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Senate Health Care Debate Timeline

As a follow-up to my August 2017 IM column on health care, this details recent actions on Capitol Hill. The House completed its work and passed a repeal and replacement for the Affordable Care Act (ACA) health care bill. The 2017 House American Health Care Act (AHC) was then forwarded to the US Senate for consideration. Upon receipt, the Senate determined that it needed to compile its own proposal. Hence, Senate majority members went into closed session to draft a new proposal.

The Better Care Reconciliation Act of 2017 (BCRA) was introduced as the vehicle used by Senate leadership to start the repeal and replace process. The following timeline provides a sense of Senate action, along with a glimpse at the procedural difficulty encountered after the seven-year attempt to totally eliminate the ACA. Though this process goes back seven years, we begin in 2017 with the 115th Congress, where a single party controls the House, Senate, and White House.

Health Care Timeline

May 4: House passes its version of health care reform, the American Health Care Act of 2017.

May 24: Congressional Budget Office (CBO) reports House bill (American Health Care Act) increases federal deficit by $119 billion; over 10 years 23 million would lose health care.

June 13: President Donald Trump weighs in with Senators at a White House lunch to “make the [House] bill more generous.”

June 22: Senate releases its Better Care Reconciliation Act of 2017.

June 26: CBO reviews draft Senate bill.

June 27: Senate Majority Leader Mitch McConnell delays vote; not enough votes for his Better Care Reconciliation Act (BCRA).

July 13: Republicans present updated version; moderates say new version will hurt those with pre-existing conditions.

July 15: Procedural vote delayed because of Senator McCain’s surgery.

July 17: Senators Mike Lee and Jerry Moran kill the bill by announcing they would vote against it.

July 25: Senator John McCain votes for a motion to proceed.

July 25: Senator Ted Cruz introduces a health care bill amendment to allow insurers to sell low cost health
insurance; bill is rejected by the Senate.

July 27: McConnell announces plans for his Health Care Freedom Act, or as his colleagues call it, “skinny repeal” bill; will not replace the ACA for two years or have a two-year transition period. It is supported by the White House, but Senators oppose the tactic.

July 28: ACA repeal vote takes place, defeated by all Democrats, and Republicans John McCain, Lisa Murkowski, and Susan Collins; bill would leave 16 million more people uninsured than ACA. After the vote, Trump continues to push for a health care resolution, while McConnell insists on moving on to tax reform and the debt ceiling.

July 28: House on August recess while Senate remains in pro forma session with no changes to the Affordable Care Act. (The pro forma session prevents President Trump from making recess appointments.)

For AFM members subject to requirements outlined under ACA, you should know that no additional work on health care has been scheduled. We expect more information after the August recess.

Health Care

Deciphering Health Care

Since the start of the 115th Congress, both the executive and legislative branches of government have been under single party control. The US House of Representatives, under the leadership of Speaker Paul Ryan (R-WI), and the Senate, under the leadership of Majority Leader Mitch McConnell (R-KY), with the backing of the Republican White House, have been fully engaged in repeal and replacement of the Affordable Care Act (ACA).

Once the process began in earnest, principal concerns came from Republicans who believed that the new health care bill should include provisions 1) to provide coverage for people with pre-existing conditions, 2) for those with employer-based health insurance, and 3) for cuts to Planned Parenthood. Democrats flatly rejected the bill saying that, in particular, its Medicaid cutback provisions would hurt too many elderly and poor Americans by eliminating Medicaid expansion eligibility included in the ACA. Democrats also complain the bill may cause unnecessary spikes in premiums for low-income families, older Americans, and those with pre-existing conditions.

The Medicaid Debate

Chief among concerns is the gradual elimination of the ACA Medicaid Expansion Program eligibility written into the new Republican House and Senate Bills. Both the Senate and House bills phase out extra money that the federal government has provided to states under ACA as an incentive to expand eligibility for Medicaid. More importantly, this means that seniors would receive fewer health care benefits under the new Senate and House bills.

What is Medicaid (not to be confused with Medicare)? It is a government funded health care program that provides health insurance to people with disabilities, the elderly, low-income seniors, and families with children and pregnant women. It helps pay medical expenses for those who cannot afford comprehensive medical coverage. Medicaid is financed by both federal and state governments. However, each state manages its own Medicaid program and decides its own rules for participation.   

