ACA Sabotage Part 1: Cost-Sharing Reductions (CSRs)

By Kayla Tarlton

The Trump administration’s ongoing attacks on the Affordable Care Act (ACA) ramped up last Thursday when two different actions were announced on Thursday October 12.  Today’s Trump Sabotage blog addresses one of those actions:   cutting off federal funding for cost-sharing reductions (CSRs).  A blog next week will address the executive order President Trump signed earlier on the same day that further threatens to destabilize the ACA insurance market.

Cancelling CSR Payments

CSR payments are reimbursements owed to insurers to cover the costs of extra out-of-pocket protections given to roughly 7 million low-income ACA marketplace enrollees across the country.

With open enrollment beginning in just a few weeks – November 1 – it is difficult to find any policy or political reasons for ending CSR payments except to cause maximum disruption to the ACA marketplace.

Ending the CSRs is not about deficit reduction. The Congressional Budget Office estimated that ending the payments would not only increase marketplace premiums by 20 to 25 percent and cause insurers to pull out of the market, it would also increase the federal deficit by $194 billion over the next ten years. This is because as premiums rise, the ACA requires that federal subsidies also rise in an attempt to keep insurance affordable.

It isn’t even clear that this is a politically wise move. Ezra Klein of Vox speculates that this decision may be a result of a flawed “theory of dealmaking,” that somehow Democrats will be blamed for hurting the ACA.  Meanwhile, polling evidence shows the exact opposite – Americans believe that Republicans, who are in control of both the presidency and Congress, now “own” the ACA and should be held accountable if it “implodes”.


In setting 2018 insurance rates, some states assumed that CSR payments would continue. In those states, regulators indicated that they will allow insurers to raise their rates and re-file them, even though there is very little time left to get this done. The time crunch means insurers and regulators will have insufficient time to conduct a thorough analysis, possibly leading to higher rate increases than are necessary.

Many other states approved 2018 insurance rates assuming that the CSR payments would not continue. This report demonstrates that 26 out of the 35 states studied attributed a major portion of their 2018 rate increases to this latest act of Trump sabotage.


Governor Malloy responded to the president’s move on Twitter, calling the decision to cut off cost-reduction subsidy payments “vindictive and deliberately designed to sabotage healthcare insurance markets.”  Last Friday, Connecticut’s Attorney General George Jepsen signed on to a lawsuit with many other states seeking an injunction that would force the administration to continue making CSR payments.

Connecticut’s Insurance Department anticipated CSR payments would come to an end when it approved an average additional 16.7% rate increase for 2018, applied to the Silver exchange plans, for increases near 30% in total over 2017 rates. Go here to see more information about approved rates by health plan.  Connecticut marketplace customers who qualify for tax credits to help them pay their premiums will be protected from these rate increases, as their federal subsidies will rise by an equal amount.

However, the 25% of Access HealthCT enrollees that do not qualify for federal assistance will be responsible for these higher premiums. It will be important for these customers to take the time to fully explore their options both inside and outside of the marketplace in an attempt to find an affordable plan that meets their health needs.

What’s Next

To add to the confusion, President Trump told Republican Senator Lamar Alexander by phone on October 14th that he wants to see a bill in Congress that funds the CSRs that he cut off abruptly on October 12. On October 17, Senator Alexander and his Democratic counterpart, Senator Patty Murray, announced they had come to an agreement on a bill to fund the CSRs.  The deal would continue CSR payments through 2019 and restore the $106 million in outreach to encourage enrollment in the ACA exchanges.

Despite this bipartisan agreement, it remains unclear whether the Alexander-Murray bill can pass the Senate and even less clear if it can pass the House, particularly as Paul Ryan just announced he is opposed to it.  The biggest wild-card of all remains President Trump, who alternately praises the bipartisan bill or describes it as an insurance company bailout, showing once again that his I-broke-it-so-Congress-can-fix-it approach is extremely destructive.

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Health Care Action Summit Wrap Up

STAGE1What a day!

On Saturday October 14, two hundred health care activists, advocates and organizations gathered at the Protect Our Care CT campaign’s Health Care Action Summit to:

  • Educate ourselves about key state and federal health care issues
  • Learn more about health policy and advocacy strategies
  • Set the stage for adoption of a Protect Our Care CT action plan for 2018 and beyond that builds our state’s capacity for positive change

The day began with a plenary featuring (l-r):

Following the plenary session, participants attended workshops focused on organizing and advocacy skill-building and on health policy challenges and solutions.

