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The Health Care Reform Vote Matters to Nonprofits, and America

by Guest Blogger

Reprinted and updated with permission from The National Council of Nonprofits.  It originally appeared in their newsletter “Nonprofit Advocacy Matters” on June 26, 2017.

Partisanship – putting political party above policy and practicality – has nearly destroyed the health care insurance and delivery system in this country. The Senate is scheduled to vote on its bill to repeal and replace Obamacare this week, a bill that no Democrat will support and many Republicans find unacceptable, but necessary for process and political reasons. In 2017, as was the case when the Affordable Care Act (ACA) was passed in 2010, partisans posture to score political points, while Americans seek leadership that solves real problems. Nonprofits, as the grownups in our communities, need to speak up. Now.

As discussed below, a bill to overhaul the American health insurance system was not made public until Thursday, yet may be voted on this week. The charitable and philanthropic communities have a major stake in what the ultimate law says and does. Charitable nonprofits make up ten percent of the private workforce and often struggle to provide quality, affordable health insurance to their workforce. Nonprofits address the most pressing needs of individuals and communities every day; loss of health insurance by millions of our fellow citizens would likely increase the demands for the services nonprofits provide. And changes in health care policy could ease or exacerbate state and local budget challenges that further increase the resource challenges that nonprofits have been experiencing for years.

In short, a Senate vote that could make or break the healthcare insurance system could also make or break the ability of charitable nonprofits to serve their communities. Our recommendation to readers: Call your Senators (202-224-3121) now and urge them to vote NO on this bill this week, and insist that good public policy is elevated above partisan positioning. We all know that a better bill can be crafted in July, or over the August recess, if the partisans will acknowledge their past mistakes and commit to a responsible future. Act now, not because you are a Democrat or a Republican, but because our ability to serve our communities is a higher calling that deserves to be heard.

EDITOR’S NOTE:  Senators King and Collins have said that they will vote no, but you can call them, thank them for their support, and urge them to stay firm as there may be some political and procedural maneuvering in the works.

Senate Health Care Reform Bill Released, Up for Fast Action

Senate Republican leaders released a discussion draft of legislation designed to repeal and replace the Affordable Care Act (Obamacare) and hope to secure final passage of the bill as early as this week. See discussion of the bill contents, below. The bill offers modifications to some of the most controversial pieces of the House-passed American Health Care Act, but it is unclear whether the discussion draft can get the 50 votes necessary to pass. The measure is being brought to the Senate floor under a special budget procedure that permits it to pass with a simple majority vote with no possibility of a filibuster. All Senate Democrats are expected to vote against the Senate bill (as did all Republican Senators when the ACA was debated in 2010), meaning that 50 of the 52 Republican Senators are needed to pass it, with Vice President Mike Pence breaking a tie. At least five or more Republican Senators have said publicly they could not support the bill in its current form, criticizing it either for being too aggressive in reducing government support of health care or for not going far enough in repealing Obamacare as Republicans have been promising for the past seven years. Each has said he is willing to negotiate terms of the legislation, suggesting that some portions may change before a final vote is taken.

The nonpartisan Congressional Budget Office (CBO) is expected to release its analysis today, June 26, identifying the costs of the Senate bill and how it compares to the House-passed American Health Care Act, which CBO determined would reduce federal spending by $119 billion while leaving 23 million more Americans without health insurance. Since rumor has it that the House could accept the Senate-passed bill and approve it quickly on Friday, the stakes are extremely high. And the rhetoric of the different camps is aggressive. Liberal Center for American Progress issued a report asserting that the Senate bill would cut benefits so much that it could “result in 18,100 to 27,700 additional deaths in 2026.” Conservative Freedom Works criticizes the bill for not permanently repealing several of the ACA taxes and delaying the end of Medicaid expansion until the next presidential administration, thus leaving room for retention by a subsequent Congress. Libertarian Cato Institute criticizes the Senate bill because it maintains ACA provisions that “drive up premiums” and fails to make market-based reforms while maintaining subsidies that mask the problems.

What It Does: Summary of the Senate Bill

Like the American Health Care Act (AHCA), which the U.S. House of Representatives passed this spring, the Senate Better Care Reconciliation Act of 2017 would cap and cut Medicaid and add to the number of uninsured individuals. Combined, these provisions could reduce payments to many nonprofit health care service providers while creating a rise in the need for a wide variety of services provided by nonprofits for those who find themselves uninsured. The Senate discussion draft would phase out Medicaid expansion under the ACA more slowly – yet deeper – than the AHCA, affecting the health care and finances of the 31 states that adopted the additional federal funding under the ACA. As currently written, the discussion draft would address the following issues:

  • Medicaid: Give states the option of changing Medicaid into a “block grant” program or putting caps on federal spending based in part on how many people live in each state. The bill would reduce eligibility for those with income of 350 percent of the poverty level, down from the current-law level of 400 percent. The measure would permit states to receive waivers to avoid certain coverage standards under the ACA to give states more flexibility in deciding insurance rules for their state; however, states would not be able to opt out of regulations governing pre-existing conditions. Finally, the legislation would also transition away from a health care inflation index to the general economic index, a change that could significantly reduce future costs while expanding the gap between actual costs and what the government will reimburse.
  • Mandates: Eliminate the individual and employer mandates for obtaining/providing health insurance coverage.
  • Taxes: Repeal the health insurance tax, Medicare surtax (by 2023), Flexible Spending Account tax, the 3.8 percent tax on investment income, the 0.9 percent tax on people who earn more than $200,000 a year, the Chronic Care tax, and tax credits for plans that cover abortions, plus delay the Cadillac tax on expensive insurance plans until 2026.
  • Premiums: Permit insurers to charge older Americans premium prices five times (rather than three times) higher than younger people. Unlike the House bill, the Senate bill would not allow insurers to charge sick people more, but a six-month “lock out” provision may be added that delays when their policy takes effect.

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