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115th Congress, Vote 226; Senate #63

A resolution to overturn the Trump Administration’s expansion of short-term health insurance.

Official Title: A joint resolution providing for congressional disapproval under chapter 8 of title 5, United States Code, of the rule submitted by the Secretary of the Treasury, Secretary of Labor, and Secretary of Health and Human Services relating to "Short-Term, Limited Duration Insurance".

Senate Joint Resolution 63: A resolution to overturn the Trump Administration's expansion of short-term health insurance.
Passage in Senate failed on October 10, 2018, 50-50 vote

Text and legislative actions available here

Synopsis: Short-term limited duration health insurance has existed for decades as an option people can use to fill a short gap in coverage. Under long-standing federal regulations, short-term plans weredefined as having a term of up to 364 days.

Short-term health plans are not regulated by the ACA, so they're stillmedically underwritten, do not have to coveressential health benefits, and can impose benefit limits that aren't allowed on ACA-compliant plans.

Prior to 2014, regular individual market health insurance in most states had all of those same drawbacks. But the ACA imposed a variety of new regulations on the individual major medical market. Although this served to make the coverage much more robust, it also greatly increased premiums in the individual market for people who don't qualify for premium subsidies. But short-term health insurance premiums remained relatively low because the plans weren't subject to the ACA's regulations.

The Obama Administration took action in 2016 to limit short-term plans to three months and prohibit their renewal. The regulations were intended to ensure that short-term health plans could only be used for their intended purpose (ie, filling in short gaps in coverage) as opposed to serving as a substitute for regular health insurance.

Then in 2018, the Trump Administration issued new regulations . They reverted to the previous term length restriction for short-term plans (up to 364 days) but went even further by also allowing short-term plans to be renewable for a total duration of up to three years. Combined with the elimination of the ACA's individual mandate penalty after the end of 2018, the Trump Administration's regulations effectively opened the door for people to use short-term plans as a fairly long-term solution to their insurance needs.

S.J.Res.63, introduced by Senator Tammy Baldwin (D, Wisconsin), was a Congressional effort to overturn the Trump Administration's regulations relating to short-term health plans. If the measure had passed, the regulations would have had "no force and effect."

Why supporters pushed for this bill

Supporters of S.J.Res.63 were mostly people and organizations who were generally opposed to the expansion of short-term plans. There were also some who felt that the Administration had gone too far by not only reversing the Obama Administration's regulations, but also allowing short-term plans to have total durations of up to three years, including renewals.

A primary concern for supporters of S.J.Res.63 was the fact that short-term plans do not cover pre-existing conditions . Senator Susan Collins (R, Maine), the lone Republican to vote in favor of S.J.Res.63, explained that her reason for supporting the resolution was all about protecting people with pre-existing conditions.

Short-term plans are harmful to those with pre-existing conditions not only because the plans themselves don't cover enrollees' pre-existing conditions, but also because they appeal to healthy people who might leave the ACA-compliant market in favor of a longer short-term plan. This leaves people who do have pre-existing conditions in a risk pool that ends up with a less healthy overall population, necessitating even higher premiums.

It was clear even before the new regulations for short-term plans were finalized that they would result in higher premiums in the ACA-compliant individual market, and that did indeed end up being the case in 2019 . Supporters of S.J.Res.63 understood that overturning the expansion of short-term plans would stabilize the ACA-compliant market – which does cover pre-existing conditions – and reverse the rate increases associated with the expansion of short-term plans.

Short-term plans are much less robust than ACA-compliant coverage. Although short-term plans are generally only purchased by fairly healthy enrollees (pre-existing conditions aren't covered and applicants with serious conditions can be rejected by the insurer), a healthy person can experience a serious medical event at any time. For some enrollees, this is when they discover the drawbacks of a short-term plan. Short-term plans often do not cover prescription drugs, maternity care, or mental health care, and generally come with a much longer list of exclusions than ACA-compliant plans.

Numerous health care organizations , including the American Heart Association, the American Academy of Pediatrics, and the American Cancer Society Cancer Action Network were supportive of S.J.Res.63, noting that short-term health plans do not adequately protect patients, and highlighting the fact that they also weaken the insurance market that does protect patients (ie, ACA-compliant plans).

Why opponents tried to stop the bill

Opponents of S.J.Res.63 included those who support the expansion of short-term plans, as well as those who generally oppose the ACA's regulations and prefer to see increased availability of plans that don't have to conform to the ACA.

Short-term plans are less expensive than ACA-compliant coverage for people who don't qualify for premium subsidies in the exchange (and for some who only qualify for modest subsidies). Opponents of S.J.Res.63 wanted to allow cheaper short-term plans to be a viable alternative to ACA-compliant coverage.

