On Thursday, March 9, the House Committees on Ways and Means and Energy and Commerce completed consideration of draft reconciliation legislation. The Ways and Means committee considered the bill for approximately 18 hours while the Energy and Commerce committee meeting lasted more than 27 hours. In the end, neither bill was amended significantly and the committees forwarded their final recommendations to the House Committee on the Budget so that final House reconciliation language can be reported next week.
Though the formal committee process is nearly completed in the House, there are several outstanding matters that must be addressed. Significantly, the Congressional Budget Office (CBO) has yet to produce a score for the legislation, which will indicate the anticipated impact of the proposal on both the deficit and on the number of individuals expected to gain or lose health care coverage. Congressional and Administration officials have already begun to question the accuracy of CBO forecasts ahead of what is widely expected to be a report showing increased spending accompanied by a loss in coverage. (A report issued by the Brookings Institution on Thursday used previous CBO estimates to predict that about three-quarters of the 20 million individuals newly insured under the Affordable Care Act (ACA) will lose coverage if the bill becomes law.)
Negotiations are ongoing between Congressional leadership, the Administration, Republican Governors, the conservative Freedom Caucus and Republican Study Committee, as well as outside conservative groups such as the Club for Growth and the Heritage Foundation on a number of issues, including Medicaid. Republican Governors from states that did not expand Medicaid continue to push for greater equity with states that did expand. One proposal under consideration is an amendment that was offered and withdrawn by Rep. Joe Barton (R-TX) that would end Medicaid expansion enrollment at the end of 2017 instead of 2020 as proposed in the reconciliation bill. Conservatives are also pushing other changes, including the imposition of work requirements on childless adult Medicaid enrollees.
Conversations are also underway between House and Senate staff to determine what provisions of the legislation reported by the House committees will not pass muster under the Senate’s Byrd rule, which limits reconciliation provisions to those primarily dealing with fiscal matters, as opposed to broader policy provisions. Changes necessitated by this review as well as changes negotiated with conservative members will likely be included in a revised bill that would be produced by the House Rules Committee prior to floor consideration. The Senate would have about two weeks for floor consideration of the reconciliation bill, bypassing Senate committee consideration. This timetable may be complicated by possible Senate floor consideration of the nomination of the Honorable Neil Gorsuch as Associate Justice of the Supreme Court.
Timeline for Congressional Action
- CBO cost and coverage estimates expected early the week of March 13
- House floor vote planned the week of March 20
- Senate floor vote planned before Easter Recess begins April 7
Click Here to download a summary of the key provisions of the American Health Care Act and how they align/do not align with AMA policy.
The AMA has launched PatientsBeforePolitics.org, an online platform that will educate and engage patients and physicians in the current health system reform debate. Central to this effort are the AMA’s nine principles for reform that any serious plan Congress is considering should adhere to. PatientsBeforePolitics.org highlights these nine principles for site visitors, providing in-depth policy information and educational resources that reinforce the critical importance of each one. Interactive tools that enable quick and easy sharing of images promoting the nine principles via Twitter, Facebook, and LinkedIn will allow site users to express their support and encourage their personal followings on these social networks to do likewise. Calls to action, customized for both patients and physicians, will directly put advocates in contact with their lawmakers to target specific reform efforts and help ensure legislation will improve health insurance coverage and health care access.
As the health system reform debate evolves, so too will PatientsBeforePolitics.org. Future phases will include additional content and interactive features designed to engage site visitors.