White House – Page 8 – Capitol Beat

President’s Latest Attempt to Destabilize Healthcare

This morning, despite ongoing bipartisan efforts to stabilize the individual insurance market following the failure of Congress to pass legislation to repeal and replace the Affordable Care Act, President Trump signed an Executive Order (EO) allowing for the creation of new association health plan (AHP) options for small employers and individuals. AHPs currently exist and are used primarily by small businesses to purchase group health coverage, but are regulated under the provisions of the ACA in the same way as coverage purchased on the individual health insurance market. Today’s EO in effect treats AHPs as large group health insurance plans and allows coverage under AHPs to be sold across state lines.

Treating AHPs in this way exempts them from important provisions covered under the ACA. As a reminder, the ACA includes provisions on insurance plans sold on the individual market which:

Require plans to cover 10 Essential Health Benefits including reproductive and maternal health services and preventive services;
Forbid insurers from charging more to individuals due to pre-existing conditions;
Limit the amount insurance companies can charge to older individuals based on age.

The American Nurses Association opposes any action – legislative or executive – which would put at risk the ability of Americans to access and receive high quality healthcare. This is particularly true when it comes to the most vulnerable Americans. It has become increasingly clear that this administration is more concerned with scoring political points and reversing gains made in healthcare than it is about actually ensuring high quality healthcare coverage for all Americans.

As a result of this EO, AHPs would be permitted to offer coverage that does not include the 10 Essential Health Benefits required to be covered under insurance plans offered through the ACA exchanges. AHPs would also be allowed to charge different prices to consumers based on age and health – including charging more for individuals with any host of pre-existing conditions.

This EO allows AHPs to sell insurance coverage which offers fewer benefits at variable prices depending on an individual’s health. This would certainly be an attractive option for someone who is young, healthy, and does not anticipate needing to use a high volume of healthcare services. The flipside is that this would have a negative impact on older adults and individuals with pre-existing conditions. The cruel irony with this plan is that these individuals would likely be stuck with plans in the individual marketplace, as they would not be able to afford the coverage offered under AHPs – which would likely not provide coverage for necessary care.

Furthermore, these insurance plans are ripe for instances of fraud, abuse, and insolvency. The Government Accountability Office in 1992 issued a report which slammed similar small business insurance arrangements and noted that they left hundreds of thousands of enrollees with millions of dollars in unpaid claims and widely failed to meet state insurance laws and regulations. The GAO report found that some plans tried to duck under state insurance regulations entirely. This type of wild, wild west approach to insurance coverage does not offer the comprehensive level of coverage at a low price that the Trump administration claims. Based on the provisions of this EO, we also expect several lawsuits to challenge this based on the legality under current federal law and on the insurance across state lines aspect.

In essence, this latest gambit by the Trump administration is another attempt to undermine the system put in place by the ACA at the expense of some of the most vulnerable Americans. Combined with the administration’s move last week to weaken the ability of Americans to access sexual and reproductive healthcare services – particularly contraceptives – covered under the ACA, this represents a significant effort to endanger the healthcare of all Americans.

We urge Congress and the Administration to continue to work toward market stabilization and to strengthen the existing system – which has resulted in coverage for tens of millions more Americans since 2014 – and to put an end to these attempts to sabotage Americans’ healthcare for political gain. ANA is committed to working with Congress and the administration on legislation and policy which aligns with our four core principles of health system transformation. This Executive Order, however, represents a major step backward from achieving those principles.

(Photo: Doug Mills/The New York Times)

Graham-Cassidy is the worst healthcare bill yet

As Congress works its way through a packed September agenda, yet another attempt to repeal and replace the Affordable Care Act (ACA) is gaining momentum. Unfortunately, this legislation – like similar bills that have come before it – has chosen to leave nurses out of the process, and as a result would leave too many patients without the care they need.

As we’ve previously addressed, legislation sponsored by Sens. Bill Cassidy (R-LA) and Lindsey Graham (R-SC) would make drastic and dangerous cuts to the American healthcare system by repealing Medicaid expansion starting in2020, eliminating the critical Prevention and Public Health Fund, and creating high-risk pools for individuals with pre-existing conditions (effectively removing ACA-implemented essential health benefit protections for those patients), among other misguided policies.

The block grants to states that Graham-Cassidy would use to replace the ACA would also continue to shrink before, in 2026, disappearing entirely, leading to even more cuts. In other words, the legislation goes further than what was proposed this summer – which at its worst was projected by the Congressional Budget Office (CBO) to cause up to 32 million Americans to lose their coverage.

Meanwhile, the process surrounding the bill continues to fall well short of Sen. John McCain’s (R-AZ) repeated calls for a return to regular order. While the Senate Finance committee has planned a single hearing around Graham-Cassidy, the CBO will not have time to fully score the legislation, meaning it will remain unclear how many patients would have their care stripped away as a result.

Criticism of the bill is widespread: on Tuesday, Democratic, Republican, and independent governors from Alaska, Colorado, Louisiana, Massachusetts, Montana, Nevada, Ohio, Pennsylvania, Vermont, and Virginia released a letter announcing their opposition, writing that, “Only open, bipartisan approaches can achieve true, lasting reforms.” And as with the so-called Affordable Health Care Act and Better Care Reconciliation Act, no Democratic senators have announced their support for Graham-Cassidy, with conservative Sen. Rand Paul (R-KY) also expressing skepticism that he’ll be a yes vote if and when it comes to the floor.

Regardless of the current whip count, which is constantly evolving, the stakes are too high to count on another dramatic late night vote that saves the day. Don’t wait: click here to be connected with your Senators and urge them to vote no on Graham-Cassidy. In the absence of real dialogue, nurses’ voices are needed now more than ever.

12 Days in September

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 1^st. We’ll have an additional update for you later this week on these and other health care-related items.