Affordable Care Act Resources
As Congress considers repealing and replacing the ACA, we will provide regular updates about replacement proposals, what they mean for cancer survivors, and how survivors and advocates can make their voices heard in this debate.
ACA Status Updates
As we reported recently, the MacArthur Amendment guts protections for pre-existing conditions by allowing states to opt out of community rating and essential health benefits—which would allow insurers to charge more based on an individual’s health status and provide fewer covered services. The bill also requires that individuals maintain continuous coverage or be penalized with a 30 percent increase on their premiums for a year. Combined with a 36% cut in tax credits to help low-income individuals pay for their plans, the AHCA works against patients who need access to quality and affordable health care the most.
The Congressional Budget Office (CBO) is set to release an analysis next week that will provide an estimate on the economic impact of the updated House legislation. A previous CBO score on the bill reported numerous concerns, including that 24 million individuals would be left without insurance, older adults would be charged far more, and that costs would rise for millions.
Now that the House passed the AHCA and the bill is in the Senate, several Senate offices told NCCS that they intend to drastically change the bill or even start from scratch. We are hopeful that the Senate will reject the House version because it is terrible for patients, and it is now critical that Senators hear from patients and constituents. We must reach out and share that cancer patients and survivors must have meaningful health and financial protections, such as maintaining pre-existing condition protections, Medicaid expansion, and tax credits.
Health reform legislation should make it easier for patients to access health care—not create roadblocks and barriers resulting in care that is far less comprehensive yet much more expensive, as the AHCA would do if signed into law.
Call your Senators today and tell them patients deserve better than the AHCA and that the cancer community will not be fooled by legislation that undermines protections for pre-existing conditions such as the MacArthur Amendment. For tools and resources on how to contact your Members, download our policy tip sheet or contact Lindsay Houff, Public Policy Manager, at email@example.com.
Yesterday, the House of Representatives passed the American Health Care Act (AHCA), including an amendment authored by Congressman Tom MacArthur (R-NJ) and brokered with members of the Freedom Caucus, which would allow states to opt out of providing essential health benefits and community rating. Essential health benefits (EHBs) are ten services the ACA requires insurers to include in all plans, such as hospitalization, prescription drugs, in-patient and out-patient care, and treatments like chemotherapy. Community rating in the ACA prohibits insurers from charging more for premiums based on health status.
A number of members, concerned that the MacArthur Amendment would not sufficiently protect people with pre-existing conditions, indicated they could not support the bill. Congressman Fred Upton (R-MI) offered an additional amendment with $8 billion over five years to help cover the costs for sicker populations, in most cases including cancer patients and survivors, through high-risk pools (see below video) or subsidies, although it was not clear exactly how this money would be used. Upton’s amendment swayed enough Members of Congress, and without a Congressional Budget Office (CBO) score, without testimonies or hearings on the impact of the bill, and with only hours to read and analyze the text of the legislation, Members of the House passed the AHCA by two votes.
High-Risk Pools Explained
House Republicans celebrated yesterday with President Trump in the White House Rose Garden after the AHCA made it through the House. But Senate Republicans are saying, “Not so fast.” Now the bill will go to the Senate, where it will face several obstacles—including a looming CBO score (preliminary estimates look grim), Senators from states that expanded Medicaid who do not want to eliminate the program, and significant parliamentary challenges. A handful of Republican Senators have already said they are not satisfied with the House version of the bill and it will be revised. The margin in the Senate is closer than in the House; Republicans can only lose two Senators’ votes.
The many obstacles awaiting the Republican health care bill in the Senate https://t.co/uQdHQq8hrO
— Vox (@voxdotcom) May 4, 2017
The American Health Care Act was a terrible bill when it failed to get a vote back in March, with recent amendments only making it far worse for patients. With health care for more than 24 million Americans in jeopardy, it is critical that we let the Senate know they cannot let this bill become law as it would be devastating for cancer patients and survivors. NCCS will continue to advocate for cancer survivors throughout this process and keep patients and survivors up-to-date on this legislation.
AHCA 2.0 Is Released (Worse for Patients than the Original Bill)
As we previously reported, the American Health Care Act (AHCA) – the effort to replace the Affordable Care Act – was not even brought to a vote in the House of Representatives before the spring Congressional recess. Members of Congress confirm that advocates who opposed the AHCA were key to the failure of the original bill. Earlier this week, the full text of an amendment to the AHCA was published and is now being considered by House Republicans. As we reported, the Congressional Budget Office’s (CBO) analysis showed that the original AHCA would be devastating to cancer patients.
However, last night the bill was revived and the MacArthur amendment makes the AHCA even worse for cancer survivors and others with serious illnesses, as it allows states to apply for waivers to opt out of key consumer protections, including essential health benefits. Essential health benefits include services such as hospital visits, prescription drugs, ambulatory services, preventative services, and much more.
