Last night, the Senate voted 52-47 to approve the reconciliation package that would repeal the bulk of the ACA. This was the first time that a major repeal of the health law has passed both houses of Congress, after numerous repeals by the House were not taken up by the Senate under its previous Democratic control. The package included several additional measures that were not included in the House-approved package from October, meaning that it will need to be voted on again by the House before it can be sent to the White House for what is expected to be a formal veto by President Obama. The Administration confirmed earlier this week that the package would be dead on arrival by issuing a Statement of Administration Policy on Wednesday.
The package was passed under the reconciliation rules, which only require a simple majority to pass, instead of the regular order, which requires a 60-vote supermajority. The vote fell largely along party lines, with Republicans Susan Collins (ME) and Mark Kirk (IL) siding with Democrats to vote against the package. Bernie Sanders was the only senator not voting on the package. Collins and Kirk’s vote were due largely to the package including a provision to defund Planned Parenthood for one year, which they and fellow Republican Senator Lisa Murkowski (AK) joined Democrats Patty Murray (WA) and Ron Wyden (OR) in an unsuccessful attempt to remove from the package in an amendment that failed by an otherwise party-line vote of 48-52, with only Joe Manchin (D-WV) siding with Republicans.
The package repeals significant portions of the ACA, including the state-optional Medicaid expansion beginning in 2018, the individual and employer mandates by changing the penalties to $0 as a workaround to budget rules, and the bulk of the law’s 21 tax increases, including the health benefits tax, medical device tax, and prescription drugs tax. It also included language to defund the Prevention and Public Health Fund and repeal the reinsurance provisions. The deal did not include a repeal of the ACA’s risk corridor program, as Republicans were unable to come up with enough votes to override a block by Democrats who claimed that the repeal violated the Senate’s budget rules.
One of NAHU’s major legislative priorities, to repeal the ACA’s Cadillac/excise tax, was passed by a vote of 90-10 showing near universal and bipartisan support in an amendment to delay the tax until 2024, offered by Dean Heller (R-NV). This is an encouraging sign for potentially moving this language in another package that stands a chance of being signed into law, either before the end of the year or next year. While this vote is effectively meaningless because the package will be vetoed by the president, for the first time in a recorded vote it demonstrates the overwhelming support of repealing the provision that is projected to hit as many as 60% of employers by 2022, growing thereafter, and threatening the very basis of employer-sponsored coverage. We are continuing to make a push to have language to repeal the tax included in other packages, such as the omnibus budget package or the tax-extenders bill before the end of the year. You can help us make your voices heard on the urgency of repealing this tax by sending an Operation Shout today.
Finally, any mention of the reconciliation repeal would be incomplete if it didn’t acknowledge that this process is an exercise in futility. Neither chamber has a veto-proof majority, meaning that with President Obama’s veto the repeal will be effectively meaningless, with the exception of the political theatrics that both parties will be expected to use during the 2016 elections—Republicans pointing to the need of a Republican president to sign the repeal into law, and Democrats shoring up their supporters to say why it is absolutely necessary to keep a Democrat in the White House. That said, we are hopeful that this is another step in the right direction of moving smaller piecemeal repeals of the law, including the Cadillac/excise tax, in the same manner that we have seen successful repeals of parts of the law, such as the small group expansion, auto-enrollment provision, 1099 requirement, long-term care CLASS Act, and $2,000/4,000 deductible cap.