115th Congress on healthcare, 2017-2018

• 115th Congress
  • Key votes: 115th Congress, 2017-2018
• Domestic policy
  • Energy and the environment
  • Healthcare
  • Immigration
• Economic policy
  • Budget
  • Financial policy
  • Taxes
  • Trade
• Foreign policy
  • Iran nuclear deal
• Trump administration

115th Congress, 2017-2018 Healthcare policy

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

115th Congress, 2017-2018 Issues

Domestic policy Key votes • Energy and the environment • Healthcare • Immigration

Economic policy and government regulations Key votes • Budget • Financial policy • Taxes • Trade

Foreign policy and national security Key votes • Iran nuclear deal

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See also: Federal policy on healthcare, 2017-2020

The main healthcare priority for Democrats in the 115th United States Congress has been to fix the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, while the main priority for most Republicans has been to repeal and replace the ACA. This page tracks the progress of each party toward its healthcare goals and initiatives. It also tracks the comments from members of Congress on a variety of healthcare issues, including, but not limited to, Medicare, Medicaid, contraception, and vaccines.

Click on the links below to read more about the 115th Congress on healthcare.

• Better Care Reconciliation Act of 2017
• American Health Care Act of 2017
• Timeline of healthcare issues and initiatives
• Members of Congress on healthcare
• Key votes on healthcare
• Timeline of ACA repeal and replace efforts

Better Care Reconciliation Act of 2017

See also: 115th Congress on the Better Care Reconciliation Act of 2017

On June 22, 2017, the U.S. 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 13, 2017, the Senate released a revised version of the bill that included changes, such as $45 billion to address the opioid epidemic and allowing the sale of health plans that do not comply with ACA standards. For detailed information on the BCRA, click here.

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 replacement bill for the ACA, but the bill was revived two days later. During the last week of July, the Senate voted on three major proposals to repeal and replace the ACA. A procedural vote on the BCRA was rejected by a vote of 43-57. A proposal to repeal the ACA and delay the effective date for two years to provide time for a replacement bill failed by a vote of 45-55. The final major amendment—the "skinny bill"—was rejected by a 49-51 vote. It contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions.

After the skinny bill failed, McConnell said, “it is time to move on,” and he called the final defeat disappointing.

For more on the BCRA, click here. For more on the Senate's effort to pass the BCRA click here.

American Health Care Act of 2017

See also: 115th Congress on the American Health Care Act of 2017 (May, revised AHCA bill)

On March 6, 2017, House Republicans introduced the American Health Care Act of 2017 (AHCA), a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. The bill did not propose repealing the ACA in its entirety, a move that was criticized by some conservatives who called for a full repeal of President Barack Obama's signature healthcare law.

The bill proposed repealing the penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The ACA's subsidies for purchasing insurance would have ended, as would have enhanced federal funding for states that expanded Medicaid. The bill also proposed a system of tax credits, based on age rather than income, and a penalty in the form of increased premiums for individuals who did not maintain continuous coverage.

On May 4, 2017, the House passed the AHCA by a vote of 217-213.

For more on the AHCA, click here.

What is the ACA or Obamacare? The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA) or Obamacare, was signed into law by President Barack Obama (D) on March 23, 2010. The aim of the law was to provide health insurance coverage to more Americans, primarily through individual health insurance marketplaces and an expansion of the Medicaid program. Click here to read more about the healthcare law.

What did members of Congress think about the AHCA?

Reps. Kevin Brady (R-Texas) and Greg Walden (R-Ore.), the bill's sponsors, wrote in an op-ed that the AHCA "will rescue those hurt by ObamaCare’s failures and lay the groundwork for a patient-centered health-care system. ... After seven years of ObamaCare’s failures, Republicans are committed to lowering costs, expanding choices and putting the American people back in charge of their own health care."

Conservative and libertarian-leaning Republicans—led by members of the House Freedom Caucus, the Republican Study Committee, and Sen. Rand Paul (R-Ky.)—criticized the AHCA because it would not have fully repealed the ACA, included an extended period for the Medicaid expansion, and would have replaced income-based subsidies in the ACA with age-based tax credits, which they said was a new entitlement. Some centrist Republicans criticized the bill because they opposed the changes to Medicaid. Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) criticized the bill because it would defund organizations like Planned Parenthood that provide women's healthcare services, as well as abortion services.