What is Medicaid Expansion? The federal government website Medicaid.gov defines the program as expanded eligibility coverage under ACA for the poorest Americans. ACA created an opportunity for states to provide Medicaid eligibility, effective January 1, 2014, for individuals under 65 years of age with incomes up to 133% of the federal poverty level (FPL). For the first time (under ACA), states could provide Medicaid coverage for low-income adults without children with guaranteed coverage through Medicaid in every state without need for a waiver.

House Deliberations 

After a month of wrangling, the new health care bill was withdrawn from consideration due to moderate and conservative Republicans who threatened not to vote for it until outstanding issues were resolved.

In the House, the Congressional Budget Office (CBO) score was not released until after the bill passed. The eventual nonpartisan score showed that 15-23 million Americans could lose their health care benefits by 2026, more than if Obamacare remained intact. The new American Healthcare Act (HR 1628) passed the House May 4 by a vote of 217 to 213.

After House passage, the bill moved to the Senate. Senators agreed to disagree with significant elements of the House bill and decided to totally rewrite it. As the House moved expeditiously to put a bill in place, the Senate worked behind closed doors with 13 Republican Senators drafting a revised bill. There was major concern over the bill being drafted without a CBO score analyzing its cost. The Senate decided to delay releasing its bill until all the pieces are in place.

Democratic Senators protested because the bill was not subject to committee hearings or debate on the floor. Now, Republican senators who heard from angry constituents at town hall meetings during their recess are carefully considering their options. Meanwhile, political pundits continue to calculate the impact of possible losses of Republican seats if the bill is signed into law without the support of voters.

The Senate bill was recently released with deep cuts to Medicaid and ending the ACA mandates for purchasing insurance, maternity care provisions, emergency services, and mental health treatment.

Now that the July 4 holiday recess has ended, the Senate is moving toward a full vote in the chamber. As of this writing, four Republican Senators will oppose it: Rand Paul (KY), Ted Cruz (TX), Mike Lee (UT), and Ron Johnson (WI). Cruz has introduced his own amendment that is now under consideration. Vice President Mike Pence, President Donald Trump, and Mitch McConnell are negotiating hard with reluctant Senate members to move the bill forward as opposition voices continue to grow from Members like Susan Collins (R-ME). Further complicating forward progress on the vote is the absence of Senator John McCain who recently had eye surgery and will be away from Washington for approximately two weeks. Failure to hold a vote could mean that no bill would pass this year, leaving the ACA as the “law of the land.”

The White House continues to weigh in with uncommitted Republicans suggesting that Trump would like to see the outstanding issues resolved and have a bill in place and ready for his signature before congress takes its August recess. At this writing, less than three weeks before August 1, few members of Congress have hope that an agreement can be reached in time. Some in leadership are beginning to believe that the best chance they have for passage of the Senate bill is to reach out across the aisle and include Democrats in the negotiations. Trump has now suggested that the Senate consider first repealing the ACA and then replacing it. Not all members of Congress support that solution.

Net Neutrality

What the Loss of Net Neutrality Means to Musicians and the Music Industry

On December 14, 2017, the Republican majority at the Federal Communication Commission (FCC), led by FCC Chair Ajit Pai, voted to repeal Obama Administration net neutrality regulations put in place in 2015. The three to two vote was divided along party lines, approving a Trump Administration plan to repeal Obama-era net neutrality protections. Those rules were intended to keep the Internet open and fair—in essence treating all traffic the same, halting Internet service providers (ISPs) from speeding up or slowing down Internet traffic from select websites and apps. It also prevented ISPs from charging additional fees for users to access content.

Prior to the December vote, some members of Congress and others in opposition to the FCC move asked the FCC not to force a vote now, but to withhold it. Complaints from some members of Congress have centered on a corrupted comment system that has revealed at least a million comments may have fraudulently used the names of real people. Also, the Commission has not held public hearings on the repeal and some 50,000 consumer complaints have been excluded from the public record, as noted in a letter to Chair Pai from Senator Maggie Hassan (D-NH). Further, Representative Ted Lieu (D-CA) expressed concern that many of the fake submissions on net neutrality were linked to Russian email addresses.

Likewise, several attorneys general have threatened to file suit, including the New York Attorney General who is working on a criminal complaint. It is suspected that members of Congress who disagree with the changes will introduce legislation designed to block the new rules.

Under the new regulations, companies would be able to block, slow, or provide fast lanes to any service they so choose. This flies in the face of a free and open Internet concept that would give consumers the choice to access the content they desire on a free and open platform. It would grant ISPs the overarching responsibility to determine what the consumer can and cannot see.

