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What’s next for health care in Washington?  

Wondering what’s next after the Republican effort to repeal the Affordable Care Act (ACA) was dramatically stopped in its tracks last week? This week has brought a pause in action on the Senate floor to repeal the ACA, but also a new round of legislative threats. Moreover, we’ve seen another promise from a petulant president to actively sabotage the law at the expense of millions of Americans who rely on it for their care. On the positive side, there are signs of bipartisan efforts to save the cost-sharing reduction subsidies that lower co-pays and deductibles for low-to-moderate income people.

Three GOP senators promote extreme bill masquerading as moderate

This week, Senators Lindsey Graham (R-SC), pictured on the right, Bill Cassidy (R-LA), pictured on the left, and Dean Heller (R-NV) announced that they are working on yet another extreme GOP-only bill with the House Freedom Caucus to gut the ACA. The bill would repeal the ACA’s Medicaid expansion and its financial assistance to help low-to-moderate income households purchase private insurance. In their place, the bill would give states a block grant worth less than what the federal government would contribute under current law. The states that expanded Medicaid would receive deep cuts in their funding, while the 19 states that have so far refused to expand would be rewarded with a windfall. The block grant would be worth less and less each year, until ending abruptly in 2026.
The bill is being mistakenly cast as a moderate alternative because it keeps a portion of the ACA’s revenue. But as Vox correctly noted, “In many ways, it’s the most radical one yet.” In addition to cutting the federal investment by over one-third, the bill would destabilize private insurance markets by requiring insurance companies to accept sick patients but eliminating both the carrot of subsidies and stick of an individual mandate to encourage healthy people to sign up.

In a sign of likely conservative support, Scott Walker, Wisconsin’s far-right governor, has already endorsed the proposal. Graham and Cassidy have reportedly been pitching their plan to a White House eager to sign anything that they can cast as tarnishing President Obama’s legacy.

 But, if this happens, we will be ready to resume our resistance! Standing by are RWV regional coordinators such as New Jersey Citizen Action, which was in D.C. last week for the Senate vote. NJCA’s Maura Collingsgru (front right in photo) reported: “What a successful trip! Repeal and delay failed in the Senate. We met with one New Jersey Senator and two Congressmen. We delivered thousands of petitions and spoke with staff members of four Congressmen to urge them to vote against any bill that increases costs and decreases coverage. We visited the Senate gallery to watch debate on repeal and rallied with Planned Parenthood. We brought New Jersey's fight to save our care to D.C. and we're back on the bus to keep the fight going back home.”

But wait, isn’t the repeal effort dead in the Senate?

From a procedural perspective, the repeal effort is not dead in the Senate but rather undead, and could potentially stay that way until the end of this Congress on January 3, 2019. We defeated multiple amendments last week, but Senate Republican Leader Mitch McConnell (KY) pulled the underlying bill (the House-passed Trumpcare bill, also known AHCA) before a vote on final passage, sending it to a kind of procedural limbo on the Senate floor calendar.
If Republicans can win 50 votes for a deal, they will simply re-start the debate on the reconciliation bill where they left off, offering their new plan as another amendment. Remember that the Senate already used up most of the 20 hours allowed for that debate during last week’s floor action, so there would be little left for debate of any new bill!

