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June 7, 2017

AHCA clears reconciliation hurdle, moving one step closer to a Senate vote

Daily Briefing

The Senate Budget Committee in an announcement Tuesday said the House-approved American Health Care Act complies with the Senate's reconciliation rules, clearing the way for the House to send the bill to the Senate for consideration.

How to succeed in the next era of health reform

House GOP leaders had delayed sending the Senate their bill to repeal and replace large portions of the Affordable Care Act (ACA) over concerns that it might not meet the Senate's strict rules for passing legislation through the budget reconciliation process. That process allows certain bills to pass the Senate by a simple majority of 51 votes, without being subject to a filibuster.

Senate Democrats had argued that a provision of the bill that repeals the ACA's cost-sharing subsidies affects the Indian Health Service and, as such, falls into the jurisdiction of the Indian Affairs Committee, which was not designated as a participant in the reconciliation process by the fiscal year 2017 budget resolution. But the Senate Budget Committee said the provision does not present an obstacle to the bill's passage.

GOP senators optimistic after Tuesday meeting

Senate Majority Leader Mitch McConnell (R-Ky.) after a closed-door caucus meeting Tuesday said GOP senators are "getting close to having a proposal to whip and take to the floor," The Hill reports.

While McConnell declined to specify a timeline for a Senate vote, several Republican senators this week said the goal is to bring the bill for a vote before lawmakers break for the July 4 recess.  

According to Republicans familiar with the meeting, McConnell presented Republican senators with options for structuring Medicaid, revamping tax credits to help individuals purchase coverage, and improving the health insurance market while lowering premium costs, the Washington Post's "PowerPost" reports.

How the AHCA would create 'Three Americas' for health care

Further, McConnell reportedly proposed keeping the AHCA's waivers, but prohibiting them from applying to the ACA's protections for individuals with pre-existing conditions. Republicans emerging from Tuesday's meeting declined to talk specifics, but according to Politico, many seemed optimistic about prospects for the Senate's bill.

However, according to the Wall Street Journal, Medicaid remains a key hurdle. Conservative Republicans continue to push for bigger Medicaid savings, while moderates and those who represent ACA expansion states are hesitant to make changes that would increase the uninsured population.

Sen. John Barrasso (R-Wyo.) said leaders proposed gradually reducing federal payments to Medicaid expansion states beyond the AHCA's 2020 deadline to give beneficiaries more time to shift from Medicaid to another source of coverage (Hellman, The Hill, 6/6; Everett et al., Politico, 6/6; Young, CQ News, 6/6 [Subscription required], Carney, The Hill, 6/6; Haberkorn, Politico, 6/6; Sullivan/Snell, "PowerPost," Washington Post, 6/6; Peterson et al., Wall Street Journal, 6/6).

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