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The Budget Resolution to repeal the Affordable Care Act (ACA) has passed in the Senate and House. The Senate passed the Budget Resolution by a vote of 51-48 last Thursday. This was quickly followed by the vote clearing the House of Representatives as well on Friday, passing 227-198.

The Senate Concurrent Budget Resolution 3 can be used to repeal key parts of the ACA. It calls on four congressional committees to submit related spending cuts and revenue increases by January 27, 2017.


The back-to-back roll call votes on amendments before the Budget Resolution vote is known as “vote-a-rama.” Amendments including an amendment ensuring continued access to coverage for those with pre-existing conditions (an ACA provision) and amendments protecting rural hospitals (posed by democrats) were all rejected by the Senate. In an unorthodox move, Democrats took to the floor to express anger about the prospect of millions of Americans losing health insurance as a result of the repeal efforts. They voiced their opinions during roll call, since debate is not allowed during a vote. Senator Ron Wyden from Oregon remarked that would cast a “no” vote, “because health care should not just be for the healthy and wealthy.” The marathon voting session ended around 1:30am Thursday morning.

Republican Intent

GOP Senators and House members continue to raise questions on the feasibility of repealing without a cohesive plan to replace the ACA. Republican Congress members maintain no consistent message regarding plans to replace this landmark health care law. There has been much debate among Republicans on how to replace the ACA, with some Senators reaching across party lines. Senator Rand Paul (R-KY) voted with the Democrats, against the Budget Resolution on Thursday’s vote. House Speaker Paul Ryan (R-WI) has been a longtime opponent of the Affordable Care Act, still asserting that the law is failing and on the verge of collapse. Ryan hopes to repeal the ACA as swiftly as possible. Senator Michael B. Enzi-(R-WY) maintains a position of responsibly replacing the ACA by laying out a calculated replacement plan with some overlap. He remarked that “we’ll build new bridges to better health care, and finally, when these new bridges are finished, we’ll close the old bridge.” Meanwhile, President-elect Trump indicated that he would like to simultaneously repeal and replace the ACA, at a press conference last Wednesday.

Defeating the Cadillac Tax

While the Budget Resolution does not address the Cadillac Tax, last week, Senators Dean Heller (R-NV) and Martin Heinrich (D-NM) introduced the Middle Class Health Benefits Tax Repeal Act of 2017. The Cadillac tax is an unpopular portion of the ACA that would impose a 40% excise tax on certain health plans. The Cadillac Tax was delayed to go into effect until the year 2020. This new bipartisan legislation shows progress to fully repeal the Tax, rather than just another delay. Companion legislation was introduced in the House of Representatives.


It isn’t just the 20 million Americans utilizing Marketplace health coverage who are bracing for the impact of a potential repeal of ACA. The Committee for a Responsible Federal Budget reports that repealing ACA will add a $350 billion budget deficit over the next 10 years. Although spending federal funds on Marketplace health coverage would save $1.55 trillion, those savings will not make up for the $800 billion in revenue from insurance mandate penalties and other taxes imposed by the ACA. (For example – the 0.9% Medicare payroll surtax on wages above $200,000/yr, currently in effect via the ACA.) Rural hospitals are preparing to face financial issues in the event the ACA is repealed, according to Kaiser Health News. The ACA expansion of Medicaid provided care to previously uninsured patients. This brought new revenue to hospitals in rural areas, which commonly provide care to poorer patients with more health issues. With the decline of manufacturing jobs, this increased business for small-town hospitals; while also creating jobs in areas with high unemployment. These smaller hospitals face uncertain futures if the ACA is repealed. Many will struggle to stay open and local residents would lose access to the sole health provider in the area.

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