Reconciliation and Repeal-and-Replace in the SenateReconciliation and Repeal-and-Replace in the Senate
Published June 21, 2017 / Updated August 22, 2020

Reconciliation and Repeal-and-Replace in the Senate

What is reconciliation and why does it matter right now?

by Caitlin Martin


Photo Credit: Paul Weaver

Senate Fast-Tracking Repeal/Replace of the Affordable Care Act

You’ve probably heard on the news that the Republican members of the Senate are determined to pass their version of the House bill that repeals and replaces the Affordable Care Act (ACA). Let’s talk about how that works.

The House Version — A Quick Review

The House version of the bill was scored by the Congressional Budget Office (CBO). They report that repeal-and-replace will lead to 14 million more uninsured Americans in 2018 — a number that reaches 19 million in 2020 and 23 million in 2026. The CBO estimates that 51 million Americans under 65 would be uninsured by 2026. Read more about the CBO report here:

CBO Scored the Latest Version of the AHCA

More details about what’s in the House bill:

What is in the Republican health-care bill? Questions and answers on preexisting conditions, Medicaid and more.

Here’s What the Republican Senate Plans to Do

The House bill is enormously unpopular — a recent Quinnipiac poll shows that only 17% of Americans support the bill . Perhaps because of its unpopularity, Republicans in the Senate are drafting their version of the bill in secret and will be using the reconciliation process to iron out differences between their version and the House version.

So — Reconciliation

The reconciliation process allows certain legislation to be fast-tracked through Congress by working around the normal steps a bill must go through to pass the House and Senate.

  • Reconciliation bills cannot be filibustered and the number of amendments that can be added is limited — this makes the process ideal for passing controversial legislation.
  • Reconciliation is part of the Congressional budget process and can be used to pass bill that affect spending, revenues, and the federal debt limit. This includes bill that affect Medicare, Medicaid, and SNAP, but not Social Security.
  • To begin the reconciliation process, the House and Senate must agree on a budget resolution that includes reconciliation directives. These directives charge committees with creating legislation regarding the budget that will then be enacted through the process.

The Republicans in Congress have been planning to pass this legislation through the reconciliation process for quite some time. In January, Congress passed a budget that required healthcare committees to draft legislation that would reduce the deficit by $1 billion — this is the vehicle for repeal-and-replace.

Normally, a Senator can offer an amendment for debate on any subject on any bill. This debate can only be stopped by a “cloture” vote that requires 60 votes. Since reconciliation limits debate to 20 hours and prohibits filibusters, the Senate can pass these bills with a simple majority of 51 votes. In contrast to this process, the Affordable Care Act was enacted into law with a normal vote that allowed for debate, public hearings, and amendments.

Read more about the reconciliation process as it applies to repeal-and-replace here:

How Does the GOP Plan to Repeal Obamacare?

Read more about the comparisons of the passage of the ACA to the passage of the AHCA here:

Every single false Republican criticism of Obamacare applies perfectly to Trumpcare

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