Take Action Now to Stop the American Health Care Act

Senate Republicans are moving forward with an extremely unpopular proposal to upend the Affordable Care Act – and they’re doing it in the most secretive way possible. Despite the fact that they still haven’t published their bill, legislators want to push through a vote before July 4.

Regardless of your political opinions on health care, the Affordable Care Act or Republicans, rushing major health care legislation through without due consideration is wrong.

It’s imperative that you act, and we’re going to show you how. In a hurry? You can skip right to the action section.

What’s the backstory?

Following the election of President Barack Obama in 2008, Congress embarked on an ambitious and lengthy project to reform health care — one of the president’s key campaign promises. In committee, it took months to fully develop and mark up the bill that eventually became the Affordable Care Act. The effort entailed hours of debate, and the bill was made available for review by the public.

From the start, the Affordable Care Act has been unpopular with many conservatives. The legislation contains a number of key provisions, but here are some of the most important:

• Ten “essential benefits” that insurers must cover, such as mental health and pregnancy, with a ban on annual and lifetime coverage limits for these benefits.
• A ban on denial of coverage on the basis of preexisting conditions.
• A radical expansion of Medicaid, the program that extends health coverage to millions of low-income Americans. Under the Affordable Care Act, 20 million people got insurance in participating states.
• Restrictions on “market rating,” the practice that allows insurers to charge differentially on the basis of age, gender, location or other factors. The ACA allows geographic and age-based differential pricing, but restricts the amount of pricing variance.
• Dependents up to age 26 can remain on their parents’ health insurance.
• Rescission, in which policyholders are dropped because they get sick, is banned.
• Certain preventative services, including mammograms, colonoscopies and annual exams, must be covered with no charge.
• Employers with more than fifty employees must provide health insurance.
• Certain high income earners face moderate tax increases, as do pharmaceutical companies.
• Americans are subject to the individual mandate, a requirement that they carry health insurance coverage, with several standardized tiers of coverage available for people with different needs.

Republicans have threatened to repeal and replace the Affordable Care Act in every campaign cycle, and President Trump made doing so a cornerstone of his campaign.

What’s the latest?

The good news: Republicans don’t have the votes to repeal and replace the Affordable Care Act.

The bad news: They can use a process called budget reconciliation to selectively strip key provisions of the ACA. In the short term, this will have a tremendous impact on many health care consumers, and in the long term, it will cause the ACA to collapse by defunding some of its most important aspects.

In May, the House passed the American Health Care Act by a narrow margin after moving it very rapidly through committee and a floor vote. The Congressional Budget Office estimated that the legislation would reduce the deficit — the stated goal of conservatives — and that by 2026, 23 million people would be uninsured.

Now, the Senate is working on its own version, but GOP leaders are refusing to release a draft bill for public review. Additionally, the bill hasn’t yet been scored by the Congressional Budget Office, which evaluates the fiscal impact of proposed legislation. Because it’s a reconciliation bill, it just needs a simple majority — 51 votes — to pass.

We don’t know exactly what’s in the Senate bill, because we can’t see it, but what we’ve gleaned doesn’t look good. Based on the House bill and what Republican senators have let slip, we could be looking at:

• A repeal of the Medicaid expansion and deep cuts to Medicaid.
• Changes to the tax credit system used to help people buy insurance.
• A waiver system that would let states lift restrictions on ratings, with older adults potentially paying a lot more for health insurance.
• A blow to the ten essential benefits by allowing states to waive that coverage requirement.
• Policies making it functionally impossible to obtain abortion coverage on an insurance plan.
• Elimination of the Prevention and Public Health Fund, which works to improve the quality of public health in the U.S.
• The return of “high risk pools,” a costly, inefficient and often ineffective method of covering people considered “uninsurable.”
• While insurers wouldn’t be allowed to ban or drop people with preexisting conditions, in states that applied for waivers, they could redefine and charge more for coverage. That would make it expensive and difficult for someone to get coverage with a preexisting condition if they’ve allowed a policy to lapse and they need care again. Changes to pricing could also push people off a policy by making it unaffordable.

If the Senate version passes, the bill will go to a conference committee that will negotiate over the differences between the two bills and develop a single, streamlined version. The House and Senate would need to vote on the finished bill before it could be sent to the White House for signature or veto.

Th bottom line? Many Americans believe the Affordable Care Act needs reform and that the U.S. has some significant health care challenges, regardless of party. However, conservative legislators are rushing the AHCA through without careful consideration or attention — and that could have devastating results for the future of health care.

