Senate Approves Reconciliation Bill To Repeal Major ACA Provisions

The Senate on Thursday voted 52-47 to approve legislation (HR 3762) that would dismantle the Affordable Care Act by repealing some of the law's major provisions, Reuters reports (Lawder, Reuters, 12/3).

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" (California Healthline, 12/3).

The Senate-approved bill would repeal the law's taxes on:

• "Cadillac" health plans;
• Medical devices;
• Indoor tanning services;
• Over-the-counter medications; and
• Prescription drugs (Bolton [1], The Hill, 12/3).

The bill also would eliminate the law's:

• Individual and employer mandates;
• The fines that can be levied on U.S. residents and businesses for not purchasing or offering health coverage under the law; and
• The ACA's subsidies to help consumers purchase health plans through the exchanges created under the law.

Further, bill would:

• Phase out the ACA's Medicaid expansion after a two-year transition period (California Healthline, 12/3);
• Remove risk-adjustment programs created under the law that reimburse insurers; and
• Repeal the Prevention and Public Health Fund created under the law (Bolton [2], The Hill, 12/3).

The House, which approved a different version of the bill in October, now must vote on the Senate's version. The White House has said the president will veto the bill if it reaches his desk (California Healthline, 12/3).

Vote Details

Senators voted on more than a dozen amendments to the bill before its final passage. Among the amendments that lawmakers voted to reject were:

• Two amendments that would have removed the bill's provision to defund Planned Parenthood; and
• Proposals that would have increased restrictions on purchasing firearms.

The Senate voted 90-10 to approve an amendment that would repeal the ACA's "Cadillac tax" (Fram, AP/Sacramento Bee, 12/3).

Sens. Susan Collins (R-Maine) and Mark Kirk (R-Ill.) were the only Republicans who voted against the final measure because of its provision to defund Planned Parenthood (Bolton [1], The Hill, 12/3).

Bill's Passage Could Make it Easier for Future ACA Repeal

While the bill is not likely to become law, the measure's passage could make it easier for GOP lawmakers to repeal the ACA in 2017 if a Republican is elected president, Politico reports.

According to Politico, the Senate parliamentarian must determine whether provisions included in a budget reconciliation measure comply with Senate rules, which are based partly on precedent. Therefore, if a Senate parliamentarian finds certain provisions to be in compliance with the chamber's rules in one measure, it is difficult to argue similar provisions included in a future measure are not compliant.  

Thomas Miller, a health care policy expert at the American Enterprise Institute, said the reconciliation measure's passage "does open up some express lanes or procedural moves for a 2017 environment, in terms of what you can do legislatively." He added, "The idea was to see how far forward the Republicans can push the ball on repeal and really set the stage for when there is a Republican president and hopefully Republican Congress to work together to use reconciliation as a policy vehicle" to repeal the ACA. However, Miller noted that the current reconciliation package is "good theater that accomplishes some goals but doesn't tell you what the health policy universe would look like" in 2017.

Sen. John Barrasso (R-Wyo.) said the symbolic repeal effort "lets the country know if we elect a Republican president come 2016, that we are absolutely committed to repealing and replacing the health care law."

Meanwhile, Sen. Chris Murphy (D-Conn.) said Republicans are "digging their own grave" by focusing on campaign pledges to dismantle the ACA. He noted, "This is really about satisfying some Republican activists who have been counting on reconciliation being used to gut Obamacare since Republicans took over" (Haberkorn, Politico, 12/3).