Sens. Looks To Amend Bill To Dismantle ACA; Obama Threatens Veto

Both Democratic and Republican lawmakers have introduced amendments to a budget reconciliation measure that would dismantle the Affordable Care Act by repealing some of the law's major provisions, The Hill's "Floor Action" reports (Carney [1], "Floor Action," The Hill, 12/2).

Background

The reconciliation process allows legislation to advance through the Senate on a simple majority vote. The process can be used to target aspects of the ACA that address spending and revenue, meaning the technique could not uproot the entire law. However, such an effort could render the law "unworkable."

The House in October voted 240-189 to approve HR 3762, which would repeal the law's:

• "Cadillac" and medical device taxes; and
• Individual and employer mandates.

In addition, the measure would strip federal funding from Planned Parenthood for one year and redirect some of the funding to community health care centers.

The Senate's proposal makes some changes to the House bill, but it still would repeal the law's "Cadillac" and medical device taxes and block federal funding for Planned Parenthood.  The updated measure goes further than the House version by eliminating the fines that can be levied on U.S. residents and businesses for not purchasing or offering health coverage under the law.

In addition, the bill would:

• Eliminate the ACA's subsidies to help consumers purchase health plans through the exchanges created under the law; and
• Phase out the ACA's Medicaid expansion after a two-year transition period (California Healthline, 12/1).

Sens. Offer Amendments

A group of three Republican senators have filed an amendment that would remove the bill's provision to defund Planned Parenthood. The amendment was filed by Sens.:

• Susan Collins (R-Maine);
• Mark Kirk (R-Ill.); and
• Lisa Murkowski (R-Alaska).

According to "Floor Action," a vote on the amendment has not yet been scheduled.

A separate amendment to strike the Planned Parenthood defunding provision from the bill has also been filed by Democratic Sens.:

• Patty Murray (Wash.); and
• Ron Wyden (Ore.) (Carney [1], "Floor Action," The Hill, 12/2).

In addition, Senate Minority Leader Harry Reid (D-Nev.) has proposed an amendment to the reconciliation measure that would prohibit the sale or gift of a firearm to any individual who has been charged with blocking or attempting to block with a threat of force another individual from accessing reproductive health care. Reid proposed the amendment in response to a shooting last week at a Colorado-based Planned Parenthood clinic. According to "Floor Action," Reid is expected to push for a vote on the amendment to be held Thursday (Carney [2], "Floor Action," The Hill, 12/2).

Obama Admin Threatens Veto

GOP Senate leaders have expressed confidence that they have the 51 votes needed to move the reconciliation bill through the chamber (Carney [1], "Floor Action," The Hill, 12/2). If the Senate approves the updated bill, the House will then have to vote on the measure before it could be sent to President Obama (California Healthline, 12/1).

Even if the bill does reach Obama's desk, the president will not sign the measure. The Obama administration on Wednesday issued an official veto threat for the bill. The administration in a statement said, "Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, members of Congress should be working together to grow the economy, strengthen middle-class families and create new jobs." The administration added, "The [ACA] is working and is fully integrated into an improved American health care system" (Sullivan, The Hill, 12/2).

CBO: Updated Reconciliation Bill Will Further Reduce Federal Deficit

In related news, the Senate's updated version of the reconciliation measure will reduce the federal deficit more than the House version of the bill, according to estimates released Monday by the Congressional Budget Office and Joint Committee on Taxation, CQ News reports (Krawzak, CQ News, 12/2).

CBO had estimated that the House version would reduce federal spending by $79 billion over 10 years (California Healthline, 12/2). In comparison, CBO and JCT estimate that the Senate's version of the bill, which is expected to include an amendment that would phase out the ACA's Medicaid expansion and a provision to eliminate the law's subsidies, would reduce the federal deficit by $1.197 trillion over 10 years.

According to the estimates, the largest spending reductions would come from eliminating the law's subsidies and Medicaid expansion, which together would reduce federal spending by $1.498 trillion.

However, CBO and JCT noted that scaling back some of the ACA's provisions without totally repealing the law could lead to an unstable health insurance market. The entities "project[ed] that repealing the subsidies and mandates established by the ACA while leaving in place the insurance market reforms would result in a less healthy population in the nongroup market and correspondingly higher average premiums." They added that "the market for nongroup insurance, particularly in smaller states, could become unstable, leading to very low to no participation by insurers and consumers" (CQ News, 12/2).