Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Passage of Budget Resolution Paves the Way for ACA Repeal

Last week, both the House and the Senate passed the fiscal year (FY) 2017 budget resolution that is expected to serve as the vehicle for repealing the Affordable Care Act (ACA) this year. The budget resolution is a non-binding legislative measure that outlines congressional budget priorities but is not presented to the president for signature. It requires only a simple majority to pass the Senate. The budget resolution passed last week contains instructions to committees in both chambers to begin drafting ACA repeal legislation. The Senate adopted the measure (S.Con.Res. 3) in the early hours of last Thursday on a 51-48 vote. Sen. Rand Paul (R-Ky.) was the only Republican to vote against the measure. He did not support the resolution because it adds to the federal deficit and does not balance the budget over the decade-long budgetary window. According to the Office of Management and Budget (OMB), the budget resolution would increase the public debt from $14.2 trillion in 2016 to $23.7 trillion in 2026. No Democrats voted in favor of the resolution, though Sen. Dianne Feinstein (D-Calif.) missed the vote as she was recovering from a medical procedure. Late-night passage of the budget resolution followed more than six hours of debate, during which Democrats forced votes on more than 19 amendments - none of which were successfully added to the resolution. S.Con. Res. 3 was agreed to by the House of Representatives on Friday by a vote of 227- 198. Nine Republicans joined all Democrats in opposition to the measure: Justin Amash (Mich.), Charlie Dent (Pa.), Brian Fitzpatrick (Pa.), Walter Jones (N.C.), John Katko (N.Y.), Raul Labrador (Idaho), Tom MacArthur (N.J.), Thomas Massie (Ky.) and Tom McClintock (Calif.). Some of the dissent stemmed from concerns about rising fiscal deficits, while other members were not in favor of taking steps to repeal the ACA without details on a replacement plan.

Repeal and Replace, Rather than Repeal and Delay

Last week, President-Elect Donald Trump definitively stated his preference for repealing and replacing the Affordable Care Act (ACA) simultaneously. He offered few specific details on what replacement would entail or how it would be accomplished, but noted that the administration would be putting forth their own replacement plan once a Secretary of Health and Human Services is confirmed. Speaker of the House Paul Ryan (R-Wis.) later confirmed that the incoming administration and GOP lawmakers are in agreement on moving ACA repeal and replace concurrently. Speaker Ryan said that a replacement strategy will be developed at the GOP retreat in Philadelphia, which takes place a week after the inauguration. Republicans hope to pass repeal and replace within Trump’s first 100 days in office. Repealing and replacing the law simultaneously will be difficult. Republican leadership has faced criticism from members of their own party, including both the conservative Freedom Caucus and centrist Tuesday Group, who are seeking more details about what replacement of the 2010 health care law will look like. During debate on the budget resolution, five GOP senators pushed for extending the deadline for drafting repeal legislation from January 27 to March 3, in order to better finalize details on a replacement bill and allow time to work with the new Secretary of HHS on administrative actions once he is confirmed. Sens. Bob Corker (R-Tenn.), Rob Portman (R-Ohio), Susan Collins (R-Maine), Bill Cassidy (R-La.), and Lisa Murkowski (R-Alaska) filed and ultimately dropped the amendment to the resolution after assurance from leadership that the January 27 deadline was nonbinding.

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