A Handy Guide To What The Hell Happened To The Affordable Care Act

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We should be scared. We should be angry. But we should also understand what’s going on — and be ready to act.

Around 1:30 a.m. this morning, Senate Republicans voted for budget changes to gut the Affordable Care Act against the vigorous protests of Senate Democrats. Now, we’ve woken up to headlines that the ACA has been repealed and millions of Americans will lose coverage, including those with preexisting conditions and young adult children covered under their parents’ insurance.

Millions of Americans rely on these provisions of the ACA to survive. Understandably, a lot of people are feeling a lot of fear and pain right now.

We should be scared. We should be angry. But there is a LOT of confusion circling the internet right now, and it is causing more fear and anguish than is necessary — and may prevent us from taking the action necessary to save insurance coverage for the millions of Americans who need it. I am not an insurance scholar, but it has become clear from my research that some clarification is necessary and I will do my best to provide it here. Some of this will change as we know more. But here is where we stand.

Understandably, a lot of people are feeling a lot of fear and pain right now.

What happened last night: Senate Republicans voted to gut the budget from portions of the ACA that are funded with taxpayer dollars. They did this because they can pass these budget changes with a filibuster-proof simple majority. That is what they got. Now, House and Senate committees have until January 27 to introduce repeal legislation. This is not a firm date and will likely be bypassed as it’s obvious to us all that the Republicans have no idea how they are going to replace the ACA. But this sets the stage so that when Republicans are ready, they can gut the bill with ease. Also note, this still has to be passed by the House as well, which seems likely to happen tomorrow.

Because only budget changes can be passed in this way, this DOES NOT affect provisions of the ACA that protect coverage of preexisting conditions and coverage of young adult children by their parents. Those are not budget issues, and they require a separate vote; in order to truly gut these provisions, they need to have a replacement plan, and they don’t.

Now, eventually that point will be moot, because the ACA cannot survive long without the budget provisions that pay for it, but we will not see an immediate cessation of coverage for millions of Americans. Also note that these provisions are incredibly popular with Americans of all political parties, and Republicans have made it clear that they do not want to repeal these provisions without a replacement. What magic they will use to do this without paying for it (which is what mandated coverage helped do) is a different question.

It’s obvious to us all that the Republicans have no idea how they are going to replace the ACA.

So please understand, what the Republicans did last night was pave the way for future repeal of the ACA, but this HAS NOT been done yet.

Some of you may have seen statements from Democrat senators saying that the Republicans did indeed vote against protecting coverage of young adult children and those with preexisting coverage, contrary to all that I just said. This is both true and untrue, and I wish that Dems were being clearer about this, because it is scaring the shit out of people.

Last night senate Democrats inserted their own amendments to proactively protect coverage for people with preexisting conditions and adult children covered by their parents. These amendments were struck down, largely on the argument that they were not budget items and therefore did not qualify. THIS WAS NOT a vote against these provisions, it was a vote against protecting the provisions. Yes, this gets senate Republicans on record as being very shitty people, but it does not repeal these important provisions. That requires a separate vote altogether.

I’m laying all of this out because when millions of lives are affected, it is important for us to be as clear as possible. This election has been anxiety producing and heartbreaking for Americans who rely on the ACA for their survival, and I don’t want obfuscation to add to that fear and pain.

I also want us to understand that we still have time to ACT. We need to be calling our representatives (especially the Republican ones) and let them know that a vote to gut the budget for the ACA will be a vote against their reelection. The passage of this budget in the House is not a forgone conclusion. We need to raise holy hell if we want to save our health care.

It is not over, but we have no time to lose. We must band together and fight those who would let our sick and disabled die because of a grudge against a president they hated. Call your representatives today.

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