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What Happens Next

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Health Care Reform?
Recap
Over the spring, House Republican leadership passed a ACA repeal and replace bill with clauses that also drastically changed Medicaid. Over the summer and early fall, Senate Republican Leadership attempted to vote not only on the House bill, but on its own versions with similar content.
These attempts were made through the Fiscal Year 2017 (FY17) budget because it allows a bill to pass the Senate with a simple majority of 51 votes instead of the usual 60, using a process called reconciliation. There are 52 Republican Senators. The House would then vote on the final Senate bill.
  
All Senate attempts failed, the latest being the Graham Cassidy Heller Johnson bill, because each time they lacked support of up to 3 key Republican Senators.
The FY17 budget reconciliation process in both the House and Senate expired at 11:59pm ET, September 30, 2017 - meaning it can no longer be used after that date.
Click here to learn more about reconciliation.
The GOP is Now At a Crossroads
Does it:
  • Continue with attempts to reform health care and Medicaid?

  • Move on to tax reform and other priorities?
Possible Next Steps for Senate Health Care Reform
Republican Congressional Leadership Can:
Use the FY18 budget process to power through major policy initiatives
Proceed with bipartisan health care reform using  "regular order"
Abandon attempts to repeal and replace the
ACA
The benefit of using reconciliation for FY18 is to pass bills  along party lines.
Possibilities ANCOR heard about so far include:
  • Combining  tax reform and ACA repeal/replace (possibly with Medicaid per capita caps).

  • Using the extra time to whip up support for the Graham Cassidy bill, which contains Medicaid per capita caps.

  • Focusing solely on tax reform for FY18 and then using FY19 negotiations to tackle health care again.
The Senate or House would have to pass a budget bill first and send it to the other chamber.
Regular order entails a committee reviewing a bill, holding hearings, voting on the bill to go to the floor, and then the whole Senate voting on it.
Senators Lamar (R-TN) and Murray (D-WA) began negotiations over the summer for a bipartisan bill to repair the ACA. These stalled when the Graham Cassidy bill gained traction. 

These negotiations do not include traditional Medicaid changes.
A bill passed through regular order would need 60 Senate votes to pass; this effort would have to be bipartisan since the GOP only has 52 Senate votes.
This means even if Republican Leadership abandons ACA repeal and replace, it could still focus on capping Medicaid.
In the press conference following the decision to pull the Graham Cassidy bill, GOP Senate Leadership made it clear it believes spending on Medicaid needs to be reigned in.
Medicaid cuts and changes  could be included:

  • In a end-of-year healthcare budget bill known as the "health minibus"; or
  • As a pay-for for infrastructure building legislation.