Affordable Care Act Resources

Senate Releases New Draft of BCRA; Cruz Amendment Included

Yesterday, Senate leadership released an updated draft version of their health care repeal bill, the Better Care Reconciliation Act (BCRA). As Andy Slavitt, former acting director of the Centers for Medicare and Medicaid Services, states, “Trumpcare went from being very bad to unworkably bad.” The bill allows insurers to deny coverage based on pre-existing conditions, and to charge higher rates to sick people.

A version of the Cruz Amendment, which we reported on last week, was included in the bill. The amendment allows insurers to also sell plans that do not comply with ACA regulations, including the law’s essential health benefits and its pre-existing conditions protections. This amendment would drastically increase premiums for sick people, provide plans that are not comprehensive, and destabilize the market. As Ezra Klein reports, this bill is terrible for anyone who is sick, has been sick, or will be sick.

Kaiser Family Foundation developed a useful interactive chart that compares the ACA, the House passed version (the AHCA), and the proposed Senate version (the BCRA).

The ACA has provided cancer survivors with unprecedented access to quality and affordable health care and we cannot afford to go back to the days when insurers could deny coverage based on health status or charge outrageous premiums for skimpy plans.

Since the release of the revised bill, two Senators have announced they will vote “No,” and with only one more needed to halt the bill.

It is critical that Senators on both sides of the aisle hear from their constituents and cancer survivors on how this bill would negatively affect access to affordable and comprehensive health care. Please call your Senators today at (844) 257-6227.

NCCS Joins Thirty-three Cancer-Related Organizations to Oppose the BCRA

NCCS joined 33 cancer-related patient advocacy and professional organizations in opposition to the revised BCRA. In the statement, NCCS CEO, Shelley Fuld Nasso wrote, “With an estimated 22 million losing coverage, severe cuts to Medicaid, and elimination of pre-existing condition protections, this bill is devastating for the American people, especially for anyone with a cancer diagnosis. It is time to end this threat that is causing fear and anxiety throughout the cancer community, and work towards bipartisan solutions to strengthen current law.”

Silver Spring, MD – The National Coalition for Cancer Survivorship (NCCS) joined 33 cancer-related patient advocacy and professional organizations in opposition to the Senate’s revised Better Care Reconciliation Act (BCRA).

“The Senate’s BCRA, just as the House’s AHCA, is a direct threat to America’s 16 million cancer patients and survivors who rely on timely and uninterrupted access to comprehensive and affordable health care,” said NCCS CEO Shelley Fuld Nasso. “With an estimated 22 million losing coverage, severe cuts to Medicaid, and elimination of pre-existing condition protections, this bill is devastating for the American people, especially for anyone with a cancer diagnosis. It is time to end this threat that is causing fear and anxiety throughout the cancer community, and work towards bipartisan solutions to strengthen current law.”

The groups who joined the effort are:

1. American Society for Clinical Oncology (ASCO)
2. American Society for Radiation Oncology (ASTRO)
3. Association of Community Cancer Centers (ACCC)
4. Association of Oncology Social Work
5. Blue Faery: The Adrienne Wilson Liver Cancer Association
6. CancerCare
7. Cancer Support Community
8. Children’s Cause for Cancer Advocacy
9. Colon Cancer Alliance
10. Cutaneous Lymphoma Foundation
11. Critical Mass
12. Deadliest Cancers Coalition
13. Fight Colorectal Cancer
14. FORCE: Facing Our Risk of Cancer Empowered
15. Inflammatory Breast Cancer Research Foundation
16. LIVESTRONG
17. Living Beyond Breast Cancer
18. Lung Cancer Alliance
19. LUNGevity
20. Lymphoma Research Foundation
21. Melanoma Research Alliance
22. National Brain Tumor Society
23. National Breast Cancer Coalition
24. National Coalition for Cancer Survivorship
25. National Comprehensive Cancer Network
26. National Patient Advocate Foundation
27. Oncology Nursing Society
28. Ovarian Cancer Research Fund Alliance
29. Sarcoma Foundation of America
30. Stupid Cancer
31. Susan G. Komen
32. Triage Cancer
33. Us TOO International
34. Young Survival Coalition

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Several GOP Senators Raise Concerns

When Senate Majority Leader Mitch McConnell (R-KY) decided to delay the vote for the Better Care Reconciliation Act (BCRA), there was a collective sigh of relief from the patient community. But our work is far from over. The Senate is still planning to move forward with their attempt to pass the bill, and now is a critical time to voice your opposition to this harmful legislation.

