12 Days in September

  
Photo: Getty Images
Photo: Getty Images

President Trump joined with congressional Democrats yesterday to clear three major items from a jam-packed congressional agenda. The stopgap agreement will raise the nation’s debt limit, keep the government open through the end of the calendar year, and provide hurricane relief for the communities and states hardest hit this hurricane season. In doing so, however, Trump and congressional leaders have ensured that an even bigger debate awaits them in December, with an unclear outlook on how it will resolve itself.

The House also passed nearly $8 billion in disaster aid in response to the devastation wrought by Hurricane Harvey. But with Hurricane Irma bearing down on Puerto Rico and Florida, lawmakers may be called on to pass additional funding soon.

Meanwhile, lawmakers still face an overflowing agenda. Here’s a quick rundown of what else to expect this September:

  • Tax reform: The President and his administration have long signaled that they hope to pass tax reform legislation before the end of the calendar year. Their failure to pass health care reform legislation this summer, however, coupled with a long list of competing priorities, makes this increasingly unlikely.
  • Health care reform: Though congressional leaders have appeared to move on to other, more pressing issues, President Trump continues to indicate he wants lawmakers to take one more shot at repealing and replacing the Affordable Care Act.
  • Immigration: Following the President’s decision to rescind the policy of Deferred Action for Childhood Arrivals (DACA) in the event that Congress fails to craft a solution in the next six months, lawmakers on both sides of the aisle are searching for a legislative fix. Democratic leaders have asked Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) to bring the Development, Relief, and Education for Alien Minors (DREAM) Act to the floor for a vote, and have suggested they will attempt to attach the bill to other priority items to force leadership’s hand. Though widely championed by progressives, the legislation could face difficulty garnering bipartisan support.

Meanwhile, the Senate HELP committee will be holding a series of hearings to determine the best path forward on creating stability in the individual health insurance markets. Democrats are certain to use this forum to put a spotlight on the administration’s recent decision to slash funding used to promote the Open Enrollment period that starts November 1st. We’ll have an additional update for you later this week on these and other health care-related items.

Trump Administration Moves Create Major Uncertainty In Healthcare System

  

The Trump administration has toyed for months with the idea of withholding cost-sharing reduction (CSR) payments to insurance companies participating in the individual insurance marketplace implemented by the Affordable Care Act (ACA). This has injected a great level of risk into the healthcare system which has in turn created a lot of uncertainty and confusion. These CSR payments are intended to help low-income individuals with income between 100% and 250% of the federal poverty level pay for co-pays, co-insurance, and deductibles. The ACA limits to a percentage of their income the amount of cost-sharing these individuals pay. For instance, an individual with an annual income of $17,000 might only have a $125 deductible compared with a $2,500 deductible for someone with a $25,000 annual income under the same insurance plan. (See a detailed description of CSR payments here). The federal government makes CSR payments to insurance companies to balance out the difference between what the individual pays and what the insurance company charges (fortunately, the Trump administration today stated that it will make CSR payments for August).

The Congressional Budget Office (CBO) on August 15th released an analysis on the impact that withholding the CSR payments would have on insurance premiums and insurance coverage. According to the CBO report, insurance premiums for individual insurance coverage would increase by 20 percent in 2018 and by 25 percent by 2020, while 5 percent of people would live in areas that would have no insurers in the non-group market in 2018.

Furthermore, withholding CSR payments would increase the federal deficit by $194 billion from 2017 through 2026, largely as a result of higher federal premium tax credit payments. Higher federal deficits would also put pressure on existing federal healthcare and social services programs, including Medicaid, and would further threaten the ability of the federal and state governments to provide health care services to the nation’s vulnerable populations.

In addition to the chaos and uncertainty the Trump administration is causing with respect to CSR payments, it is also making moves to undo some of the progress made under the ACA toward achieving quality outcomes and a higher degree of care coordination. A recent rule proposal published on the website of the Office of Management and Budget would eliminate the mandatory implementation of the bundled payment models for cardiac care coordination and cardiac rehabilitation, as well as implement changes to the comprehensive care joint replacement model. These advanced payment models promote care coordination and place an emphasis on patient outcomes and quality of care; elimination of these models would be a detriment to patients and nurses alike.

Stable payment systems and innovative payment models which emphasize care coordination and patient outcomes will better enable nurses to provide quality care and ensure that patients are able to receive the best quality of care in a timely fashion and with better outcomes. As such, the American Nurses Association strongly supports both the federal CSR payments and the implementation of the aforementioned advanced payment models.

“No”

  
Photo: Susan Walsh, AP
Photo: Susan Walsh, AP

Following a dramatic late night vote that saw Senators reject Majority Leader Mitch McConnell’s (R-KY) so-called “skinny” bill repealing the Affordable Care Act (ACA), lawmakers from both sides of the aisle are publicly calling for a fresh approach to reforming health care that embraces bipartisanship and transparency, and actively seeks solutions from experts who know health care best, including America’s 3.6 million nurses.

Sens. Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK) joined with all 48 Senate Democrats to vote against legislation that would’ve stripped the individual and employer mandates introduced by the ACA, among other harmful provisions, and which was intended to pave the way for a conference committee of representatives from both chambers, who would be responsible for crafting a bill that both could pass.

But House Speaker Paul Ryan (R-WI) seemed unwilling to guarantee that his chamber wouldn’t just skip the conference process and pass “skinny” repeal itself, prompting McCain and others to publicly withhold their support early yesterday evening. While subsequent assurances from Ryan and Vice President Mike Pence were enough to win back the support of some of those Senators, McCain ultimately came to the same conclusion as his colleagues from Alaska and Maine, and voted no.

The nursing community showed up like never before in this fight, driving thousands of calls and e-mails to Congress. Hundreds traveled all the way to Washington, DC last month to deliver our message face-to-face with our legislators: The only way our country can truly reform our healthcare system is by working together. No more closed doors. No more dead-of-night deals. No more decisions made without a single nurse consulted.

While this victory is heartening, we know there are those who will continue pushing lawmakers and the administration to undermine our health system and harm those who have gained coverage as a result of the ACA. If you haven’t yet, please join our RNAction community to learn more and get the latest updates on how you can help ensure that our representatives in Washington continue to protect our care and put patients first.