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.

Advertisements

Senate Health Bill Vote Expected Next Week

Published in Woonsocket Call on June 25, 2017

The long-awaited Senate health bill text crafted by a group of 13 GOP senators (all male) appointed by Senate Majority Leader Mitch McConnell of Kentucky to replace and repeal President Obama’s Affordable Care Act of 2017 (ACA), popularly, called Obamacare, was unveiled days ago. Republican lawmakers have worked for over seven years to dismantle the Democratic president’s landmark health care law. Supporters say that ACA brought health care coverage to an estimated 20 million Americans, covered between marketplace, Medicaid expansion, young adults staying on their parent’s plan, and other coverage provisions. Critics charge that Obamacare imposed too many costs to business owners.

Minority Leader Chuck Schumer and Senate Democrats lashed out at GOP Senate leadership charging that the Senate health bill, titled “Better Care Reconciliation Act of 2017,” was written behind closed doors without a single committee hearing being held or draft bill text being circulated to the public. Some Republican senators also expressed frustration for not seeing the details of the GOP bill before its release on June 22, 2017.

Like Senate Democrats, Health and Human Secretary Tom Price was left in the dark, too. At a Senate hearing before the release of the Senate bill the Trump Administration’s top health official stated that he had not seen any legislative language.

Senate Health Bill “Meaner” than House Version

Despite President Trump’s campaign pledge not to touch popular entitlement programs, like Medicare and Medicaid, he strongly endorsed the House Republican passed health bill, the American Health Care Act of 2017 (AHCA). At the eleventh hour, Trump twisted the arms of reluctant GOOP House members to gain their support of the controversial health care bill. Celebrating the passage of AHCA at the White House Rose garden, the president told the attending Republican lawmakers and guests that the GOP health bill was a “great plan,” adding that it was “very, very, incredibly well-crafted.” It was reported weeks later, after a closed-door luncheon with 15 Republican Senators, Trump had called AHCA “mean” and urged the attending Senators make their legislative proposal “more generous.”

With the release of the Senate health bill, Senate Minority Leader Schumer called the bill “meaner” than the House passed version, stressing its negative impact was far worse than AHCA. Trump called the House health bill “mean.” Schumer views the Senate’s version “meaner.”

GOP Senate leadership is pressing for a floor vote before the upcoming July 4th Congressional recess. To meet this deadline, this vote must take place by the end of next week, either Thursday or Friday, after 20 hours of debate. Early next week the Congressional Budget Office will release its score, detailing cost and coverage impact, on the Senate health bill. Moderate Republican senators might just be influenced not to vote for the bill if reduces health coverage for millions of Americans.

It usually takes 60 votes to pass a bill in the Senate. But, GOP Senate leadership is using a technical parliamentary procedure, referred to as reconciliation, to allow the Senate health bill to pass with only 50 votes, including the Vice President as a tiebreaker.

At press time, there are four conservative senators (Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin) and one moderate senator (Dean Heller of Nevada)., who have publicly expressed their opposition to the Senate health 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.

Meanwhile, a 100-year old organization, Planned Parenthood, is gearing up to fight a provision of the Senate health bill that would cut $555 million in funding. Two moderate GOP Senators, Susan Collins of Maine and Lisa Murkowski of Alaska, are on the fence voting for the bill if cuts are made to Planned Parenthood.

Aging Groups See Writing on Wall if Senate Passes Health Bill

The released 142-page GOP Senate health bill, written hastily behind closed doors, will overhaul the nation’s health care system, impacting on one-sixth of the nation’s economy. Dozens of aging, health care and medical groups, including AARP, National Committee to Preserve Social Security and Medicare (NCPSSM), the American Medical Association, and the American Hospital Association, are voicing their strong opposition to the GOP Senate’s health care fix.

And this list keeps growing as next week’s Senate vote approaches.

