The American Health Care Act (AHCA), the Affordable Care Act (ACA) repeal set forth in a current budget reconciliation bill, is on schedule to go to the full House floor for a vote this week. The bill cleared two key House committees the week before last (see WICs article, "ACA Repeal Bill Clears Two Key House Committees," March 10, 2017), and also passed out of the House Budget committee on March 16. The final stop for the bill before it hits the House floor is the Rules Committee. Though substantive changes were not made to the bill in Ways and Means, Energy and Commerce, or Budget, it is expected that the bill will need to undergo some additional amendments to make it palatable to more conservative House Republicans who currently stand opposed to the AHCA because they believe it doesn't not go far enough to repeal the ACA and because it creates a new entitlement in the form of tax credits. Speaker of the House Paul Ryan has indicated that he will introduce amendments in the Rules Committee markup aimed at gaining enough support to pass the bill out of the House on March 23. The date of March 23 has symbolic significance as the date the ACA was signed into law.
The AHCA will face significant challenges in the Senate. Several Republican Senators have expressed opposition to the bill in its current form, for reasons ranging from the bill's defunding of Planned Parenthood to its being viewed as "Obamacare Lite". If the House does adopt measures to appease more conservative members, it's likely to turn off some moderate Republicans. On the other hand, more conservative Republican Senators share the concerns of the House Freedom Caucus which believe the House bill does not go far enough to fully repeal the ACA.
Complicating matters on the Senate side is a process known as the "Byrd rule", named for long-serving Senator Robert Byrd (D-WV). The Byrd rule dictates that the Senate may only consider items in a budget reconciliation bill that actually impact the budget. "Extraneous" matters must be struck from the bill before it may be considered by the Senate. There are several pieces of the House bill that may become problematic under the Byrd rule, and which Democrats may challenge in a procedural motion nicknamed a "Byrd bath". If an item is challenged, the Senate parliamentarian must make a ruling on whether the item is or is not appropriate for consideration within the reconciliation bill. The reason this rule and process is important is because unlike most bills, budget reconciliation bills are not subject to filibuster, which means they may pass by a simple majority rather than by the 60-vote threshold needed for cloture for bills going through the normal process. If items are deemed "extraneous", they would then be subject to Senate consideration under regular process, which would require significant Democratic support in order to move forward.
The process of moving the AHCA out of the House and to the Senate is moving very quickly, and ANCOR will continue to update members of breaking news through the ACC, Weekly Update, WICs, and action alerts. Stay tuned!