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Healthcare Reform: ACA Repeal and Replace Efforts

 

 

Action Alert, September 2017

Action Alert

Tell Your Senators to Oppose the Graham-Cassidy Legislation on Healthcare Reform

 

Background

Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI) recently introduced legislation known as Graham-Cassidy to repeal and replace the Affordable Care Act (ACA). The hope of these lawmakers was to hold yet another vote on repeal before October 1. A simple majority (51 votes) is all that is needed to pass the measure. Unfortunately, the Graham-Cassidy proposal is more extreme than other recent Senate proposals and would be particularly harmful to individuals and families impacted by chronic health conditions. Specifically, the new proposal would:

 

  • Allow insurance companies to charge more for those individuals with pre-existing health conditions

  • Allow states to more easily opt out of requiring quality health insurance options and comprehensive benefits

  • Expand the ability for individuals to purchase low-quality health insurance benefits in lieu of more comprehensive coverage

  • Eliminate the individual and employer mandates

  • Dramatically reduce the federal commitment to Medicaid expansion

  • Eliminate the Prevention and Public Health Fund

     

    While this effort was initially dismissed by many, it has quickly gained support and could be voted on next week. In order to protect patients with chronic conditions, please contact your Senators and ask them to oppose the Graham-Cassidy repeal and replace proposal. 

     

    Take Action

  • Contact the health Legislative Assistants (LAs) in the offices of your two U.S. Senators and use the message below for a voicemail or brief e-mail. The contact information for your Senate offices can be found at www.Senate.gov.

     

    Dear _______,

     

    My name is _________ and I am a constituent from [home town]. On behalf of patients with chronic health conditions, I urge the Senator to oppose the Graham-Cassidy healthcare proposal. This proposal would be absolutely devastating to individuals and families affected by chronic illness that rely on access to quality, affordable health care.

     

    [Explain a little about your particular situation]

     

    Thank you for your consideration of my request. Please tell me how you have responded to my request.

     

    Sincerely,

    [Name]

    [Address]

Background

September 21, 2017, update from the Digestive Disease National Coalition:

 

A bipartisan group of ten state governors wrote to Senate Majority Leader Mitch McConnell (R-KY) and Senate Democratic Leader Charles Schumer (D-NY) asking them to not consider the Graham-Cassidy bill  and urged support for bipartisan efforts to make health care more available and affordable for all Americans. Here is their letter: www.colorado.gov/governor/sites/default/files/bipartisan_governors_letter_re_graham-cassidy_9-19-17.pdf

 

Talk show host Jimmy Kimmel does a nice job summing up the problem with the Graham-Cassidy bill for people with pre-existing health conditions: www.youtube.com/watch?v=cOlibbx5sx0&utm_source=STAT+Newsletters&utm_campaign=638824a318-MR&utm_medium=email&utm_term=0_8cab1d7961-638824a318-149690465


The Senate Finance committee will hold a hearing on Monday of next week on the Graham-Cassidy legislation. “Senators have expressed a strong desire to examine the details of the Graham-Cassidy proposal through a public hearing," Senate Finance Committee Chairman Orrin Hatch said in a statement. "A hearing will allow members on both sides of the aisle to delve deeper into its policy and gain a better understanding of what the authors hope to achieve." 

 

Senate HELP Committee Chairman Lamar Alexander (R-TN) issued a statement yesterday declaring that his committee’s efforts to seek a bipartisan solution to stabilizing the individual health insurance market concluded without any solutions: http://thehill.com/policy/healthcare/351431-gop-chairman-declares-bipartisan-obamacare-fix-dead

 

Action Alert, July 2017

Ask Senators to vote NO and go back to the drawing board

 

There have been several developments during the last several days related to the Senate effort to repeal and replace the Affordable Care Act (ACA).

 

Please contact the offices of your two Senators and urge them to go back to the drawing board!

 

Take Action:

  • Secure the contact information for your Senators by visiting www.Senate.gov and using the “Find Your Senator” query tool in the upper right corner.
  • Call the office and ask for the Health Legislative Assistant. You can either leave a voicemail or request their e-mail address and send them a message using the template below.
  • Politely and occasionally follow up on your request. You should have an expectation that the office will respond to your specific concerns.

