ACA Repeal and Replace Legislative Timeline 2017

The Republican Party has promised to repeal the Affordable Care Act (“ACA” and also referred to as “Obamacare”), and as such, has released a number of proposals to repeal and replace the law. The House of Representatives’ American Health Care Act (“AHCA”) and the Senate’s Better Care Reconciliation Act (“BCRA”) are two bills currently up for debate in Congress.  Below is a timeline of attempts to repeal the ACA since Trump’s inauguration.

 

CURRENTLY: Congresspeople are discussing changes to the ACA. President Trump is threatening to let the marketplaces collapse and has expressed disappointment in the Republican party.

August 2, 2017

Bipartisan Efforts to Change the ACA Underway

Senator Lamar Alexander (R-TN) released a statement that said in September the Senate health committee will hold bipartisan hearings related to stabilizing the individual market. In the House of Representatives, a 40-person group, comprised of both parties, has endorsed an outline of ideas aimed at making urgent fixes to the ACA.

July 29, 2017

President Trump Tweets that “Bailouts” Will End Soon If There is No Healthcare Reform

After the defeat of the healthcare bill in Congress, President Donald Trump tweeted that “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!” The tweet suggests that he would end payment of the insurer subsidies that a US district court declared unconstitutional in the House v. Price case.

July 27, 2017

The Health Care Freedom Act (so-called “skinny bill”) fails to pass.

By a vote of 49-51, the Health Care Freedom Act failed to pass in the Senate. Senators Susan Collins, John McCain, and Lisa Murkowski were the only Republicans who voted against the bill alongside all Democrat Senators. After the vote, Senate Majority Leader Mitch McConnell makes a speech expressing his disappointment. Senate Minority Leader Chuck Schumer also makes a speech wherein he promises that the Democrats will do their part in confirming nominees and suggests that future healthcare reform should be done in a bipartisan manner.

July 27, 2017

Republicans Release the “Skinny Bill”

A couple hours before the vote was expected to open, Republican leadership released its so-called “skinny bill” called the Health Care Freedom Act.

This bill would repeal the individual mandate retroactive to 2016. It would also repeal the employer mandate through 2025. It also changes the ACA’s waiver requirements and the HHS would not be able to revoke a state’s waiver before its expiration date (eight years from which it is given). It increases the amount that people can contribute to Health Savings Accounts. The medical device tax would be repealed for three years. Finally, it would defund Planned Parenthood for one year.

July 27, 2017

Some Republican Senators Express Opposition to the “Skinny Bill,” Prompting Discussion with the House

Senators Lindsey Graham (R-South Carolina), Ron Johnson (R-Wisconsin), and John McCain (R-AZ) declared that they would not vote for the “skinny bill” which would repeal the individual and employer mandates in the ACA.


House Republicans are getting ready to enact “martial law” in their chamber, which would waive chamber rules that mandate they wait three days after a bill is made public to vote on the legislation on the floor. If the bill were passed, this would allow House Republicans the opportunity to take up the Senate bill immediately and enact the bill as soon as Sunday.

July 26, 2017

Senate Vote-O-Rama Continues

Senators introduce and vote down a number of amendments and bills. One such bill was introduced by Senator Steve Daines (R-Montana). This bill was a single payer bill (the Conyers bill in the House), which Senator Daines introduced in the hopes of getting Democrats on the record for voting on the bill, which is unpopular in some swing states. Minutes later, Senator Bernie Sanders announced his support for the bill. The bill failed to pass with 57 “no” votes and 43 abstentions.

July 26, 2017

Senate Vote-O-Rama Begins

Senators introduce and vote down a number of amendments and bills, including the Obamacare Repeal Reconciliation Act (“ORRA”), which would repeal most provisions of the ACA without replacement.

July 25, 2017

Vote on procedural question related to newest version of the BCRA fails to pass.

Hours later, the Senate voted 57-43 against a procedural motion related to whether the Cruz and Portman Amendments comply with Senate rules and added to the BCRA. It needed 60 votes to advance since it has not been scored by the CBO.

