“Skinny” Repeal would have Gargantuan Impact



“Skinny” repeal is all the rage in Washington these days, as Senators look to a bill that would undo one of “Obamacare’s” least popular provisions: the individual mandate, which requires all Americans to carry health insurance or face a stiff tax penalty.

In theory, eliminating this mandate might sound like a pretty good deal. So why are some calling the “skinny” repeal the “sham” repeal?

In short, because the skinny/sham repeal would destroy the individual health insurance market. Keep in mind that the skinny/sham repeal eliminates the individual mandate without eliminating the requirement for insurers to cover preexisting conditions, which happens to be one of the most popular provisions of the Affordable Care Act (ACA).

Imagine: you know that insurers have to cover everything the moment you purchase health insurance. If you are a smart consumer, what do you do?

If you answered “not carry health insurance until I get sick or injured,” you win, and the insurance markets lose. This is similar to the way COBRA works; you wait until you get sick to use it, because it will cover everything the moment you take it out. That’s one of the reasons COBRA is so expensive.

The net effect of repealing the individual mandate? Insurers lose money hand over fist and choose to either leave the individual market or go out of business. That’s why the Congressional Budget Office (CBO) has already estimated that simply cutting the individual mandate will cost 15 million Americans their health insurance coverage.

This is why the preexisting condition exclusion and the individual mandate go hand in hand. You can’t have full coverage of all preexisting conditions without the individual mandate. To think otherwise is simply misguided, and to try and pass it into law for the sake of political expediency is simply alarming.

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.


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.

Congress and White House Continue to Threaten Americans’ Healthcare


The healthcare of millions of Americans is currently under threat from multiple branches of government. The non-partisan Congressional Budget Office (CBO) on July 13 released its analysis of President Trump’s proposed FY 2018 federal budget; it continues to threaten the healthcare access of the most at-risk populations of Americans. President Trump’s proposed cuts to Medicaid would result in a $610 billion reduction in Medicaid spending by 2027. This number presumably does not include the additional potential cuts to Medicaid – such as the Better Care Reconciliation Act of 2017 (BCRA) repeal of Medicaid expansion – included in the anticipated $1.25 trillion in spending reductions by 2027 associated with the repeal and replacement of the Affordable Care Act. The Trump budget would severely impact vulnerable populations’ access to vital health care services. These vulnerable populations include children and adults with disabilities, low-income elderly individuals, individuals with chronic conditions, individuals with mental health conditions and substance use disorders, and individuals who need long-term supports, such as home and community-based services and skilled nursing facilities. Medicaid is a critical source of funding for these services and it has broad public support. Such enormous reductions in Medicaid spending would inevitably force states to make tough decisions as to which services to provide to which of these vulnerable populations, ripping away from millions of Americans their only source of healthcare coverage.

Congress, meanwhile, has its own plans for reducing Americans’ access to critical healthcare services. According to the CBO, the Senate’s BCRA would also reduce Medicaid spending dramatically – by $756 billion through 2026. The plan would roll back Medicaid expansion and would create a per-capita cap on the amount of federal Medicaid funding states receive, limiting the amount of Medicaid funding available to states even beyond 2026. These reductions would impact vulnerable populations in a way similar to those under President Trump’s budget. Furthermore, the BCRA would reduce subsidies to pay for individual health insurance coverage by $396 billion by 2026. These changes would leave an additional 22 million Americans without healthcare coverage by 2026. The numbers are even worse for a straight repeal of the Affordable Care Act (ACA), which the CBO estimates would leave 32 million more American uninsured and cause insurance premiums to double through 2026. Meanwhile, the Republican Study Committee – the House Republicans’ conservative policy making arm – has released its budget priorities for the FY 2018 budget. These include a complete repeal of the ACA, a conversion of Medicaid into a block grant or per-capita cap program (see ANA’s policy primers on Medicaid block grants here), and phases in an increase in the Medicare eligibility age.

These developments are bad enough on their own. But they have also overshadowed the fact that the Children’s Health Insurance Program (CHIP), which provides healthcare coverage to 8 million American children, is up for reauthorization this year. If CHIP is not reauthorized by September, federal CHIP funds will not be available to states and current funds would run out within a year, thus putting healthcare access for those 8 million children at risk. CHIP reauthorization has been overlooked in the battles over healthcare reform in the House and Senate, and only one hearing on the subject has been held in either house during this Congress.

The Senate is still in the process of deliberating healthcare reform and the dismantling of the ACA. All of these healthcare reform proposals fly in the face of ANA’s 4 core principles of health system transformation and place our nation’s most vulnerable populations at risk of losing vital healthcare services. While the prospects for any bill to pass still look dim, ANA urges you to keep the pressure on your senators and representatives to ensure that they know that nurses do not support these reform efforts. Contact your elected officials today to let your voice be heard!