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Sen. Warner’s Office Analyzes “Trumpcare’s Impact on Virginia”


From Sen. Mark Warner’s office:

Today, Senate Republicans will publicly release draft changes to the House-passed Trumpcare bill to repeal the Affordable Care Act. Senate Majority Leader Mitch McConnell (R-KY) has said that he expects to vote on the proposal – a bill affecting one-sixth of the American economy that no Democratic Senators have yet seen and which was written in a secretive, backroom process by Republican staffers – next week.

While the legislation is expected to differ in part from the bill that passed the House on May 4, Republicans are expected to leave in place the vast majority of the House proposal, which independent experts have determined would result in healthcare coverage that covers less, costs more, and lead millions to lose coverage altogether – all while cutting taxes for the wealthiest Americans.

Below, you will find some relevant background to help inform any editorials you may write.


This is not the way the Senate should work. Normally, the Senate would hold hearings—with experts, doctors, patients, and stakeholders – in full view of the American public. A bill would be worked up through committees and senators would have the opportunity to review the bill and suggest changes.

No – this isn’t “the same thing Democrats did.” When the Senate considered the Affordable Care Act, the Senate Finance and HELP committees held nearly 100 hearings and roundtables. Both committees considered hundreds of amendments and both accepted dozens of Republican amendments. Instead of an open, transparent, bipartisan process, Senate Republicans developed their proposal in secret. They are planning to jam through a bill that will have devastating impact on the health and financial security of people across the country without giving Democratic colleagues, states, stakeholders, consumers or patients  the opportunity to evaluate it.


In 2016, almost 400,000 Virginians purchased health insurance through the federal insurance marketplace. Of those who purchased their own insurance on the marketplace, 84 percent received tax credits to help lower their premiums, and more than half – 59 percent – received cost-sharing payments to help defray other out-of-pocket costs.

Trumpcare would raise premiums. The non-partisan Congressional Budget Office (CBO) estimates that Trumpcare would increase individual market premiums by 20 percent in 2018, largely due to elimination of the individual mandate. In Virginia, that means the average premium would increase by $972.

And older Virginians would pay even more. Trumpcare weakens the Affordable Care Act rule that limits how much insurers can raise prices based on age. Trumpcare would allow insurers to charge older enrollees five times more than younger enrollees starting in 2018 (versus the three times as much under current law.) Average premiums would increase for all ages starting at about age 46, and the AARP, among other consumer groups, has noted that this is an “age tax” for older Americans. The Senate’s version of the bill is also expected to allow higher premiums for older people. Under Trumpcare, a 64-year-old Virginian making $26,500 a year could expect to pay an age tax of$12,000 more for their health care premiums than under current law. Moreover, the elderly and disabled account for two-thirds of Medicaid spending; it will be difficult to protect this vulnerable population as Trumpcare massively cuts the Medicaid program.

Paying more for less coverage. Trumpcare will allow states to waive the requirement in the Affordable Care Act that insurance plans cover certain basic benefits, such as maternity care, prescription drug coverage, and mental health care. If Republicans in the state legislature eliminated federal essential health benefits, people would face “substantial increases” in out-of-pocket spending for these benefits, according to the CBO. The CBO says enrollees would face additional costs in the “thousands of dollars in a given year” for services such as maternity or mental health. Eliminating essential health benefits could affect nearly every Virginian, including those who receive health coverage through their employers.

Trumpcare also allows states to undo the protections that prohibit insurance companies from charging more for consumers based on their health status. Under that scenario, the CBO has said that “people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.” The alternative solutions put forward by Republicans – high-risk pools for those with pre-existing conditions – don’t work. Thirty-five states had them before the Affordable Care Act, and they were chronically underfunded, outrageously expensive, and provided insufficient access to care.


Trumpcare would blow a hole in Virginia’s budget. In FY 2016, Virginia received about $4 billion in federal Medicaid funds – 51 percent of the state’s funding for people covered by Medicaid. Virginia historically has run one of the leanest Medicaid programs in the country, with lower reimbursement rates than many other states. But as a result of the steep cuts to Medicaid in Trumpcare, Virginia would be forced to pick up an additional $900 million in costs for Medicaid over the next ten years in order to maintain the same level of care.