July 25, 2017

Republicans release new version of the BCRA with amendments.

The Senate introduced a new version of the Better Care Reconciliation Act of 2017 that incorporates the Cruz and Portman Amendments.
For an executive summary of the BCRA bill, including these amendments, visit our page here.

July 25, 2017

The motion to proceed on debate of the healthcare bill is successful.

The motion to proceed on debate passes after Vice President Pence breaks a Senate 50-50 vote. Only two Republican Senators – Susan Collins and Lisa Murkowski – voted against the motion. Afterwards, Senator John McCain delivers a speech encouraging discussion of the bill and forgoing bipartisan politics.

July 25, 2017

Republican leadership announce their plan for debate should the motion to proceed succeed.

Senate Majority Leader Mitch McConnell announced that after the 20 hours of debate, he will call for a vote on the “clean repeal” bill that passed in 2015. If it fails, he will call for a vote on a version of the BCRA which includes the Cruz and Portman Amendments. Since this is expected to fail (this version of the BCRA has not been scored by the CBO, and thus requires 60 votes to pass), Senate leadership will introduce a “skinny repeal” bill. This bill would leave almost all of the ACA in place, though it would eliminate the individual mandate, the employer mandate, and the medical device tax. Senate leadership hopes to work off this bill in the future to more completely repeal and replace the ACA.

July 20, 2017

The CBO released its report on the July 20th version of the BCRA, which included the July 13th Amendment (though not the Cruz Amendment).

According to the CBO’s analysis, the BCRA is projected to reduce the cumulative federal deficit by $321 billion between 2017 and 2026. The CBO also projects that the bill would increase the number of uninsured Americans, and that, by 2018, 15 million more individuals would be uninsured than would be under current law. By 2020, that difference would reach 19 million more people, and in 2026, 21 million more people would be left uninsured compared to current law.

July 20, 2017

The Senate releases the latest version of the BCRA, which is sent to the CBO for scoring.

This version of the BCRA incorporates the July 13th Amendment, though it drops the Cruz Amendment and includes minor changes in the Medicaid section.

For an executive summary of the BCRA bill, visit our page here.

July 19, 2017

The CBO released its score of the Obamacare Repeal Reconciliation Act (“ORRA”), which would repeal the ACA but not replace it.

The CBO reports that by 2018, 17 million more people would be uninsured than would be under current law. That number would increase to 27 million in 2020, and finally to 32 million in 2026. The agency also projects that the ORRA would decrease the federal deficit by $473 billion from 2017 to 2026.

July 19, 2017

The Senate posted the Obamacare Repeal Reconciliation Act (“ORRA”), which would repeal the ACA but not replace it.

Despite objections from Republican senators, the Senate posted the ORRA onto its website. This bill is virtually identical to the bill that both the Senate and the House of Representatives passed and that President Obama vetoed in 2016.

July 19, 2017

Senator John McCain diagnosed with brain cancer, prompting turmoil in the Senate.

Although Senator John McCain has been critical of the BCRA, without his vote, Republicans may not have the votes necessary to pass any healthcare bill. As such, his presence in the Senate is crucial to ACA repeal efforts.

July 18, 2017

Senate Majority Leader Mitch McConnell Announces that He Will Hold a Vote the Week of July 24th

Senate Majority Leader Mitch McConnell announced that he would call for a vote to proceed on the BCRA even though he knows it will not pass.

July 18, 2017

“Repeal Only” Plan Quickly Collapses

Early in the morning on July 18th, President Trump announced that Republicans should “let Obamacare fail” and that they will replace the ACA only when the markets collapse.

Almost immediately after the Senate proposed a plan to introduce a “repeal only” bill, Senators Susan Collins (R-Maine), Shelley Moore Capito (R-West Virginia), and Lisa Murkowski (R-Alaska) announced they would oppose such a measure, effectively killing the plan.

