PROTECT OUR CARE. ** WEEKLY WRAP UP ** [ August 25-31, 2018 ] [Watch the new ad from Protect Our Care]

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1 PROTECT OUR CARE ** WEEKLY WRAP UP ** [ August 25-31, 2018 ] [Watch the new ad from Protect Our Care] On SCOTUS Hearings Eve, New Ads Preview Reality If Collins Refuses To Stand Up for Mainers In the latest phase of a campaign to educate the public about what s at stake for health care in the Supreme Court, Protect Our Care this week launched new television and radio ads in Maine and Alaska urging constituents to ask Senators Susan Collins and Lisa Murkowski to oppose Judge Brett Kavanaugh s nomination. The new TV ad in Maine shows the scary future we could face if Justice Brett Kavanaugh sides with the Trump Administration and casts the deciding vote to strike down the Affordable Care Act and its protections for 130 million Americans with pre-existing conditions. Radio ads up in Maine and Alaska highlight the impact Kavanaugh s vote could have on hundreds of thousands of state residents living with pre-existing conditions. Watch the new TV ad airing in Maine. Listen to the radio ads airing all week in Alaska and Maine. The new ad campaign comes after two months of activity in the Senators states and in DC -- including this past weekend s massive 50-state Unite for Justice Day of Action -- where constituents have implored the Senators to stand up for their health care and oppose Kavanaugh s nomination to the Court. The groundswell of opposition to Kavanaugh s nomination is borne out by poll after poll showing weak support for Kavanaugh, making him the most unpopular Supreme Court nominee in three decades, less popular

2 than Harriet Miers, whose nomination was withdrawn. In fact, a new Protect Our Care-PPP poll released last week found that just 42 percent of Mainers want Sen. Collins to confirm Judge Kavanaugh and that a vote to confirm him would harm Sen. Collins re-election prospects. Senators Collins and Murkowski have claimed a commitment to health care - this nomination may be the truest test of where they actually stand yet. NEW POLL: Alaska Voters Want Sen. Murkowski To Reject Kavanaugh And Will Remember Her Vote As Judge Brett Kavanaugh s Senate Judiciary Committee hearing approaches next week, a new survey conducted by Clarity Campaign Labs on behalf of Protect Our Care and Planned Parenthood Action Fund shows that voters in Alaska want Sen. Lisa Murkowski to reject Kavanaugh and stand up for health care protections and women s constitutional rights, including abortion. POLL HIGHLIGHTS: Alaska voters strongly support current ACA protections, which prohibit insurance companies from discriminating against people with pre-existing conditions, such as cancer, diabetes, or pregnancy. In fact, nearly eight in 10 voters (78 percent) believe the Supreme Court should keep those protections in place. Seventy-one percent do not want to see the Supreme Court restrict women s constitutional rights, and 45 percent of Alaska voters believe the right to have an abortion is at risk. Alaskans made clear they will hold Sen. Murkowski accountable for her vote on Kavanaugh s nomination. Forty-five percent would view Sen. Murkowski less favorably if she voted for an anti- ACA nominee by a 29 percent margin. By 33 points, voters would view Sen. Murkowski less favorably if she voted for an anti-roe nominee (49 percent compared to 16 percent). Almost twice as many voters would be less likely to vote for Sen. Murkowski if she voted to confirm Judge Kavanaugh (41 percent less likely compared to 22 percent more likely). Fifty-five percent of Alaska voters said they would be very or somewhat likely to contact their U.S. senators regarding Kavanaugh s Supreme Court nomination. Statement from Leslie Dach, campaign chair of Protect Our Care: As this poll shows, Alaskans do not want protections for the more than 130 million Americans with preexisting conditions taken away from them by the Supreme Court, and they want Senator Lisa Murkowski to vote no on Kavanaugh s nomination. Senator Murkowski has claimed a commitment to health care, and this nomination offers an opportunity to do just that. Read the full memo here. Protect Our Care Takes the Health Care Fight to Local Communities Across the United States

