Health Care Repeal in U.S. Senate

Many aspects of the Obama Administration’s Affordable Care Act (ACA) also known as “Obamacare” are of particular concern; however, the most important aspect of repealing Obamacare to the structural pest management industry is the employer mandate. The employer mandate requires employers with 50 or more workers to provide health insurance to all employees working 30 hours a week or more. In every effort to repeal Obamacare thus far, the employer mandate has been continuously targeted. Unfortunately, every repeal vote in the Senate to date has failed.

In May, the U.S. House of Representatives narrowly passed the American Health Care Act (AHCA) which would repeal and replace Obamacare. Much like the House, the Senate has held several attempts on repealing the controversial seven-year law. Despite the first few failed efforts, on Tuesday, July 25, 2017, the Senate voted in favor of beginning debate on repealing Obamacare by a 50-50 vote with Vice President Mike Pence breaking the tie, in favor of beginning debate. Subsequently, Majority Leader McConnell has held several votes on different versions of repealing Obamacare: 1. Repeal and Replace (Senate Version w/ Cruz and Portman Amendments), 2. Repeal and Delay (w/Paul Amendment), and 3. “Skinny Repeal” (Repeals a select few parts of Obamacare including the Employer Mandate, but the overwhelming majority of Obamacare remains intact).

1. Repeal and Replace Vote: The first major vote held in the Senate that would repeal and immediately replace Obamacare. Key elements of this repeal version consisted of: Rolling back the Medicaid expansion and capping the program’s spending, reducing marketplace subsidies, eliminating the individual and employer mandates, and some taxes on the health-care industry, included Cruz amendment, which allows insurers to offer cheaper, narrower health plans alongside their more robust ACA-compliant plans, and would’ve allowed those narrow plans to charge people differently based on their preexisting conditions, and also included the Portman amendment, which would’ve added $100 billion in Medicaid spending. FAILED 43-57.
2. Repeal and Delay with Paul Amendment: The second major vote held in the Senate would repeal most of Obamacare in its entirety within two years. Within the two-year timeframe, Congress is expected to find a replacement. Key elements of this repeal version consisted of: Removing Medicaid expansion, individual and employer mandates, marketplace subsidies, the marketplace exchanges themselves, and the ACA’s taxes on the wealthy and the health-care industry — all two years from now, would leave marketplace regulations, such as preexisting conditions protections, in place, and also includes the Paul amendment, which would ban people from using subsidies to buy plans that cover abortion. FAILED 45-55.
3. Skinny Repeal: The third major repeal effort includes the “skinny repeal” which would repeal only a few major provisions of Obamacare. Key elements of this repeal version consisted of: Repeal the individual mandate and pause the employer mandate for six years and leave the Medicaid expansion, subsidies, taxes and marketplace regulations such as preexisting conditions protections in place. FAILED 49-51.

The process for sending the health care bill for debate was highly unusual with few details published ahead of debate, but the Skinny Repeal was expected to pass as a way to advance the process and set up a conference committee with the House to negotiate a new bill. Early Friday morning the health care repeal efforts failed. Following the failed votes Majority Leader McConnell signaled that while he was disappointed that it was time to “move on.”

The Senate will now begin the process of holding hearings in the Senate Health, Education, Labor and Pensions Committee to garner a bipartisan solution on Health Care. While Congress continues to work on health care revisions, the Trump Administration will have some executive options pertaining to enforcement of specific provisions of Obamacare, like the employer mandate. The health care debate is certainly not over and NPMA will continue to monitor and provide updates and advocacy for NPMA members.