Speaker of the House Paul Ryan (R-Wis.) and Reps. Walden and Brady countered opposition in their party by explaining that they wanted to make additional changes to the healthcare system but they had to put forward a bill that had a chance of passing the Senate. Walden said that passing a full repeal of the ACA would require support from Democrats, but Democrats expressed strong opposition to a full repeal. Because a repeal bill would not have met the 60-vote threshold, Walden and Brady proposed a reconciliation bill that would have only needed a simple majority to pass in the Senate. Walden said, “Part of what we’re getting criticized for is what’s not in this bill. There are a lot of things that we will do going forward in the next bucket that we are prohibited from putting in this bill because of the rules of the Senate on reconciliation. So we could load this thing up, but then you got to get 60 votes in the Senate. You can get 60 votes in the Senate, I’m all for doing more. I want to get as much reform as I can here. This is the start. This is one piece.”

No Democratic members of Congress expressed support for the AHCA. House Minority Leader Nancy Pelosi (D-Calif.) said the bill "hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across America." Senate Minority Leader Chuck Schumer (D-N.Y.) said the bill "would cut and cap Medicaid, defund Planned Parenthood, and force Americans, particularly older Americans, to pay more out of pocket for their medical care all so insurance companies can pad their bottom line."

Click here to read more about the House GOP's second attempt to pass the AHCA in May 2017.

Click here to read more about the House GOP's initial attempt to pass the AHCA in March 2017.

Click here to read more about the American Health Care Act of 2017.

Timeline of healthcare issues and initiatives

October 10, 2018: Senate rejects resolution to undo expanded access to short-term healthcare plans

On October 10, 2018, the Senate rejected a resolution that proposed overturning a Trump administration rule that expanded access to short-term healthcare plans by a vote of 50-50. The rule allowed individuals to purchase health insurance plans that were not required to cover people with pre-existing conditions or other health services. Republican Sen. Susan Collins (R-Maine) voted with the 49 senators in the Democratic caucus in support of the resolution. Fifty Republicans voted against the resolution.

Speaking about healthcare before the vote, Senate Democratic Leader Chuck Schumer (D-N.Y.) said, “In a few short weeks the American people will head to the polls where they can vote for another two years of Republican attempts to gut our health-care system, or they can vote for Democratic candidates who will safeguard the protections now in place and work to make health care more affordable.”

Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, said that the short-term plans provided people with less expensive healthcare options. He said the message is “you can pay less with less coverage and at least you will have some insurance. But our Democratic friends will say, 'Oh no, we don't want to do anything that will lower the cost of insurance'"

June 22, 2018: Bipartisan legislation to slow opioid crisis passes the House

On June 22, 2018, the House passed a bipartisan package of 58 bills aimed at fighting the opioid crisis. The legislation included provisions such as requiring healthcare providers to write prescriptions for Medicare recipients electronically to monitor the levels and frequency of prescriptions; lifting many prescription limits on an opioid addiction treatment drug; extending Medicare coverage to include addiction treatment; directing the National Institutes of Health to develop nonaddictive painkillers; and requiring medical records to list a patient's addiction history.

Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee, said of the bill’s bipartisanship, "At a time when it seems we couldn’t be more divided, it’s clear that striking back against addiction is something that transcends politics and brings us together as a community, as a country and a Congress."

Rep. Frank Pallone Jr. (D-N.J.) questioned the legislation's impact, saying, "This bill makes incremental changes to support those affected by the opioid crisis, but it's far from perfect. I do question if this bill will have a meaningful impact on the opioid crisis."

May 30, 2018: Trump signs Right to Try bill

On May 30, 2018, President Donald Trump signed S 204—the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017. The law allows terminally ill patients to use unapproved, investigational drugs after all approved treatment options have been tried.

