Congress can’t keep kids covered as 2017 comes to a disappointing end


Congressional Republicans immediately followed their passage of a tax bill that will have a devastating impact on public health by voting for an irresponsible spending stopgap that needlessly jeopardizes the roughly nine million American children who rely on coverage from the Children’s Health Insurance Program (CHIP). While regrettable, this sequence of events was a fitting conclusion to 2017 on Capitol Hill, where majority lawmakers showed a persistent and troubling desire to limit Americans’ access to health care.

While the stopgap bill passed by the House and Senate will fund CHIP through the end of March 2018, it continues to create reckless uncertainty as state officials who manage the program are forced to run it on a month-to-month basis. Despite the widespread bipartisan support the program has historically enjoyed, congressional leaders proved unable to reach an agreement on the usual five-year long-term spending approval that CHIP has received in the past.

Republicans also chose to punt to 2018 on health marketplace stabilization efforts that are even more urgent in the wake of the tax bill’s passage. While the proposals from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), as well as Susan Collins (R-ME) and Bill Nelson (D-FL) will not mitigate all the damage done by individual mandate repeal, they will help lessen the negative impact from President Trump’s unilateral and dangerous decision to end stabilization funding earlier this fall.

And though both measures would have an objectively positive impact on the health marketplace congressional Republicans seem intent on destroying, it remains unclear whether the measures – together or separately – could garner a majority of support in either chamber, particularly the House of Representatives where more conservative members enjoy increasing influence.

Despite these developments, almost nine million Americans reportedly signed up for coverage during this year’s Open Enrollment period that concluded on December 15, nearly matching last year’s total. This took place despite the administration’s efforts to limit enrollment, by cutting the sign-up period in half and slashing funding for promotional efforts to educate the public. The enrollment figures are a clear sign that Washington’s focus in 2018 must turn away from creating roadblocks to health care, and instead find new ways to help Americans get and stay covered.

American Nurses Association Strongly Opposes the Tax Cuts and Jobs Act


Massive tax bill will significantly reduce the number of Americans with health insurance

Silver Spring, MD – The following statement is attributable to Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA), in response to the Tax Cuts and Jobs Act.

“The American Nurses Association is deeply concerned about the devastating impact that the Tax Cuts and Jobs Act will have on health care in this country. Under the guise of a promise to slash taxes for corporations and middle-class Americans is a clear intent to dismantle the Affordable Care Act (ACA), which has helped nearly 16 million Americans obtain health coverage. It is also no secret the actions that will be pursued to make up for the inflated deficit caused by this tax bill will be the cutting of essential anti-poverty programs as well as Medicare and Medicaid.

Eliminating the ACA’s individual mandate will lead to an estimated 13 million fewer Americans having health insurance. The resulting domino effect will be negative health outcomes, higher costs, and fewer individuals with access to critical primary care and preventive services. This is irresponsible and further proves that health care is being handled like a political game to be won at any cost. Frustratingly, this bill was pushed through without input from patients, consumers, or health care experts, including the country’s 3.6 million registered nurses, whom the public ranks as the most ‘honest and ethical’ profession.

Amid numerous failed attempts to ‘repeal and replace’ the ACA, ANA voiced strong opposition to legislation that would threaten health care affordability, access, and delivery for millions of people across the nation. ANA will continue to advocate for a health system that ensures universal access to a standard package of essential health care services for all citizens and residents.”

For high resolution images of the ANA logo or photos of ANA leadership, please click here.

Tax reform and individual mandate repeal put patients in the crosshairs


With the Senate speeding toward a final vote on tax reform legislation, Majority Leader Mitch McConnell (R-KY) and his leadership team are considering the inclusion of two additional health care proposals. Their hope is that these proposals will persuade undecided Senators to vote yes and make up for the fact that the bill includes the misguided decision to repeal the individual mandate. Unfortunately, while these proposals may have merit on their own, they won’t be enough to mitigate the damage caused by individual mandate repeal, which the Congressional Budget Office (CBO) estimates will lead to 13 million Americans losing health coverage.

Proponents of the two proposals have claimed that they would at least mitigate – if not completely undo – the harm of individual mandate repeal. The first, from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) would restore cost sharing reduction (CSR) payments through 2019, after the Trump administration unilaterally decided to end the payments earlier this year.

The second, from Sens. Susan Collins (R-ME) and Bill Nelson (D-FL), provides $2.5 billion in both 2018 and 2019 for state reinsurance programs, which reimburse insurers for some or all of the costs associated with highest-cost claims.

However, without the individual mandate, fewer healthy people will sign up for coverage and average costs and premiums across the individual market will rise by 10 percent, according to the CBO; some providers have projected even larger increases. To offset this 10 percent increase, $10 billion in federal reinsurance funds would be needed each year (as opposed to the temporary “solution” offered by Collins-Nelson).

Worse, repealing the individual mandate increases uncertainty and instability about future open enrollment periods, risk pool profiles, and premium rates. Put simply, insurers would be forced to reconsider whether they want to continue taking part in the health insurance marketplace at all, a recipe for further disruption and additional loss of coverage among individual market enrollees.

Finally, while the Alexander-Murray proposal to reinstate CSR payments would be a laudable approach on its own, CBO has found that it would also fail to reverse the coverage reductions that will result from individual mandate repeal. In short, repeal creates a problem far bigger than the one Alexander-Murray was initially intended to address.

With a final vote looming, now is the time to tell your Senators that they should stand with patients and reject this bill. In the absence of substantive debate and expert input, grassroots pressure is the best hope for stopping this harmful legislation once and for all.