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Republican effort to repeal the ACA, July 2017

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115th Congress, 2017-2018
Healthcare policy
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For more on healthcare policy, view the following articles:
•Healthcare overview
•Graham-Cassidy Obamacare replacement plan
•Republican effort to repeal the ACA, July 2017
•Better Care Reconciliation Act of 2017 (Senate bill)
•115th Congress on the Better Care Reconciliation Act of 2017
•Republican senators on the BCRA
•American Health Care Act of 2017 (House bill)
•House's second attempt to pass the AHCA, April - May
•House's initial attempt to pass the AHCA, March
•House roll call vote on the AHCA
•Republicans who were likely to vote against the AHCA, March
•Timeline of ACA repeal and replace efforts
•Federal policy on healthcare, 2017-2020

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For information on the September 2017 Republican effort to modify the ACA, click here. During the last week of July, the Senate voted on three major proposals to repeal and replace the Affordable Care Act, but each one failed. On July 25, 2017, the Senate held a vote on a motion to proceed to the American Health Care Act (AHCA), the House-passed repeal and replace bill. The motion was approved 51-50. Vice President Mike Pence voted in favor of the bill to break the 50-50 tie. After the motion to proceed passed, the Senate rejected a procedural vote on the Better Care Reconciliation Act (BCRA), the Senate's version of the healthcare bill, by a vote of 43-57. Sixty votes were needed to secure passage.[1][2]

On July 26, 2017, the Senate rejected a proposal to repeal the ACA and delay the effective date for two years to provide time for a replacement bill. The proposal was similar to the repeal-only bill—the Restoring Americans' Healthcare Freedom Reconciliation Act—passed by Congress in 2015. On July 28, 2017, the Senate voted on an amendment from McConnell, also referred to as the "skinny bill." The amendment contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions.[3][4]

After the skinny bill failed, McConnell said, "it is time to move on," and he called the final defeat disappointing. To read more about the votes taken by the Senate during the last week of July, click here to be taken to that part of the article.[5]

What happened after the July 2017 effort to repeal and replace the ACA failed?

On August 1, 2017, Senator Lamar Alexander (R-Tenn.) said that the Senate Health, Education, Labor, and Pensions (HELP) Committee would be working with Sen. Patty Murray (D-Wash.) and other committee Democrats to craft a bipartisan bill to stabilize the individual health insurance markets. Alexander said the committee would hold hearings beginning the week of September 4, 2017, with the goal of passing a bill by September 27, the final date for insurers to decide whether to offer plans on the ACA's health insurance exchanges in 2018. Alexander said he wanted the bill to fund the cost-sharing reduction reimbursements for insurers and also include some flexibility in insurance market regulations.[6]

Senate Majority Leader Mitch McConnell (R-Ky.) told reporters on August 5, 2017, that he would consider the bipartisan bill "if the Democrats are willing to support some real reforms rather than just an insurance company bailout."[7]

On September 19, 2017, Alexander said that the bipartisan effort had failed. He said, "During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted."[8]

Murray commented on Alexander's statement, saying, “I am disappointed that Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare bill, but I am confident that we can reach a deal if we keep working together — and I am committed to getting that done.”[8]

Background


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On June 22, 2017, the Senate released the Better Care Reconciliation Act of 2017 (BCRA), its version of the House bill, the American Health Care Act (AHCA). The bill was a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. On July 17, 2017, after weeks of negotiating the bill, Senate Majority Leader Mitch McConnell (R-Ky.) said that his party was unable to agree on a final replacement bill for the Affordable Care Act (ACA)—commonly known as Obamacare—and would instead vote on a bill to repeal, but not replace, the ACA.[9]

On July 19, 2017, after GOP senators met with President Donald Trump in the White House to discuss healthcare, Senate leadership said that they would try to revive the Better Care Reconciliation Act of 2017 (BCRA)—or a version of it—in an attempt to repeal and replace the ACA. When asked about the possibility of reviving and amending the BCRA, Senate Majority Whip John Cornyn (R-Texas) said, "We're discussing that. I'm more optimistic that that would be the case. But if there's no agreement, then we'll still vote on the motion to proceed but it'll be to the 2015 just-repeal bill."[10][11]

The 2015 bill—the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015—proposed repealing the parts of the ACA that impacted the federal budget, such as the advanced premium tax credits and the Medicaid expansion. It also proposed suspending federal funding for Planned Parenthood for one year.[12]

Before the Senate voted on the motion to proceed to the AHCA, four Republican senators had voiced opposition to the repeal-only bill, and four voiced opposition to the BCRA. One of the four senators opposed to the BCRA, Sen. Rand Paul (R-Ky.), said that "he could vote for the motion if he is guaranteed a subsequent vote on the repeal-only measure," according to The Hill.[13]