Here’s my simple guide to the changes on the health care bill that won over the Freedom Caucus: https://t.co/5hXtq6IZm3
— Margot Sanger-Katz (@sangerkatz) April 27, 2017
Margot Singer-Katz of the New York Times reported:
The waivers would also allow insurers to charge people based on their age and health status. Republicans have time and again promised the American public that they would protect individuals with pre-existing conditions. While the bill includes language that would protect people with pre-existing conditions, the protection is a false promise. Without the requirement for insurers to provide a standard set of benefits and by allowing insurers to charge higher premiums based on health status, the “protections” for pre-existing conditions are misleading. A cancer patient might be offered a health insurance plan, but it could be a plan without the benefits the survivor needs and at a price that is astronomical.
To make matters worse, with the proposed amendment there is no limit to how much an insurer can charge older Americans. Cancer disproportionately affects older individuals, so these provisions pile on top of each other to harm those who need access to care the most. The AHCA also relies heavily on high-risk pools for states that choose the waiver, but there are no requirements for eligibility, premiums, or benefits. As a result, there is no guarantee people who are sick could access or afford a high-risk pool.
For cancer survivors, this bill is completely unacceptable, and it is critical that our community reaches out to Members of Congress to let them know that we deserve better and that we will not be fooled by empty promises of “protections.” Cancer patients’ lives depend on affordable access to services like prescription drugs, treatments, and doctor and hospital visits.
Please contact your Members of Congress today and share this message:
DO NOT ALLOW THIS BILL TO MOVE FORWARD BECAUSE IT WOULD HARM PATIENTS.
“Healthcare is not dead, we’re still working on it.” – Paul Ryan
During recess this week and last, Members of Congress continued to hear from constituents at town hall events where a major focus has been on health care and backlash against efforts to repeal the Affordable Care Act.
Meanwhile, the conservative House Freedom Caucus has been working with moderate Republicans to come up with an amendment to add to the replacement bill, which failed on the House floor last month. This amendment was released this Thursday by Congressman Tom MacArthur and would effectively allow states to opt out of the ACA’s essential health benefits—a list of ten mandatory services including hospitalization, prescription drugs, in-patient care, out-patient care, and many other necessary services.
The amendment would also allow states, through waivers, to opt out of community rating rules which require that states charge sick individuals the same amount as health individuals. This would take us back to the days where insurers could charge people based on their expected health care costs, giving them free reign to charge them especially high premiums. To hear more about the essential health benefits and community rating, watch our ACA Webinar here.
The Congressional Budget Office reported that the Republican replacement plan, The American Health Care Act (AHCA), would have caused 24 million Americans to lose insurance coverage and this amendment would only increase that number since many sick patients would be priced out of the market in states that submit the waivers described above. Many House Republicans are supportive of the ban on preexisting conditions and eliminating community rating would essentially make those protections pointless, so it will likely remain difficult for moderate Republicans to get behind this legislation. The White House is saying the complete text of a new bill is likely to circulate by the weekend in hopes that Congressional leaders will schedule a vote before the president reaches his 100-day mark.
While Republicans continue their internal battle over the future of the ACA, NCCS remains on the front lines making sure the cancer survivor’s voice is present during the debate. Please contact your Members of Congress today to share your story and let them know that the ACA works and should be repaired, not replaced.
We are speaking out on behalf of the more than 16 million cancer survivors in America who deserve better than these legislative proposals that would be harmful to patients.
Cost-Sharing Reduction Subsidies & the “Death Spiral”
In addition to legislative activity to repeal the ACA, supporters of the health care law are also keeping a close eye on administrative activities that could undermine the law. Cost-sharing reduction (CSR) subsidies, which help insurers pay medical bills for low-income customers, are now the center of debate as the Administration has the authority to continue or discontinue these payments. A coalition of insurers, providers, hospitals, and businesses sent a letter to President Trump this week, urging the administration to remove uncertainty about CSRs, which help 7 million people, 60 percent of people who purchase insurance on the exchanges. Without the $7 billion of cost-sharing reductions, the ACA marketplace could collapse. In an interview with the Wall Street Journal, President Trump indicated that he would use the subsidies as negotiating leverage with Democrats.
A popular Republican sentiment says the ACA is in a death spiral and that if left alone, the law would “explode.” However, a new Standard & Poor’s report says the health law’s marketplaces are actually becoming more stable and may even church out profits for some participating health insurers by 2018.
Final “Market Stabilization” Rule Issued
The Trump administration issued its final rule on “market stabilization” this week. NCCS commented on the proposed rule in February and expressed concern that the proposal would increase cost and burden for consumers and may not have the desired intent to stabilize the market. Julie Appleby of Kaiser Health News summarized the changes: “The final rule upholds much of what was proposed by the administration in February, including a shorter enrollment window, tighter vetting of people who sign up outside of those open periods and efforts to require some consumers to show proof of prior insurance coverage.” Tim Jost also provides a detailed analysis of the final rule in Health Affairs.
