Affordable Care Act (ACA) Repeal and Replace Update

Lauren Pollow and Stephen B. Hanse in Legislative

Senate Republicans are making a final push this week to repeal and replace the ACA. They are still anticipating a possible vote by Friday on a pared-down version of the original bill which ultimately intends to repeal a few sections of the ACA. Lawmakers are expecting a marathon series of votes on the “skinny bill”, language that targets requirements contained in the ACA such as the individual and employer mandate. Senators have continued to release amendments for discussion, and AHCA will continue to keep us updated on their proposals and process.

For more information, please review the AHCA’s summary below:


As I write this update, it is 4 PM on Wednesday in Washington, D.C. There has been considerable activity in the Senate, but little has changed. The Senate, as predicted, did not have 50 votes to repeal and replace the Affordable Care Act (ACA) and also lacked 50 votes for a simple repeal.

The most important vote for us was the vote late last night on the Portman/Cruz amendment. That amendment would have added two provisions to the Better Care Reconciliation Act (BCRA), but it did not fundamentally change the BCRA itself. You may recall that the BCRA is the Senate Republican version of repeal and replace that would hurt our sector quite badly.

Senate Majority Leader Mitch McConnell was very smart in allowing the Portman/Cruz amendment because it had something for all of his caucus. The Cruz part of the amendment would have allowed insurance companies to sell plans that did not include the essential benefits required in the ACA. The Portman part of the amendment would have added $100 billion to Medicaid, unfortunately in ways that did not assist us. His theory was that this amendment would attract both conservatives and moderates.

But the plan did not work. In the end, the amendment and BCRA only received 43 votes. This was worse than the outcome that leadership expected and helps us in a couple of ways. First, if it had received 50 votes, leadership would have been provided with the pathway to a bill that could actually pass. Second, by receiving considerably less than 50 votes, the Senate sent a message that the BCRA is not the way to go. And if a bill ends up in conference, the members should set all this talk of Medicaid reform aside.

We are grateful that all 48 Democratic senators voted against the BCRA. They were joined by nine Republicans who made a difficult vote that could create some political problems for them - and has even made one of them the subject of a Presidential tweet storm. These include Sen. Susan Collins (ME), Senator Bob Corker (TN), Senator Tom Cotton (AR), Senator Lindsey Graham (SC), Senator Dean Heller (NV), Senator Mike Lee (UT), Senator Jerry Moran (KS), Senator Lisa Murkowski (AK), and Senator Rand Paul (KY).

Having failed at repeal and replace, Republican leadership then turned to the strategy of a straight repeal. That also did not succeed. Predictably, all 48 Democratic senators voted no and were joined by seven Republicans: Collins, Heller, Murkowski, Lamar Alexander (TN), Shelley Moore Capito (WV), John McCain (AZ), and Rob Portman (OH).  

These were the two major votes planned for the debate, but the Senate is not finished. The underlying bill that is still under consideration is the House bill, with the notable name of AHCA (the American Health Care Act). Senate rules allow 20 hours of debate on that bill, and the Senate is likely to use all of that. A series of amendments will then be offered, with a final vote likely to occur on Friday.

The AHCA will not pass but the current talk is that at the very end of all of this, Leader McConnell will offer a stripped down version of repeal. Pundits are calling this a "skinny repeal." It may just repeal the individual mandate, employer mandate, and medical device tax. The purpose is not to pass something that the House will then support. The purpose would be to pass something that would get the House and Senate in a conference committee with the hopes that a conference committee would find the path to some compromise that could pass both Chambers. To get to conference, the Senate has to pass something - no matter how small - and that may be the plan.

It's unclear at this point if the "skinny repeal" can get the 50 votes to pass, but most lobbyists believe that it can.

If it does, there will be enormous power given to a limited number of conferees. Their assignment would be to come up with a plan that both the House and Senate would have to approve. We will begin a massive lobbying effort to influence them and others who can influence them. Timing is not clear. They could work through the August recess, or all could be put on hold until September.

In the meantime, we need your help. Our lobbying has mattered. We have had an outsized role in protecting our residents, and we have to continue to do so. Call every Republican House and Senate member with which you have any connection, and use the state-specific talking points to explain the devastating impacts Medicaid cuts would have. You can register for our online grassroots Care Advocacy resource to easily locate and contact them.

Thanks so much for all your efforts.  This is the biggest threat to Medicaid in our history, but together we can win this.


Mark Parkinson
President and CEO


Lauren Pollow
Director, Government Affairs
518-462-4800 x25

Stephen B. Hanse, Esq.
President and CEO
518-462-4800 x11