Background on ACA Repeal (12.22.16)


Budget resolution.   Most likely, congressional leaders will take up a “budget resolution” during the first week of January and will vote on it the following week.  Adopting a budget resolution will allow Congress to use a so-called “reconciliation bill” to repeal the ACA.  (Press reports may make it sound like the vote on the budget resolution is the repeal of the ACA, but actually, a “reconciliation bill” must then be enacted to repeal the law.)

Reconciliation bill.  Congress is expected to take up the reconciliation bill to repeal portions of the ACA in late January or early February.  A reconciliation bill is intended to be used for changes in law that are primarily budgetary in nature.  It can be used to effectively repeal the ACA’s individual and employer mandates, the premium tax credit, cost-sharing subsidies, and the Medicaid expansion. It is not expected, however, that the reconciliation bill can be used to repeal the consumer protections in the ACA, such as the ban on pre-existing condition exclusions, the ban on annual and lifetime coverage limits, and the provision allowing children to stay on their parents’ insurance plans until age 26.  But, there are no black and white rules about this; it will be up to the Senate parliamentarian to decide.

Impact of repeal.  A bill to repeal the all or part of the ACA is likely to have a delay of two or three years before it takes effect, in order to give Congress time to develop an alternative way to help people get insurance.  But, experts think that the uncertainty created by repealing the current law before knowing what will take its place will destabilize the insurance market right away.  As a result, there will likely be significant premium increases as early as 2018, causing up to 30 million people to lose their insurance (so more people will be uninsured than before the ACA was enacted). The Urban Institute estimates that over four million children will lose coverage by 2019 if the ACA is partially repealed, as planned.

Outlook for passage of repeal bill.  Barring an unexpected development, the reconciliation bill to repeal the ACA will pass in the House, where the Republicans have a solid majority. If it also passes the Senate, the new president will likely sign it.  But there is a possibility that the bill can be stopped in the Senate.  A reconciliation bill needs only 51 votes to proceed in the Senate, while most bills require 60 votes to advance.  There will be 52 Republicans in the Senate next year, but if all Independents and Democrats vote against repeal, then only three Republicans need to oppose the bill for the measure to fail. (Three votes against the bill are needed to prevent passage because a 51st vote can be cast by the vice-president if there is a tie, and he will vote for repeal.) 

Republican Senators who might oppose repeal right now.  Some Republican Senators are concerned about destabilizing the insurance market, thus increasing the number of uninsured, if the ACA is repealed without enacting an alternative at the same time.  And some Republican Senators are concerned because their Republican-led states will lose a lot of Medicaid funds if the ACA’s Medicaid expansion is repealed.  Thus, it may be possible to persuade three Senators to vote against repealing the ACA before a replacement is enacted. The following Senators are considered most likely to consider opposing the repeal bill.  If you are represented by any of them, please let them know now that you oppose repeal of the ACA without simultaneously replacing it with a law that will maintain or improve the coverage provided by the ACA.  Lamar Alexander (TN), Shelley Moore Capito (WV), Susan Collins (ME), Jeff Flake (AZ), Dean Heller (NV), John McCain (AZ), Lisa Murkowski (AK), Rob Portman (OH), and Patrick Toomey (PA).