Lunchtime speaker Wendy Fields (Executive Director, Democracy Initiative),  charged attendees with committing themselves to becoming part of a grassroots movement in the state to demand accountability from policymakers for a health care system that benefits everyday people.

The day ended with a reception with invited elected officials.  Both Senator Richard Blumenthal and Representative Elizabeth Esty were able to stop by to offer words of encouragement to attendees.


Be sure to follow us on Facebook, Twitter, Youtube and Instragram for more highlights, photos and videos from the Summit. Don’t forget to sign up for Protect our Care CT’s action alerts here.

Attendees left inspired to keep up the fight against the erosion of health care access and eager to support a health care agenda that delivers on the promise of quality, affordable health care we can ALL count on.

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Defending health care – at the state level

By Rosana Garcia Ferraro

capital3“I think it’s immoral and unconscionable of the state legislature and the governor to allow this to happen,” Offir said. “Connecticut needs a budget but it shouldn’t be created by causing the death of its citizens.” via ctnewsjunkie

Jessica Offir is talking about the impact proposed Medicaid cuts may have on her and many like her who rely on a program called Medicare Savings – a state program which helps low-income seniors and people with disabilities like Jessica pay for care that Medicare doesn’t cover.

She traveled all the way to Hartford – despite her disabilities and fragile health – to tell her story at a press event organized by health care advocates to shine a light on the massive cuts to Medicaid that have been proposed at the state level to balance the budget.

You may remember Jonathan Miller, who told his story at a press event held back in March.  He would be affected by the cut to the same program Jessica was talking about on Tuesday.  This is what he has to say about this proposed cut:

Jonathan (Oct 2017 Quote).png

Closer look at the cuts:

Medicaid cuts proposed in budget negotiations and documents include:

  • Cutting 9,500 low-income parents from Medicaid (HUSKY A)
  • Dropping 68,000 low-income seniors and people with disabilities from the Medicare Savings Program Jessica was speaking about
  • Capping adult dental services to $1000 – which
  • Ending the Community First Choice program, which helps people stay at home
  • $20 million in cuts to the Medicaid expansion program (HUSKY D)
  • $2.2 million in cuts to the Medicaid program for children and parents (HUSKY A)

Read more about the moving stories told in this press conference:

Advocates Rush To Save Healthcare Programs For Low-Income Residents (CT NewsJunkie, 10/10/17)


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Join Us October 14 at Health Care Action Summit

By Lynne Ide

Protect+Our+Care+CTIn early 2017, a network of organizations and individuals that care about health care started the Protect Our Care CT campaign.

The campaign was sparked by a shared desire to protect the positive gains made by the Affordable Care Act, block the erosion of Medicaid, women’s health and Medicare programs – and stand together for state and federal solutions that deliver on the promise of universal quality, affordable health care for everyone.

We believe this is a marathon fight, not a sprint.

On October 14 Protect Our Care CT is hosting a Health Care Action Summit. Please join us!

We are calling state health care activists, advocates and organizations that care about the fight for universal quality, affordable health care to join together and build power to:

  • fight back against the erosion of access to health care
  • build support for a health care agenda that delivers on the promise of quality, affordable health care we can ALL count on
  • require more vision, backbone and accountability from policymakers to help us achieve real change that benefits everyday people

Health Care Action Summit on Saturday, October 14 from 8:45 am – 3:30 pm at Thomas Edison Middle School (1355 North Broad St.) in Meriden. Register TODAY

The Summit will start with a provocative morning plenary.  Jacob Hacker, director of the Institution for Social & Policy Studies at Yale University, an expert on the politics of U.S. health and social policy, will kick off a panel discussion with his latest thinking on how we get to universal health care.  Hacker was one of the leaders in the “public option” approach as a means to achieve universal coverage.

