The Administration continues to urge the Senate to return to efforts to repeal and replace the Affordable Care Act (ACA). Senators Bill Cassidy (R-LA) and Lindsey Graham (R-SC) are promoting a bill they cosponsored which includes a Medicaid per capita cap and block grant of the Medicaid expansion funding and the market place subsidies. While their proposal may be revised, The Arc is especially concerned about the proposed cut and caps to Medicaid. Based on a recent opinion by the Senate Parliamentarian, the Senate can return to debate on health care any time before the special budget reconciliation rules for fiscal year 2017 expire on September 30; maintaining the protection of needing only a simple majority to pass the legislation until that date.
The Senate is involved in a number of efforts to address health care issues in a bipartisan manner. The Senate Health Education Labor and Pensions (HELP) Committee, under the leadership of Chairman Lamar Alexander (R-TN) began holding four hearings last week and will continue this week on ideas to stabilize the individual insurance marketplaces. His intent is to reach bi-partisan agreement on a narrow time limited proposal that could be passed by the end of the month. While legislation has not been drafted, the Committee is considering ensuring that funding is appropriated for cost sharing reduction payments that help low income people afford insurance and changes to the existing waiver program that allows states to create marketplaces that do not meet the requirements of the ACA.
The Senate Finance Committee held a hearing on the Children’s Health Insurance Program (CHIP) for which federal funding will expire this year. CHIP was created in 1997 and has strong bi-partisan support. States can create a separate program for children, expand Medicaid, or some combination of both. CHIP has been very successful at expanding insurance coverage for children. The Arc urges Congress to renew funding for CHIP as soon as possible so that states can continue their programs without interruption.
This issue of Capitol Insider is devoted to a review of the Senate’s consideration of the effort to repeal/replace the Affordable Care Act.
Health Care; Medicaid; Long Term Supports and Services –
Repeal of The Affordable Care Act Fails in The Senate: A Week In Review
Last week was a critically important week for people with intellectual and developmental disabilities (I/DD) and their families, indeed, for all people with disabilities. The result was what The Arc and its members had worked hard for over the last nine months. However, the week of Senate legislative action played out like an intense roller-coaster ride and the results were not predictable until the final vote in the early hours of Friday, July 28.
As the week began, Senate Majority Leader Mitch McConnell (R-KY) planned a series of Senate floor votes on the efforts to repeal or replace the Affordable Care Act (ACA) and make fundamental structural changes to the Medicaid program. It was expected that the votes could be close, with 52 Republicans in the Senate and 48 Members of the Democratic caucus (including the two Independents who vote with the Democrats). Republicans would need at least 50 votes in support of any action or legislation to proceed – Vice President Mike Pence would be called upon to break any tie votes. Several Republicans had already expressed serious reservations about various provisions of the bills under consideration.
Monday, July 24:
Senator John McCain (R-AZ) made the surprise announcement that he would be returning to Washington DC, despite his recent brain surgery and cancer diagnosis.
Tuesday, July 25:
The Senate voted on the “Motion to Proceed” on debate of the repeal of the ACA. This is a procedural voted needed to begin debate on the bill. With Vice President Pence casting the vote to break the tie, the motion passed the Senate 51-50. Senator Susan Collins (R-ME), Senator Lisa Murkowski (R-AK) and all Democratic Caucus Senators voted no.
Following the successful motion to proceed, the Senate voted to replace the House-passed text with it’s own text, a version of the Better Care Reconciliation Act
- This bill included an amendment by Senator Ted Cruz (R-TX) that would allow insurance companies to sell plans that do not comply with current insurance regulations as long as some of their plans do comply. Insurers could drop maternity care, mental-health treatment, and other benefits if they sell at least one health plan that includes them.
- This bill also included an amendment by Senator Rob Portman (R-OH) which would provide $100 billion to help people cover their deductibles and other expenses when they lost Medicaid coverage, and it would let states set up such arrangements without needing special federal approval.
