August 7, 2017

By Mike Amery, Esq., Senior Legislative Counsel

In the early hours of Friday, July 28, Senate Majority Leader Mitch McConnell (R-KY) called for a vote to move forward on a bill to reform the Affordable Care Act (ACA). The bill had been reduced to a “skinny bill” impacting just a few issues including the individual health insurance mandate. Passing it would allow the Senate to appoint members to a conference committee to join the House in the creation of a final bill that would still have to pass both bodies.

The votes of the Democrats were known, all 48 would vote “no.”  Vice President Mike Pence arrived in anticipation of needing to cast the deciding vote in case of a 50-50 tie. As Republicans cast their ballots, Lisa Murkowski (AK) and Susan Collins (ME) voted “no.” At 1:38 a.m., with the vote count standing at 50-49 against, Sen. John McCain (AZ) also voted “no.” The majority leader pulled health care reform from the Senate floor.

Congress has begun its August recess and we felt it is worth a look back at the reform effort and the potential for action in September.

2017 ACA Repeal and Replace Timeline

  • March 7 - American Health Care Act (AHCA) introduced in the House by Republicans.

  • March 17 - AAN opposed the AHCA due to estimates by the Congressional Budget Office (CBO) that more than 20 million Americans would no longer have health insurance due to the elimination of the individual mandate and the scaling back of Medicaid coverage. This version would reduce federal deficits by $337 billion over the coming decade.

  • March 24 - The House pulled the AHCA from floor vote after it became clear that a majority of the chamber did not support the bill.

  • May 4 - The House passed an amended version of the AHCA which would still cause millions to become uninsured. The AAN joined other medical groups, including the AMA, in opposing the legislation as it conflicts with our Principles for Health Care Delivery.

  • June 22 - The Senate released a discussion draft of the Better Care Reconciliation Act (BCRA). The AAN joined other medical organizations in releasing a statement opposing the Senate health care bill, as it includes provisions that will limit access to care including cuts to Medicaid funding and state waivers that could affect coverage for those with pre-existing conditions. Five Republican senators, Rand Paul (KY), Mike Lee (UT), Ted Cruz (TX), Ron Johnson (WI), Dean Heller (NV), stated their opposition.

  • June 27 - Senate vote was postponed and Senate Republicans added a new provision to the bill that would make those who have a lapse in coverage for 63 days or more wait six months before obtaining insurance in order to prevent a “death spiral” in the individual insurance markets. The $2 billion in funding for opioid abuse was increased to $45 billion in an effort to sway moderate Republicans.

  • July 17 - Senate vote postponed again on revised bill which included an amendment by Republican Sens. Ted Cruz (AZ) and Mike Lee (UT) allowing insurers to offer less comprehensive plans for healthier individuals, essentially creating a two-tiered individual insurance market.

  • July 25 - Senate voted on motion to proceed to debate the House health reform bill. The original Senate health reform bill, BCRA, failed to pass.

  • July 26 - Senate failed to pass the Obamacare Repeal Reconciliation Act, the bill to repeal the ACA without a replacement.

  • July 28 - By a 49-51 vote, the Senate failed to pass The Health Care Freedom Act, the “skinny” bill to repeal some ACA provisions such as the employer and individual mandates and the medical device tax.

  • July 29 - President Trump threatened to withhold subsidies from insurance companies used to promote stability in the insurance market. The result would be the collapse of the health insurance exchanges created by the ACA, leaving individuals in the exchanges without access to insurance carriers.

  • July 29 - Sen. Bernie Sanders (I-VT) declared that he will file legislation creating a “Medicare for All” single-payer health system.

Members of Congress are now back in their districts and the issue of health reform remains a top priority, whether it be to “repeal and replace Obamacare” or have reforms to the ACA that will stabilize insurance markets, continue Medicaid expansion, and keep the core elements of the 2009 legislation. Sen. McConnell has indicated that the next step will be to negotiate with Democrats.

The AAN continues to meet with both Republicans and Democrats to promote the AAN's health reform principles and ensure that patients have access to the neurologists they need.