During a signing ceremony, Trump said, "With the Right to Try law I’m signing today, patients with life-threatening illnesses will finally have access to experimental treatments that could improve or even cure their conditions. These are experimental treatments and products that have shown great promise, and we weren’t able to use them before. Now we can use them. And oftentimes they’re going to be very successful. It’s an incredible thing. The Right to Try also offers new hope for those who either don’t qualify for clinical trials or who have exhausted all available treatment options. There were no options, but now you have hope. You really have hope."

It passed the House on May 22, 2018, by a vote of 250-169. Two hundred and twenty-eight Republicans and 22 Democrats voted for the bill. One hundred and sixty-nine Democrats and no Republicans voted against the bill. The Senate passed the bill by unanimous consent on August 3, 2017.

More than 100 advocacy groups, including the American Cancer Society Cancer Action Network and Friends of Cancer Research, opposed the bill because they said it could give patients false hope that their disease could be cured by an experimental drug. They also said that the Food and Drug Administration’s (FDA) compassionate-use program allows terminally ill patients access to experimental treatments.

Rep. Frank Pallone (D-N.J.), the House Energy and Commerce Committee’s ranking member, opposed the bill. He said during debate about the bill, “FDA oversight of access to experimental treatments exists for a reason — it protects patients from potential snake oil salesmen or from experimental treatments that might do more harm than good. By removing FDA oversight, you are counting on physicians and manufacturers to serve as the gatekeeper and protector of patients. I simply don’t buy that that’s going to work.”

Supporters of the bill said that terminally ill patients should have access to any treatment that could potentially save their lives. They also said that the FDA’s program to approve experimental treatments on a case-by-case basis was not efficient enough for patients with life-threatening illnesses.

Rep. Michael Burgess (R-Texas), the House Energy and Commerce health subcommittee chairman, said, “It’s about patients. It’s about having more time with their loved ones.”

March 21, 2018: House passes Right to Try bill

On March 21, 2018, the House passed a bill that would allow terminally ill patients access to experimental drugs not approved by the Food and Drug Administration (FDA) to treat their illness. The House passed HR 5247—the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2018—by a vote of 276-149. The House chose to vote on its own version of the Right to Try bill instead of taking up the version that the Senate passed on August 3, 2017.

The major difference between the House and Senate versions centered on who could qualify for experimental drugs. The Senate bill proposed allowing access by a patient “diagnosed with a life-threatening disease or condition.” The House bill proposed allowing access by a patient “diagnosed with a stage of a disease or condition in which there is reasonable likelihood that death will occur within a matter of months.” Patients would also qualify if their illness could result in “significant irreversible morbidity that is likely to lead to severely premature death.”

The House bill was not taken up by the Senate. Instead, the House voted to pass the Senate’s version of the bill on May 22, 2018.

January 22, 2018: Congress approves CHIP funding

On January 22, 2018, Congress approved funding for the Children's Health Insurance Program (CHIP) in a six-year reauthorization. The previous funding for CHIP expired in September 2017, and disagreements between Democrats and Republicans in Congress over how to best fund the program caused a four-month lapse in federal funding. At the time of the reauthorization, the program covered 9 million low-income children.

December 22, 2017: Congress repeals individual mandate as part of tax law

See also: Federal policy on taxes, 2017-2018

On December 22, 2017, President Donald Trump signed HR 1—the Tax Cuts and Jobs Act—into law. The law, among other things, eliminated the Affordable Care Act's (ACA) individual mandate beginning in 2019.

The ACA required every individual to obtain health insurance and established fines for those who did not. The fines were designed to be based on the number of months a person went without health insurance in a given year and to increase each year from 2014 to 2016. The fine schedule was written as follows:

• 2014: maximum of $95 or 1 percent of income, whichever is greater
• 2015: maximum of $325 or 2 percent of income, whichever is greater
• 2016 and thereafter: maximum of $695 or 2.5 percent of income, whichever is greater

The Internal Revenue Service (IRS) was given responsibility for collecting the fine, assessed annually as a tax penalty during the income tax filing period. The law established a hardship exemption from the fine for individuals who meet certain qualifications—such as being homeless, being a victim of domestic violence, or filing for bankruptcy.

