Last week, Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana (with their co-sponsors, Senators Dean Heller (R-NV) and Ron Johnson (R-WI)) released the "Graham-Cassidy-Heller-Johnson Amendment" ("Graham-Cassidy bill"), which, if passed, would have repealed major sections of the Patient Protection and Affordable Care Act (ACA).
Specifically, the bill would have repealed the ACA's individual and employer mandates, ended the Medicaid expansion in 2020, replaced the ACA's subsidy program with state block grants (which would have allowed states to decide how their healthcare system would operate), weakened restrictions against pre-existing condition protections, and defunded Planned Parenthood.
Congress had until the end of this week to use its 2017 Budget Reconciliation Bill as a way to repeal the ACA, and the senators in the spotlight were thought to be the same three whose votes led to the defeat of the Health Care Freedom Act (so-called, "skinny bill"): Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK).
In order to be considered under reconciliation rules, the Graham-Cassidy bill was required to be analyzed by the Congressional Budget Office (CBO) to ensure that it reduced the deficit in both its first decade and afterward. In addition, the parliamentarian would have to rule that the bill complied with other aspects of the Byrd rule, which governs the kinds of legislation the Senate may consider through reconciliation.
The CBO made it clear that it would not have had the opportunity to provide estimates of the bill's full impact, but promised to release a preliminary analysis—which it did Monday evening. The CBO reported
that the bill "would reduce the on-budget deficit by at least $133 billion and result in millions fewer people with comprehensive health insurance that covers high-cost medical events."
Yesterday afternoon, Majority Leader Mitch McConnell announced he will not bring the Graham-Cassidy bill to a vote this week. With every Senate Democrat opposed to the bill, and the public announcement by three Senate Republicans—Rand Paul (R-KY), John McCain (R-AZ), and Susan Collins (R-ME)—that they opposed the bill, it could not pass.
The cancellation of this week's vote impedes the ability of the Senate Republicans to move forward with repeal of ACA under the budget reconciliation process.
Venable's healthcare attorneys will continue to monitor the progress of all ACA repeal and replace efforts.
If you have any questions concerning the above, please contact the authors.