Cost-sharing reduction subsidies threatened

Threats from Congress are not the only ones we’re watching closely. Over the weekend, Donald Trump unleashed an angry tweetstorm directed at the Americans whose health insurance he’d hoped to take away and the members of Congress who had defied him.  Trump falsely called  cost-sharing reduction (CSR) payments a “bailout” for insurance companies and threatened to stop making these payments, which keep deductibles and copayments low for low-to-moderate income families on the individual market. 
Under the ACA, insurance companies are required to keep cost-sharing artificially low for low-to-moderate income patients and the federal government is required to make up the difference in payments to insurers. If Trump cuts off those payments, insurance companies could abruptly withdraw from individual markets or they could hike their premiums to make up for their costs. Rates must be set by mid-August, leaving insurers just two weeks to cope with the uncertainty caused by the White House. 
But nothing in yesterday’s court’s ruling requires the Trump administration to keep making the payments, and Trump could still proactively stop paying  for CSRs by re-writing the Obama-era regulation that authorized them.
The prospect that the Trump administration could cut off the payments has encouraged some fledgling bipartisan efforts in Congress. Lamar Alexander (R-TN), who is chair of the Senate health committee, urged Trump to continue the CSR payments and said he'd seek bipartisan legislation extending the payments for one year.  He promised hearings in September on legislation to “stabilize and strengthen the individual insurance market” for 2018. Senator Patty Murray (D-WA), the senior Democrat on the health committee, said she welcomed Alexander’s statement.
So, stayed tuned! We will to monitor developments in Congress. Next week, we will report on what RWV regional coordinators have been doing on the state and local level, while the federal work to defend the ACA and Medicaid has been raging. 



A victory for women, LGBTQ people and our families!

Today, we are breathing a sigh of relief that the Senate GOP’s madcap drive to repeal the Affordable Care Act (ACA) has been stopped in a middle-of-the-night vote, and by the slimmest of margins. For now, we have beaten back the threat that millions of us would lose our health insurance coverage and our access to Planned Parenthood.  We celebrate a real victory for women, LGBTQ people and our families!

The Senate heroines of last night’s victory are two women who stood up to bullying by the administration and their Republican colleagues – Susan Collins of Maine and Lisa Murkowski of Alaska.  Yes, they were joined by Senator John McCain, who cast the crucial third vote against the “skinny, freedom” repeal bill, but it was Collins and Murkowski who steadfastly opposed all of the Senate Trumpcare bills. They deserve our heartfelt thanks!

The biggest thanks, however, must go to all of you who sacrificed so much to bring about this victory! It was the national mobilization of women, LGBTQ people and our families that held off round after round of Trumpcare efforts.

How did you make this victory possible?

You marched for women’s health in protests all across the nation back in January. You participated in the Save Our Care Bus tour and organized or joined countless rallies, vigils and protests. You showed up whenever your voice was needed! 

You helped explain what’s at stake for women, through social media postings, dissemination of fact sheets, presentations at community forums, letters to the editor, media interviews and sit-downs with your friends and family.

You gathered stories of what would happen if #ILoseCoverage and helped disseminate these stories through an incredible social media campaign.

You joined the #IAmMedicaid campaign and shared the stories of what Medicaid means to women, LGBTQ people and our families. While the threat of Medicaid cuts will continue as Congress turns to the budget and tax cuts this fall, we have started to change negative public perceptions about Medicaid by emphasizing its importance to women across our lifespans – from reproductive health care to nursing home care.

You helped us explain in user-friendly language each “policy-wonky” twist and turn of the Trumpcare legislative saga. You helped women, LGBTQ people and our families see through the deceptive language being used to promote policies that would have devastated our families.  And, we must give a special shout-out here to our amazing graphic artist, Brucie Rosch!


What’s next? Accountability and vigilance!

So, today, you should savor the victory! But, our work will continue.

The national day of action – Our Lives on the Line – will go on as planned tomorrow in Washington, D.C., and at more than 150 events across the country.  Why? The early-morning defeat of the “freedom to lose your health care” bill in the Senate is unlikely to be the end of the drive by the Trump administration and its allies in Congress to destroy the Affordable Care Act, slash Medicaid, defund Planned Parenthood and ban abortion coverage.

We will need to hold accountable those members of Congress who voted for various versions of the Trumpcare bill. There will be plenty of opportunities to do this during the August Congressional recess.

And, we must remain vigilant! When Congress returns to work in September, there will be more challenges to Medicaid, the Children’s Health Insurance Program and other vital health care programs as budget season heats up.

So, we thank you for all you have done, and urge you to stay connected for the work ahead!




It’s not over yet. Keep the pressure on!

A quick recap of yesterday’s action to get you up to speed

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Support the 3 GOP women standing against ACA repeal! 

