Obamacare and Planned Parenthood Get Axed by Senate

WASHINGTON, D.C. — The Senate took a first step toward dismantling the Affordable Care Act, aka Obamacare, and defunding Planned Parenthood, and now the ball is in President Obama’s court.

But the president has already stated his intention: he will veto the bill.

The “Restoring America’s Healthcare Freedom Reconciliation Act” or less formally the “Obamacare repeal bill,” passed 52-47, with Sen. Susan Collins (R- Maine) and Sen. Mark Kirk (R- Ill.) joining the Democrat opposition.

Sen. Bernie Sanders (D- Vermont) was absent for the vote.

The new bill would dismantle the individual mandate, as well as the employer mandate — an unpopular provision that requires mid-size businesses to provide health insurance for workers.

Other major provisions of the bill include:

  • Reversing Medicaid expansion after a 2-year transition period.
  • Repealing certain tax increases including taxes on medical devices and prescription drugs
  • Preventing federal funds from reaching Planned Parenthood for 1 year.
  • Take new monies from repeal and invest them in Medicare Trust Fund.

An amendment sponsored by Sen. Dean Heller (R-Nevada) to repeal the “Cadillac tax”, a levy on expensive insurance plans slated to begin in 2018, also passed in a vote of 90-10.

But an amendment from Sen. Collins and Kirk and Sen. Barbara Murkowski (R- Alaska) to remove language targeting investments in Planned Parenthood failed.

President Obama will undoubtedly veto any bill that would hurt his signature law or restrict women’s reproductive rights. Nonetheless, Republican Senators are basking in the victory of the moment because it is the first time a repeal measure on Obamacare has passed the Senate.

And, the gesture, veto or no, is still meaningful for anti-Obamacare conservatives because it gives them a chance to flex their political muscle, put their aversion for the President’s health reform bill in writing and fulfill a promise to their constituents on the eve of an election year.

Before the vote began, Sen. Mitch McConnell (R-Kentucky), the majority leader, seemed to be suppressing a grin. “A new Senate that’s back on the side of the American people will vote to move beyond all of the broken promises, all the higher costs and all the failures,” he said.

“We will vote to build a bridge away from Obamacare and toward better care.”

Then Sen. Patty Murray (D-Washington) spoke, citing the millions of Americans who now have health insurance.

“I am ready, and I know our colleagues on this side are, to work with anyone who has good ideas about how we can continue making healthcare more affordable, and expanding coverage and improving quality of care, but the legislation we have spent the last few days debating, which has no chance of becoming law, will do the exact opposite.”

She continued, “I hope, once this bill reaches the dead-end it has always been headed for, Republicans will drop the politics and work with us to deliver results for the families and communities we serve.”

Under budget reconciliation, a special process that pertains only to revenue-related programs, and can’t be filibustered — it requires only 51 votes, instead of 61 to pass. It also allows unlimited amendments and 20 hours of negotiation.

Sen. Elizabeth Warren (D- Mass.) , responded to the conservative attack on Planned Parenthood, which was exacerbated in recent months by reports that centers used fetal tissue for research. She stressed that no federal funds are currently being spent on abortion, under the Hyde Amendment, calling the bill “a reckless scheme.”

“This isn’t a game for the millions of women who depend on Planned Parenthood for basic medical care every year and have nowhere else to go.”

Sen. Harry Reid (D- Nevada) who defended the Affordable Care Act earlier on Thursday, also argued against repeal, and against the conservative view that constituents are hammering to see Obamacare killed. He listed states whose Republican governors “displayed courage” by expanding Medicaid despite criticism from their own Republican senators .

“If Obamacare is so awful why are Republicans in Kentucky, Wyoming, Montana, North Dakota, New Hampshire eager to use it? Simple. The Affordable Care Act expands coverage and cuts costs. It’s good for the states.” It should be noted that Kentucky expanded Medicaid when Steve Beshear,a Democrat, was governor. The current governor, Republican Matt Bevin, is planning to roll back that expansion.

Sen. Dan Sullivan (R- Alaska) disagreed.

“Probably no other state in the country has been more negatively damaged by Obamacare than Alaska,” he said. Of the five insurers who initially offered healthcare plans on the exchanges only two are left, he said and both will raise premiums by about 40% this year.

Sullivan said many Alaskans chose to stomach the penalty for not complying with the individual mandate, rather than paying for health insurance “that’ s been forced on them by the federal government and that they cant afford.”

He also found it “a bit ironic” that Democrats were complaining about a predictably partisan vote on the repeal, noting that Obamacare originally passed through the House and Senate on party lines 6 years ago. “To hear their concerns now rings a little hollow.”

