On the first day of the new Congress, Senate Republicans took the first concrete steps towards repealing the Affordable Care Act. As mentioned in the related budget article in this Human Needs Report, the budget resolution introduced on Tuesday, Jan. 3 had only one purpose: to lay the groundwork for eviscerating major portions of the landmark health care reform bill that has helped millions of Americans.

The budget resolution, which passed the Senate on Jan. 12 and the House on Jan. 13, allows Congress to use a special legislative procedure known as reconciliation. The budget resolution gives four committees that have jurisdiction over health care policy – two in the House and two in the Senate – until Jan. 27 to draft portions of repeal legislation. These portions will then be combined into a final piece known as a reconciliation bill, which would also only need a simple majority to pass the Senate (for more information on reconciliation, see this blog from the Center on Budget and Policy Priorities). It’s widely expected that the reconciliation bill would eliminate the billions of dollars provided to the states that have chosen to expand Medicaid eligibility, and repeal the subsidies that help lower-income individuals afford insurance through the exchanges. It was noted in the process of passing the legislation that the Jan. 27 deadline is non-binding.

Original reports were that Republicans hoped to pass the repeal reconciliation bill by Feb. 20, with the terminations of programs set to take effect in two or more years, and without offering a replacement bill at the time the repeal is enacted. However, concern from some Republicans and comments from President-elect Trump have some now saying that the Republicans may try to offer a replacement plan at the same time as the legislation to repeal the law, and that the Feb. 20 timeline may get pushed into March to give Republicans more time to put their replacement plan together. President-Elect Trump commented that his Administration’s plan would be released soon after the confirmation of his nominee for Secretary of the Department of Health and Human Services, Rep. Tom Price, and that it would provide “insurance for everybody.” The specifics of what a replacement plan may look like and when it will be revealed have not yet been released.

Advocates contend that Members of Congress who vote to repeal the ACA with no plan in place to assure continued coverage, or a plan that reduces benefits or increases costs, are willing to put millions of people’s health and lives in peril. It was also announced on Jan. 4 that President-elect Trump will take executive actions on health care on his first few days in office, but no details of what those executive actions will look like were provided.

A report from the Urban Institute estimates that repealing portions of the ACA through the reconciliation process described above without a comparable replacement plan in place would cause 30 million people, 82 percent of whom are in working families, to lose their coverage by 2019. It would also remove important consumer protections, jeopardizing the health and financial security of children, seniors and adults. Several advocacy groups held a day of action on Jan. 10 to urge Members of Congress to protect health coverage for millions of children and families and delay repealing Obamacare until congressional Republicans unveil their plan for replacing it. That was followed by many well-attended events nationwide staged by Democratic members of Congress, labor, and advocacy groups opposing the repeal of the Affordable Care Act on Jan. 15, with many additional events planned. To see a variety of resources showing the impact of repealing the ACA, see this blog from CHN.

As opposition to loss of Affordable Care Act protections and benefits becomes more vocal, and concerns rise about cuts to Medicaid and Medicare as well, pressure will intensify on senators to prevent this damage. That pressure was felt by Sens. Collins (R-ME) and Heller (R-NV) in votes they took opposing cuts to Medicare and Medicaid on amendments to the budget resolution (see the related budget article in this issue). If all Democratic remain unified, the defection of 3 Republican Senators would defeat specific ACA replacement plans.

For more information on the budget resolution, see the related article in this Human Needs Report.

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