Affordable Care Act (ACA) Repeal and Replace Update

Lauren Pollow and Stephen B. Hanse in Legislative

On July 25, 2017 the Senate voted to debate a repeal and replace of the ACA, which Senate Majority Leader Mitch McConnell achieved by a narrow margin (more below from AHCA). The vote to proceed was split 50 to 50 with Vice President Pence casting the deciding vote.

There will now be 20 hours of debate during which amendments can be introduced and voted on. Importantly, the Better Care Reconciliation Act of 2017 (BCRA), the amendment containing the most harmful Medicaid cuts for long-term care providers, failed to pass last evening. *Please note that this is a change from the AHCA bulletin represented below.

AHCA and NYSHFA will continue to provide daily updates as the vote moves forward. Members are expected to return today at 11:30 AM and we anticipate that amendments will be introduced by both parties until there is a final bill. At this time, we expect this process to conclude on Friday.

Please see the overview from AHCA below for more information:


A threshold question was whether the Senate could even debate the bill. For that to happen, Senate Majority Leader Mitch McConnell needed 50 of his 52 Republican colleagues to vote yes. That is exactly the number he received. Senator John McCain (Arizona) made a dramatic and heroic entrance and provided the final vote needed for that motion. But there was much more to Senator McCain's entrance than just his vote. He then spoke on the bill and indicated that he just wanted to open debate, but ultimately he would join the list of four other Republican senators and vote against the BCRA when the final vote takes place.


To get their votes on the motion to proceed, Leader McConnell promised Senator Rand Paul (Kentucky) and other conservatives that the first amendment the Senate would take up will be a clean repeal of the Affordable Care Act (ACA). Specifically, the amendment is the 2015 language that both the House and Senate passed and that President Obama vetoed.

This is likely to fail. It requires 50 votes, but already, four Republicans have indicated they will vote no - and I suspect three or four more will join them.


The current plan is that if the straight repeal fails, the next amendment for consideration will be the BCRA. Again, this is the version that contains the two provisions that hurt us. It lowers the growth of the per capita cap to CPI Urban, and it restricts provider assessments to only 5 percent. The most important part of this entire debate is that we need this amendment to fail.

We currently believe that it will fail. The following Republican senators have indicated opposition to it: Paul, Lee (Utah), Moran (Kansas), Collins (Maine), and now McCain. Others that may vote against include Capito (West Virginia), Murkowski (Alaska), and Heller (Nevada). There could be others. To fail, we need just three no votes, and we have pretty good confidence in the five publicly-stated above and some confidence in at least two or three more.


Assuming those two major amendments fail, the House Bill is left. It does not touch provider assessments and has a slightly more generous growth rate. But it won't pass. There are even more no votes in the Senate on the House Bill than the two prior discussed amendments.

The current discussion is that Leadership will then offer a "skinny" version of an ACA repeal. It may just include a repeal of the individual and employer mandates. It is not at all clear if that would pass. If it does not pass, that is the likely end of this round of the repeal and replace attempts. If it does pass, then the House could either take it to conference or just vote on it without going to conference. A conference committee would give us the chance to demand that the House stand firm in its growth rates. Even better would be a straight House vote. That would be better because this "skinny" repeal will likely have no changes to traditional Medicaid.


This still very fluid. The process is likely to take from now until early Friday morning. In the meantime, we will continue our lobbying efforts, particularly focusing on those that have committed to help us or are on the fence.

We will update you any time there is key information or when we think you could be receiving misinformation from the press.

The current state is that we face an enormous risk but have the votes to succeed. We will continue to do everything we can to end up with that result.


You can help. I've said this many times. The Affordable Care Act repeal and replace effort is the biggest threat we have faced to Medicaid in the history of our sector. The 100,000-plus contacts we have made thus far have made a difference, and we cannot let up. We must keep fighting to protect the millions of patients and residents who depend on Medicaid for long term care.

Call every Senate and House Republican that you have any connection to and use the state-specific talking points to explain the devastating impacts proposed Medicaid cuts in the BCRA would have. You can register for our online grassroots Care Advocacy resource to easily locate and contact them.

We appreciate everything you do.


Mark Parkinson
President and CEO


Lauren Pollow
Director, Government Affairs
518-462-4800 x25

Stephen B. Hanse, Esq.
President & CEO
518-462-4800 x11