1. Update
  2. Economic Justice

Health Care Access-and the Safety Net-Under Threat

By Amelia Kegan, November 23, 2016

The incoming administration and the congressional majority want to repeal the Affordable Care Act. But the threats before us are much greater than one bill. We are looking at the biggest threat to health care access, Medicaid, and the future of the safety net that we have seen in 50 years. And it's coming fast—possibly even before the president-elect officially takes office.

The threat to health care access, Medicaid, and the future of the safety net it's coming fast—-even before the president-elect officially takes office.

We’re hearing that there could be an immediate effort to repeal the Affordable Care Act (ACA), with no opportunity for senators to filibuster or amend the legislation. If the Republican caucus chooses to stick together, the ACA could be repealed in January. A procedural tool called “budget reconciliation” allows Congress to make major changes to entitlement programs and tax policy with just 51 votes in the Senate and a simple majority in the House. This process provides limited opportunity for amendment.

Some of the biggest, most significant pieces of legislation in recent years have happened through this budget reconciliation procedure. It’s how Congress passed the 2001 and 2003 Bush tax cuts through, and, ironically, it's how Congress passed the Affordable Care Act in the first place.

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Now, it could be the way that congressional leaders and the incoming president not only eliminate the Affordable Care Act but also fundamentally alter the Medicaid program and gut the food stamp program (known as SNAP) as we know it.

The consequences of these actions would be disastrous for enormous swaths of the U.S. population. Twenty-two million people would find themselves stripped of their health insurance. Many who live in lower-income families. Harmful and lasting changes to the SNAP program could mean children and families struggling to make ends meet would not be guaranteed access to nutrition assistance when they need it.

As Robert Greenstein of the Center on Budget and Policy Priorities told Vox, "I think there’s a potential in the first seven months, by the August recess, for Congress to pass policies that do more to increase poverty and hardship and widen inequality than we’ve seen in half a century."

Of course, the proposals won't be sold as taking away health coverage for millions. The argument will be that we need to repeal what’s there to make way for a “replacement” sometime in the future. This is not acceptable. The Affordable Care Act isn’t perfect. Programs like Medicaid, and SNAP can be improved. But we cannot be satisfied with kicking millions of people off of health insurance with promises of a future better health care proposal “in the works.”

According to Robert Greenstein of the Center on Budget and Policy Priorities, Congress could do more in seven months to increase poverty and hardship and widen inequality than we’ve seen in half a century.

Before us lie challenges unlike any we have seen in recent history. But these challenges aren’t insurmountable. We need to work now—not in January, not after the inauguration, now – to make sure that senators stand up and clearly oppose any efforts to repeal the ACA without a concrete plan to replace it. And we need to be making that case right now—not in January, not after the inauguration, now.

Then we need to make sure that enough senators oppose what could be coming in a second reconciliation bill – fundamental changes to the nature of our country’s largest safety net programs—Medicaid and SNAP (food stamps) potentially along with other critical programs or irresponsible tax cuts that undermine our country's ability to pay for these sorts of priorities. This is about more than funding cuts to the safety net, it’s about changes – under the guise of “flexibility” and “cost controls” – that deny millions of people—those who are truly struggling to get by—health coverage and needed food assistance.

As we face serious threats to the very existence of our safety net programs, we have the opportunity to step into this space in a powerful way. Now, more than ever, FCNL's prophetic voice is needed to call on the moral urgency to protect those programs and policies that enable low-income families and vulnerable populations to put food on the table, access health care, and live with dignity.


Amelia Kegan

  • Legislative Director, Domestic Policy

Amelia Kegan leads the domestic policy team's work in analyzing legislation, advocating on Capitol Hill, and developing legislative strategy. Prior to coming to FCNL, Amelia worked at a variety of other national non-profits in D.C. and Chicago, focusing on federal budget, tax, and low-income policy.