3 This week, Protect Our Care announced its first-ever nationwide bus tour. Kicking off in Bangor, Maine on September 24, the bus, Care Force One, will head west to Phoenix, Arizona before coming back east, concluding with an event in West Palm Beach, Florida on November 2. The bus will make 48 stops across 23 states, covering a total of 11,303 miles. The tour will highlight for the public that the Republican war on health care is very much alive, with Republican officials using legislation, regulations and the courts to continue their attacks on protections for the 130 million Americans with pre-existing conditions, for women and older Americans and on Medicaid and Medicare. Recently pro-repeal Republicans have claimed to support the protections for people with pre-existing conditions in the Affordable Care Act, even as they work to dismantle them. The Republicans repeal-and-sabotage agenda over the past 18 months has included: Supporting legislation to repeal the Affordable Care Act, which threatens protections for women, older adults and people with pre-existing conditions, as well as a whole host of provisions of tens of millions of Americans rely upon for their care and coverage; Pushing regulations that promote junk plans that can discriminate against people with preexisting conditions and refuse coverage of essential health benefits, such as mental health care, emergency care and maternity care, driving up both risks and costs for consumers; Slashing funding for outreach and enrollment assistance, which experts predicted would lead to 1.1 million fewer people enrolled in the health insurance exchanges across the country and raise costs for those who do enroll; Filing a lawsuit to overturn the Affordable Care Act; then, the Trump Administration made the shocking decision not to defend the Affordable Care Act and actually agree in part with the plaintiffs, arguing that protections for people with pre-existing conditions should be overturned, Gutting and obstructing the Medicaid expansion, which currently covers 15 million people and serves as a lifeline to rural communities from coast to coast, and Jeopardizing improvements to Medicare, including reduced costs for prescription drugs. At local events across the country, the bus tour will demonstrate that Americans broadly oppose Republicans repeal-and-sabotage agenda, which has cut health care coverage dramatically and driven up costs for millions. For example, the Center for American Progress estimates that the Republicans tax bill and their junk plans regulations will cause health insurance premiums to be $3,110 higher next year for a typical family of four. Check out when Care Force One is slated to come to you, with additional stops being added along the way. Check out protectourcare.org/bus-tour/ for the latest. Bangor, ME on Monday, September 24, 2018 Portland, ME on Monday, September 24, 2018 Syracuse, NY on Tuesday, September 25, 2018 Binghamton, NY on Tuesday, September 25, 2018 Philadelphia, PA on Wednesday, September 26, 2018 Harrisburg, PA on Thursday, September 27, 2018

4 Pittsburgh, PA on Thursday, September 27, 2018 Cleveland, OH on Friday, September 28, 2018 Columbus, OH on Friday, September 28, 2018 Wheeling, WV on Monday, October 1, 2018 Charleston, WV on Monday, October 1, 2018 Cincinnati, OH on Tuesday, October 2, 2018 Indianapolis, IN on Tuesday, October 2, 2018 Lansing, MI on Wednesday, October 3, 2018 Grand Rapids, MI on Wednesday, October 3, 2018 South Bend, IN on Wednesday, October 3, 2018 Milwaukee, WI on Thursday, October 4, 2018 Green Bay, WI on Thursday, October 4, 2018 Madison, WI on Friday, October 5, 2018 Cedar Rapids, IA on Friday, October 5, 2018 Des Moines, IA on Monday, October 8, 2018 Minneapolis, MN on Monday, October 8, 2018 Fargo, ND on Tuesday, October 9, 2018 Minot, ND on Tuesday, October 9, 2018 Billings, MT on Wednesday, October 10, 2018 Butte, MT Thursday, October 11, 2018 Missoula, MT on Friday, October 12, 2018 Reno, NV on Monday, October 15, 2018 Las Vegas, NV on Tuesday, October 16, 2018 Phoenix, AZ on Wednesday, October 17, 2018