Key for cancer survivors who purchase insurance on the ACA exchanges will be a short enrollment period, November 1 through December 15, half the length of the previous enrollment periods. Additionally, anyone with a lapse in premiums will be required to repay past-due premiums before enrolling. As NCCS said in our comments:
What You Can Do
With Members of Congress at home in their districts for recess, it is critical to continue to show support for the ACA and the protections it has provided for cancer patients and survivors.
Call, meet with, or attend a town hall event with your Member and share your story. NCCS is here to help; visit our Protect Our Care page for more or contact our Public Policy Manager, Lindsay Houff, at firstname.lastname@example.org with any questions.
As talks of “repeal and replace” quickly resurfaced after the downfall of the American Health Care Act (AHCA), the House Republicans’ newest proposals are even more devastating for cancer patients than the AHCA would’ve been.
— NCCS (@CancerAdvocacy) April 4, 2017
The newest Republican health care proposals would eliminate even more patient protections, including the essential health benefits that require insurers to cover services such as chemotherapy, hospital visits, prescription drugs, and doctor visits. One of the most concerning proposals is to eliminate community rating within the ACA, which bars insurers from charging people with pre-existing conditions more than healthy individuals for the same insurance policy. Community rating is one of the fundamental provisions of the ACA that protects cancer survivors’ ability to purchase affordable insurance.
Protection for people with pre-existing conditions is seen as a requirement even by many who want to repeal the ACA. Recognizing this fact, Republicans on Thursday released text of an amendment that would set aside money for an “invisible” high risk pool to help lower premiums for sicker people, providing $15 billion for states to reimburse health insurers for covering those patients. The $15 billion would be spread across all states and over almost a decade, making it an insufficient sum. The Kaiser Family Foundation stated that, “It’s nowhere near enough money to cover a meaningful share of the claims for high-cost patients.”
But as we reported last week, it’s not just Congress who can impact the ACA – the administration has leverage to either strengthen or weaken the ACA marketplace through a number of ways. The administration could withhold cost-sharing subsidies which would wreak havoc on the marketplace and cause even more uncertainty for insurers. Outreach and enrollment assistance were critical to the success of previous enrollment periods. An administration that is not behind the ACA could scale back or eliminate support of enrollment assistance. In fact, in January, the Trump administration announced plans to eliminate advertising near the end of the enrollment period.
Opportunities for Advocates
Over the next two weeks, Congress will be on recess. This will present constituents and advocates with multiple opportunities to remind your elected officials that the majority of people across America oppose repealing the ACA. Members of Congress must hear this simple message: Do not take away our care. Stop trying to repeal the Affordable Care Act.
A major factor in the failure of the AHCA was the groundswell of support for the ACA and advocates making noise at town halls, rallies, and calling their members. Please continue your efforts to share your stories about how the ACA has helped you and how Republican proposals are not acceptable for cancer patients. Let’s put the pressure on Members of Congress again and protect our care.
NCCS is here to help.
- Read our contact Congress tip sheet » [PDF]
- Watch our most recent webinar on the ACA (embedded below), which includes a message from a Congressional staffer on how to contact your members.
- Contact Lindsay Houff, Public Policy Manager at email@example.com with any questions you may have, or for help with setting up a meeting with your Members of Congress.
NCCS Webinar: ACA Update (April 6, 2017)
Last week at a press conference after the American Health Care Act (AHCA) was pulled from the House floor, Paul Ryan said, “The ACA is the law of the land for the foreseeable future.” But this week lawmakers signaled that the fight is far from over. Republican leadership vowed to restart negotiations for repealing the ACA.
While Republicans might try to resurrect repeal and replace, they could in the meantime focus on administrative avenues to undermine the ACA and the marketplace:
The bizarre lawsuit that could still blow up the ACA insurance markets https://t.co/CgEa40fFYZ
— Vox (@voxdotcom) April 3, 2017
- They may use a waiver process to allow states to undercut the ACA, and they can continue to not enforce the individual mandate, a critical component to the law that helps to stabilize the marketplace.
- The administration could also use regulations to weaken the ACA by pulling back on cost-sharing subsidies. A pending court case, House v. Price, could blow up insurance markets across the country with cost-sharing payments the federal government makes to insurance companies to help cover the cost of low-income people in the crosshairs.
- The House Freedom Caucus this week also targeted the ACA’s essential health benefits, and its community rating provisions, which if eliminated would destroy the ACA and its insurance reforms.