Repeal ACA

See also: Republican effort to repeal the ACA, July 2017

Favor repeal of the ACA

Rep. Jim Jordan (R-Ohio)

• During an interview on ABC’s “This Week” on February 26, 2017, Rep. Jim Jordan (R-Ohio) was asked if Republicans had the votes to pass a bill to repeal and replace the ACA. He said, “We’d better have the votes for that, because that’s what we told the people, and I’m confident President Trump wants to do that." When asked about Republican Governor John Kasich's (Ohio) warning to conservative Republicans that repealing all of the law would hurt some people in his state, Jordan replied, "Well, we didn't tell the American people we're going to repeal it except we're going to keep the Medicaid expansion. We didn't tell the American people we're going to repeal it, except we're going to keep some of the tax increases that some are talking about. We told them we were going to repeal it and replace it with a market-centered, patient-centered plan that actually brings back affordable health insurance. We got to remember where we're at. Obamacare said this -- it said we're going to have all these mandates, all these regulations. We're going to drive up the cost of insurance, we're going to make people buy it, and if they don't buy it, they're going to get penalized. What did -- what kind of plan is that? That's what Americans are living under now. And so we have said, let's get rid of that, and let's put on President Trump's desk the exact same plan we put on President Obama's desk just a year and a half ago."

Sen. Michael Enzi (R-Wyo.)

• On January 3, 2017, Senate Budget Committee Chair Michael Enzi (R-Wyo.) introduced a budget resolution to repeal the ACA using reconciliation. Enzi said, “It is time to lift the burdens and higher costs Obamacare has placed on all Americans. The Senate this week is focused on true legislative relief from this law that Americans have long demanded, while ensuring a stable transition in which those with insurance will not lose access to health care coverage. Unwinding this tangle of partisan gridlock to make meaningful changes will not be easy. Our goal is to create a health care system where Washington makes fewer decisions, and families are empowered to control their own health care with more choices and lower costs.”

Rep. Kevin McCarthy (R-Calif.)

• On December 5, 2016, House Majority Leader Kevin McCarthy (R-Calif.) said that the House would work on repealing the ACA in the first week of 2017 through a budget process known as reconciliation. Parts of the ACA could be eliminated by a simple majority vote under reconciliation, rather than the usual 60 vote threshold. When asked when the vote would be held, McCarthy said, “I don’t want to set it down, but I’ll tell you it’s very soon."

Speaker Paul Ryan (R-Wis.)

• On January 5, 2017, Speaker Paul Ryan (R-Wis.) said that Republicans would put forward their plan to replace the ACA after members of Trump's Cabinet were confirmed. He said, “Our legislating will occur this year. Our legislating on ObamaCare, our repealing and replacing and transitioning, the legislating will occur this year. What date all this gets phased in on is something we do not now know because we’re waiting for the Trump administration to be stood up, we’re waiting for Tom Price to be confirmed and become the secretary of Health and Human Services." Ryan did not offer specifics about the replacement bill but added, "Can we in this country have a healthcare system that gives us access to affordable healthcare in this country without a costly government takeover and a death spiral, which ObamaCare’s giving us? And the answer is yes."

Oppose repeal of the ACA

House Minority Leader Nancy Pelosi (D-Calif.)

• In an op-ed on January 31, 2017, House Minority Leader Nancy Pelosi (D-Calif.) wrote, "Instead of focusing on jobs and wages, Republicans have decided to launch an all-out assault on affordable health care in America. Their plan is to repeal the Affordable Care Act, slash Medicaid, and destroy the sacred Medicare guarantee that has protected generations of Americans. The Republicans' plan won't make America great again. It will make America sick again. The facts are these. The Congressional Budget Office -- whose director was appointed by a Republican speaker -- has documented the dire consequences of repealing the ACA. The number of uninsured Americans will increase by 18 million in the first year alone, surging to 32 million by 2026. The costs of premiums for Americans in the individual market will double in the same time, with the repeal of the Affordable Care Act. ... Repeal of the Affordable Care Act will lead to death, disability and suffering. And Republicans will do all of this to give a massive new tax break to the wealthiest -- as they abandon seniors and working families across America. That injustice is not what the American people voted for in November. Democrats will stand our ground to protect the Affordable Care Act, because we believe -- as did many of the marchers -- that health care is the right of every American, not just the privileged few."

