Wednesday, December 28, 2016

#NoRepealWithoutReplace: Tweet to save the ACA

A quick review of the cliff's edge the ACA is up against -- and (perhaps) how to back off it:

1. Republicans are vowing to use budget reconciliation to repeal the core elements of the ACA by February, delaying the defunding of some or all benefits for 2-3 years while they allegedly craft and enact a replacement..

2. As Republicans will have a 52-48 majority in the 115th Congress, insta-repeal can be stopped if three or more Republican senators balk at repeal-and-delay, calling instead for simultaneous repeal-and-replace (none of them will take a stand outright for preserving and amending the ACA).

3. Eighteen Republican senators represent states that have enacted the ACA's Medicaid expansion, which has by itself cut the ranks of the uninsured by about 20% nationwide -- and by more than that in many expansion states.

4. Governors in expansion states are extremely queasy about rolling back coverage, which would create severe hardship for hospitals as well as enrollees. That goes for Republican governors as well as Democrats.

5. If the Republican Congress passes repeal-and-delay and makes repeal of the taxes that fund ACA benefits effective immediately, the Medicaid expansion is doomed, regardless of whether it's funded during the delay period. There will be no money to extend it in a "replace" bill. That's doubly true if Republicans block-grant Medicaid.

6. The time to act is now, while members are home, before the 115th Congress reconvenes on January 3 [or in the weeks following!].

While social media is no substitute for direct contact by constituents, it's one arrow in the quiver. I've created a list of Republican senators' Twitter handles.  I"m no social media expert, but to do what I can, I'd like to solicit ideas to generate and mutually support contextual (mass?) tweeting at those who might be persuadable.  I don't want to duplicate efforts in progress -- if you know of a train to jump aboard, please let me know.

I tried a few this morning. Here's one in response to this from Rob Portman, R-Ohio:

I love taking my family to our  parks, such as my favorite @CVNPNPS. Important we preserve these treasures:
Others here here and here.

For supporting stats, Families USA has posted fact sheets about the effects of the ACA in each state, starting with how many people stand to lose coverage under repeal. State-by-state totals for the expansion of Medicaid enrollment from Sept. 2013 to Sept. 2016 is provided by CMS here.

There should be a better hashtag than #NoRepealWithoutReplace -- but as no Republican will openly support preserving the ACA, #SaveTheACA won't do.  "No repeal without replace" is the goal. One suggestion sent to me was #NoReplaceNoRepeal -- is that better? [Update: Families USA and allies are using #ProtectOurCare -- it's probably best to join the chorus.]

Update: below, a rough and tentative list of Republican senators who might hesitate to inst-repeal the ACA (most but not all in Medicaid expansion states):

Susan Collins, Maine
Lamar Alexander, Tennessee
Bob Corker, Tennessee
John McCain, Arizona
Jeff Flake, Arizona
Dean Heller, Nevada
Pat Toomey, Pennsylvania
Rob Portman, Ohio

And based on even thinner hunches/hints/inferences based on situation:

John Hoeven, North Dakota
Richard Burr, North Carolina
Steve Daines, Montana
Bill Cassidy, Louisiana
John Kennedy, Louisiana
Chuck Grassley, Iowa
Cory Gardner, Colorado

Update II, 1/8/17: To everyone's shock, Rand Paul (KY) and Tom Cotton (AR) have expressed reservations about repeal-and-delay as opposed to simultaneous repeal-and-replace. Both are in states with enormously successful Medicaid expansions that are mainly responsible for slashing each staet's uninsured population nearly in half (44%) in Arkansas or by more than half (57%) in Kentucky.

Update III, 1/9: As reported today by the startup political news site Axios, nine Republican senators so far have expressed qualms about repeal-and-delay:  Susan Collins, John McCain, Lamar Alexander, Rob Portman, Ron Johnson, Bill Cassidy, Tom Cotton, Bob Corker and Rand Paul. While some have intimated that they'll vote for a repeal-and-delay bill if it comes to the floor, , it's also true that the larger the queasy contingent, the likelier it is that a subset will make a stand (and only three are needed to kill passage via reconciliation). It's also possible that the queasies will insist that repeal of key features such as taxes that the fund benefits or the individual mandate be delayed along with the premium subsidies and Medicaid expansion -- and that the hard-core right wing may then in turn balk, on grounds that the bill is a "repeal" only in name.

If you have any suggested additions/subtractions, please let me know.

P.S. Those who are hell-bent or boxed into swift repeal may be flexible as to which repealed provisions will get a stay of execution -- for example, whether repeal of all or some taxes will be delayed along with repeal of Medicaid expansion and marketplace subsidies.

1 comment:

  1. I would like to see Pat Toomey not repeal without replacement, but I am not hopeful - PA came through bigly for Trump and Toomey, and Toomey is now safe for six years. He is also a "fiscal conservative", so he wants to cut spending - subsidies/Medicaid. OK, I am calling his office, also Casey and Gov Wolf.
    Burr also won reelection, and NC didn't even expand Medicaid, so I doubt he will help.
    Gardner won by waving around his "they took away my insurance" letter, so I am skeptical - but he's coming up for reelection in 2020 in bluish Colorado. Maybe there is some hope with pressure.