That would leave Virginia with three choices: (1) raise taxes; (2) cut funding from things like schools, roads, and economic development; or (3) cut benefits, enrollment, and/or reimbursement rates to hospitals and medical providers across the Commonwealth.

Medicaid cuts don’t just hurt the poor – they would also jeopardize care for children and middle class Americans. About half of all births in this country are covered by Medicaid. In Virginia, about one in three childrenrelies on Medicaid for their health care – which would be in jeopardy under Trumpcare.

Medicaid also covers the long-term care costs of two-thirds of Americans living in nursing homes, many of them middle-class Americans who spent all of their savings on care before becoming eligible. In Virginia, 15 percent of all seniors and people with disabilities rely on Medicaid for their care.

With an average of three Virginians dying each day from an opioid overdose, Trumpcare would also be disastrous for the battle against the opioid crisis. It could upend coverage for millions of Americans who are guaranteed access to behavioral health services, including substance abuse treatment, as a result of the Affordable Care Act. Medicaid is the primary payer of behavioral health services in the Commonwealth. 12 percent of adult Medicaid beneficiaries live with some form or a substance abuse disorder, and Medicaid finances one-third of the medication-assisted treatment administered for opioid and other substance use disorders in the country. All of that would be in jeopardy.


While Senator Warner is the first to acknowledge that Congress must act to improve the Affordable Care Act to encourage market stability and ensure greater affordability, actions taken by the Trump Administration are undermining our health care system.

Both public and private analyses released earlier this year showed that the individual marketplaces were relatively stable and improving, and that insurers, on average, were getting closer to break-even margins. A March 2017 analysis from the non-partisan Congressional Budget Office said that “under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increase in premiums…The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable.”

An April 2017 Standard & Poor’s (S&P) report found that “2016 results and the market enrollment so far in 2017 show that the ACA individual market is not in a ‘death spiral.’” The analysis found the health insurance market is set for stability and profitability as long as the Administration is not “disruptive.” Despite the fact that experts have said the individual health insurance market has been showing signs of stabilization, moving toward profitability, the Administration and Congressional Republicans have put this progress at risk.           

President Trump signed an Executive Order undermining the law. On January 20, 2017, his first day in office, President Trump signed an executive order telling federal agencies, to the extent permissible, to exempt, delay, or defer any Affordable Care Act provisions that impose a cost or penalty on individuals. Health insurers and experts have been clear that undermining the enforcement of the individual responsibility requirement will weaken the risk pool, which in turn drives up premiums. The Congressional Budget Office estimated that repealing this provision could raise premiums by up to 20 percent and that“substantial uncertainty about enforcement of the individual mandate” could lead insurers to withdraw from the marketplace.

The Trump Administration has deliberately undercut outreach and enrollment efforts. On January 26, 2017, the Trump Administration cut 75 percent of television advertising and all digital advertising for the final week of health insurance enrollment, resulting in an estimated 500,000 fewer Americans purchasing coverage. Based on previous open enrollments, the last week has been proven a critical time for enrolling younger, healthier enrollees. The U.S. Department of Health and Human Services Inspector General is now investigating the Administration’s actions to end outreach activities abruptly before the open enrollment period ended.

President Trump will not commit to making Cost-Sharing Reduction Payments, creating market instability. President Trump continues to threaten to withhold $7 billion in annual cost sharing reduction (CSR) payments that lowers consumers’ deductibles and co-pays. The National Association of Insurance Commissioners wrote in a letter to Office of Management and Budget Director Mick Mulvaney in May 2017 that “the uncertainty of this funding [CSR payments] could add a 15-20 percent load to the rates or even more.”

