What’s Next for Obamacare?

Republicans rally around “repeal and delay” strategy

Republicans and the incoming Trump administration have been careful not to talk about exactly what they plan to do to the Patient Protection and Affordable Care Act (PPACA) beyond repealing virtually all of its coverage expansions and the taxes that help fund them. But they seem to be coalescing around a strategy of “repeal and delay,” in which they would pass a bill to kill many of the major provisions of the act by a certain date, and then set to work on crafting and passing a replacement before that date arrives, according to Kaiser Health News (KHN).

It would be quicker for Congress to simply repeal the health law outright, but Republicans can’t do that because they would need 60 votes in the Senate to fend off Democrats’ delaying tactics, and they will have only 52 GOP members. Instead, they will be limited to using a special budget strategy that will let them pass their bill with 51 votes.

That so-called “budget reconciliation” measure does not let lawmakers repeal the entire PPACA—only the parts that directly affect federal spending. While budget reconciliation has been widely discussed, there has been less focus on how long the process takes, according to the KHN article.

The word “reconciliation” refers to the process by which congressional committees that control permanent spending programs, such as Medicare and Medicaid, as well as tax policy, take action to “reconcile” that spending with the terms of the annual budget resolution.

That means the first action must be to pass a budget resolution, which Congress failed to do last year.

A budget resolution, which is essentially a planning document for spending and taxes for the coming fiscal year, does not go to the President for a signature. But, like a regular bill, it does have to be passed by both the House and Senate in the same form. And while the budget resolution also may not be filibustered in the Senate, lawmakers have up to 50 hours to debate it and unlimited time to vote on proposed amendments, which can take up to another full day.

Once that measure is agreed to by the full House and Senate, the action moves back to congressional committees. The budget resolution often includes “reconciliation instructions” to committees. Those instructions order proposed legislative changes to the programs that the committees oversee to meet the terms of the budget. That triggers the reconciliation bill that goes to the President.

In the normal course of events, those changes take from several weeks to several months to accomplish. Legislative changes need to be written, voted on by the committee, and reported back to the House or Senate budget committees, which then forward them to the House or Senate floor for votes. Again, Senate debate is limited to 20 hours, with unlimited additional voting on amendments. House and Senate negotiators then hammer out a compromise, pass it again in the full House and Senate, and then send it to the President.

The last budget reconciliation bill, considered a dry run by Republicans for the coming year, was launched by the budget resolution at the end of April 2015. The resulting reconciliation bill was sent to President Obama (who vetoed it) on January 26, 2016.

If Republicans were simply to recycle their 2015 bill, however, the process could be dramatically shortened. That bill called for repeal of funding for the Medicaid expansion, as well as for jettisoning premium and other subsidies that help individuals afford private coverage, along with the taxes to pay for those benefits, as of December 31, 2017.

Health analysts and health provider groups have warned that repealing major pieces of the PPACA without immediately replacing them could cause a virtual collapse of the individual insurance market, which covers approximately 20 million people, according to the KHN article.

Source: Kaiser Health News; December 14, 2016.