On July 24, 2017, The Hill reported that the Senate would instead vote on a motion to proceed to the American Health Care Act of 2017 (AHCA), the House-passed repeal and replace bill. GOP leadership urged rank-and-file senators to vote for a motion to proceed so that they could begin debating the bill on the Senate floor.[13]

On July 25, 2017, the Senate held a vote on a motion to proceed to the AHCA, the House-passed repeal and replace bill. The motion was approved 51-50. Republican Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) and all Senate Democrats voted against the motion. Vice President Mike Pence voted in favor of the bill to break the 50-50 tie, the fourth time he has cast a tie-breaking vote. Sen. John McCain (R-Ariz.), who had recently been diagnosed with brain cancer, returned to Capitol Hill to cast a vote in favor of the motion. Without his vote, the motion would have failed.[1]

The bill was used as a legislative vehicle through which Senators could propose and vote on amendments to the bill, some of which constituted entirely new bills. In total, 191 amendments were proposed and 10 received a vote.[14]

Amendments voted on by the Senate

Tuesday, July 25, 2017

After the motion to proceed on the healthcare bill passed, the Senate rejected a procedural vote on the Better Care Reconciliation Act of 2017 (BCRA) by a vote of 43-57. Sixty votes were needed to secure passage. GOP Sens. Lisa Murkowski (R-Alaska), Tom Cotton (R-Ark.), Jerry Moran (R-Kan.), Rand Paul (R-Ky.), Susan Collins (R-Maine), Dean Heller (R-Nev.), Lindsey Graham (R-S.C.), Bob Corker (R-Tenn.), and Mike Lee (R-Utah) voted against the repeal and replace proposal. No Democrats voted for the motion. The proposal included amendments from Sens. Rob Portman (R-Ohio) and Ted Cruz (R-Texas). Portman's amendment proposed including funding to help individuals in states that expanded Medicaid, like Ohio, pay for deductibles and copays if they lost their Medicaid coverage. Cruz's amendment proposed allowing insurance companies to sell plans that did not meet the ACA's requirements, as long as they also offered plans that did meet the requirements.[2]

How many GOP senators voted to repeal Obamacare?

September 14, 2017: Commenting on the apparent change of position among Republican senators who voted against Obamacare repeal, Senator Ben Sasse (R-Neb.) claimed, “With just one exception, every member of the Republican majority already either voted for repeal or explicitly campaigned on repeal.”
Is Sasse correct?

Read Ballotpedia's fact check »

Wednesday, July 26, 2017

On July 26, 2017, the Senate rejected a proposal to repeal the Affordable Care Act and delay the effective date for two years to provide time for a replacement bill. The proposal was similar to the repeal-only bill—the Restoring Americans' Healthcare Freedom Reconciliation Act—passed by Congress in 2015 and included an amendment from Sen. Rand Paul (R-Ky.) that would have prohibited the use of tax credits for health plans that covered abortion services. The proposal was rejected by a vote of 45-55, with Republican Sens. Shelley Moore Capito (R-W.Va.), Susan Collins (R-Maine), Dean Heller (R-Nev.), John McCain (R-Ariz.), Rob Portman (R-Ohio), Lamar Alexander (R-Tenn.), and Lisa Murkowski (R-Alaska) voted against the measure.[3]

Other votes the Senate took on July 26 on the healthcare bill include the following:[15][16][17]

  • A motion from Sen. Joe Donnelly (D-Ind.) to remove provisions from the American Health Care Act that would reduce federal Medicaid spending and prevent Medicaid expansion, sending the bill back to committee. The motion was rejected 48-52 down party lines.
  • A motion from Sen. Bob Casey (D-Pa.) to remove provisions from the AHCA that would reduce access to Medicaid for individuals with disabilities, sending the bill back to committee. The motion was rejected 48-51 down party lines. Sen. Ron Johnson (R-Wis.) did not vote.
  • A motion from Sen. Dean Heller (R-Nev.) to "express the sense of the Senate that Medicaid expansion is a priority and that Obamacare must be improved." The motion was rejected 10-90, with Sens. Shelley Moore Capito (R-W.Va.), Bill Cassidy (R-La.), Susan Collins (R-Maine), Mike Enzi (R-Wy.), Cory Gardner (R-Colo.), Dean Heller (R-Nev.), John McCain (R-Ariz.), Lisa Murkowski (R-Alaska), Rob Portman (R-Ohio), and Daniel S. Sullivan (R-Alaska) voting in favor.