There are competing legislative proposals on this issue, including Representative Marsha Blackburn’s (R-TN) BROWSER Act, or HR 2520, the Balancing the Rights of Web Surfers Equally and Responsibly Act. These proposals would require companies such as AT&T, Facebook, and Google, to get user permission before selling their Internet browser history.

Aside from some of the fundamental changes by the Republican majority on the Pai Commission that give clear advantage to tech companies, the AFM rejects the FCC’s recent changes because of limitations these new rules can possibly place on the free flow of music audio and music opinion content.

AFM International Vice President and President of Local 99 (Portland, OR) Bruce Fife, summarizes net neutrality and its meaning to our industry this way: “The concept of net neutrality is simple. It means that Internet service providers must treat all data the same. They can’t speed it up for some, slow it down for others, or even worse, block access to websites altogether. They need to treat everyone the same, which in our business, creates a level playing field for musicians working to market themselves, their performances, and their recordings.”

AFM Solidifies Federal Arts Relationships

On August 25, AFM International President Ray Hair traveled to Washington, DC, to strengthen our ties with federal arts leaders. This full day of activity ended with solid gains in our relationships with two of our nation’s most historic and highly valued arts agencies.

National Endowment for the Arts

National Endowment for the Arts (NEA) Chair Dr. Jane Chu graciously hosted a meeting with AFM President Ray Hair and myself

to discuss how the AFM and the NEA can work together moving the endowment’s agenda. Chu, who is an accomplished pianist, studied music growing up. She eventually received a bachelor’s degree in piano performance and music education from Ouachita Baptist University, as well as master’s degrees in music and piano pedagogy from Southern Methodist University. Chu also holds a master’s degree in business administration from Rockhurst University and a

L to R) NEA Chair Jane Chu, AFM President Ray Hair, AFM Legislative Director Alfonso Pollard, and NEA Music & Opera Director Ann Meier Baker at NEA headquarters in Washington, DC.

L to R) NEA Chair Jane Chu, AFM President Ray Hair, AFM Legislative Director Alfonso Pollard, and NEA Music & Opera Director Ann Meier Baker at NEA headquarters in Washington, DC.

PhD in philanthropic studies from Indiana University.

Our meeting was also attended by National Endowment for the Arts Music & Opera Director Ann Meier, who is an accomplished vocalist, with a long list of outstanding vocal and administrative credits. After some discussion between Hair and Chu about their undergraduate and graduate studies in the North Texas area, the conversation shifted to NEA programs and how these programs support a broad range of community arts and professional organizations that help support the careers of AFM musicians. Chu also gave a quick overview of her newest initiative “Creativity Connects,” which will examine how the arts are central to the nation’s “creativity ecosystem” and investigate how support systems for the arts have changed. The project also will explore how the arts connect with other industries.

In addition, the NEA celebrates its 50th Anniversary this year and Chu extended a personal invitation to Hair to encourage AFM members to participate in the agency’s “Tell Us Your Story” project. The goal is to gather stories about how the arts have influenced your life. The link to the project is http://arts.gov/tell-us-your-story. Hair strongly encourages all AFM members to visit the site and leave powerful stories about themselves and their artistic lives. We feel that AFM members have some of the most compelling stories in the industry. Take a moment to reveal yourselves.

Smithsonian Museum

(L to R) Curator of American Music John Edward Hasse with AFM President Ray Hair and AFM Legislative Director Alfonso Pollard at the Smithsonian National Museum of American History.

(L to R) Curator of American Music John Edward Hasse with AFM President Ray Hair and AFM Legislative Director Alfonso Pollard at the Smithsonian National Museum of American History.

Later in the day, Hair followed up on a special invitation from Dr. John Edward Hasse, curator of American music at the Smithsonian Institution’s National Museum of American History. For decades, Hasse has interacted with the AFM and with AFM musicians, especially in the Washington, DC, area. His unique invitation included a behind-the-scenes tour of the museum with an eye toward partnering with the AFM to possibly acquire historic union documentation that outlines professional work by some of America’s greatest artists and prominent AFM members.

Aside from sharing background about some of the museum’s most precious musical artifacts, we visited locations within the museum that are being developed as new performance sites. However, one of the most important aspects of the visit included a discussion about how the Smithsonian can partner with the AFM to acquire relevant performance artifacts of the most renowned AFM members, past and present.

This is an exciting project and Hair has promised to work with Hasse on possibilities. AFM members with ideas must first contact Hair or myself. Of course, these artifacts will involve only materials of the highest value and quality and there is no guarantee of acceptance of every idea. However, your thoughts are always welcome. Feel free to reach out to our office.