Voters across the country have turned out to town halls to make their voices heard, even though their representatives sometimes don’t show up — or try to stop proceedings early. The majority of voters in the U.S. support the Affordable Care Act and oppose the AHCA.

What can I do?

Contact your senators. If you can, call them. You can also visit their district or Washington, D.C. offices, fax them or send them snail mail. Be sure to include your full name and address to be counted. You can find contact information on the Senate website.

Only call your senators: Out-of-state callers cannot be counted, and they block access for legitimate constituents. Instead, pledge to phone a friend — or three — when you’re done calling to encourage them to contact their elected officials.

If you’ve never called elected officials before, don’t worry! It’s a straightforward process, and you can rally some friends to do it as a group if you’re feeling nervous. Your senators work for you, whether or not you voted for them. By calling local district offices, you can also connect with someone close to your community who will understand where you’re coming from.

For Democratic senators:

Democrats have broadly said that they stand against the bill and intend to vote in opposition. However, it’s important to call and affirm your support for that choice — and to share your story. Democratic senators will use what you tell them in conversations with colleagues, and they may talk about examples from their constituents while speaking out on the floor.

Keep your remarks brief, but personal. Consider issues relevant to your area and your senator’s stated values and think about including a remark that references them.

For example, you might say:

I would like to thank the senator for her opposition to the American Health Care Act. The Affordable Care Act has allowed me/a family member/a loved one to obtain health care for a chronic medical condition/a serious illness/a healthy pregnancy and that would not have been possible before. It’s important to me to retain access to health care for all Americans, because health care is a human right that also creates economic and social opportunities. I know that economic recovery/health care excellence/small businesses are important to the senator, and the ACA supports these goals.

For Republican senators:

While the GOP likes to claim it has a united front, some Republicans have expressed concerns about provisions in the AHCA, as well as the lack of transparency. They include Lisa Murkowski of Alaska, Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Susan Collins of Maine, Lindsey Graham of South Carolina, Jeff Flake of Arizona, Dean Heller of Nevada and Cory Gardner of Colorado.

In other words, don’t assume your senator(s) support the bill! Start by asking the staffer for the senator’s position on the bill. If the staffer indicates that the senator hasn’t taken a position yet or is still weighing things over, tell them you hope the senator will consider taking an opposing stance. Again, stay brief, but personal — and appeal to the senator’s known political positions. You can use this overview of the impacts of the American Health Care Act by state to customize your call.

For example:

I’m disappointed to hear that! The lack of transparency surrounding the bill concerns me, as I think everyone should have an opportunity to read it before bringing it to a vote. I know the senator cares about the welfare of her constituents, and I hope she is considering the economic impacts of the AHCA, as well as the number of people who might lose insurance coverage under the bill. I would also like the senator to know that I/a family member/a loved one has been able to access health care for a chronic condition/serious illness/emergency because of the ACA, and I don’t know what we would have done without it.

If you have a story to tell, tell it! Instead of saying something formulaic like “The Affordable Care Act helped me get coverage for cancer last year,” say “When I was diagnosed with liver cancer, I was very concerned that it might bankrupt our family. I was grateful for my ACA coverage, which helped me access the treatment I needed. While I’m in remission now, I don’t want anyone else to have to worry about the cost of cancer care.”

Humanize yourself to staffers so they can put real names and stories to abstract figures.

If your senator supports the American Health Care Act, let them know you’re not happy about it. Remember that staffers aren’t responsible for their senators’ positions, so stay friendly, even if you’re feeling impassioned.

You could say:

I’m sorry to hear that. I was hoping that the senator would change her mind after seeing so many public health and medical organizations warn that the AHCA could be very dangerous for the welfare of millions of Americans. I’m worried that I might lose my health care coverage, or that changes to my coverage would make it hard for me to get care for my diabetes/pregnancy/chronic illness/etc. I’m also concerned about friends, family, and community members who are benefiting from the Medicaid expansion and other important provisions of the Affordable Care Act.

Please ask her to reconsider the fiscal and public health effects of this bill, especially in light of the fact that Republicans are refusing to make it available for public review. I am concerned that the lack of transparency and short timing means that some senators may be voting on a bill they haven’t had an opportunity to read and carefully consider.

And remember, your voice matters in protecting accessible and affordable health care.

Take Action!

Add your name to this Care2 petition to demand that the Senate brings the bill to the floor for public debate!

Photo credit: Ted Eytan