Initial ACA Repeal, Repair, Replace Efforts Begin to Solidify as Senate Confirms HHS Secretary Price

February 10, 2017

Congressional Republicans plan to begin work on the 2017 reconciliation bill to repeal, repair, and replace key parts of the Affordable Care Act at the end of February and hold crucial votes on the legislation in March.  Along with repealing the individual and employer mandates and most of the ACA tax provisions, including the Cadillac Tax, four important replacement provisions may be added to the bill, including:

  • Expanding Health Savings Accounts;
  • Enacting high-risk health insurance pools;
  • Reforming Medicaid; and
  • Authorizing tax credits to help Americans buy individual plans.  
This week, Vice President Mike Pence told House Republicans he believes the reconciliation bill can include many more "replace" provisions than first thought.  Moreover, some Republicans are hoping the bill could also include funding for the ACA cost-sharing subsidy as a way to keep the individual market from imploding in 2018.  However, it is still not clear what replacement provisions the Senate parliamentarian will allow in the reconciliation bill, which will be taken up and passed under an expedited process that only requires 51 votes in the Senate.  Reconciliation bills may only include tax and budgetary provisions.  Reforming Medicaid and finding the revenue to continue covering the 20 million Americans who receive coverage under the ACA are proving to be two of the most complex pieces of the replace plan.  Meanwhile, the confirmation this week of Rep. Tom Price (R-GA) as HHS Secretary is expected to speed up the process as well.  There are around 1,400 references in the ACA that give the Secretary of HHS latitude to reduce regulatory burdens and help stabilize the individual market during any transition period.  A proposed rule already at OMB for review and approval reportedly would modify the ACA's special enrollment periods to reduce the ability to game the system and help keep insurers in the individual market.  President Trump has also said he would release his ACA replacement plan shortly after Rep. Price is confirmed, but the timetable is unclear given his remarks last weekend that the replacement would not likely occur until next year.