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Health care reform update

July 27, 2017

By Scott Lyon, Senior Vice President

8:30am Wednesday, July 26, 2017

On Tuesday, July 25, the Senate voted to advance floor debates on health care policy with a vote of 51-50 with Vice President Pence casing the deciding tie-breaking vote.

This starts the debate that Senate Republicans hope will end with passage of “skinny” legislation – a repeal bill that can be reconciled with the House of Representatives’ American Health Care Act.

This “skinny” repeal legislation is likely to include the repeal of some of the Affordable Care Act mandates (both employer and individual) as well as some ACA-imposed taxes with the expectation that a conference committee of Senate and House members would produce more robust legislation.

Beginning Thursday morning the Senate is expected to begin a “vote-a-rama” which is actually a real thing on amendments and 20 hours of debates. Here are the steps:

1. Senate will vote on a straight repeal of the ACA. This was demanded by Senate conservative members Sen. Rand Paul and Sen. Mike Lee and it took this agreement to get their votes to even proceed with debate.

2. Next, the Senate will most likely vote on Repeal & Replace with some version of the Senate’s Better Care Reconciliation Act. This is not expected to pass with a few conservatives thinking it doesn’t’ go far enough in getting rid of the ACA and some moderate Republicans thinking it goes too far in cutting Medicaid. The Senate parliamentarian requires sixty ‘yes’ votes to pass anything due to the “Byrd Rule.” (The Byrd rule was passed in 1985 and says that any bill going through the budget reconciliation process — what Republicans in the Senate hope to do with their healthcare bill — can be blocked on the grounds that it contains an “extraneous matter” or something “merely incidental” to the federal budget.)

3. Numerous mandates are expected to be offered up along the way, including attempts by the Senate Democrats to force Republicans to vote on several popular options of the ACA. This is, of course, a political move to force the Republicans to go on record as opposing popular provisions. One example is the ACA requirement to allow dependents up to age 26 to remain on their parent’s plan. However, all that said, none of these amendments are expected to pass. We can just call this pure political posturing.

4. The final vote is expected to be a substitute amendment to replace the American Health Care Act with the skinny repeal bill. The details around this are not well known at the moment. It could be as skinny as repealing just the individual and employer mandate, and the medical device tax.

How this all plays out over the coming days is anyone’s guess. There are many procedural hurdles, political hurdles and roadblocks along the way. Finding a viable option to the mandate that keeps individuals in the pool is one of the biggest challenges.

As always, we will keep reporting on what we see and hear out of Washington, D.C.

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