On Tuesday, Senate Majority Leader Mitch McConnell (R-KY) decided not to hold a vote on the plan drafted by Republican Senators Lindsey Graham (SC), Bill Cassidy, MD, FACG (LA), Dean Heller (NV), and Ron Johnson (WI) to repeal the Patient Protection and Affordable Care Act (“ACA”). This was touted as the last opportunity to pass health reform in the Senate this year, as September 30th is the deadline to use the legislative budget process to pass any repeal bill by a simple majority. However, Sen. McConnell decided to pull the vote after Republican Senators Susan Collins (ME), Ted Cruz (TX), John McCain (AZ), and Rand Raul, MD (KY) all came out in opposition to the bill for various reasons. While substantive policy discussions may still be making headlines, this latest failure by Republicans to come to a consensus should seal the fate of repealing the ACA this year.
ACG’s take: As the College has stated throughout the year, the process to repeal the ACA had become a test of political strategy and gamesmanship in order to get something/anything passed, as opposed to an opportunity for Congress to improve substantive issues with the ACA. There is much to improve, including provider issues impacting GI practices, and fixing certain quirks in the ACA’s patient coverage and cost-sharing protections. Congress must also deal with stabilizing insurance markets across the country, along with other traditional year-end health care bills. ACG will continue to be your voice on Capitol Hill, advocating for clinical GI and patients.
Will ACA repeal resurface? ACG continues to monitor these issues, as efforts to repeal the ACA may resurface in the form of bills, hearings, press conferences, etc. Congress can also try again via the budget reconciliation process starting next year. Senate Republicans will once again face the dilemma of coming to a consensus, but they may have a greater political incentive to pass ACA repeal in what is expected to be a busy primary season for those Senate Republicans up for reelection in November 2018.
Don’t forget CHIP: As ACG has previously alerted membership, September 30th is also an important deadline to reauthorize Medicaid’s Children’s Health Insurance Program (CHIP). According to the 2017 June enrollment report, nearly 36 million individuals are enrolled in CHIP, or are children enrolled in the Medicaid program. The Senate Finance Committee has a 5 year deal in place to reauthorize the program, yet the U.S. House announced this week that it will not take up legislation to extend funding, and will instead address any funding shortages later this fall. A must-pass reauthorization could provide leverage to include Medicaid policy changes desired by Republicans. Conversely, it could further fracture the relationship between House and Senate Republicans, and cause more headaches for Republican leadership.
Whitfield L. Knapple, MD, FACG
Chair, ACG Legislative and Public Policy Council