The U.S. Senate continued to debate a potential repeal of at least part of the Affordable Care Act, also known as â€œObamacare,â€ on Thursday night. Itâ€™s not clear what the Senate will eventually approve.
Itâ€™s also not clear what type of agreement the Senate can reach with the U.S. House of Representatives, if the Senate passes a bill. The House has already passed its own bill, the American Health Care Act.
On Thursday night, the Senate debate was focused on a so-called â€œskinny repeal,â€ which would roll back parts of the Affordable Care Act, or ACA. It would repeal the mandates that most people have health insurance and that large employers cover their employees, but it would leave most of the health law in place, The New York Times reported.
It wasnâ€™t clear if the Republican-controlled Senate had the votes to advance the legislation.
The vote on â€œskinny repealâ€ expected tonight comes after Senate Republicans were unable to reach consensus on broader legislation to repeal and replace the Affordable Care Act and after an earlier repeal bill failed on Wednesday.
The health care debate in the Senate started with a 51-50 vote on Tuesday.
As the health care debate has played out in Congress this year, there has been some concern in Oak Ridge and Anderson County over the potential repeal of the Affordable Care Act, which was signed into law by President Barack Obama in March 2010. Itâ€™s considered his signature domestic legislative achievement.
There has also been some concern here over possible Medicaid cuts.
In May, a small group of residents had a spur-of-the-moment protest during a ribbon-cutting ceremony at the renamed Rocky Top post office to let U.S. Representative Chuck Fleischmann know that they werenâ€™t happy with his vote on the Houseâ€™s American Health Care Act. That bill, which would repeal and replace major parts of the Affordable Care Act, passed in the Republican-controlled House on Thursday, May 4, in a 217-213 vote.
Last week, Jennifer Enderson, president of Emory Valley Center, outlined concerns about potential Medicaid cuts that could affect EVC and other agencies across the state. As of Monday, July 17, there was still $770 billion in Medicaid cuts proposed in health care legislation, according to information provided by Enderson.
â€œThis could affect people with intellectual and developmental disabilities that rely upon Medicaid (TennCare) for their long-term services and supports such as personal assistance, transportation, respite, employment, and community integration,â€ according to information that was provided by Enderson and forwarded from the Arc of Tennessee, described as the nationâ€™s largest and leading organization for people with intellectual and developmental disabilities.
An estimated 102,000 Tennessee residents have intellectual or developmental disabilities, the information said. These are most often lifelong disabilities, including Down syndrome, cerebral palsy, spina bifida, autism, traumatic brain injury, and others.
â€œIf Medicaid is capped, the needs are still there, but will shift to states, families, and communities,â€ the Arc information said.
In Tennessee, Medicaid funds long-term services and supports for people with intellectual or developmental disabilities through programs that include Medicaid waivers and other programs. The long-term services and supports provided through the programs allow people to live in their home communities and their family members to remain in the workforce, the information said. The services and supports include family supports, employment supports, transportation, respite, community integration services, and personal assistance.
Those home- and community-based services and supports are optional in the Medicaid plan and therefore have a high risk of being cut, the Arc information said.
If states cannot afford to offer home- and community-based services, then there could be even longer waiting lists for those services. Also, institutional care could be the only option for people with significant disabilities, and â€œmore people would sit at home waiting for services and losing valuable skills learned in school and other programs,â€ the information said.
Enderson said EVC employees and board members have contacted U.S. senators Lamar Alexander and Bob Corker, both Tennessee Republicans, on multiple occasions to outline their concerns regarding the proposed legislation.
The â€œskinny repealâ€ being considered Thursday reportedly doesnâ€™t deal with Medicaid at all, including the Affordable Care Actâ€™s Medicaid expansion, but itâ€™s not clear if changes to Medicaid might come up later, such as in a House-Senate conference.
Those protesting the House bill in Rocky Top in May said they wanted to hold Fleischmann accountable for his House vote, no matter what happens in the Senate. One of their primary concerns was the potential rollback of protections for people with pre-existing conditions. Before the Affordable Care Act, a pre-existing condition could beÂ a major obstacle to someone trying to buy health insurance on their own.
â€œThe ACA corrected that,â€ Oak Ridge resident Joan Nelson said.
There are many other parts of the House bill that could hurt Tennesseans, Nelson said, including the cuts to Medicaid and to taxes that have supported the Affordable Care Act. The tax cuts would mainly benefit the rich and super rich, â€œTrump and his buddies,â€ Nelson said.
She said low-income residents would pay more for health insurance under the House bill, and the cuts would fall most heavily on working families, children, people with disabilities, and seniors who use Medicaid for nursing home care.
â€œThey have basically repealed the ACA, and they have not replaced it,â€ Nelson said.
Her husband, Jim Nelson, said the ACA helped him. Nelson was laid off when he was 63 and was temporarily without insurance. There was no policy at any price that would cover his pre-existing conditions, Nelson said.
â€œSo, at age 64, and with several pre-existing conditions, I was without adequate coverage,â€ Nelson said. â€œI was literally living on borrowed time.â€
But he was able to â€œhang onâ€ until the Affordable Care Act was fully enacted in early 2014, Nelson said. His insurance policy then allowed him to pay for his doctor visits and the medications needed to treat his chronic conditions, Nelson said.
â€œNo questions asked except my age and whether I smoked or not,â€ he said. The insurance covered his pre-existing conditions, a range of preventive services, and other features that adequate policies should cover, Nelson said.
Nelson later became eligible for Medicare when he turned 65.
He said he worried about a return to the days of an unregulated, for-profit health care system, whether millions of hard-working Americans could lose access to decent care. Under the House bill, billions of dollars could be diverted from health care to the wealthy, Nelson said.