Support the three GOP women standing against ACA repeal!

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Don’t be fooled! The new “improved” Senate bill is worse!

The Cruz amendment only makes this bill worse!

The Senate’s Republican leaders just released a new “improved” version of their Trumpcare bill, and it’s even worse than the previous version. This bill includes a controversial provision pushed by Senator Ted Cruz (R-TX) that amounts to the latest bad idea from Republicans trying to repeal the Affordable Care Act (ACA). Cruz says he wants to give consumers "choice,” by allowing insurers to sell cheaper skimpy plans that do not cover essential services like maternity care, prescription drugs and cancer screenings, as long as they also sell comprehensive plans. But the choice Cruz is offering is between insurance you don't want (the skimpy plans) and insurance you won’t be able to afford (the comprehensive plans, which will cost much more than they do now).

The same bad features from the previous version of Trumpcare still in the bill – including deep cuts to the Medicaid program, a provision preventing women on Medicaid from using Planned Parenthood and a ban on using federal premium subsidies to buy health plans that cover abortion.   Overall, the new bill is likely to lead to millions of people losing coverage, and leave millions more stuck with insurance that doesn’t cover what they need.  We’ll know more about exactly how the bill will hurt women, LGBTQ people and our families early next week, when the Congressional Budget Office (CBO) releases its analysis. But we know enough now to strongly oppose this bill.

We’ve stopped Trumpcare before and we must act again to show the Senate that they can’t get away with cutting health care for millions of people.  But we need to act quickly.  Senate leadership says that they’re going to vote on Trumpcare next week!

Our messages are simple: This bill can’t be fixed.  The bill cuts taxes for the rich and health care for the poor and middle class.  Don’t take health care away from people with pre-existing conditions.  Millions of people shouldn’t be pushed off or priced out of their coverage. 

Ready to get started?  The Senate switchboard number is 202-224-3121, or call toll free at 866-426-2631.  Want to find an event near you?   Try here and here.  Need a social media badge to show your opposition to the bill?  Check out RWV’s Facebook and Twitter channels and remember to use the hashtags #KillTheBill and #ProtectOurCare.

Want to know more about the latest Senate bill?

What else do we know about today’s version of the Senate bill?  It’s not all that different than the bill that passed the House in March, and the earlier version of the Senate bill.  It does away with the individual mandate, scales back eligibility for help paying premiums, pushes people who get premium assistance into plans that cover less, allows insurers to charge older folks five times as much as younger adults and ends the expansion of Medicaid.  People who are not able to maintain continuous coverage, possibly because they were laid off, or aged out of their parents’ plan, would be “locked out” for six months before they could buy their own insurance. 

The version of the bill introduced today does include a few provisions that are different than earlier versions of the bill.  But none of these changes make coverage better, and some even make things worse.  For example, because Medicaid cuts will devastate care for those struggling with addiction, an earlier version of the bill allocated $2 billion for states to address the national opioid crisis.  This version includes $45 billion, but addiction experts say that doesn’t even come close to meeting the need.  The Senate bill also allows people to use health savings accounts to pay for premiums, a benefit that mostly helps middle class and upper-income folks. 

The changes pushed by Ted Cruz, to allow insurers to sell stripped down plans, are very likely to make things worse for many of us, but especially women.  Here's why: The Cruz amendment would let insurance companies sell cheaper, skimpier health plans on that do not follow ACA rules, as long as they also offer a plan that does follow them. Under the ACA, all health plans must cover essential health benefits like maternity care, mental health care and prescription drugs. 

Young, healthy people will be inclined to save money by buying stripped down health plans with very limited coverage or just by skipping health insurance altogether. Meanwhile, anyone who has health problems that need treatment, including many people ages 50 to 64, will enroll in the more comprehensive ACA-compliant plans. The result will be the creation of two separate health insurance “risk pools” – one with young healthy people and a second one with sicker and older people. The expense of covering medical care for this second group of people will quickly drive up the cost of premiums for the ACA compliant plans to the point where the coverage will be unaffordable. This is what’s known as a “death spiral” in the health insurance world, meaning that eventually the health plan dies from lack of people able to pay the price of coverage.

