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.

“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.

“Skinny” Repeal would have Gargantuan Impact

  

mitch-mcconnell-healthcare

“Skinny” repeal is all the rage in Washington these days, as Senators look to a bill that would undo one of “Obamacare’s” least popular provisions: the individual mandate, which requires all Americans to carry health insurance or face a stiff tax penalty.

In theory, eliminating this mandate might sound like a pretty good deal. So why are some calling the “skinny” repeal the “sham” repeal?

In short, because the skinny/sham repeal would destroy the individual health insurance market. Keep in mind that the skinny/sham repeal eliminates the individual mandate without eliminating the requirement for insurers to cover preexisting conditions, which happens to be one of the most popular provisions of the Affordable Care Act (ACA).

Imagine: you know that insurers have to cover everything the moment you purchase health insurance. If you are a smart consumer, what do you do?

If you answered “not carry health insurance until I get sick or injured,” you win, and the insurance markets lose. This is similar to the way COBRA works; you wait until you get sick to use it, because it will cover everything the moment you take it out. That’s one of the reasons COBRA is so expensive.

The net effect of repealing the individual mandate? Insurers lose money hand over fist and choose to either leave the individual market or go out of business. That’s why the Congressional Budget Office (CBO) has already estimated that simply cutting the individual mandate will cost 15 million Americans their health insurance coverage.

This is why the preexisting condition exclusion and the individual mandate go hand in hand. You can’t have full coverage of all preexisting conditions without the individual mandate. To think otherwise is simply misguided, and to try and pass it into law for the sake of political expediency is simply alarming.