In Repealing Obamacare, Congress Should Look to the 2015 Reconciliation Bill

Alyene Senger / January 11, 2017

In the coming days and weeks, Congress will work to repeal major parts of Obamacare using the budget reconciliation process. This is the same process Congress used last year to send a repeal bill to President Barack Obama’s desk.

Budget reconciliation is the favored vehicle for repeal because it is not subject to a Senate filibuster, enabling the bill to pass with only a simple majority. However, certain Senate rules restrict what can be included, making a complete repeal of Obamacare through reconciliation unlikely.

The last time Congress tried to use reconciliation to repeal Obamacare in 2015, the House and Senate took very different approaches.

The House initially passed a much more limited repeal bill that left the bulk of Obamacare in place. Then, the Senate amended that bill to include repeal of Obamacare’s core parts: funding for Medicaid expansion, exchange subsidies, and nearly all of the law’s tax increases.

Ultimately, it was the Senate’s more robust repeal bill that was adopted by both chambers and sent to the president, who eventually vetoed it.

Here’s a list of provisions included in the two versions of that reconciliation bill:

The House bill:

• Rescinded funds for Obamacare’s Prevention and Public Health Fund.
• Prohibited abortion providers from receiving certain federal reimbursements for one year.
• Increased funding for community health centers.
• Repealed the individual mandate and employer mandate.
• Repealed two taxes: the medical devise tax and the excise tax on high-cost employer-sponsored health coverage (commonly referred to as the “Cadillac tax”).

The Senate’s amendment to the bill (which served as the final version):

• Rescinded funds for Obamacare’s Prevention and Public Health Fund.
• Increased funding for community health centers.
• Eliminated funding for territories to set up exchanges.
• Prohibited the secretary of Health and Human Services from administering the Affordable Care Act’s transitional reinsurance program after Jan. 1, 2016.
• Appropriated funds to the Department of Health and Human Services to award as grants to states for substance abuse or mental health needs.
• Recaptured excess payments from premium tax credits.
• Repealed the Affordable Care Act’s premium tax credits and cost-sharing subsidies (effective approximately two years after enactment).
• Eliminated the requirement for the disclosure of information to carry out eligibility requirements for certain programs.
• Repealed the small business tax credit (effective approximately two years after enactment).
• Repealed the individual and employer mandates by eliminating the penalty for noncompliance.
• Prohibited abortion providers from receiving certain federal reimbursements for one year.
• Repealed the Affordable Care Act’s enhanced federal funding for the Medicaid expansion population (effective approximately two years after enactment).
• Repealed reductions in Medicaid disproportionate share hospital payments.
• Repealed 14 taxes, which include: the excise tax on high-cost employer-sponsored health coverage; higher penalties and restrictions on health savings accounts, flexible spending accounts, and health reimbursement accounts; limits on contributions to flexible spending accounts; a tax on prescriptions drugs; a tax on medical devices; a tax on health insurers; limits on employers’ ability to deduct expenses paid for retiree prescription drug coverage; an increase in the amount spent on health expenses before deductibility; an increase in the Medicare payroll tax; a tax on indoor tanning; a tax on investment income; limits on employee remuneration; and exclusions for targeted tax credits for certain advanced biofuels.
• Moved the budgetary savings from the bill into the Medicare hospital insurance trust fund.

Congress has promised for years to repeal all of Obamacare, and last year’s reconciliation bill was a positive first step. Now that Republicans enjoy unified government, Congress should again pass legislation in the coming weeks that repeals at least as much of Obamacare as the previous reconciliation bill.