July 17, 2017

Vote Postponed after More Republicans Say They Will Not Vote to Proceed on the BCRA

After two more Republican Senators (Senators Mike Lee (R-Utah) and Jerry Moran (R-Kansas))announced their opposition to the BCRA, Republican leaders have postponed the vote for the BCRA.

July 13, 2017

July 13th Amendment to the BCRA

The Senate amended the Better Care Reconciliation Act of 2017. The July 13th Amendment incorporates many suggestions made by Senator Ted Cruz, including what is referred to as “the Cruz Amendment.” In the private market, the Cruz Amendment would allow insurers to offer minimal coverage plans that do not comply with Affordable Care Act (“ACA”) requirements so long as the insurer also made available at least one gold plan, one silver plan, and one bronze plan (which would have a lowered 58% actuarial value under the BCRA).

It would also make some minor changes to Medicaid. First, it would allow states to apply block grant funding for the Medicaid expansion population. Secondly, under the amendment, the bill would also allow states to exceed block grant caps in the case of a public health emergency.

Senators Susan Collins (R-Maine) and Rand Paul (R-Kentucky) almost immediately announced that they would not vote to proceed with the bill. As a result, no other Republican Senators could say “no” without the bill collapsing.

The CBO was expected to release an updated analysis by July 21. Its previous scoring of the bill estimates that 15 million more people will be left uninsured compared to the ACA by 2018. By 2026 that number would increase to 22 million.

For an executive summary of the BCRA bill, including the July 13th Amendment, visit our page here.
For a standalone summary of the July 13th Amendment, visit our page
here.

July 11, 2017

August Recess Delayed for the BCRA

Senate Majority Leader Mitch McConnell delayed the start of the Senate’s August recess until the third week in August in order to work on the BCRA.

June 27, 2017

Vote Delayed on the BCRA

The Senate postponed the vote on the bill until after the July 4th recess.

June 26, 2017

CBO Report Released for the BCRA

The CBO released its scoring of the bill. It estimated that 15 million more people would be left uninsured compared to the ACA by 2018. By 2026 that number would increase to 22 million.

June 22, 2017

“Discussion Draft” of the Senate’s Better Care Reconciliation Act Released to the Public

After working on a draft of the bill for weeks, the Senate released the Better Care Reconciliation Act (“BCRA”) to the public.

Within a few hours, several prominent Republican Senators spoke against the bill.

For an executive summary of the BCRA bill, visit our page
here.

June 19, 2017

Senate Majority Leader Mitch McConnell Announces that Bill Was Sent to the CBO

according to Senator Majority Leader Mitch McConnell, would be released to the public on Thursday, June 22nd. Reportedly only some members of the 13-man working group had seen a draft of the bill, and both Republicans and Democrats expressed displeasure at being left out of the process. Senate leaders announced that they planned to vote on the bill by June 30.

In the meantime, Senate Democrats raised more opposition to the bill, including giving speeches that went late into the evening on Tuesday, June 19th, slowing other Senate business to a crawl.

May 9, 2017

Senate Republicans Create Working Group for Bill

Senate Majority Leader Mitch McConnell created a Senate 13-man working group tasked with crafting a version of the AHCA. The Republican Party was criticized for failing to include any women on the 13-man working group, including pivotal vote Senator Susan Collins (R – Maine).

May 4, 2017

Senate Announces Plan to Write Its Own Bill

Within hours after the House passed the bill, Republican Senators stated that they would be drafting their own version of an ACA repeal and replace bill that would achieve the necessary 50 votes to pass.

May 4, 2017

House of Representatives Votes to Pass the Bill

In a narrow 217 to 213 vote, the AHCA passed Congress with all new amendments incorporated.

Moments before the main vote, the House voted unanimously to eliminate a provision that would carve out an exception for Congressional members for the AHCA.  Essentially this provision made it so state waivers, which would eliminate or modify ACA requirements for pre-existing conditions and essential health benefits, would not apply to members of Congress.

