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On January 13, 2017, Congress adopted a concurrent budget resolution for fiscal year 2017. The annual budget resolution is an agreement between the House and Senate on a budget plan for the upcoming fiscal year and at least the following four fiscal years (the 2017 resolution, however, exceeds that requirement and sets forth budgetary levels for FY 2018 – FY 2026). It is noteworthy that the 2017 resolution establishes health care legislation reserve funds, one of which would allocate $2 billion of savings from a repeal toward reducing the deficit, but hold the rest for eventual health care replacement legislation. The budget resolution is not sent to the president for his signature and thus does not become law, but it does provide a framework for subsequent legislative action on appropriations bills.
The adoption of the resolution kicks off the budget reconciliation process. The budget reconciliation is noteworthy, because it sets the stage for parts of the Affordable Care Act (ACA) to be repealed. Budget reconciliation would repeal only parts of the law that have a budgetary impact (example: individual mandate penalties, large employer mandate penalties, subsidies, Medicaid expansion), which means many insurance market reforms that do not have a budget impact cannot be repealed through this process (example: guaranteed issue, pre-existing condition, etc.).
Budget reconciliation bills are considered by Congress using expedited legislative procedures that prevent a filibuster and restrict amendments in the Senate. The Senate can pass a budget reconciliation bill with a simple majority (as opposed to needing 60 votes to overcome a filibuster). In order for Congress to completely repeal and replace the ACA, or make amendments to provisions that do not have a budgetary impact, 218 votes are needed in the House and 60 votes are needed in the Senate. Republicans hold 52 of the Senate’s 100 seats, which means at least eight Democrats in the Senate would be needed. As such, it would be difficult for Congress to pass changes to the ACA outside of the budget reconciliation process.
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