5 Tucson, AZ on Wednesday, October 17, 2018 Denver, CO on Friday, October 19, 2018 Kansas City, MO on Monday, October 22, 2018 Springfield, MO on Monday, October 22, 2018 St. Louis, MO on Tuesday, October 23, 2018 Memphis, TN on Tuesday, October 23, 2018 Nashville, TN on Wednesday, October 24, 2018 Richmond, VA on Thursday, October 25, 2018 Raleigh, NC on Thursday, October 25, 2018 Atlanta, GA on Friday, October 26, 2018 Miami, FL on Wednesday, October 31, 2018 West Palm, FL on Thursday, November 1, 2018 West Palm, FL on Friday, November 2, 2018 Mike Pence Confirms GOP Still Gunning for Americans Health Care Last night in Wisconsin, Vice President Mike Pence told reporters that, We made an effort to fully repeal and replace Obamacare. And we'll continue. With Leah Vukmir in the Senate, we ll go back to that, joining the list of Republicans this week calling yet again for repeal. Vice President Pence reminded everyone of Republicans real goal: attacking the health care of tens of millions of Americans. If Mike Pence and the GOP have their way, protections for people with pre-existing conditions would be stripped overnight; lifetime limits would once again be the norm; and women and seniors would see gender and age taxes applied to their care. The contrast couldn t be more clear: the same week Tammy Baldwin introduces legislation to stop junk plans and maintain the protections Americans rely on, the Vice President doubles down on the Republican war on health care. WHO CALLED FOR REPEAL THIS WEEK? Vice President Mike Pence: We Made An Effort To Fully Repeal And Replace Obamacare. And We ll Continue. We made an effort to fully repeal and replace Obamacare. And we'll continue. With Leah Vukmir in the Senate, we ll go back to that. [Twitter, 8/30/18] Senator John Thune (R-SD): It Would Be Nice To Have Members Who Enable Us To Pass [Repeal]. It would be nice to have members who enable us to pass it, Senate Republican Conference

6 Chairman John Thune (S.D.) said when asked about the possibility of ObamaCare repeal legislation coming up for a future vote. [The Hill, 8/29/18] Senator David Perdue (R-GA): I d Love To Have Somebody Take Care Of [Repeal]. I d love to have somebody to take care of that, Sen. David Perdue (R-Ga.) said of repealing ObamaCare. [The Hill, 8/29/18] Senator Ron Johnson (R-WI): Hopes Arizona s Next Senator Will Favor Repeal. Sen. Ron Johnson (R-Wis.) said he hopes the next senator from Arizona will be a strong ally who recognizes that ObamaCare is not a proper solution. [The Hill, 8/29/18] Senator Bill Cassidy (R-LA): I Want Somebody Who Is For Affordable Health Care, And Right Now Obamacare Is Not Affordable, Nor Is Health Care. Cassidy said he doesn t know whether the Senate will move another comprehensive health-care reform package, but he expects Republican leaders will push piecemeal efforts to make affordable once more that which has not been affordable since ObamaCare passed. I want somebody who is for affordable health care, and right now ObamaCare is not affordable, nor is health care, which is a direct result of ObamaCare, Cassidy said. [The Hill, 8/29/18] BACKGROUND: IF REPUBLICANS RETAIN A MAJORITY IN CONGRESS NEXT YEAR, THEY WILL TRY TO REPEAL HEALTH CARE AGAIN The Hill: GOP Lawmakers Vow To Try Again At Repeal Next Year If They Keep Majorities. GOP lawmakers say they won t have time to hold another vote to repeal the law in 2018 but vow to try again next year if they manage to keep their Senate and House majorities. [The Hill, 8/29/18] Axios: Many Republicans Assume Their Party Will Take Another Stab At Repeal If Midterms Go Their Way. Many Republicans assume their party will take another stab at repealing and replacing the Affordable Care Act if the midterm elections go their way, even though GOP candidates aren't making a big deal about it on the campaign trail. [Axios, 8/6/18] New York Magazine: It Is Hard To Think Of A Legislative Priority That Would Rank Higher In [Trump s] Mind Than Health Care Repeal. If Republicans can add a couple more seats, they could give themselves enough margin to overcome the squishy reservations of Susan Collins and Lisa Murkowski. If they merely hold their narrow majority, they might simply prevail on the two senators to submit. (Murkowski appeared to have been bought off by a special deal for her state last year.) Trump has never stopped talking about the failed repeal vote nor reliving his anger with McCain. It is hard to think of a legislative priority that would rank higher in his mind. A congressional party shorn of its most prominent Trump skeptics, many of whom are retiring, would behave even more submissively toward its leader. [New York Magazine, 8/6/18] Politico: With Larger Majority, No Longer Could Collins Or Murkowski Block Health Care Repeal. With even a slightly larger GOP majority, no longer could Murkowski or her independent-minded brethren like Susan Collins of Maine or Rand Paul of Kentucky effectively dictate which nominees or majority-vote legislation make it through the chamber. Gone, too, would be the constant headaches for Republican leaders sweating an absence, wavering senator or Vice President Mike Pence s availability to break a tie. Republicans might even have another shot at repealing Obamacare or shrinking the size of the federal government. [Politico, 7/31/18]

