Post-Election Update: What does the Budget have to do with the ACA?

budget repeal provisions ACAThere have been many stories in the news over the last few weeks about potential changes to our health care system and last night the Senate voted on a budget resolution that started the ball rolling on to repeal provisions of the  Affordable Care Act (ACA).

President-elect Donald Trump, Speaker of the House of Representatives Paul Ryan, and Senate Majority Leader Mitch McConnell have continued to state that they are eager to make changes to our health care system. In December, on 60 Minutes, Speaker Ryan stated that the repeal of the Patient Protection and Affordable Care Act (ACA) was a priority in the House of Representatives.  Senator McConnell has repeatedly confirmed that the ACA repeal will be the first item the Senate votes after the inauguration of President-elect Trump.

Yesterday, President Trump stated that he would offer his own plan to repeal and replace the ACA simultaneously, as soon as his nominee for Secretary of Health and Human Services, Tom Price, is confirmed by the Senate.

But repealing an entire law, as if it never existed, is a complicated thing.  Especially a law that has been in effect for six years and touches so many people and involves so many federal and state agencies.  And the steps that they are taking to repeal the law are also complicated.

Road to Repeal

Normally, when a bill is proposed in the Senate or House of Representatives, it is reviewed by one or more committees and then if suggested by a committee, all of the members have the opportunity to vote on the bill. Most bills require a majority vote.  In the Senate that means 51 votes are required to pass.  However, if some members don’t want there to be a vote on a bill, they can filibuster it. A filibuster is procedure where debate over a bill is extended to delay or prevent a final vote. Sixty votes are required to break a filibuster. To avoid the filibuster, Senator McConnell has lead an effort to pass changes to the ACA through the budget reconciliation process, which cannot be filibustered and only requires 51 votes, which the Republicans have.

Senate Action Yesterday

Yesterday, the Senate took the first steps to repeal the ACA. Members of the Senate voted 51-48 to pass a budget blueprint, which directs the House and the Senate to come up with repeal legislation by January 27. The House of Representatives could vote on the budget blueprint by Friday.

What Does a “Replacement” Look Like?

Even though Congress is moving forward with plans to repeal the ACA, exactly what they would replace the ACA with is still unclear, and when changes will go into effect is also unknown.

Repealing the ACA will have a significant impact on the cancer community.  In previous blogs we have explained some of the consumer protections in the ACA, as well as the danger in only keeping protections for people with pre-existing conditions, without also keeping those consumer protections.

In this blog, we wanted to start to share with you one of the proposals that these leaders have advocated for, as they might be part of a “replacement.”

President-elect Trump has suggested that he would replace the ACA, with High Risk Pools. A high risk pool is a health insurance coverage option available for people with pre-existing conditions that is subsidized by the government.

History of High Risk Pools

High risk pools are not a new idea. In fact, more than 35 states had high risk pools to try to help people with pre-existing conditions access health insurance coverage, before the ACA became law.  While those high risk pools offered a lifeline for many people to get access to coverage when they couldn’t get it another way, they were not a solution to the problem. For example, in California, the state’s high risk pool only offered coverage up to $75,000 a year.  Cancer care is often much more expensive than that, which left people to pay for their care out-of-pocket. Many of those state high risk pools had 6-month waiting periods for coverage if you had a pre-existing condition, wait lists due to state budget constraints, and very high deductibles and out-of-pocket costs.

Kaiser Health News released a video in October, describing why high risk pools may sound like a good idea, but have some challenges in reality.

For a more detailed explanation of high risk pools and our past experience with using high risk pools to try to meet the needs of people with pre-existing conditions, visit: http://kff.org/health-reform/issue-brief/high-risk-pools-for-uninsurable-individuals.

We hope that our elected officials will keep these issues in mind as they make their decisions over the next few days, weeks, and months on any changes to health care system.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  1. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at http://familiesusa.org/share-your-storyor at canceradvocacy.org/blog/share-your-aca-story.

Do You Need Health Insurance Now?

We also want to remind you that change is Washington is rarely swift and that we may not see changes for most of 2017.  That means that we have to continue to operate with the system we have for now and ensure that people have health insurance coverage for 2017.  If you do not have health insurance coverage, you can apply for Medicaid at any time or purchase a policy through the State Health Insurance Marketplaces until January 31, 2017.

For more information about how to choose a health insurance policy (including making choices between employer-sponsored options), watch our recorded webinar. If you aren’t sure what your health insurance options are, our recently released toolkit, Finances 101, may be useful.

Stay Tuned

Stay tuned to our Blog and sign up for our newsletter, as we will continue to provide updates as more information becomes available in the coming weeks and months.