Due to an opinion by the Senate parliamentarian, this bill would have required 60 votes to pass. With 57 “no” votes and 43 “yes” votes, the BCRA did not pass. The no votes were cast by Senators Murkowski (R-AK), Collins (R-ME), Heller (R-NV), Corker (R-TN), Cotton (R-AR), Graham (R-SC), Lee (R-UT), Moran (R-KS), Paul (R-KY), and the whole Democratic caucus.
Wednesday, July 26:
Following the defeat of the BCRA, the Senate held a vote on the Obamacare Repeal Reconciliation Act, a “repeal and delay” bill. This bill failed with 55 no votes and 45 yes votes. The no votes were cast by Senators Murkowski (R-AK), Collins (R-ME), Heller (R-NV), Alexander (R-TN), Capito (R-WV), Protman (R-OH), and the whole Democratic caucus.
Thursday, July 27 into Friday, July 28:
At around 10:30 pm Thursday, Majority Leader McConnell introduced the language of what had been called the “skinny repeal.” Officially titled the Healthcare Freedom Act, this bill would have struck down a few provisions of the ACA, including the individual mandate, the employer mandate, and the medical device tax. The Congressional Budget Office (CBO) reported that the Health Care Freedom Act would cause 16 million people to lose insurance and individual market premiums to go up by 20 percent. The insurance coverage provisions would have also resulted in a loss of $235 billion in the Medicaid program over 10 years.
At about 1:30 am Friday morning, the final vote on the Senate series of repeal efforts was completed with a defeat of the Health Care Freedom Act by a vote of 51-49, with Senators Collins (R-ME), Murkowski (R-AK), McCain (R-AZ), and the whole Democratic caucus voting against the bill.
What We Narrowly Avoided:
If the Health Care Freedom Act had passed the Senate, a joint House-Senate conference committee would have considered the Health Care Freedom Act and the House-passed American Health Care Act (AHCA) to develop a bill to be considered by both the House and Senate. Through the AHCA, per capita caps and over $830 billion in cuts to Medicaid over a decade would have been part of the consideration by the conference committee. The House also could have simply passed the “skinny repeal” without going to conference. Both of these scenarios were of major concern to many Senators and were a factor in decisions to oppose the bill.
The Arc of the United States released statement on the failure of the effort to repeal the Affordable Care Act (ACA) and make fundamental structural changes to the Medicaid program which can be seen here.
Several Senators have already announced efforts to work together to produce legislation to address issues left in limbo by the failure of the House and Senate efforts. Some are looking to work in a bipartisan manner to ensure that the affordability provisions in the ACA remain funded and to address health insurance market place issues. House Minority Leader Nancy Pelosi (D-CA) wrote to House Speaker Paul Ryan (R-WI) and Senate Majority Leader McConnell indicating that “we have a responsibility to pivot from the current debate on health care and to work in a bipartisan fashion to lower costs, improve quality, and expand coverage, while strengthening the stability of the marketplaces.” Senate Minority Leader Chuck Schumer (D-NY) has similarly expressed a desire to work in a bipartisan manner to resolve the identified problems of the ACA.
As Congress continues to debate health care policy, The Arc and other disability advocates expect to remain fully engaged. In the meantime, sincere thanks and acknowledgement are due to the extraordinary efforts of people with disabilities and their families, friends, supporters, and providers throughout the country who shared their life experiences and made their voices heard on the issues of affordable, accessible health care and the critical importance of home and community based services and health care through Medicaid. This work over the last nine months clearly affected elected officials. It was a powerful combined effort and it helped force the defeat of misguided attempts to repeal the ACA and cut and cap the Medicaid program.
