Category: Election 2016

An extraordinary 114 million voters cast ballots Tuesday and delivered the House of Representatives back into the hands of the Democratic party, while voters in more conservative states chose to oust several Democratic incumbents to ensure that the Senate remains under Republican control for the 116th Congress. While some races have yet to be called, turnout was the highest it’s ever been for a midterm election, and the outcomes ensure that lawmakers will have to find a way to reach bipartisan consensus to achieve any meaningful health policy outcomes before the next national election in 2020.

In the Illinois 14^th congressional district, registered nurse Lauren Underwood successfully unseated her incumbent opponent, ensuring that the 116^th Congress will benefit from the perspective and insights of a member of America’s most trusted profession. Endorsed by ANA-PAC, Underwood focused her campaign messaging on the need to improve health policy and is likely to make it a major component of her agenda once in office.

Similarly, Democratic candidates across the country put health care at the center of their campaigns, and the new House majority is widely expected to tackle issues like market stabilization once the 116th Congress convenes, as well as other measures to shore up the Affordable Care Act (ACA). As with all issues in the new Congress, getting a bill on the President’s desk for signature will require bipartisan cooperation with Sen. Mitch McConnell (R-KY) and his now expanded majority.

Despite uncertainty around how fruitful any such cooperation might be, divided control of Congress ensures that any subsequent attempts to repeal and/or replace additional elements of the ACA will be dead on arrival, particularly given the prominence of protecting patients with pre-existing conditions in Democratic campaign messaging. House Democrats will also likely consider legislation to bring back the ACA’s mandate that individuals attain health coverage, which was eliminated in the tax package congressional Republicans passed late last year.

While more progressive candidates tended to focus on the need for a single-payer health care system, most commonly referred to as Medicare for All, this approach will be a non-starter in the Republican Senate, increasing the likelihood that more incremental reforms will be the focus on Capitol Hill. Despite this, single-payer proponents will continue to push both incumbent lawmakers and those who challenge them on the left to embrace Medicare for All, in the hopes of eventually electing a Congress that can pass it.

In post-election press conferences, both President Donald Trump and current Democratic Minority Leader Nancy Pelosi (who is widely expected to attempt to regain the title Speaker of the House) indicated that they would seek to find common ground on a number of issues, including legislation that would reduce prescription drug costs, though details on how to accomplish this shared goal are unclear.

On the ballot initiative front, three states voted to do what their governors and state lawmakers had so far refused to do: expand access to Medicaid. Voters in Idaho, Nebraska, and Utah all approved measures to allow adults and their families to receive coverage via this federal program. States will now be required to submit a State Plan Amendment that outlines how they will implement these programs, with deadlines arriving either in early March or April of next year, depending on the state. Other states that have held off on Medicaid expansion are likely to consider similar initiatives going forward.

The open enrollment period to purchase individual health insurance coverage on the federal and state health insurance exchanges began on Wednesday, November 1^st and runs through Saturday, December 15^th. The open enrollment period is the only opportunity for individuals to enroll or re-enroll in an existing exchange plan for coverage for calendar year 2019. All consumers can access federal and state exchanges via www.Healthcare.gov; most consumers will purchase health insurance on the federal exchange, though consumers in these 12 states will purchase health insurance on their state of residence’s exchange. Consumers enrolled in a plan in 2018 who fail to update their information by December 15^th will be automatically re-enrolled in the same or similar plan for 2019 (and must pay their premium for January to maintain coverage); consumers who were not enrolled in 2018 and do not sign up for a plan for 2019 will be locked out of exchange coverage until 2020.

Like last year, the administration has scaled back its efforts to encourage consumers to sign up for individual health insurance plans on the exchanges. The U.S. Department of Health and Human Services (HHS) plans to spend $10 million on marketing and outreach, including email, text messaging and auto-dial messages, as well as targeting individuals who are uninsured – particularly young and healthy individuals. The amount that HHS budgeted for marketing and outreach matches the amount that it budgeted in 2017; however, this is roughly 10 percent of what was budgeted for previous open enrollment periods.

The administration has also added additional confusion regarding what constitutes an individual health insurance plan by promoting subpar health insurance coverage, such as association health plans and short-term, limited duration insurance. While these plans may offer low premiums, they do not provide the comprehensive coverage of pre-existing conditions required for plans sold on the exchanges and often come with high deductibles and out-of-pocket spending. The administration also ended cost-sharing reduction subsidies, though insurance plans on the exchanges are still required to provide cost-sharing reductions for individuals with household income at or below 250 percent of the Federal Poverty Level and this policy change will not impact these consumers’ out-of-pocket spending. And in December 2017 Congress repealed the individual mandate penalty for individuals who failed to purchase individual health insurance coverage.