Sen. Bernie Sanders (I-Vt.)

• In an op-ed on January 9, 2017, Sen. Bernie Sanders (I-Vt.) wrote, "Let me be absolutely clear: The impact of repealing large pieces of the Affordable Care Act, which Republicans are planning to put on Donald Trump’s desk on his first day in the White House, would be devastating. If Republicans get their way, 30 million Americans, 82 percent of whom are from working families, will lose their health insurance. With Medicare privatized, seniors will see their premiums increase by as much as 50 percent while their benefits are cut and funding for nursing-home care dries up. Underfunded hospitals around the country, particularly in rural areas, could be forced to close their doors, leaving millions of Americans with nowhere to turn for critical medical care. Patient protections, like preventing insurance companies from denying coverage because of a preexisting condition, removing the cap on maximum health-care benefits, allowing children to stay on their parents’ health insurance plans until age 26 and preventing discrimination by insurers, would be eliminated. Meanwhile, the pharmaceutical industry’s greed will be rewarded as prescription drug costs for older Americans will likely rise by as much as 50 percent, and the wealthiest 2 percent can look forward to a $346 billion tax break. Not only is the Republican plan immoral and bad economic and social policy, it violates numerous promises that Donald Trump made to the American people during his campaign."

Sen. Chuck Schumer (D-N.Y.)

• On January 4, 2017, Senate Minority Leader Chuck Schumer (D-N.Y.) said, "They [Republicans] want to repeal it and then try to hang it on us, not going to happen. They're going to own it and all the problems in the healthcare system. ... We're united in our opposition to these Republican attempts to make America sick again."

Medicaid

Thirty-one states expanded Medicaid under the ACA. Twenty Republican senators represent states that expanded Medicaid, while 32 Senate Republicans represent states that did not expand Medicaid. Completely repealing the ACA would strip states of federal funding for Medicaid and result in individuals losing healthcare coverage. Some senators have proposed keeping the federal funding for the states, and others have suggested creating a transition period for states to figure out how to provide coverage for citizens on Medicaid. Sen. John Thune (R-S.D.) said that coming up with a solution to this problem is the most difficult issue Republicans face in their repeal and replace efforts. Thune said, "You don’t want to punish or penalize states that didn’t expand [Medicaid], but the states that did expand are going to say, ‘We don’t want to get punished for expanding, either.’ To me, that’s probably the thorniest and most difficult issue to resolve."

Sen. Kamala Harris (D-Calif.)

• In a series of tweets on February 24, 2017, Sen. Kamala Harris (D-Calif.) said, "1 in 2 Californian children depend on Medicaid. This plan's cuts to Medicaid attacks those who need heath care most. ... It’s vital we improve the ACA, not repeal it. More than 5 million Californians are counting on us to stop playing politics w/public health."

Sen. Steve Daines (R-Mont.)

• In February 2017, Sen. Steve Daines (R-Mont.) said that he supported giving states that expanded Medicaid a four-year transition period to find funding for those who gained heathcare because of the expansion. He said, “As [Vice President] Mike Pence said, we need to have a soft landing and not too long a runway. I’m actually tossing out a four-year kind of transition right now, but to really give the states the power there of how they want to spend money."

Sen. Rand Paul (R-Ky.)

• In February 2017, Sen. Rand Paul (R-Ky.) said that he opposed repealing some parts of the law and keeping others like Medicaid subsidies. He said, “One thing we were unified on about a year ago when we voted was complete repeal. That’s all some of us are going to vote for. There’s still division. There are some people who want to keep part of ­ObamaCare."

Medicare

Medicare is the federal program that provides health insurance for people 65 or older, as well as certain younger people with disabilities and people with permanent kidney failure requiring dialysis or a transplant, sometimes called end-stage renal disease (ESRD), legally considered a disability. The program was established by Title XVIII of the Social Security Act, which President Lyndon Johnson signed into law on July 30, 1965. The program consists of four parts (Parts A through D), covering everything from hospitalization, doctor visits and special services, medical devices, and prescription drugs, and is administered by the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services.

Rep. Mark Sanford (R-S.C.)