NCCS wants to ensure the stability of the marketplace, so that cancer survivors can continue to purchase affordable insurance. We are concerned that administrative actions could increase premiums, cause insurers to leave the marketplace, and negatively impact access to health care for millions. Cancer survivors need access to affordable and quality health care, and Congress should work to ensure the ACA is in place for those who need it the most. The Medicaid expansion was a critical piece of the ACA in covering millions more Americans and giving them access to critical health coverage. Under the ACA, 32 States expanded Medicaid, and now several, including Kansas, are rushing to expand now that the ACA is at risk of repeal.
Although Republicans in Congress are likely planning to take another run at repealing the ACA, no new proposals have been presented yet. Therefore, it is critical that advocates remain engaged and advocate for a bipartisan solution that would strengthen and build upon progress of the ACA. Continuing to share stories of cancer survivors who have benefited from the ACA is a great way to illustrate the importance of the law and how it has given patients unprecedented protections and access to health care. The AHCA would have been devastating for cancer survivors. Calls and engagement from patients across the country helped stop the bill – but our job is far from over! We need to keep the momentum going and the message loud: The ACA is not perfect, but is it a step in the right direction and we need to strengthen the law, not repeal it.
NCCS will continue to monitor the process and we will be hosting a webinar on Thursday, April 6 to give an update on where the law stands and the potential outcomes for the future of the ACA. Sign up for our newsletter to be notified of this and future NCCS webinars.
Today, Speaker of the House Paul Ryan withdrew the American Health Care Act (AHCA) when it became clear that he did not have the votes to pass it. In his press conference, he said that the Affordable Care Act (ACA) is the “law of the land for the foreseeable future.” The National Coalition for Cancer Survivorship (NCCS) strongly opposed the AHCA, which would have harmed millions of Americans, including cancer patients and survivors, and advocated aggressively against its passage.
Hopefully now, Members of Congress can finally work in a bipartisan manner to improve and strengthen the ACA. The ACA led to historic reductions in the uninsured, caps on out-of-pocket expenses, and critical patient protections to name a few, providing millions of Americans with health and financial peace of mind.
NCCS is grateful to advocates across the country who shared their stories, called and wrote their Members of Congress, attended town halls, and made their voices heard. This bill would have been bad for Americans and especially bad for cancer patients and survivors. Our community let Congress know that we did not approve of this legislation and helped put a stop to it.
Trump's budget on health: 3 losers and 2 winners https://t.co/5kTvFY3NhY
— Vox (@voxdotcom) March 16, 2017
Further, the report outlines how premiums would rise for various populations. For example:
“A 64-year-old who earns $20,000 would see her premiums rise from $1,700 to $14,600 under the Republican plan — a 758 percent increase. She’d be expected to spend more than half her annual income on health insurance.”
(Vox.com – “2 winners and 3 losers under the CBO score of the GOP health plan”)
This bad news rattled many Members of Congress, and led House Speaker Paul Ryan to admit that the AHCA “must change to pass the House, marking a significant retreat from his earlier position that the carefully crafted legislation would fail if substantially altered.”
(Washington Post – “Ryan: Health care plan must change to pass the House”)
Despite the unfavorable CBO analysis, the AHCA made its way through three House committees, without a single hearing to gain patient or provider perspective on the bill. Next week, the AHCA is expected to be brought to the House floor, where it has been reported that a manager’s amendment will be used to make changes to the bill to increase conservative support. The future of the AHCA remains unknown, as many House Republicans are divided on the bill and several Senators have publicly voiced their concern about the legislation, particularly the reduction in the Medicaid expansion.
CNN’s Town Hall with Tom Price
CNN hosted a town hall meeting this week, with Health and Human Services Secretary Dr. Tom Price. Colon cancer survivor Brian Kline said that the Medicaid expansion saved his life and saved him from bankruptcy. He said, “My life really depends on having access to my doctors and medical care. Why do you want to take away my Medicaid expansion?” Secretary Price responded that the Medicaid program has problems and does not work well for everyone.
— CNN (@CNN) March 16, 2017
Public Opinion of the AHCA and ACA
The Kaiser Family Foundation released polling that showed that about half of respondents believe the AHCA will reduce the number of people covered, and a similar share of respondents believe the AHCA will increase costs, with Republicans more optimistic about the effect of the AHCA than Democrats. The public remains split on the ACA, with just over half of respondents opposing repeal, and approximately half with a favorable view of the ACA.
— Kaiser Family Found (@KaiserFamFound) March 15, 2017
The AHCA would be a significant step backward from the ACA’s affordability and patient protections, and will hurt millions of Americans, including cancer patients and survivors. As a full House vote is expected next week, timing is critical and your voice must be heard! Call your Representative and Senators today and let them know that cancer patients and survivors deserve better.
NCCS Statement on CBO Score of American Health Care Act
The Congressional Budget Office (CBO) analysis of the American Health Care Act (AHCA) provides further evidence that this legislation would be devastating for cancer patients. First, CBO estimates that compared to the ACA, 14 million more people would be uninsured in 2018. That number would rise to 21 million in 2020, and then to 24 million in 2026. Health care coverage is a leading indicator for cancer outcomes. With approximately 16 million cancer survivors and an estimated 1.6 million new cancer diagnoses in 2016 alone, these increases in the number of uninsured Americans would have a significant impact on cancer patients and their families.