The most recent Senator to speak out against the bill is North Dakota Senator John Hoeven, after meeting with hospital executives and constituents. Senator Hoeven is one of several Republican senators who have said they cannot vote for the legislation as drafted. Sens. Rob Portman (R-OH), Shelley Moore Capito (R-WV) and Jerry Moran (R-KS) also said they could not vote for the bill.

The Cruz Amendment

In the meantime, Senator Ted Cruz (R-TX) drafted an amendment to the BCRA that is currently being scored by the Congressional Budget Office. Text of his amendment is not available, but based on reporting, the Cruz amendment would permit issuers to offer non-ACA compliant plans in a state as long as the issuers also offer an ACA-compliant plan. This proposal would gut consumer protections and would lead to adverse selection in the marketplace, creating a two-tiered system. Cancer survivors know they need comprehensive coverage, and plans that cover needed scans, tests, and treatments may be unaffordable.

According to Modern Health’s reporting:

Cruz’s proposal would mean insurers could sidestep ACA rules requiring that they:

• Accept all customers regardless of pre-existing conditions;
• Vary premiums based only on age, charging older people up to five times more than younger people under the Senate bill;
• Set no annual or lifetime benefit limit; and
• Offer 10 minimum essential benefits in all plans.

The Congressional Budget Office (CBO) said Monday that the Senate bill’s provision allowing states to waive ACA rules such as essential benefits would lead to higher premiums and higher out-of-pocket costs for people who need services no longer included in essential benefits, such as cancer survivors. The CBO reported that some people would forgo needed services because of those higher costs.

An Unfixable Bill

While several Senators have expressed concerns with this bill, they will no doubt be targeted by leadership with amendments to the BCRA in order to garner their vote. It is important that as advocates and survivors we let them know this bill cannot be fixed. As the Center on Budget and Policy Priorities notes: “The Senate bill isn’t fixable: every major element would cause people to lose coverage or make it unaffordable.”

Yesterday, Senator McConnell said that if they cannot pass a repeal bill, they will have to work with Democrats to address problems in the insurance markets. A bipartisan approach to fixing the ACA’s market issues, rather than dismantling the ACA, would be best for the health of cancer survivors in the United States.

NOW is the time to call your Senators to voice your opposition to this harmful legislation. Everyone should call, but the following states are especially critical: Alaska, Arizona, Colorado, Kansas, Louisiana, Maine, Nevada, North Dakota, Ohio, Tennessee, and West Virginia. Please share this message with friends and family who live in any of those states. Thank you for standing up to protect cancer patients, survivors, and their families. Call 844-257-6227 to be directly connected with your Senators.

As you likely heard on Tuesday, Senate Majority Leader Mitch McConnell (R-KY) announced he would not proceed with a vote on the Better Care Reconciliation Act (BCRA) this week, as was previously planned. The BCRA, the Senate’s bill to replace the Affordable Care Act, was released last week in draft form and on Monday, the Congressional Budget Office (CBO) released their report on the bill.

The CBO analysis confirmed what we already knew. Just like the House version, the BCRA would be devastating; causing 22 million people to lose coverage, including 15 million who depend on Medicaid, and increasing costs for less coverage for millions of sick, elderly, and low-income Americans.

The BCRA’s damage doesn’t stop there.

By allowing states to waive essential health benefits, the bill essentially guts protections for pre-existing conditions, potentially affecting those on employer-sponsored health plans. While insurers would not be able to deny coverage to cancer patients, insurers would be able to deny coverage for certain benefits and treatments, such as chemotherapy or prescription drugs.

In addition, the BCRA not only phases out the Medicaid expansion, but seeks drastic and permanent cuts to Medicaid, which has helped millions of cancer patients get access to health care that their lives depend on.

Taking Action

On Tuesday, CPAT advocates with NCCS went to the Hill for over 160 meetings with Members and their staff, sharing their stories and asking their Members of Congress to vote NO on this destructive bill.

Although the BCRA will not be brought to the floor this week, the battle is far from over. As we speak, Senators are negotiating changes and plan to resubmit the bill to the CBO and vote after the 4th of July recess. It is critical that we continue to let our Senators know that no amount of tinkering will fix such a disastrous and flawed bill.

The only option is for a new, bipartisan, and open process to take its place—one that will build on the success of the Affordable Care Act and actually improve our nation’s health care system.