Thursday, July 27, 2017

On July 27, 2017, the Senate voted on four measures related to the healthcare bill:[18][19][20][21]

  • An amendment offered by Sen. Steve Daines (R-Mont.) that would have created a nationwide single-payer health insurance system. All Republicans voted against the amendment, joined by four Democrats: Sens. Joe Donnelly (D-Ind.), Heidi Heitkamp (D-N.D.), Joe Manchin (D-W.Va.), and Jon Tester (Mont.). The remaining 43 senators voted "present."
  • A motion from Sen. Luther Strange (R-Ala.) that would have provided a greater amount of premium assistance to low-income individuals. The motion was rejected 50-50. All Democrats voted against the motion, joined by Republican Sens. Susan Collins (R-Maine) and Lisa Murkowski (R-Alaska).
  • A motion from Sen. Chuck Schumer (D-N.Y.) to send the bill back to committee. The motion was rejected 43-57. All Republicans voted against the measure, joined by Democratic Sens. Dick Durbin (D-Ill.), Kirsten Gillibrand (D-N.Y.), Tim Kaine (D-Va.), Chris Murphy (D-Conn.), and Mark Warner (D-Va.).
  • An amendment from Sen. Dean Heller (R-Nev.) to repeal the ACA's 40 percent excise tax on high-cost health plans. The amendment was approved 52-48. Sens. Bob Corker (R-Tenn.) and Ben Sasse (R-Neb.) were the only Republicans voting against, while Sens. Catherine Cortez Masto (D-Nev.) and Martin Heinrich (D-N.M.) were the only Democrats voting in favor.

Friday, July 28, 2017

In the early morning hours of July 28, 2017, the Senate voted on an amendment from Senate Majority Leader Mitch McConnell (R-Ky.), also referred to as the "skinny bill." The amendment contained the following provisions:[22]

  • A repeal of the requirement for individuals to enroll in health insurance
  • A repeal of the requirement for employers to offer health insurance
  • A delay of the tax on medical devices
  • A suspension of federal funding for community health centers that include Planned Parenthood
  • Greater funding for other community health centers
  • An expansion of the ability of states to get waivers from ACA provisions
  • A repeal of public health program fund

The amendment was rejected by a 49-51 vote. Sens. Susan Collins (R-Maine), John McCain (R-Ariz.), Lisa Murkowski (R-Alaska) joined 48 Democrats in voting against the amendment.[23]

Restoring Americans' Healthcare Freedom Act of 2015

Background

On July 18, 2017, Senate Majority Leader Mitch McConnell (R-Ky.) said that he would schedule a vote on a bill to repeal, but not replace the ACA. The bill would give Congress two years to develop a replacement plan before provisions of the ACA would end. McConnell "emphasized that his proposal is the same as the vote held to repeal the Affordable Care Act in 2015," according to CNBC. In 2016, Congress passed the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015. The bill would have repealed several parts of the ACA, but it was vetoed by President Barack Obama on January 8, 2016. Sen. Susan Collins (R-Maine) and former Sen. Mark Kirk (Ill.) were the only Republicans who voted against the bill.[24][25]

Commenting on the failure to create a repeal and replace bill, McConnell said, "As of today we just simply do not have 50 senators who can agree on what ought to replace the existing law. What we do have is a vote that many of us made two years ago at a time when the president of the United States would not sign the legislation that would repeal Obamacare and with a two-year delay give us an opportunity to build something better on a bipartisan basis."[26][27]

Members of the Senate attempt to revive repeal and replace efforts

See also: Better Care Reconciliation Act of 2017

On July 19, 2017, GOP senators met with President Donald Trump in the White House to discuss healthcare. During the meeting, Trump said that Congress should stay in Washington, D.C., until they pass a bill to repeal and replace the ACA. Trump said, "We shouldn't leave town until this is complete. We should hammer this out and get it done. ... We can repeal, but we should repeal and replace. ... Frankly I don’t think we should leave town unless we have a health insurance plan, unless we can give people great health care. Because we’re close. We’re very close.’’[28]

After the meeting, Senate leadership said that they would try to revive the BCRA—or a version of it—in an attempt to repeal and replace the ACA. When asked about a repeal and replace plan, Sen. John Thune (R-S.D.) said, "I think yeah, I would say that it is contemporarily sort of revived. ... There are going to be some meetings tonight up here with people who have issues, still have outstanding issues, I think the question will be ... can we find a way to yes. ... We don't have any delusions about the fact that this is going to be very hard. We still have members who are not there." Senators met to discuss the BCRA later that evening, but it was unclear which bill the senate would vote on.[11][10][29]

Summary of major provisions of the 2015 repeal-only bill

Partial Obamacare repeal

The Restoring Americans' Healthcare Freedom Reconciliation Act would have repealed the parts of the Affordable Care Act (ACA) that affected the federal budget. This included funding for certain provisions as well as the federal government's ability to collect some revenues under the law.[30]

The bill would have eliminated the ACA's penalty for individuals who do not purchase health insurance, known as the individual mandate. The advanced premium tax credits and reduced cost sharing provisions, which provided financial assistance to individuals purchasing insurance on the health insurance exchanges, would have ended. Individuals receiving advanced tax credits in excess of the amount they were eligible for would also have been required to pay back the full amount to the federal government; the ACA only required a partial amount be paid back.[30]

