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Monday, August 7, 2017

Capitol at night

The last few weeks have been a whirlwind as it seems that every day there was a new bill or amendment that further threatened access to health care. Although the U.S. House of Representatives passed their legislation to repeal and replace the Affordable Care Act (otherwise known as the ACA or “Obamacare”) in May, by the end of July, Senate Republicans had tried and failed at every turn to pass their own companion legislation. Although, their efforts were unsuccessful this time, there is still a great risk to our health care system. In this brief break from debate, we want to provide you with a brief summary of action so far and an analysis of the risks still to come.

May 4th, 2017—The U.S. House of Representatives passed the American Health Care Act (AHCA) by a vote of 217-213. The AHCA would have repealed Medicaid Expansion, replaced ACA subsidies with tax credits, eliminated the mandates for insurance coverage, and allowed states to opt out of the ACA’s federal regulations on essential health benefits (which provide a basic set of minimum health care requirements). The Congressional Budget Office (CBO) estimated that 23 million people would be left uninsured.

June 22nd, 2017—The U.S. Senate released the Better Care Reconciliation Act (BCRA), the companion legislation to repeal and replace the ACA. The BCRA included many of the same provisions found in the AHCA, fundamentally changing Medicaid, rolling back essential health protections, weakening care and coverage and causing premiums to skyrocket. The CBO estimated that 22 million people would be left uninsured.

June 28th, 2017- Senate Majority Leader Mitch McConnell, after weeks of insisting that the bill would pass before the 4th of July, was forced to delay the vote on the legislation due to a lack of support. Senate Republicans needed 50 votes for passage and many moderate Republican Senators proclaimed that they would not support the bill in its current form.

July 13th, 2017—Senate Leader Mitch McConnell released a new proposal to repeal and replace the ACA. This legislation would still restructure and defund Medicaid and allow states to waive essential health benefits. However, the new bill would have allowed insurers to sell weakened, skimpy plans that would not adhere to ACA regulations. As long as an insurer sold a least one comprehensive plan that adhered to ACA regulations, they could also sell weakened plans with less benefits, driving up the costs for patients with pre-existing conditions in need of more comprehensive coverage. At least two Republican Senators immediately opposed this legislation—Senators Susan Collins (ME) and Rand Paul (KY)

July 19th, 2017— Two more Republican Senators announce they will not support the bill—Senators Mike Lee (UT) and Jerry Moran (KS)—stopping the legislation in its tracks as there was no chance of its passage in the current form.

The same day, a “repeal only” bill was introduced in the Senate. The legislation was an updated version of a repeal measure that almost all Republican Senators voted for in 2015. The bill simply repealed large parts of the ACA with absolutely no plan to replace them, leaving 32 million more people uninsured and doubling premiums in a decade, according to the CBO.

Senators Shelley Moore Capito (WV), Lisa Murkowski (AK), and Susan Collins (ME), all announced that they would vote no on the motion to proceed to debate over a full ACA repeal.

July 25th, 2017—Republicans narrowly succeeded in getting enough votes to open debate about ACA repeal, clearing the first hurdle in their efforts to pass repeal legislation. Senator John McCain (AZ) had just been diagnosed with brain cancer and returned to DC to provide a critical vote. Once debate was open, however, the Senate quickly voted down a revised version of the BCRA, including the original provisions along with two proposals that would allow insurers to sell plans that don’t comply with ACA regulations as well as the addition of $100 billion to the replacement plan to help Medicaid expansion enrollees purchase private insurance.

July 26th, 2017—The Senate voted (55-45) “no” on the proposal to repeal much of the ACA without a replacement. Senators moved on to discussing a “Skinny Repeal” that would have eliminated the ACA’s individual and employer insurance mandates as well as the medical device tax. The CBO estimated that this version would leave 16 million people without coverage within a decade.

July 28th, 2017—The “Skinny Repeal” bill was defeated after Senator John McCain (AZ) joined Lisa Murkowski (AK), and Susan Collins (ME) (who had been long-time opponents of the measure) and voted no along with all Senate Democrats.

What Next?

Now, the path forward is uncertain. While this defeat was certainly a victory for health care advocates, there is still a possibility that efforts to repeal and replace the ACA might resurface.

There are a few ways the Senators could still work to take apart the ACA.

  1. Senators have been working on health care reform through a process called “reconciliation.” Reconciliation is used to reconcile spending legislation within the year’s federal budget (currently FY17). Procedure within reconciliation can be vague and confusing, but many experts say that this reconciliation process can continue until Congress passes a new budget resolution for FY18. This means that Senators can continue to introduce new health care reform bills for consideration, as long as Senate Republicans can get enough “yes” votes, before a new budget is passed.
  2. The Children’s Health Insurance Program (CHIP) will expire after September if lawmakers do not pass legislation for the extension of its funding. There is a risk that Republicans might include repeal language in the CHIP extension, forcing Congress to pass the bill or run the risk of leaving millions of children without health care.
  3. President Trump could announce that he will not continue to make the payments for the ACA’s cost-sharing subsidies—causing insurers to flee the marketplace or else raise premiums by an estimated 20%. This would create extreme upset in the health insurance marketplace.

We have all fought hard to protect our care, and so far we have succeeded, but the battle is not yet won. Only time will tell what comes next, and it is imperative that we all stay focused, gather our strength, and battle on. Make sure you have signed up to be a CSC Grassroots Advocate to stay up-to-date on breaking health care reform news. We also provide updates on a variety of policy issues that impact individuals impacted by cancer. Be an advocate today.