Please call your Senators today at (844) 257-6227 so this bill is stopped from harming millions of cancer patients and survivors who should only be focused on their health; NOT on whether they’ll be able to keep or afford their health care.

Despite such statements, the Senate version is very similar to the House and is actually worse than we thought. Sarah Kliff at Vox.com sums it up:

Furthermore, the bill significantly threatens anyone with a pre-existing condition, by allowing states to waive Essential Health Benefit (EHB) requirements. As Tim Jost at Health Affairs Blog points out:

 
Basically, yes, people with pre-existing conditions won’t be denied the ability to purchase health insurance. HOWEVER, that insurance might not cover any treatments or medicines they need. Without requirements for benefits to be covered, insurers will offer skimpy plans that won’t meet the needs of cancer survivors. Premiums will rise for more generous plans that people with pre-existing conditions need. Note: waiving EHB also returns annual and lifetime limit caps for millions of people.

Finally, what BCRA does to Medicaid, which millions of children and low-income, disabled, and elderly Americans rely on for health care is cruel. Per Sarah Kliff again:

Please call (844) 257-6227 TODAY and tell your Senators NO on the health care bill. Even if you’ve called before, please call again.

Call EVERY DAY until the Senate votes.

Senators in Alaska, Arizona, Colorado, Iowa, Louisiana, Maine, Nevada, Ohio, Tennessee, and West Virginia are crucial votes. Please share this message with friends and family members who live in these states, and ask them to call (844) 257-6227.

If you haven’t already called your Senators’ offices to tell them to reject the AHCA, now is the time. If you have called, thank you! And keep calling. If you have friends or family in Alaska, Arizona, Colorado, Iowa, Ohio, Maine, Nevada, Tennessee, and West Virginia, please urge them to call. Senators from these states are crucial votes and need to hear from their constituents. Senate leadership set a goal of July 4th recess to bring the bill to the floor and access to health care for millions of cancer survivors across the U.S. is at stake.

Call 844-257-6227 to be connected to your Senators today.

As we reported last week, moderate Republicans in the Senate seem to be caving on their earlier promises to reject any bill that slashes Medicaid funding. Senators Collins and Capito have reportedly stated they would consider a “phasing out” of the Medicaid expansion program.

However, lengthening the timeframe for ending the program does nothing to help the millions of people who depend on Medicaid for health insurance, including low-income, disabled, and elderly Americans. Because the Senate can only lose two votes on the AHCA, each Senator is critical and it is extremely concerning to hear moderate members negotiate away their constituents’ access to health care.

To increase confusion around the American Health Care Act (AHCA), President Trump this week changed his analysis of the House passed bill from being “incredibly well-crafted” to now being, “Mean, mean, mean,” as the Senate considers the legislation. Earlier this year, Trump said his health care replacement would be “great” and “would cover everyone.” The AHCA is a far cry from providing coverage for everyone. In fact, it would take health insurance away from millions and cause costs to go up for our most vulnerable communities.

Adding to the growing list of negative analyses of the AHCA, the following reports and estimates were released this week:

• The Center for Medicaid and Medicare (CMS) independent actuary this week released a report that found the bill would result in 13 million fewer insured, a 61% increase in cost sharing (including deductibles, copayments, and coinsurance), and an increase of $221 billion in out-of-pocket health costs.
• An analysis by the Center for American Progress showed that “as many as 27 million Americans could face annual limits on their coverage, and 20 million could be hit with lifetime limits.”
• An analysis by The Commonwealth Fund estimates that nearly one million jobs will be lost if the AHCA is implemented, with most coming from the health care sector. The hardest hit states would be those that expanded Medicaid.
• The Center on Budget and Policy Priorities reports that people of all ages will lose coverage under the AHCA, but strikingly, the uninsured rate for children will increase by 50 percent.
• Finally, the American Medical Association (AMA) came out against the AHCA saying the bill’s Medicaid caps are a “disaster” and would hurt their patients.

Not only is the AHCA a bad bill, it’s also extremely unpopular with the public. The New York Times reported this week on their analysis of each states’ perception of the bill and found that not a single state favors the AHCA.

The question is, will Republican senators vote yes on a bill this harmful and this unpopular?

To learn how you can get more involved in this effort, visit the NCCS Protect Our Care webpage. If you have any questions about advocacy, please contact Lindsay Houff at lhouff@canceradvocacy.org.