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Health Policy and Advocacy

Healthcare Reform: What Now?

Elizabeth Welch-Carre, EdD MSN APRN NNP-BC

Last week was dramatic in the Senate as several bills were introduced that would change or repeal the Affordable Healthcare Act (ACA). Ultimately, the Senate did not pass any legislation that affects the current healthcare law in place. 

On July 25, the Senate passed a motion to begin debate to repeal the Affordable Care Act (ACA) by a vote of 51 to 50. All 48 Democrats and two Republican Senators opposed the motion. Vice President Pence cast the tie-breaking vote allowing the debate (Stark, 2017) and what is called “vote-o-rama” to commence. During this time period all members of Congress were invited to propose new amendments to be voted upon before the bill is finalized.

The final bill was brought to the floor in the form of a “skinny bill” which would have

  • removed some ACA mandates
  • increased the number of uninsured to 43 million by 2026 (CBO, 2016)
  • increased premiums for non-group members by as much as 20% (CBO, 2016).

The future of healthcare reform is unclear. The Senate GOP has stated that they intend to change their focus to other legislation, most notably tax reform and infrastructure. However, both parties have maintained that they want to improve and stabilize the current healthcare market (Schroeder, 2017). President Trump is encouraging Republicans to find a replacement bill for the ACA. A bipartisan group of House members, called the Problem Solvers Caucus, also are gathering to discuss ways to improve the existing healthcare law.

NANN will continue to provide updates and advocate for the following:

  • Medicaid coverage for infants who need it
  • no per capita cap, because many infants may reach that cap early in life
  • continued coverage of essential health benefits
    • ambulatory patient services
    • emergency services
    • hospitalization
    • maternity and newborn care
    • mental health and substance use disorder treatment, including behavioral health
    • prescription drug coverage
    • lab services
    • preventative and wellness services and chronic disease management
    • pediatric services such as oral and vision care
  • coverage of pre-existing conditions, because many infants have congenital conditions and many pregnant women and mothers have pre-existing conditions
  • continuation of individual mandates to increase the pool of funds to cover all individuals, rather than the use of costly high-risk pools
  • continuation of employer mandates because for many individuals, that is their primary means of obtaining insurance.


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Congressional Budget Office. (December 2016). Repeal the individual health insurance mandate. Retrieved from:

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Krieg, G. (June 26, 2017). Comparing the Senate health care bill to Obamacare and the House propsal. CNN. Retrieved from:

Ohlemacher, S., & Taylor, A. (July 26, 2017). What’s next: Senate GOP considers “skinny” health care bill. ABC News. Retrieved from:

Ramsey, L. (July 26, 2017). The Senate just rejected a plan to repeal Obamacare without a replacement. Business Insider. Retrieved from:

Schroeder, R. (July 30, 2017). Where health-care reform goes after failure to repeal and replace Obamacare. Market Watch. Retrieved from:

Stark, L. (July 25, 2017). Vote tally: How each senator voted on GOP health care motion. CNN. Retrieved from: