Anxiety Over ACA Repeal Grows as Negative Impacts Become Apparent


Anxiety among both the public and lawmakers continues to rise as House and Senate Republicans last week took the first step toward their ultimate goal of repealing the Affordable Care Act.  At least 5 Republican Senators have stated their support for having a replacement plan to go along with any repeal legislation. Several Republican governors who have expanded Medicaid under the ACA have also expressed their concern over a model that does not include replacement legislation. Governors John Kasich and Rick Snyder of Ohio and Michigan, respectively, have been particularly vocal; their states stand to lose a combined $86 billion in federal funding if the ACA is repealed.

Efforts to repeal the ACA were further muddied on January 17th, when the Congressional Budget Office released its report which details the impact of repealing the ACA without replacement legislation. The CBO is the non-partisan Congressional office tasked with providing independent analyses of budgetary and economic issues to support the Congressional budget process. Highlights of the report include:

  • 18 million people could lose their health insurance coverage within the first year, and 32 million could lose coverage within ten years, between Medicaid and the individual insurance market
  • Destabilization of the individual insurance market due to the elimination of the individual mandate and premium subsidies for low-income individuals resulting in a “death spiral”
  • Half of the country would be living in areas with no insurer in the individual market in the first year, and three-fourths would live in such areas by 2026
  • Premiums for health insurance coverage purchased on the individual market would be 20 percent to 25 percent higher in the first year

Congress has a daunting landscape as it moves ahead with its plans to repeal and replace the ACA. It is a near certainty that the Affordable Care Act will be altered in some way. It is less certain what those alterations might look like. ANA stands by its core principles and demands that any replacement legislation reflect our principles: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.

Democracy in Action: My Front-Row Seat to the Inauguration & Women’s March


This weekend, I attended both the inauguration and the Women’s March on Washington. In other words, I spent Friday surrounded by staunch supporters of President Trump and Saturday surrounded by those who oppose him.

Both days, I stood shoulder-to-shoulder with smart people who care passionately about this country and who answer the call to engage in the political process. It gave me a unique glimpse into the conversations we are having—and not having—in this country.

January 20th: Inauguration Day

I took President Obama’s farewell speech advice to heart: “If you’re tired of arguing with strangers on the internet, try talking with one of them in real life.” So, wearing my ANA pin, I spoke to everyone around me.

Everyone I met cared about many of the same issues that I do, like providing health care for all, fostering a strong economy, and ensuring quality education for our children. The people I spoke with firmly believe that Donald Trump will deliver in all of these areas. After President Trump spoke, the man standing next to me even said: “I love this man!”

At every turn, I saw that supporters of the new president are reasonable and willing to listen. For example, when people booed Hillary Clinton, I couldn’t help but blurt out: “This is disrespectful.” Two women near me replied: “You’re right.” Together, we created a small clapping section for all of the Democrats coming to the stage to counter the booing. Of course, I also clapped as Speaker Ryan, Vice President Pence, and President Trump were announced. Respect is respect.

Here’s where respect was lacking. As my husband and I were standing in line to attend the Inaugural Ball, protesters screamed at us. This was after hearing all afternoon about protesters breaking windows and starting fires. One protestor jumped in front of my husband so aggressively that three police in riot gear intervened. People around us expressed their disgust the behavior of “those sore losers.”

January 21st: Women’s March on Washington

The next day, I joined the Women’s March on Washington. I was surrounded by throngs of women and men chanting “This is what democracy looks like!” Attendees were overjoyed that their voice was being heard after the inauguration the day before. It was a peaceful protest—not one person in the throng of 500,000 people was arrested. And yet, every time I saw a sign or heard someone shout Not my president!, the previous day’s discussion about “sore losers” rang in my ears.

The Unifying Message from Two Ends of the Spectrum

Both days taught me about the way we listen to those who oppose us. More than ever, I believe that we only let ourselves hear the most extreme fringes of the opposition. This, in turn, allows us to label the other side as “crazy” and more readily dismiss differing points of view. Instead, what we so desperately need is to generate conversations that begin and end with respect. To quote Scottish historian Thomas Carlyle: “In any controversy, the instant we feel angry, we have already ceased striving for Truth, and begun striving for Ourselves.”

