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.
UPDATE: Following their successful vote on the motion to proceed, Senate Republican leadership saw a subsequent vote on a bill with amendments from Sens. Ted Cruz (R-TX) and Rob Portman (R-OH) fail. Votes are scheduled to resume Wednesday morning.
Only Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) chose to break with their party, listen to their constituents, and reject these dangerous plans. We’re hopeful that their courageous example will influence their colleagues to do the same as more pivotal votes are taken.
The 20 hours of floor debate that now follow will likely take up the rest of the week, with multiple votes expected on the different bills in play. Here’s where we stand:
First, Senators will debate then vote on a repeal of the ACA without a replacement. This is widely expected to fail, but will still take place after being guaranteed to Sen. Rand Paul (R-KY) in exchange for his yes vote on today’s motion to proceed.
Debate will then move to a modified version of the Better Care and Reconciliation Act (BCRA), which is also expected to fail due to last-minute changes that mean the bill must pass with 60 (rather than 50) votes, per Senate parliamentary procedure.
The Senate would then begin what’s known as vote-a-rama, with amendments from Democrats and Republicans under consideration, most likely to the House bill (the American Health Care Act, or AHCA) in the event that the previous two bills fail to pass. The final bill that results from this process will also have difficulty garnering a majority of yes votes.
The final expected vote will then consider a substitute put forward by Majority Leader Sen. Mitch McConnell (R-KY), and which will include a simplified version of the plan Republicans actually want to pass.
If successful, that bill would then be taken up by a conference of negotiators from both the House and Senate, in the hopes of producing final legislation that both chambers could pass.
As with today’s motion to proceed, Vice President Pence will be on hand to break any 50-50 tie.
Once again, the lack of understanding around the final plan Republicans hope to pass is a sad commentary on a process that’s been anything but transparent, and has failed to give the American people a clear idea of the ramifications both for themselves and the country’s health care system.
All nurses should urge their Senators to oppose this undemocratic process and reject the idea that reforming health care should be done in secret. We also continue to urge residents in the following states to push heavily on those Senators who have publicly expressed concern about the impact of these proposals on their constituents’ care:
The Congressional Budget Office (CBO) this week scored several versions of the misguided health care legislation put forward by Senate Republicans, finding that between 22and 32 million Americans would lose coverage if any of these bills were passed into law. Public opposition from moderate senators including Susan Collins (R-ME), Shelly Moore Capito (R-WV), and Lisa Murkowski (R-AK) has forced Majority Leader Mitch McConnell (R-KY) to consider several possible paths forward, all of which will prove challenging.
The Better Care Reconciliation Act (BCRA) was introduced in mid-June and would take away coverage for an estimated 22 million Americans. Its failure to garner support from a majority of Senate Republicans is why other bills are now in play.
An updated version of the BCRA included an amendment from Sen. Ted Cruz (R-TX) that would deregulate the insurance market and allow providers to offer plans for those with pre-existing conditions that would be separate from (and likely much more expensive than) plans offered to those without. The CBO has not scored this bill, in part because it, too, lacks the necessary support to move forward.
Yet another updated version of the BCRA that does not include the Cruz amendment received its CBO score earlier today, and would also result in 22 million losing coverage.
The Obamacare Repeal Reconciliation Act (ORRA) was introduced yesterday, and would repeal the ACA without a replacement – commonly known as “repeal and delay.” Instead, Congress would be given two years to come up with an alternative plan. Over the next decade, CBO estimates that ORRA would cause 32 million Americans to lose coverage.
As McConnell continues trying to find a way forward, uncertainty over which version of repeal will be put to a vote next week – and whether it would include a replacement for the Affordable Care Act (ACA) or not – is a fitting conclusion to a process that has lacked transparency and failed to incorporate the expertise of healthcare providers, including America’s 3.6 million nurses.
Lead to unaffordable premiums for seniors and individuals with pre-existing conditions.
Cut or cap Medicaid and end state-based Medicaid expansion, which would have a devastating impact on those who can’t afford health care in the private market.
Worsen the opioid and suicide epidemics, at a time when states are struggling to cope with the toll these epidemics have taken.
Nurses have joined with concerned citizens across the country to make their voices heard, and are closer than ever to defeating these bills. It’s critical that we send a clear message to our representatives: reforming America’s health care system should be done in a transparent and bipartisan manner, and include input from those who care for and treat patients every day.
Senate Republicans, however, are continuing to negotiate, which is why concerned advocates should continue calling their Senators and urging them to follow a process that allows adequate time for public input and embraces common-sense fixes to the ACA. Making health care better isn’t impossible, as long as nurses are given a seat at the table.