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- 1 How You Can Resist
- 2 Recent Updates
- 3 What We Know About the Senate Healthcare Bill
- 4 Impact of Health Care Bill Passed by the House
- 5 Vulnerabilities
How You Can Resist
- Call your Senator by dialing tel:844-6-RESIST and tell them to oppose Trumpcare.
- Find out when your Senators are holding town halls and other Upcoming Events/Opportunities. Show up and tell them to oppose Trumpcare.
- Call your Representative by dialing tel:844-6-RESIST and tell them how you feel about their vote on repealing the Affordable Care Act. See the complete list of how each representative voted here.
- Find health-care organizations with volunteer opportunities, with nationwide networks of groups, and with information and opportunities for online activism.
- Visit Trumpcare Toolkit and Trumpcare Ten to contact senators who could provide the deciding votes against Trumpcare. See Our Amendments to submit an amendment to Trumpcare, which could slow down the process of passing the bill. See how your senator is planning to vote here.
- 8/4/17 The Senate passed a bill called "right to try", which expands terminally ill patients' access to treatments that are not yet approved by the FDA.
- 7/27/17 The Senate voted to reject the "skinny" version of a new health bill after all 49 democrats, and three Republicans voted "no." The deciding Republican votes were Susan Collins (ME), Lisa Murkowski (AK), and John McCain (AZ.) After this deciding vote, Republicans do not have further plans, for now, to revise or repeal the Affordable Care Act. 
- 7/25/17 The Senate voted to open debate on a bill to repeal major parts of the Affordable Care Act (ACA/Obamacare). But only a few hours later, the Senate did not get the 60 votes needed to pass their most detailed plan to replace the ACA. The Senate is now moving ahead with debate, amendments (changes) and a final vote over the next few days. If a bill is passed, it would have a big effect on the American health care system. In addition to all the other problems this would cause, health care accounts for almost one-sixth of the United States’s economy.
What We Know About the Senate Healthcare Bill
Senate Republicans plan to secretly write versions of a new bill and release the draft right before it comes up for a vote, at the end of July. The Senate has also proposed an option to repeal Obamacare with no replacement. On July 25, only two Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the motion to start debating the bill, though a few other Republicans had been expected to vote no as well. No Democrats voted in favor to debate a Republican replacement bill.
The June 25 vote was on a detailed amendment (or update) meant to please conservatives and moderates in the Republican Party. One proposal, offered by Senator Ted Cruz, Republican of Texas, would have allowed insurers to sell stripped-down "skinny" health plans, without maternity care or other benefits required by the Affordable Care Act, if they also sold plans that included such benefits. The amendment also included money to help pay out-of-pocket medical costs for low-income people, including those who buy private insurance after losing Medicaid coverage as a result of the Senate bill. This proposal was written by Senator Rob Portman, Republican of Ohio, and other senators from states that have expanded Medicaid under the Affordable Care Act.
Nine Republicans, both conservative and moderate, voted against the package.
Next steps include 20 hours of debate on 2 out of 3 major Republican proposals:
- Full repeal, with no replacement—Failed to pass with a vote of 43–57
- Partial repeal—This version would repeal the coverage provisions in the Affordable Care Act, including the individual mandate (requiring everyone to sign up for insurance or receive a penalty), Medicaid expansion, and premium subsidies, but it leaves in place insurance market reforms, like ensuring a base level of coverage.—Still requires a vote
- "Skinny" repeal—This version would repeal several parts of the ACA, but leave the Medicaid program. This would not lower premiums or eliminate ACA insurance regulations.—Still requires a vote
Once debates are over at the end of July, the Senate will vote on dozens of amendments introduced by both Democrats and Republicans, leading up to a final bill.
Impact of Health Care Bill Passed by the House
The American Health Care Act (Part II) is a Republican replacement bill for the Affordable Care Act that was narrowly passed by the House of Representatives on May 4, 2017. There were two big changes made at the last minute: First, the GOP tacked on an extra $8 Billion for High Risk Pools, which knocks the savings down to $142.3 billion. Secondly, they added an option for individual states to opt out of the pre-existing condition protections, which would let carriers strip policies down to bare bones, charge those with such conditions more for coverage and so on. 
- Unusually, this version of the bill was passed before the nonpartisan Congressional Budget Office could make a report on how many people would be covered under the bill and how much it would cost. Now that it has been completed, the new CBO score for the new AHCA (Upton Amendment included) has projected a loss of coverage for 23 million people in a decade.  It also estimates that 1/6 of the population will see a destabilization in their insurance markets by 2020. 
FIND UPDATED COVERAGE LOSSES BY CONGRESSIONAL DISTRICT
HEALTH COVERAGE LOSSES BY STATE (CBO SCORE UPDATE)
Impacts of Essential Health Benefits waivers.
- The bill allows states to waive (not require) rules requiring insurance companies to cover Essential Health Benefits, and rules that prevent insurance companies from charging some people more than others (known as community rating rules).. This could leave sicker people, those with pre-existing conditions, with higher costs, pushing them into expensive high-risk pools (which are supposed to reduce costs for the healthier population, but cost the state and individuals a lot of money).
- More than 130 million non-elderly Americans have preexisting conditions (chronic illnesses or past illnesses), and under the AHCA such people could end up spending thousands more on health insurance than they did under Obamacare. If a state files these waivers, it will be easier for insurers to discriminate against people who have a history of having more health problems. *The average extra cost for certain health conditions can be seen here.
