Senate GOP Mounting Final Push for ACA Repeal

Some Senate Republicans are pushing hard for a vote next week to overhaul the Affordable Care Act after abandoning the effort earlier this summer. The replacement plan rolled out last week by GOP Sens. Lindsey Graham of South Carolina and Bill Cassidy of Louisiana faces major challenges, but its sponsors claim they are just a handful of votes short of passing the bill. If the measure garners support from at least 50 of the Senate’s 52 GOP senators, leaders are expected to hold a vote. 

Time is tight

The Senate’s ability to make wholesale changes to the ACA by a simple majority vote expires after Sept. 30, meaning a bill would need to clear Congress by the end of next week. Senate GOP leaders have instructed the Congressional Budget Office to analyze the Graham-Cassidy measure as quickly as possible. The CBO won’t have time to produce a detailed analysis before the end of next week, but it is expected to release a preliminary assessment that could sway votes. 

The proposal could win over previous Senate holdouts in ways the other GOP bills did not. It would replace federal funding for the ACA with block grants to states and cap traditional Medicaid spending. The money would be distributed to states under a complex funding formula that appears to provide more funding to a number of rural, politically conservative states that did not expand Medicaid. A number of governors are still assessing the impact on their states and their opinions also could affect the Senate vote tally. 

Most ACA taxes would remain in place

The proposal would also repeal the law’s employer and individual mandates and keep all of the ACA’s taxes in place (including the Cadillac tax) except for the tax on medical devices. Enhancements to health savings accounts (HSAs) in the measure would increase contribution limits, let both spouses make catch-up contributions to the same account, allow account holders to use funds to pay medical expenses for children under the age of 27, and permit funds to be used to pay premiums for individual-market plans. 

Currently there’s only one hard “no” vote

While three "no" votes would kill the bill, there is just one hard "no" vote currently -- Sen. Rand Paul of Kentucky, who has criticized keeping ACA taxes largely intact. Other important votes and prior holdouts -- Susan Collins of Maine, Lisa Murkowski of Alaska, and John McCain of Arizona – are reportedly undecided. Prospects may get a boost from a newly-scheduled hearing on the bill this Monday at the Senate Finance Committee.  

On the other side of the Capitol, Speaker Paul Ryan says the House would bring up the bill for a vote if it were to pass the Senate. 


Geoff Manville
by Geoff Manville

Partner, Mercer’s Law & Policy Group

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