The Washington, DC-based AARP, representing a whopping 38 million members, vows to hold GOP Senators accountable for a bill that hurts older Americans. The nonprofit group charges that “the legislation imposes an “Age Tax” on older adults – increasing health care premiums and reducing tax credits [that made insurance more affordable under Obamacare], makes cuts to both Medicaid funding, and yet gives billions of dollars in take breaks to drug and insurance companies.”

“AARP is also deeply concerned that the Senate bill cuts Medicaid funding that would strip health coverage from millions of low-income and vulnerable Americans who depend on the coverage, including 17 million poor seniors and children and adults with disabilities. The proposed Medicaid cuts would leave millions, including our most vulnerable seniors, at risk of losing the care they need and erode seniors’ ability to live in their homes and communities,” says
AARP Executive Vice President Nancy LeaMond, in a statement.

“The Senate bill also cuts funding for Medicare which weakens the programs ability to pay benefits and leaves the door wide open to benefit cuts and Medicare vouchers. AARP has long opposed proposals that cut benefits or weaken Medicare, adds LeaMond.

LeaMond says, “As we did with all 435 Members of the House of Representatives, AARP will also hold all 100 Senators accountable for their votes on this harmful health care bill. Our members care deeply about their health care and have told us repeatedly that they want to know where their elected officials stand. We strongly urge the Senate to reject this bill.”

Another Washington-DC based organization, the National Committee to Preserve Social Security and Medicare, an advocacy group whose mission is to protect Social Security and Medicare, issued a stinging statement criticizing the Senate health bill.

“The Senate’s version of AHCA is an exercise in political expediency that does nothing to safeguard access to quality healthcare for older Americans. President Trump rightly called the House-passed bill ‘mean’ and lacking ‘heart.’ Unfortunately, the Senate bill is only marginally less mean in some ways, and even more heartless in others, says Max Richtman, President & CEO of the National Committee to Preserve Social Security and Medicare.

Adds, Richtman, “The Senate health bill is “a lose-lose for seniors and the American people. The biggest loss is that the AHCA ends the Medicaid program as we know it. Astoundingly, the Senate bill makes even deeper cuts to Medicaid than the House did. This is devastating news for today’s and tomorrow’s seniors suffering from Alzheimer’s, cancer, the after-effects of stroke and other serious conditions who depend on Medicaid to pay for long-term care. Millions will lose Medicaid coverage over the next ten years.”

“Despite some tweaks to premium subsidies, the Senate legislation will make healthcare unaffordable for many near seniors aged 50-64. The legislation allows insurers to charge older Americans five times as much as younger adults. Though the Senate bill nominally protects people with pre-existing conditions, the waiver of essential benefits means older patients with pre-existing conditions like diabetes, cancer, and heart disease will pay sky-high premiums [making these premiums unaffordable to most]. Finally, the bill weakens Medicare by reducing the solvency of the Part A Trust fund,” notes Richtman.

Looking at a Crystal Ball

Darrell M. West, vice president and director of Governance Studies at the Washington, D.C.-based the Brookings Institution, says that the Senate health bill does not fix the issues critics had with the House version. “It moves Medicaid from an entitlement to a discretionary program. It uses a longer phase-in period than the House, but imposes deeper cuts on the program. This is very problematic from the standpoint of poor and disabled people who need help,” says West.

According to West, Republican Senators from more moderate states already have said they will not support the current version. There also are conservative Senators who feel the bill does not go far enough in repealing Obamacare. If those positions hold up, it doesn’t look like the bill will pass.

West warns those who oppose the passage of the Senate health bill to not underestimate Senate Majority Leader Mitch McConnell. “He is willing to negotiate with individual Senators to get their votes so it is premature to call the bill dead. McConnell knows the Senate well and understands what compromises need to be made to get to 50 votes,” notes West.

If Senate Republicans pass their health care bill next week, I predict they might just find out that they have “awakened a sleeping giant,” the Democrats. When the dust settles after the 2018 mid-term elections we will find this out.

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.