Republicans attempted to use the budget reconciliation process to repeal the Affordable Care Act (aka Obamacare) and pause federal funding for Planned Parenthood. Budget reconciliation is the one chance each year that the majority party gets to bypass the Senate filibuster to get a bill to the President’s desk without needing a single vote from the minority party.
The House originally passed this bill on October 23, 2015, sending it to the Senate. To meet the requirements of the budget reconciliation process, so that the bill could not be filibustered, Senate Republicans amended the bill, sending it back to the House. The House then passed the revised bill on January 6, 2016. The President vetoed the bill on January 8, 2016.
The bill would have:
Repealed Obamacare, or the key parts of it — The Republicans’ bill, Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, doesn’t actually repeal Obamacare in its entirety. Instead it goes after some of the key features of Obamacare that are necessary to make the whole system work. It would have:
- Restricted the federal government from operating health care exchanges
- Phased out funding for subsidies to help lower and middle-income individuals afford insurance through the health care exchanges
- Eliminated tax penalties for individuals who do not purchase health insurance and employers with 50 or more employees who do not provide insurance plans
- Eliminated taxes on medical devices and the so-called “Cadillac tax” on the most expensive health care plans
- Phased out an expansion of Medicaid over a two-year period
Ended federal funding to Planned Parenthood — The bill would also end federal funding of Planned Parenthood for one year by prohibiting Medicaid reimbursements for Planned Parenthood services. Instead, the bill would increase funding for a community health program.
Federal funding for Planned Parenthood supports its reproductive health, maternal health, and child health services — but not its abortion services or the subsequent transfer of fetal tissue that may follow, which are what brought the organization into focus last year. Existing law prohibits federal funds from being used for abortions, and the bill also does not address the organization’s practices regarding fetal tissue, which were made legal in 1993.
What Republicans Say
House Education and the Workforce Committee Chairman Rep. John Kline (R-MN2) had said that H.R. 3762 “represents an important opportunity to reduce federal spending and help rein in our nation’s deficits and debt” caused by “the president’s flawed health care scheme.” Committee member Rep. Phil Roe (R-TN1), an OB/GYN physician, said, “The . . . wasteful spending included in ObamaCare have put a strain on hardworking families and have succeeded only in making our already struggling economy worse.”
Rep. Matt Salmon (R-AZ5), one of seven House Republicans who voted against the bill in the first House vote, said he agrees with the overall concept to “act boldly and fully repeal this terrible law”, referring to the Affordable Care Act (Obamacare), but voted against the bill “because this bill didn’t go far enough” to repeal the Affordable Care Act entirely.
What Democrats Say
Rep. Chris Van Hollen (D-MD8) said in a press release, "For the 61st time . . . our Republican colleagues are moving forward on legislation to dismantle the Affordable Care Act. . . . Why in the world are we here on the floor of the House of Representatives passing legislation that’s going to take away affordable health care to 15 million Americans, including three million children?"
All but one Democrat voted against in the two House votes. That was Rep. Collin Peterson (D-MN7), the most conservative Democrat in the House according to our ideology analysis.
The White House had said the President would veto the bill: “Repealing the health care law would have implications far beyond these Americans who have or will gain insurance . . . More than 150 million Americans with employer-based insurance would be at risk of higher premiums and lower wages, or losing their coverage altogether. It would raise taxes on certain middle-class families.”
The reconciliation process traditionally has been used by lawmakers to reduce the deficit through revenue increases (tax hikes) and cuts to entitlements (e.g. Medicare and Medicaid, but not Social Security which cannot be changed under a reconciliation bill). The process has been used in the past to enact both tax cuts and tax increases, reforms to student loan programs, and even some minor pieces of the Affordable Care Act (aka Obamacare). Earlier this year there was talk of using it to pass a tax code overhaul that Obama and the Republicans could conceivably come to an agreement on.
The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Dec 3, 2015.
TITLE I--HEALTH, EDUCATION, LABOR, AND PENSIONS
(Sec. 101) This bill amends the Patient Protection and Affordable Care Act (PPACA) to terminate the Prevention and Public Health Fund, which provides for investment in prevention and public health programs to improve health and restrain the rate of growth in health care costs. Unobligated funds are rescinded.
(Sec. 102) Funding for community health centers is increased.
(Sec. 103) Certain funding for U.S. territories that establish health insurance exchanges is no longer available after 2017.
(Sec. 104) The Department of Health and Human Services (HHS) may not collect fees or make payments under the transitional reinsurance program.
