President-elect Trump, Majority Leader McConnell and Speaker Ryan are all publicly committed to repealing and replacing the Affordable Care Act on day 1 of Trump’s presidency. If they are serious about doing so, this is how it will work: In an article by Paul Winfree and Brian Blase, written earlier this month at Politico, they explain how a two-budget reconciliation process can be used to first secure repeal, then secure a replacement.
Last year, Congress failed to pass a budget for fiscal year 2017, creating an opportunity for Congress to pass two budgets next year, rather than just one. This gives Republicans two shots at getting filibuster-proof reconciliation bills to Trump.
Remember, “reconciliation” only requires 51 votes in the Senate, which Republicans have.
The first budget is simple. The spending and tax levels include one assumption: The ACA is repealed. That ACA repeal budget should also include instructions to the relevant committees in Congress. Congress should be able to easily pass a budget resolution with these criteria with simple majorities in each chamber and begin the process of work on the reconciliation bill before Inauguration Day. This will set up the ability for Congress to pass a reconciliation bill repealing all the budgetary components of the ACA immediately after Trump is sworn into office.
This process is how the ACA was passed in the first place, so there is no ethical harm in killing it in the manner in which it was born. Democrats practically ensured its doom in the manner in which they passed it, with zero Republican votes in the House or Senate. This leaves us with a great many question marks regarding a replacement plan. President Trump has indicated that he intends to keep adults on their parents’ plan through age 26 and preventing insurance companies from denying coverage to people with pre-existing conditions. Speaker Ryan and ranking committee members in the House have said the same.
This means that many of the new “costs” added to the system by the ACA will remain in place and that Republicans will have to find a way to pay for them. I imagine that much of the 2017 news cycle will be consumed with talk about the ACA’s replacement.
If, however, Republicans do not use this “two-budget” process, ensuring that then President Trump can sign the repeal on his first day in office, it will be clear that repeal and replace will probably never happen and that the ACA is here to stay. If, for whatever reason, we begin hearing talk of repealing and replacing at the same time, it will be safe to assume that this is a process intended to fail. There will simply be too much debate amongst Republicans to get everyone on board, simultaneously for both the repeal and the replace scenarios.
If the ACA is going to be repealed, it will likely be on Trump’s first day in office, or not at all.