And the day will include a selection of health policy and skill building workshops:

Health Care 101. A beginner’s guide, this workshop focuses on the basics of health policy. Learn about how people are covered and how people get care, with a specific focus on the Connecticut health care environment. The workshop is intended to help people understand the key proposals, debates and issues in current health policy. Rosana Garcia Ferraro, Policy Associate, Universal Health Care Foundation of Connecticut

Why Is Health Care So Expensive and What Can We Do About It? The United States spends twice as much on health care as the next most costly country. Americans are paying more and more out-of-pocket fees for their health care and seeing the cost of prescription drugs go through the roof. This workshop will explore the reasons for our expensive system and then turn to what we can do about it. Chuck Bell, Programs Director, Consumers Union

Bold Ideas for Getting to Universal Health Care. Instead of continuing to play defense against ACA and Medicaid cuts, health advocates are eager to play offense to fight for quality, affordable health care for all. This workshop will give a brief overview of how other countries provide universal health care and then explore some of the bold ideas to reach that goal in the US – at both the state and federal level. Topics covered will include single payer/Medicare for All, Medicare and Medicaid public options, and all-payer rate setting. Participants will explore the pros and cons of these different approaches. Jill B. Zorn, Senior Policy Officer, Universal Health Care Foundation of Connecticut

Leading-Edge State-Based Health Care Reform. States are often described as “laboratories of democracy.” In health care policy, often great ideas that start in one state are adopted by others and sometimes programs that start in states can inspire federal policy. For example, both the national Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA) were modeled after policy initiatives that started in Massachusetts.  In this workshop, we’ll explore some of the progressive health care ideas being proposed and implemented in Massachusetts and other states, focusing on ways to lower costs, promote health and expand access to care. Brian Rosman, Director of Policy and Government Relations, Health Care for All

A Healthy Connecticut Requires Health Equity. Health equity ensures that all people have access to optimal health despite their race, ethnicity, culture, or socioeconomic status. Connecticut is one of the wealthiest states in the country and is often heralded as being one of the healthiest states. Yet, Connecticut also has some of the greatest health disparities in the country. This workshop will explore health inequities in the state and strategies for achieving optimal health for all.  Led by Health Equity Solutions

Organizing the Community to Influence Elected Leaders. Nonpartisan organizing to educate and hold elected officials accountable is key to success in changing the state’s health care debate. This workshop will feature best practices in organizing communities to put pressure on state and local elected officials to protect and advance health care in our state. It will highlight and draw lessons from a successful Bridgeport campaign. We want you to walk away ready to organize to engage elected officials. Brenda Lopez, Lead Organizer; Alison Martinez-Carrasco, Youth Organizer; Luis Luna, Worker Organizer, Make the Road CT

From Message to Action. In this workshop, we will discuss tools and strategies for effective messaging and communications about health care that inform your constituents and move them to take action. We will talk about how to identify your audiences, frame your message, and select your communications channels. The workshop will include a combination of presentations and case studies. Leslie Gabel-Brett, Ph.D., Strategy and Communications Consultant

Your Voice and Your Experience Matter; Advocating for Change in Health Policy. How can YOU make a difference in state and federal policy around health care and other issues? In this interactive session, you will learn from experts in the field how to tap into the power of your own health care experience, along with other strategies and tips on advocating with policymakers – and then practice your new skills! Deb Polun, Senior Director for Policy and Outreach, Community Health Center Association of CT and Susan Yolen, Vice President for Policy & Advocacy, Planned Parenthood of Southern New England

Stories for Social Change: A Workshop for Advocacy Stories. Participants in this workshop will learn about the power of stories to convey the importance of issues related to health care access. They will learn key storytelling concepts and practice techniques for developing stories for different audiences and contexts. Through this process, they will gain confidence in their storytelling, develop strategies for supporting one another, and hone their abilities to connect and persuade. Michaela Blei, Director of Education at The Moth, co-founder of Speech/Act, storytelling-for-advocacy collective and Onnesha Roychoudhuri, co-founder of Speech/Act

Getting Involved in Electoral Campaigns. Whether you are interested in working on an electoral campaign seeking to put a family, friend or neighbor in office – of if you feel compelled to run for office yourself, this workshop is for you. We will unpack and identify the basics of what it takes to successfully volunteer on a campaign or to run for office. Ann Pratt, Director of Organizing, CT Citizen Action Group

Please register TODAY! We need YOU to stand with us

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Continued Threats to Health Care

By Jill Zorn

dreamstime_xs_85425281While Congress is not actively working on overt health care repeal at the moment, major threats to health care programs continue.

ACA Sabotage

Frequent (private jet) flyer HHS Secretary Tom Price may be gone, but the Trump administration continues to up the ante on Affordable Care Act (ACA) sabotage.  Their bag of tricks includes a shorter open enrollment season, shutdown of the enrollment system during crucial weekend hours, huge cuts to advertising and enrollment assistance budgets, and frequent claims that “Obamacare” is imploding/exploding.

