Even as it moves forward with a much-criticized overhaul of Medicaid that could affect the health coverage of millions, the Trump administration continues to claim that it is neither cutting Medicaid nor undermining the Affordable Care Act. Documents recently obtained by American Oversight not only provide a glimpse into the administration’s early efforts to attack the ACA, they also mirror some of the talking points officials have used to justify their latest move.
Announced in late January, the administration’s plan to allow states to receive capped Medicaid block grants instead of open-ended federal funding is yet another example of the multi-year effort to sabotage the ACA, which had expanded Medicaid coverage to millions of Americans. The move follows the failed attempts to outright repeal and replace the health-care law, President Donald Trump’s own threats to let it fail, and even the Department of Health and Human Services’ promotion of anti-ACA videos.
HHS calendars from July 2017 include a script for one such video that was apparently never released publicly and is far more elaborate than the testimonial videos HHS had shared. Employing a metaphor of two unstable boats — one, representing Medicaid, “packed with people, listing and about to sink”; the other, representing personal coverage, occupied by one person rowing in a circle — the video says that “Obamacare is jeopardizing Medicaid” by “crowding out those who need Medicaid most.” That argument was also used by Seema Verma, the director of the Centers for Medicare and Medicaid Services, in justifying the administration’s block-grants plan.
The script was included in a calendar appointment for then-HHS Secretary Tom Price to “Record audio for motion graphic video.” Also included in the event was David Pasch, who ran the department’s digital communications until June 2018. Politico, reporting in June 2018 on HHS officials’ politicized and potentially Hatch Act–violating communications, said that Pasch had previously worked for the Koch-aligned Generation Opportunity, the creators of the viral “Creepy Uncle Sam” ad that warned young people not to sign up for the ACA’s marketplaces.
You can read the script below, and learn more about our investigation into the administration’s ACA sabotage attempts here.
 Two lifeboats in the water. The first is named “Medicaid” and is packed with people, listing and about to sink. The second lifeboat called “Personal Coverage,” has only one person in it manning the one of the two oars, and is rowing in circles. (Medicaid has too many of the wrong people and individual market has not enough of the right people).
 The two lifeboats meet up side-by-side. The Personal Coverage boat places its oar onto the bulwark of the Medicaid boat. Passengers start leaving “Medicaid,” (choice) walking across the oar and onto “Personal Coverage.” “Medicaid” starts to stabilize and float on a more even keel (preserving the safety net). “Personal Coverage” is now rowing straight with more people to man the oars.
 Obamacare has failed the American people.
Most folks who aren’t retired, on Medicare, or get insurance from their jobs, either buy personal coverage or sign up for Medicaid.
Medicaid was created to be a safety-net for our most vulnerable – the elderly, disabled, children, and low-income mothers.
This is an important program. Obamacare has weakened it by cramming in 14 million new people who would be better off with personal coverage.
This is crowding out those who need Medicaid most, and causing healthcare costs to skyrocket for everyone else;
 Obamacare is jeopardizing Medicaid and increasing the cost of personal coverage;
BETTER CARE will strengthen Medicaid and create more options for individuals and families;
It offers flexibility – lowering costs and expanding choices;
BETTER CARE will give Americans a helping hand – moving away from government-run healthcare – and onto more personalized plans that better meet their needs;
Right now, the marketplace for purchasing coverage is collapsing. Insurers are abandoning Obamacare, and Medicaid is on an unsustainable path. It can’t stay afloat as is.
BETTER CARE strengthens both of these, delivering better care for all of us – so nobody falls out of the boat.
Part of Investigation: