Thoughts on the Historic US Senate Debate Over Health Care Reform

capitol-buildingAt around 2 a.m. this morning, the U.S. Senate’s effort to pass a bare-bones health care reform bill (the ‘skinny’ bill) to repeal parts of the Affordable Care Act (ACA) failed when Sen. John McCain (R-Ariz.) joined  Republican Senators Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska) to cast the deciding vote in opposition. Over the last three days, Senate leadership has tried repeatedly to rally the necessary votes to pass legislation that would either repeal the ACA or remove what many regard as the most offensive parts of the law. In a dramatic climax to the week, Sen. McCain gave a thumbs down to what was considered the Senate’s final option to end former President Barack Obama’s signature health care legislation.

Here’s how the week unfolded:

  • Tuesday, July 25: The Senate narrowly votes (51-50 with Vice President Mike Pence casting the tie-breaker vote) to open debate on HR 1628, the ACA repeal and replace bill passed by the U.S. House of Representatives in May. North Carolina Senators Richard Burr and Thom Tillis both voted to open debate.
  • The Senate promptly attempted to gut the House bill and substituted it with an amendment, which included the Senate’s earlier plan, the Better Care Reconciliation Act, along with modifications attempting to curry support among key Republicans including proposals allowing insurance companies to offer bare-bones, low-cost coverage plans and offering aid to low-income Americans who would have had to purchase private insurance after being dropped from Medicaid rolls. This plan failed when nine Republicans broke rank with party leadership and opposed the bill. Sens. Burr and Tillis both voted in favor of passage.
  • On Wednesday, July 26, Senate leadership brought forth a straight repeal bill that would have eliminated the individual and employer mandates, ended Medicaid expansion and rolled back the ACA’s many tax laws. This proposal would have had a two-year transition period, during which a replacement plan could have been devised. The bill failed to pass on a 45-55 vote with seven Republican Senators voting against it. Senators Burr and Tillis voted in favor of passage.
  • Finally, Senate leaders introduced the ‘skinny bill,’ which sought to repeal the ACA’s individual and employer mandates and the medical device tax. It also would have given insurance companies more flexibility to offer plans that don’t comply with ACA regulations. This bill failed in a 51-49 vote with Sen. McCain casting the decisive vote. Senators Burr and Tillis voted for passage of the bill.

Throughout this most recent debate over health care reform and since passage of the ACA, the North Carolina Medical Society (NCMS) has remained engaged with our Congressional delegation and focused on how the policy in each of the proposals impacts your patients and you. We have pushed to maintain or improve upon the number of North Carolinians who have affordable, meaningful insurance coverage as well as   a predictable and sustainable future for both Medicare and Medicaid. Most recently, we have joined with a coalition of other medical societies nationally and with the North Carolina Hospital Association to address our concerns to Senate leadership and Senators Burr and Tillis.

We hope that those real conversations can continue to focus on how to fix the problems with the ACA and achieve affordable, effective  coverage for as many citizens as possible. We look forward to continuing to work collaboratively with our U.S. Senators and Representatives to fashion strong, innovative and cost-effective policy, driven not by political concerns but by the needs of your patients.

We appreciate your input and invite you to continue to comment to help us understand your thoughts on this important issue.



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