Connecticut’s marketplace, Access HealthCT, is protected from some of these efforts.  For example, our exchange controls its marketing and outreach budget and is not dependent on the federal government for that funding.  Still, with disinformation constantly emanating from the federal government, the challenge will be getting the word out that the ACA is a reliable source of coverage and people should enroll.

And Connecticut’s marketplace is certainly vulnerable to some of the forms of sabotage.  Of particular concern is the continued uncertainty surrounding payment of cost sharing reductions that is driving higher insurance rates.   As this blog post explains, the rates set in Connecticut are 16.7% higher on average, based on the assumption these payments will not be received from the federal government.  This poses an extra hardship for people that are not eligible for subsidies based on their income and must pay the full cost of their insurance premiums.

Federal Budget and Tax Reform

Both the House and Senate are working on budget frameworks for 2018 that rely on huge cuts in expenses to partly offset their planned huge cuts to taxes.  At the same time, they are working on tax “reform” which will translate into massive tax cuts for the ultra-rich and corporations, and lead to the need to cut expenses even further.

As with the effort to repeal the ACA, the budget is being drawn up by Republicans only, with no input from Democrats.  And, just as in the repeal fight, the budget could be passed with only 50 Republican votes in the Senate via the budget reconciliation process.

The draft budget under consideration in the House includes:

  • Implementation of the American Health Care Act (AHCA). This was the repeal bill that passed in the House but died in the Senate.  Even though it didn’t become law, the massive cuts to Medicaid in that bill, made by imposing funding caps, are now part of the baseline in the proposed House budget.
  • Proposed cuts to Medicaid and other health programs of $1.5 TRILLION over the next 10 years
  • Cuts to Medicare of just under $500 billion and privatizing the program through vouchers
  • Other major cuts to discretionary programs like SNAP (food stamps) and housing aid

The proposed Senate budget resolution includes similar draconian cuts to health and social service programs.  Once both chambers pass a budget resolution, they will have to come together in a conference committee to reach a compromise on the budget framework and reconciliation instructions.

CHIP Reauthorization

October 1 came and went, without Congress passing legislation to reauthorize the Children’s Health Insurance Program (CHIP).  While Connecticut has sufficient funds to keep our program running through February,  several states are already seeking emergency funding or requesting to curtail enrollment.

The good news is both chambers are currently working on CHIP legislation.  But disagreements on the length of the reauthorization, how to pay for the program and what legislative vehicle should be used to get the measure to the president’s desk could lead to further delays.  As this New York Magazine article points out, any delay poses a fundamental danger to the program:

The longer this all drags on, the more some states will begin curtailing CHIP services, and the more likely it will become that the reauthorization bill will be taken hostage by interest groups looking for must-pass legislation to pull their own pet legislation through Congress. 

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Calling All Health Care Activists: Join Us at Oct. 14 Action Summit

By Lynne Ide 

Protect+Our+Care+CTA broad-based campaign called Protect Our Care CT came together earlier this year to protect positive gains made by the Affordable Care Act, block the erosion of Medicaid, women’s health and Medicare programs – and stand together for state and federal solutions that deliver on the promise of universal quality, affordable health care for everyone.

Activists and advocates across the nation have stopped the GOP-led efforts in Washington, DC to gut health care programs.  But we know they will keep at it.

In Connecticut, the persistent state budget crisis threatens Medicaid coverage, access to health services and public health programs that serve vulnerable individuals and families.

This is a marathon fight, not a sprint. And we need YOU to stand with us.

We are calling state health care activists, advocates and organizations that care about the fight for universal, quality, affordable health care to join together for a:

Health Care Action Summit on Saturday, October 14 from 8:45 am – 3:30 pm at Thomas Edison Middle School (1355 North Broad St.) in Meriden. Register here.

The day will start with a provocative morning plenary.  Jacob Hacker, director of the Institution for Social & Policy Studies at Yale University, an expert on the politics of U.S. health and social policy, will present his latest thinking on getting to universal health care.

Hacker’s presentation will be followed by a lively conversation with State Comptroller Kevin Lembo, Tekisha Everette (Health Equity Solutions), and Tim Foley (SEIU – CT State Council) – all moderated by Frances Padilla (Universal Health Care Foundation of Connecticut).

