This week, Congress continued the process of repealing the ACA through the budget-reconciliation process. After a vote-a-rama of various healthcare amendments by the Senate on Wednesday night and into the early morning hours on Thursday, it voted 51 to 48 to approve a budget resolution instructing the House and Senate to develop legislation to repeal the ACA. The only Republican to defect to the Democrats and vote against the budget resolution was Senator Rand Paul (KY). Last week, Paul was the lone Republican to vote with the Democrats in an initial vote of the budget process, on the basis that the budget resolution didn’t balance the budget. Earlier today, the House followed the Senate and voted 227-198 along party lines to advance the budget resolution, setting the stage for reconciliation to take place by instructing Congress to repeal budget-relevant parts of the Affordable Care Act.In a wide-ranging press conference on Wednesday, President-Elect Donald Trump suggested that there would be no lag time between a repeal of the ACA and enacting a replacement. Trump said, “We're going to be submitting, as soon as our secretary's approved, almost simultaneously, shortly thereafter, a plan. It will be repeal and replace. It will be essentially simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour.” Trump did not provide details of the Republican plan, but asserted that it would be “far less expensive and far better.”
Trump’s statement has put increasing pressure on Republicans, who have wide disagreements over the timeline for repeal and replace of the law, and even greater disagreements over which of their plans will comprise the final replacement plan. This week, Senate Health, Education, Labor and Pensions (HELP) chairman Lamar Alexander (R-TN), arguably one of the more powerful voices in the healthcare-reform debate, outlined his thoughts on what should happen in the repeal/replace strategy, noting that, “It's not about developing a quick fix. It's about working toward a long-term recovery that works for everyone.” Alexander would prioritize stabilizing the insurance markets and not repealing any of the ACA’s subsidies or mandates until new market rules are in place. Additionally, House Republican Conference Chairwoman Cathy McMorris Rodgers (R-WA), the number four-ranked House Republican, pledged that “No one who has coverage because of Obamacare today will lose that coverage.”
Mark Meadows (R-NC), chairman of the House Freedom Caucus, warned that the Freedom Caucus would need to agree on a replacement plan before voting on a repeal. The Freedom Caucus is comprised of several dozen of the most conservative House Republicans who have often voted against major Republican legislation in recent years for failing to adhere to their objectives, forcing more establishment Republicans to compromise with Democrats to get enough votes for key legislation to pass the House. Meanwhile, the New Democratic Caucus, a group of moderate Democrats, sent a letter to Republican leadership this week offering to work with them on the changes to health reform but urging them not to repeal protections against preexisting conditions, the Medicare prescription drug “donut hole” fix and other provisions.
This week, the Senate HELP Committee confirmed that it will be holding a courtesy hearing on January 18 for Representative Tom Price (R-GA), who is Trump’s nominee for HHS secretary. The hearing is non-binding as the Senate Finance Committee is charged with voting on Price’s nomination and processing his paperwork. There has not yet been a date announced for that hearing, nor has a hearing date been set for Trump’s nominee for CMS administrator, Seema Verma.
As Congress continues to hash out the details over the future of health reform, we encourage you to meet with your federal legislators when they are back in district. With the reconciliation repeal already moving forward, we urge you to focus your discussions on what would be the most useful budget-relevant policies to be repealed through the reconciliation process. We have prepared some talking points to assist in this effort. If you plan to meet with your member of Congress in the coming weeks, please let us know by emailing firstname.lastname@example.org so that we may provide additional talking points as needed.
Finally, as a reminder, if you have suggestions regarding our work with the Trump transition team and members of Congress on the future plans to reform the ACA, send your thoughts and ideas to ACAreform@nahu.org.