Under the act, the Medicaid expansion would have been rolled back. State Medicaid programs also would no longer have been required to provide the 10 essential health benefits established under the ACA. Medicaid payments to disproportionate share hospitals, which serve greater proportions of low-income patients, would have been increased; under the ACA, these payments were reduced in anticipation of an increase in individuals covered by health insurance.[30]

The bill would also have eliminated many of the ACA's taxes and fees:[30]

  • Excise tax on high-cost health plans
  • Brand-name prescription drug fee
  • Excise tax on medical devices
  • Annual health insurer fee
  • Indoor tanning services tax

Planned Parenthood funding

One section of the Restoring Americans' Healthcare Freedom Reconciliation Act would have also suspended for one year federal funding for community health centers that provide family planning, reproductive health, and related medical services and that also provide abortions in cases other than rape, incest, or to save the life of the mother. This would have included the nonprofit organization Planned Parenthood.

In place of funding for Planned Parenthood, the bill would have increased annual funding to other community health centers by $235 million in 2016 and 2017.[31]

Republican senators who opposed the plan to repeal the ACA without a replacement

Before the Senate voted on the repeal-only bill, four Republican senators had voiced opposition to it. In 2015, Sens. Lisa Murkowski (R-Alaska), Rob Portman (R-Ohio), and Shelley Moore Capito (R-W.Va.) all voted for the repeal-only bill. In 2015, Sen. Susan Collins (R-Maine) voted against the repeal-only bill.

Sen. Lisa Murkowski (R-Alaska)

On July 18, 2017, Sen. Lisa Murkowski (R-Alaska) issued the following statement opposing the plan to repeal the ACA without a replacement:

“ As I've been saying, the Senate should take a step back and engage in a bipartisan process to address the failures of the ACA and stabilize the individual markets. That will require members on both sides of the aisle to roll up their sleeves and take this to the open committee process where it belongs. The individual market in states like Alaska and in rural communities across America has continued to deteriorate since we last voted to repeal the Affordable Care Act. Alaskans have seen their premiums increase over 200 percent, only one insurer remains on our individual market, and the state was forced to enact a costly reinsurance program to keep our sole remaining provider from leaving. At the same time, the coverage offered on the exchange has become coverage in name only for too many Alaskans with premiums close to $1,000 a month on average and many facing deductibles approaching $10,000. Repealing the ACA without a clear path forward just creates confusion and greater uncertainty. As I stated earlier this year, I cannot vote to proceed to repeal the ACA without reform that allows people the choice they want, the affordability they need and the quality of care they deserve.[32][33] ”

Murkowski voted for the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 on December 3, 2015.[24]

Sen. Susan Collins (R-Maine)

On July 18, 2017, Sen. Susan Collins (R-Maine) issued the following statement opposing the plan to repeal the ACA without a replacement:

“ I will vote no on the motion to proceed to repeal the Affordable Care Act without a replacement. I voted against this same proposal in 2015. I do not think that it’s constructive to repeal a law that is so interwoven within our health care system without having a replacement plan in place. We can’t just hope that we will pass a replacement within the next two years. Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets. I have recommended to Chairman Alexander that the Senate Health Committee begin to hold hearings to examine ways to fix the many flaws in the ACA so that it will work better for all Americans.[34][33] ”

Collins voted against the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 on December 3, 2015.[24]

Sen. Rob Portman (R-Ohio)

On July 18, 2017, Sen. Rob Portman (R-Ohio) said that he opposed the plan to repeal the ACA without a replacement. Part of his statement appears below.

“ I have said consistently that I support repeal and replace, and I’m not giving up on doing both of those things. I don’t think it’s appropriate just to repeal, we’ve also got to put a replacement in place to help deal with the very issues I just talked about. Over the past year, as I’ve said, we’ve had a lot of destabilization of our insurance market in Ohio. That’s true around the country. Ohio has been hit harder than most states though, I will say. When the 2015 bill was passed we had at least two insurance companies providing insurance, writing insurance in every Ohio County. Most counties had multiple insurance companies. We’ve gone, by the way, during that period from 16 insurance companies in Ohio to about 10. And again, 19 counties now have no insurance company in the individual market and 27 only one insurer. And, so, there’s an urgency here for Ohio, and the best approach I think is to continue to work with my colleagues in the hopes that we can come together around a replacement plan that actually works to address these problems. These are real problems and we can’t ignore them.[35][33] ”

Portman voted for the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 on December 3, 2015.[24]

Sen. Shelley Moore Capito (R-W.Va.)