â€œWe feel like it was very poorly thought out and mean-spirited,â€ he said of the House bill.
Others also worried about people who could lose health insurance.
â€œOr it will become so expensive that they canâ€™t afford it,â€ Norris resident Kathy Decker said.
Anderson Walsh, 17, of Oak Ridge, said he was worried about the estimated 24 million people who could lose their health insurance under the House bill. He has a pre-existing condition, a heart defect known as a bicuspid aortic valve. He wouldnâ€™t be directly affected, but he could be indirectly affected, Walsh said. Among other things, Walsh, who will need costly surgery someday, said he was concerned about potential lifetime caps.
His mother, Ann Walsh of Oak Ridge, said the Affordable Care Act was a â€œbaby step in the right direction.â€
â€œIt is time for universal health care,â€ she said. â€œMedicare for all. For-profit health care will never be in the best interest of the patient.â€
Asked about the protesters, Fleischmann cited their First Amendment right to peacefully assemble and thanked them for expressing their opinions.
Obamacare is “imploding,” “falling apart,” Fleischmann said. The House vote was a step in the right direction, but it would change in the Senate, Fleischmann said.
Among the changes approved by the House were more choices, removing tax penalties, and giving more power to states, Fleischmann said. Democrats are welcome to help fix the legislation, he said, but they are clinging to the Affordable Care Act in â€œdogmatic fashion.â€
Fleischmann said he is opposed to the individual mandate in the Affordable Care Act that requires people to buy insurance.
â€œPeople are literally begging me to repeal Obamacare,â€ he said.
The congressman, whose district includes Oak Ridge, released a statement after the House vote in May.
â€œFor far too long, Obamacare has hurt American families by not keeping its promises of lowering costs, while increasing patient choice,â€ Fleischmann said. â€œThat is why I voted in favor of the American Healthcare Act.Â This bill will reduce premiums, stabilize the market, and ensure patient choice.Â While there is more work ahead to rebuild our broken healthcare system, passing this legislation was a critical first step. I look forward to collaborating with my Senate colleagues to give the American people the healthcare they deserve.â€
The New York Times has previously reported that the House bill would eliminate tax penalties for people who go without health insurance, and it would roll back state-by-state expansions of Medicaid, which cover millions of low-income Americans. The bill would offer tax credits, depending upon age, in place of government-subsidized insurance policies.
The nonpartisan Congressional Budget Office said the first version of the bill would trim the federal budget deficit considerably but also leave 24 million more Americans without health insurance after a decade.
As the Senate has more recently debated health care legislation, there have continued to be concerns about the number of people who could lose health insurance if the Affordable Care Act is repealed, the possible impact on those with pre-existing conditions, and the potential Medicaid cuts. In a report released Thursday night, the CBO said 15 million more people would be uninsured by 2026 under the GOP â€œskinny repealâ€ bill. ItÂ would decreaseÂ federal budgetÂ deficits by about $179 billion over a decade, according to the budget office.
On July 13, Alexander, chair of the Senate health committee, said his first concern was helping the 162,000 low-income Tennesseans who currently have no help with their health insurance and the 350,000 Tennesseans who may not be able to buy insurance in the individual market next year.
His goals remain unchanged since May, Alexander said: Help the thousands of Tennesseans and millions of Americans who will be trapped in â€œcollapsingÂ AffordableÂ Care Act exchangesâ€Â with fewÂ or even zero options for health insurance in 2018 unless Congress acts; lowerÂ premium costs, which have increased under the ACA; gradually give states more flexibility on the Medicaid program, but do it in a way that does not â€œpull the rug out from under peopleâ€ who rely on the federal program; and make sure those with pre-existing conditions have access to insurance.
Alexander has been in favor of repealing and replacing the Affordable Care Act at the same time. He voted in favor of a motion to proceed on the House bill on Tuesday, although that bill is not currently being considered.
Corker also voted on the motion to proceed on Tuesday. Senators on both sides of the aisle will be able to offer amendments and have their voices heard, Corker said after that vote.
â€œI am hopeful that the final product developed by both chambers will be one that works better for the American people than what is in place today,â€ Corker said.
On Thursday, Corker said he believes the â€œbest path forwardâ€ is for Congress to repeal the Affordable Care Act after a reasonable transition period.
â€œThis takes us back to a level playing field where, by a date certain, all sides have incentive to work together to develop a health care replacement that can generate broad support and will stand the test of time,â€ Corker said. â€œRegardless of how we move forward, it is my hope that our focus will be not only on coverage but also on lowering the actual cost of health care.â€
In March, Alexander introduced, along with Corker, legislation that he said would â€œrescueâ€ Americans with Affordable Care Act subsidies who have no options for health insurance on the exchanges in 2018.
This month, Alexander said the Senate health committee has a responsibility to hold hearings during the next few weeks to continue exploring how to stabilize the individual marketsâ€”no matter what happens with the health care bill.
â€œI will consult with Senate leadership, and then I will set those hearings after the Senate votes on the health care bill,â€ Alexander said.
On Thursday, Alexander said millions of Americans are worrying that they may not be able to buy insurance in 2018. If the legislative process can move to a conference committee between the House and Senate, Alexander said he is convinced that â€œweâ€™ll be able to agree on a way to improve the Affordable Care Act.â€ That means major parts of the 2010 law could be repealed and replaced with parts that work better, including provisions that transfer responsibilities to the states to â€œmake decisions that give consumers more choices of health insurance at lower costs,â€ Alexander said.
You can watch live vote tallies from the Senate in this New York Times voteÂ tracker.
More information will be added as itÂ becomes available.
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