May 3, 2017

Upton Amendment Introduced

Senator Fred Upton introduced an amendment aimed at addressing concerns that the AHCA would leave consumers with pre-existing conditions with unaffordable out-of-pocket costs.  This amendment create a fund of $8 billion that would be available to states from 2018 to 2023.  This money would go to states that permit insurers to charge higher premiums to individuals with pre-existing conditions, and would be used to offset those higher costs for these individuals

Read our summary of the Upton Amendment here.

April 24, 2017

MacArthur Amendment Introduced

Representative Tom MacArthur offered an amendment to the bill that aimed to generate more support from the House Freedom Caucus, which was holding out for more extensive repeal of the ACA.

Under the amendment, states could apply for a waiver from the federal government which would essentially allow them to opt out of many provisions of the ACA.  Under such waivers, states could allow insurers to charge consumers more based on age, change or eliminate the ACA’s essential health benefits requirements, and charge individuals with pre-existing conditions higher premiums.

Read our summary of the MacArthur Amendment here.

April 20, 2017

House Republicans Attempt a New Version; Revised Bill Leaked

Huffington Post posted an article about a new, unreleased version of the AHCA that aimed to appeal to the House Freedom Caucus.  Hours later, Politico published a leaked version of this new revised AHCA.  That version of the bill introduced state waivers for some of the ACA’s key provisions.

Later that day, White House officials announced that they were aiming to resurrect a revised version of the AHCA bill and hoped to pass it before Trump’s 100th day in office (April 29).  However, all parties were skeptical that the House would achieve this goal; the House still needed to pass a budget by April 28.

April 6, 2017

April 6th Amendment Introduced

Right before the congressional spring recess, Representatives Gary Palmer and David Schweikert submitted an amendment to the AHCA to the House Rules Committee that would create a federal “invisible risk sharing program” within the AHCA’s Patient and State Stability Fund (“PSSF”) program.

For a full summary of the April 6th Amendment, visit the Health Affairs Blog.

March 24, 2017

House Fails to Hold Vote; Pulls Bill from the Floor

After much debate and multiple postponements, the AHCA was pulled from the Floor.  Moderate House Republicans refused to vote yes on the bill after introduction of the Manager’s Amendment.  At the time, Speaker Paul Ryan said that he did not expect the bill “or anything close to it” to survive.  President Trump reported that he was going to “let the marketplaces collapse” under the ACA.

March 20, 2017

Manager’s Amendment Introduced

House Republicans released a “Manager’s Amendment” which adopted some of the Budget Committee’s recommendations.

These recommendations include, but are not limited to, creating a work requirement for Medicaid enrollees, giving states the option to fund adult and children populations with block grants, and application of the premium penalty to individual plans only.

For a full summary of the Manager’s Amendment, click here.

March 16, 2017

Committee Votes Bill to the Floor

The House Budget Committee voted 19 to 17 to sent the AHCA to the Floor of the House.  In passing it to the Floor, the committee recommended several changes to the bill.

March 12, 2017

CBO Releases Budget Analysis

The CBO projected that 52 million Americans would be left uninsured under the AHCA.  The agency also said that insurance premiums would be higher through 2020.  Premiums would then be lower compared to the ACA after 2020.

For an executive summary of the CBO assessment, visit our page here.

March 8, 2017

Approved in Committee

Both committees approved the AHCA the day after it was released to the public.  The vote was along party lines, with committee Republicans overwhelmingly voting yes on the bill.

Despite Democrat Representatives’ protests, both committees approved the AHCA without a nonpartisan economic analysis from the Congressional Budget Office (“CBO”).

March 7, 2017

Support from President Trump
Right after the AHCA was released to the public, President Donald Trump and his administration immediately announced their support.

March 7, 2017

AHCA Introduced in the House of Representatives

Republicans introduced the two bills that constitute the original AHCA to the House Energy and Commerce Committee and the House Ways and Means Committee.

For an executive summary of the AHCA bill, visit our page here.


You may view the infographics dated to late March 2017 here and here.