The lunch speaker is Wendy Fields, executive director of the national Democracy Initiative.  Fields, who started her organizing and advocacy career in Connecticut, will address the power and importance of grassroots organizing as a means for democratic change of our health care system.

The day will also feature ten workshop sessions (one block in the morning and one in the afternoon) on a variety of timely health care policy and skill building topics.

Please join us! Register today: Health Care Action Summit.

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Graham-Cassidy Failed. Now What?

By Jill Zorn


This week marked another failure of Congress to pass a bill to repeal and replace the Affordable Care Act (ACA).   This time it was the Graham-Cassidy bill that couldn’t find the votes to be passed in the Senate and then sent to the House.

As Politico reports,

At one point, the bill seemed to have a real chance of success. And then it ran into the same hurdles that killed every other GOP health plan. Ultimately, a number of Senate Republicans remain wary of transforming the U.S. health system in such a haphazard process — especially with plans to make deep cuts to Medicaid and roll back protections for people with pre-existing conditions.

Why did the bill fail?

A terrible process

The beginning of the end of Graham-Cassidy began on Friday, September 22, when Senator John McCain announced that he could not “in good conscience” vote for the bill.  Just as he had on a previous repeal effort he objected to the rushed and unusual process that broke well-established norms in the Senate for law-making.  Read his statement here.

Another Senator, quoted in Politico, expressed similar concerns about the messy process:

“I can’t be on CNN defending something if it’s in its 27th iteration when I think it’s the third iteration. That’s not the way I do business,” said Sen. John Kennedy (R-La.). “I don’t even know what the last version looked like.”

Too much division within the Republican party

There seems to be no way to satisfy both the extreme right and the more moderate wings of the party.  As Sarah Kliff wrote in Vox:

There is no clear ground between the Senate moderates and conservativesAny future Republican repeal efforts will confront the same obstacle as those we’ve seen fail in recent months. There appears to be no policy middle ground between someone like Sen. Rand Paul (who wanted to see the insurance markets completely deregulated) and Sen. Susan Collins (who wanted to ensure nobody in her state lost coverage).

Supporters of repeal and replace don’t agree on their goals

It turns out that “repeal and replace” is a slogan, not a plan.  Reporter Dylan Scott interviewed policy experts in conservative think tanks for his Vox article, Obamacare Repeal Died Again.  Republicans Have No Plan B:

“There really wasn’t a robust and serious conversation about what is the conservative or Republican solution to health care policy,” Dan Holler, who oversaw the repeal debate for Heritage Action for America, told me. “There was really no consensus within the Republican Party on where to go forward.”

The public is against repeal

The one hearing held on the Cassidy-Graham bill was targeted by a large group of protesters, many of them from the disabled advocacy group ADAPT.  These demonstrators illustrated the reality that Americans were against this bill.  A poll taken just a few days before the hearing showed only 20 percent of those asked approved of the legislation.

The visible opposition of talk show host Jimmy Kimmel may have also helped stop the bill.  Another poll shows voters trusting him more on health care issues than they trust Republicans in Congress.  His message about needing to make sure people with pre-existing conditions retained coverage was one that resonated with the public.

Ironically, the result of the past tumultuous months of repeal attempts is that the ACA is now more popular than ever.

Maybe ACA repeal failed for this simple reason, articulated by Ezra Klein in his Vox article Why Obamacare Survived:

The secret to Obamacare’s persistence is that the American people want the health care system made better — by which they mean they want more people to have affordable health insurance — and Obamacare achieves that goal. By contrast, the GOP, at every single turn, has offered plans to make the system worse.

What’s Next?

The next federal fiscal year begins on Monday.  Does that mean we have to be ready immediately for another attempt at repeal?

The good news is, it seems we will get a brief reprieve, while congress turns its attentions to a tax reform package.  But the bad news is possible repeal of the ACA is not likely to go away completely until there is political change in Washington D.C.

The danger of repeal using the reconciliation process is certainly far from over and this article games out some of the possible routes.  In fact, Senators Graham and Cassidy emerged from a meeting with the president yesterday vowing to hold hearings and keep trying to pass their bill.

At the same time, repealing the ACA next year will not be easy and faces clear obstacles.  And talk of a bipartisan compromise to stabilize the marketplaces is again in the air.

It’s impossible to predict the future in this extremely volatile political environment.  But there is no question that advocates will have to remain vigilant.

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