Module 5: Maladministration of our healthcare system
Chairperson
Representative _____ will now preside over the hearing of the article of impeachment on the intentional undermining of Americans’ health care access, affordability and quality.
Presiding member
Thank you Chair_____ __________. The clerk will read the article.
Clerk
In his conduct of the office of President of the United States, Donald Trump, in violation of his sworn oath to faithfully execute his office and to preserve, protect, and defend the Constitution of the United States, and in violation of his constitutional duty to take care that the laws be faithfully executed, has refused to properly administer the Patient Protection and Affordable Care Act and has taken systematic measures against the goals for which it was passed, those of health care access, affordability, and quality. This conduct has included the following offenses:
Minutes after taking office, The President signed an Executive Order directing members of his administration to undermine the Affordable Care Act. The Trump Administration has complied with his Executive Order, while ignoring the fact that their actions need to be consistent with the law.
The Affordable Care Act’s intent was to “expand coverage in the individual health insurance market,” Trump and his administration have openly defied that goal and instead sought to limit healthcare coverage through the ACA exchanges.
The Trump administration may have violated the Impoundment Control Act by using funds Congress appropriated for ACA outreach efforts to produce and publicize 23 video testimonials “from people who said they had been ‘burdened by Obamacare,’ including families, health care professionals and small business owners.”
The ACA statute clearly states that the secretary of Health and Human Services may only grant a state waiver request if the state plan “‘will provide coverage that is at least as comprehensive as’ ACA-compliant coverage.” The Trump administration has repeatedly violated this basic restriction by granting state waivers that, for example, impose work requirements on adults seeking medicaid coverage.
The Trump administration has failed to address skyrocketing prices of lifesaving medicines, and blocks efforts from Congress to do so.
Mr. Trump betrays veterans by severely harming and attempting to privatize the Veterans’ Administration’s health system. After putting their bodies on the line for America, veterans are finding themselves without care and with unexpected medical bills.
Under Trump, the Department of Health and Human Services pursues efforts to limit Medicare and Medicaid access, leaving millions without care when they are most vulnerable.
Mr. Trump has attempted to allow medical discrimination based on religious beliefs in violation of separation of church and state.
These instances of maladministration are of sufficient gravity to merit Mr. Trump’s removal from office.
Presiding member
Thank you. As the chief executive of the nation, it is a moral obligation on the President to ensure that Americans have adequate access to healthcare services. Mr. Trump has not only failed in this, but he has failed in his Constitutional obligation to be sure that our laws are faithfully executed by systematically undermining the Affordable Care Act to further his personal ambitions as the leader of the Republican party. Regarding the dismantling of the Affordable Care Act, I call upon the first witness, [Witness 1], to present evidence.
Witness 1
Mere hours after taking office, the president signed an executive order directing members of his administration to undermine the Affordable Care Act. Since then, they have happily complied with that order’s underlying intent while conveniently ignoring the demand that their actions be “consistent with law.” And while the courts have repeatedly affirmed that the president has wide discretionary latitude to decide how to enforce the law, they have not recognized a president’s right to effectively repeal laws through executive action. And that’s essentially what Mr. Trump is doing.
While the ACA’s intent was to “expand coverage in the individual health insurance market,” Trump and his administration have openly defied that goal and instead sought to limit healthcare coverage through the ACA exchanges. As former senior White House staffer Steve Bannon bragged, Trump ended payments to health insurance companies subsidizing health care for the poorest Obamacare customers in order to “blow” up the Affordable Care Act.
The Trump administration also decided to cut the ACA’s marketing budget by 90%, despite robust evidence from a Center for Medicare Services (CMS) study showing “that paid outreach was responsible for 40 percent of all enrollments.” In addition to cutting down on outreach, the administration made it harder for people to find accurate, comprehensive information about the law and its guarantees. No amount of obfuscation could possibly make a convincing case that these actions were undertaken with any goal except to undermine enrollment.
Then there’s the administration’s use of state waivers. While Obamacare made room for state-level innovation through waivers, it set clear parameters. The statute clearly states that the secretary of Health and Human Services may only grant a state waiver request if the state plan “‘will provide coverage that is at least as comprehensive as’ ACA-compliant coverage.” The Trump administration has repeatedly violated this basic restriction by granting state waivers that, for example, impose work requirements on adults seeking medicaid coverage.
Furthermore, the 2017 Republican tax cuts effectively eliminated a penalty that people would have to pay if they did not enroll in health insurance, which has led to a series of court cases aimed at invalidating the entire ACA. Known as the individual mandate, this part of the Affordable Care Act was intended to push people to purchase insurance in order to more evenly distribute health care costs and make covering Americans with chronic illnesses more economically feasible for insurance companies. While the tax law did not undo the individual mandate itself, it made the penalty $0. In doing so, it provided some opponents of the ACA fodder to levy a legal challenge. ((More: https://www.vox.com/policy-and-politics/2019/7/9/20686224/affordable-care-act-constitutional-lawsuit-fifth-circuit-court-texas-district-court)
Under President Trump, the Affordable Care Act is being dismantled. The White House supported the failed repeal effort in Congress in 2017, and retaliated against Sen. McCain when he played a crucial role in stopping the repeal. Under Trump, the DOJ has asked the courts to fully strike down the existing ACA. Such a move would leave millions of people, especially those with pre-existing conditions, uninsured. Mr. Trump has also systematically loosened and rolled back Obama-era restrictions on short-term healthcare plans that don’t meet the Affordable Care Act’s standards. These poorly-regulated plans effectively defraud patients and do not provide adequate coverage. The Trump administration has continued pursuing various avenues of eroding ACA coverage and raising premiums.
