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Tuesday, July 28, 2015

Health Policy on the Hill: Threats to the ACA and Medicaid in Congress

An occasional column that rounds up the latest activity in Congress affecting access to health care.

Although Republicans in Congress missed their self-imposed July 24 budget reconciliation deadline where they hoped to repeal the Affordable Care Act, that doesn’t mean the drama is over. After the August recess, Republicans may still use reconciliation to attempt to dismantle the ACA, and cut Medicaid and other health care programs that serve low-income Americans.

Budget framework proposes troubling changes to vital health insurance programs

To recap, in May, both chambers of Congress agreed to a fiscal year 2016 budget resolution, a non-binding framework for congressional spending and policy priorities.  Families USA continues to have serious concerns about this budget proposal, which calls for severe cuts to Medicaid through harmful structural changes, such as a block grant and per capita caps.  

The proposed budget framework also calls for a repeal of the ACA’s Medicaid expansion (which 31 states, including D.C., have implemented so far).  

ACA repeal, cuts to Medicaid remain top GOP health care priority

Despite the Supreme Court’s ruling affirming the ACA, many Republicans would still like to use this year’s budget process to get an ACA repeal bill to President Obama’s desk.  

Two weeks ago, Representative Paul Ryan (R-Wisconsin), chairman of the powerful House Ways and Means Committee, asserted that House Republicans still intend to use reconciliation to “go after Obamacare.”

Just last week, House Majority Leader Kevin McCarthy (R-California) said that even though his party would miss the July 24 deadline, a bill to repeal the ACA could come in September. And yesterday, Senate Majority Leader Mitch McConnell (R-Kentucky) and Senator Mike Lee (R-Utah) both released statements reaffirming their commitment to repeal the ACA through reconciliation.

Some opponents of the ACA prefer to use budget reconciliation as the vehicle for ACA repeal because such a bill could move quickly through Congress with limited debate and opportunity for amendments.  These types of bills cannot be filibustered in the Senate, and only require a simple majority vote (51 instead of the usual 60) to pass. 

Presidential veto would be likely, but mark a new milestone for ACA opponents

On a more positive note, even if Republicans can get an ACA repeal bill through the use of reconciliation to the president’s desk, there is no way he would sign a bill that dismantles one of his signature legislative achievements. 

If Republicans get a repeal bill to the president, however, it would represent a new milestone in their campaign to attack the ACA.  They've held more than 50 repeal votes on the law, but have never been able to cross the hurdle of landing a bill on President Obama's desk.  If they accomplished this, Republicans could gain political leverage with the next president for repeal (or at least repeal and replace).  As for Medicaid, any serious conversations in Congress about instituting block grants or per capita caps undermine the important work to persuade the remaining 20 states to expand Medicaid.

Other ACA provisions that may be modified: medical device and health insurance tax

This fall we could see renewed attempts to repeal or change key parts of the ACA: 

  • Medical device tax—allows for a small, 2.3 percent excise tax on certain medical devices 
  • Health insurance tax—charges health insurers an annual fee to help pay for the ACA’s expansion of health coverage.

Both the medical device community and health insurers are benefiting from the ACA--thanks to the health care law, they're receiving millions of new customers.  

Unfortunately, some lawmakers are spending substantial time and effort on budget tactics and repeal votes to repeal the health care law and cut Medicaid, both of which have dramatically expanded health coverage to millions of low- and middle-income Americans, many for the first time. Instead, Congress should be working to build upon and expand these existing programs by enrolling and providing health coverage to additional consumers and by making health insurance even more affordable.