Dear _______,

My name is _________ and I am a constituent from _________. I am also an advocate for (your health condition). I write to urge you to vote NO on the Senate’s healthcare bill and go back to the drawing board.

The Senate healthcare bill would:

  • Jeopardize patient access to quality, affordable & available coverage
  • Cut-off health coverage for millions of Americans
  • Bring back annual and lifetime caps on coverage
  • Price people with pre-existing conditions out of the insurance market

I write to urge you to maintain stability for chronic disease patients as you and your colleagues consider healthcare reform. It is my hope that the Senate will develop a bill that preserves key patient protections and respects the circumstances of those combatting chronic and costly illnesses.

Specifically, please ensure any Senate proposal:

  • maintains essential health benefits
  • prohibits pre-existing condition discrimination
  • prohibits lifetime and annual caps on benefits
  • limits out-of-pocket costs for patients in a meaningful way
  • allows young adults to stay on family coverage until they are 26

[Add a paragraph of brief information about your condition. Tell your story.]

Patients need a transparent, bipartisan effort to stabilize the insurance market, bring down premiums, and retain the protections that are so critical to patients, consumers and their families. I urge the Senate to go back to the drawing board, and work together to find ways to protect patients with serious illness.

Thank you for your time and your consideration of this letter. Please tell me how you have responded to my request.

Sincerely,

[Name]
[Address]

 

 

Background

July 26, 2017, late afternoon, update from the Digestive Disease National Coalition:

  • As expected, the Senate rejected the amendment to repeal the Affordable Care Act with a two-year delay and a promise to replace. The vote was 55-45 against the amendment.
  • Senate Majority Leader McConnell is getting low on options for a comprehensive repeal/replace measure, but some of the votes that have been taken during the amendment process give him an idea where senators stand on certain issues. He may be looking for an opportunity to craft a new or revised proposal that is sensitive to those interests that he feels can get 50 votes—again relying on the Vice President to break a deadlock. It’s unclear right now if a new or revised proposal will materialize.
  • As the major repeal/replace options are being voted down, the “skinny” option is getting much more attention. The “skinny” option would dramatically pare down the Senate proposal to only contain a repeal of the Affordable Care Act’s (ACA) individual and employer mandates as well as a repeal of ACA’s medical device tax. If the Senate can pass the “skinny” option, then the Senate would call for a House-Senate conference in which the House-passed American Health Care Act and the Senate “skinny” bill would be negotiated into a final bill subject to an up or down vote by both the House and Senate.
  • There will be more action tomorrow on remaining amendments, with a “vote-a-rama” later in the day in which any and all amendments would be quickly voted on and dispensed with.
  • It’s hard to tell when a vote for a final bill will occur. Several delays today stretched things out so there is more time remaining for debate at this time than was anticipated. Most observers are expecting a final vote by the end of the week.

 

http://thehill.com/blogs/floor-action/senate/343887-senate-rejects-repeal-only-obamacare-amendment

 

 

July 26, 2017, morning, update from the Digestive Disease National Coalition:

 

  • Senate debate and votes on major amendments started yesterday. Last night, the Senate voted down a modified version of the Better Care Reconciliation Act (BCRA). The modified BCRA amendment was the initial repeal and replace proposal made by Majority Leader Mitch McConnell that also included the controversial proposal by Senator Ted Cruz (R-TX) that would allow insurance companies to offer low-quality benefits as long as they offered an ACA-compliant plan, and a proposal by Senator Rob Portman (R-OH) to add back in $100 billion to assist those impacted by the BCRA’s rollback of the Medicaid expansion. The amendment failed by a vote of 43-57.
  • The Senate is expected to vote today on an amendment with a plan to repeal the Affordable Care Act (ACA) with a two-year delay—with the promise of using the two-year delay to replace the ACA. The plan stands a good chance at failing, as some centrist Republicans have said they would oppose repealing the ACA without a replacement.
  • The Senate end game remains unclear. As it looks now, most major amendments that represent repeal/replace ideas appear headed for failure. Many observers think that McConnell will be working to craft a final proposal-the substance of which is now unknown-that he hopes can get the votes to pass, or to dramatically pare down the Senate version of the legislation to include only a repeal of the individual and employer mandates as well as a medical device tax repeal. If he can get the Senate to pass either version, then he would call for a House-Senate conference in which the House-passed American Health Care Act and the Senate version would be negotiated into a final bill subject to an up or down vote by both the House and Senate.

