December 28, 2016

URGENT POLICY ALERT: Contact your Senators to try to stop repeal of ACA!

Please pay special attention if you are from AK, AZ, CO, ME, NV, PA, OH, TN, or WV.

And please share with family, friends, and anyone else who might be interested.

Hello Family Voices Network -

Please forgive the intrusion during the holiday season, but this week may be a critical time for contacting your Senators to try to stop repeal of the Affordable Care Act (ACA or Obamacare).  Only three Republican Senators need to vote against a repeal bill to defeat the measure.

As soon as Senators return to Washington in January, the leadership may try to get all the Republicans to agree to a "repeal and delay" bill, which would repeal significant parts of the ACA with a delayed effective date of two to three years to give them time to develop a replacement law.

If Senators do not hear from their constituents now they are not as likely to resist the pressure from the party leadership to vote for the bill.  Taking action will take you only a few minutes.

People from all states should contact their Senators. Even those who want repeal may ask their leadership to postpone a vote if they hear from enough constituents. But, if you are in AK, AZ, CO, ME, NV, PA, OH, TN, or WV, taking action now is especially important because it is possible that one or both of your Senators would be open to voting against repeal legislation at this time.  These Senators are: Lisa Murkowski (AK); Jeff Flake and John McCain (AZ); Cory Gardner (CO); Susan Collins (ME); Rob Portman (OH); Patrick Toomey (PA); Lamar Alexander (TN); and Shelley Moore Capito (WV).

Please tell your Senators to oppose any bill that would repeal the ACA (even with a delayed effective date) before the enactment of a replacement plan that maintains or improves access to affordable and comprehensive health care. If you can, get your relatives, friends, and neighbors to contact their Senators as well.

Background information on the likely repeal process is at the end of this message.

Here's what to do:

*** Communicate with your U.S. Senators as soon as you possibly can in one or more of the following ways:  calling, emailing, going to a local town-hall meeting, or making an appointment to see him/her in a local office. Below are some points you can make in your call or email message, or at a meeting.  Personalize your message as much as possible.

To find your Senators' and their contact information. Go to  Click on "Senators" in the upper left-hand corner, then select your state. Your two Senators' names will be displayed, along with their Washington office phone numbers and a link to send them an email.  The phone numbers of their local offices will be on their websites (usually on the homepage or "contact" page), which can be reached by clicking on the Senator's name. 

[If you already know the names of your Senators, you can call them through the Capitol Switchboard at 202-224-3121 (not toll-free).]

If you have any questions, please feel free to contact Janis Guerney at


{Remember, F2F employees must use their personal email addresses, phone numbers and time.}

Your message can be very brief, but personalize it as much as possible. 

If you are calling, you probably will have a chance only to leave the main message (below), but if the receptionist gives you time to elaborate, please tell him/her why you care so much about the ACA. Remember to leave your name and personal address so they know you are a constituent. 

If you are emailing, your main message should be made first.  You can elaborate or not, but your message should not be too long in any case.  Some suggestions for points to include in your message are below.

Main message:  I am a constituent whose child/grandchild/friend's child has special health care needs. My child and family and others like mine benefit greatly from the Affordable Care Act (ACA). Therefore, I urge you to vote against any bill that would repeal the ACA (even with a delayed effective date) before replacing it with another law that will maintain or improve access to affordable and comprehensive health insurance and services.

Personal points (provide explanations):

My family/child needs the protections of the ACA -

* ban on pre-existing condition exclusions

* allowing children to stay on parents' insurance plans until age 26

* ban on annual and lifetime dollar limits for insurance coverage

* other

My family needs the ACA's financial help to pay for insurance -

* premium subsidies

* cost-sharing subsidies

* small business subsidies

I / my family member(s)/friends have benefited from the ACA's Medicaid expansion:

Some adults with special health care needs are not otherwise eligible for Medicaid, but cannot afford or do not have access to employer-sponsored or other insurance. Now they can get coverage from the ACA's Medicaid expansion.

General points (personalize as much as possible):

About 15 million - 20 percent - of our nation's children have special health care needs or disabilities, such as autism, epilepsy, diabetes, cancer, traumatic brain injury, sickle cell disease, or intellectual disability, to name just a few.  Put another way, one out of five families with children has at least one child with special health care needs. 

