Graham-Cassidy Failure Won’t End Obamacare Repeal Efforts

Stay ahead of developments in federal and state health care law, regulation and transactions with timely, expert news and analysis.

By Alex Ruoff

The latest Obamacare repeal bill failed, but it won’t be the last word on the matter as several Senate Republicans vowed to take on overhaul of the health law alongside tax reform.

Two of the Senate Republicans who drove the latest effort to repeal the Affordable Care Act will try to renew their plan to overhaul the health law next week, Sen. Ron Johnson (R-Wis.) told reporters Sept. 25. However, many Republicans don’t expect ACA repeal will get easier after another failure.

Senate leaders announced Sept. 26 that they don’t have the votes to pass a repeal bill by Oct. 1, the deadline to pass legislation with 51 votes. Johnson and Sen. Lindsey Graham (R-S.C.) will now insist on packaging ACA repeal with tax reforms, Johnson said. The pair want to include language aimed at repealing the ACA in the next budget bill currently being designed by the Senate Budget Committee, he said.

“We’re both on the Budget Committee, and we’ll insist on passing a budget that would have reconciliation instructions for both tax reform and health reform,” Johnson said.

Together, Johnson and Graham could block a budget resolution from passing the Senate Budget Committee. Johnson declined to say if that’s the plan, only that he would insist on including health reform in the reconciliation instructions. The pair have several supporters in the Senate, including Sens. Ted Cruz (R-Texas) and James Lankford (R-Okla.), who both told reporters they won’t give up repeal after September.

Sen. Orrin Hatch (R-Utah), chairman of the Senate Finance Committee, told reporters Sept. 25 he wants to lift some of the ACA’s taxes as part of tax reform. However, some Republican members of the Senate Budget Committee warned that taking on the ACA again could compromise their tax reform efforts.

House Stance

House Republicans appear to want to keep tax reform and ACA repeal separate. Rep. Mark Meadows (R-N.C.), head of the influential House Freedom Caucus, told reporters Sept. 26 that repeal could be done in a fiscal year 2018 reconciliation bill and that he doesn’t want to compromise tax changes with a health-care debate.

House Budget Chairwoman Diane Black (R-Tenn.) told reporters Sept. 26 she’s considering adding health language to the House’s budget resolution for fiscal 2018, but no decision has been made. Rep. Tom Cole (R-Okla.), a House Budget Committee member, called the move “high risk.”

Republicans wanted to pass an ACA repeal bill in fiscal year 2017 and tax reform in fiscal 2018 via the budget reconciliation process, which allows passage by a simple majority in the Senate of legislation that affects federal spending. The reconciliation bill meant for ACA repeal expires Oct. 1.

Next Chance for Repeal

Senate Budget Committee members are debating parameters of a fiscal 2018 reconciliation bill that would spin off of the 2018 budget resolution, which would set federal spending, revenue, and deficit targets. This is the vehicle Republicans hope to use to pass tax reform along party lines.

A Senate aide told Bloomberg BNA that repealing some of the ACA’s taxes or altering some ACA-related federal spending could be done without explicit instructions in the Senate reconciliation bill because it falls into the jurisdiction of the Senate Finance Committee, also charged with designing tax reform. But a major overhaul of the health law would also need special instructions for the Senate Health, Education Labor and Pensions Committee, similar to those outlined in the fiscal 2017 reconciliation bill.

However, trying to pass both an ACA overhaul and tax reform would be incredibly complicated, Sen. John Thune (R-S.D.), a Budget Committee member, told reporters. It would require setting federal spending targets for both goals, he said.

“It could be done, but it makes tax a much heavier lift,” he said.

The latest plan to repeal the ACA ran into many of the same sticky issues the last one did, including concerns from Republicans about passing major legislation along party lines, without holding hearings. In addition, Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine), who voted against a repeal bill in July, both oppose major cuts to Medicaid.

Sen. John Boozman (R-Ark.), a Budget Committee member, told Bloomberg BNA he doesn’t see these issues changing anytime soon and worries they would sink a joint tax-health bill.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

Request Health Care on Bloomberg Law