(Sec. 105) This bill makes appropriations for FY2016 and FY2017 for HHS to award grants to states to address substance abuse or to respond to urgent mental health needs.
(Sec. 201) This bill amends the Internal Revenue Code to require individuals to pay back the full amount of advance payments in excess of their premium assistance tax credit. (Currently, there is a limit on the amount of excess an individual must pay back.)
(Sec. 202) Provisions relating to the premium assistance tax credit, reduced cost-sharing, and eligibility determinations for these subsidies are repealed on December 31, 2017.
(Sec. 203) The small employer health insurance tax credit does not apply after 2017. (This credit is for certain employers who make contributions toward employee health coverage purchased through a health insurance exchange.)
(Sec. 204) The penalty for individuals who do not maintain minimum essential health care coverage is eliminated.
(Sec. 205) Large employers are no longer required to make shared responsibility payments.
(Sec. 206) For one year, this bill restricts the availability of federal funding to a state for payments to an entity (e.g., Planned Parenthood Federation of America) that:
is a 501(c)(3) tax-exempt organization; is an essential community provider primarily engaged in family planning services and reproductive health; provides for abortions other than abortions in cases of rape or incest, or where a physical condition endangers a woman's life unless an abortion is performed; and received a total of more than $350 million under Medicaid in FY2014, including payments to affiliates, subsidiaries, successors, or clinics. (Sec. 207) This bill amends part A (General Provisions) of title XI of the Social Security Act (SSAct) to require the additional payments to U.S. territories for Medicaid under the Health Care and Education Reconciliation Act of 2010 to be made by the end of FY2017 instead of the end of FY2019.
This bill amends title XIX (Medicaid) of the SSAct to end the expansion of Medicaid under PPACA on December 31, 2017.
After 2017, hospitals may no longer elect to provide Medicaid services to individuals during a presumptive eligibility period.
States must maintain Medicaid eligibility standards for individuals under 19 years old through FY2017 instead of through FY2019.
The federal medical assistance percentage (FMAP, the federal matching rate for Medicaid expenditures) for U.S. territories is 50% after 2017 (currently, the FMAP is 55%).
The increased FMAP for childless adults and home and community-based attendant services under PPACA ends December 31, 2017.
After 2017, states may no longer elect to provide certain individuals with a presumptive eligibility period for Medicaid.
Medicaid benchmark plans are no longer required to provide minimum essential health benefits after 2017.
After 2017, states are no longer required to operate a website for Medicaid enrollment that is linked to the state's health benefit exchange and Children's Health Insurance program (CHIP).
(Sec. 208) Medicaid allotments for disproportionate share hospitals are increased.
(Sec. 209) The excise tax on high cost employer-sponsored health coverage (popularly known as the "Cadillac tax") does not apply after 2017.
(Sec. 210) Health savings accounts (HSAs), Archer medical savings accounts (MSAs), health flexible spending arrangements (HFSAs), and health reimbursement arrangements may be used to pay for over-the-counter medications.
(Sec. 211) This bill lowers the tax on distributions from HSAs and Archer MSAs that are not used for medical expenses.
(Sec. 212) Salary reduction contributions to an HFSA under a cafeteria plan are no longer limited.
(Sec. 213) The annual fee on manufacturers and importers of brand name prescription drugs is eliminated.
(Sec. 214) The excise tax on medical devices is eliminated.
(Sec. 215) The annual fee on health insurers is eliminated.
(Sec. 216) Medical costs are allowed as a tax deduction regardless of whether the costs are taken into account when determining the amount of the subsidy for an employer-sponsored retiree prescription drug plan under Medicare part D (Voluntary Prescription Drug Benefit Program).
(Sec. 217) A tax deduction is allowed for medical expenses in excess of 7.5% (currently, 10%) of adjusted gross income.
(Sec. 218) The additional Medicare tax on income above a certain threshold is eliminated.
(Sec. 219) The indoor tanning services tax is eliminated.
(Sec. 220) The net investment income tax is eliminated.
(Sec. 221) A health insurer is allowed a tax deduction for the full amount of an employee's compensation. (Currently, there is a limit on the amount of an employee's compensation that a health insurer may deduct.)
(Sec. 222) Provisions relating to the economic substance doctrine are repealed. (The economic substance doctrine treats a transaction as having economic substance if it has a purpose other than reducing income taxes. Currently, there are penalties for claiming tax benefits for transactions without economic substance.)
(Sec. 223) Funds are transferred from the Department of the Treasury to the Federal Hospital Insurance Trust Fund.