7 Vox: If Republicans Win In November, Repeal Could Quickly Be Back On The Agenda. It s not at all out of the question that Republicans will hold on to the House and expand their Senate majority in the 2018 midterms. And if they do, repeal could quickly be back on the agenda. There would certainly be forces pushing for this, so I take it seriously, Kim Monk, who tracks health care policy for Capital Alpha. Senate aides say privately that Republicans remain open to taking on repeal again next year. [Vox, 5/14/18] FRAUD ALERT: New GOP Proposal Falsely Claims to Protect People With Pre-Existing Conditions Last week, 10 Senate Republicans falsely claimed they had a new bill that would ensure protections for people with pre-existing conditions in the Affordable Care Act survive a Trump-GOP lawsuit to dismantle them. In reality, the bill doesn t. In fact, it says that if you have a pre-existing condition like cancer, asthma, or diabetes, insurance companies can specifically refuse to cover the health care you need. As The Hill points out, [...]the bill would allow insurers to exclude coverage of pre-existing conditions. Premiums could also vary based on age, gender, or occupation all of which is currently prohibited under [the ACA]. Policy Experts Agree the New GOP Bill Drafted by Three Chief Architects of Senate Repeal (Senators Cassidy, Graham, and Heller) Will Not Protect People with Pre-Existing Conditions: Larry Levitt, Kaiser Family Foundation: Bill A Mirage. If the goal is to protect people with preexisting conditions, the bill is a bit of a mirage, said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, a nonpartisan health care research group Under the bill, insurers could not decline coverage for people with pre-existing conditions, Levitt said, but it would allow insurers to exclude coverage for anything related to those conditions. You don t have to be real creative to imagine how this might work. These pre-existing condition exclusions were typical before the ACA. [Charlotte News & Observer, 8/24] Aisling McDonough, Senate Health Policy Adviser: Let s Say You Have Cancer. Under This Bill, You Can Buy Health Insurance, But That Plan Doesn t Have To Cover Your Treatment. [Twitter, 8/24] Levitt: The Big Loophole Is That It Would Allow Pre-Existing Condition Exclusions. It prohibits individual premiums from varying based on health, but allows them to vary based on age, gender, occupation, and leisure activities. It would allow premium variation based on health in the small business market, Levitt said in an . The big loophole is that it would allow pre-existing condition exclusions, which were common in individual market plans before the ACA. An insurer would have to give you insurance if you have a pre-existing condition, but it could exclude any services associated with your preexisting condition, he said. This would make protections for people with pre-existing conditions a bit of a mirage. [Insurance Journal, 8/27] Levitt: Even Prescription Drug Coverage Could Be Denied. "Under the measure, insurers would still be able to refuse to cover certain services or prescription drugs for patients with pre-existing conditions,