And you don’t have to take our word for it. The week before Aetna announced it would not be selling insurance plans in the Virginia market next year, the company’s CEO pointed directly to the Trump Administration’s threat to eliminate cost-sharing reductions as a move that put too much uncertainty into the system. He said he believes it’s time to admit that the ACA needs to be fixed, not repealed.

Senator Warner has been pressing the Administration for months to stop playing politics with the stability of Virginia’s healthcare markets.

Instead of improving our health care system, President Trump said letting it explode is the best strategy. The President has made repeated comments suggesting the best strategy is to let our health care system fail. At the White House on March 24, 2017, the President said “the best thing we can do politically speaking is let Obamacare explode.” The President was asked if he would let our health care system explode, and he responded: “Bad things are going to happen to Obamacare. There’s not much you can do to help it. I’ve been saying that for a year and a half.”

But that’s not true – Senator Warner has proposed a number of commonsense improvements to the Affordable Care Act, to fix what isn’t working, and strengthen the parts that are helping Virginians access affordable, quality health insurance.


Senators Warner knows that there is more to do to improve the health care system in our country, and stand ready and willing to work with anyone to improve the existing law to increase affordability for Virginia families.

  • Senator Warner’s Expanded Consumer Choice Act would create a lower-cost, higher-deductible “copper” plan option that covers the essential health benefits and consumer protections required by the ACA, which analyses have shown could decrease the cost of premiums by as much as 17 percent.
  • Senator Warner’s Commonsense Competition and Access to Health Insurance Act would allow insurers to offer coverage across state boundaries, which would increase choice and competition among plans, potentially driving down costs while maintaining quality and value.
  • Senator Warner’s Commonsense Reporting Act would improve flexibility and affordability for employers by streamlining the amount of paperwork they need to fill out for their employees’ health care coverage.
  • Joe Mancini

    Well said, Senator. We are seeing a tsunami coming that will wash away much of the social safety net, and the next targets will be Medicare and Social Security (AHCA eliminates over a half-billion in taxes that have helped to stabilize Medicare). I hope you are submitting this as an op-ed to every newspaper in Virginia.

    ~ On Senate Trumpcare proposal ~

    WASHINGTON — U.S. Sen. Mark R. Warner (D-VA), a member of the Senate Finance Committee, released the following statement after Senate Majority Leader Mitch McConnell (R-KY) released draft text for a Republican healthcare repeal bill:

    “This bill would kick millions of people off their insurance, raise healthcare costs for Virginians, especially seniors, and leave states on the hook for hundreds of millions of dollars for Medicaid, which provides coverage for some of our most vulnerable citizens – including the elderly, the disabled, and one-third of Virginia’s children. At the same time, it gives the wealthiest Americans a huge tax break.

    “The American Medical Association, the American Cancer Society, the American Heart Association and the AARP have all said that Republican plans will reduce access to affordable health insurance, and put people with pre-existing conditions at risk. This is cruel, harmful and short-sighted.

    “Instead of trying to jam this bad bill through Congress on a party-line vote, President Trump and Senate Republicans should work with Democrats to strengthen and improve the Affordable Care Act.”

  • Beyer Statement On Unveiled “Health Care” Legislation Text

    June 22, 2017 (Washington, DC) – Rep. Don Beyer issued the following statement today after Senate Republican leaders lifted the veil of secrecy on their draft “health care” legislation:

    “All legislation begins with goals. The goal of the Senate GOP bill unveiled today, like that of the House bill already passed, is not to improve health care, but rather to deliver a massive tax cut to the super-rich and eliminate health care for millions of Americans.

    Nearly 70 million Americans are enrolled in Medicaid today, a program which would be dramatically slashed if this bill is passed into law. These cuts would be particularly harmful for seniors, children, veterans, individuals suffering with addiction like those affected by our current opioid epidemic, individuals with mental illness, individuals with disabilities, and low-income Americans.

    Cutting taxes for the wealthiest among us while hurting these millions is not just ‘mean.’ It would exacerbate the opioid epidemic and eliminate many Americans’ ability to participate in society and be taxpaying citizens.

