An unexpected health care ruling leads to turmoil


Friday night’s ruling by a federal district judge in Texas v. Azar that the Affordable Care Act (ACA) is unconstitutional has created fresh uncertainty in the U.S. health care system. While the ruling does not immediately impact the health law itself, it could potentially upend the American health care system in significant ways.

Members of Congress on both sides of the aisle immediately vowed to take steps that would retain the ACA’s protections for patients with pre-existing conditions and Essential Health Benefits (EHB) while the case continues to make its way through the legal system (experts widely believe that Friday’s decision will be appealed to the Fifth Circuit Court of Appeals and could ultimately reach the Supreme Court).

ANA’s official statement noted that “This ruling puts at risk access to quality, affordable, and accessible health care for the millions of Americans whose lives have improved due to the coverage expansions and consumer protections under the ACA.”

Incoming Senate Finance Committee Chairman Chuck Grassley (R-IA) promised on Twitter that his committee would hold hearings on the ruling, and that he would work with Democrats to “strengthen” the ACA through legislation, while Sen. Susan Collins (R-ME) said she was sure the ruling would be overturned and that “There is widespread support for protecting people with preexisting conditions.”

Senate Minority Leader Chuck Schumer (D-NY) vowed to press for a vote on the Senate floor “urging an intervention in the case,” and House Minority Leader Nancy Pelosi (D-CA), widely expected to lead Democrats as Speaker in the 116th Congress, pledged to “move swiftly to formally intervene in the appeals process.”

President Trump indicated via Twitter that a potential Supreme Court ruling that upheld Friday’s decision would offer an opportunity to work in a bipartisan fashion “to deliver great health care.” He called on lawmakers to formulate and pass a replacement for the ACA, despite the limited success of previous efforts to do so.

Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), was quick to clarify via social media that the ruling would not adversely impact consumers who were still shopping for individual health insurance coverage during the Open Enrollment period that ended on Saturday, December 15th. In a formal statement, the Department of Health and Human Services (HHS) echoed this point, noting that “This decision does not require that HHS make any changes to any of the ACA programs it administers or its enforcement of any portion of the ACA at this time.”

The Texas v. Azar lawsuit was brought following the congressional repeal of the individual mandate in December 2017 as part of the Tax Cuts and Jobs Act. The Texas Attorney General, along with AGs in 19 other states, argued that this repeal eliminated the Supreme Court’s rationale for finding the individual mandate constitutional in the 2012 Supreme Court decision NFIB v. Sebelius. Though driven by these states, the focus will now shift to Congress, following an election cycle in which support for major provisions of the Affordable Care Act and health care in general were key campaign issues.

Congressional Action in December


Lame Duck Watch

Now that the midterm elections have passed, the 115th Congress has entered its biannual period referred to as a “lame-duck” session. Some lawmakers who return for the lame-duck session will not be in the next Congress because they are retiring or lost their reelection. For that reason, they are referred to as lame-duck members. Lame-duck sessions are never predictable and can occasionally lead to high stakes drama. Here are a few issues we’re taking note of as the lame-duck gets underway.

Government Funding

Yesterday, President Trump threated to shut down the federal government if Congress does not give him $5 billion to build a wall on the U.S.–Mexican border that he campaigned on. Democrats have only agreed to $1.6 billion in funding. If Congress doesn’t pass seven appropriations bills by December 7, nonessential operations at multiple federal agencies will come to a halt due to a lack of funding.

Senate Appropriations Committee Chairman Richard Shelby has stated that a one-year continuing resolution (CR) is likely unless negotiators make significant progress on an agreement on border wall funding by next week, but did not rule out another short-term CR if there is some progress.

A continuing resolution funds the government at the same levels as the previous fiscal year for a set amount of time. Many Republicans would prefer a one-year CR be completed before Democrats take control of the House next year, rather than risk a shutdown which could give Democrats leverage in appropriations negotiations.

Title VIII

Senate Health Education Labor & Pensions Committee Chairman Lamar Alexander announced that there would not be another markup for the Committee this year. This means that Title VIII reauthorization will not happen in 2018. It’s a very unfortunate development after the House passed reauthorization unanimously on a voice vote in July. ANA and the Nursing Community Coalition will continue to fight for this long overdue reauthorization.

ANA-PAC’s Success in the 2018 Mid-Term Elections


It’s clear that the November 6th midterm elections were a successful day for the nursing profession and health care more broadly. The American Nurses Association Political Action Committee (ANA-PAC) paid dividends for its members and the profession by spending more than $422,000 to help elect longstanding champions of nursing like Reps. David Joyce (R-OH-14) and Frank Pallone (D-NJ-6), as well as Sens. John Barrasso (R-WY) and Tom Carper (D-DE) while helping usher in fresh faces for the 116th Congress like Rep. Elects Joe Morelle (D-NY-25) and Dusty Johnson (R-SD-At-Large).

Rep. Elect Morelle has collaborated with the American Nurses Association-New York during his time in the state assembly and consistently helped secure legislative victories to advance the nursing profession, including passage of a bill that strengthens education requirements for future nurses and establishing a commission to evaluate and report on barriers to entry into the nursing profession in New York while Rep. Elect Johnson was responsible for overseeing the South Dakota State Employee Health Care Plan in his capacity as chief of staff to Governor Dennis Daugaard, where he heard and implemented input from health care professionals across the state, including nurses. He is dedicated to bringing stability to a health care market that has experienced a great deal of uncertainty in the past year and a half.

On a particularly great note, registered nurse Lauren Underwood achieved victory as the next Member of Congress representing the Illinois 14th congressional district. Besides being a fellow nurse, she also earned the distinct honor of being elected the first congresswoman from her district. Lauren will join registered nurses Reps. Karen Bass (D-CA-37) and Eddie Bernice Johnson (D-TX-30) in the 116th Congress.

If there was ever any proof ANA knows how to support the correct candidates it’s this: of the more than 120 candidates for federal office supported by ANA-PAC, an impressive 94% have won their election. A total of 96% of incumbents, 91% of those running in open seats and 90% of candidates running against a sitting federal lawmaker won their elections while 93% of those candidates the PAC endorsed were elected. This showcases ANA staff’s ability to identify candidates who are both invested in moving nurses forward and are likely to run successful campaigns that are responsive to their voters’ broader interests, including the need for increased access to affordable health care.

Not surprisingly, ANA staff are already evaluating the political landscape on Capitol Hill and strategizing for the 116th Congress. A Republican-controlled Senate and a Democratic-controlled House is just one of the many factors being considered in terms of how best to advance ANA’s legislative and regulatory agendas. Whether the issue is safe staffing, nursing scope of practice or safe patient handling, staff are determined to find new ways to build and enhance bipartisan support of our issues.

This cycle, ANA’s members helped the ANA-PAC achieve and exceed its fundraising goal by raising more than $500,000 since January 1, 2017 (remember: no ANA dues money is ever used to support political candidates). Staff, along with the ANA-PAC Board of Trustees, will be utilizing these contributions to continue cultivating relationships on both sides of the  political aisle, and maintaining our non-partisan presence on Capitol Hill. Stay tuned to Capitol Beat for more updates as the legislative agenda for the 116th Congress develops.

To learn more about ANA-PAC, check out of FAQs and see who the PAC supported in your state please check out the ANA-PAC website.