Graham-Cassidy is the worst healthcare bill yet

Photo: ABC
Photo: ABC

As Congress works its way through a packed September agenda, yet another attempt to repeal and replace the Affordable Care Act (ACA) is gaining momentum. Unfortunately, this legislation – like similar bills that have come before it – has chosen to leave nurses out of the process, and as a result would leave too many patients without the care they need.

As we’ve previously addressed, legislation sponsored by Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) would make drastic and dangerous cuts to the American healthcare system by repealing Medicaid expansion starting in2020, eliminating the critical Prevention and Public Health Fund, and creating high-risk pools for individuals with pre-existing conditions (effectively removing ACA-implemented essential health benefit protections for those patients), among other misguided policies.

The block grants to states that Graham-Cassidy would use to replace the ACA would also continue to shrink before, in 2026, disappearing entirely, leading to even more cuts. In other words, the legislation goes further than what was proposed this summer – which at its worst was projected by the Congressional Budget Office (CBO) to cause up to 32 million Americans to lose their coverage.

Meanwhile, the process surrounding the bill continues to fall well short of Sen. John McCain’s (R-AZ) repeated calls for a return to regular order. While the Senate Finance committee has planned a single hearing around Graham-Cassidy, the CBO will not have time to fully score the legislation, meaning it will remain unclear how many patients would have their care stripped away as a result.

Criticism of the bill is widespread: on Tuesday, Democratic, Republican, and independent governors from Alaska, Colorado, Louisiana, Massachusetts, Montana, Nevada, Ohio, Pennsylvania, Vermont, and Virginia released a letter announcing their opposition, writing that, “Only open, bipartisan approaches can achieve true, lasting reforms.”  And as with the so-called Affordable Health Care Act and Better Care Reconciliation Act, no Democratic senators have announced their support for Graham-Cassidy, with conservative Sen. Rand Paul (R-KY) also expressing skepticism that he’ll be a yes vote if and when it comes to the floor.

Regardless of the current whip count, which is constantly evolving, the stakes are too high to count on another dramatic late night vote that saves the day. Don’t wait: click here to be connected with your Senators and urge them to vote no on Graham-Cassidy. In the absence of real dialogue, nurses’ voices are needed now more than ever.

September Heats Up on the Hill as Congress Turns Back Toward Healthcare


As expected, Capitol Hill has turned out to be a beehive of activity in the month of September. With government funding, the debt limit, and hurricane relief funding taken care of, Congress is increasingly turning its eye back toward healthcare reform. Democrats and Republicans have each introduced new healthcare reform bills (which, shockingly, go in drastically different directions), and several House and Senate committees have held hearings on healthcare reform. On a positive note, there seems to be a significant shift toward bipartisan cooperation on healthcare reform (at least with respect to the individual insurance market) since the dramatic collapse of the Senate Republicans’ efforts to repeal and replace the Affordable Care Act in the early morning hours of July 28th.

Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) Unveil Yet Another Repeal and Replace Plan

Republican Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) introduced a “new” healthcare reform bill this morning – which, it should be noted, is a very long shot for even seeing a vote on the Senate floor. At this point, the ACA repeal and replace effort feels like the movie Groundhog Day, in that we keep seeing the same proposals over and over again. The Graham-Cassidy bill – also supported by Sens. Dean Heller (R-NV) and Ron Johnson (R-WI) – is not substantially different from any of the other repeal and replace bills we have seen from House and Senate Republicans. It repeals Medicaid expansion in 2020; it eliminates the $1 billion Prevention and Public Health Fund; it creates high-risk pools for individuals with pre-existing conditions; it defunds Planned Parenthood for a year; it puts a per-capita cap on Medicaid funding and gives states the option to convert their Medicaid programs into block grants (see ANA’s policy primer on block grants); and it ends premium tax credit assistance and cost-sharing subsidies and puts greater control of healthcare spending in state hands. As with all other repeal and replace proposals to date, the current proposal fulfills none ANA’s 4 principles for health system transformation. Under Senate rules, the Senate must vote on this measure (if it comes to a vote) by September 30th in order to pass with a simple 51 vote majority. We hope that it does not come to that.