Heritage Action, a conservative organization focused on limited government, opposed S.J.Res.63 because they felt that it would curtail the affordable health insurance options available to people who could not afford ACA-compliant coverage. The Small Business & Entrepreneurship Council had similar reasons for opposing the resolution, noting that short-term plans provide a measure of flexibility and affordability that some entrepreneurs cannot obtain in the ACA-compliant market. [To clarify, short-term plans are less expensive because their coverage is less robust and they don't cover pre-existing conditions; some enrollees understand these drawbacks before they enroll, but some do not.]

Some ACA opponents feel that the ACA imposed too many regulations on health insurance, and has too many mandates. They believe, for example, that people shouldn't have to buy health plans that include maternity coverage or mental health coverage or prescription drug coverage if they're confident that they won't need those services. So the expansion of short-term plans – which don't have to follow any of the ACA's mandates – was a victory for those who support fewer health insurance regulations in general. They opposed S.J.Res.63 as it would have limited access to less-regulated plans.

Votes and status:

S.J.Res.63 was filed under the Congressional Review Act , which allows lawmakers to disapprove of regulations issued by federal agencies. If enacted, a resolution under the Congressional Review Act will prevent the federal regulation in question from taking effect and will prevent "substantially similar" regulations from taking effect in the future unless they're authorized by Congress.

S.J.Res.63 needed a simple majority to pass, but the vote was 50-50 so the resolution died at that point. Senator Susan Collins (R, Maine) was the only Republican to vote in favor of the resolution. She was joined by all 47 Democrats in the Senate, as well as the two Independents (Bernie Sanders of Vermont and Angus King of Maine). The other 50 Republicans voted against the resolution, resulting in the 50-50 tie vote.

If S.J.Res.63 had passed in the Senate, it would have also needed the support of the House. If it had passed both chambers, President Trump could have vetoed it – which he most certainly would have done – and it would have needed a two-thirds majority vote in both chambers of Congress in order to take effect. So the resolution was a long-shot from the beginning, and was essentially a way for Senators to go on record with their opposition to the expansion of short-term plans.

10/10/2018 Status: Senate joint resolution defeated

More: select a member to see his or her other key health care votes.

Yes (50)
Our pick
D Doug Jones AL
D Dianne Feinstein CA
D Kamala Harris CA
D Michael Bennet CO
D Richard Blumenthal CT
D Christopher Murphy CT
D Thomas Carper DE
D Chris Coons DE
D Bill Nelson FL
D Mazie Hirono HI
D Brian Schatz HI
D Tammy Duckworth IL
D Richard Durbin IL
D Joe Donnelly IN
D Edward Markey MA
D Elizabeth Warren MA
D Benjamin Cardin MD
D Chris Van Hollen MD
R Susan Collins ME
I Angus King ME
D Gary Peters MI
D Debbie Stabenow MI
D Amy Klobuchar MN
D Tina Smith MN
D Claire McCaskill MO
D Jon Tester MT
D Heidi Heitkamp ND
D Margaret Hassan NH
D Jeanne Shaheen NH
D Cory Booker NJ
D Robert Menendez NJ
D Martin Heinrich NM
D Tom Udall NM
D C. Cortez Masto NV
D Kirsten Gillibrand NY
D Charles Schumer NY
D Sherrod Brown OH
D Jeff Merkley OR
D Ron Wyden OR
D Robert Casey PA
D John Reed RI
D Sheldon Whitehouse RI
D Timothy Kaine VA
D Mark Warner VA
D Patrick Leahy VT
I Bernard Sanders VT
D Maria Cantwell WA
D Patty Murray WA
D Tammy Baldwin WI
D Joe Manchin WV
No (50)
R Lisa Murkowski AK
R Dan Sullivan AK
R Richard Shelby AL
R John Boozman AR
R Tom Cotton AR
R Jeff Flake AZ
R Jon Kyl AZ
R Cory Gardner CO
R Marco Rubio FL
R John Isakson GA
R David Perdue GA
R Joni Ernst IA
R Charles Grassley IA
R Michael Crapo ID
R James Risch ID
R Todd Young IN
R Jerry Moran KS
R Pat Roberts KS
R Mitch McConnell KY
R Rand Paul KY
R Bill Cassidy LA
R John Kennedy LA
R Roy Blunt MO
R Cindy Hyde-Smith MS
R Roger Wicker MS
R Steve Daines MT
R Richard Burr NC
R Thom Tillis NC
R John Hoeven ND
R Deb Fischer NE
R Benjamin Sasse NE
R Dean Heller NV
R Robert Portman OH
R James Inhofe OK
R James Lankford OK
R Patrick Toomey PA
R Lindsey Graham SC
R Tim Scott SC
R Mike Rounds SD
R John Thune SD
R Lamar Alexander TN
R Bob Corker TN
R John Cornyn TX
R Ted Cruz TX
R Orrin Hatch UT
R Mike Lee UT
R Ron Johnson WI
R Shelley Capito WV
R John Barrasso WY
R Michael Enzi WY