GOP Meets for ACA Strategy Session and Senate Alternatives


Last week, there was flurry of activity and chatter on Capitol Hill surrounding the ACA’s repeal-and-replace. Much of the focus surrounded Congressional Republican’s three-day retreat in Philadelphia, where House and Senate Republicans were expected to plot their legislative agenda for the 115th Congress.

Congressional leaders held a special session on Thursday morning to try to reach a consensus on how to move forward on an ACA repeal and replacement strategy; unfortunately, no consensus was reached, which seemed to suggest that House and Senate Republicans were more divided on how to move forward than previously thought.

In the House, Speaker Ryan (R-WI) suggested on Thursday a more piecemeal approach towards health reform that’s focused on a “repeal and repair” of the system. Chairman Greg Walden (R-OR), a close Ryan ally, later this week will consider four separate bills that affect changes to the individual market in the House Energy and Commerce Committee. The changes would permit insurers to tighten enrollment periods, an attempt to try to ensure coverage for pre-existing conditions, and consideration on a measure to allow insurers to charge seniors higher rates. The committee will also examine potential reforms to the Medicaid program.

In the Senate, Senators Cassidy (R-LA) and Collins (R-ME) introduced the Patient Freedom Act. Hoping to chart a path that gives states options for reform, the bill would allow states to either 1) keep the ACA as is, 2) switch to a different insurance expansion plan that auto-enrolls individuals into a subsidized catastrophic plan, or 3) move forward with a repeal and no coverage expansion (meaning states would lose federal Medicaid expansion funds).

Senator Rand Paul (R-KY), also introduced his own bill. His legislation primarily focused on repealing the ACA’s employer and individual mandates, which includes a repeal of the ban on pre-existing conditions. The plan includes a two-year open enrollment period in which individuals with pre-existing conditions cannot be denied, but by and large the bill emphasizes tax credits and a more deregulated health market as an alternative to the ACA.

Stay tuned for more activity on Capitol Hill this week on the healthcare reform front.

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.