ACA Repeal and Replacement Update – May 11, 2017

Top takeaways from the week: 1) Senators have begun meeting to discuss Affordable Care Act (ACA) repeal and replace legislation; 2) The CBO analysis of the American Health Care Act (AHCA) is expected the week of May 22; and 3) Democratic Senators have sent several letters to Congressional leadership and the Trump Administration opposing legislative and administrative efforts to undermine the ACA.

The Senate is now charged with the next steps on repealing and replacing the Affordable Care Act (ACA) after the House passed the American Health Care Act (AHCA) (H.R. 1628) last week by a vote of 217-213. As in the House, Republican Senators also hold a wide range of perspectives on what an ACA replacement should look like, which, coupled with their slim majority, will make agreement on a final bill challenging.

Yesterday, the Congressional Budget Office (CBO) announced that its analysis of version of the AHCA as passed by the House will be released the week of May 22. Budget resolution rules limit the Senate’s ability to formally move forward with reconciliation legislation absent a CBO score and also require the Senate to achieve at least the same deficit savings as the legislation that passed the House. CBO Press release:

Senate Action –

The Senate this week began holding a number of meetings to discuss the AHCA, with many Senators indicating their intention to wholly re-write the legislation and to pursue a longer legislative timeframe than their House counterparts. In framing the long road ahead, Senate Majority Leader McConnell (R-KY) noted on Monday that “this process will not be quick or simple or easy, but it must be done.”

Senate Leadership have established an official working group to tackle crafting legislation, which includes the following members: Majority Leader McConnell (R-KY), Majority Whip Cornyn (R-TX), Finance Committee Chair Hatch (R-UT), HELP Committee Chair Alexander (R-TN), and Sens. Cruz (R-TX), Cotton (R-AK), Gardner (R-CO), Lee (R-UT), Portman (R-OH), Toomey (R-PA), Enzi (R-WY), Thune (R-SD), and Barrasso (R-WY). Additionally, Sens. Cassidy (R-LA) and Collins (R-ME) have established their own working group of five more moderate members.

The official working group, plus Sens. Capito (R-WV) and Johnson (R-WI), held a meeting on Tuesday to discuss Medicaid prior to a larger meeting of all Senate Republicans and Vice President Pence on the overall reform strategy. During the meeting, members sought to reconcile two conflicting ideas: reducing federal spending and ensuring that low-income individuals do not lose coverage. Sen. Portman (R-OH) argued for a more gradual Medicaid expansion phase-out and Sen. Capito (R-WV) described her desire to preserve the expansion, albeit with greater state flexibility. Senators also discussed increasing funding for invisible risk pools to help lower premiums for those with high-risk.

Meanwhile, Democratic Senators have sent several letters to Senate Leadership opposing their efforts:

  • On Friday, Senate HELP Committee Ranking Member Murray (D-WA) and Finance Committee Ranking Member Wyden (D-OR) sent a letter to HELP Committee Chair Alexander (R-TN) and Finance Committee Chair Hatch (R-UT) urging them to “engage in an open and transparent debate including holding hearings on any potential legislative product so that families and community can understand the impact on their health and financial security.” Press release: Letter:
  • The next day, all 48 Democratic and Independent Senators sent a letter to Majority Leader McConnell (R-KY), Finance Committee Chair Hatch (R-UT) and HELP Committee Chair Alexander (R-TN), urging them to drop current repeal efforts and work in a bipartisan way to reform and improve the current law. The letter specifically notes Democrats’ readiness “to develop legislation with Republicans that will improve quality, lower costs, and expand coverage for all Americans. But Republicans need to set aside their current partisan efforts and work with us to get this done.” The letter also urged Republicans to encourage the Trump administration to cease actions that might destabilize the marketplaces. Press release with text of the letter:

Administrative Action –

On Monday, 13 Democratic Senators sent a letter to Office of Management and Budget (OMB) Director Mulvaney, Secretary of Treasury Mnuchin, and HHS Secretary Price on Monday calling on the Administration to commit to making cost-sharing reduction (CSR) payments “to ensure the viability of the health care system” and to release internal documents related to CSRs. Press release with text of the letter: