Congress has officially taken the first step toward repealing the Affordable Care Act after the House voted to approve a budget resolution that directs committees to start crafting legislation to repeal the law.
The House voted 227-198 Friday to approve the resolution a day after the Senate voted 51-48 to clear it. Nine conservative House Republicans voted against the measure: Justin Amash of Michigan, Charlie Dent of Pennsylvania, Brian Fitzpatrick of Pennsylvania, Walter Jones of North Carolina, John Katko of New York, Raul Labrador of Idaho, Tom MacArthur of New Jersey, Thomas Massie of Kentucky and Tom McClintock of California.
The resolution, which is nonbinding, sets budgetary and spending levels for Obamacare. It will act as a vehicle for Republicans to craft legislation that would gut Obamacare via the reconciliation process.
Reconciliation is reserved for bills that address budget and spending levels. Any bill cleared by the Senate parliamentarian to use reconciliation can be approved via a simple 51-vote majority instead of 60 votes needed to break a filibuster in the Senate.
Republicans in Congress passed a reconciliation repeal bill in 2015, which President Obama vetoed, that gutted Obamacare’s mandates and taxes, but left in place insurer regulations for what plans can be sold on the law’s exchanges.
The budget resolution passed Friday directs four Senate and House panels to draft repeal legislation that can use reconciliation. The measure gives the panels a non-binding deadline of Jan. 27 to get legislation done, but Sen. Bob Corker, R-Tenn., said Wednesday that Republican leaders told him that date is the earliest that legislation could be ready.
House Majority Leader Kevin McCarthy hoped to get a repeal bill to President-elect Trump by the end of February. However, House Speaker Paul Ryan said there is no hard and fast deadline for repeal and replace.
A major sticking point in the repeal legislation will be the length of any transition period for Obamacare. Republicans have suggested leaving Obamacare intact for a few years while a GOP replacement is created.
Now some House conservatives want the period to be two years, with other Republicans aiming for three or as long as four.
Ryan said on the House floor Friday that there would be a “stable transition period so people don’t have the rug pulled out from under them. This will be a thoughtful, step-by-step process.”
However, it remains unclear whether Republicans will repeal the law first without a full replacement ready to go, which is against the wishes of President-elect Trump who said repeal and replace should be “essentially simultaneous.”
Some moderate House and Senate lawmakers have also expressed doubts about moving forward with repeal and no replacement plan.
Ryan said that a repeal bill with no immediate replacement is needed now to offer relief to people being affected by the law.
“The law is collapsing,” he said. “Insurers are pulling out. The deductibles are so high [that] it doesn’t even feel like you have insurance in the first place.”
House Minority Leader Nancy Pelosi fired back that Ryan doesn’t understand what the Affordable Care Act brought to the country “in terms of expanding benefits, lowering cost and expanding access.”
“I understand why the speaker may want to concentrate on the mythology on the ACA because he is not going to focus on what the bill does today,” she said. The resolution “does not create more good paying jobs.”
With the vote, four committees are now tasked with writing legislation that can gut Obamacare and meet reconciliation’s requirements. The House Energy and Commerce Committee, House Ways and Means Committee, Senate Health, Education, Labor and Pensions Committee and Senate Finance Committee will write the legislation.
The resolution included a nonbinding deadline of Jan. 27 for all committees to complete this task. However, some Republican lawmakers have said that deadline is the earliest legislation could get done.
It also remains to be seen what exactly will be in the reconciliation package. Democrats said they expect Republicans to include provisions such as defunding Planned Parenthood, eliminating the Medicaid expansion and the individual mandate.
“I assume they are going to try and do a lot of the same things,” said Rep. Frank Pallone, D-N.J., ranking member of Energy & Commerce. “If you proceed in that direction you are going to kill the ACA and honestly I don’t think they are gonna replace it.”
Another looming question is when will replacement occur. Rep. John Shimkus, R-Ill., said that it appears unlikely any replacement provisions will be included in the repeal legislation due to reconciliation instructions.
“I think you have to be very careful because reconciliation is only budgetary numbers and stuff like that,” said Shimkus, also a member of Energy & Commerce.
Republican leadership has appeared to ease some doubts from members over replacement.
Rep. Mark Meadows, R-N.C., chairman of the House Freedom Caucus, said in a statement that Ryan is committed to bringing up a replacement measure “within days, not weeks of a repeal measure.”
