On Friday, the House of Representatives approved a concurrent budget resolution that sets up a reconciliation bill to repeal the Affordable Care Act.  The resolution (S.Con.Res.3) was adopted by the Senate at approximately 1:00 AM on Thursday, January 12 by a vote of 51 to 48.  Senator Rand Paul (R-KY) was the only Republican to break ranks.  Senator Dianne Feinstein missed the vote due to a heart pacemaker procedure. Senator Jeff Sessions (R-AL) also cast a vote in support, something he might not have done if not needed because he has been nominated for a cabinet position.  Although over two dozen amendments were offered none were adopted but on some votes Republican Senators Collins (ME), Heller (NV), Portman (OH) and Capito (WV) did split with their party on some votes.

The resolution directs the key four committees in the Senate and House to report their repeal measures by January 27, but that date is not now considered binding.  Technically if the committees do not respond by the date specified, the Budget committee can take over.  There had been an effort by some Republican senators to push the January 27 date to March 3 to develop a replacement but those efforts halted when they were assured the January date would not be binding.

In terms of a replacement plan there have been cross-signals about what and when a replacement would be available or enacted.  President-Elect Trump earlier indicated that he wants a rapid repeal along with a replacement but that view has not aligned with some Capitol Hill Republicans.  On Monday, January 16, the President-elect told the Washington Post his transition team was very close to unveiling their plan.  He further said, “we’re going to have insurance for everybody…There was a philosophy in some circles that if you can’t pay for it, you don’t get it’s not going to happen with us…[people covered] can expect to have great health care. It will be in a much simplified form.  Much less expensive and much better.”  If he carries through on such a proposal, he may be in conflict with some in his party who talk about “universal access” as opposed to “universal coverage.”

Related to an ACA repeal is the role of Medicaid and its conversion to a block grant.  Senate Finance Committee members are scheduled to meet with some governors on Thursday of this week but it is not clear that all Republican Governors are yet aligned with a block grant.  There have been some concerns raised at least behind closed doors by some Republicans who have taken the ACA Medicaid expansion option.

Now that a resolution and authority is in place timeframes for the repeal should emerge in the next week after the inauguration.  It is also believed that at the same time, Congress is likely to get ready with a second budget resolution that will set up a second budget reconciliation bill that would be a vehicle for a number of Republican priorities possibly including tax reform and tax cuts, block granting some programs including Medicaid, and moving mandatory spending to discretionary spending.  Some people on Capitol Hill think this second reconciliation bill could take place as early as mid-to-late March.