The CBO report confirms that the AHCA will disproportionately harm low-income and older Americans, with 5 million fewer Medicaid enrollees in 2018 and 14 million fewer in 2026, resulting in $880 billion reduction in Medicaid spending. The report states that under the AHCA, “insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.” With Americans 50 and older disproportionately diagnosed with cancer, the AHCA would make matters even worse by threatening their financial well-being.
Finally, despite claims that the Affordable Care Act (ACA) is in a ‘death spiral,’ the CBO report states, “the nongroup market would probably be stable in most areas under either current law or the legislation.” These facts alone show why the AHCA must not move forward, and why we must do all we can to build off of the progress of the ACA.
GOP Repeal Plan, the AHCA, Moves Forward in the House
The American Health Care Act (AHCA), the long-awaited Republican bill to repeal and replace the Affordable Care Act (ACA), was unveiled earlier this week. NCCS released a statement opposing the AHCA, explaining that this legislation would be devastating for older, sicker, and poorer Americans, let alone those facing a cancer diagnosis. By ending the ACA’s cost-sharing provisions and replacing ACA subsidies with tax credits based on age, not income, this bill would make coverage more expensive, if not completely out of reach, for many cancer survivors. Additionally, the legislation radically restructures the Medicaid program and shifts funding from the federal government to states.
The bill preserves two of the most popular provisions of the ACA, which allow children to stay on their parent’s plan until the age of 26, and forbids insurers from denying coverage for individuals with pre-existing conditions such as cancer. However, these protections are useless if individuals are unable to afford insurance.
— Center on Budget (@CenterOnBudget) March 9, 2017
The AHCA hurts older Americans the most by allowing insurance companies to charge up to five times as much for premiums as younger individuals. With more than 60% of cancer diagnoses occurring in older Americans and many cancer survivors depending on Medicaid, this bill leaves the most vulnerable populations without sufficient access to care.
Major medical and interest groups, including AARP, the American Medical Association (AMA), America’s Health Insurance Plans (AHIP) and the American Hospital Association (AHA), have publicly opposed or expressed serious concerns with the AHCA, citing that the bill would result in millions of Americans losing coverage and benefits. The bill still lacks a complete analysis by the Congressional Budget Office (CBO), but several analyses have already concluded that the AHCA would make health insurance less affordable. A report by the Center on Budget and Policy Priorities found that consumers’ costs would likely increase even more than tax credits would fall, since the House plan would probably cause individual market premiums to rise.
ACA beneficiaries react to age-based tax credits in GOP replacement plan: "I’m scared, I’ll tell you that right now" https://t.co/mN0dVA9zjm
— Abby Goodnough (@abbygoodnough) March 8, 2017
It’s not just large interest groups that are speaking out against the AHCA. Individuals across the U.S. are realizing that this replacement plan would undo much of the progress made by the ACA and force patients to carry the burden of the cost of health care. A New York Times article highlights the story of a woman named Martha from North Carolina who voted for Donald Trump because she believed his Administration would make health care more affordable. In an interview earlier this year, President Trump vowed the replacement plan would have “insurance for everybody,” but the AHCA is far from achieving that goal. Since the release of the replacement bill, Martha is growing increasingly nervous because the replacement plan would decrease her premium subsidy by more than $5,000 per year.
Despite the absence of a cost estimate for the AHCA by the CBO, the health care plan passed in two House committees Thursday and will now head to the House Budget Committee for consideration and mark-up. The bill will face significant hurdles, not just in opposition from Democrats, but also from Republican Members who either feel that the bill goes too far, specifically with the elimination of the Medicaid expansion, and Republicans of the Freedom Caucus who feel the bill does not repeal enough of the government’s role in subsidizing health care coverage.
The AHCA would be a significant step backward from the ACA’s affordability and patient protections, and will hurt millions of Americans, including cancer patients and survivors. Call your Representative and Senators today and let them know that cancer patients and survivors deserve better.
NCCS Statement on the American Health Care Act (GOP Replacement Bill)
Even upon initial review, there is no question that the American Health Care Act (AHCA) is a significant step backward from the ACA’s affordability and patient protections, and will hurt millions of Americans, including cancer patients and survivors. With reductions to Medicaid and subsidies, the AHCA would result in millions of people unable to afford or maintain health care coverage. The true scope of its impact remains unknown, as leaders in Congress plan to move forward with the legislation without a complete analysis by the Congressional Budget Office. Insisting on moving ahead with this legislation without having a clear understanding of its full impact should alone serve as a clear warning about the perils within this legislation.
