Health Care

What’s Next for Health Care


We scored a major victory with the failure of the TrumpCare vote(s) in the Senate. What comes next is playing out on three different fronts:

  • Talks continue among Republicans and the White House to draft another bill in secret.
  • The White House is openly sabotaging the Affordable Care Act.
  • Other Republicans are talking about a bipartisan approach. 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.

The zombie bill that won’t die.

Senators Graham (R-SC) and Cassidy (R-LA) continue to push another attempt at repeal of the Affordable Care Act, even though three previous attempts have failed. Republicans could still use the reconciliation process—which lets them pass legislation in the Senate with only 50 votes—to jam this through.

Now that we’ve seen the text, we know it is thoroughly similar to previous versions of TrumpCare. It still destroys Medicaid as we know it by fundamentally transforming the program into a cap system. It still undermines protections for people with pre-existing conditions and people who need treatment for opioid abuse.

Two new but equally damaging approaches this bill would take: it literally takes money from states that expanded Medicaid and gives it to states that did not. It takes all of the money going out the door to help people afford insurance through tax credits, and bundles it into one “block grant” given to states with no questions asked. But first, the bill would deeply cut the amount of money going to states. Then, it only allows the block grants to grow at 2%, a far slower growth rate than medical costs grow. And to top it all off, there is virtually no accountability for how this money is spent...slush fund!

We’ve proved before we can defeat TrumpCare. If this bill gains momentum, we’ll have to show them we can do it again.

The Trump Administration’s deliberate sabotage.

Trump has said over and over that he intends to deliberately sabotage the ACA as a way of leaving Democrats no choice but to support one of Republicans’ terrible bills. Not only is this an appalling politicization of his control over the Department of Health and Human Services (HHS), it will also have devastating implications for people who rely on the Affordable Care Act. There are at least three examples of Trump’s direct and intentional sabotage: holding cost-sharing reduction payments hostage, making it harder for people to get insurance, and using public outreach funding to produce anti-ACA propaganda videos.

Holding CSRs Hostage. Cost-sharing reduction payments (“CSRs”) are payments that the federal government makes to insurance companies, who are required to reduce co-pays and deductibles for low-income people. Every month since he was inaugurated, Trump has threatened to stop making these payments, bringing about tremendous uncertainty for insurance companies. This uncertainty has made it extremely difficult for insurers to accurately set their prices, and has led to them either raising their prices or just leaving marketplaces altogether. Trump then uses this talking point that insurers are raising prices or leaving the marketplace to justify his false claim that the Affordable Care Act is failing.

Erecting Barriers to Healthcare Access. Trump has also made it clear he wants to make it harder for people to get insurance through the marketplace. In July, he and HHS Secretary Tom Price cancelled contracts in 18 cities that offered assistance to people trying to sign up at libraries, neighborhood centers, and over the phone. He also announced he’s shortening the open enrollment period when people can get new insurance from 92 days to just 45, adding new documentation barriers to enrollment and allowing insurance companies to deny coverage to people who couldn’t previously afford their premiums.  

Anti-ACA Propaganda Videos. Finally, the Department of Health and Human Services was recently reported to have used its public outreach funding to produce anti-ACA propaganda videos, that fortunately very few people actually watched. Nevertheless, that funding is intended to help people know about and understand their options for getting insured through the Affordable Care Act—it is certainly not intended to scare people away from getting insured.

These likely are just the beginning of Trump’s using the powers already available to him to sabotage the ACA. Last month, the White House issued a request for information on which ACA regulations were “burdensome,” likely an effort to collect new ideas for further sabotage.

A new bipartisan process.

Senator Collins, a Republican who opposed TrumpCare, has called for a new bipartisan process. Senator Murkowski, Senator McCain, and Democrats agree.

We also support a bipartisan process that hears from expert witnesses, allows time for town halls, and is done through the regular order of committee hearings in the House and Senate. The most important outcome of any bipartisan process is that people are better off—not worse off—after new legislation passes than they were under current law. That means, at an absolute minimum:

  • No fewer people covered than under current law;
  • Patient protections and quality of coverage are the same or better;
  • No cuts to Medicaid. Period.  

Topics swirling in bipartisan talks so far seem to be the cost sharing reductions mentioned above, public outreach, and additional funding to help insurers cover very sick people. Those are good places to start. But it is important that Democrats not compromise on affordable, quality health care in exchange.