Three GOP Senators Derail ‘Skinny’ Repeal Maneuvers

Published in the Woonsocket Call on July 30, 2017

After seven years of vowing to repeal and replace President Obama’s Affordable Care Act, nicknamed Obamacare, Congressional GOP efforts went down in flames on Friday when Sens. John McCain, of Arizona, Susan Collins of Maine, and Lisa Murkowski, of Alaska, voted nay in supporting the Senate Republican’s “skinny” repeal bill.

Sen. McCain, giving his no vote with a thumb down gesture, left Republican Senators gasping and Democratic Senators clapping. The 80-year old Arizona Senator, recently diagnosed with an aggressive brain cancer, had flown back to vote. The Senator’s vote was considered the decisive vote to derail the GOP’s long-time efforts to repeal and replace Obamacare.

Senate Republicans Begin Efforts to Repeal Obamacare

On July 25, GOP leadership began its efforts to begin debate on the Senate health care bill to repeal AHA. On that Tuesday afternoon, the Senate passed a “motion to proceed” vote by 51-50, the deciding vote being cast by Vice President Mike Pence. The votes outcome allowed the upper chamber to begin debate on the Senate Republican’s Obamacare repeal-and-replace proposal. Sens. Collins and Murkowski had opposed this motion, but McCain, returning to Washington, D.C. after being diagnosed with brain cancer, voted yes to proceed with the debate.

Senators began a 20- hour period of debate, considering various amendments to the House version of the health care bill. By a vote of 43 to 57, the Senate rejected one version that included Sen. Ted Cruz’s (R-TX) controversial amendment that would have allowed those with pre-existing conditions to be separated into plans with much higher premiums. The Senate also rejected, by a vote of 45 to 55, another version that would have repealed the ACA with no replacement but with a two-year delay, giving GOP senators more time to create their replacement.

Late Thursday evening, GOP Senate leadership finally unveil its expected “skinny” repeal bill, formally called the Health Care Freedom Act, that would repeal ACA’s individual and employer mandates, temporarily repeal the medical device tax, and give states more flexibility to allow insurance that doesn’t comply with Obamacare regulations.

CBO’s analysis of the “skinny” repeal bill, estimated that 15 million more people would be uninsured next year than under Obamacare, with 16 million more in 2026, and that premiums would increase 20 percent next year, compared to current law.

Earlier that day, Sen. McCain and Republican Senators Lindsey Graham of South Carolina and Ron Johnson of Wisconsin, held a news conference threatening to oppose the “skinny” repeal bill if the House Speaker did not offer sound guarantees that the House would enter negotiations after the Senate passed it. They feared that the House would end up passing “the skinny bill” rather than a more comprehensive bill hammered out in conference committee.

Ryan’s carefully crafted statement to the concerned Senators that the House would be willing to go to a conference committee did not include a specific guarantee that the House would not vote on the Senate’s proposal. Both Graham and Johnson went on to vote for the legislation. But, after his surprising vote it seems that McCain still had his concerns.

Before the Senate vote, President Trump even tweeted his displeasure of Murkowski’s opposition, her no vote against debating Obamacare repeal, says the Alaska Dispatch News. The state’s daily newspaper reported that Interior Secretary Ryan Zinke called the state’s Senators, Murkowski and Dan Sullivan, to inform them that Murkowski’s vote would “put Alaska’s future with the administration in jeopardy.”

After Zinke’s call, “Murkowski, who chairs the Senate and Natural Resources Committee, sent a message back to the Interior Secretary and Trump. Overseeing the agencies confirmation process, a committee hearing on nominations to the Interior and Energy departments, was “postponed indefinitely” with no reason given, stated the Alaska Dispatch News.

Finally, early Friday, by a vote of 49-51, Senate Republicans failed to repeal Obamacare with three Republican senators — McCain, Collins and Murkowski – joining 48 Democrats to vote against the “skinny” repeal bill. Sen. McCain’s reputation as a political maverick was evident when he voted against GOP Senate leadership. But, this vote will be considered his political legacy.

A Sigh of Relief

Reacting to the defeat of the Senate’s ‘skinny’ repeal bill, AARP Executive Vice President Nancy LeaMond, in a statement, called the vote “a victory for Americans age 50-plus.”

“The ‘skinny’ bill the Senate defeated would have dramatically increased health care costs, caused millions to lose their health coverage, and destabilized the insurance market,” says LeaMond.” She also thanked Senators Collins, McCain, and Murkowski, Senate Democrats and Independents who “called, emailed, rallied and wrote to object to this seriously flawed bill.”