Further, Americans 50 and older, who are disproportionately diagnosed with cancer, are going to be hit the hardest, seeing their premiums rise and subsidies fall. Evidence shows that the cost of care impacts patient outcomes: as patients delay care, they skip screenings, don’t fill prescriptions, and choose treatments based on cost rather than effectiveness. Not only will this reduction in affordability hit millions of people in their pocketbooks, it also will negatively impact their chance of surviving their cancer diagnosis. And while the AHCA retains certain patient protections related to pre-existing conditions, out-of-pocket maximums, and lifetime caps, those protections are meaningless to patients if coverage is unaffordable. NCCS is also concerned that the continuous coverage provision will disproportionately hurt cancer patients.
The AHCA would be devastating for older, sicker, and poorer Americans, let alone those facing a cancer diagnosis. It does not deliver on the promises of better, more affordable coverage. This cannot and should not be the way forward in health care in America; we must raise our voices and demand better.
GOP Tax Credits, Medicaid Proposals, and a ‘Secret’ Replacement Bill
In addition to tax credits and health savings accounts, President Trump mentioned ensuring that people with pre-existing conditions have access to insurance, ensuring a “stable transition” for people with ACA coverage, providing flexibility in state implementation of Medicaid, and allowing insurers to sell plans across state lines (though some experts have said selling across state lines will not be helpful).
Two important papers came out today that measure the GOP tax credits against those in the ACA.
Read about ‘em here: https://t.co/AYm6Q6tOVT
— Sarah Kliff (@sarahkliff) March 1, 2017
Tax credits have become a major issue, with Democrats concerned that the tax credits will not be sufficient to help low-income individuals purchase insurance, and the most conservative Republicans opposed to any kind of subsidy or credits. The legislative text leaked last week had age-based tax credits, as have some of the previous plans proposed by Speaker Paul Ryan and Secretary of Health and Human Services Tom Price. For low-income individuals who need assistance purchasing coverage, age-based tax credits may make insurance unaffordable.
Earlier this week, President Trump met with the nation’s governors as part of the National Governors Association meeting. Many governors have expressed a desire to retain the Medicaid expansion, which 31 states implemented, covering 12 million additional people with enhanced federal funding. Proposals to transition the Medicaid program to a block grant would shift more of the burden to states. Bloomberg reports that a group of Republican governors, led by Ohio’s John Kasich and Wisconsin’s Scott Walker, are developing a proposal to give more control of Medicaid to states, retain coverage levels, and allow states flexibility in how to implement the Medicaid expansion.
Reports from Capitol Hill today indicate that there is a new version of an ACA replacement plan that is being kept secret to avoid leaks. According to Bloomberg, “House Republican leaders have a new version of their major Obamacare repeal and replacement bill. They just don’t want you to see it. The document is being treated a bit like a top-secret surveillance intercept. … The unusual secrecy is a reflection of the sensitivity—and the stakes—surrounding the GOP effort to rewrite the Affordable Care Act.”
While the legislative text is not yet public, some Members have indicated that the bill will be marked up next week, even before the Congressional Budget Office has a chance to estimate the cost and coverage implications of the proposal.
It’s not too late to let your Members of Congress know that access to quality, affordable health insurance is critically important for cancer patients and survivors. Even if you’ve already called, you can call again! If your Senators or Representative are already supportive of the ACA, take a moment to thank him or her. If you have stories of how the ACA has helped you, members of your family, or people you know, please share them with NCCS and with your Members of Congress.
Town Hall Events
Support for the ACA at town hall events across the country continued to make headlines this week. Throughout the recess, constituents pressed their Members of Congress to articulate specific plans around repeal and replacement of the Affordable Care Act (ACA), and shared personal stories that illustrated the need to preserve the ACA. Town hall events will continue throughout the weekend, so check TownHallProject.com to see if there is an event in your district.
Draft ACA Replacement Bill Leaked
Republicans passed a budget resolution back in January that called for major changes in the ACA, but they have yet to coalesce around a replacement plan. However, a draft reconciliation bill that outlines the GOP Obamacare replacement was leaked by Politico earlier today. The 106-page draft bill confirms many of our concerns that a Republican replacement plan will be catastrophic for cancer patients.
The leaked Republican plan to replace Obamacare, explained https://t.co/pFqjkJR0Ao
— Vox (@voxdotcom) February 24, 2017
Sarah Kliff from Vox.com outlines what this bill would do and what it would mean for sick individuals. If passed, this bill would make insurance better for people who are young and healthy and make insurance worse for people who are old and sick. And the plans for young and healthy individuals would be less expensive because they would cover much less, since this draft bill eliminates the essential health benefits and other benefits that raised the price of plans. Like other Republican plans proposed, this bill relies heavily on high risk pools, which have proven in the past to be expensive and provide inadequate coverage.
