House and Senate reconciliation: No need to fear the ACA’s repeal

Repealing the ACA law is not the same as destroying the ACA law. Obamacare, and the laws governing Obamacare will continue to exist but the free market bindings will be loosened.

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CNN video screenshot of Steny Hoyer, Democrat Whip

WASHINGTON, January 13, 2017 — The House is expected to vote on repealing Obamacare today. It is expected to pass. Obamacare supporters push the fear of lost benefits, but the Affordable Care Act can only be changed by an act Congress with the president’s approval.

Because of that, there is no need to worry about the loss of key, very popular, benefits.

Changes in the ACA must be approved by a simple majority in the House of Representatives, but because it takes 60 votes to end a filibuster, a super majority of 60 percent will be needed in the Senate to tackle this very partisan legislation. President Trump will have to sign it. The president-elect has said that he expects a replacement bill on his desk by February 20, 2017.


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Another approach will probably be taken here: reconciliation. When both houses of Congress pass a bill but do so with different expenditures authorized—if, for instance, the Senate passes a defense bill that allows $500 million in spending, but the House passes essentially the same bill with $600 million in spending—the bill must be reconciled.

Leaders from the Senate and the House discuss the differences and reach a compromise. Then the compromise is taken back for a vote, but only a simple majority, greater than 50 percent, is needed to pass the reconciled bill.

That’s how the GOP will repeal Obamacare.

The House and the Senate will both agree to spend zero in the coming year. Since this doesn’t directly change the law, but rather reconciles an amount, the law passes with a simple majority. With no funding, those elements of the Affordable Care Act that require government expenditure will be inoperative, even though, technically, the law is still in effect. Any changes or replacement law will have to pass the 60-vote senate threshold.

That means that most popular provisions in the law that will stand until modified. Unless the law is repealed or fundamentally changed, there should be no concern over loss of those provisions.

The current law says, for instance, that health insurance policies cannot have a preexisting condition clause. This clause has no budgetary impact, so unless the law is changed, there will be no preexisting condition clauses. Similarly, the law says are there no lifetime benefit limits and a child can be medically dependent on the parents until 26 years old. Those benefits will still be the law.

But after the law is defunded, what could happen next?

The new Congress and the new president will come up with a new law that may improve the healthcare system. While the specifics are yet to be determined, the general idea will be to get government as far out of the health care market as possible.

Medical care by itself is less expensive than medical care wrapped in government bureaucracy.

In order for the GOP to change the current law or pass an entirely new law, at least eight Democratic senators will have to approve of the bill. To get those votes, the Dems will make certain demands. If the GOP follows Trump’s lead, they will include the Democrats in drafting new legislation despite President Obama instructing Democrats to not work with Trump or the GOP.


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While the sides will never totally agree, there may be room for compromise. The Dems will insist that the three popular benefits remain. They will also insist that the new law have some provision to cover all Americans, although that may be a bit tricky.

The new law will eliminate government control over health care spending and health care decisions. Instead, the patient and the doctor will have more control over healthcare decisions. The new law will also give consumers more control over the health care dollars.

As much as possible, the new law will encourage market forces to act which usually results in lower cost, higher quality, and more efficiency.

The specifics of exactly how to do this will be worked out by members of Congress. And it will take some time to implement. As a result, while the repeal of the Affordable Care Act will come quickly, the full application of a new law is likely to take years.

Have no fear though. Congress and the president what to make the system better for all Americans. The new healthcare law will do just that.

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