Sen. Lamar Alexander (R-Tenn.) decried the “unfunded mandate on Medicaid” in a press statement Thursday, he wrote, “When I was governor, Medicaid only made up about 8 percent of Tennessee’s state budget. By last year, it was 30.6 percent. States paying more and more to expand Medicaid means less to spend on other priorities like higher education, roads, and law enforcement.”

Sen. Barbara Boxer (D- Calif.) said on Wednesday she thinks that Republicans secretly want the bill to fail. “They have nothing, nothing, to replace it with. It’s kind of a joke.”

Sen. Johnny Isakson (R-Georgia), who also spoke on the floor Wednesday said, “The promise of lower cost healthcare and better benefits was exactly wrong. What the American people were promised is wrong… It’s time the American people got the truth, better coverage, lower costs and do it the old fashioned way with a private competitive system.”

McConnell said Thursday, the House would have a chance to vote again on the amended bill, and then, he continued, “President Obama will have a choice. He can defend the status quo that’s failed the middle class by vetoing the bill or he can work toward a new beginning and better care by signing it.”

Senators Grill Price, but He Stands His Ground

WASHINGTON — Repeal of the Affordable Care Act and its consequences were on the hot seat as senators questioned Rep. Tom Price, MD (R-Ga.) Wednesday about his fitness to serve as Secretary of Health and Human Services.

“I have serious concerns about your qualifications for the department you hope to lead,” said Sen. Patty Murray (D-Wash.), ranking member of the Health, Education, Labor, & Pensions (HELP) Committee, at a hearing on the nomination. “Just last week you voted to begin the process of ripping apart our healthcare system without any plan to replace it, even though [it’s estimated that] 30 million people will lose their coverage.”

Wednesday’s hearing was a “courtesy” hearing before the committee, which is not tasked with sending Price’s nomination to the Senate floor for a vote. That responsibility falls to the Senate Finance Committee, which is scheduled to hold a formal confirmation hearing and vote on the Price nomination next Tuesday.

Healthcare for All

Price maintained that if he is confirmed, he will fulfill president-elect Donald Trump’s promise of healthcare for everyone. “The principles that I think are absolutely imperative for the healthcare system is one that’s affordable for everybody, one that provides access to health coverage and care for everybody, one that’s of highest quality, that’s responsive to patients … one that incentivizes innovation, and that insures choices are made and preserved by patients,” he said.

Access was a word that Price returned to frequently when he was asked if he would guarantee that certain groups would not lose healthcare coverage under a replacement for the ACA. “It’s incredibly important that we have a system for every single American to have access to the kind of coverage they need and desire,” he said in answer to another question.

Access to health insurance is not an exact match for President-elect Donald J. Trump’s promise of health insurance for all, a point hammered home by Vermont Sen. Bernie Sanders, the independent who challenged Hillary Clinton for the Democratic nomination. “I have access to buying a $10 million home. I don’t have the money to do that,” Sanders said.

Democratic senators also pressed Price on potential conflicts of interest, specifically his healthcare stock trades, several of which been the subject of media coverage. Price maintained that many of his stock trades are done through a broker so he is not always aware of them, and that he has disclosed any relevant trades as required by the House Office of Government Ethics.

In response to questions about his purchase of stock in six pharmaceutical companies shortly before introducing a bill blocking a regulation that would likely have hurt those same companies, he noted that “My opposition to having the federal government dictate what drugs are available to patients is longstanding.”

Contraception Coverage

Murray also asked Price about his views on paying for contraceptive coverage. “You have said you don’t think cost is an issue for women in buying birth control and stated, ‘Bring me one woman who has been left behind … there is not one,’ correct?” she said.

“I think what I said and what I meant was that when I had patients in my office who were unable to afford medication, we did everything we could to make certain they got that medication. What I meant to capture in that conversation was that if there are individuals who are unable to afford that med, or any med, that there are avenues within the healthcare system physicians and others take to make sure individuals receive medication that they need.”

Murray related the example of a constituent diagnosed with endometriosis who takes contraceptives for chronic pain and who told Murray that “No copay birth control is an essential tool for helping women like me with endometriosis who otherwise would have to live with chronic pain.”

“Women are deeply concerned about the impact this election could have on access to healthcare they need; I’ve heard from many of them,” said Murray. “Will you commit to ensuring all 18 FDA-approved methods of contraception continue to be covered so women don’t have to go back to paying extra costs for birth control?”

“What I will commit to … is that we believe strongly that every single American ought to have access to the kind of coverage and care they desire and want,” said Price. “That’s our commitment and it runs across the board.”