Senator Bernie Sanders (I-VT) Goes (Medicare For) All-In on Single-Payer

On the other side of the aisle, Sen. Bernie Sanders (I-VT) has introduced his Medicare for All Act of 2017. As the name implies, this plan would extended Medicare eligibility to all Americans and transform the American healthcare system into a government-run, single-payer system. This bill – which has the support of 16 Democratic co-sponsors (though notably no endorsement from party leadership) – would phase in Medicare eligibility by age over 4 years, eventually extending eligibility to Americans of all ages. The Medicare for All Act of 2017 would do away with the country’s current system of employer-based insurance coverage and, it should be noted, significantly increase the amount of money the U.S. government spends on healthcare services. The chances of it passing, however, are non-existent, given that Democrats are in the minority in the Senate and the House, and do not control the White House. Still, the introduction of the Medicare for All Act of 2017 does shift the conversation toward a single-payer healthcare system to a significant degree.

Children’s Health Insurance Program Reauthorization Shows Progress

The Children’s Health Insurance Program (CHIP) provides healthcare coverage to low-income children whose families do not qualify for Medicaid; it is a crucial source of healthcare coverage for roughly 9 million children each year. CHIP funding is generally reauthorized every few years. The current CHIP authorization is set to expire on September 30th, placing the healthcare coverage of 9 million children at risk. Fortunately, Sens. Orrin Hatch (R-UT) and Ron Wyden (D-OR) of the Senate Finance Committee announced yesterday that they have reached a deal to extend CHIP for five years and would transition CHIP to its traditional federal-state partnership and provide additional protections for low-income children and flexibility for states (full legislative language will be released in the coming days).

Senate Health, Education, Labor, and Pensions Committee Holds Hearings on Insurance Premiums

The Senate Health, Education, Labor, and Pensions (HELP) Committee held hearings on September 6th, 7th, and 12th, focused on stabilizing premiums and helping individuals in the individual insurance market in 2018. The committee also has another hearing scheduled for September 14th on the same subject. Panelists during these hearings have included state insurance commissioners and governors, and the hearings have focused on affordability and state flexibility. The Senate HELP Committee is led by Chair Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) and has begun to move forward in a bipartisan way to stabilize the individual insurance market with the goal of protecting consumers from huge price increases.  

With so much activity happening on Capitol Hall, it can be difficult to keep it all straight. ANA encourages you to engage with your senators and representatives and make clear to them that any healthcare reform effort must align with our principles of health system transformation: 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.

American Nurses Association Stands Behind Assaulted Utah Nurse


The video is disturbing, and underscores the need for federal officials in OSHA to take steps to protect healthcare workers from violence. In it, Utah nurse Alex Wubbels calmly tells a detective that she cannot draw blood from an unconscious patient without a warrant, an arrest, or some form of consent (e.g. from the patient or a medical power of attorney). A hospital administrator can be heard on her speakerphone, backing up nurse Wubbels and asking the detective to not get angry at the messenger.

The detective snaps, pushes nurse Wubbels outside, and arrests her as she screams for help.

Perhaps the most disturbing part about this story is that Wubbels did everything right. “Alex Wubbels did everything correct,” said Aimee McLean, President of the Utah Nurses Association. “She stepped away from her patient’s unit, she deescalated, she followed hospital policy and procedure. This never should have happened.”

Indeed, touching a patient, performing a procedure, or drawing blood from a patient without their consent is assault and battery and is contrary to a patient’s right to privacy. Wubbels followed her hospital policy, her obligations under her nurse practice act to advocate for her patient, and her ethical duty under provision 3.1 of the Code of Ethics for Nurses to protect the privacy and confidentiality of her patient.

She did so calmly and professionally, and with the backing of her administration. And she was arrested for it.

So what’s the lesson to be learned here? For one, that Alex Wubbels is a hero to her patient, to her hospital and to nurses across the country. Two, even when nurses do everything right, we oftentimes still face repercussions. Rightfully refusing an unsafe assignment sometimes leads to discipline. Rightfully speaking out about unsafe patient care conditions sometimes leads to termination. And, taken to an extreme, doing everything exactly right in advocating for the rights of your patient apparently sometimes leads to arrest.

But, make no mistake about it: nurses will do what’s right in the interests of advocating for our patients, regardless of the situation.

The upshot here? Nurses are closing their ranks around Alex Wubbels. Across the country, we are speaking up online, in the media, and as professional organizations to decry what happened to nurse Wubbels and to call for accountability and changes to ensure this never happens again. We hope the public and the federal government will join us.

Alex Wubbels, ANA has your back. #Nursesunite