President Barack Obama on Friday vetoed legislation that would have repealed the Affordable Care Act and cut federal funding for Planned Parenthood. The bill goes back to the Republican-led Congress, which does not have the votes to override the veto.
The Restoring Americans’ Healthcare Freedom Reconciliation Act easily passed the House by a vote of 241 to 181. Passage of H.R. 3762 marked the final step in a long, deliberative “reconciliation” process initially promised by House and Senate Republicans after they assumed control of Congress in January 2015. Reconciliation is a parliamentary procedure that allows expedited consideration of federal spending and tax policies in order for these concepts to more easily fall into compliance with pending congressional budget resolutions. Federal budget resolutions passed in 2015 by House and Senate Republicans, respectively, included provisions authorizing the use of reconciliation to address PPACA.
In the Senate, reconciliation is an extremely powerful tool because it prohibits the use of the filibuster and consideration of non-germane amendments. It needs only a simple majority to pass the legislation and requires that underlying proposals not have an impact on the federal deficit. To ensure its limited use, the Senate parliamentarian is required to review reconciliation bills and employ arcane “Byrd Rules,” named after the late Sen. Robert Byrd (D-WV), to determine whether each provision, as well as potential amendments, meets the high threshold for consideration under this parliamentary tactic. Previous rulings by the parliamentarian and pressure from Senators Ted Cruz (R-TX), Mike Lee (R-UT) and Marco Rubio (R-FL) to eliminate additional sections of PPACA prompted additional changes to the House’s initial reconciliation bill.
The House’s first version of H.R. 3762 only sought to fully repeal the individual and employer mandates, the law’s Prevention and Public Health Funds, the “Cadillac” excise tax on high-value employer-sponsored health insurance plans, and the medical device tax. In a nod to pro-life advocates outraged by the recent videos depicting the alleged for-profit sale of organs harvested from aborted fetuses, the legislation also stripped 2016 funding for Planned Parenthood.
Though the Senate’s reconciliation legislation would fully repeal the Prevention and Public Health Fund, medical device tax and “Cadillac tax,” and discontinue funding for Planned Parenthood for a year, the Senate parliamentarian ruled that scrapping the individual and employer mandate violated the Byrd rules. In lieu of full repeal, the Senate ultimately decided to include provisions to lower the fines associated with the individual and employer mandate to zero dollars, essentially rendering both policies moot without violating the Byrd rules.
The Senate’s PPACA reconciliation bill also took aim at PPACA’s federal health insurance exchanges and expanded Medicaid policy. In addition to repealing expensive subsidies offered to low-income individuals to offset the cost of purchasing health insurance through the online exchanges, the Senate bill eliminates the Department of Health and Human Services’ (HHS) authority to operate a federal exchange in states that opted not to create one. Both of these insurance exchange policies, however, would not take effect for two years.
Finally, the legislation repeals funding to assist states with offering expanded Medicaid coverage for low income patients over a two-year period. The two-year phaseout of the exchange and Medicaid provisions, in theory, is designed to allow a new President to craft alternative proposals related to expanded health insurance coverage for patients.
Because of Obama’s promised veto, the value of the approved legislation is largely symbolic. The GOP plans to use it as campaign fodder throughout the remainder of the 2016 election season. The House has tentatively scheduled its veto override vote for sometime around January 22 to coincide with the annual anti-abortion “March for Life” rally in Washington, DC.
It is unclear at this time whether the Senate will follow the House’s lead and schedule a similar vote, especially since Republicans already know they lack the requisite super majority needed to override a presidential veto. Nevertheless, Republicans hope that H.R. 3762 clearly demonstrates to voters in the upcoming Presidential election exactly how they will seek to repeal PPACA.
Democrats are counting on existing support for PPACA and Planned Parenthood to counter the GOP’s efforts. The American College of Radiology urges all radiologists to continue to monitor the Advocacy in Action newsletter for additional coverage of the PPACA repeal effort.