Max Richtman, President and CEO of the National Committee to Preserve Social Security, in a statement stated, “Senators Susan Collins, Lisa Murkowski and John McCain were under extreme pressure from the White House and their colleagues to vote with the party instead of voting for the American people. It’s important to applaud them for stopping this train wreck of a healthcare bill. We have to wonder, however, why other Senators were willing to put their constituents at risk by cutting off their healthcare coverage.”

“We urge the majority party to put raw politics aside and work with Democrats to improve the Affordable Care Act in a way that benefits millions of American families in both blue states and red states. Let’s move forward, not back,” said Richtman.

A Bipartisan Approach

President Trump and Congress must finally listen to listen to their constituents to create policies to bring health care coverage to those in need. It is time to put politics aside and work in a bipartisan manner to hammer out a viable solution to provide affordable health care insurance to millions of Americans without coverage. McCain, Collins, and Murkowski, did just that when they resisted their party’s pressure to vote their own personal conscience not party line. They believed that the bill they voted against would do more harm than good.

Obamacare can be reworked to become more cost effective and to provide more health insurance to those in need of coverage. A recently released USA Today/Suffolk University poll at the end of June says that “just 12 percent of Americans support the Senate Republican health care plan. But, “a 53 percent majority say Congress should either leave the law known as Obamacare alone or work to fix its problems while keeping its framework intact.”

The majority of America says keep Obamacare, but make it better. Hopefully, lawmakers will listen.

GOP Senators Avoid Angry Constituents During July Recess

Published in Woonsocket Call on July 9,2017

With Senate Republican leadership pulling their health care bill, titled “Better Care Reconciliation Act of 2017,” scheduled for vote before the Fourth of July recess, because they were unable find 50 votes, opponents continue their lobby against an anticipated rewrite of the unpopular Senate bill. Mobilization to oppose passage of a GOP health care bill began immediately after the House passed its legislation, titled “The American Health Care Act” in May.

“It is essential that all of those who oppose this dangerous bill have their voices heard,” said Richard Fiesta, Executive Director of the Alliance for Retired American, one of many aging groups mobilizing its membership during the Fourth of July recess. “The fact that most Republicans in the Senate are too afraid to show up in public should tell you everything you need to know. The Senate bill is dangerous to all Americans, particularly older Americans, and must be stopped,” he said.

Lawmakers Choose to Not Face Angry Constituents

Throughout the nation, thousands of constituents of GOP senators made it clear to their lawmakers returning to their home districts, “vote no on the Senate version of the healthcare bill,” that would repeal and replace President Obama’s Affordable Care Act of 2017 (ACA), popularly, called Obamacare. Opponents of Trumpcare held sit-ins (referred to as die-ins) to remind their GOP Senators that 22 million low-and medium-income Americans would lose their health coverage with the slashing of $800 billion from Medicaid, warning that there would be a significant increase in premium costs.

According to the Town Hall project, between January to May, 33 GOP senators have not held a single in person town meeting this year, these lawmakers choosing not to face angry constituents who oppose the Senate health care bill. During this 11-day recess, most Republican senators chose not to hold town meetings, most skipping their community’s Fourth of July parades, to keep away from hostile crowds.

But, Moderate GOP Sen. Susan Collins, of Maine, appeared at Fourth of July parade in Eastport, Maine and was overwhelmingly thanked for her opposition to the Senate health bill. At the parade, the Washington Post stated that spectators urged Collin’s “to stay strong” in opposing the GOP Senate’s version of the health care bill. The Post noted that only three other Republican senators, Ted Cruz, of Texas, Dean Heller, of Nevada, and Lisa Murkowski, of Alaska, also appeared in their community’s Fourth of July parades.

Seeing the Writing on the Wall

Political reality is now setting in for Senate Majority Leader Mitch McConnell, of Kentucky, who has shifted his position on repealing Obamacare if he cannot pull the 50 votes necessary to pass his health care bill. With all Democratic and Independent senators in their caucus opposing passage of the bill, GOP senate leadership can only afford the defection of two Republican senators if they want their bill to pass. Can he revise this legislation to satisfy the concerns of moderate and conservative members of his caucus to ensure passage?

The Washington Post reported, last Thursday, at a Kentucky Glasgow Rotary Club lunch, McConnell admitted to the attending Rotarians that Republicans would have to work with Democrats to stabilize the health insurance markets if they failed to pass the Senate bill.

As predicted with the GOP senators returning from recess, facing angry constituents, a growing number are now publicly withholding their support for the senate bill. At press time, there have been multiple reports that ten senators are now opposing the legislation.