Presiding member
Thank you, [Witness 1]. Regarding the failure to address rising drug prices, I call upon the next witness, [Witness 2].
Witness 2
Despite Mr. Trump’s promising to address the price gouging of many drugs, including insulin, the prices are still increasing. Americans continue to spend more than anyone else in the world on medicines. Mr. Trump has not introduced or supported any meaningful policy around decreasing drug prices. The White House has rejected a bill by Speaker Pelosi which would allow Medicare to negotiate drug prices. All the while, Americans are dying from rationing lifesaving medicines which they cannot afford.
The ACA prohibits insurers from imposing lifetime caps on coverage, which were often in the $1 million range -- a relevant consideration when a single drug might now cost that much. The ACA contains these and many other pharmaceutical policy-related provisions. A ruling striking it down would mean that all Americans, not just those in the individual market, would feel the effects.
Presiding member
Thank you, [Witness 2]. Regarding the harm to the Veterans Affairs healthcare system, I call upon the next witness, [Witness 3].
Witness 3
The Trump administration is intentionally harming the Veterans Affairs healthcare system, and betraying veterans in the process, leaving them without care or with surprise bills. In 2017, Mr. Trump mulled an executive order that would close VA hospitals, even stating that he could declare a national emergency to do so. A whistleblower alleged this year that under Trump, the VA abandoned more than 200,000 benefits applications without adequately notifying the veterans who filed them. The VA has also attempted to conceal its extensive privatization efforts under Trump’s leadership. Worse still, it appears that the VA Department policy has been under inappropriate influence from 3 Mar-A-Lago members.
Veterans’ healthcare has also been affected by the Trump Administration undermining the Affordable Care Act. As of 2015, roughly 260,000 nonelderly veterans were enrolled in marketplace plans. At a time when one-third of returning service members from Iraq and Afghanistan are experiencing mental health or cognitive issues, the last thing veterans need is the Trump Administration gutting access to important mental health coverage. But that’s exactly what they’re doing, and they’re doing it while simultaneously attempting to privatize, chronically understaff, and dismantle the VA.
Presiding member
Thank you, [Witness 3]. Regarding the efforts to limit access to Medicaid and Medicare, I call upon the next witness, [Witness 4].
Witness 4
The HHS issued guidance in 2018 to impose work requirements on people getting coverage through the Medicaid expansion. This cruel decision would leave people with physical limitations, or who are unable to find work, unable to get healthcare. In 2019, the OMB issued a proposal lowering the poverty line, which would disqualify millions of people from health coverage among other benefits. Mr. Trump also issued an executive order which could raise Medicare prices.
Presiding member
Thank you, [Witness 4]. Regarding the efforts to allow discrimination in healthcare for religious reasons, I call upon the next witness, [Witness 5].
Witness 5
During his term, HHS issued a proposed rule to revoke anti-discrimination protections from the Affordable Care Act from protecting transgender Americans from discrimination by doctors. Allowing doctors to choose to refuse treatment for patients is extremely dangerous, violates the Hippocratic Oath, and serves as a denial of reliable medical care to vulnerable community. It is also a violation of the Constitutional separation of church and state. Mr. Trump has also allowed employers to deny their workers coverage for contraception for religious reasons.
Chairperson
Thank you Representative _________. It is clear that Mr. Trump and his administration are intentionally preventing millions of Americans from getting the healthcare they need. When it comes to healthcare, the majority of American families find themselves at risk of bankruptcy when they can’t afford healthcare. In the worst cases, they find themselves at the risk of death.
The President’s attacks on the Affordable Care Act are among his most severe and broadly salient offenses, and his actions are arguably impeachable. Specifically, look to Article II, which states that the president must “take care that the laws be faithfully executed.” How to determine what is faithful execution is a matter of ongoing debate, but it is pretty clear that Trump isn’t faithfully administrating the ACA.
As a candidate, Mr. Trump promised Americans affordable, accessible healthcare, and has not only reneged on that promise, but is also allowing and indeed causing healthcare to be further and further out of reach. This demonstrates unacceptable dishonesty and misgovernance. We will now vote on the committee recommendation for the article of impeachment on [subject]. All in favor, say “aye.”
Committee
Aye.
Chairperson
All opposed, say “nay.”
Committee
[Silence]
Chairperson
The clerk will record that the “ayes” have it. The article of impeachment on the mistreatment of immigrants is hereby referred to the floor of the House with a recommendation of “do pass.” [Bangs gavel]