Medicaid is one of the most crucial pieces of the U.S. health care system and provides critical health care coverage to low-income, disabled, and elderly Americans as well as to low-income children. It pays for nearly half of all births in the nation, and is the largest payer of long-term services and supports such as nursing home care and home and community-based services. Medicaid is also the largest single payer for behavioral health services, including mental health and substance use disorder treatment. Medicaid plays a major role in the treatment and prevention of chronic diseases like diabetes and cardiovascular disease; Medicaid recipients and uninsured individuals have a higher prevalence of chronic disease than the population at large.
These impacts have grown with Medicaid expansion. Since the Affordable Care Act expanded eligibility to childless adults with monthly income up to 138 percent of the Federal Poverty Level, 11 million more Americans now have access to comprehensive health care coverage. These individuals now have a means by which to treat and manage chronic conditions and comorbidities, to receive care that enables them to stay in their homes and communities, to seek treatment for debilitating mental health and substance use disorders amidst the raging opioid crisis, and to bring healthy babies into the world. Medicaid expansion has driven down hospitals’ uncompensated care costs, allowing them more resources to treat patients. (See ANA’s recent Health Policy piece on this subject). Medicaid expansion has also figured prominently in policy debates at both the national and state levels. Republican and Democratic lawmakers alike cited Medicaid expansion as reasons for their opposition to the ultimately failed American Health Care Act.
Medicaid expansion has moved the U.S. health care system toward achieving the American Nurses’ Association’s (ANA) core principles of health care reform: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.
Despite a major legislative setback, discussions around health care reform and the future of the Medicaid program continue. ANA is committed to preserving the coverage gains made in recent years. ANA will continue to provide our members with all new developments on health care reform and the Medicaid program.
Following their failure to hold a vote on the misguided American Health Care Act (AHCA), congressional Republicans now head into a two-week recess with more questions than answers. Despite continuing negotiations with the House Freedom Caucus, the basic dynamic hasn’t changed: for every vote Republicans pick up from the conservative wing of their House caucus, they lose votes from their moderate wing. And the reason for their continued failure hasn’t changed: the AHCA is a fundamentally flawed bill that would cause millions to lose health coverage by cutting Medicaid and taking away essential benefits.
Even worse, proposed concessions made by Vice President Mike Pence could undermine protections for people with pre-existing conditions, and lead to states allowing insurance companies to charge sick people more for coverage than healthier individuals, to name just two possible outcomes.
Republicans’ persistence and the AHCA’s shortcomings underline the importance of the next two weeks. As is customary for recess periods, Members of Congress from across the country will be holding town halls to hear directly from their constituents. Now more than ever, it’s imperative that lawmakers understand that a majority of voters are opposed to the AHCA and similar efforts to make Americans less healthy.
Earlier this week, the Senate passed a resolution amending the Title X Family Planning Grant Program to allow states to withhold family planning funds from going to Planned Parenthood and other organizations that provide reproductive health services. The program, which allocates money for counseling, contraception and prenatal care, cannot be used for abortion services under previous law. The measure, which had already been passed in the House, sought to go even further and restrict any (Title X) grant money from going to any clinic providing these services.
Republican Senators Susan Collins and Lisa Murkowski joined with Senate Democrats in opposing the measure, leaving the Senate tied with a 50-50 vote count. Vice President Mike Pence, who is constitutionally designated the ‘President of the Senate’ and is entitled to break ties in the chamber, cast a vote in favor of the misguided measure, allowing it to pass.
The Supreme Court confirmation fight also escalated in the Senate this week, with 34 of the chamber’s 48 Senate Democrats lining up to filibuster President Trump’s conservative nominee, federal judge Neil Gorsuch. Some Democrats cautioned against moving forward with the nomination while some of the President’s campaign associates are currently under federal investigation, while others were concerned by Senate Republicans’ refusal to consider Judge Merrick Garland’s nomination last year. Though judicial confirmations typically require a consensus 60-vote majority to limit floor debate and confirm a nominee, Senate Republicans are considering a ‘nuclear option’ that would amend Senate rules to confirm Judge Gorsuch by simple majority (51 votes). The Senate Judiciary committee plans to vote on the nomination on Monday, and a full vote before the Senate is expected by week’s end.
Finally, tensions between the conservative House Freedom Caucus and President Trump continued to escalate following last week’s failed attempt to hold a vote on the American Health Care Act. President Trump singled out the caucus in a string of tweets, accusing them of hurting the Republican agenda. The back and forth escalated further when the President singled out Members of Congress by name for obstructing the repeal of the Affordable Care Act.