Week of November 30, 2015
CONGRESS
Senate broadens number of ACA provisions to be repealed through reconciliation
The Senate voted 52-47 this week to pass a budget reconciliation bill that would repeal key provisions of the Affordable Care Act (ACA), including the individual and employer mandates as well as taxes on high-cost health plans and medical device manufacturers.
The bill would also eliminate two other key provisions in two years (after the 2016 election). It would end the Medicaid expansion that 30 states and the District of Columbia have already opted to pursue, as well as ACA subsidies for low-to-moderate income consumers to purchase health insurance.
Moderate Republicans Susan Collins (R-ME) and Mark Kirk (R-IL) sided with Senate Democrats in opposing the bill.
Budget reconciliation was a maneuver used by Senate Democrats in 2009 to pass specific provisions in the ACA without the 60-vote majority needed to overcome a filibuster. It is intended to apply only to provisions that impact spending and revenue.
The measure broadens the House reconciliation bill passed last month (H.R. 3762) that cuts but not eliminates the individual mandate penalties and keeps the Medicaid expansion intact (see Update for Weeks of October 5th and 12th). It also includes an amendment that would restore the threshold for the tax deduction for medical expenses back to the pre-ACA level of 7.5 percent, at least for those who have reached age 65.
Even if it passes the House, the repeal measure faces a certain veto from President Obama. However, several Republican leaders acknowledge that the effort is intended to demonstrate what provisions Congress could repeal if a Republican wins the presidency in 2016. In addition, the fact that the tax on high-cost or “Cadillac” plans (that is not effective until 2018) passed as an amendment with only ten dissenting votes is likely to provide momentum for a stand-alone repeal bill that has enough support to override a Presidential veto.