by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Health care is huge this year. Huge. And it will continue to be a contentious topic of discussion for years to come, as Americans are not only waiting to see what the final Republican health care alternative looks like, but also when and how it will impact their lives.
The current political forecast shows Congress working towards a budget resolution for the year ahead. As part of that budget resolution, Republicans will be using ‘budget reconciliation’ to their advantage in efforts to speed up a repeal and replace of the Affordable Care Act (ACA).
If you’re wondering what this budget reconciliation business is all about, it’s part of the budget resolution process that allows Congress to direct one or many committees to craft legislation to change an existing law’s taxing, spending, or debt limit provisions. If Republicans stay the course, the plan is that repeal and replace will come out of two budget reconciliation bills in 2017 – the first bill consisting of a partial repeal of the ACA by phasing out the law’s taxing and spending provisions (think Medicaid expansion funding and health insurance subsidies), while the second would outline tax reform and insert other fiscal components that are a part of a finalized Republican health reform plan. Yuval Levin, editor of National Affairs, provides a great explanation here.
In summary, if a conservative health plan is going to get to President Trump’s desk, Republicans are relying on budget reconciliation. A repeal of the law in one sweep requires 60 Senate votes, and that’s just not in the cards. Through budget reconciliation, the Senate can first secure a simple majority (51 Republican votes) – enough to bypass a filibuster – to phase out the ACA’s subsidies by 2019. In the meantime, Congress will give itself a two-year window to come up with their idea of a more market-driven health reform.
What does reform entail? That depends on the various conservative proposals that have been discussed for over a decade, but they all want to give patients more say over their health care. You can read more about them here, here, and here.