Health Care

What’s Next for Health Care

At the end of the September, we scored a major victory when TrumpCare was once again defeated in the Senate. While the Republicans’ ability to use reconciliation (the process that allows them to pass legislation with only 50 votes) expired on September 30, this won’t be the last we hear about health care this year. Here’s what you can expect:

  • Senate Republicans will continue to try to gather 50 votes to repeal the Affordable Care Act.
  • The Trump administration will continue to sabotage our health care system to score political points.
  • Some Republicans will support a bipartisan health care bill We support a bipartisan approach as long as it does no harm: it should cover no fewer people than current law, it can’t reduce coverage quality or protections, and it should make no cuts to Medicaid.

“We’ll be revisiting this issue at some point.”

The demise of Graham-Cassidy was a huge win for every American who cares about protecting quality health care coverage for their fellow citizens. The Republicans wanted to demolish the health care system just so they could say they managed to accomplish something—anything—this year. But you didn’t let them. Don’t forget that President Trump said he would sign an Obamacare repeal bill on day one, and that the Republicans expected to pass a repeal bill within his first 100 days. The fact that we are now over 250 days into this administration and the Affordable Care Act remains the law of the land—and is as popular as it has ever been—is a testament to the power of citizens across the country who have pushed back.

However: every GOP failure to repeal the Affordable Care Act so far has been followed by an even more destructive attempt. This time, the Republicans left a backdoor in their tax scam so they can take aim at Medicare and Medicaid and try to repeal critical parts of Obamacare. If they don’t roll further attacks on the health care system into the tax battle, they will likely try to go back to health care next year, again using reconciliation. Senator John Thune has already said that Republicans will “be revisiting this issue at some point,” so it isn’t a question of whether the Republicans will take aim at Obamacare again—it’s when they’ll try it.

Republican donors won’t let them quit the health care fight. Senator Cory Gardner, the head of the National Republican Senate Committee (which is responsible for electing Republicans to the Senate), complained during a recent caucus meeting that “donors are furious” that the Senate hasn’t passed Obamacare repeal. Lindsey Graham himself said that dwindling donations to the Republican Party as a result of their TrumpCare failure in July helped bring his bill back to life, saying it was like a bad “employer assessment.” Senators Gardner and Graham have forgotten that their employer isn’t their billionaire donors, but their constituents— only 24% of whom supported their bill.

We don’t know what a new bill would look like, but it’s likely to look a lot like Graham-Cassidy. Every Republican proposal so far would reduce the number of Americans with health care coverage, destabilize insurance markets, and force states to cut back on the services they provide for low- and middle-income Americans. As long as the Republicans’ top health care priority remains repeal at any cost, we will oppose their efforts.

We won’t let them operate in the shadows. We will beat repeal as many times as the Republicans keep bringing it back.

“It’s clearly sabotage.”

Last time TrumpCare failed, we told you about the ways the Trump administration was unilaterally undermining health insurance markets. While recently-fired Department of Health and Human Services (HHS) Secretary Tom Price was flitting around the country on wasteful, taxpayer-funded private charter flights, his department continued working to destabilize state health care markets by:

Slashing Enrollment Outreach. The Trump administration reduced this year’s advertising budget for open enrollment by 90%, and reduced the budget for navigators—whose job it is to help people enroll in coverage—by 40%. Most egregiously, in late September HHS broke its commitment to partner with nonprofit organizations nationwide on enrollment events. When asked what he thought the department's rationale for skipping the events might be, the executive director of the Mississippi Health Advocacy Network responded that “it’s clearly sabotage.”

Making it unnecessarily difficult for people to sign up. This year’s open enrollment, the period of time during which people can sign up for health care coverage for the following year, is the shortest since rolled out in 2013. It’s just 45 days this year, compared to the six month open enrollment in its first year. In addition, the Trump administration has announced that—which most states use for enrollment—will be taken down from midnight to noon nearly every Sunday during open enrollment.

Undercutting State Initiatives. Under the Affordable Care Act, states can use 1332 waivers to test innovative ways to provide coverage to their citizens. Last year, Minnesota submitted an application for a 1332 waiver to create a reinsurance program to keep premiums lower. Since then, Minnesota’s governor says that HHS has “disrupt[ed] and possibly severely damage[d] Minnesota’s health care system” by playing politics with their application. Oklahoma had to withdraw their own waiver application for similar reasons.

It is clear that the Trump administration would rather indulge in their self-fulfilling talking points about failing markets than take steps to ensure Americans have access to affordable, quality health coverage. The fact remains that Obamacare is working well in states that are proactively maintaining healthy markets—such as New York, where they recently announced that average premiums will decrease by 5% for 2018. Regardless of what happens on Capitol Hill or what would be best for Americans, the Trump administration will keep trying to find ways to reduce access to care.

“It needs to be bipartisan.”

Senators Lamar Alexander and Patty Murray have restarted their bipartisan negotiations to stabilize state health insurance markets. While no details have been released, reports suggest that the Republicans will authorize two years of funding for cost sharing reduction (CSR) payments, which help low-income Americans afford health insurance, in return for allowing “copper plans” on the exchanges and loosening the protections required to have a 1332 waiver approved. While we support authorizing the CSR payments, we are very concerned that trading only two years of funding in return for permanent changes to the type of coverage offered under Obamacare will open the door to further erosion of the promise of quality, affordable coverage that the ACA represents. People will be worse off under these changes than they are under current law.

There is some support in the Senate for a bipartisan approach. Senator Lisa Murkowski, whose vote was critical in derailing the first repeal effort, said in response to a question about the future of the health care debate that she feels “it needs to be bipartisan.” However, as long as the Republican leadership in the Senate is opposed to taking any action that could help lower costs or improve access to care, these efforts are unlikely to gain any traction.