On July 18, 2017, Sen. Shelley Moore Capito (R-W.Va.) issued the following statement opposing the plan to repeal the ACA without a replacement:

“ As I have said before, I did not come to Washington to hurt people. For months, I have expressed reservations about the direction of the bill to repeal and replace Obamacare. I have serious concerns about how we continue to provide affordable care to those who have benefited from West Virginia’s decision to expand Medicaid, especially in light of the growing opioid crisis. All of the Senate health care discussion drafts have failed to address these concerns adequately. My position on this issue is driven by its impact on West Virginians. With that in mind, I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.[36][33] ”

Capito voted for the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 on December 3, 2015.[24]

Timeline of ACA repeal and replace efforts

  • July 28, 2017: The Senate voted on an amendment from Senate Majority Leader Mitch McConnell (R-Ky.), also referred to as the "skinny bill." The amendment contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions. The amendment was rejected by a 49-51 vote. Sens. Susan Collins (R-Maine), John McCain (R-Ariz.), Lisa Murkowski (R-Alaska) joined 48 Democrats in voting against the amendment.[37][38]
  • July 25, 2017: The Senate held a vote on a motion to proceed to the American Health Care Act of 2017 (AHCA), the House-passed repeal and replace bill. The motion was approved 51-50. Republican Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) and all Senate Democrats voted against the motion. Vice President Mike Pence voted in favor of the bill to break the 50-50 tie. Sen. John McCain (R-Ariz.), who was diagnosed with brain cancer the previous week, returned to Capitol Hill to cast a vote in favor of the motion. Without his vote, the motion would have failed.[1]
  • July 21, 2017: The Senate parliamentarian ruled that the provision suspending funding for Planned Parenthood for one year in the revised BCRA did not meet the rules of reconciliation. She also ruled that the provision prohibiting the use of tax credits for plans that cover abortions in circumstances other than rape or incest or to save the life of the mother did not meet the requirements.[39]
  • July 20, 2017: The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the revised version of the Better Care Reconciliation Act (BCRA). Key findings can be viewed here.[40]
  • July 19, 2017: After meeting with Trump in the White House, Senate leadership attempted to revive the BCRA or a version of it.[10]
  • July 17, 2017: Senate Majority Leader Mitch McConnell (R-Ky.) said that his party was unable to agree on a final version of the BCRA and would instead vote on a bill to repeal, but not replace, the ACA.[41][42]
  • July 15, 2017: Senate Majority Leader Mitch McConnell (R-Ky.) said that the Senate would not vote on the BCRA until after Senator John McCain (R-Ariz.) recovered from his eye surgery. McCain was recovering at his home in Arizona.[43]
  • July 11, 2017: Following a briefing with GOP senators, Senate Majority Leader Mitch McConnell (R-Ky.) delayed the start of the Senate's August recess to the third week in August in order to complete work on the BCRA and other items on the legislative agenda.[44]
  • June 27, 2017: Senate Republican leaders postponed a vote on the BCRA until after the July 4 recess.[45]
  • June 26, 2017: The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the Better Care Reconciliation Act (BCRA) and its impact on the number of uninsured. Key findings can be viewed here.[46]
  • June 6, 2017: The Senate Budget Committee announced that the AHCA complied with the Senate reconciliation process. House Republicans were waiting for the committee's verdict on the AHCA before sending it to the upper chamber.[47]
  • May 24, 2017: The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the AHCA as amended and its impact on the number of uninsured. The AHCA would reduce the federal deficit by $119 billion between 2017 and 2026 due to a $1.1 trillion decrease in direct spending and a $992 billion reduction in revenues. Compared to the ACA, 14 million more people would be uninsured in 2018 under the AHCA, and 23 million more people would be uninsured in 2026. In total, under the AHCA, 51 million people would be uninsured in 2026, compared to 28 million who would be uninsured under the ACA.[48]
  • May 4, 2017: The House passed the AHCA by a vote of 217-213.[49]
  • May 3, 2017: House Majority Leader Kevin McCarthy (R-Calif.) said that the House would hold a vote on the revised version of the AHCA on May 4, 2017. He wrote in a tweet, "Doing nothing is not an option. The American people are tied to #Obamacare’s sinking ship, and we have to act now. #AHCA."[50]
  • May 2, 2017: The House voted to approve waiving a rule requiring lawmakers to wait at least one day before voting on the AHCA. It would allow leaders in the House GOP to hold a vote on the AHCA as soon as they secured enough votes for passage.[51]
  • April 27, 2017: House Majority Leader Kevin McCarthy (R-Calif.) said that the House would not vote on the revised version of the AHCA before President Donald Trump 100th day in office.[52]
  • April 26, 2017: The House Freedom Caucus said that they would support the AHCA because of an amendment that would allow states to opt out of some provisions of the ACA.[53]
