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On Jan. 4, the Senate introduced and voted to take up budget legislation that would begin the process promised by Republicans to repeal key elements of the Patient Protection and Affordable Care Act (ACA). As expected, the proposed budget resolution is narrowly focused on making use of “reconciliation” instructions – legislative language that can set up a fast-track process shielding qualifying legislation from a filibuster in the Senate and allowing legislation to be passed in that chamber with only 51 votes, rather than the 60 votes normally needed to clear procedural hurdles.
In accordance with the budget’s reconciliation instructions, the Finance and Health, Education, Labor & Pensions (HELP) committees in the Senate and the Ways and Means and Energy and Commerce committees in the House each are charged with finding $1 billion in savings as part of the ACA repeal process. The instructions direct the committees to report conforming legislation by Jan. 27, 2017.
If agreed to by the Senate and House, the budget resolution would compel the taxwriting committees to decide the fate of the various health care-related taxes adopted as part of the ACA, including the 3.8 percent net investment income tax and the 0.9 percent Medicare payroll tax on certain high-income taxpayers, the medical device tax, and the so-called “Cadillac tax” on high-cost employer-sponsored health plans, in addition to the individual and employer mandates.
As the budget resolution moves forward and lawmakers contemplate the prospect of a post-ACA health care system, some congressional Republicans have begun discussing a “repeal and delay” strategy that would allow them more time to develop a replacement for the current law.
Meanwhile, on Jan. 10, House Speaker Paul Ryan (R-Wis.) stated that he intends to use every mechanism possible—legislation and regulations—to replace the Affordable Care Act (ACA) concurrent with repeal. Ryan suggested that the House intends to enact some policies—without providing details—in the repeal legislation and bring additional reforms later. He further reiterated that attaching any policy to reconciliation will be up to Senate Republicans since Senate rules are more stringent than those in the House.
However, it appears Republicans in Congress are nowhere close to agreement on a major health bill that would replace President Obama’s signature domestic achievement. A number of Republicans in the House and Senate have said publicly that they wanted to hold off on voting to eliminate the health law until a replacement measure could be negotiated.
For now, the Senate is planning to vote on Jan. 12 on the budget resolution that would set up parliamentary protections for a health care repeal bill that would have to emerge from House and Senate committees by Jan. 27. The House intends to vote on Friday, Jan. 13, if that budget measure clears the Senate.
For his part, President-election Donald J. Trump has urged Republicans to move forward with an immediate repeal of the ACA, and replace it quickly thereafter.