8 said Larry Levitt, a senior vice president for health reform at the nonpartisan Kaiser Family Foundation." [Roll Call, 8/24] Chris Sloan, Avalere Health: Bill Allows Insurance Companies To Effectively Discriminate. "Really this just prevents insurance companies from saying no you can t buy this coverage but this allows the opportunity to say no through price or through benefits You can make a product so expensive based on medical history, based on gender, based on age, or based on not covering something that someone needs that they can t afford then you ve effectively discriminated against them. [ThinkProgress, 8/24] So, Let s Call This Bill What It Is: A mirage, says Larry Levitt with the Kaiser Family Foundation. An election season scam, says Protect Our Care. Shameful, says Health Care For America Now. A fraud, writes Jeffrey Young for the Huffington Post. Instead of Pushing Scam Bills, Senators Could Actually Support People with Pre-existing Conditions By Doing the Following: 1. Support the Senate Democrats resolution that would allow the Senate to defend preexisting condition protections in court. This summer, the Trump Administration refused to defend against a lawsuit brought by twenty conservative states aimed at overturning the Affordable Care Act and its protections for people with pre-existing conditions. Last month, Senate Democrats introduced a resolution that would authorize the Senate Legal Counsel to intervene in the lawsuit and defend protections for people with pre-existing conditions. 2. Join the Senate Democrats effort to overturn Trump administration s junk plan rule that lets insurance companies discriminate against people with pre-existing conditions. Earlier this month, the Trump Administration finalized a rule that allows insurance companies to deny coverage to people with pre-existing conditions. Experts warn that this move will only increase the cost of comprehensive care, ultimately making it even harder for people with pre-existing conditions to get the care they need. Senate Democrats introduced legislation that would overturn Trump s rule. 3. Oppose Trump s nominee to the Supreme Court, Brett Kavanaugh. As cases to overturn the Affordable Care Act make their way through the courts, Senators should come out against Brett Kavanaugh, President Trump s nominee to the court, since he has previously criticized Chief Justice Roberts decision to uphold the Affordable Care Act. NEW REPORT: How the Trump-GOP Lawsuit and the Next Supreme Court Justice Could Take Away Your Health Care Heading into two monumental moments in health care next week - hearings on Judge Brett Kavanaugh s nomination to the U.S. Supreme Court, beginning September 4, and a hearing on Texas, et al. v. United States, et al in a federal district court on September 5 - Protect Our Care released a new report on the relentless GOP attack on health care and people with pre existing conditions.

9 As the report shows, if you are a woman, if you re over 50, if you re on Medicaid, or if you have a preexisting condition, the Republican lawsuit in Texas and the next Supreme Court justice will determine whether you will continue to have health care. This report shows just how much Americans have to lose if Trump and his Republican allies successfully use their power and the courts to take away people s health care. Included in the report: What life was like for people with pre-existing conditions before the ACA How Texas v. United States could take us back How Texas v. United States fits in with the broader Republican repeal-and-sabotage agenda Who stands to be harmed by the lawsuit, on a state by state basis How the latest Republican promise to protect people is a scam Read the report, The Relentless Republican War on People with Pre-Existing Conditions: The Lone Star Edition, here. Protect Our Care Calls on Senate to Protect People with Pre-Existing Conditions and Pass Sen. Baldwin s Resolution This week, Senator Tammy Baldwin (D-WI) and a coalition of 29 other Senators introduced a resolution to block insurers from selling the Trump Administration's short-term, junk insurance plans that remove protections for Americans with pre-existing conditions and fail to cover essential health benefits like maternity care, mental health treatment and prescription drugs. As Senate Republicans continue to push new legislation that takes health care away from people with pre existing conditions in a cynical, election season legislative scam, Senator Baldwin and her colleagues are showing true leadership by working to stop President Trump s expansion of junk insurance plans in its tracks. If the GOP truly cared about protecting Americans with pre-existing conditions, they would join their colleagues on this resolution in taking concrete action to preserve the protections and essential health benefits that tens of millions of Americans depend on - and they would do so immediately. BACKGROUND: Short-Term Plans May Exclude Coverage For Pre-Existing Conditions. Policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition could be considered pre-existing and so excluded from coverage. [Kaiser Family Foundation, 2/9/18] As Many As 130 Million Nonelderly Americans Have A Pre-Existing Condition. [Center for American Progress, 4/5/17] One in 4 Children Would Be Impacted If Insurance Companies Could Deny Coverage Or Charge More Because Of A Pre-existing Condition. [Center for American Progress, 4/5/17] Junk Plans Mean Higher Premiums For People With Pre-Existing Conditions. "By promoting shortterm policies, the administration is making a trade-off: lower premiums and less coverage for healthy people, and higher premiums for people with preexisting conditions who need more comprehensive coverage." [Washington Post, 5/1/18]