  • April 13, 2017: House Republicans added an amendment to the AHCA in an attempt to unite the party behind the bill. Rep. Tom MacArthur (R-N.J.), co-chair of the Tuesday Group, and Rep. Mark Meadows (R-N.C.), head of the House Freedom Caucus, introduced an amendment that proposed retaining the 10 essential health benefits as the federal standard for what health plans must cover, but would allow states to acquire a waiver from the requirement. Other provisions in the ACA that would be retained by the amendment included the prohibition on denying coverage for pre-existing conditions, the requirement to cover individuals on their parents' health plan until age 26, and limits on how much insurers may vary premiums for reasons such as age, gender, and health status (known as community rating). In addition to waiving the essential benefits standard, the amendment would allow states to obtain waivers from the community rating provisions, except for the rules limiting premium variance based on gender and age. States could only waive the limits on varying premiums based on health status if they had also established a publicly funded high-risk pool to cover individuals with costly conditions.[54][55][56]
  • April 3, 2017: White House officials discussed changes to the AHCA with the House Freedom Caucus. Officials proposed allowing "states to choose to apply for waivers to repeal two ObamaCare regulations that conservatives argue are driving up premiums. Those two regulations detail ObamaCare's essential health benefits, which mandate which health services insurers must cover, and 'community rating,' which prevents insurers from charging sick people higher premiums," according to The Hill.[57]
  • Rep. Mark Meadows (R-N.C.) said that the proposed changes would result in enough votes from Freedom Caucus members to pass the bill, but he said that he wanted to see the full text of the legislation before making a final decision.[57]
  • March 24, 2017: The House was expected to vote on the AHCA, but House Republican leaders withdrew the AHCA from consideration amid dwindling support.[58]
  • March 24, 2017: The House Rules Committee approved an amendment to the AHCA that would have repealed the ACA's requirement that insurers provide federally determined essential health benefits. Under the amendment, each state instead would have been required to determine which essential benefits insurers licensed in that state must cover. The amendment also would have provided $15 billion to states to promote access to preventive care, dental care, and vision care, and to provide maternity and newborn care and mental health services. The $15 billion would have been funded by maintaining a 0.09 percent Medicare tax on high-income earners for six years.[59][60][61]
  • March 23, 2017: The House was expected to vote on the AHCA, but the vote was canceled.[58]
  • March 20, 2017: The House added an amendment to the AHCA that provided for extra funding for tax credits for older Americans to help them pay their premiums and instructed the Senate to design the tax credits. It removed a provision in the original bill that would have allowed individuals to deposit leftover tax credit money into a health savings account. The amendment would have allowed states to establish work requirements for their Medicaid programs and would have allowed states to receive federal Medicaid funding in the form of a per-member amount or block grants, whichever they chose. The amendment would have repealed many of the ACA's taxes and fees and would have delayed the 40 percent excise tax on employer-sponsored plans until 2026. Finally, the amendment contained a provision specific to New York state: it would have prohibited New York from receiving federal reimbursement for Medicaid payments that counties make to the state in an attempt to shift more Medicaid spending to the state level.[62]
  • March 6, 2017: Representatives Kevin Brady (R-Texas) and Greg Walden (R-Ore.) introduced the American Health Care Act of 2017, a reconciliation bill to modify the budgetary and fiscal provisions of the ACA. It did not propose completely repealing the ACA.[66]
  • January 23, 2017: Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) introduced S 191—the Patient Freedom Act of 2017. The legislation proposed replacing the ACA.[67][68]
  • Cassidy discussed the bill, saying, "I would say what we’re doing is moving the locus of repeal to state governments. On the one hand, that is philosophically consistent with where Republicans are. States should have the right to choose. It is also consistent with our long-stated [principle], ‘If you like your insurance, you can keep it.’"[69]
  • January 12, 2017: The Senate passed S Con Res 3, a budget resolution to begin rolling back the ACA, by a vote of 51-48. Sen. Rand Paul (R-Ky.) was the only Republican who voted against the budget resolution because he said that it increased the federal debt. Paul added, “I won’t vote for a terrible budget just to repeal Obamacare. … If I have to weigh the two problems, I actually think the debt is a more important problem than Obamacare.”[71][72]
  • January 4, 2017: The Senate passed S Con Res 3, a motion to begin debating a budget bill, by a vote of 51-48. The budget resolution proposed repealing parts of the ACA that related to the budget and taxes. The final legislation was expected to eliminate provisions that provided tax credits for low-income individuals to obtain health coverage, required all individuals to obtain coverage, and required employers to provide coverage to their employees.[73][74]

Bill texts

Text of the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015

Below is the text of the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015. This is the language that was expected to be voted on in a repeal-only approach.

Text of the Better Care Reconciliation Act of 2017

The text below reflects the language of the Better Care Reconciliation Act as it was introduced.