“There have been little to no senator-level discussions on amendments to the Senate health bill during the July recess,” says Dan Adcock, Director of Government Relations and Policy for the National Committee to Preserve Social Security and Medicare (NCPSSM). He expects more negotiations to take place when the Senate reconvenes this Monday.

Adcock says, “there would be a delay between an announced “compromise” bill and Senator floor consideration since the Congressional Budget Office would first need time to perform a cost estimate on the amended sections of the bill.”

Senator Cruz’s Fix for Senate Health Bill?

According to Adcock, that is being most talked about in the corridors of the Capitol is Sen. Ted Cruz’s proposal to replace the existing language in Senate bill — that would allow insurance companies to pick and choose which Obamacare essential benefits they would offer — with a plan to require that insurance carriers offer at least one plan with Obamacare essential benefits and all other plans could decide which benefits to include and exclude.

But, Adcock sees a multitude of problems with the Cruz proposal, making it difficult to be inserted into a final Senate health bill.

“First, it really is not that different from the current language that allows insurance companies to offer plans without the required ACA essential benefits,” says Adcock. “Under the Cruz proposal, healthy people would enroll in health plans that aren’t required to cover all ACA essential benefits, while sick people or enrollees with pre-existing conditions would tend to enroll in plans with all of the ACA essential benefits. As a result, the latter plans would be very expensive and unaffordable for less healthy enrollees,” he says.

Adcock estimates that Texas Senator’s proposal and the Senate health bill’s essential benefits waiver provisions would be particularly harmful to the 40 percent of enrollees age 50 to 64 who have one or more pre-existing condition.

“Second, there is a good chance that the Senate Parliamentarian will rule that the Cruz proposal violates Budget Reconciliation rules because it is superfluous to reducing federal spending,” says Adcock, noting that if this happens his proposal in the form of an amendment would face a 60-vote point of order. The Senate Republicans do not have the 60 votes they need to waive this budget rule.

Another point that is being negotiated between Senate leadership and moderate and conservative senators is provisions that would restructure federal payments to state Medicaid programs, says Adcock, noting that the Senate bill and House-passed healthcare bills would restructure the way federal funding is provided to the states – changing from the current matching rate formula to per capita caps or block grants at state option.

Medicaid Cuts Hit LTC Sector

“Per capita caps limit federal funding for state Medicaid programs to an arbitrary per beneficiary funding level. This would ultimately shift costs to states by eliminating the guarantee of additional federal funds if state costs increase because of underlying health care costs, demography or complexity of care. We are particularly concerned about how these cuts would affect Medicaid long-term care coverage – both home and community and nursing home care,” Adcock added.

Adcock also sees other negatives of the draft Senate health care bill.

“From the year 2025 on, the senate bill bases the per capita cap on an even less generous measure than the House bill. While the House bill used a measure based on medical inflation, the Senate bill would allow Medicaid to grow only at the rate of general inflation. Medical inflation has historically grown at a higher rate than general inflation. And, even the index used in the House-passed AHCA would be unlikely to keep up with growth in health care costs,” notes Adcock.

Adcock added, “some moderate Republican senators object to linking Medicaid payments in 2025 and thereafter to general inflation. However, Sen. Pat Toomey – who drafted this provision – does not want to compromise on it.”

And, Sen.Portman and Capito also continue to express interest in increasing funding for Opioid substance abuse treatment, adds Adcock. The Senate health bill includes $2 billion for this purpose. Portman has called for $40 billion for treating Opioid addictions, he says.

With senators returning to Washington, D.C., after their roughly one-week Fourth of July recess, there are only 14 legislative working days before their month-long August recess begins on July 28 with their return Sept. 5.

Recently, ten Senate Republicans have called on Senate Majority Leader McConnell to cancel the upcoming August recess to allow them to focus on five priorities: fixing health care, funding the federal government by Oct.1 to avoid a shutdown, dealing with the debt ceiling, passing the budget resolution and improving the nation’s tax code.

This will not likely happen due to the Senate’s legislative workload.

According to Adcock, the Senate either needs to approve its health care bill or abandon it by the upcoming August recess because the repeal of Obamacare is holding up consideration of the FY 2018 budget resolution and tax reform.

“That’s because the Senate healthcare bill is being considered in the form of the FY 2017 budget reconciliation bill. There cannot be a conference agreement on the FY 2018 budget reconciliation bill until the FY 2017 budget reconciliation is either enacted or abandoned,” he says.

