Understanding Budget Reconciliation and the Senate Parliamentarian’s Ruling – What’s Happening Now to the Republican Efforts to Repeal the Affordable Care Act
The Senate Parliamentarian has just ruled that key provisions in the Republican efforts to repeal and replace the Affordable Care Act will require 60 votes. The Senate rules require 60 votes to defeat a filibuster. Senate Republicans are trying to dodge that rule by entitling their changes as “Budget Reconciliation”, which they can pass with 51 votes, relying on Vice President Mike Pence to break a 50/50 tie.
The contents of their replacement bill must directly affect the federal budget. The parliamentarian of the Senate has ruled that a number of their key provisions will require 60 votes. These include the six months waiting period, the cost sharing reduction payments, defunding Planned Parenthood and restrictions on abortions. The ruling also likely dooms Senator Cruz’ amendment to allow insurers to offer substandard coverage.
What does this all mean and why is it important? The six-month waiting period is the Senate Republican’s alternative to the individual mandate in Obamacare. It is meant to prevent individuals gaming the system by enrolling only when they become ill. The payments for cost sharing reductions are the refundable tax credits that individuals can qualify for to reduce their copayments and deductibles, which the parliamentarian ruled were duplicative of existing law. The defunding of Planned Parenthood for a year was a key provision to woo social conservatives, as were the restrictions on abortion coverage,
This is a pretty clear indication that changes to the ACA’s regulations on individual and small business insurance such as the minimum loss ratios, the ten essential health benefits and the three to one rate band on age rating may not be repealed absent a 60 vote majority. There is no ruling as yet on the options for states to receive a Medicaid block grant in lieu of the Medicaid per capita cap.
As you may recall, the ACA passed the Senate with a sixty vote majority in 2010. Some of the financing provisions were then amended with a fifty nine vote majority after the death of Massachusetts Senator Kennedy and the surprise upset by Senator Scott Brown.
Jost, Senate Parliamentarian Rules Several BCRA Provisions Violate the Byrd Rule, Health Affairs Blog (July 21, 2017) at
Prepared by: Lucien Wulsin