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What’s Next In The United States Senate For The American Health Care Act (AHCA)

On May 4, 2017, the House of Representatives passed The American Health Care Act (AHCA) by a vote of 217-213. Senate Republicans are developing their House bill and have said they would like to vote on legislation before the 2017 July Fourth recess. Majority Leader Mitch McConnell has tapped a working group of 13 senators to spearhead the work.


Senate GOP leaders face a challenge in creating a bill that can maintain the backing of at least 50 of the 52 Republicans in the chamber. Republicans plan to use a fast-track budget process called reconciliation to pass a revised version of the AHCA. With a 52-person majority in the United States Senate, this process allows Senate Republicans to get around the need for a 60-vote majority. It only takes a simple majority, typically 51 votes, in the Senate to pass a reconciliation bill. Majority Leader Senator Mitch McConnell, has also begun the process of fast-tracking a floor vote under Rule 14, which enables the Senate to put legislation directly on the Senate calendar for an immediate floor vote.


Since the beginning of May, Senate Republicans have wrestled with revisions to the House version of the AHCA. Among the critical decisions is how much to reduce Medicaid spending and how to revise the federal approach to insurance subsidies and regulations. The House bill proposes a major restructuring of Medicaid’s federal financing from an open-ended commitment into a system of capped contributions as well as revising the approach to insurance subsidies and regulations created by Democrats in the Affordable Care Act (ACA).


Clearing a bill for Trump’s signature in the Senate would likely require changes to the timeline for ending ACA’s expansion of Medicaid payments and a solution to how to equitably treat states with drastically different Medicaid spending levels. These issues surrounding Medicaid highlight a split among Republicans, with those whose states expanded their Medicaid program for the poor and disabled under the ACA to those who states that did not. Almost half of the 30 states that expanded Medicaid have at least one GOP senator. In addition, moderate Republican Senators are pressing for a slower phaseout of the federal payments to Medicaid expansion states than the House-passed bill set out. The House version of the AHCA drops the payments starting in 2020 for new people who sign up under the expansion, moderates in the Senate are pushing for a seven-year phaseout.


Much remains unsettled about the Senate GOP plans for a health bill. While legislative language has not been publically released, Senate Republicans have been privately seeking the Congressional Budget Office’s input on different proposals for revising the House bill. In comparison to the House, the Senate is barred from voting on a bill before a cost and impact estimate is released from the nonpartisan Congressional Budget Office.


News and Media

August 3, 2017:
Senators Plan Bipartisan Hearings On Health Care

Dave Anderson, CEO of HealthNow New York, talks with Steve Inskeep about lawmakers' plans to hold bipartisan hearings on health insurance exchanges. NPR's Scott Horsley has details and analysis.


June 6, 2017:
What's next for the American Health Care Act

The Point of Health podcast features Donald Ingalls, Vice President, State and Federal Relations of BlueCross BlueShield of Western New York. The episode covers the latest updates on Republican's efforts to repeal and replace the Affordable Care Act.


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