April 2017 – Capitol Beat

The First 100 Days, AHCA Down But Not Out, Shutdown Averted

AHCA
As President Trump reaches his hundredth day in office, his goal of repealing and replacing the Affordable Care Act (ACA) has stumbled once again, with Speaker Paul Ryan and House Republican leadership unable to find the necessary votes to pass the American Health Care Act (AHCA) and move debate to the Senate.

As we wrote yesterday, despite newfound support from the House Freedom Caucus, moderate House Republicans are still opposed to the AHCA, in part due to the inclusion of an amendment that would allow states to opt out of programs that provide Essential Health Benefits and maintain Community Rating Provisions. The ANA continues to oppose the AHCA due to serious concerns that the bill would violate key organizational principles and harm both nurses and patients alike.

Resolved to continue
House and Senate leadership were able to temporarily avert a government shutdown, passing a one-week spending measure on Friday that maintains current spending levels and gives lawmakers additional time to negotiate a longer-term package that will fund the government through September 30th. House Democratic Leader Nancy Pelosi had previously stated that her caucus would not vote for such an agreement if Speaker Ryan and the White House held a vote on the AHCA this week.

100 Days In
While the President has signed a number of executive orders and legislation in his first 100 days that repeal actions taken toward the end of President Obama’s second term, the White House has been consistently stymied by a Congress that seems unwilling to embrace its broader legislative agenda, despite Republican control of both chambers.

The President’s biggest victory is arguably the confirmation of Supreme Court Justice Neil Gorsuch, who was approved by the Senate earlier this month to fill the seat that was vacated following the death of Justice Antonin Scalia. Despite a limited number of achievements, polling consistently shows that the President’s conservative supporters continue to approve of his job performance and are optimistic he’ll be able to fulfill his campaign promises.

AHCA Redux: Surge Pricing for Pre-existing Conditions

With the 100-day mark bearing down on the Trump Administration, House Republicans are seeking to revive its previously stymied health reform bill, the American Health Care Act, in hopes of giving the President a win.

In March, House Republicans pulled the AHCA bill ahead of a full House vote because it lacked the requisite support. The House Freedom Caucus, a group of more than 40 of the most conservative members of the House Republican conference, refused to support a previous iteration of the AHCA for not going far enough in repealing provisions established by the Affordable Care Act.

In order to appeal to Freedom Caucus members and other powerful conservative interest groups, like the Club for Growth, Republican leaders added provisions to the AHCA that would allow states to opt out of the Essential Health Benefits and Community Rating Provisions. These provisions will gut critical consumer protections for pre-existing conditions, potentially leading to higher costs based on age, gender, and medical history. ANA previously opposed the House Republican plan in part because of its changes to Medicaid, which this bill converts into a per capita funding model that further imperils access to health care. The most recent changes to the AHCA are an even further departure from ANA’s principles.

ANA’s Government Affairs and Health Policy teams have been working to assess the impacts of this new version of the legislation on the health care system, and have been reaching out to key allies on Capitol Hill to voice our concerns. At this point, the House Freedom Caucus has decided to support this bill, which eliminates one of the biggest hurdles the bill faced. Advancement of this legislation now largely rests in the hands of more moderate, centrist House Republicans. To make your voice heard by reaching out to those members, visit the TrumpCare Toolkit here.

To stay informed on the latest from Capitol Hill, follow ANA’s Capitol Beat blog, sign up for action alerts, and check out our health care reform site.

The latest on health reform and the end of recess

With the two-week Congressional recess coming to an end, we wanted to give you a quick recap of district work period activity and a preview of things to come next week when Congress is back in session.

Members of Congress have been in their home districts for the last two weeks since their failed attempts to repeal the ACA and replace it with their own legislation, and they definitely got an earful from constituents. From moderate House Republican members like Rep. Mike Coffman to conservative House Freedom Caucus members like Rep. Raul Labrador, House Republicans faced angry constituents across the country on issues ranging from healthcare to taxes.

That said, the White House signaled over the recess their continued optimism in cobbling together support in Congress for a health reform deal, and House Freedom Caucus Chairman Mark Meadows confirmed that these discussions had progressed. But though the White House was initially eager to try to build support for a bill and bring it up for a vote before the President’s 100 days in office mark next week, Congressional leaders on both sides of the aisle poured cold water on that idea. ANA’s Government Affairs team has been in touch with key Congressional offices, and have learned that the legislative language could include state waivers that would allow states to opt out of the community rating and essential health benefits provisions. The community rating provisions, established under the ACA law, stops insurance companies from raising premiums based on an individuals’ health and would undermine protections for those with pre-existing conditions.

Since the final legislative language has not been made public, it’s unclear whether this compromise will move votes, and there are no updated whip counts on how individual House Republican members plan on voting for such a bill. House Republicans will hold a conference call tomorrow (Saturday, April 22^nd) to discuss the way forward on a health reform bill.

On an even more pressing front, Congressional leaders have to pass a government spending bill by April 28^th in order to avoid a government shutdown. There’s been discussion of passing a one-week funding stopgap, which would maintain current levels of funding for an additional week while Congress continues to negotiate a long-term deal. That said, the White House is insisting that a funding bill include moneys for a border wall, which Democrats have made clear is a non-starter, further imperiling talks. Next week will be a busy one on Capitol Hill, so be sure to stay informed with updates here at ANA’s Capitol Beat.