    It would do irreparable harm to millions of Americans.”


    WASHINGTON, D.C. – Today, U.S. Senator Tim Kaine, a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, released the following statement on the release of the Senate Republican health care bill:

    “Senate Republicans kept their health care bill completely secret from the American people until the 11th hour, and now we know why. This bill isn’t just mean; it’s cruel. It would hurt Virginians – particularly seniors, children, people with disabilities, and working families – all to deliver a giant tax break to the wealthiest Americans and shift costs to the states. It slashes Medicaid, hurts the 22,000 Virginians who rely on Planned Parenthood for health care, weakens health benefits, and raises health costs for Virginia’s families at a time when we should be working to lower costs. It also shatters President Trump’s promises that no one would lose coverage or pay more. Passing this bill would mean less money in thousands of families’ pockets in Virginia alone and fewer options for affordable, high-quality health care.

    “When I speak to doctors and health care experts, they worry about the serious consequences of upending the current health care system for political gain. When I speak to Virginians, they are fearful about an outright repeal of the Affordable Care Act and instead want Republicans and Democrats to work together on improvements to the law. That’s what Congress should be doing: listening to their constituents, patients, and providers about how we can keep improving health care for everyone, not rushing to pass a bill that would cause so much pain.”

    ~on Senate Health Care bill~

    Attorney General Mark R. Herring issued the following statement on the Senate’s proposed health care bill:

    “At a time when families across the Commonwealth and the country are facing a devastating heroin and opioid crisis, this Senate bill makes the challenge more difficult, just like the House bill. That is dangerous and downright irresponsible. We should be using every resource necessary to combat this epidemic and ensure no additional family has to endure the pain of losing a loved one to an overdose.

    This bill also slashes Medicaid funding, rips health care away from hundreds of thousands of Virginians, and recklessly defunds Planned Parenthood, which would restrict access for more than 20,000 Virginia women who rely on the organization for safe, affordable healthcare. As Attorney General, I have fought to protect accessible healthcare for all Virginians, and I promise to never stop fighting. I hope Democrats and Republicans can agree that this is the wrong approach, and instead come together to work on proposals to strengthen our healthcare system for everyone.”

  • Virginia House Democratic Leader David Toscano:

    “The second Republican health care plan is no longer a secret-and it looks just as bad as the House Republicans’ plan. It will only create more problems for Virginians. We are lucky to have Mark Warner and Tim Kaine fighting for us in the U.S. Senate.”

  • RobertColgan

    Modern Republicanism, in its most bareboned manifestation:
    tons of money for police, little or nothing for tending to the needs of the electorate.
    Psychopaths rule.

  • SEN. WARNER: “I will stand with you to fight these Medicaid cuts”
    ~ Senator meets with Va. parents, educators opposed to steep cuts in Medicaid services ~

    WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) today met in his Capitol Hill office with parents and educators from across Virginia who are deeply concerned about the impact of proposed Medicaid cuts on Virginia children and families. A congressional Republican proposal to cut-and-cap federal Medicaid funding by $839 billion would severely impact the availability of community-based services for lower-income, disabled and elderly Virginians, including two-out-of-three Virginia nursing home residents.

    In addition, Virginia school districts receive about $33 million in federal Medicaid reimbursements for school-based services each year, providing critically important services such as school nurses, special classroom aides and health diagnostic services to eligible children. A list of federal Medicaid reimbursements by Virginia school district, compiled by Sen. Tim Kaine (D-VA) and released yesterday, is available here.

    “These federal cuts to Medicaid will have a direct impact on the ability of thousands of Virginians to access effective, community-based care,” Sen. Warner said. “What’s worse is, these federal funding cuts simply push the cost down to the state and localities — and ultimately to parents. That’s not just ‘mean:’ it will deprive access for thousands of children to services that accommodate their special needs and help them grow into more independent adults.”

    Sen. Warner met today in his Capitol Hill office with concerned families and children from Roanoke, Charlottesville, Ashland, Virginia Beach, Fairfax and Arlington. Health providers and disability advocates from Danville, Richmond and Warrenton also attended, as well as school administrators from Fairfax and Alexandria.

