factual, but the general consensus among actuaries and insurers was that the market was stabilizing,” he said.
Democrats insist they are still open to bipartisan solutions to control health insurance costs. In a USA Today op-ed Tuesday, Sen. Murray stressed that lawmakers have found plenty of common ground on the issue before and they still have time to revisit it before rates for 2019 are finalized.
“As more insurers file rates demanding patients pay the price for the health care sabotage we’ve seen this past year, and as some Republicans throw in the towel on bipartisanship and point fingers, I want any Republican who is interested in solutions, not partisanship, and who is focused on helping patients, not special interests, to know that I’m still ready to get back to work,” Murray wrote.
She recalled working with Senate Health Committee Chairman Lamar Alexander, R-Tenn., on a bipartisan package to lower costs and stabilize markets that nearly passed in March. She blamed Republican leadership for initially blocking a vote and then inserting “extreme policies” on abortion coverage and other issues into the bill that Democrats could not support.
However, Republicans maintain Democrats rejected overtures to greatly reduce premiums because they refuse to fix a fundamentally broken law. In a Senate floor speech last week, Sen. Alexander said he sees no hope for an agreement with Democrats, so he is urging the Trump administration and state governments to step in to assist patients.
“By their words and by their actions, what Democrats really were saying was: we won’t change one sentence of Obamacare, even parts that obviously are not working, and even when most of their caucus supports the changes,” Alexander said.
According to Gary Nordlinger, a political consultant and an adjunct professor at the George Washington University Graduate School of Political Management, the “you break it, you buy it” argument might work for Democrats, but it may not be as easy to sell as they think.
“Anytime you have to explain in a political campaign, it makes your job more difficult,” he said. “I don’t think you can just blame Republicans. You have to connect the dots for voters and that’s the challenge.”
The midterm elections will be a referendum on President Trump and the changes he has instituted. The rising cost of insurance and the millions more people who are uninsured now than in 2016 could be part of an effective Democratic narrative about Trump’s failings.
“It can’t be the only thing they focus on,” Nordlinger said. “I think you’ve got to do a broader message.”
Despite the new Democratic PR push, Republican strategist Matt Mackowiak doubts either party will want to make health care a central element of their midterm campaigns. Republicans failed to repeal and replace Obamacare, but Democrats cannot fully shirk responsibility for a bill they voted into law.
“It’s hard for me to believe Democrats are going to be able to effectively blame Republicans for a bill named after the previous Democratic president,” Mackowiak said. “I don’t think that dog will hunt.”
The new Democratic digs over insurance costs come as their advantage in public opinion polls continues to narrow. In a generic ballot matchup, the Democratic lead over Republicans has shrunken from double digits to just five points, according to the RealClearPolitics average.
“I do think the political environment is improving [for Republicans], and its improving because the president is improving his numbers…,” Mackowiak said, pointing to recent positive developments in the economy and foreign policy. “There’s a lot of success there and the public is responding to it.”
He is unsure if it makes sense politically for Democrats or Republicans to pursue bipartisan solutions to rising premiums between now and November, but he suggested legislative time to do it will be limited if Democrats continue to demand the full 30 hours of debate permitted on Trump nominees.
“The Democrats are choosing to waste thousands of hours of floor time for no reason whatsoever,” he said.
According to Nordlinger, a genuine centrist campaign to reduce insurance costs in time to impact 2019 rates could pay off for both parties, even if it nullifies attack lines that appeal to their bases.
“When you get outside the hard core of both parties, the great majority of people in this country love bipartisan cooperation,” he said.