GOP Budget Agreement Could Repeal Parts of ACA via Reconciliation

House and Senate Republicans are nearing a budget agreement that would allow the Senate to use the budget reconciliation process to repeal portions of the Affordable Care Act, the AP/San Francisco Chronicle reports (Taylor, AP/San Francisco Chronicle, 4/27).

Background

The Senate last month voted 52-46 to approve Republicans' fiscal year 2016 budget proposal, which includes changes to federal health programs and a provision to repeal parts of the ACA.

The proposal calls for more than $400 billion in Medicare savings over 10 years but does not provide many specifics on how those savings would be achieved. The plan also calls for states to have more flexibility in running Medicaid programs and seeks about $400 billion in Medicaid savings over a decade.

The House last month also approved a Republican budget plan that seeks deficit reduction in part through revisions to federal health spending and repealing the ACA.

Under the House plan, Medicare would transition to a "premium support" model for future beneficiaries. Medicare would provide funds for beneficiaries who join the program after 2023 to purchase private coverage. The plan also calls for the federal government to give states a lump sum to run their individual Medicaid programs (California Healthline, 4/23).

Budget Agreement Details

The developing budget agreement instructs two Senate committees with the authority to do so to move forward with repealing parts of the ACA through reconciliation.

The budget reconciliation process allows budget bills to be passed by a simple majority. Doing so would avoid legislative hurdles that Republicans typically would need 60 votes to bypass (Bade, Politico, 4/27). Because of rules regarding the use of reconciliation, it could not be used to pass a measure repealing the entire ACA. However, it could be used to pass legislation that would make such significant alterations to the ACA that it would need to be replaced (Fuller, "218," Roll Call, 4/13).

While President Obama would veto an ACA repeal, he could be forced to approve a GOP plan that helps individuals who would lose coverage if the Supreme Court strikes down the ACA's subsidies to help U.S. residents purchase coverage through the federal exchange in the case King v. Burwell (California Healthline, 4/23). Further, Republican lawmakers view a repeal vote as sending a message to the president (AP/San Francisco Chronicle, 4/27).

The agreement also would make cuts to Medicare, but does not include a proposal by Rep. Paul Ryan (R-Wis.) to turn the program into a voucher-like system for future beneficiaries (Parker, New York Times, 4/27). According to the AP/Chronicle, the proposal has drawn opposition from Democrats and some Republicans.

Otherwise, the agreement is very similar to one first offered by Ryan in 2012, according to the AP/Chronicle (AP/San Francisco Chronicle, 4/27). It includes various cuts to domestic social programs over the next 10 years to eliminate the federal deficit (Lawder, Reuters, 4/27).

Next Steps

Congressional aides familiar with the negotiations say the final agreement could be unveiled Tuesday, with the House and Senate both likely to consider the measure this week (AP/San Francisco Chronicle, 4/27). However, the deal is being held up by Sen. Bob Corker (R-Tenn.) for undisclosed reasons. According to Politico, Corker's vote is needed to move the bill out of conference (Bade, Politico, 4/28). In addition, Sen. Bernie Sanders (I-Vt.) said he would not sign the budget conference agreement, according to a spokesperson (New York Times, 4/27).

If the agreement does reach the chambers for consideration, the House and Senate are likely to vote among party lines to approve the measure, with Republicans supporting the deal and Democrats voting against it (AP/San Francisco Chronicle, 4/27).

Congressional Leaders Still Could Use Reconciliation for King Fix

Meanwhile, a GOP source has said that the budget agreement's inclusion of an ACA repeal via reconciliation does not rule out the chance that House and Senate leaders could use the process to instead pass a contingency plan if the Supreme Court rules to strike down the law's coverage subsidies, Politico reports (Politico, 4/27).

The high court is expected to release a decision in the case by the end of June. If the court strikes down the federal exchange subsidies, the ruling would eliminate about $28.8 billion in subsidies to 9.3 million individuals in 34 states in 2016, according to an Urban Institute analysis (California Healthline, 3/5).

Sanders Warns Govs.

In related news, Sanders on Monday issued a warning to governors in all 50 states about potential cuts included in the anticipated budget agreement, The Hill reports.

In letters to each governor and the mayor of Washington, D.C., Sanders included statistics about how many individuals in the areas could lose health coverage because of the budget. For example, Sanders' letter to Ohio Gov. John Kasich (R) said that about 234,000 Ohio residents could lose coverage in 2016 if the GOP budget agreement is enacted. Further, he noted that cuts to food stamp programs could cause 1.8 million Ohio residents to be at risk of losing nutrition assistance (Shabad, The Hill, 4/27).