Programming Note: Given the potential impact and volume of activity related to ACA legislative discussions, we will be sending out a weekly update summarizing relevant developments each Thursday afternoon. This will be in addition to the regular Monday morning update, which will continue to cover a broad array of health care topics.  

ACA Repeal and Replacement Update – January 5, 2017

As promised, GOP lawmakers immediately took steps to begin the process of repealing the Affordable Care Act (ACA) upon coming back into session on January 3. While Republicans in both chambers appear to be aligned in their resolve to repeal much of the ACA, there reportedly continues to be division within the party on the scope and timing of the repeal, as well as the substantive framework and scope of a replacement package. Republicans are considering either a two- or threeyear repeal delay, which would allow the Marketplaces to continue to function during a transition period. However, GOP thought leaders Joe Antos and Jim Capretta published a blog post this week arguing that “repeal and delay” would create too much risk of disruption in the market.

Executive branch leaders from the current and incoming administration, President Obama and Vice President-elect Pence, both met with lawmakers from their parties this week to discuss ACA strategy. Vice President-elect Pence stated that President-elect Trump would use his executive authority to begin to render the ACA ineffective immediately upon taking office.

Despite some calls for the release of a replacement package prior to a vote to repeal the ACA, it seems clear that Congress will take steps to repeal the ACA prior to introducing a replacement. The GOP aims to have a repeal bill on President-elect Trump’s desk by February 20. Speaker Ryan has indicated that the House will consider a replacement package this year.

Senate Action

On January 4, Senate Budget Committee Chairman Enzi (R-WY) introduced a “repeal resolution” with reconciliation instructions to the Senate Finance Committee, Senate HELP Committee, House Ways & Means Committee, and House Energy & Commerce Committee to produce legislation that achieves at least $1 billion each in deficit reduction over 10 years (FY 2017-2026). Legislation achieving these goals is due from each Committee by January 27, and will be combined for consideration on the floors of the respective chambers. Senate Budget Resolution:

Following introduction of the resolution, the Senate voted along party lines to start 50 hours of debate on the budget resolution, with Sen. Paul (R-KY) as the only Republican voting with Democrats against the measure. Sen. Paul has indicated that he would likely vote to repeal the ACA, but that he would not pass a budget that drastically increases the federal deficit just to facilitate repeal. Although Sens. Rubio (R-FL), Lee (R-UT) and Cruz (R-UT) also expresses concern about the impact of the resolution on the deficit, each ultimately voted to begin discussion on the resolution.

The Senate has since begun to consider amendments to the resolution, with a Democratic amendment to stop repeal voted down on party lines this afternoon. Although the resolution is ultimately expected to pass, debate is expected to continue with a “vote-a-rama” next week.

It has also been reported that Senate Finance Committee Republicans will host a roundtable of Republican governors on January 19 to discuss ideas for reforming Medicaid, including what policies should be included as part of an ACA replacement package.

House Action

The House voted on January 3 to approve a rules package intended to facilitate a smooth repeal of the ACA. Among other things, the package contained a provision that exempts any ACA repeal or reform measures from congressional rules limiting how much legislation can increase direct spending. Text of House rules package:

The Republican Study Committee also introduced a bill called the American Health Care Reform Act of 2017 (H.R. 277), which fully repeals the ACA effective January 1, 2018 and includes the following provisions among others:

  • Converts the tax deduction for employer-sponsored health insurance and insurance by the self-employed into an above-the-line standard deduction for health insurance ($7,500 for individuals or $20,500 for families);
  • Expands access to and allowable expenses for health savings accounts;
  • Expands federal support for state high-risk pools to $25 billion over ten years with premiums capped at 200% of the average premium of the state;
  • Allows individuals with pre-existing conditions to move between health insurance markets so long as they maintain continuous coverage; and
  • Allows Americans to purchase health insurance across state lines and small business to pool together to negotiate better rates.

Bill text and summary: and