Just after the swearing-in of Senators today, Senator Mike Enzi introduced the framework for the repeal of the Affordable Care Act.
Because Republicans intend to repeal the act via budget reconciliation measures, it's not immediately clear as to what they're doing, but it is, in fact, the first step.
The reconciliation process, explained in detail here, can only be used to pass bills that affect spending and revenue — budgetary matters, in other words. It was created in the 1970s to make it easier for Congress to keep a budget, by giving the Senate tools to more easily change laws regulating big mandatory spending programs like Medicare, Medicaid, and the like.
Last year, Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act, a repeal bill that uses the reconciliation process. The Senate parliamentarian ruled that all the parts of Obamacare that it repealed — Obamacare's insurance subsidies, Medicaid expansion, the law’s tax increases, and its mandate to purchase coverage — could be dismantled through reconciliation.
The bill, introduced by Georgia Rep. and Health and Human Services Secretary-designate Tom Price, left some parts of Obamacare standing, like the requirement that insurers cover young adults through age 26. (That provision is very popular, and possibly harder to tackle through the reconciliation process.) It also left the requirement to cover Americans with preexisting conditions partially intact (you can read more about that from Sarah Kliff).
The problem they're having is twofold. First, they can't seem to agree on how to replace it. And second, there's a groundswell of opposition to the bill's repeal from doctors, hospitals, other health care providers alongside Republican governors in states that expanded Medicaid.
“Repeal is not going to be as simple as some people might have thought,” said G. William Hoagland, a former Senate GOP budget official who is now senior vice president at the Bipartisan Policy Center.
“There are a number of Republicans, particularly in the Senate, who are going to be very nervous about voting to repeal something without knowing what this process may ultimately produce. … It could get a lot messier than people appreciate.”
Indeed, especially for those governors who expanded Medicaid on the promise that the federal government would cover the bulk of the costs.
Thirty-one states, including many with Republican governors, have expanded Medicaid through Obamacare and could lose billions of dollars if the law is cut back.
And in recent weeks, several state Republican leaders, including Arizona Gov. Doug Ducey and Montana House speaker Austin Knudsen, have voiced concerns about the loss of Medicaid coverage in their states.
And this is the key. If you live in a state with Republican Senators, I urge you, your neighbors, and fellow citizens to flood their offices with objections. It's more important than ever right now. We only need to peel off three Republicans or so in order to stop them from moving forward on a framework to take health care access away from over 20 million people.