 

Here is some of the latest news coverage:

 

Government Brief

  • Nine Senate Republicans joined all of the chamber's Democrats to reject an updated version of the House-passed Better Care Reconciliation Act. The 43-57 vote underscores the momentous task facing Senate GOP leaders to get their fractured conference in line on a plan to repeal Obamacare this week. (The New York Times)
  •  The Senate is expected to vote today on an amendment to replace the House-passed language with a plan to repeal Obamacare with a two-year delay. The plan stands a good chance at failing, as some centrist Republicans have said they would oppose repealing the ACA without a replacement. (The Washington Post)

 

 

July 25, 2017 update from the Digestive Disease National Coalition:

 

  • The Senate voted today to proceed with consideration of health reform legislation. The vote required intervention from the Vice-President to break a 50-50 tie. Several wavering senators voted to proceed with debate, but final passage of Senate legislation is not a sure thing. Senators have said their vote on final passage will be based on the substance of what they are voting on.
  • The Senate is scheduled for 20 hours of debate on the legislation and amendments and should be able to finish consideration this week—as early as Wednesday evening or as late as Friday.
  • There are likely to be several key amendments proposed. They are:

 

o   A Rand Paul-type complete repeal amendment

o   A Repeal Now and Replace Later amendment

o   A modified Cruz amendment that allows insurance companies to offer low quality health benefits, while adding more funding for Medicaid

o   The Better Care Reconciliation Act (the Senate’s original repeal/replace legislation)

o   A “skinny” plan that would only repeal the individual and employer mandate and the medical device tax (this amendment would be designed simply to get the Senate to conference with the House)

o   Some more-comprehensive product that is negotiated between now and the time for a final vote

 

(Much of the above could change)

  •   Most voluntary health organizations and medical societies are continuing to ask their constituents to urge their senators to vote NO on the bill and go back to the drawing board.

 

 

from April 2017

The leadership of the House of Representatives is continuing to work with conservative and moderate Republicans in an effort to repeal and replace the Affordable Care Act (ACA). Their proposal, the American Health Care Act (AHCA), was pulled from consideration a few weeks ago when it could not muster the votes to pass. However, House leaders continue to try to find common ground in order to modify the House leadership bill to make it passable.

 

The House of Representatives could vote on this bill when it returns on April 24 from the Easter recess. Grassroots outreach and educating Members of Congress about the needs of chronic disease patients continues to influence the overall debate. Please reach out to your House member and ask him or her to protect patients and oppose discriminatory and dangerous provisions.

 

 

US Congress Contact Information

House Representatives (search by zip code, state, or name)

 

The emerging House leadership plan includes a number of provisions that would be devastating for patients with chronic, complex, and costly medical conditions. The bill would remove protections for individuals with pre-existing health conditions and eliminate the ACA's Essential Health Benefits--federal quality standards for health insurance policies. In place of these protections, the bill would expand health savings accounts and tax credits, establish state risk sharing subsidies, and leave it to states to determine which essential health benefits they will offer--likely leading to lower quality benefits for patients with costly diseases.

 

Patients with costly health conditions could never put enough money in a health savings account, nor take advantage of a tax break associated with not utilizing healthcare services. Further, segregating costly patients into high risk pools has not worked in the past and would jeopardize access for the most vulnerable. Elimination of the federal mandate that insurers offer a minimum level of benefits and allow states the flexibility to decide these benefits would likely mean that many states would have the incentive to not recommend comprehensive benefits to those with pre-existing health conditions. Insurers could also dramatically hike premiums for those with expensive chronic health care needs.
 

 

 

Updated 9/21/2017

This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.

 

Updated in 2015 with a generous grant from Shire, Inc. 

 

This website was updated in 2015 with a generous grant from Shire, Inc. This website is an educational resource. It is not intended to provide medical advice or recommend a course of treatment. You should discuss all issues, ideas, suggestions, etc. with your clinician prior to use. Clinicians in a relevant field have reviewed the medical information; however, the Oley Foundation does not guarantee the accuracy of the information presented, and is not liable if information is incorrect or incomplete. If you have questions please contact Oley staff.
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