See also

Footnotes

  1. ↑ 1.0 1.1 1.2 Senate.gov, "On the Motion to Proceed (Motion to Proceed to H.R. 1628)," July 25, 2017
  2. ↑ 2.0 2.1 2.2 Senate.gov, "On the Motion (Motion to Waive All Applicable Budgetary Discipline Re: Amdt. No. 270)," July 25, 2017
  3. ↑ 3.0 3.1 3.2 Senate.gov, "On the Amendment (Paul Amdt. No. 271 )," July 26, 2017
  4. ↑ Senate.gov, "On the Amendment (McConnell Amdt. No. 667 )," July 28, 2017
  5. ↑ The Hill, "McConnell: 'Time to move on' after healthcare defeat," July 28, 2017
  6. ↑ Axios, "Next step on health care: Short-term stabilization bill," August 1, 2017
  7. ↑ The Associated Press, "McConnell to consider bipartisan plan to pay health insurers," August 6, 2017
  8. ↑ 8.0 8.1 The Hill, "GOP chairman declares bipartisan ObamaCare fix dead," September 19, 2017
  9. ↑ CNBC, "GOP gives up on replacing Obamacare now: McConnell and Trump call for simply repealing," July 17, 2017
  10. ↑ 10.0 10.1 10.2 Politico, "Key Senate Republicans to meet and try to revive health bill," July 19, 2017
  11. ↑ 11.0 11.1 The Hill, "Senate GOP revives negotiation over ObamaCare repeal and replace," July 19, 2017
  12. ↑ ABC News, "McConnell calls for Obamacare repeal vote after replacement plan fails," July 18, 2017
  13. ↑ 13.0 13.1 The Hill, "Senate heads to new healthcare vote with no clear plan," July 21, 2017
  14. ↑ Congress.gov, "H.R.1628 - American Health Care Act of 2017 - Amendments," accessed August 16, 2017
  15. ↑ Senate.gov, "On the Motion (Donnelly Motion to Commit H.R. 1628 with Instructions )," July 26, 2017
  16. ↑ Senate.gov, "On the Motion (Casey Motion to Commit H.R. 1628 with Instructions )," July 26, 2017
  17. ↑ Senate.gov, "On the Motion (Motion to Waive All Applicable Budgetary Discipline Re: Heller Amdt. No. 288 )," July 26, 2017
  18. ↑ Senate.gov, "On the Amendment (Daines Amdt. No. 340 As Modified )," July 27, 2017
  19. ↑ Senate.gov, "On the Motion (Motion to Waive All Applicable Budgetary Discipline Re: Strange Amdt. No. 389 )," July 27, 2017
  20. ↑ Senate.gov, "On the Motion (Schumer Motion to Commit H.R. 1628 with Instructions )," July 27, 2017
  21. ↑ Senate.gov, "On the Amendment (Heller Amdt. No. 502 )," July 27, 2017
  22. ↑ Axios, "Here’s the Senate’s “skinny” health care bill," July 27, 2017
  23. ↑ Senate.gov, "On the Amendment (McConnell Amdt. No. 667 )," July 28, 2017
  24. ↑ 24.0 24.1 24.2 24.3 24.4 Senate.gov, "On Passage of the Bill (H.R. 3762 As Amended)," December 3, 2015
  25. ↑ The Hill, "House passes ObamaCare repeal, sending measure to president," January 6, 2016
  26. ↑ CNBC.com, "McConnell says GOP doesn't have votes to replace Obamacare, but will vote on repeal in 'very near future,'" July 18, 2017
  27. ↑ CNBC, "GOP's Obamacare repeal-only push quickly collapses," July 18, 2017
  28. ↑ The Hill, "Trump to GOP senators: Cancel your recess," July 19, 2017
  29. ↑ Reuters, "Republicans meet late into night as Trump demands new U.S. healthcare plan," July 19, 2017
  30. ↑ 30.0 30.1 30.2 30.3 Congress.gov, "H.R.3762 - To provide for reconciliation pursuant to section 2002 of the concurrent resolution on the budget for fiscal year 2016," accessed January 4, 2016
  31. ↑ House Republicans, "H.R. 3762," accessed January 4, 2017
  32. ↑ Murkowski.Senate.gov, "Murkowski’s Statement on Senate Healthcare Process," July 18, 2017
  33. ↑ 33.0 33.1 33.2 33.3 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source.
  34. ↑ Collins.Senate.gov, "Senator Collins’ Statement on Senate Plan to Repeal ACA without a Replacement," July 18, 2017
  35. ↑ Portman.Senate.gov, "Portman: 'I Don't Think It's Appropriate Just to Repeal, We've Also Got to Put a Replacement In Place,'" July 18, 2017
  36. ↑ Capito.Senate.gov, "Capito Statement On Health Care, Vote To Repeal Obamacare," July 18, 2017
  37. ↑ Senate.gov, "On the Amendment (McConnell Amdt. No. 667 )," July 28, 2017
  38. ↑ Axios, "Here’s the Senate’s “skinny” health care bill," July 27, 2017
