Last week, the House debated and ultimately voted to repeal the Patient Protection and Affordable Care Act (PPACA) and the health care provisions of the Health Care and Education Reconciliation Act of 2010 collectively known as health care reform. After seven hours of debate the final vote count was 245-189 in favor of repeal, a virtually party-line vote with 3 Democrats (Boren, OK; McIntyre, NC; Ross, AR) joining ranks with Republicans to repeal the law. The vote was seen as largely symbolic – GOP candidates making good on their campaign promise to repeal reform – and the bill is likely to stall out in the Senate. Even if the Senate were to pass the repeal bill, President Obama will veto it, ensuring that the health reform law, and all its investments and programs, stays intact. You can read NACHC’s statement on the repeal efforts in the House here. Now that the House has acted, though, where do we go from here?
House leaders have promised to follow their repeal efforts with “replace” efforts. Last week four House committees – Energy and Commerce, Ways and Means, Education and Workforce, and Judiciary – were instructed to come up with replacement proposals that lower insurance premiums without increasing taxes or accelerating Medicare’s insolvency. Committees will focus on proposals that provide increased competition and choice, increased access to insurance for those with pre-existing conditions, proposals addressing medical malpractice reform, and proposals giving states greater flexibility in their Medicaid plans, among other things. The replace effort will not contain an individual mandate requiring everyone of at least moderate means to purchase health insurance coverage. Republicans do not have a timeline for drafting replacement bills and each committee will likely hold hearings and markups in the coming weeks and months. On the budget side, Republican Leadership has stated that they will use parliamentary tactics and the appropriations process to defund pieces of the health reform law and deny the Administration the funds necessary to carry out the law.
Now that the House has passed the repeal bill, it goes to the Senate for consideration. Senate Majority Leader Harry Reid (NV) has said he won’t bring up the bill for a vote, however, Senate Minority Leader Mitch McConnell (KY) has vowed he will ensure the bill comes up for consideration and a vote. If the bill were to come up, it’s generally agreed that there are not the necessary 60 votes to pass repeal, so health reform will continue to be the law of the land for the foreseeable future. It’s anyone’s guess how or when the Senate Minority will bring repeal up for a vote, but there are certainly a number of ways to do it—whether the votes are there to pass it or not. Given that the Senate rules allow for more debate and amendments than the House, if the bill were to come up there may be extended debate and votes on many individual pieces of the reform law.
From here in the Beltway, one thing is crystal clear: the health reform debate and discussions are far from over. Here at NACHC we’re working to ensure the investments in health reform continue to bring health centers toward our goal of serving 40 million patients by 2015. Keep tuning in to Health Centers on the Hill for updates and information on the health reform repeal and health centers’ other legislative priorities.