    “When Virginians hear about cutting and capping Medicaid, they should recognize this about more than numbers. It’s about Josh from the Roanoke Valley, Matt and Chris from Ashland, and Charlie and her parents in Charlottesville,” Sen. Warner said. “It’s about providing support and services to families. It’s about improving quality of life and providing independence for our disabled citizens. And it’s about peace of mind for so many Virginia parents like these who have extraordinary children with special needs.”

    Among the personal stories Sen. Warner heard today:

    Marlo Dean’s 15-year-old son Dante has intensive health needs because of a rare brain disorder. Dante just received a Medicaid waiver after being on the waiting list for 10 years. “Cutting Medicaid is not the right thing — it’s not the humane thing,” Dean, from Virginia Beach, told Sen. Warner.

    Tom and Kim Goodloe of Ashland brought their twin sons, both of whom were born with a rare genetic disease. The Goodloes spoke of decades of challenges meeting the medical and financial needs of their two sons. “To us and these other families, rolling-back Medicaid is not just a worry — it is a terror,” Kim Goodloe told Sen. Warner. “It is beyond my imagination that we would cut Medicaid. It would jeopardize everything we have been fighting for for years.”

    Angie Leonard of Botetourt County attended with her 22-year-old autistic son, Joshua. Leonard says Medicaid helped provide community-based services so her son could attend school, enter the workforce and live independently.

    Rebecca Wood of Charlottesville brought her daughter, Charlie, who was born three-and-a-half months early and could face a lifetime of chronic health challenges. Rebecca worries about a reduction in Medicaid services as well as Republican healthcare proposals to allow insurers to once again deny coverage due to pre-existing conditions — or put a lifetime cap on insurance benefits. “I can’t believe I’m going legislator to legislator begging for the future of my child,” Wood said. “Our country is better than this.”

    Senator Warner has long advocated for making changes to improve the 2010 Affordable Care Act, including a no-frills, lower cost option, allowing insurers to sell policies across state lines, and elimination of certain regulations and paperwork requirements faced by smaller employers.

  • From AG Mark Herring’s campaign:

    John Adams Stands Silent While ‘Trumpcare’ Rips Healthcare Away From Virginians

    Richmond – White collar defense attorney John Adams, the Republican nominee for Attorney General, has made it clear he has no interest in whether Virginians have access to affordable insurance and healthcare. Adams has remained silent as President Trump and Republicans in Congress have tried to strip away healthcare from millions of Americans and cut funding for Medicaid and treatment for opioid and heroin abuse. His silence is right in line with his extreme views and politics.

    Adams went to federal court twice, in Zubik v Burwell and in the infamous Hobby Lobby case, to fight against women’s access to birth control, a key health benefit of the Affordable Care Act.

    Adams has also been silent as Trumpcare’s proposed Medicaid cutbacks would cripple Virginia’s efforts to combat the heroin and opioid epidemic.

    Finally, Adams has been endorsed by arch-conservative US Senator Mike Lee of Utah, an architect of the Senate’s plan to devastate Medicaid who appears to be withholding his support of the just-released Senate bill in hopes of an even crueler version. In a campaign statement, Adams hailed Lee as, “a leading voice for constitutional conservatism and has been at the forefront of the battle over repealing Obamacare.”

    In the same statement, Lee heaped praise on Adams saying, “I have urged John to seek political office because I know he shares my conservative values…”

    “John Adams has continually demonstrated that he stands with Trump and wealthy special interests over Virginians,” said Adam Zuckerman, Campaign Manager for Attorney General Mark Herring. “It’s shameful that John Adams would stand with Donald Trump and Mitch McConnell in their efforts to rip healthcare away from thousands of Virginians, defund Planned Parenthood, denying women access to birth control and reproductive health care, and stand silently by as President Trump and congressional Republicans hamper efforts to combat the heroin and opioid epidemic in Virginia.”