Finally, Adcock notes, “A conference agreement on the FY 2018 budget resolution is necessary to set in motion consideration of a FY 2018 budget reconciliation bill that would include tax reform and perhaps cuts to mandatory spending programs, like Medicare and Medicaid. Budget reconciliation bills are filibuster-proof in the Senate.”

Calling for Political Compromise

A recently released USA Today/Suffolk University poll at the end of June says that “just 12 percent of Americans support the Senate Republican health care plan. On the other hand, “a 53 percent majority say Congress should either leave the law known as Obamacare alone or work to fix its problems while keeping its framework intact.”

So, now it’s time for the White House and Congress to read the political winds. Americans want health care fixed for the right reasons, not for political reasons. Lawmakers must put aside their philosophical differences and craft a “win-win” compromise to fix Obamacare’s flaws.

It’s the right thing to do.

GOP Health Care Reform Moves to Senate

Published in Woonsocket Call on May 7, 2017

House Speaker Paul Ryan’s words are now coming back to haunt him and GOP leadership that rammed American Health Care Act (AHCA), without procedural safeguards, through the House chamber days ago. “I don’t think we should pass bills that we haven’t read that we don’t know what they cost,” said Ryan in a 2009 interview on MSNBC when Congress was debating President Obama’s 1990-page Affordable Care Act (ACA), or Obamacare.

Last month, the Trump Administration efforts to repeal and replace Obamacare, with the American Health Care Act (AHCA) went down in flames when so many GOP moderates and conservative House lawmakers opposed the bill that the leadership didn’t dare bring it up for a vote. Successful negotiations of the GOP factions crafted a new version that passed last Thursday by a razor-thin vote of 217-213, a slim margin of four votes. All 193 Democrats opposed passage, along with 20 Republican lawmakers. With House passage, the bill moves to the Senate for deliberation.

Before the House vote on the GOP health bill there were no legislative hearings held to debate its merits and its full text was posted on the Web less than 24 hours before the vote. Ryan did not even wait for the nonpartisan Congressional Budget Office (CBO) to provide an updated financial analysis of AHCA. The CBO’s analysis of the original bill, pulled moments before a scheduled vote on March 24, 2017, found that the GOP health care proposal estimated that if passed 24 million or more Americans could be uninsured by 2026.

Opposition Mounting to GOP Health Care Proposal

With the passage of AHCA, Democratic Policy and Communication Committee Co-Chair David N. Cicilline (D-RI) issued the following statement, saying “This is the cruelest and most immoral thing I’ve seen the Republican Party do to the American people. They just passed a bill that they know will result in the deaths of thousands of working people each year. I don’t know how they sleep at night.”

“All you need to know about this bill is that Republicans tried to exempt themselves from coverage [of the GOP health care proposal]] before they got caught. That’s because they know it’s a raw deal,” says Senator Sheldon Whitehouse. This legislation sets us on a path to the bad old days when insurance companies could refuse coverage to those with preexisting conditions and deny people health benefits that should be in every plan – like ‎maternity and mental health care, he says.

Whitehouse warns that AHCA’s passage will leave millions of Americans without access to affordable health insurance. “Rhode Islanders rely on the Affordable Care Act and it’s working here. If they want to improve it, that’s one thing, but this House bill will hurt Rhode Islanders,

Within hours of the House vote on AHCA, a joint statement was issued by six prestigious national medical organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Psychiatric Association American and the American Osteopathic Association), representing over 560,000 physicians and medical students, denouncing the GOP health bill. Dozens of other state and national health care organizations, including the American Medical Association, American Nurses Association and American Hospital Association (and this number grows daily) also gave a thumb down on the Republican health bill that is considered “unworkable and flawed.”

Aging advocacy groups came out swinging, too.

AARP, representing 38 million members and considered to be one of the nation’s most powerful aging lobbying groups, plans to hold GOP House lawmakers accounting for their support of AHCA while gearing up to oppose the Republican health care proposal in the Senate.

In a statement, AARP Executive Vice President Nancy LeaMond reiterated AARP’s opposition to the GOP health bill passed in the U.S. House of Representatives, calling it “flawed” and warning that the legislative proposal “would harm American families who count on access to affordable health care.”

LeaMond says, “the bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”

According to LeaMond, AARP will continue its opposition of AHCA as it moves for Senate consideration because it “includes an Age Tax on older Americans, eliminates critical protections for those with pre-existing conditions, puts coverage at risk for millions, cuts the life of Medicare, erodes seniors’ ability to live independently, and gives sweetheart deals to big drug and insurance companies while doing nothing to lower the cost of prescriptions.