10 Short-Term Junk Plans Can Refuse To Cover Essential Health Benefits. Typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways. [Kaiser Family Foundation, 2/9/18] Under Many Short-Term Junk Plans, Benefits Are Capped At $1 Million Or Less. Short-term plans can impose lifetime and annual limits for example, many policies cap covered benefits at $1 million or less. [Kaiser Family Foundation, 2/9/18] For more information, see Protect Our Care s fact sheet on short-term junk plans. The Truth Behind Mike Braun s Health Care Record Yesterday in Evansville, Indiana, President Trump campaigned for Mike Braun, a long-time supporter of the GOP repeal-and-sabotage agenda and a proponent of repealing the Affordable Care Act (ACA). Braun is also a supporter of the Trump-GOP lawsuit to eliminate the ACA s protections for 2.7 million Hoosiers living with pre-existing conditions. Here s a closer look. Although Braun Has Claimed To Support Protections For People With Pre-Existing Conditions, the Truth Is: Braun Supports A Lawsuit That Would Overturn Protections For People With Pre-existing Conditions. The Republican, [Braun], however, has also endorsed a Republican lawsuit that would rescind the health care law along with that popular provision. [Politico, 8/13/18] Braun Is Campaigning On The Repeal Of The Affordable Care Act And Its Protections For People With Pre-existing Conditions. On the subject of the ACA, his website reads, There is no repairing this broken law; the only option is to repeal and replace every word and regulation. [Braun For Indiana, Accessed 8/14/18] Braun, June 2018: I Will Fully Repeal Obamacare. In the Senate, I will use my business experience and work with President Trump to fully repeal Obamacare and implement free-market solutions that will provide better healthcare for Hoosiers. [City-County Observer, 7/26/18] May 2018: The Tea Party Has Endorsed Braun, In Part Because He Supports Repealing Obamacare. Our supporters were proud to endorse Mike, because he is a strong supporter of the Penny Plan, term limits, repealing Obamacare. [Tea Party, 5/9/18] Why The Truth Matters: 2,745,700 Hoosiers Live With A Pre-Existing Condition. About one in two Hoosiers, 50 percent, lives with a pre-existing condition. [CAP, 4/5/17] 1,382,000 Indiana Women And Girls Have A Pre-Existing Condition. Approximately 1,382,000 women and girls in Indiana live with a pre-existing condition. [CAP & National Partnership For Women and Families, June 2018] 377,100 Indiana Children Already Have A Pre-Existing Condition. Roughly 377,000 Hoosiers below age 18 live with a pre-existing condition. [CAP, 4/5/17]

