June 20, 2017

Senate Might Vote on ACA Overhaul Next Week

Holland & Knight Healthcare Blog
Miranda A. Franco

Senate Republican leaders continue to express their desire to hold a vote next week before the upcoming July 4 recess. Majority Leader Mitch McConnell (R-KY) has chosen to officially fast-track the Affordable Care Act (ACA) repeal and replace legislation, allowing it to skip over the committee process as a means to avoid a long and contentious path forward. This allows him to bring the bill to the floor quickly once Republicans are ready to vote. However, both Democrats and Republicans are indicating concerns over not yet having seen any of the text. The full text of the bill is expected to be released this week.

Staff have already sent sections over to the Congressional Budget Office (CBO) for review and under reconciliation rules, the Senate’s bill must achieve the same federal savings as the Affordable Health Care Act (AHCA) passed by the house, $119 billion. A score from the CBO could come early next week.

Senate Budget Committee Chairman Mike Enzi (R-WY) announced that the Senate parliamentarian cleared the House GOP’s repeal bill, the American Health Care Act (AHCA),  for Senate consideration under reconciliation. Democrats are still likely to challenge provisions of the bill, depending on what the Senate version of the legislation looks like, on the grounds that they violate the rules of reconciliation, which is limited to budgetary measures that affect the deficit. Democrats have also indicated their desire to slow action on all Senate business, in an effort to protest their frustration with ACA overhaul efforts.

Much remains uncertain, as lawmakers are expressing various levels of optimism on whether or not it will successfully pass. Divisions remain about how to phase out the ACA’s Medicaid expansion, and how to reform the Medicaid program in general. The Senate bill may include a longer off-ramp for ending Medicaid expansion than under the House bill. Senators may also be considering whether to vary Medicaid payment rates by state in order to address discrepancies between those states that have expanded their programs and those that have not. The Senate is also weighing the possibility of keeping some of the ACA’s taxes in place, at least temporarily, in order to stabilize the insurance market in the short term.

Another potential sticking point is Planned Parenthood funding. A provision that would eliminate the entire $555 million in federal funding for the organization may need to be dropped in order to gain the support of members like Sen. Collins (R-Maine) and Sen. Murkowski (R-Alaska).

At this juncture, it is unclear if Republicans have the votes needed to pass a bill. Republicans, who hold 52 seats in the Senate, are planning to pass their repeal bill under reconciliation allowing them to bypass a Democratic filibuster. However, they can afford to lose only two votes, with Vice President Mike Pence breaking a tie.

If the Senate is able to pass legislation, Republicans would still have to spend time merging the bill with the House-passed (AHCA). Major differences are expected, with the Senate bill likely being more modest in repeal of the ACA than its House counterpart.

Holland & Knight will continue to provide updates as things progress.

Related Insights