Impacts on people with pre-existing conditions and community health ratings
- The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.
- This table shows what premiums will be required of single people making 175 percent the federal poverty line. It shows that the AHCA raises premiums for older, poor Americans by as much as 850%
Healthcare from Employers
- Under the AHCA, employers in states that use waivers can choose which regulations (10 Essential Health Benefits and requirements that would protect people with pre-existing conditions) they want to follow, to help lower the costs of their insurance plans. A company that operates in two states can drop protections allowed in one state, and use that same healthcare policy in another state that doesn't have a waiver. It's not clear whether employers would actually drop those protections. 
- Employers will not be required to offer insurance dating back to the beginning of 2016, and small businesses won't get tax credits to help offer insurance to their employees starting in 2020.
Healthcare from Medicaid/Medicare
- One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Before Obamacare, Medicaid was restricted to specific groups of low-income Americans (including pregnant women, the blind and the disabled). Obamacare opened up the program to anyone below 133% of the poverty line (about $15,000 for an individual) in the 31 states that opted to participate. Allowing more people to participate in Medicaid helped lower the rates for those who were uninsured. AHCA would end Medicaid expansion in 2020 and cut the program by $880 billion . Medicaid participation changes frequently because people's financial situation determines whether they are eligible. People who need to go back on Medicaid again, or for the first time, will not be able to do so after 2020.
- The per-person limits on Medicaid spending will disproportionately harm the people who need health care the most, including people with disabilities and the elderly.. The government would reimburse states using a "block grant," or one lump sum, instead of per-person payments. This would allow states to kick people off care, charge premiums, and cut benefits for children.
- Phasing out the Medicaid expansion would disproportionately impact Americans with disabilities, 10 million of whom are currently covered by Medicaid. The new proposal could also shift money away from schools, which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.
- The Congressional Budget Office has not yet estimated how the cost of privately purchased health care would change.
- The White House and House GOP members agreed to an amendment, the Upton Amendment, that adds $8 billion over 5 years to help sicker people pay for health insurance. But this amount of money is probably only enough to cover 76,000 of the 130 million people living with a pre-existing condition. Such people are put in so-called high-risk pools, with very high insurance premiums. The Center for American Progress estimates that the Upton Amendment will have "almost no effect".
Tax Cuts for the Wealthy
- Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes increases, leading to tax cuts of $883 billion. Most of these would benefit the wealthy, according to the Congressional Budget Office. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.
- The bill discontinues two taxes that helped to pay for Obamacare—a Medicare payroll tax and a 3.8% tax on investment income for people who earn over $200,000 (or couples who earn over $250,000).
- The bill lets people save more of their money in tax-free health savings accounts (about twice as much as what was allowed with ACA).. This allows wealthier people to get tax breaks through a pre-tax account, grow their funds tax-free, and use this money for healthcare expenses tax-free.
A Small Majority
In the Senate, there is a small Republican majority, of only 52 Republicans to 48 Democrats. This means that Republicans can only afford to lose three supporting votes.
Senate Majority Leader Mitch McConnell can try to pass the bill through "budget reconciliation," which is a simple majority vote, rather than the typical 2/3 majority required to pass legislation to overcome a filibuster. Budget reconciliation cannot be filibustered.
Budget Reconciliation/The Byrd Rule
One of the process’s most important provisions is that reconciliation bills must be about budgets only, not changing laws. That's why the measure to repeal ACA's individual mandate penalties seems allowable.  The Byrd rule in the Senate requires that all provisions in a bill that goes through the reconciliation process have to deal with the federal budget. That means various parts of the AHCA, like gutting Obamacare regulations on insurers and allowing states to waive essential health benefits and protections for people with pre-existing conditions, could fail to qualify in the Senate. 
Midterm Elections in 2018
Because the bill has passed the House, most resistance efforts will now focus on the Senate. Republicans who support the bill and are up for re-election in 2018 are most likely to respond to pressure to oppose passing the bill. These upcoming elections are especially important considering that just 31 percent of Americans are either "favorable" or "somewhat favorable" towards the ACHA.  9 Senate Republicans are up for re-election in 2018, and most of them come from consistently red states. The exceptions to this are Jeff Flake and Dean Heller. If you live in one of these states, call tel:202-224-3121 and ask for these senators' offices:
- Jeff Flake, Arizona
- Roger Wicker, Mississippi
- Deb Fischer, Nebraska
- Dean Heller, Nevada
- Bob Corker, Tennessee
- Ted Cruz, Texas
- Orrin Hatch, Utah
- John Barrasso, Wyoming
What to Say When You Call: "The AHCA will cause severe negative impacts on low-income people and only benefits the wealthy. I am calling to urge the senator to vote against the healthcare bill that was passed without an assessment from the Congressional Budget Office."
The Senate cannot take up the vote until the Congressional Budget Office finishes its analysis of its costs, which is expected to take one to two weeks.
On Thursday, May 4, Senator John Corbyn (R-Texas) said, "We're not under any deadline, so we're going to take our time." Senator James Lankford (R-Oklahoma) also said the version of the bill that the House approved is "definitely still not the final product."
See the complete list of how each representative voted .