11 643,800 Older Hoosiers Live With A Pre-Existing Condition. 643,800 Indiana adults between the ages of 55 and 64 live with at least one pre-existing condition, meaning attacks on these protections significantly threaten Hoosiers approaching Medicare age. [CAP, 4/5/17] Floridians Become the Latest Victims of GOP s War on Health Care This week, Florida announced final rates for 2019 individual-market health insurance plans, which indicate a 5.2 percent premium increase, in contrast to the average nationwide 4.3 percent decrease that Brookings Institution analysts predicted would occur absent GOP sabotage, on top of last year s 45 percent rate hike due to Washington Republicans repeal-and-sabotage agenda. For the past year and a half, President Trump and his Republican allies in Congress have engaged in a deliberate, aggressive campaign to undermine health care and families in Florida are once again forced to pay the price. Until we stop Republicans war on health care, insurance companies will continue to make huge profits and enjoy record tax breaks from Republicans while they charge working families more and more. Washington Republicans should start working on bipartisan solutions to make coverage more affordable, instead of helping their friends in the insurance industry make another buck on the backs of hardworking Floridians. From the Insurance Companies: Cigna: The Most Significant Factors Requiring The [30 Percent] Increase Include Elimination Of The Individual Mandate Penalties And Anticipated Changes To Regulations Regarding Short Term Medical And Association Health Plans That Will Impact The Affordable Care Act Risk Pool. [Cigna, 6/20/18] Molina Healthcare: Repeal Of Mandate Driving Up Rates. The individual mandate penalty will not be enforced for the 2019 plan year, resulting in younger and healthier members dropping coverage. In addition, the other Non-ACA compliant alternative plan availability will further reduce the overall enrollment of marketplace. [7/20/18] From the Experts: Brookings Analysis Estimates That Individual Market Premiums Would Decrease If Not For GOP Sabotage. Among its key findings: Estimates That Average Premium Would Fall By 4.3 Percent In 2019 In Stable Policy Environment. "I estimate that the nationwide average per member per month premium in the individual market would fall by 4.3 percent in 2019 in a stable policy environment." [Brookings Institution, 8/1/18] Insurance Companies' Revenues Will Far Exceed Their Costs In "I project that insurers revenues in the ACA-compliant individual market will far exceed their costs in 2018, generating a positive underwriting margin of 10.5 percent of premium revenue. This is up from a modest positive margin of 1.2 percent of premium revenue in 2017 and contrasts sharply with the substantial losses insurers incurred in the ACA-compliant market in 2014, 2015, and The estimated 2018 margin also far exceeds insurers margins in the pre-aca individual market. " [Brookings Institution, 8/1/18]

12 Absent Republican Sabotage, Average Premiums For ACA-Compliant Plans Would Likely Fall In "In this analysis, I define a stable policy environment as one in which the federal policies toward the individual market in effect for 2018 remain in effect for Notably, this scenario assumes that the individual mandate remains in effect for 2019, but also assumes that policies implemented prior to 2018, like the end of CSR payments, remain in effect as well. Under those circumstances, insurers costs would rise only moderately in 2019, primarily reflecting normal growth in medical costs." [Brookings Institution, 8/1/18] State Events In states across the country this week, health care advocates stood up and made their voices heard: ALASKA Sunday, August 26 Unite for Justice Rally Alaskans gathered in Anchorage to ask their representatives including Senator Lisa Murkowski to vote no on Judge Brett Kavanaugh s nomination to the Supreme Court. Participating organizations included Unite for Justice, People for the American Way, and Protect Our Care. Facebook Live Thursday, August 30 Poll Release Press Conference This week, ACLU Alaska, Protect Our Care, and Planned Parenthood released polls showing that Alaskans oppose Brett Kavanaugh s nomination to the Supreme Court. On Thursday, groups gathered to share the poll results, joined by local advocates who spoke about the threat Kavanaugh poses to health care.

13 Anchorage Daily News: Poll: Alaskans divided over Kavanaugh s Supreme Court nomination Facebook Live ARIZONA Sunday, August 26 Rise Up and Shine: A Call to Order (Brunch) to #SaveSCOTUS Arizonans sat down for Sunday brunch to discuss the threat Brett Kavanaugh poses to a broad swath of Americans especially those living with pre-existing conditions. Participants included state Rep. Athena Salman, Arizona Health Care Voters, and Planned Parenthood Advocates of Arizona. MAINE Sunday, August 26 Unite for Justice Rally Mainers gathered to opposed Brett Kavanaugh s nomination to the Supreme Court, and several shared their personal health care stories to emphasize just what Kavanaugh s confirmation could mean to them. Participants included Mainers for Accountable Leadership, Maine People's Alliance, NARAL, and the Planned Parenthood Maine Action Fund.

