Supporters of the Affordable Care Act (ACA) won another huge battle against TrumpCare this week, but the war rages on. The threat will continue to loom until Trump is removed from office, Democrats retake the House or Senate, or the Senate provides him a win with a bipartisan market stabilization bill in the wake of the stinging defeat of Graham-Cassidy, his third failure to repeal the ACA.
Graham-Cassidy failed for the same reasons previous iterations of TrumpCare did: it was a horrible bill lacking support from a single healthcare organization or votes to pass under a budget rule requiring only 51 (50, with Pence) votes. In dramatic fashion, Senators John McCain (R-AZ) and Susan Collins (R-ME) once again delivered the kill shot, foreseeing the devastation the bill would have caused their states and the nation, and the bill was pulled. ACA supporters won this third battle with even greater unity than ever, with a first-ever joint letter from all major insurer and provider groups and the National Association of Medicaid Directors unanimously opposing. But TrumpCare will be back, sooner than we think, while the war continues behind the scenes at the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS).
Senate Republicans, now desperate for a win to assuage major donors like the Koch Brothers in advance of the 2018 midterms, have two more shots to repeal the ACA with a simple majority. The GOP still hasn’t passed a budget resolution for 2018, which begins on October 1. It’s expected it will include a major tax reform proposal – but could also include another repeal attempt. That would complicate the outlook for both, and tax reform is do-or-die for the Republican majorities in the House and Senate. More likely is another shot at ACA repeal in the Fiscal Year 2019 budget resolution, which is due in April and would leave them with a few months before the midterms.
Republicans have only failed to repeal the ACA by a handful of votes. It’s important to remember Sen. Menendez (D-NJ) is likely going to prison, and McCain has terminal brain cancer, and their replacements could be a yes for TrumpCare. Alabama radical Roy Moore is likely headed to the Senate in December to fill Sessions’ seat, and it’s anybody’s guess what else could occur to change the composition of the Senate. There’s a reason sponsor Sen. Lindsey Graham (R-SC) said, “We’re on a path to pass this bill. It’s just a matter of when. It will be in this Congress.”
Our hope is while Senate Republicans flail this fall on tax reform (arguably harder to pass than ACA repeal), the bipartisan market stabilization effort led by Senate Health Committee Chairman Lamar Alexander (R-TN) and Patty Murray (D-WA) will gain traction. A bipartisan approach is much preferred by the public, and Trump, who has yet to accomplish a single item he promised to deliver in his first 100 days after 250 on the job, could sign it, like the rapid deal he struck with Schumer and Pelosi to raise the debt ceiling earlier this month. The only way to prevent the next rise of zombie TrumpCare is to serve him up an alternative rationale policymakers can agree on, but it would need to happen before April. All he wants is a win.
While the legislative outlook remains murky, what’s clear is the guerilla war against the ACA inside HHS and CMS continues unabated:
- This week, we saw CMS declare it will shut down healthcare.gov on Sundays during the already-shortened annual enrollment period this fall. Sundays are when most volunteers are working and when most working uninsured are shopping for coverage, so this was a blatant act of mean-spirited sabotage by the Trump Administration.
- There remains agonizing uncertainty in the insurance industry created by Trump’s game of making monthly decisions on whether to pay the subsidies for millions of eligible enrollees. Plans have to finalize rates and sign contracts this week and will do so without knowing whether the government will pay its bills.
- HHS Secretary Tom Price has already shortened the enrollment period to only 45 days, November 1 – December 15, and virtually eliminated funding for outreach advertising, navigators, and other enrollment support.
They are doing literally everything possible to undermine the law they swore an oath to uphold.
The TrumpCare resistance can savor this latest victory, but can’t get complacent. This was just the latest battle in the war to save the ACA. There is much more fighting to come, and it won’t end until Trump either signs a bipartisan alternative, is out of office, or loses the House or the Senate. Stay woke.
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