• On January 11, 2017, Rep. Mark Sanford (R-S.C.) said, “Math and demographics dictate that we deal with Medicare. What you can’t say is, ‘We’re going to address the nation’s budget. We’re going to get our financial house in order,’ and then not address entitlements. The longer we wait, the harder the problems become ... I hope that [Trump] takes a look at the compelling math.”

Contraception

Rep. Phil Roe (R-Tenn.)

• In February 2017, when asked if Republicans would keep the requirement under the ACA that insurance companies cover contraception at no cost, Rep. Phil Roe (R-Tenn.), co-chair of the GOP Doctors Caucus, said, “We probably wouldn’t require that, but in doing that, we need to make them behind or across the counter. In other words, you come in [to a pharmacy], you want birth control, you get it, you go.”

Vaccines

On February 21, 2017, Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), chairman and ranking member of the Senate Committee on Health, sent a letter to members of Congress explaining the importance of vaccines. They wrote, "We write to you today to highlight the importance of immunizations, which protect Americans, especially infants and children, against outbreaks of serious and deadly infectious diseases. Vaccines save lives. ... As members of Congress, we have a critical role to play in supporting the availability and use of vaccines to protect Americans from deadly diseases."

Although they did not mention Trump, Alexander and Murray argued that Congress should take a stand against those who have suggested that vaccines cause autism, something that Trump did during the 2016 campaign. According to The Hill, “[S]cientists and researchers have found no evidence connecting vaccines to developmental disorders."

Reps. Greg Walden (R-Ore.), Frank Pallone Jr. (D-N.J.), Michael Burgess (Texas-R), and Gene Green (D-Texas) also signed the letter.

Health savings accounts

Health savings accounts are financial accounts that allow for tax-free (at the federal level) deposits and withdrawals for healthcare expenses. Health savings accounts were permanently written into the tax code when former-President George W. Bush signed the Medicare Prescription Drug Improvement and Modernization Act in 2003. The accounts are coupled with high-deductible health plans and are designed to allow individuals to save for future out-of-pocket healthcare expenses. Health savings accounts stay with individuals through retirement, even if they change jobs.

Supporters argue that expanded use of health savings accounts could reduce healthcare spending and costs and lower the number of uninsured individuals. Critics say the accounts are harmful for low-income individuals and expanded use of the accounts could exacerbate the uninsured rate.

Sen. Rand Paul (R-Ky.)

• In February 2017, Sen. Rand Paul (R-Ky.) commented on health savings accounts (HSA), saying, “What if 30 percent of the public had health savings accounts? What do you do when you use your own money? You call up doctors and ask the price. ... If you create a real marketplace, you drive prices down." According to The Hill, Paul's ACA replacement plan "would eliminate the requirement that the accounts be tied to high-deductible health plans, increase the amount of money users are allowed to add to their HSA each year and allow people to use their accounts to pay for deductibles and premiums, which currently is not allowed."

High-risk pools

Senate Majority Leader Mitch McConnell (R-Ky.)

• In February 2017, Senate Majority Leader Mitch McConnell (R-Ky.) discussed creating high-risk pools for individuals with pre-existing conditions, saying, "They can work if properly funded by a combination of the federal government and the state government and be based at the state level. So that's the goal here. We fully understand the need for high-risk pools to take care of those with pre-existing conditions, and that will be part of anything that comes next."

Drug pricing

Sen. Claire McCaskill (D-Mo.)

• On March 28, 2017, Sen. Claire McCaskill (D-Mo.) said that "her office has asked Purdue, Janssen/Johnson & Johnson, Insys, Mylan and Depomed to turn over internal studies that projected the risks of misuse, abuse or addiction to the powerful painkillers. McCaskill’s office said it will investigate whether those manufacturers have contributed to the growing opioid epidemic that has claimed nearly 200,000 lives in the last 15 years," according to The Hill. She said, “I hear it everywhere I go — drug overdose deaths, the vast majority of them related to prescription opioids or heroin, are single-handedly destroying families and communities across Missouri and the country. The vast majority of the employees, executives, sales representatives, scientists and doctors involved with this industry are good people and responsible actors, but some are not. This investigation is about finding out whether the same practices that led to this epidemic still continue today, and if decisions are being made that harm the public health.”

