Update on the Effort to repeal the Affordable Care Act (ACA)

Update on the Effort to repeal the Affordable Care Act (ACA)

September 27, 2017

Updated Wednesday, September 27, 2017 

After a closed-door meeting on Tuesday, September 26, 2017, Senate Republicans decided against holding a vote on their most recent effort to repeal and replace the Affordable Care Act (“ACA”): the Graham-Cassidy bill. The decision comes after three Republican senators announced their opposition to the bill.  

The bill sought to hand over control of healthcare to the states. Under the bill, states would have received block grants to develop and fund their own healthcare systems, maintaining significant control over how the funds would be used. Additionally, the bill would have ended Medicaid expansion, eliminated the employer mandate, and permitted states to apply for waivers allowing insurers to consider preexisting conditions when calculating insurance premiums. 
The bill’s failure delivers a significant blow to repeal and replace efforts, as Senate Republicans will lose their ability to pass healthcare reform by simple majority on September 30 when the fiscal 2017 budget reconciliation period ends. Thus, Republicans will have to work with the Democratic minority to pass revise the ACA.

Updated Friday, July 28, 2017

In a vote held in the early hours of today, Friday, July 28, 2017, the Senate by a narrow 51-49 margin voted down the “skinny repeal” healthcare plan.  The so-called “skinny repeal” proposal stripped the individual and employer mandates related to having and providing insurance, and it would have repealed taxes on certain types of medical devices.  The plan was seen as a compromise to eliminate several pillars of the Affordable Care Act while allowing the majority of the law to stay in place until a comprehensive alternative was crafted.   With the failure of this newest bill, it is unclear whether the Senate will make another attempt, or whether efforts to repeal the Affordable Care Act will be abandoned for the time being.

Updated Thursday, July 27, 2017

On the evening of Wednesday, July 26, 2017, the Senate rejected a measure that would have repealed the Affordable Care Act without a replacement. The Senate voted on a “clean repeal” that would eliminate the Affordable Care Act with the intention of replacing it at a later time. However, the measure did not have enough support, failing 55-45. Senate leadership will now attempt to draft a new Senate bill, which is likely to be a limited measure that repeals the individual mandate and certain taxes, while temporarily leaving the bulk of the Affordable Care Act intact for the immediate future.

Original Post from Tuesday, July 26, 2017:

On Tuesday, July 25, 2017, the US Senate voted to begin debate on a repeal of the Affordable Care Act. The Obamacare Repeal Reconciliation Act would repeal the Affordable Care Act over a two-year period and phase out all aspects of the ACA, including:

  • Healthcare exchanges,
  • Subsidies for low to moderate income Americans,
  • Various taxes passed to fund aspects of the ACA; and
  • The expansion of Medicaid, which was the primary program used to insure roughly 20 million Americans since 2009.

Senate Majority Leader Mitch McConnel decided a two-step approach (repeal and then replace) was the best approach. The motion to begin debate, however, passed by one vote and required Vice President Pence to cast the tie-breaking vote. Late into the night, the Senate attempted to pass a replacement for the ACA, known as the Better Care Reconciliation Act, but that effort failed by a fairly large margin. As a result, the Senate will now begin what could be several weeks of debate to craft a replacement bill that can secure the required 60 votes to ensure ultimate passage. There is an open question of whether the body will recess for the month of August, which is customary.

The House of Representatives passed in May a replacement bill for the ACA, called the American Health Care Act. That bill impacted the ACA in three major ways:

  • Removed the mandate requiring individuals to have insurance and for employers to provide it. It did however allow young adults to remain on their parent’s insurance until the age of 26;
  • Provided limited-time tax credits for individuals, based on their age, to subsidize the cost of premiums. The tax credits would expire in 2020;
  • Repealed the federal government’s expansion Medicaid and instead opted to give states block grants to cover such cost; and
  • Allowed states to determine the essential benefits required to be provided in qualified plans.

The non-partisan Congressional Budget Office (CBO) estimated that the number of uninsured Americans would increase to 23 million by 2026 under the House plan. According to the CBO, the removal of the individual mandate, cuts to Medicaid funding and the reduction of the value of tax credits for low to middle-income people were the largest contributors to the projections.

Ian McLin contributed to this blog post.

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