By Michaela Keller, NACHC Federal Affairs Staff

Now that the 115^th Congress is underway, it is expected that Republicans will move ahead quickly to fulfill one of their top campaign promises – repeal of the Affordable Care Act. With a majority in both the House and Senate, Republicans are charting a course to send a repeal bill to the President-Elect, possibly within the next two months. However, a repeal of this kind is easier said than done and major obstacles – including the lack of consensus on an alternative, the desire to maintain certain aspects of the law and the continued opposition and concern being expressed by a number of health care stakeholders – may quickly change the course of this plan. Understanding the steps involved in Congressional process will help advocates better track the debate. Here are a few of the major actions related to a repeal plan that we are likely to see in Congress over the next couple of weeks and months: 

Senate Budget Resolution Vote

The Senate is planning to vote in early January on a budget resolution that will include instructions to repeal large parts of the Affordable Care Act through reconciliation. As you may recall, reconciliation is the process by which legislation in the Senate can pass with a simple majority (51 votes) rather than 60 votes as required for major pieces of legislation; however, any legislation passed through reconciliation must only involve budget-related changes, meaning that any changes that do not have a fiscal impact cannot be included.

The budget resolution process in the Senate will likely take several days and will culminate in what many call a “vote-a-rama” or a series of several votes that will take place over several hours and potentially stretch long though the day and night.

House Budget Resolution Vote

Once the Senate passes the budget resolution with reconciliation instructions, the action shifts to the House, which will move quickly take up a vote to pass the resolution. Predictions are that this vote will occur prior to Inauguration Day on January 20^th.

It is important to note that while the budget resolution is the first step in the process of repealing the Affordable Care Act, nothing happens to the ACA just yet – it merely sets up Congress for the next step in the process, which is to introduce a repeal bill.

Repeal Bill Moves Forward

The process of introducing repeal legislation will begin in the House, given that it must comply will the rules of reconciliation to include only budget-related changes and any bills that have an impact on revenue must originate in the House. The House Committees with jurisdiction over health care, including Energy and Commerce and Ways and Means, will start this process in the House by marking up legislation that they will then send to the House Budget Committee, which will craft a repeal bill.

House Repeal Bill Vote

The House Ways and Means repeal bill will eventually go to the House floor to be voted on. The expectation is that the House repeal bill will look similar to the repeal bill that was passed by both the House and Senate but vetoed by President Obama in 2015. While that bill did not fully repeal the ACA, it did repeal many of its major tenets, including Medicaid expansion, premium tax credits, and the individual and employer mandates, among other provisions (check out our blog post on that bill here).

Senate Repeal Bill Vote

Once the House votes on its repeal bill, it will go to the Senate. It’s not clear at this point whether the bill will go through the Senate Committees with jurisdiction or go right to the Senate floor for a vote. Once a bill comes to the floor, there will likely be extensive debate, with Republicans looking to potentially include additional repeal provisions from the ACA and Democrats looking to force several votes on specific provisions included in the bill.

Conference Committee/ House Vote

If the Senate votes on passing a bill that is different than the House passed bill, either a conference committee will be formed to deal with the changes or the House will vote on the Senate passed bill. It is anticipated that this process will take place rather quickly.

Repeal Bill Signed into Law

By this point, the President-Elect will be sworn into office and the final repeal bill that Congress agrees upon will be sent to the President’s desk to be signed into law.

While we will likely continue to hear talk about a “replace” plan while the repeal bill is debated, it is much less clear when, and in what form, we will see what Congress’s plan for “replace” will include. As you’ve heard before and will continue to hear, fundamental changes to the health care system will be debated over the coming weeks, months and potentially years – changes that could greatly impact the work of health centers and impact the patients we serve. None of these actions is a foregone conclusion, but advocates need to be informed and engaged. That’s why we’ll be keeping a close eye on how that debate unfolds and will continue to keep you updated as this process moves along.

Questions? Email us, at federalaffairs@nachc.org.