Single-payer

Sen. Bernie Sanders (I-Vt.)

• On July 30, 2017, during an interview with Jake Tapper, Sen. Bernie Sanders (I-Vt.) said that he would introduce a single-payer healthcare plan. Sanders said, "We're just -- we're tweaking the final points of the bill. And we're figuring out how we can mount a national campaign to bring people together. Here is where we are, Jake. And it's important for Americans to understand this. We are the only major country on Earth, the only one, not to guarantee health care for all people. The result is 28 million people who are uninsured, millions of people who are paying deductibles and co-payments that are far too high. And if the Republicans had gotten their way, there would have been another 30 or 32 million people thrown off of health insurance. That is crazy. What we should do is move in the direction of every other major country, guarantee health care to all people as a right, not a privilege."

Tapper then said to Sanders, "But let's talk about single payer because it was attempted in your home state of Vermont and it didn't work because they couldn't get the funding because it would be too expensive, the Democratic governor said. And then recently it was -- it failed in California as well. Democrats again not able to come up with a way to pay for it. These are cobalt blue states, Vermont and California, where people wanted single payer and there were problems because it would cost too much. How do you make it national if you can't even get it in Vermont or California?"

Sanders replied, "A single payer health care system, in my view and according to studies that I have seen, would save the average family significant sums of money. And what Republicans sometimes do is confuse the issue and they say, well, you're going to pay more in taxes. What they forget to tell you is that, if you are a family of four now paying $15,000 or $20,000 a year in private health insurance, you're not going to be paying that at all. Once again, if you look at Canada single payer health care system per capita, their costs are far, far less than the United States. If you look at the U.K., if you look at countries around the world, all of one -- all of which have different approaches to a national health care system in every instance, they are spending substantially less per capita than we spend in the United States, substantially less for prescription drugs. The problem with our system is it is so complicated for the consumer, for the doctors is that a hospital, for example, might be dealing with 15, 20, 30 different insurance policies. It takes an enormous amount of time, energy and expense to figure out that you have a $5,000 deductible, you have a $10,000 deductible. The goal simply is to say that every person in this country through a single payer system is entitled to a comprehensive health care approach and that will save substantial sums of money in administrative costs, substantial sums of money in lower prescription costs, substantial sums of money in doing away with the profiteering of the drug companies."

Right to try

Sen. Ron Johnson (R-Wis.)

• On August 3, 2017, the Senate unanimously passed S 204—the Trickett Wendler Right to Try Act of 2017. The bill, which was introduced by Sen. Ron Johnson (R-Wis.), proposed allowing terminally ill patients to use experimental drugs, biological products, and medical devices not approved by the Food and Drug Administration (FDA) to try to treat the illness after a physician has exhausted all other approved treatment options.

• After the bill passed, Johnson said, “By passing the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017 today, the Senate took a strong stand in support of the millions of Americans and their families suffering from terminal illnesses. Patients with terminal diseases ought to have a right to access treatments that have demonstrated a level of safety and could potentially save their lives. I’m proud that today, the Senate stood up for terminally ill patients who just want to reclaim their freedom – who want the right to hope. Among many others, I thank Chairman Lamar Alexander, Sen. Joe Donnelly and the Goldwater Institute for their support for this legislation. I strongly urge Speaker Ryan and the House to quickly take up this legislation and send this bill to the president’s desk for his signature.”

Key votes on healthcare

See also: Key votes: 115th Congress, 2017-2018

Senate

An amendment to repeal the ACA, including Paul amendment (No. 271) (S Amdt 271 to S Amdt 267 to HR 1628)

 Amendment Rejected (45-55) on July 26, 2017

An amendment to repeal the ACA, including Paul amendment (No. 271)

• The details: All Democrats, two Independents, and seven Republicans voted against the amendment. 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 amendment. The amendment proposed repealing the Affordable Care Act and delaying 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. It 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.

