Last week, Congress took the first step in a process to repeal and replace the ACA by passing S. Con. Res. 3, a Fiscal Year 2017 budget resolution, to instruct congressional health committees to write legislation, known as budget reconciliation bills, to rescind many key features of the ACA.
On January 12, 2017, the Senate approved S. Con. Res. 3 by a vote of 51-48, and the House approved the resolution on January 13 by a vote of 227-198. Senator Rand Paul (R-KY) was the sole Republican vote against the resolution in the Senate; nine Republicans in the House opposed the resolution. The President does not need to sign this resolution; only simple majorities in Congress are required to pass the legislation and have it take effect.
As directed by S. Con. Res. 3, four congressional committees with jurisdiction over health care – Senate Finance; Senate Health, Education, Labor, and Pensions; House Energy and Commerce; and House Ways and Means – will each draft legislation to “replace” the ACA, and the content of these reconciliation bills will be forwarded to the House and Senate Budget Committees, which will craft a single bill. “Replace” legislation needs to pass both the House and Senate, where reconciliation legislation is not subject to filibuster.
Over the weekend, President-elect Trump promised to deliver his own healthcare reform plan with the goal of providing “insurance for everybody” and including a requirement that drug companies negotiate prices with the Medicare and Medicaid programs. President-elect Trump noted that his plan is “very much formulated down to the final strokes” but that he is waiting to unveil his proposal after Representative Tom Price is confirmed as HHS Secretary.
Congress and the President-elect have not come to an agreement on timing of the next step in the “repeal and replace” process. President-elect Trump has stated that “repeal and replace” should occur “simultaneously.” House Speaker Paul Ryan (R-WI) has urged that the two be done “concurrently.” Senator Lamar Alexander (R-TN), chairman of the Health, Education, Labor and Pensions (HELP) Committee, outlined a three step process and urged his colleagues fully repeal the law “only when there are concrete, practical alternatives in place.” Chairman Alexander’s statement can be found here, on pages S195-196.
Representative Price will have two confirmation hearings – one before the Senate HELP Committee on January 18, 2017, and one to be scheduled before the Senate Finance Committee. Only the Finance Committee will vote on the Price nomination, and a full Senate vote on the Price nomination is expected in February. If confirmed as HHS Secretary, Representative Price has promised to divest any holdings in companies that may pose a conflict of interest and to resign as an American Medical Association delegate.
As Congress considers reforms to Medicaid as part of an ACA replacement plan and more broadly to provide states with greater flexibility, Republican governors and lieutenant governors are scheduled to meet with Senate Finance Committee Republicans this week. The state officials from states that did and did not expand Medicaid under the ACA will include: Gov. Asa Hutchinson (AR); Gov. Rick Scott (FL); Gov. Butch Otter (ID); Gov. Terry Branstad (IA) and Lt. Gov. Kim Reynolds (IA); Lt. Gov. Jeff Colyer (KS); Gov. Rick Snyder (MI); Gov. John Kasich (OH); Gov. Dennis Daugaard (SD); Gov. Greg Abbott (TX); and Gary Gov. Herbert (UT).