Under this proposal, states could continue to cover the Medicaid expansion population — but they would get significantly less federal funding, which could push some states to drop out of the program entirely. This proposal is likely to cause more rift among the Republican party as support for Medicaid expansion grows among Republican Governors and Members of Congress. Senator Murkowski (R-AK) said she would not vote to repeal the expanded Medicaid health care program, which is a key component of the ACA. Republican Governors like John Kasich are also speaking out in support of the expansion. Cancer patients often rely on Medicaid to help pay for the enormous costs of treatment and care.
Without the ACA or Medicaid Expansion, cancer patients could be left without access to quality and affordable health care. We need to share stories with Members of Congress from people who benefited from Medicaid. If you or someone you know had Medicaid coverage for cancer treatment, please share your story with us.
The biggest takeaway from this leaked draft bill is that it does not come close to providing the coverage that the ACA does. This legislation would not provide adequate or affordable coverage to sick individuals and is therefore not acceptable for cancer patients and survivors.
Call your Members of Congress today to let them know the ACA is critical for cancer patients and must not be repealed.
Republicans Reveal Broad Repeal and Replace Legislation Outline
On Thursday, House Speaker Paul Ryan (R-WI) announced that Republicans plan to introduce repeal and replace legislation the week of February 27. This followed a Republican caucus meeting where the elements of the legislation were outlined. The Hill summarized the plan saying, “The GOP bill will include tax credits, an expansion of Health Savings Accounts, money for high risk pools to care for the sick, and a major restructuring of Medicaid to cap federal payments.” The New York Times reports that the outline did not include costs or “estimates of the number of people who would gain or lose insurance under the plan, nor did it include comparisons with the Affordable Care Act, which has extended coverage to some 20 million people.”
NCCS is extremely concerned by this proposal. These policies are a significant step backwards from the access and affordability protections of the ACA and threaten to be catastrophic for cancer patients.
This week, NCCS and other patient advocacy groups met with staff on the House Energy and Commerce Committee to discuss legislation to retain protections for people with pre-existing conditions. Chairman Greg Walden introduced the Pre-Existing Conditions Protection Act, which would restore some of the patient protections in the ACA. NCCS continues to urge Congress not to repeal the ACA, as millions of cancer patients and survivors depend on it for access to quality, affordable health care.
HHS Releases Proposed Rule on ACA
On Tuesday, the Department of Health and Human Services (HHS) released a proposed rule on ACA market stabilization. According to Kaiser Health News, the proposed rule “was actually begun by the outgoing Obama administration. In part, it is an effort to address complaints by insurers that consumers were ‘gaming’ the system to purchase coverage only when they were sick and then dropping it when they were healthy.” The rule attempts to provide some certainty to health plans to encourage them to stay in the market by tightening enrollment options for consumers. These changes could make it more difficult for consumers to enroll in plans and result in fewer people covered.
Additionally, the rule itself states that changes in valuations of plans “could reduce the value of coverage for consumers, which could lead to more consumers facing increases in out-of-pocket expenses, thus increasing their exposure to financial risks associated with high medical costs.”
The public comment period is open through March 7, and NCCS plans to submit comments.
With this week’s announcement of a timeline and broad elements of a bill, it is more important than ever to make our voices heard in Congress. During the week of February 18-26, Members will be on recess and will return to their state and district offices to meet with constituents.
Recess is a critical time to meet with your members and let them know that the ACA has provided cancer survivors and patients with unprecedented protections and quality, affordable, and accessible health care coverage. Whether you attend a town hall event in your district, set up an in-person meeting with the district office, or call your Member, every effort is vital in saving our care:
- Use this PDF for tips and sample questions for contacting Members of Congress or attending town hall meetings »
- Here’s an up-to-date list of town hall events for all congressional districts »
NCCS can help you set up a meeting with your Members of Congress. Email Lindsay Houff, Manager of Policy.
February 13: More of the Same from Congressional Republicans
The Brookings Institute released a report entitled, “Five-State Study of ACA Marketplace Competition.” The study authors conducted on-the-ground interviews and research in five states, California, Florida, Michigan, North Carolina, and Texas, to see what is and what isn’t working.
Read the report summary and additional information »
Our take away is this: of course the ACA is not perfect. But in the states that fully embraced and implemented the law, ACA is working rather well. There are lessons learned and to be applied. Changes exist that can be made to improve accessibility and affordability in the ACA, instead of repealing it and replacing it with a piecemeal approach that would not only be catastrophic for cancer patients, but a significant step backward for the health and financial well-being of all Americans.
Georgia Congressman Dr. Tom Price was confirmed by the Senate and sworn in to be the new head of the Department of Health and Human Services (HHS). Sec. Price will now take over as the point person in the Trump Administration for dismantling the ACA. Read more about Sec. Price’s contentious confirmation and background »
Earlier this week, President Trump did an interview with Fox News. When asked about a timeline for repeal of the ACA he said, “I would like to say, by the end of the year, at least the rudiments, but we should have something within the year and the following year.” This caused several Members of the Republican caucus to reaffirm their commitment to repeal the ACA as quickly as possible, including Speaker Paul Ryan who said repeal will pass this year.
