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Capitol Hill Report: Republican Health Care Bill Moving —What Happens Next?

March 20, 2017

By Mike Amery, Esq., Senior Legislative Counsel

AHCA Overview: What You Need to Know
The American Health Care Act (AHCA) is legislation currently pending in the US House of Representatives that would effectively “repeal and replace” the Affordable Care Act, also known as “Obamacare.” The AHCA is a reconciliation bill, meaning that all provisions in the bill must impact budgetary items such as spending and taxation. It is the first part of the “three buckets” strategy Republicans have laid out for health care reform.

What is the process for the AHCA to be passed into law?
House Republicans have succeeded in passing the bill through three House committees on straight party line votes. The legislation will come to the House floor this week, although opposition from House Republicans exists and there is no support from Democrats. Republicans will need a majority vote of 216 (five House seats are currently vacant).

If the bill passes the House, the Senate will take it up with the goal of delivering it to President Trump's desk in the first week in April. Because this is a reconciliation bill, Senate Republicans only need 50 votes (plus the tie-breaking vote of Vice President Pence) to pass the legislation. With 52 members, Republicans can afford to lose two votes, but as of this writing, at least 10 GOP senators have expressed concerns, with Rand Paul (R-KY) declaring the AHCA “dead on arrival.”

What does the non-partisan Congressional Budget Office (CBO) say about the AHCA?

  • 14 million fewer people would have health insurance coverage in 2018
  • 24 million fewer people would have health insurance coverage in 2026
  • $880 billion reduction in Medicaid spending over 10-year period
  • Insurance premiums decrease by 10 percent by 2026
  • $337 billion net reduction in deficit spending over 10-year period

What do Republicans say about the AHCA?
Republicans believe that without changes in Obamacare, the current system will fail. House Speaker Paul Ryan has said, "You have to remember this law is getting much worse. It is what actuaries say, 'Entering a death spiral.' High, high premiums increase, high deductibles, no choices. We have to fix this problem." 

In a press conference, Ryan claims the AHCA will create lower costs, give consumers more choice, put patients in control, and provide universal access to care.  However, after the CBO report was released, Ryan acknowledged that changes would have to be made to pass the House.

What are Democrats saying about AHCA?

Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ) and Ways and Means Committee Ranking Member Richard Neal (D-MA) released a joint statement after the CBO released its estimates, stating:

“Today's CBO report now confirms what we already knew: despite promises that 'everyone would be covered' and 'no one would be worse off,' this Republican bill would rip away health insurance from 24 million Americans over the next decade and ask millions to pay more for less coverage. This is a major step backwards for millions of Americans who now enjoy the benefits and protections of quality health insurance gained under the Affordable Care Act.” 

What is the AAN's position on AHCA?

Earlier this year, the AAN Board approved a set of health care principles to guide the Academy advocacy efforts related to health reform. The AHCA contains provisions we support such as protections for individuals with pre-existing conditions but we are concerned about coverage. 

The first principle states that the AAN will support efforts that provide, “Access to high-quality health care and preventative care through insurance coverage for all, including those most vulnerable to health care disparities, regardless of pre-existing conditions” which is only partially met by the House Republican proposal. The AHCA continues health insurance guarantees for those with pre-existing conditions, but the CBO estimates of millions losing health insurance are clearly contrary to the goal of insurance coverage for all.

For this reason, AAN President Terrence L. Cascino, MD, FAAN, issued a statement last week expressing the AAN's concerns and calling for Congress to take steps to ensure access to care before moving forward with the AHCA.

What's really going to happen with the AHCA?
The CBO score has been very damaging to the Republican efforts to repeal and replace Obamacare. They are getting opposition from both moderate and conservative members of the House Republican Conference as well as outside interest groups like the AAN. I have been talking with GOP members almost every day and find Republican members in support as well as those who “aren't there yet.” House Republicans can only lose 20 votes before they no longer have a majority. Ryan has some work left to do to get to a majority.   

Neurology on the Hill Prompts BRAIN Initiative Support 
Although the AHCA is the talk of the town here in DC, there are other critical issues the AAN is simultaneously working to advance. One of the key issues is maintaining the momentum and funding for the BRAIN Initiative. The AAN has been tremendously successful in advocating for the program that will “map the brain,” seeing funding levels increase to $160 million for 2017.

AAN Neurology on the Hill advocates brought the issue to their members of Congress again this year. After our visits, members of Congress created a “Dear Colleague” letter authored by Reps. Earl Blumenauer (D-OR), Cathy McMorris Rodgers (R-WA), Bill Pascrell (D-NJ) and Tim Murphy (R-PA) asking for robust funding increases for 2018.

This letter asks for other members of the House join the authors in signing it prior to it being delivered to the House Appropriations Committee in advance of their debates over funding levels for 2018.

Trump Budget Cuts NIH Research
President Trump released a proposed budget that calls for reductions of $5.8 billion in funding for the National Institutes of Health. The president's budget is a recommendation to Congress, which will set the final totals through the appropriations process. Fortunately, Congress has been very supportive of NIH recently, including adding $4 billion at the end of 2016.

We are talking with members of Congress and their staff about the importance of maintain and increasing funding for NIH. I already had a chance to talk with Rep. Kevin Brady(R-TX), chair of the House Ways and Means Committee, and have several meetings this week where this will be a top priority.  

The AAN will be at the forefront in advocating for NIH and research and we encourage all AAN members to join this effort. Please watch for an AAN Action Alert that asks you to contact your US representative and urge them to sign this letter as a way of supporting strong funding for the NIH and the BRAIN Initiative, or you can take action right now.

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