Despite veto threat, Congress sends Obama bill to dismantle the ACA

The bill would scrap the law's Medicaid expansion, among other provisions

The House on Wednesday voted 240-181 to pass a budget reconciliation bill that would repeal major provisions of the Affordable Care Act (ACA)—marking the first time such a measure has passed both chambers of Congress.

The bill now goes to President Obama, who the White House has said will veto the measure. Neither the House nor Senate has enough votes to repeal a veto, according to USA Today.

The reconciliation process allows legislation to advance through the Senate on a simple majority vote by avoiding legislative hurdles that lawmakers typically would need 60 votes to bypass. The process can only be used for measures that address spending and revenue, meaning it could not be used to repeal the entire ACA.

Bill details

Among other provisions, the bill would:

  • Eliminate funding for the ACA's Medicaid expansion and insurance premium subsidies starting in 2018;
  • Repeal the ACA's so-called "Cadillac Tax" on high-end health plans, the law's taxes on medical devices, and other revenue provisions; and
  • Scrap the law's individual and employer mandates.

The measure also would defund Planned Parenthood.

GOP plans to put forward ACA replacement plan

Republican leaders note that some provisions in the bill would be delayed so legislators would have time to craft replacements. "House Republicans are starting 2016 unified in opposition to this law and focused on putting together a patient-centered alternative that grants Americans freedom in their health care choices," House Speaker Paul Ryan (R-Wisconsin) said in a statement.

Ryan has asked committee chairs to use several House proposals to replace the ACA with a single plan.

According to The Hill, Republicans have not yet agreed on any single replacement proposal, but plan to discuss possible options during a GOP retreat next week.

A rare event: Congress approves change to the ACA

Meanwhile, Democrats criticized the repeal measure as being largely symbolic. Rep. Jim McGovern (D-Massachusetts) said on the House floor during debate over the bill, "If this were a serious effort, [Republicans would] at least have offered an alternative" (The Hill, 1/6; Muchmore, Modern Healthcare, 1/6; Kelly, USA Today, 1/6).

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