14 Monday, August 27 Opioids and Pre-Existing Conditions Press Conference On Monday, Maine advocates on the front lines of the opioid crisis spoke about the importance of protecting the Affordable Care Act. Advocates stressed the importance of continuing support for programs that aid in recovery and maintaining access to affordable health care for those seeking treatment for substance use disorders. Facebook Live NEVADA Sunday, August 26 Unite for Justice Rally Nevadans showed up in Las Vegas to talk about what Brett Kavanaugh s confirmation to the U.S. Supreme Court would mean for them especially those with pre-existing conditions. Participants included Make It Work Nevada, Planned Parenthood, NARAL, Nevada NOW, and the Human Rights Campaign.

15 Facebook Live PENNSYLVANIA Sunday, August 26 Unite for Justice Rally Congressman Dwight Evans, other elected officials, notable advocates, activists, and more than 20 organizations joined Philadelphia residents to voice their concern over the nomination and potential confirmation of Judge Brett Kavanaugh to the U.S. Supreme Court Philadelphia Inquirer: Hundreds rally in Philadelphia against Trump s Supreme Court nominee ABC 6: Rally Coverage PHL 17: Calls to Deny Confirmation Facebook Live TENNESSEE Thursday, August 30 Women s Health Press Conference On Thursday, Protect Our Care was joined by Equity Alliance and Healthy and Free Tennessee for a workshop to educate Tennesseans about the threat Brett Kavanaugh would pose to women s health and reproductive rights if he is confirmed to the Supreme Court.

16 Facebook Live WEST VIRGINIA Thursday, August 30 Mental Health and Opioids Press Conference On Thursday, Protect Our Care was joined by West Virginians for Affordable Health Care, West Virginians Together for Medicaid, WV Free, WV Citizens Action Group, and the National Association of Social Workers (WV) for a press conference highlighting the importance of the Affordable Care Act (ACA) with regards to mental health and addiction services, specifically for women. They discussed how West Virginians with substance abuse disorder would be affected if protections for pre-existing conditions under the ACA are removed. WV News: WV groups sound alarm about Texas lawsuit targeting the ACA Facebook Live Local Headlines Check out what coverage health care received in local areas nationwide. Below are some highlights:

17 Alaska KTVF: Alaskans ask Murkowski to vote against Kavanaugh for Supreme Court Justice Alaska Native News: Statewide Poll Shows Alaskans Deeply Concerned With Kavanaugh Nomination Daily News Miner: No on Kavanaugh Arizona AZ Central: Sen. John McCain's thumbs-down recalled as a 'watershed moment' in U.S. health care Florida Miami Herald: Florida Influencers: Medicaid expansion should be top health care priority for Tallahassee Maine Bangor Daily News: A Kavanaugh Supreme Court could undermine health care access NECN: Maine Residents Protest Supreme Court Nominee Nebraska Omaha World-Herald: Medicaid expansion gets enough signatures to appear on Nebraska ballot Nevada Las Vegas Sun: Health exchange head says Heller bill gives illusion of protecting preexisting conditions Ohio Akron Beacon Journal: Editorial: Ohio s continuing Medicaid success story Crain s Cleveland Business: Crain's editorial: Medicaid's marvel Pennsylvania Philadelphia Inquirer: Hundreds rally in Philadelphia against Trump s Supreme Court nominee West Virginia Gazett Court nominee Kavanaugh has established position against health care MetroNews: Manchin amendment regarding Obamacare lawsuit passed over Wisconsin Wisconsin State Journal: Mandela Barnes goes after Scott Walker for rejecting Medicaid expansion In Case You Missed It

18 The Center for American Progress released a new report making clear that the GOP s recent sham legislation will do nothing to protect Americans with pre-existing conditions: New Scam Pre-Existing Conditions Bill Provides No Cover to Vote for Judge Brett Kavanaugh [August 30] The Center on Budget and Policy Priorities released a new analysis which further underscores the benefits of Ohio s Medicaid expansion: More Evidence That Medicaid Expansion Improves Health, Supports Employment [August 27] Families USA released two new reports this week, one highlighting the risks of the the upcoming Texas lawsuit and the other on the broader role health care will play in the midterm elections: Texas v. United States: The Latest Court Case to Threaten Health Coverage for Millions [August 31] Health Care Voters Face Critical Choices in the States in 2018 [August 29]