“Birth control is an essential part of women’s healthcare and if you are confirmed I will be holding you accountable for that,” Murray responded.

As was expected, Price received friendlier queries from Republicans on the HELP Committee. “You are clearly one of premier people in all of Congress to understand the problems of healthcare, and have the background … to solve the problems we have,” Sen. Orrin Hatch (R-Utah) said to Price, an orthopedic surgeon.

Sen. Rand Paul, MD (R-Ky.), also spoke favorably of Price. “I think what I regret about this kind of hearing is sort of the vitriol, the rancor and partisanship that should go into something; we want the same things. To question your motives is insulting; To question whether you’re honest is insulting … I think we all want the most amount of insurance for people, and the least amount of cost.”

Paul and Price discussed ideas that might be included in a Republican replacement for the ACA, including health savings accounts and high-deductible catastrophic coverage. “I think health savings accounts and high-deductible catastrophic coverage make a whole lot of sense for many individuals; they ought to have the choice,” said Price.

He also said a replacement plan could include high-risk pools to insure people who might otherwise have trouble getting coverage. Sen. Al Franken (D-Minn.) who was called on next to question Price had his own comment on the risk pool idea: “I’ll tell you how to get a really big risk pool — it’s called Medicare for everyone,” he said.

Price also discussed the Meaningful Use regulations for physicians’ use of electronic health records. “Electronic medical records and electronic health records (EHRs) are so important because … they allow the patient the opportunity to have their health history with them at all times, and allow the provider access to that,” he said. “We in the federal government have a role [in EHRs], but that role ought to be interoperability, to make certain that different systems can talk to each other so it inures to the benefit of the patient.”

But the Meaningful Use rules have really been burdensome for doctors, Price added. “I have had more than one physician tell me that the final regulations and rules related to Meaningful Use were the final straw for them … and they quit.”

“I think the thing that’s absolutely imperative, is to find out what things ought to be determined and checked … that the metrics used actually correlate with what’s being provided … so if we truly worked with those providing the care, saying, ‘What is it that we could ask you to measure that would really correlate with the outcome and quality of care provided,’ I suspect there’s some really specific things we could use.”

“Hope those watching are reassured by what they heard from you,” committee chairman Sen. Lamar Alexander (R-Tenn.) said as the hearing concluded. “While we intend to repair damage from Obamacare and that would mean repealing major parts of it, that won’t become effective until alternatives are in place … we don’t want to pull the rug out from everybody.”

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Volunteers deliver petitions to the Senate HELP Committee with more than 510,000 signatures from people opposing the nomination of Rep. Tom Price, MD, as Health and Human Services secretary. (Photo by Shannon Firth)

Voices Opposed

Just before the hearing began Wednesday morning, representatives of Planned Parenthood, the National Physicians Alliance, Physicians for a National Health Program, and Public Citizen, hand-delivered stacks of boxes containing various anti-Price petitions that they report include 500,000 signatures.

“As a physician, it just doesn’t look like he puts the interests of patients first,” said Susan Molchan, MD, a psychiatrist, nuclear medicine physician, and member of the board of directors for the National Physicians Alliance, told MedPage Today.

Molchan cited his stock buys in tobacco companies as evidence that Price has put corporate interests ahead of patients. Price opposed regulating nicotine as a drug, but Molchan said “nicotine has clearly been accepted as a drug, a very addictive drug for years.”

Price’s support for privatizing Medicare, by transitioning to a voucher-like program for future beneficiaries, also worried Molchan.

“To throw Medicare, which has much lower overhead than private insurance … into the grinder of private health would be terrible.” While she acknowledged that Medicare has its flaws, “it works better than the private health industry, which is out for big corporate entities,” she said.

If his nomination is confirmed, Price’s leadership, “will further erode standards for the approval of medical devices and the approval of drugs,” said Sammy Almashat, MD, MPH a research associate for Public Citizen’s Health Research Group based here.

“We’re very concerned that his presence [at HHS] will send a message to the FDA that the standards should be lowered even further than they already have been.”

His support for repealing the Affordable Care makes him “very dangerous” particularly for Americans with life-threatening diseases such as cancer and HIV and other chronic diseases, he said.

“[G]utting the minimal safety nets that still exist in the form of Medicare, in the form of the Affordable Care Act, would be disastrous for those patients. As a physician, I don’t see how another physician could support such policies.”

Healthcare Proponents Rally at Women’s March

WASHINGTON — Among the masses that descended on the nation’s capital Saturday for the Women’s March was Katie MacMillan, a fourth-year medical student.