Their effort continues in the face of mounting pressure and resistance from constituents across the country who don’t want ACA repealed. Across the country, concerned people are attending ACA rallies and town halls to voice their opposition to repeal of the ACA. According to CNN on Thursday night, two Republican members of Congress—Reps. Jason Chaffetz of Utah and Diane Black of Tennessee—saw this opposition firsthand at two of their town halls.
And it’s no surprise, as more and more people are learning about how important the health and affordability protections are in the ACA. While 12 million individuals still signed up for Obamacare through the federal and individual state-run exchanges, data show that the Trump administration’s pulling of advertisement and sign-up effort had an impact.
February 3 – Inadequate Replacement Plans
Congressman Walden also outlined legislation he plans to propose, which will require individuals with pre-existing conditions, such as cancer, to maintain continuous coverage in order to be protected from discrimination by insurance companies based on health status. We are encouraged by Congressman Walden’s efforts to maintain the pre-existing conditions protections and will continue working to ensure the patient voice is at the center of the process. We are currently concerned that the continuous coverage requirement would be problematic for cancer survivors as it does not consider the realities of the disease, age, employment, or personal and life changes. And again, there is no guarantee that the plans available for people with pre-existing conditions would be affordable.
These plans and others were examined and discussed Thursday during a hearing held by the House Energy & Commerce Subcommittee on Health. Although these proposals are works in progress, we know that the concepts behind them are not in the best interests of cancer patients and survivors.
What Can You Do Now?
Cancer survivors deserve better. Call your members of Congress today and ask they not repeal the ACA. Explain how the law works for you as a cancer survivor. We should build upon the ACA’s progress and strengthen the legislation, not take away access to health care for millions and destabilize the already fragile markets.
Please consider sharing your story with us, to help us advocate for cancer survivors.
ACA Update January 26: Watch Our Webinar
Affordable Care Act Update: What Advocates and Cancer Survivors Need to Know
The webinar begins with an introduction by Lindsay Houff, Policy Manager at NCCS. Lindsay gives some background information about the Affordable Care Act—how it was passed, the main reforms created by the bill, and potential strategies Republican lawmakers will use to repeal it.
For her presentation, Monica Bryant, COO of Triage Cancer, starts with a list of consumer benefits that the ACA provides. She breaks down the three main sources of health coverage for Americans (employer-based, the individual marketplace, and Medicare/Medicaid) and how a full repeal of the ACA would impact each group. “The reality is that everybody who has health insurance in this country is going to be impacted,” Ms. Bryant said. She also addresses how ACA repeal could affect cancer survivors in particular.
Additional links discussed in the webinar:
- http://www.cancerfinances.org/ – A Toolkit for Young Adults with Cancer
- Healthcare.gov – Open enrollment deadline is January 31
- A helpful tip sheet from NCCS for best practices when contacting your lawmakers in Congress »
ACA Update January 24, 2017
In early January, Congressional Republicans took the first steps toward repealing the ACA. Significant public outcry at the prospect of repealing the ACA without a replacement plan has been effective, as both legislators and the new administration now indicate that a replacement needs to be considered at the same time as repeal efforts.
While they have not yet coalesced around a replacement plan, Republicans have presented a few potential plans, all of which have provisions that would be problematic for cancer survivors. Some of the ideas for replacement plans include high-risk insurance pools and health savings accounts (HSAs). Check back for future posts, where we look at what some of these proposals mean to cancer survivors. Yesterday, Senators Bill Cassidy (R-LA) and Susan Collins (R-ME) introduced legislation that would give states several options going forward, including keeping the current health care exchanges, though with reduced federal support.
On Friday, one of President Donald Trump’s first actions following the inauguration was to sign an executive order that directs the federal government to minimize the economic burden of the ACA while Congress works to repeal it. Policy experts have suggested that the order will have little short-term impact, but it is an important signal that changes to the ACA are a high priority for the new administration.
Key to the repeal and replace efforts will be President Trump’s pick to run the Department of Health and Human Services (HHS). The Senate Finance Committee held hearings today to consider Rep. Tom Price, a physician from Georgia.
What Can You Do Now?
- Watch our webinar “Affordable Care Act Update: What Advocates and Cancer Survivors Need to Know” from January 25
- Share your story with NCCS (at the bottom of this page) and on social media using the hashtag #ProtectOurCare
- Call your Members of Congress and let them know that cancer patients need access to affordable, quality health insurance.
Follow this helpful tip sheet for best practices when contacting Congress »
How Can I Get Involved?
There are numerous ways for you to make your voice heard.