The Senate continues to try and move forward on a plan to repeal the Affordable Care Act (ACA). On July 17, plans to repeal the ACA and cap Medicaid were put on hold when four Republican Senators announced their intent to vote “no” on a motion to begin debate. The next morning, Senate Majority Leader Mitch McConnell (R-KY) announced that there would be a vote on Obamacare Repeal Reconciliation Act (ORRA), which does not include Medicaid per capita caps, but does repeal Medicaid expansion, the increased federal match for the Community First Choice option, the individual and employer mandates, the premium tax credits, and a number of other provisions. The bill would not take effect for two years, giving Congress time to develop a replacement. However, it is unclear whether insurers will continue to participate in the market when the long-term framework is unknown. Within hours of this announcement, three Republican Senators announced their opposition to voting to repeal and delay replacement with a new plan.
Senate Majority Leader McConnell then announced that there will be a vote on a motion to begin debate early this week. It is unclear whether the vote will be on the ORRA or a revised Better Care Reconciliation Act (BCRA). The Senate is also considering revising BCRA to includes $200 billion in non-Medicaid funds for expansion states in an effort to win support from Senators from the Medicaid expansion states. The Congressional Budget Office has evaluated the ORRA and BCRA and found that they will increase the number of uninsured Americans by 32 million and 22 million, respectively.
To further complicate the situation, the Senate Parliamentarian, who must review provisions to make sure they comply with the Senate rules, has found that several provisions could be challenged and would require 60 votes to keep them in the bill. The provisions include a prohibition of Planned Parenthood funding, ending the essential health benefits requirement in Medicaid, continuing funding for cost sharing subsidies, allowing states to change the requirement that plans spend at least 80% of premium income on health care, and the six- month waiting period prior to enrollment without continuous coverage. The Parliamentarian continues to review the bill and may issue additional findings. It is unclear if the Senate has the votes to pass any legislation at this point, but the leadership is expected to keep working to try and find agreement on repealing the ACA.
On July 13, the Senate released a new discussion draft of the Better Care Reconciliation Act (BCRA). The Senate was unable to secure support to pass the bill before the July 4 recess and Majority Leader Mitch McConnell (R-KY) and Administration officials continue to work hard to convince at least 50 Senators to support the bill. To address strong criticism regarding the impact on people with disabilities, the new draft includes $8 billion for a four-year home and community based services demonstration for rural states. This woefully inadequate one-time fund is much smaller than the $19 billion cut from the enhanced federal match (which is not time-limited) in the Community First Choice state option. Additionally, the draft bill still includes per capita caps, which, when combined with cuts to Medicaid expansion, will result in reductions in Medicaid spending by 35% by 2036, compared to current law. Additional changes include allowing insurers to sell plans that cover fewer services, increased funding to address the opioid crisis, and maintaining the Affordable Care Act’s high-income payroll tax and investment income tax. In a statement, The Arc warned that the new draft continues to pose a severe threat to people with disabilities.
Senate Majority Leader McConnell has announced that a vote on the BCRA will be delayed for at least a week. Advocates should continue reaching out to their Senators and organizing against the BCRA. Please call your Senators and take part in our emergency letter-writing campaign.
Senate Majority Leader Mitch McConnell (R-KY) continues to push hard for a Senate vote this week before Congress begins its July 4 recess. This process is expected to advance today or tomorrow with the release of the Congressional Budget Office’s (CBO) report projecting the Senate measure’s impact on the number of insured Americans and federal deficits. The CBO had projected that the House’s bill would result in 23 million fewer Americans having health insurance and over $830 billion in cuts to Medicaid over 10 years.
The Majority Leader will need to win over the five Republican Senators – four conservatives and moderate Dean Heller (R-NV) – who announced their opposition to the measure last week. Republicans control 52 seats and can afford only two defections to still pass the bill with Vice President Pence to break the tie, assuming no Democratic support.
Should the Senate measure pass, attention could immediately turn back to the House of Representatives to pass the Senate’s bill. President Trump has indicated his intent to sign Congress’ health care legislation into law.
