Healthcare Repeal and Replace Effort Takes a Possibly Fatal Blow

By Zach Cahill and David White

Repeal and Replace is Dead…

Is a headline that has run many times over the past few months, but the current Republican healthcare reform effort was certainly dealt a serious, if not lethal, blow early Friday morning, July 28.

When debate opened in the Senate on Tuesday, July 25, no one knew what bills were being considered or what leadership had in mind for a final vote. Over the past 72 hours, three different bills were presented and defeated. At 1:30 am Friday, the Senate voted down a bill that would have repealed a few parts of the Affordable Care Act without replacing any of it – this was referred to as the “skinny” repeal bill.

This was the final offer for Senate Republicans and was offered more as a strategy to get the Senate and House into a conference committee. Once the Senate and House entered into a conference committee, Republican leadership could write the bill in complete isolation and offer a new bill that members would only be able to vote up or down without amendments – one that would likely have included massive cuts to Medicaid and an end to Medicaid expansion as the bill passed by the House and the originally proposed Senate bill both did. 

Earlier in the week, Senator John McCain (R-AZ) returned to Washington after having undergone surgery just days earlier to remove a blood clot related to a brain cancer diagnosis. He was expected to play a key role in getting the Republicans to the number of votes they needed.  And while he voted earlier in the week to allow debate on the healthcare bill to proceed, he promptly followed that vote by an impassioned speech criticizing the secretive process the Senate leadership used to develop the bill. 

The drama came to a climax around the earliest hours of July 28 when Senator McCain cast the deciding vote by literally giving the “thumbs down” on the Senate floor.  For all intents and purposes, Senator McCain’s thumbs down ended the Senate’s attempt at repeal and replace – for now.  The reconciliation process used by the House and Senate to move these bills is still available until the beginning of the next fiscal year and/or the passage of the FY 2018 budget.

The bills voted on in both chambers of Congress have been of great concern to the American Society of Nephrology (ASN). 

In the last two months, ASN has raised concerns about the direction the Senate was taking with the healthcare reform bill, reflecting the ASN’s Guiding Principles for Healthcare Reform, and highlighting that it could have harmful effects on millions of Americans – including the 40 million Americans with kidney diseases and the nearly 700,000 with complete kidney failure.  ASN’s critique focused on the impact to kidney patients of policies that reduce coverage, remove protections, and drastically cut Medicaid coverage.  

ASN pointed out that Americans with kidney diseases disproportionally represent the vulnerable populations that Medicaid serves. ASN maintained that jeopardizing the individual insurance market and reducing coverage protections could be detrimental to these patients and all patients with chronic disease who need early detection and treatment.  Moving forward, ASN has offered to work with both chambers of Congress and the relevant committees to find solutions to stabilize the individual insurance markets and address gaps in current law.

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Zach Cahill and David White
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Repeal and Replace is Dead…

Is a headline that has run many times over the past few months, but the current Republican healthcare reform effort was certainly dealt a serious, if not lethal, blow early Friday morning, July 28.

When debate opened in the Senate on Tuesday, July 25, no one knew what bills were being considered or what leadership had in mind for a final vote. Over the past 72 hours, three different bills were presented and defeated. At 1:30 am Friday, the Senate voted down a bill that would have repealed a few parts of the Affordable Care Act without replacing any of it – this was referred to as the “skinny” repeal bill.

This was the final offer for Senate Republicans and was offered more as a strategy to get the Senate and House into a conference committee. Once the Senate and House entered into a conference committee, Republican leadership could write the bill in complete isolation and offer a new bill that members would only be able to vote up or down without amendments – one that would likely have included massive cuts to Medicaid and an end to Medicaid expansion as the bill passed by the House and the originally proposed Senate bill both did. 

Earlier in the week, Senator John McCain (R-AZ) returned to Washington after having undergone surgery just days earlier to remove a blood clot related to a brain cancer diagnosis. He was expected to play a key role in getting the Republicans to the number of votes they needed.  And while he voted earlier in the week to allow debate on the healthcare bill to proceed, he promptly followed that vote by an impassioned speech criticizing the secretive process the Senate leadership used to develop the bill. 

The drama came to a climax around the earliest hours of July 28 when Senator McCain cast the deciding vote by literally giving the “thumbs down” on the Senate floor.  For all intents and purposes, Senator McCain’s thumbs down ended the Senate’s attempt at repeal and replace – for now.  The reconciliation process used by the House and Senate to move these bills is still available until the beginning of the next fiscal year and/or the passage of the FY 2018 budget.

The bills voted on in both chambers of Congress have been of great concern to the American Society of Nephrology (ASN). 

In the last two months, ASN has raised concerns about the direction the Senate was taking with the healthcare reform bill, reflecting the ASN’s Guiding Principles for Healthcare Reform, and highlighting that it could have harmful effects on millions of Americans – including the 40 million Americans with kidney diseases and the nearly 700,000 with complete kidney failure.  ASN’s critique focused on the impact to kidney patients of policies that reduce coverage, remove protections, and drastically cut Medicaid coverage.  

ASN pointed out that Americans with kidney diseases disproportionally represent the vulnerable populations that Medicaid serves. ASN maintained that jeopardizing the individual insurance market and reducing coverage protections could be detrimental to these patients and all patients with chronic disease who need early detection and treatment.  Moving forward, ASN has offered to work with both chambers of Congress and the relevant committees to find solutions to stabilize the individual insurance markets and address gaps in current law.

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