The Supreme Court’s decision last Thursday upholding the use of subsidies in the Affordable Care Act (ACA) didn’t stop Republicans in Congress from talking about their next steps to try to repeal the law (for more information on the Supreme Court’s decision, read CHN’s statement). According to CQ, several Republican leaders have indicated they’ll likely use a process known as reconciliation to try to repeal the ACA. In fact, CQ quoted Rep. Kevin Brady (R-TX), a member of the House Ways and Means Committee, as saying, “Now it’s clear that this is the highest and best use for reconciliation, as full a repeal as this process allows.”
Under budget resolution rules, reconciliation instructions may be given to a number of different committees requiring them to come back with legislation that would produce savings, usually by cutting spending in programs under their jurisdictions. As was noted in a previous Human Needs Report, because reconciliation bills cannot be filibustered, they can pass the Senate with only a simple majority instead of the 60 votes required in most other Senate deliberations. However, unlike the budget resolution itself, bills drafted as a result of reconciliation instructions have to be signed into law by the President and therefore are subject to a possible veto. President Obama would veto legislation that repealed or crippled the Affordable Care Act; overriding the veto would require a highly unlikely two-thirds vote in both the House and Senate. (For more information on reconciliation, see this piece released last week by the Senate Budget Committee.)

The reconciliation instructions in the FY16 joint budget resolution require that reconciliation bills reduce the deficit. When Congress agreed on a joint budget resolution in May, it included these instructions to the specific committees with jurisdiction over the Affordable Care Act; committees were told to reduce the deficit by between $2 billion (in the Senate) and $3 billion (in the House) over the next 10 years. Recommendations are due to the Budget Committees by July 24.

However, the Congressional Budget Office and the Joint Committee on Taxation released a report on June 19 saying that repealing the ACA would increase the national debt by $353 billion over 10 years, or by $137 billion over 10 years if ‘dynamic scoring,’ a highly uncertain and controversial way of estimating the impacts of a budget, is used. Therefore, if legislators indeed attempt to fast-track a bill that both reduces the deficit and repeals the ACA, they will need to come up with savings of close to $140 billion over a decade. Advocates are concerned that Medicaid and/or Medicare might be the targets of devastating cuts to make up this offset. The budget resolution already calls for slashing Medicaid; according to the Center on Budget and Policy Priorities, the cut appears to be roughly $500 billion (or about 13 percent) over 10 years, and if the repeal of Medicaid expansion is included, the cuts would be about $1.35 trillion, relative to current law, over that period.

Reconciliation isn’t the only way Republicans are trying to take down the ACA; the House and Senate appropriations bills for the Department of Health and Human Services would defund the law. Advocates who celebrated the Supreme Court’s decision vowed to keep fighting attempts to defund, block and repeal the law or portions of it, and instead called for states who haven’t yet acted on the law’s option to expand Medicaid eligibility to do so to ensure that their low-income residents have access to quality, affordable, life-saving health care. President Obama has repeatedly said he would veto any bill that attempts to repeal all or part of the ACA as well.

Stay tuned to the Human Needs Report and CHN’s blog, Voices for Human Needs, for updated information.

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