The Senate hurtles toward disaster [Update: First major vote fails]

  

UPDATE: Following their successful vote on the motion to proceed, Senate Republican leadership saw a subsequent vote on a bill with amendments from Sens. Ted Cruz (R-TX) and Rob Portman (R-OH) fail. Votes are scheduled to resume Wednesday morning.


pc-quote

By the thinnest possible margin, Senate Republicans voted today to begin debate on their various proposals repealing and possibly replacing the Affordable Care Act (ACA), each of which would strip coverage from millions of Americans and devastate our country’s health care system.

Only Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) chose to break with their party, listen to their constituents, and reject these dangerous plans. We’re hopeful that their courageous example will influence their colleagues to do the same as more pivotal votes are taken.

The 20 hours of floor debate that now follow will likely take up the rest of the week, with multiple votes expected on the different bills in play. Here’s where we stand:

  • First, Senators will debate then vote on a repeal of the ACA without a replacement. This is widely expected to fail, but will still take place after being guaranteed to Sen. Rand Paul (R-KY) in exchange for his yes vote on today’s motion to proceed.
  • Debate will then move to a modified version of the Better Care and Reconciliation Act (BCRA), which is also expected to fail due to last-minute changes that mean the bill must pass with 60 (rather than 50) votes, per Senate parliamentary procedure.
  • The Senate would then begin what’s known as vote-a-rama, with amendments from Democrats and Republicans under consideration, most likely to the House bill (the American Health Care Act, or AHCA) in the event that the previous two bills fail to pass. The final bill that results from this process will also have difficulty garnering a majority of yes votes.
  • The final expected vote will then consider a substitute put forward by Majority Leader Sen. Mitch McConnell (R-KY), and which will include a simplified version of the plan Republicans actually want to pass.
  • If successful, that bill would then be taken up by a conference of negotiators from both the House and Senate, in the hopes of producing final legislation that both chambers could pass.
  • As with today’s motion to proceed, Vice President Pence will be on hand to break any 50-50 tie.

Once again, the lack of understanding around the final plan Republicans hope to pass is a sad commentary on a process that’s been anything but transparent, and has failed to give the American people a clear idea of the ramifications both for themselves and the country’s health care system.

All nurses should urge their Senators to oppose this undemocratic process and reject the idea that reforming health care should be done in secret. We also continue to urge residents in the following states to push heavily on those Senators who have publicly expressed concern about the impact of these proposals on their constituents’ care:

  • Alaska – Sen. Murkowski
  • Arizona – Sens. Flake and McCain
  • Louisiana – Sen. Cassidy
  • Ohio – Sen. Portman
  • Nevada – Sen. Heller
  • West Virginia – Sen. Capito

Click here to make your call now. Together, we can still win this battle.

A bad process leaves the Senate with nothing but bad options

  

The Congressional Budget Office (CBO) this week scored several versions of the misguided health care legislation put forward by Senate Republicans, finding that between 22 and 32 million Americans would lose coverage if any of these bills were passed into law. Public opposition from moderate senators including Susan Collins (R-ME), Shelly Moore Capito (R-WV), and Lisa Murkowski (R-AK) has forced Majority Leader Mitch McConnell (R-KY) to consider several possible paths forward, all of which will prove challenging.

july14

  • The Better Care Reconciliation Act (BCRA) was introduced in mid-June and would take away coverage for an estimated 22 million Americans. Its failure to garner support from a majority of Senate Republicans is why other bills are now in play.
  • An updated version of the BCRA included an amendment from Sen. Ted Cruz (R-TX) that would deregulate the insurance market and allow providers to offer plans for those with pre-existing conditions that would be separate from (and likely much more expensive than) plans offered to those without. The CBO has not scored this bill, in part because it, too, lacks the necessary support to move forward.
  • Yet another updated version of the BCRA that does not include the Cruz amendment received its CBO score earlier today, and would also result in 22 million losing coverage.
  • The Obamacare Repeal Reconciliation Act (ORRA) was introduced yesterday, and would repeal the ACA without a replacement – commonly known as “repeal and delay.” Instead, Congress would be given two years to come up with an alternative plan. Over the next decade, CBO estimates that ORRA would cause 32 million Americans to lose coverage.

As McConnell continues trying to find a way forward, uncertainty over which version of repeal will be put to a vote next week – and whether it would include a replacement for the Affordable Care Act (ACA) or not – is a fitting conclusion to a process that has lacked transparency and failed to incorporate the expertise of healthcare providers, including America’s 3.6 million nurses.

The American Nurses Association continues to oppose these efforts because they all fail to meet our principles for health system transformation.

Each of the bills under consideration would:

  • Lead to unaffordable premiums for seniors and individuals with pre-existing conditions.
  • Cut or cap Medicaid and end state-based Medicaid expansion, which would have a devastating impact on those who can’t afford health care in the private market.
  • Worsen the opioid and suicide epidemics, at a time when states are struggling to cope with the toll these epidemics have taken.

Nurses have joined with concerned citizens across the country to make their voices heard, and are closer than ever to defeating these bills. It’s critical that we send a clear message to our representatives: reforming America’s health care system should be done in a transparent and bipartisan manner, and include input from those who care for and treat patients every day.

Senate Republicans, however, are continuing to negotiate, which is why concerned advocates should continue calling their Senators and urging them to follow a process that allows adequate time for public input and embraces common-sense fixes to the ACA. Making health care better isn’t impossible, as long as nurses are given a seat at the table.

Another Poor Score

  

Today’s Congressional Budget Office (CBO) report confirms what we already suspected: despite last minute changes made prior to a misguided and party-line House vote, the American Health Care Act (AHCA) seriously threatens health coverage affordability, access, and care delivery, and would cause roughly 14 million individuals to lose coverage by 2018, and 23 million to lose coverage by 2026.

The American Nurses Association (ANA) remains opposed to the AHCA and urges the Senate to abandon the bill advanced by the House in favor of a more transparent process that truly aims to expand access to affordable quality care.

Photo: Carlos Barria, Reuters
Photo: Carlos Barria, Reuters

According to the report, the AHCA would allow for various waivers that would undermine protections for those with pre-existing conditions, and undercut access to essential health benefits for roughly one-sixth of the population. Taken together, these waivers would cause premiums to “vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” according to the CBO. “Over time, it would become more difficult for less healthy people (including people with pre-existing medical conditions) in [states that make use of the waivers] to purchase insurance because their premiums would continue to increase rapidly.”

The bill also continues to pose a serious threat to those Americans who rely on Medicaid, a majority of whom are children. Rolling back state expansion of Medicaid would effectively cut off coverage for millions of low-income Americans and further upend the health care landscape.

Though today’s score was marginally better than the first assessment released in March, the negative consequences for those who need care most remain extreme. In particular, the CBO noted that “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for” those not covered by group health insurance plans.

The ANA encourages the Senate to draft a comprehensive health care plan that protects Americans from being denied insurance coverage because of pre-existing conditions and provides access to affordable health insurance coverage plans that offer a minimum standard of benefits. These include preventative services and screenings, inpatient and outpatient services, prescription drug coverage, mental health, maternity services, and chronic disease management.