The ACA helps these families greatly.  Among its most important provisions are:

  • The prohibition against refusing to insure or charging more for coverage of children with pre-existing conditions, or excluding coverage for services related to that condition.  Before the ACA, children could be denied insurance, charged more for insurance, or denied coverage for the services they needed most because they had a pre-existing condition, such as a congenital heart defect, cerebral palsy or asthma.
  • Elimination of annual and lifetime benefit caps. Before the ACA, a very sick premature infant might reach on his or her lifetime cap on coverage before even leaving the hospital, sometimes leading to the family's bankruptcy. 
  • A prohibition against rescinding coverage when someone gets sick. Before the ACA, an insurance company might terminate a child's coverage, based on a meaningless error in the insurance application, when the child started to incur significant medical costs due to a severe illness or injury, thus leaving the family struggling to pay for the child's care.
  • A requirement that young adults be permitted to stay on their parents' insurance policies until age 26. This provision helps many young adults with chronic illnesses or disabilities who do not have access to employer-sponsored insurance but are not eligible for Medicaid.
  • A provision allowing former foster children to receive Medicaid until age 26.  This provision helps these very vulnerable young adults as they pursue employment or further education.
  • No-cost preventive care for children based on the "Bright Futures" recommendations of the Maternal and Child Health Bureau and the American Academy of Pediatrics.   No-cost check-ups and screenings help to ensure that health or developmental problems are detected and addressed early in a child's life, helping to avoid more expensive treatment or special education later on.
  • Medicaid expansion to all individuals with incomes up to 138% of the federal poverty level.  This provision helps individuals with chronic illnesses or disabilities who do not have access to employer-sponsored insurance and are not otherwise eligible for Medicaid.

    Please vote against any repeal of the ACA until another law is enacted that will maintain or improve the access to affordable and comprehensive coverage and care that the ACA now provides.


Background on the ACA Repeal Process

Budget resolution. Most likely, congressional leaders will take up a "budget resolution" during the first week of January and will vote on it the following week. The budget resolution must be identical in both the House and Senate, but does not need to be signed by the president. Adopting a budget resolution will allow Congress to use a so-called "reconciliation bill" to repeal the ACA. (Press reports may make it sound like the vote on the budget resolution is the repeal of the ACA, but actually, a "reconciliation bill" must then be enacted to repeal the law.)

Reconciliation bill. A reconciliation bill is intended to be used for changes in law that are primarily budgetary in nature. It can be used to effectively repeal the ACA's individual and employer mandates, the premium tax credit, cost-sharing subsidies, and the Medicaid expansion. (It is not expected that the reconciliation bill can be used to repeal some other important parts of the ACA -- such as the ban on pre-existing condition exclusions, the ban on annual and lifetime coverage limits, and the provision allowing children to stay on their parents' insurance plans until age 26 - because these are not primarily budgetary. But, there are no black and white rules about this; it will be up to the Senate parliamentarian to decide. If these provisions cannot be repealed in a reconciliation bill, 60 Senators must vote to repeal them.)

Impact of repeal. A bill to repeal the ACA is likely to have a delay of two or three years before it takes effect, in order to give Congress time to develop an alternative way to help people get insurance. Experts predict that the resulting uncertainty in the insurance market will cause insurers to pull out of the market or significantly raise premiums as early as 2018, and that up to 30 million people could lose their insurance coverage.  

-Outlook for passage of repeal bill. Barring an unexpected development, the reconciliation bill to repeal the ACA will pass in the House, where the Republicans have a solid majority. If it also passes the Senate, the new president will likely sign it. But, there is a possibility that the bill can be stopped in the Senate. A reconciliation bill needs only 51 votes to proceed in the Senate, while most bills require 60 votes to advance. There will be 52 Republicans in the Senate next year, but if all Independents and Democrats vote against repeal, then only three Republicans need to oppose the bill for the measure to fail. (Three votes against the bill are needed to prevent passage because a 51st vote can be cast by the vice-president if there is a tie, and he will vote for repeal.)

Republican Senators who might oppose repeal right now. Some Republican Senators are concerned about destabilizing the insurance market, and thus increasing the number of uninsured, if the ACA is repealed without enacting an alternative at the same time. And some Republican Senators are concerned because their Republican-led states will lose a lot of Medicaid funds if the ACA's Medicaid expansion is repealed. Thus, it may be possible to persuade three Senators to vote against repealing the ACA before a replacement is enacted. If you are represented by any of the following Senators, let them know that you oppose repeal of the ACA without a replacement being enacted at the same time. Republican Senators who might consider opposing repeal include: Lamar Alexander (TN), Shelley Moore Capito (WV), Susan Collins (ME), Jeff Flake (AZ), Dean Heller (NV), John McCain (AZ), Lisa Murkowski (AK), Rob Portman (OH), and Patrick Toomey (PA).


Janis Guerney

Public Policy Co-Director

Family Voices