  39. ↑ CNN, "Senate parliamentarian: Anti-abortion provisions in GOP health care bill violate budget rules," July 21, 2017
  40. ↑ Congressional Budget Office, "H.R. 1628, the Better Care Reconciliation Act of 2017: An Amendment in the Nature of a Substitute," July 20, 2017
  41. ↑ CNBC.com, "McConnell says GOP doesn't have votes to replace Obamacare, but will vote on repeal in 'very near future,'" July 18, 2017
  42. ↑ CNBC, "GOP's Obamacare repeal-only push quickly collapses," July 18, 2017
  43. ↑ The Washington Post, "McConnell defers vote on Senate health-care bill as McCain recovers from surgery," July 16, 2017
  44. ↑ CNN, "McConnell delays start of recess until third week in August," July 11, 2017
  45. ↑ The Wall Street Journal, "Short on Backers, GOP Delays Vote on Health Bill," June 27, 2017
  46. ↑ Congressional Budget Office, "Congressional Budget Office Cost Estimate: Better Care Reconciliation Act of 2017," June 26, 2017
  47. ↑ The Hill, "Budget Committee: House healthcare bill can move to Senate," June 6, 2017
  48. ↑ Congressional Budget Office, "Congressional Budget Office Cost Estimate: American Health Care Act of 2017," May 24, 2017
  49. ↑ Clerk.House.gov, "Final Vote Results For Roll Call 256," May 4, 2017
  50. ↑ Twitter, "Kevin McCarthy," May 3, 2017
  51. ↑ The Hill, "House GOP paves way for fast-tracking potential healthcare vote," May 2, 2017
  52. ↑ The Hill, "Republicans won't vote on ObamaCare replacement bill this week," April 27, 2017
  53. ↑ The Hill, "Freedom Caucus endorses revised ObamaCare repeal-and-replace bill," April 26, 2017
  54. ↑ NPR, "MacArthur Amendment to the American Health Care Act," April 13, 2017
  55. ↑ National Association of Insurance Commissioners, "Patient Protection and Affordable Care Act of 2009: Health Insurance Exchanges," April 20, 2010
  56. ↑ Politico, "White House plans Obamacare showdown next week," April 20, 2017
  57. ↑ 57.0 57.1 The Hill, "Pence presents new healthcare offer to Freedom Caucus," accessed April 4, 2017
  58. ↑ 58.0 58.1 The Hill, "House cancels ObamaCare repeal vote as GOP defections mount," accessed March 24, 2017
  59. ↑ The Hill, "Live coverage: Trump, GOP scramble for ObamaCare votes," March 24, 2017
  60. ↑ Washington Post, "This is why Obamacare is canceling some people's insurance plans," October 29, 2013
  61. ↑ U.S. House of Representatives, "Policy Amendment to the Manager's Amendment (Policy Changes) to H.R. 1628," accessed March 24, 2017
  62. ↑ Politico, "GOP leaders pile on sweeteners to sell Obamacare repeal," March 20, 2017
  63. ↑ The Hill, "Budget panel advances ObamaCare bill with three GOP defections," accessed March 16, 2017
  64. ↑ EnergyCommerce.House.gov, "Energy and Commerce Committee Advances Legislation to Repeal and Replace Obamacare," accessed March 9, 2017
  65. ↑ WaysandMeans.gov, "Ways and Means Republicans Take Historic Action to Repeal Obamacare & Ensure More Americans Have Access to Affordable Care," accessed March 9, 2017
  66. ↑ House Energy and Commerce Committee, "Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act," accessed March 7, 2017
  67. ↑ Congress.gov, "S.191 - Patient Freedom Act of 2017," accessed March 13, 2017
  68. ↑ Collins.Senate.gov, "Cassidy, Collins Release Legislative Text for Obamacare Replacement Plan," accessed March 13, 2017
  69. ↑ The Wall Street Journal, "GOP Senators Propose Health Law Replacement That Lets States Opt Out," accessed March 13, 2017
  70. ↑ Clerk.House.gov, "Final Vote Results for Roll Call 59," accessed January 13, 2017
  71. ↑ Senate.gov, "On the Concurrent Resolution (S. Con. Res. 3)," accessed January 13, 2017
  72. ↑ USA Today, "Sen. Rand Paul using Obamacare repeal to protest debt," accessed January 13, 2017
  73. ↑ Congress.gov, "S.Con.Res.3," accessed January 6, 2017
  74. ↑ Senate.gov, "On the Motion to Proceed (Motion to Proceed to S. Con. Res. 3)," accessed January 6, 2017
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