Despite these headwinds, 11.8 million Americans enrolled in coverage for 2018 on the federal and state exchanges, representing only a 3.7 percent decline from 2017. ANA has joined with other consumer- and provider-based groups to ensure consumers are aware of their options and are well-positioned to make the best choices for themselves and their families. It is essential that nurses ensure consumers are aware of the current insurance marketplace landscape, the need to select plans that offer meaningful coverage and that the open enrollment period is the only time they’ll be able to select plans from the marketplace exchanges.

ANA developed a toolkit of materials that can be customized and tailored to reach your nurses. ANA sent this toolkit to the presidents and executive directors of its Constituent and State Nursing Associations and to the presidents and executive staff leaders of its Organizational Affiliates; the toolkit includes the following:

• Sample Social Media Messaging to encourage nurses and health care consumers to visit Healthcare.gov and either obtain coverage or re-enroll in a previously selected plan.
• Frequently Asked Questions pertaining to open enrollment and the current political environment.
• Talking Points to offer clear and concise explanations for why ANA is committed to promoting open enrollment and ensuring health care consumers are aware of all their health coverage options.

Health care stands to play a pivotal role in the midterm elections next Tuesday, November 6^th. Public polling throughout 2018 has consistently shown health care to be the most important issue on voters’ minds, and the open enrollment period underscores how important health care is to individual consumers. ANA-PAC recently finalized its list of congressional endorsements for the 2018 election cycle, supporting candidates from both parties who are committed to advancing the nursing profession and ensuring that nurses have substantive input when lawmakers are crafting health policy. To find your polling place, please visit our #NursesVote Action Center and make certain that your voice is heard on this pivotal Election Day.

Two weeks ahead of Election Day, health care continues to dominate campaign-related headlines and the attention of voters across the country, with one recent poll finding that 71% of Americans describe health care as “very important” in helping them decide how they’ll vote this year.

Senate Majority Leader Mitch McConnell (R-KY) recently gave an interview in which he described his caucus’s failure to repeal and replace the Affordable Care Act (ACA) as a major “disappointment,” and indicated that they would make another attempt to do so should Republicans hold their majority in the Senate (it’s likely the House would follow suit if it, too, remained under Republican control).

It was unclear if McConnell’s comment that he and his colleagues are “not satisfied with the way Obamacare is working” meant that they would be willing to reconsider legislative steps to stabilize the individual insurance marketplace, an idea that is more likely to garner bipartisan support. Previous Senate attempts to repeal and replace the ACA have garnered support from most – but not all – Republicans.

The majority leader also claimed that “Entitlements are the long-term drivers of the debt,” referring to Medicaid, Medicare, and Social Security. Passing legislation that reduces spending on such programs would be politically treacherous and is not a talking point that Republican candidates in more moderate districts and states seem eager to include in their campaign messaging.

In House races, protections for patients with pre-existing conditions have taken on increased importance, with candidates from both sides of the aisle insisting to voters that they consider those protections sacred. This is a tougher sell for Republicans who voted in favor of the American Health Care Act, which would have hobbled those protections as implemented by the ACA.

Many Democratic candidates, in addition to supporting ACA stabilization, are also calling for a system that helps even more uninsured Americans get access to health coverage. While only some have embraced a version of a single-payer system (most commonly referred to as Medicare for All), President Trump recently published an opinion piece in USA Today in which he claimed that such a system “would mean the end of choice for seniors over their own health care decisions.” The piece was widely criticized for containing factual errors, and polls continue to find that a majority of voters – including Republicans – support a single-payer system in some form.

As congressional campaigns race to the finish line, this year’s Open Enrollment period kicks off on November 1, with the Trump administration continuing to approve waivers to states that want  their residents health coverage that falls short of the requirements implemented by the ACA. While not tied to a specific piece of federal legislation, these efforts would be more sharply questioned by a Democratic-controlled House or Senate, with the possibility of legislation being passed that aims to stop them. This dynamic also underscores the importance of supporting candidates at the state level who want to ensure that patients have access to meaningful, comprehensive health insurance.

As you review the issues and the candidates running in your congressional district and state, ANA-PAC recently finalized its list of congressional endorsements for the 2018 election cycle, supporting candidates from both parties who are committed to advancing the nursing profession and ensuring that nurses have substantive input when lawmakers are crafting health policy. To find your polling place, request an absentee ballot, or find out how to vote early, please visit our #NursesVote Action Center and make certain that your voice is heard on this pivotal Election Day.