Trump Administration Intensifies Efforts to Erode Nation’s Access to Healthcare

  

The Trump administration has recently escalated its attacks on the health system under the Affordable Care Act (ACA) and continues to undermine the ability of Americans – particularly low-income women and individuals with pre-existing conditions – to access affordable and comprehensive healthcare coverage. These policy decisions – which come at the same time as a U.S. Supreme Court ruling with implications for access to reproductive healthcare services – are certain to erode the healthcare coverage gains made since 2010 and create significant harm, risk, and uncertainty for some of America’s most vulnerable populations.

The Centers for Medicare & Medicaid Services (CMS) on July 10 announced that it would further cut grants to nonprofit organizations that assist individuals in signing up for health insurance coverage on the ACA’s individual market. The federal government provided $63 million to such organizations in 2016, $36 million in 2017, and will provide only $10 million this year – a total reduction of roughly 84 percent. CMS, in another significant shift, will also encourage such organizations to enroll individuals in Association Health Plans (AHPs) as opposed to the more comprehensive ACA health plans. These plans – which the administration expanded last month and which ANA strongly opposes – offer coverage without essential health benefits guarantees and will disadvantage individuals with pre-existing conditions.

The administration argues that insurance companies and brokers are much better at enrolling individuals into insurance plans, and that AHPs offer a less expensive option for Americans struggling to pay for health insurance. However, despite major outreach efforts last year by outside groups – including ANA – to enroll individuals in ACA plans, enrollment dipped for the first time since the law was implemented. Meanwhile, the expansion of AHPs will result in higher premiums and fewer coverage options for Americans with pre-existing conditions, while individuals who purchase coverage through an AHP will have less comprehensive coverage than what is required of ACA health plans.

The administration on July 7 also announced that it would suspend billions of dollars in risk adjustment payments required by the ACA to be paid to insurance companies. These payments are intended to stabilize the individual market by preventing insurance companies from only seeking out healthy individuals and encouraging them to promote coverage for individuals with costly pre-existing conditions.

Suspending these payments creates uncertainty in the individual market, just as insurance companies are determining premiums for calendar year 2019, and could significantly increase premiums in the individual market. The administration’s moves to expand the use of AHPs and decrease the amount of funding available for outreach could be disastrous for individuals who purchase health coverage through the individual market and will likely lead to another year in which the number of Americans without health insurance coverages rises.

The administration, however, has not only taken aim at the ACA’s healthcare coverage regulations. In June, the administration issued a proposal to change regulations related to Title X funding, which provides grants for critical family planning services for millions of Americans, particularly low-income women. This proposed rule would prohibit a recipient of Title X funding from “performing, promoting, referring for, or supporting, abortion as a method of family planning, nor take any other affirmative action to assist a patient to secure such an abortion.” This represents a gag order on providers and denies patients full medical information. This was recently bolstered by the U.S. Supreme Court ruling in NIFLA v. Becerra, where the Court ruled that it is unconstitutional on First Amendment grounds for the state of California to require family planning facilities to post information about state-sponsored abortion services.

This is antithetical to the Code of Ethics for Nurses which states that the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. This proposed rule interferes with that relationship and violates basic ethics of the profession, while threatening the ability of millions of Americans to access basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and well-woman exams. The uninsured, women of color and low-income families will be disproportionately affected if the clinics and health centers in their communities can no longer offer the needed care and critical medical information.

ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. The recent moves by the Trump administration fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services. The midterm elections this November are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. We urge you to make nursing’s voice heard loud and clear by supporting candidates who align with ANA’s principles for health system transformation and who are proven to be advocates for nurses and their patients!

Title X, the Gorsuch fight, & escalating tensions

  

freedom-caucus-wh-meetingEarlier 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.

GOP Pushes the AHCA, Supreme Court hearings and more

  

On Monday, the Senate Judiciary Committee kicked off confirmation hearings for Supreme Court nominee Neil Gorsuch. The hearings are expected to last four days, with Gorsuch hoping to avoid hot-button issues like access to reproductive rights, campaign finance, and executive powers. Senate Judiciary Committee Chairman Chuck Grassley (R-IA) hopes to have Gorsuch’s nomination voted out of committee by April 3rd and a vote before the full Senate by April 8th (before the two-week Easter recess).

Last week, House Republicans advanced the American Health Care Act (AHCA), their repeal-and-replacement plan for the Affordable Care Act, out of the House Budget Committee following a blistering Congressional Budget Office report of the impact of the legislation. The AHCA bill is expected to be considered by the House Rules Committee on Wednesday, where the Republican majority on the panel is expected to approve the bill and send it to the floor for a full House vote.  The full House is expected to vote on the legislation some time Thursday, which is the seventh anniversary of the signing of the current ACA law. ANA opposed the current AHCA legislation in a letter sent to Capitol Hill leaders earlier this month.

House Republican leaders are frantically whipping votes in favor of the bill, but the continued chorus of complaints from the conservative House Freedom Caucus and more moderate members has set the stage for a razor thin margin in the lead up to Thursday’s vote. House Republican leaders are expected to release a ‘Manager’s Amendment,’ which is a series of changes to the legislation that can be made by House leadership following the regular committee process to shore up support for the bill. The expected changes to be released later this week would be to:

1) Allow states to impose work requirements on Medicaid recipients (appeasing conservative members)

2) And expand health tax credits for seniors (appeasing moderate members).

Though Freedom Caucus members still take umbrage with the current bill for not going far enough and moderates are concerned with the number of Americans that could lose coverage, the changes could be enough to get Republican to the 216 votes needed to pass the bill.

Stay tuned to the Capitol Beat for further updates on health reform and other activity happening on Capitol Hill.