After Demise Of Repeal And Replace, Health Care Advocates Still Fearing Cuts

Aug 3, 2017

For supporters of the federal Affordable Care Act, also known as Obamacare, last week’s failed vote to repeal the law was cause for celebration. But the future of federal funding for health care programs in Vermont remains uncertain, and advocates say they are not resting easy.

Sarah Launderville is the executive director of the Vermont Center for Independent Living, and has spent 20 years advocating for the rights of people with disabilities. Last week, in Washington, D.C., Launderville was rallying against the latest threat to funding.

“We were with the National Council on Independent Living, where we have this huge march and rally where thousands of people with disabilities take to the streets, and we go from our hotel at the Grand Hyatt, all the way up to the Congress building,” Launderville says.

Launderville and other activists would be arrested for trespassing later that day, for taking their protest to the Hart Senate Office Building. It was all part of a last-ditch effort to compel Senate lawmakers to reject a plan to repeal the Affordable Care Act.   

“Medicaid is the most important part of this for us, because it’s the only insurance that pays for long-term supports and services,” Launderville says.

Repeal of the Affordable Care Act could have jeopardized hundreds of billions of dollars in Medicaid funding.

Launderville got to witness the law’s moment of truth, thanks to a friend who’d secured gallery passes to the U.S. Senate. The vote came shortly after midnight on Thursday. And Launderville says that as long as she lives, she’ll never forget the moment when Arizona Sen. John McCain cast the third Republican vote needed to thwart the repeal.

"There's probably a hundred things the Trump administration could do that would impact Vermonters' ability to get the care they need." — Chief Health Care Advocate Mike Fisher

“It was very powerful,” Launderville says. “And when you’re in that moment, you’re not supposed to be nodding your head or smiling, and those two things are very difficult for me not to do.”

Launderville says her group left the Senate chambers, headed to a spot near the Capitol steps, and began to celebrate. But she says it’s too early to declare victory.

“We can be excited and cheer for a moment, but it’s not going to be the end of the road for us,” Launderville says.

That’s because the future of funding for Medicaid and other federal health care initiatives remains in limbo. Two Republican senators have already begun working on legislation that would put long-term caps on Medicaid funding, a move Launderville says would threaten services for people with disabilities in Vermont.

Mike Fisher, chief of the Vermont Office of the Health Care Advocate, says even though the ACA will remain the law of the land, there are other funding threats on the political horizon.

“There’s probably a hundred things the Trump administration could do that would impact Vermonters’ ability to get the care they need,” Fisher says.

Fisher says he’s worried the Trump administration will simply stop enforcing the individual mandate that, under the ACA, requires all Americans to buy health insurance. Fisher says that mandate is needed to expand the insurance risk pool; without it, he says, younger, healthier people could drop out of the pool, and increase rates for everyone else.

Fisher also says he’s worried about federal defunding of something known as “cost-sharing reductions.”

“Those are payments that go to insurance companies that help low-income Americans who are experiencing real health care challenges be able to afford the care they need,” Fisher says.

Trump has said he’s considering ending those payments immediately.

Blue Cross Blue Shield of Vermont says if cost-sharing reductions go away, rates for all policyholders in Vermont would go up by 2 percent.