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January 12, 2017

Senate moves forward on ACA repeal—and Trump weighs in on replacement timing

Daily Briefing

The Senate early Thursday morning voted 51-48 to advance a budget resolution that initiates Republicans' efforts to repeal the Affordable Care Act (ACA) through the reconciliation process.

Lawmakers from both parties also proposed a total of more than 180 amendments to the resolution. The Senate voted on 19 of those amendments, but none were approved.

The resolution now heads to the House, which likely will consider the measure on Friday.

Budget resolution details

The budget resolution instructs two House committees and two Senate committees to draft and approve a reconciliation measure by Jan. 27 that includes provisions to repeal parts of the ACA.

Sen. Bob Corker (R-Tenn.) and four GOP colleagues had proposed an amendment extending that date to March 3. However, they withdrew the amendment after receiving assurances from GOP leaders that Jan. 27 would not be a hard deadline, Corker said. "That is a placeholder," Corker added. "That is the earliest [the committees] can come back" with a repeal plan.

The budget reconciliation process allows bills related to spending and revenue to be passed by a simple majority of at least 51 votes, without being subject to a filibuster. Republicans lack a filibuster-proof majority in the Senate, but hold 52 seats in the chamber.

Ryan discusses ACA replacement plans

The budget resolution does not include instructions on how to replace the ACA if it is repealed. However, House Speaker Paul Ryan (R-Wis.) on Tuesday said congressional Republicans will propose legislative language to replace the ACA at the same time they move to repeal the law.

Ryan said the final budget reconciliation measure could include some language to replace the ACA, though he added that he does not know exactly which language could be included. "That's a question that really is more of a Senate question, as to what you can put in reconciliation, what you cannot put in reconciliation," he said.

According to Ryan, lawmakers "will pass as much as we can" initially to replace the ACA and then would produce another bill to "show you the full scope of what a real replacement effort looks like."

Congressional Republicans likely would need some Democrats to vote for such legislation because it could not be passed via the budget reconciliation process. According to the New York Times, getting those votes could be "difficult" for Republicans.

Trump discusses ACA repeal efforts

President-elect Donald Trump on Tuesday said Republicans in Congress should quickly replace the ACA after they repeal it.

Trump indicated that he would not support a long gap between when the ACA is repealed and when a replacement plan is implemented. He said, "Long to me would be weeks," adding, "It won't be repeal and then two years later go in with another plan."

During a press conference on Wednesday, Trump said, "We're going to be submitting as soon as our [HHS] secretary is approved, almost simultaneously, shortly thereafter, a plan" to reform health care. Trump has nominated Rep. Tom Price (R-Ga.) to serve as HHS secretary under his administration. Sen. Lamar Alexander (R-Tenn.), chair of the Senate Health, Education, Labor and Pensions Committee, recently said he expects Price "would be confirmed at least by mid-February."

According to Vox, Trump's comments suggest Price could be involved in implementing an ACA replacement plan via the executive branch. Trump did not provide details on how his administration would seek to repeal and replace the ACA, but said his plan would "repeal and replace" the law "essentially simultaneously," likely "on the same day or the same week."

(Peterson/Andrews, Wall Street Journal, 1/12; Kurtzleben/Chang, NPR, 1/12; Kaplan/Pear, New York Times, 1/12; Weyl, Politico, 1/12; Carney, "Floor Action," The Hill, 1/12; Haberman/Pear, New York Times, 1/10; Werner, AP/Sacramento Bee, 1/10; Everett, Politico, 1/10; Phillip, "PowerPost," Washington Post, 1/10; Bennett /McPherson, Roll Call, 1/10; Fram, AP/Sacramento Bee, 1/10; Krawzak et al., CQ News, 1/10 [subscription required]; Cornwell/Stephenson, Reuters, 1/10; McIntire, Morning Consult, 1/11; Japsen, Forbes, 1/11; Morse, Healthcare Finance News, 1/11; Kliff, Vox, 1/11; Clark, McClatchy/Miami Herald, 1/11; Mangan, CNBC, 1/11; Lesniewski, Roll Call, 1/11; Trump, press conference transcript, 1/11; Diamond, "Pulse," Politico, 1/12)

The 12 keys to hospital and health system success in 2017

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