Next Tuesday, the House of Representatives is planning to vote to override President Obama’s veto of the reconciliation package that would repeal major parts of the ACA. Barring a major change in the hearts and minds of many in Congress, this attempt is doomed to failure. A veto override requires two-thirds support in both the House and Senate chambers, and given the vote tallies on the package over the past month, there simply aren’t enough votes to override the president. The House voted 240-181 (including three Republican defectors), and the Senate voted in December 52-47 (including two Republican defectors). A veto override would require 290 votes in the House and 67 votes in the Senate. Bottom line, President Obama’s veto was final.
Of course, the doomed to fail veto override attempt won’t be the last word of Republicans in Congress on repealing and replacing the ACA. Speaker Paul Ryan (R-WI) and House Majority Leader Kevin McCarthy (R-CA) are working on getting consensus on a replacement bill this year ahead of the November elections. Speaker Ryan announced that the House would have a “complete agenda,” with healthcare as one of the core five pillars, by the time that the party has a presumptive presidential nominee. National security, the economy, poverty, and constitutional issues (largely aimed at curtailing presidential executive orders) round out the remaining agenda items. House Majority Whip Steve Scalise (R-LA) has been lobbying his colleagues to put forth a single replacement plan before the elections to give voters a clear choice between the current ACA and the Republican alternative. The most likely plans to be offered for consideration are from House Budget Committee Chairman Tom Price (R-GA) and Representative Bill Flores (R-TX) from the Republican Study Committee.
Price’s bill has been offered in the 111th, 112th, 113th, and is pending action in the current 114th Congress. The replacement calls for individuals to receive annual tax credits ranging from $900 for children, to $1,200 for those 18-45 up, to $3,000 for those ages 50 and over. Individuals could also opt out of their employer-based plan, Medicare, Medicaid, TRICARE or VA coverage and instead use the tax credit to purchase coverage on the individual market. HSAs could be funded with refundable tax credits of $1,000 annually. The employer exclusions would continue for plans up to $20,000 for families and $8,000 for individuals, while also allowing employers the ability to provide a defined contribution for individuals to purchase outside coverage. Flores’s bill, the American Health Care Reform Act, would create a standard deduction of $7,500 for individuals and $20,500 for families to purchase health insurance. It would also permit insurance sales across states lines and allow businesses to form pools to negotiate better rates.
However, Ryan’s Senate counterparts are more tepid about having a full replacement plan offered before the November general elections. Senate Majority Leader Mitch McConnell (R-KY) stated that he prefers to offer solutions after the election and instead make the election a referendum on President Obama’s (and the Democratic party’s) record. McConnell contends that by not having an alternative for Democrats to campaign against that it could help them retain the Senate, as Republicans have at least five seats that are favorable for Democratic pickups. Senate Majority Whip John Cornyn (R-TX) supports McConnell’s argument not to put forward any specific plan before the elections. The leading Senate replacement plan is the Patient Choice, Affordability, Responsibility and Empowerment (CARE) Act, which was introduced last February by Senate Finance Committee Chairman Orrin Hatch (R-UT), Senator Richard Burr (R-NC), and House Energy and Commerce Committee Chairman Fred Upton (R-MI). It contains many of the components of the ACA, including tax credits for individuals with incomes up to 300% of poverty, and small business to purchase insurance, along with a slew of consumer protections such as prohibiting pre-existing conditions exclusions, and covering children up to age 26.