Senate Health Care Repeal Attempt -- NASN Advocacy Education Brief

By NASN Profile, RN, BSN, NCSN posted 08-14-2017 08:29


On July 28, 2017, the Senate’s attempt to repeal the Affordable Care Act (ACA) failed by a vote of 49 to 51. For now, repeal of the ACA with its fundamental changes to the structure of Medicaid, as well as major cuts to the program, is off the legislative table. The Senate wrote its own version of a healthcare repeal bill, the Better Care Reconciliation Act (BCRA) which was a companion bill to the House bill, the American Health Care Act (AHCA). Both these bills would change the structure of the Medicaid into either a per capita cap or a block grant. Medicaid is a federal-state partnership with the federal government committing to covering a certain amount of a states’ Medicaid costs. These changes threatened the flow of Medicaid to schools which is approximately one percent of the Medicaid budget.

The Senate was not able to muster the necessary votes to pass the BCRA so they attempted to pass a scaled down version known as “skinny repeal.” The skinny bill would have ended the individual mandate and ended the employer mandate. It would have also given states more flexibility to opt out of the ACA regulations.

It seems Senators wanted to use the “skinny repeal” as a vehicle to pass something out of the Senate so that they would be able to go to a Conference Committee with the House bill. In other words, select Members from the House and the Senate would work on finding compromise and common ground to merge a new bill together. So while cuts to Medicaid were not in the Senate “skinny bill,” they could have been included in the Conference Committee bill.

So for now, repeal of the ACA is dead and along with it fundamental changes to the structure of Medicaid as well as major cuts to the program. However, Members of both the House and Senate speak of trying again. We will monitor the situation and keep you informed as events and occurrences happen.