This week marks a truly historic time in the lives of people with intellectual and developmental disabilities. The system of home and community based services that has taken decades to build with bipartisan support is facing unprecedented risk. The Arc urges its network of advocates across the country to make every effort to contact their Senators and urge them to vote NO. See Action Alert.
On June 22, 2017, the Senate Budget Committee released a discussion draft of health care reform legislation, the “Better Care Reconciliation Act of 2017.” Some Senators are claiming that provisions have been added to this bill to protect people with disabilities. However, provisions related to people with disabilities are wholly inadequate. Click here to see key points on why the disability provisions fail to provide any meaningful protections for people with disabilities.
The Senate draft is substantially similar to the harmful bill (H.R 1628) passedby the House in May. Among other things, both measures radically restructure the financing of the Medicaid program to pay for the repeal of the tax provisions and other revenue producing provisions of the Affordable Care Act. As a result, deep cuts to health care and community living supports for low income people would be used to fund tax breaks that largely benefit corporations and wealthy individuals.
Reactions to the Senate draft were swift and overwhelmingly negative from the disability community and others, evidenced by a highly-publicized protest in the Senate. Click here to watch MSNBC’s coverage of the protest which included numerous arrests and an extensive analysis of Medicaid’s significance to people with disabilities.
As The Arc’s CEO Peter Berns noted in his statement on the day the Senate draft was released, “This bill will have a devastating impact on individuals with intellectual and developmental disabilities and their families. Make no mistake – people’s lives and independence are on the line.”
Senate Majority Leader Mitch McConnell (R-KY) continues to seek Senate passage of the American Health Care Act (H.R. 1628), which passed the House of Representatives in May. News reports continue to indicate that the Senate may vote on the bill as soon as the end of June. While the Majority Leader has not released proposed Senate changes to the bill, reports continue to indicate that Medicaid per capita caps will remain in the bill, jeopardizing the availability of Medicaid home and community-based services for people with I/DD.
The Arc is continuing its efforts to preserve health care and long-term services and supports under the Affordable Care Act and Medicaid. On June 16, The Arc hosted a Facebook Live briefing (part 1, part 2) with Nicole Jorwic, Director of Rights Policy. On June 19, The Arc co-hosted a briefing on Capitol Hill on “Understanding the Devastating Impact of Medicaid Per Capita Caps on People with Disabilities” with Marty Ford, Senior Executive Officer for Public Policy, as a panelist. Additionally, The Arc released a fact sheetdetailing Medicaid’s optional and waiver services that are at risk if per capita caps are enacted.
Senate Majority Leader Mitch McConnell (R-KY) has placed the American Health Care Act on the Senate calendar with a vote planned by the end of June. The Senate is planning to skip the committee process. The bill is expected to be substantially similar to the version that passed the House. Very few details of the bill have been made public. One likely change is extending the time frame for phasing out the Medicaid expansion. However, Medicaid per capita caps are likely to remain in the bill, jeopardizing the availability of services for people with I/DD. The Arc is continuing its efforts to defeat the bill, and recently released a new video.
Javi, a man with autism and Ehlers-Danlos syndrome, and his mother Linda have benefitted from Medicaid. Linda became a single parent when Javi was just seven years old, and was able to work full time because of the support Javi received through Medicaid. Last week, The Arc released their story, the sixth in a series featuring people who rely on Medicaid and/or the Affordable Care Act. Please share this video widely with your networks to show the impact of cutting Medicaid and repealing major health care protections. For an especially easy option, retweet The Arc of the US and share our Facebook post.
Soojung’s daughter, Alice, was born with Rett syndrome and relies on Medicaid to get the health care and services she needs to survive and thrive. Last week, The Arc released their story, the fifth in a series featuring people who rely on Medicaid and/or the Affordable Care Act. Please share this video widely with your networks to show the impact of cutting Medicaid and repealing major health care protections. For an especially easy option, retweet The Arc of the US and share our Facebook post.