March 23, 2017

What you need to know on ACA repeal: The nonstop negotiations—and a vote tonight?

Daily Briefing

    Update: Politico late Thursday afternoon reported that House GOP leaders have canceled the planned vote on their bill to replace the Affordable Care Act. We'll have further details in Friday's Daily Briefing.

    The House GOP's legislation to repeal and replace the Affordable Care Act (ACA) hangs in the balance after the House Rules Committee adjourned Wednesday night without advancing the bill.

    The full House was expected to consider the American Health Care Act (AHCA) Thursday, but it remains unclear whether the vote will actually occur. White House officials and Republican House leaders late last night were still scrambling to appease conservative lawmakers' concerns.

    Several industry stakeholders have voiced opposition to the bill, and the American Medical Association in a letter released after recent amendments to the bill called on lawmakers to reconsider provisions that would increase premiums and the uninsured rate.

    Behind the scenes, House leadership and Trump work to lock in votes

    House leaders need 215 favorable votes to pass the AHCA in the House. With one Democrat expected to be absent on Thursday, GOP leaders can afford only 22 "no" votes from Republicans, presuming that no Democrats vote in the legislation's favor.

    For now, it remains unclear whether House leaders and President Trump have the needed votes. Media outlets are reporting varying numbers of Republicans in opposition, ranging from a high of 32 reported by NPR/WNYC to a low of 24 reported by CNN.

    The latest hang-up is a last-minute demand from the conservative House Freedom Caucus to repeal the ACA's essential health benefits, which require health plans to cover at least 10 types of services, including emergency services, hospitalization, maternity and newborn care, and prescription drugs. Conservative lawmakers say that reducing the range of services that insurers are required to cover will lower premiums.

    But some House Republicans are concerned adding such an amendment would prevent the bill from being considered in the Senate under budget reconciliation rules. The reconciliation process—which enables lawmakers to pass a bill by a simple majority of 51 votes, without needing to overcome a filibuster—is limited to bills related to spending and revenue.

    For instance, Rep. Michael Burgess (R-Texas) said repealing the essential health benefits was not "available to us under the reconciliation rules in 2015, and [it] aren't available to us under the reconciliation rules under 2017."

    Anthem CEO pens support for parts of the House GOP's ACA replacement plan 

    To sidestep the issue, the Washington Post's "PowerPost" on Tuesday reported that White House officials and House leaders hoped to pass the bill in the House without a provision repealing essential health benefits, then rely on Senate Republicans to attempt to amend the legislation once it reaches the Senate. If the Senate parliamentarian rules that the provision cannot be passed under reconciliation, it would be dropped. But after meeting with Trump on Thursday afternoon, House Freedom Caucus Chair Mark Meadows (R-N.C.) said no deal had yet been reached with the White House.

    Another potential conflict is that amending the bill to appease conservatives could alienate moderate Republicans who already feel that the bill has gone too far, the New York Times reports. For instance, Rep. Frank A. LoBiondo (R-N.J.) said, "Under the current proposal, many South Jersey residents would be left with financial hardship or without the coverage they now receive."

    House Rules Committee adjourns without advancing the bill

    Even as the White House and GOP leaders continued to bargain with conservatives, House Rules Committee Chair Pete Sessions (R-Texas) adjourned his panel after 13 hours of debate without advancing the legislation. He told committee members they would resume debate on the bill Thursday morning because House leadership was still negotiating certain points of the bill.

    Rep. Jim McGovern (D-Mass.) commented on the "extraordinary" circumstances, saying, "Here we are; it's almost midnight and we [don't] know what we're going to be voting on tomorrow."

    The House Rules Committee determines which amendments are ruled in order for consideration when the bill reaches the House floor. The panel yesterday heard testimony on several amendments, including one that would freeze the Medicaid expansion enrollment in 2018. According to Politico, the panel did not make any final decisions on the amendments.

    (Pradhan, Politico, 3/23; Frieden, MedPage Today, 3/23; Katz/Quealy, New York Times, 3/22 [accessed 3/23]; Steinhauer, New York Times, 3/22; Dickson, Modern Healthcare, 3/22; Sanger-Katz, "The Upshot," New York Times, 3/23; DeBonis, "PowerPost," Washington Post, 3/22; AP tweet, 3/23; Diamond, "Pulse," Politico Pro, 3/23 [subscription required]; Dawsey/Haberkorn, Politico, 3/22).

    Navigating the first 100 days of the Trump administration

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    Since Donald Trump won the presidential election in November, health care reform has since quickly risen to the top of the GOP's policy agenda—and heath care executives are grappling with a new sense of uncertainty.

    While many unknowns will remain across the next few months and potentially even years, the first 100 days of the Trump administration will provide significant insight into the direction of reform efforts. Read our briefing to learn what five key issues you should watch.

    Download the briefing

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