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A Closer Look at Healthcare Issues
1. APPROVING BUDGET AUTHORITY FOR HEALTH-LAW REPEAL: Voting 227 for and 198 against, the House on Jan. 13, 2017, adopted a budget blueprint for fiscal 2017 (S Con Res 3) that would set the table for later congressional passage of bills to repeal taxation and spending portions of the Affordable Care Act, defund Planned Parenthood and weigh possible cuts to Social Security, Medicare and Medicaid. Because the Senate had already adopted the resolution, this vote put it into effect. Congressional budget resolutions do not require a presidential signature.
 
Supporter Earl Blumenauer, D-Ore.:
A Red Line
"The troubling fact for the Republicans bent on repealing the [ACA] is that...most of the major provisions are wildly popular: No lifetime limits on health care; no denial for pre-existing conditions...allowing children to stay on their parents' health insurance until they are age 25; not charging women higher premiums than men simply because of their chromosomes."
 
Opponent Andy Biggs, R-Ariz.:
A Red Line
"Obamacare must be repealed. In fact, there is no constitutional authority given to the federal government to take over our healthcare system. These issues are, in fact, best left to the states to manage. I am advocating for a complete repeal of Obamacare as soon as possible, with a transition period [to a replacement] of no longer than 24 months."
 
A yes vote was to clear the way for bills repealing key parts of the Affordable Care Act.
(Votes lookup at Roll Call #58)
 
2. PREVENTING AFFORDABLE CARE ABORTION COVERAGE: Voting 238 for and 183 against, the House on Jan. 24, 2017, passed a GOP-sponsored bill (HR 7) that would prevent taxpayer-subsidized insurance policies in Affordable Care Act marketplaces from covering abortions, which are legal in the United States under conditions set by the Supreme Court in Roe v. Wade. Because the ACA already required policyholders to personally pay the share of their premium applicable to reproductive care, there was dispute over whether this bill would change anything.
 
In other provisions, the bill would prohibit the use of tax credits to subsidize premiums for ACA policies that cover abortions, prevent the District of Columbia from using locally raised funds to pay for abortions and add the so-called Hyde Amendment to permanent law. A standard part of appropriations bills since 1976, the Hyde measure prohibits the spending of federal funds for abortions except in cases of rape or incest or to save the life of the mother.
 
Supporter Diane Black, R-Tenn.:
A Red Line
The bill would ensure that "hard-earned tax dollars are not used to fund the destruction of innocent life."
 
Opponent Judy Chu, D-Calif.:
A Red Line
The bill "is a woman's health catastrophe....In effect, it makes abortion an option only for the wealthy."
 
A yes vote was to send the bill to the Senate, where it failed.
(Votes lookup at Roll Call #65)
 
3. ALLOWING SALE OF HEALTH PLANS ACROSS STATE LINES: Voting 236 for and 175 against, the House on March 22, 2017, passed a bill (HR 1101) that would allow small businesses to band together to form "association health plans" qualified to sell policies across state lines free of Affordable Care Act requirements. Supporters said the bill would give small firms more scale for competing against large corporations. But critics said that by pre-empting state laws, the bill would result in substandard health plans from states with low standards flooding markets in well-regulated states.
 
Supporter Bradley Byrne, R-Ala.:
A Red Line
The bill would help small businesses "increase their bargaining power [and negotiate] for lower health-insurance rates on behalf of their employees just like their large competitors do."
 
Opponent Joe Courtney, D-Conn.:
A Red Line
"The guts of this bill -- and it is quite extraordinary coming from the Republican Party -- is to pre-empt state governments from having any say over the solvency and the benefit design" of association health plans.
 
A yes vote was to send the bill to the Senate.
(Votes lookup at Roll Call #186)
 
4. PASSING REPUBLICAN REPEAL OF AFFORDABLE CARE ACT: Voting 217 for and 213 against, the House on May 4, 2017, passed a Republican bill (HR 1628) that would dismantle the Affordable Care Act on terms allowing states to waive most ACA coverage requirements, including ones concerning pre-existing conditions, while adding 24 million uninsured Americans by 2026; cutting taxes for well-off individuals and health-related companies by at least $600 billion over 10 years; gradually slashing Medicaid outlays by 25 percent; ending Medicaid's status as an open-ended entitlement program; defunding Planned Parenthood and reducing federal deficits by $30 billion per year.
 
In addition, the proposed American Health Care Act would end the individual mandate requiring Americans to obtain health insurance or pay a tax penalty; phase out the ACA's expanded Medicaid eligibility in 31 states; add per-person spending caps and the possibility of work requirements to Medicaid and exempt qualified states from the ACA's "essential health benefits" coverage requirements. And it would allow waivers under which insurers could deny coverage based on pre-existing conditions in states that establish federally funded high-risk pools and other programs to help unhealthy individuals obtain and afford coverage.
 
The Republican bill would use tax credits based mainly on age to make premiums affordable in the individual market. By contrast, the ACA relies primarily on premium subsidies to keep policies bought in state and federally run exchanges at affordable levels. The bill mirrors the ACA in requiring members of Congress and their staffs to purchase policies under the same terms that apply to their constituents, but ensures that those on Capitol Hill will receive a full-benefits package even if their home state obtains a waiver to provide lesser coverage.
 
Then-Speaker Paul Ryan, R-Wis.:
A Red Line
"Let's return power from Washington to the states. Let's help give people peace of mind. Let's put the patient, not bureaucrats, at the center of this system. This bill does all of those things. This bill delivers the promises that we have made to the American people."
 