LeaMond warns, “We promised to hold members of Congress accountable for their vote on this bill. True to our promise, AARP is now letting its 38 million members know how their elected Representative voted on this health bill in The Bulletin, a print publication that goes to all of our members, as well as through emails, social media, and other communications.”

Medicaid Takes a Major Blow

“The bill threatens the very heart of the Medicaid program, taking away the guarantee that Medicaid will be there when seniors need it most. By slashing Medicaid funding by over $800 billion, the AHCA will place tremendous strain on state budget, says Kevin Prindiville, Executive Director of Justice in Aging, a nonprofit advocacy group for low-income seniors. “States will be forced to cut services, restrict eligibility, and reduce benefits for seniors, children, people with disabilities, and low-income older adults, he says.

“Congress is forcing families to pay more out-of-pocket when grandparents and other loved ones need nursing home care or home care. Two-thirds of all Medicaid spending for older adults pays for long-term services and supports. The AHCA puts this vital care for seniors in jeopardy,” says Prindiville. “By passing the ACHA, the House chose to cut taxes for the wealthy and pharmaceutical companies while harming Medicare beneficiaries by increasing Part B premiums and reducing the life of the Medicare Trust Fund, he says.

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare calls the AHCA vote “appalling” for retirees and views the “raid of Medicare, cuts to Medicaid among the most problematic parts of the AHCA.”

“Despite the bill’s name, risking the health of our nation’s most vulnerable citizens to give the wealthy an $ 600 billion tax cut is tremendously uncaring — and does not reflect real American values,” says Richtman. In modifying the original AHCA bill to give reluctant Republicans political cover, the House leadership made a bad piece of legislation even worse,” he says.

No Protection for Pre-existing Conditions

“Recent amendments to this cruel, ill-advised bill could put coverage for older Americans with pre-existing conditions like cancer and diabetes out of reach. The $8 billion (over 5 years) added to the legislation at the last minute to defray the cost of higher premiums is woefully inadequate. It’s a thin veil that covers a head of snakes,” notes Richtman

“Equally inadequate are the meager tax credits that the GOP bill offers older Americans to buy insurance. A $4,000 annual tax credit doesn’t come to close to covering premiums for seniors ages 60-64, meaning millions of older Americans will lose coverage altogether,” says Richtman.

According to Richtman, AHCA slashes nearly $1 trillion from the Medicaid by converting the social health care program into a block grant program or imposing per capita caps. “This would make it harder for impoverished seniors to access long term skilled nursing care and community or home care. Overall, the Congressional Budget Office estimates that 14 million people will be kicked off the Medicaid rolls in the next 10 years if this bill becomes law,” he says.

Richtman observes that the enactment of AHCA would reduce Medicare’s solvency by repealing Obamacare’s 0.9 percent payroll tax on wages above $200,000. This could lead to cuts in Medicare, including privatizing the program — harming current and future beneficiaries, he says.

“Under the GOP bill, insurers can charge older enrollees five times more than younger ones. The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people by as much as 25 percent,” notes Richtman.

Senate Becomes New AHCA Battle Ground

After the politically decisive House vote to pass AHCA, President Donald Trump and House GOP lawmakers celebrated their major political victory at the White House Rose Garden claiming that they had fulfilled a promise made 7 years ago to repeal and replace Obamacare. But this celebration was short lived. Like House Democratic lawmakers, Democratic and Republican Senators began voicing their skepticism and strong opposition to the House’s passed health bill. Holding a slim 52-to-48 advantage in the upper chamber, GOP Senate Leadership must craft a bill that can win the support of at least 50 of their caucus members.

Washington insiders are now reporting that the House’s unpopular AHCA is “Dead on Arrival” in the Senate. Senate Republicans say they will not vote on the House passed bill and the upper chamber is expected to move slowly in crafting its health bill, starting from scratch. Many GOP Senators opposed AHCA, especially those who want to protect their constituents with pre-existing conditions and others who represent states that have expanded their Medicaid program under Obamacare.

A group of 13 Republican Senators (all men) have begun the process of hammering out their own health bill. Senate rules do not allow a review of the legislation or the determination of the rules of the debate until the CBO provides its official fiscal impact estimate. Because of this the health policy debate may not begin until summer.

Hopefully, Senate Majority Leader Mitch McConnell, a Republican from Kentucky, and his partisan working group will reach across the aisle to Democratic Senators to assist in crafting a bipartisan solution. Won’t that be refreshing.