Senate races towards repeal through reconciliation process


January 09, 2017

The Senate took initial steps towards repeal of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) with its release of a budget containing reconciliation instructions, which could serve as the foundation for the passage of future health legislation through the budget reconciliation process. The technique is designed to allow Senate Republicans to pass legislation with a simple majority, in a process where the bill could not be filibustered. Although the instructions are vague, the 52-Republican majority is sufficient to effectuate at least a partial repeal. The debate over the budget resolution could take several days, as Democrats may propose numerous amendments to slow down the process.

Reconciliation. The reconciliation process was developed to allow Congress any easier means to maintain a budget for complex federal spending programs like Medicare and Medicaid. Thus, a repeal effort through the budget reconciliation process will not repeal all of the ACA because the process can only be used to pass legislation affecting spending and revenue. However, previous reconciliation repeal efforts suggest that the reconciliation process could be used to repeal the ACA’s tax credits, Medicaid expansion, and insurance mandates—a repeal wide-reaching enough to strip 22 million individuals of health insurance coverage.

Resolution. Senator Mike Enzi (R-Wyo), Chairman of the Senate Budget Committee, promises that the resolution provides the tools necessary to repeal what he calls a "failed law." Enzi notes that the resolution instructions are designed to facilitate immediate action on repeal and to achieve billions of dollars in deficit reduction over 10 years. The American Medical Association (AMA) urged Congress to provide the American people with a concrete replacement plan, so that a comparison between the ACA and its replacement could be made, before lawmakers go ahead with a repeal effort.

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