I also learned that nurses are uniquely prepared to generate the important discussions we need to have as a nation. We are skilled, respectful, and trusted listeners and communicators—even when faced with people who have widely differing points of view.

My ANA pin opened the doors to discussion on both days. So, I urge you to use your voice, listen intently beyond the shouting, and generate your own powerful conversations.


HHS Nominee Dodges Questions on ACA repeal, Medicare, and Medicaid in Confirmation Hearing


As expected, Congressman Tom Price (R-GA), Health and Human Services Secretary nominee, faced intense scrutiny at today’s confirmation hearing before the Senate Finance Committee. Despite President Trump’s recent Executive Order instructing his Administration to facilitate the repeal and replacement of the Affordable Care Act (ACA) by “minimizing any unwarranted economic and regulatory burdens,” Price would not reveal whether penalties would be removed for people who don’t purchase insurance. He said that our current system works for the government, but not patients. As Secretary, he would ensure that everyone has “access to affordable coverage.”

Throughout the hearing, Price skirted questions about the replacement plan. He declined to reveal any potential changes to ACA. Instead, he stressed that it was Congress’ responsibility to devise an ACA replacement plan. He maintained that, as Secretary, he would merely implement the plan passed by Congress.

Ranking Member, Senator Ron Wyden (D-OR), referenced Price’s previous ACA replacement legislation during questioning. He expressed concerns that repeal would destroy the market and urged Price to keep patients at the “center of healthcare, not money or special interests.” Price said he wouldn’t abandon individuals with pre-existing conditions, but stopped short of guaranteeing coverage. He repeated his desire to make sure every American had an “option and opportunity for care.”

In his own plan, Price has supported privatizing Medicare in the past, but denied plans to privatize it in the replacement. Sen. Bill Nelson (D-FL) pointed out that seniors are “petrified about a privatized Medicare.” When questioned on Medicaid, Price would not reveal whether the replacement plan would eliminate the ACA’s Medicaid expansion. Despite his past efforts to change Medicaid into block grants, which would provide money directly to states and allow them to make coverage decisions, Price said he would defer to Congress.

Price weighed in on a successful nursing program. Sen. Tim Scott, (R-SC), highlighted the Nurse Family Partnership, a Medicaid-funded program which pays to send nurses into the homes of low-income, first-time mothers. While he was impressed with the program, Price pointed out that Medicaid “coverage doesn’t always equal care.” Price did share that he favors an eight year extension of the Children’s Health Insurance Program.

Price has been a vocal critic of the Center for Medicare & Medicaid Innovation (CMMI), which pays providers based on quality and outcomes. He said CMMI should incentivize innovation and benefit patients, but that CMMI is “off track a bit” in that it dictates how providers must practice without exception.

Senate Democrats questioned Price’s judgment for receiving discounts and actively trading health care stocks. Price said everything he did was ethical and legal. The discounts, he said, “were available to every single individual that was an investor at the time.” Despite the testy exchanges around ethics, there was bipartisan support for improving access to high-quality healthcare in rural America. Sen. Pat Roberts (R-KS) pointed out that the rural healthcare delivery system was “under stress.” He asked if Price would reduce documentation burdens on providers and hospitals. Price agreed, noting that government sometimes puts up roadblocks to expanding technology, especially in rural areas. He said we ought to be incentivizing innovation for patients to receive the highest quality care. Price said telemedicine is improving lives of patients in rural communities. If confirmed, he promised to strengthen rural healthcare and establish less burdensome regulations.

Senate Finance Committee Chairman Orrin Hatch, (R-UT), praised Price’s “performance.” He said Price has the experience and qualifications to effectively lead HHS. He plans to schedule a committee vote to send Price’s nomination to the full Senate for final vote as soon as possible.