So, one effect of the Cruz amendment would be to harm people with pre-existing conditions, making it difficult for them to find any affordable plan that covers the care they need. Some lower income people with pre-existing conditions (those who earn less than $42,000 a year) would be eligible for some financial assistance in paying premiums, under the Senate bill. But, the subsidies are tied to plans with $6,000 deductibles, so a low to moderate-income individual would be responsible for the first $6,000 in medical costs. Meanwhile, an estimated 1.5 million people with pre-existing conditions who earn more than $42,500 would get no financial help in paying the skyrocketing premiums for the comprehensive ACA-compliant plans. Even the insurance companies think the Cruz amendment is a bad idea! AHIP, an insurance industry trade group, says it would "de-stabilize the individual market and increase costs for those with pre-existing conditions."

But even the cheaper, skimpy coverage Cruz is promoting isn’t a solution – it’s part of the problem we tried to fix with the ACA.  Before 2010, insurers were allowed to sell skimpy plans on the individual market.  Only 12% of plans covered maternity care.  Skimpy plans had unrealistically low limits on annual coverage, leading many people who faced big bills with no way to pay.  Personal bankruptcy has dropped by 50% since the ACA went into effect and skimpy plans were banned.  Too many women and their families experienced the false promises of skimpy health insurance.  RWV knows how important it is to have comprehensive coverage with strong consumer protections.  We’ll be showing up to #ProtectOurCare starting right now.  Join us!

Can we stop this bill? Yes!

As members of Congress returned to D.C. this week following the Fourth of July Congressional recess, it has become clear that our hard work is paying off! West Virginia’s moderate Republican Senator, Shelley Moore Capito, said in a recent interview that she would cast the deciding vote against Trumpcare, if it came down to it. “I only see it through the lens of a vulnerable population who needs help, who I care about very deeply,” Capito said. “So that gives me strength. If I have to be that one person, I will be it.”

West Virginia FREE (WV FREE), RWV’s Charleston based regional coordinator, was busy over the Fourth of July recess, working hard to keep up the pressure on Senator Capito. WV FREE took advantage of the time Capito was at home in West Virginia, working with their coalition partners to rally for Capito’s support at a local Fourth of July parade. They also worked with their allies to put up lawn signs in Senator Capito's neighborhood that read “Protect Our Care, Save Our Jobs, #SaveMeCapito.”

WV FREE conducted a phone canvass to highlight the devastating impact Trumpcare would have on 180,000 West Virginians, and to encourage Capito to take a strong stance against it. Canvassers made phone calls to West Virginians in areas with the highest Medicaid enrollment rates, and offered to patch them through to Senator Capito’s office.

Another GOP Senator, Susan Collins of Maine, tweeted this afternoon that she still is a “no” vote on the Senate bill, even with the revisions unveiled today. RWV regional coordinator Maine Consumers for Health Care has been pressing her hard.

In a sign of just how tough it is going to be for ACA opponents to gather 50 votes for a bill to repeal and replace the ACA, two Republicans broke away from their party’s leadership and introduced their own plan, just moments before Majority Leader Mitch McConnell started briefing Senators on the details of his plan.  In an interview on CNN, Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) said that they have devised an as yet-unnamed plan that would retain most of the taxes included in the ACA, and send the money to the states in block grants.  States would be free to provide coverage as they see fit, with limited oversight from the federal government.  Although the Senators implied that their plan would continue the financial assistance for consumers that has made coverage gains possible under the ACA, they also acknowledged that this funding could be cut, perhaps within months, if the Republicans pass legislation cutting taxes.

The release of an alternative ACA repeal bill was unexpected, to say the least!  We don’t know whether or when the Cassidy/Graham repeal bill might be considered by the Senate.  But the willingness of two Senators to propose their own alternative bill means that getting to 50 votes for any repeal bill will be even more complicated.  Let’s keep the pressure on!


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