Motion to advance the Better Care Reconciliation Act of 2017, including Cruz and Portman amendments (S Amdt 270 to S Amdt 267 to HR 1628)

 Motion Rejected (43-57, 3/5 majority required) on July 25, 2017

A procedural vote to advance the Better Care Reconciliation Act of 2017 (BCRA), including the Cruz and Portman amendments.

• The details: All Democrats, two Independents, and nine Republicans voted against the motion. 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, a version of the Better Care Reconciliation Act of 2017 (BCRA). The proposal also 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 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.

Motion to begin debate on the American Health Care Act of 2017 (HR 1628)

 Motion to Proceed Agreed to (50-50, Vice President voted Yea) on July 25, 2017

Proposed providing for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017.

• The details: 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. Fifty Republicans voted for the motion. Republican Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) voted with all Senate Democrats and two Independents against the motion. Vice President Mike Pence voted in favor of the bill to break the 50-50 tie, the fourth time he cast a tie-breaking vote. The vote did not change existing law; it simply opened debate on healthcare.

House

American Health Care Act of 2017 (HR 1628)

 Bill passed (217-213) on May 4, 2017

Proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare.

• The details: Two hundred and seventeen Republicans voted to approve the bill. One hundred and ninety-three Democrats and 20 Republicans voted against the bill. The bill proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. It proposed repealing the tax penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The ACA's subsidies for purchasing insurance would end, as would the enhanced federal funding for states that expanded Medicaid. The bill proposed its own system of tax credits, based on age rather than income, and a penalty in the form of increased premiums for individuals who did not maintain continuous coverage. The bill now heads to the Senate.

See also: House roll call vote on the American Health Care Act of 2017

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.

• 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) voting against the measure.

• July 25, 2017: 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 also included amendments from Sens. Rob Portman (R-Ohio) and Ted Cruz (R-Texas).

• 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.

• 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.

• 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.

• July 19, 2017: After meeting with Trump in the White House, Senate leadership attempted to revive the BCRA or a version of it.

• 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.

• 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.

• July 13, 2017: A revised version of the BCRA was released.

• 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.

• June 27, 2017: Senate Republican leaders postponed a vote on the BCRA until after the July 4 recess.

• 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.

• June 22, 2017: The Senate released its version of the bill to replace the ACA, the Better Care Reconciliation Act of 2017.

• 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.

• 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.

• May 4, 2017: The House passed the AHCA by a vote of 217-213.

• 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."

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• March 24, 2017: The House was expected to vote on the AHCA, but House Republican leaders withdrew the AHCA from consideration amid dwindling support.

• 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.

• March 23, 2017: The House was expected to vote on the AHCA, but the vote was canceled.

• 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.

• March 16, 2017: The United States House of Representatives Committee on the Budget voted 19-17 to approve the AHCA. Three Republicans—Reps. David Brat (Va.), Mark Sanford (S.C.), and Gary Palmer (Ala.)—voted against advancing the bill.

• March 9, 2017: The United States House of Representatives Committee on Energy and Commerce approved the AHCA.

• March 9, 2017: The United States House of Representatives Committee on Ways and Means approved the AHCA.

• 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.

• 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.

• 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.’"

• January 13, 2017: The House passed S Con Res 3, a budget resolution to begin rolling back the ACA, by a vote of 227-198. Nine Republicans joined every Democratic member of the House to vote against the budget resolution. The nine Republicans were: Justin Amash (Mich.), Charlie Dent (Pa.), Brian Fitzpatrick (Pa.), Walter Jones (N.C.), John Katko (N.Y.), Raul Labrador (Idaho), Thomas Massie (Ky.), Tom MacArthur (N.J.), and Tom McClintock (Calif.).

• 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.”

• 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.

See also

• 115th Congress on the American Health Care Act of 2017 (April)
• 115th Congress on the American Health Care Act of 2017 (March)
• Republicans who were likely to vote against the AHCA, March 2017
• Federal policy on healthcare, 2017-2020
• American Health Care Act of 2017
• Alternative proposals to the Affordable Care Act (Obamacare)
• Obamacare overview
• Restoring Americans' Healthcare Freedom Reconciliation Act of 2015
• House Freedom Caucus
• Tuesday Group
• Problem Solvers Caucus

Footnotes

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