Then-Minority Leader Nancy Pelosi, D-Calif.:
A Red Line
"Most Americans don't know who their member of Congress is. But they will now, when they find out that [Republicans] voted to take away their health care. They will know when you put an age tax on them, or undermine Medicare and Medicaid and the rest."
 
A yes vote was to send the bill to the Senate, where it failed by a one-vote margin.
(Votes lookup at Roll Call #256)
 
5. LIMITING FEDERAL & STATE MALPRACTICE LAWSUITS: Voting 218 for and 210 against, the House on June 28, 2017, passed a GOP-sponsored bill (HR 1215) to limit medical-malpractice lawsuits in federal and state courts. In part, the bill would cap non-economic (punitive) damages at $250,000, limits plaintiffs' lawyers' contingency fees and narrow the window for filing suits. The bill places no caps on economic damages and does not pre-empt state laws that impose higher or lower medical-malpractice caps.
 
Supporter Ken Buck, R-Colo.:
A Red Line
"Trial lawyers too often stand between patients and their doctors. With the looming threat of excessive, unending lawsuits, healthcare providers have to worry more about the trial lawyer at their door than the patient in their office. [The bill] places important limits on these lawsuits so that the truly wronged are compensated without enriching trial lawyers at the same time."
 
Opponent Jan Schakowsky, D-Ill.
A Red Line
"Nearly half a million Americans die every year from preventable medical errors, and many more are permanently injured. This bill does nothing to solve that problem. Instead, it just takes away the right of the injured consumers. And if you believe that average Americans should not be barred from the justice system as they seek to hold wrongdoers accountable, then you must oppose this bill."
 
A yes vote was to send the bill to the Senate, where it failed.
(Votes lookup at Roll Call #337)
 
6. DISBANDING OUTSIDE PANEL ON MEDICARE COSTS: The House on Nov. 2, 2017, voted, 307 for and 111 against, to abolish a panel of health experts from outside the government that was created by the Affordable Care Act to help control Medicare costs. The GOP-drafted bill (HR 849) would eliminate the 15-member Independent Payment Advisory Board, which was not yet in operation. The IPAB is empowered to propose cuts in payments to Medicare providers if they are needed to keep per-capita Medicare costs from exceeding official projections. Congress would need supermajority votes by both chambers to override the panel's recommendations. The board is barred from actions that would ration care, change Medicare co-payment or deductible levels or raise premiums levels.
 
Supporter Buddy Carter, R-Ga.:
A Red Line
"Medicare is too important to be left in the hands of unaccountable people" who would "take an axe to Medicare spending, adversely affecting untold numbers of vulnerable seniors...."
 
Opponent Louise Slaughter, D-N.Y.:
A Red Line
The board "is about keeping Medicare spending in line, nothing more, nothing less."
 
A yes vote was to send the bill to the Senate, where it failed.
(Votes lookup at Roll Call #604)
 
7. CUTTING HEALTH LAW TO PAY FOR CHILDREN'S INSURANCE: Voting 242 for and 174 against, the House on Nov. 3, 2017, passed a GOP-drafted bill (HR 3922) that would extend the Children's Health Insurance Program (CHIP) through fiscal 2022 and other health programs including Community Health Centers through fiscal 2019. The bill's 10-year, $18 billion cost would be paid for by offsets including cuts in Affordable Care Act preventive-care outlays and increases in Medicare premiums for the top 1 percent of taxpayers. Democrats said it was wrong for the bill to weaken the ACA and Medicare in order to finance health insurance for underprivileged children.
 
Then providing care to 9 million children, CHIP is a federally funded, state-run discretionary spending program designed mainly for families that are not poor enough to qualify for Medicaid, but which cannot afford adequate private health insurance for their children.
 
Supporter Bradley Byrne, R-Ala.:
A Red Line
"We should not let petty political arguments keep us from ensuring that children have access to affordable health insurance, keeping the doors open at community health centers or allowing Alabama's hospitals to continue serving communities in need."
 
Opponent Frank Pallone, D-N.J.:
A Red Line
Republicans "are now using the reauthorization of CHIP and Community Health Centers as a way to once again sabotage the ACA. Make no mistake, if Republicans can't repeal the ACA outright, they'll cripple it any time they can."
 
A yes vote was to send the bill to the Senate, where it failed.
(Votes lookup at Roll Call #606)
 
8. REPEALING EXCISE TAX ON MEDICAL DEVICES: Voting 283 for and 132 against, the House on July 24, 2018, passed a bill (HR 184) that would repeal a 2.3 percent excise tax levied by the Affordable Care Act on manufacturers and importers of medical devices used by hospitals and doctors, from CT scanners to surgical tools. Because the repeal was not paid for, the bill was projected to add more than $20 billion to federal debt through fiscal 2028. The purpose of the excise tax is to help pay the cost of premium subsidies in ACA marketplaces. Repeal advocates said the tax dampens innovation and costs jobs in the medical-devices industry, while foes called it fair to tax an industry that reaped large profits from the law's expansion of healthcare to millions of Americans.
 
Supporter Erik Paulsen, R-Minn.:
A Red Line
"Usually the government puts an excise tax on things we want to discourage, like tobacco, alcohol or gas-guzzling automobiles. Why would we want to discourage medical innovation? Only in Washington would you impose a tax on lifesaving medical devices and then think you are going to help reduce healthcare costs."
 
Opponent Richard Neal, D-Mass.:
A Red Line
The bill amounts to "billions of dollars in unpaid tax cuts...on top of the $2.3 trillion this Congress has already passed into law, all with borrowed money. Republicans are using the deficit, which they keep making larger, to justify the deep cuts they plan to make to Medicare, Social Security and Medicaid."
 
A yes vote was to send the bill to the Senate, where it failed.
(Votes lookup at Roll Call #372)