“This isn’t all about ‘Not-Trump,'” said MacMillan, referring to Donald Trump, who was sworn in as the 45th president on Friday. An aspiring pediatrician at Quillen College of Medicine in Johnson City, Tenn., MacMillan wants to ensure that women’s reproductive rights are respected, as are vaccination criteria for U.S. children.

“We want women to have access to anything they need to to make the right choices for their bodies,” she said.

As for vaccines, MacMillan said people mistakenly associate them with autism because symptoms of the condition often surface around the time when their children get their shots, but the two events are unrelated. “A lot of people are afraid, and I think fear motivates people in a bad way to make uninformed choices,” she emphasized.

 

Many marchers were in step with MacMillan, armed with signs and banners that promoted reproductive rights and “Medicare for All,” among other hot button issues.

Annie Kolarik, a fellow fourth-year medical student, agreed that Trump wasn’t the only reason for the protest, stating that “the need to fight for women’s rights’ existed before Trump and will exist long after he’s gone.”

MacMillan and Kolarik were joined by other healthcare professionals on the day after Trump’s inauguration. “Sister protests” were held all around the world, including in Boston, Chicago, Miami, New York, Denver, and London.

Saving the ACA

Some healthcare advocates were there to stump for the beleaguered Affordable Care Act (ACA). Late on Friday, Trump signed an executive order pressing government departments to “change, delay or waive provisions of the law that they deemed overly costly for insurers, drug makers, doctors, patients or states,” according to the New York Times. The move will essentially allow the U.S. Department of Health and Human Services (HHS) to begin unraveling the law before Congress can repeal it.

Elizabeth Collins, MD, a resident at Thomas Jefferson Hospital in Philadelphia who drove to Washington with friends, told MedPage Today “Our whole goal is ultimately single-payer healthcare but [the ACA] is about as close as we’ve gotten.”

Another ACA advocate, Kyle Ragins, MD, MBA, an organizer for Doctors for America and a resident at the University of California Los Angeles, said he was pleased at the physician turnout on Saturday.

“I think people appreciated seeing a doctor’s presence … to offer perspective that healthcare providers are on the side of the American people,” Ragins said in a phone interview.

Since the ACA was implemented, Ragins said he has been able to help patients, who have presented in the emergency department, gain healthcare coverage. “To be able to say [to a patient], ‘It sounds like you have a chronic condition that’s going to require specialist care … and you need to get health insurance, so that you can do that’ … to be able to do that from the emergency department is huge.”

Single-Payer Advocates

Carol Paris, MD, the new president of Physicians for a National Health Program, a single-payer advocacy group stood with fellow doctors at the march, holding “Medicare for All” posters.

Paris, a retired psychiatrist from Nashville, Tenn., told MedPage Today, that while she was pleased to see 20 million people get insurance through the ACA, she believes the law is flawed.

On the other hand, repealing the ACA will result in a “leaner and meaner” ACA under a different name, she said.

Paris said she does agree with conservatives that the ACA triggered “needless expense and bureaucracy,” but those same conservatives have told her a single payer system is not “politically feasible.”

Still, she is undeterred: “I will not tolerate another administration and another 4 years of incrementalism.”

Reproductive Rights

A call for maintaining reproductive rights was a dominant theme, with chants of “Women’s rights are human rights.” The main march was co-sponsored by Planned Parenthood, with NARAL Pro-Choice America and Emily’s List named as “social justice partners.”

Ilyse Hogue, president of NARAL, said that she was proud her organization was taking part in the event.

“The diversity driving these marches and the progressive values they represent demonstrate the strength of the grassroots political power at the core of this movement. It also sends a strong message to the anti-choice politicians trying to roll-back our right to access basic reproductive health-care, including abortion,” she said in a press release.

A representative for the American Congress of Obstetricians and Gynecologists (ACOG) said in an email that it was not participating in the march “in any kind of official capacity.” ACOG did not issue any statements regarding the march, although last week, it did officially stand against a House bill (HR 490) that bans abortion after the detection of the fetal heartbeat, which occurs as early as 6 weeks gestation, measured from the woman’s last menstrual period.

“This bill is both unconstitutional and unnecessary political interference in the practice of medicine,” according to an ACOG news release.

Donna Harrison, MD, executive director of the American Association of Pro-life Ob.gyns called the march a “pro-abortion march disguised with a more palatable spin.”

“It is interesting to us that with all the talk about focus on women, none of the participants will cover the documented association between abortion and preterm birth, abortion and breast cancer, and abortion and psychological suffering,” Harrison stated in an email, adding that the organization will take part in the March for Life on January 27.