May 16 2017

The effort to repeal the Affordable Care Act is now in the hands of the U.S. Senate. Rather than try to pass a version of the House’s American Health Care Act, Senators might start fresh and draft their own bill. This has raised several important questions. When do we expect the Senate to pass a bill? Which bill becomes law: the House’s or the Senate’s? And what will the Senate’s bill include?

Several senior Senators have said that they are working toward a goal of passing a repeal bill before the Congressional August recess, which would likely mean a vote in late July. Whether they can stick to that timeline remains to be seen.

If the Senate passes its own bill, that bill would need to be reconciled with the House bill in a conference committee. A conference committee includes Senators and Representatives from both parties, appointed by the leaders of each party in the Senate and House, with a partisan make-up that reflects that of each chamber. This means Republicans would have the majority on the conference committee. Their task would be to negotiate a compromise bill that can pass both the Senate and the House, without any further amendments, since both chambers have to pass the same, identical bill before it can go to the president’s desk for his signature.

It’s also possible that a conference committee would be bypassed if the House accepts the bill that the Senate produces. This would normally be considered unlikely, but when the American Health Care Act was passed, a slim majority in the House seem to want to pass any bill that’s viewed as repealing at least part of Obamacare. So they may be willing to accept whatever the Senate does, especially if they feel pressure to get something done sooner rather than later.

It’s harder to predict what the Senate bill might look like in terms of substance. The Senate Republican Leader, Mitch McConnell of Kentucky, can only afford to lose the votes of two Republican Senators, so for now he’s aiming to get all 52 Republican Senators on board.  And while there are a number of working groups attempting to deal with this issue, McConnell has tasked a working group of 13 Senators to come up with a bill they can all live with. This won’t be easy as he has to contend with moderates and conservatives who hold deeply divergent views, particularly on Medicaid. Two other key players to watch are Senator Lamar Alexander of Tennessee, who chairs the Health, Education, Labor, and Pensions Committee, and Senator Orrin Hatch of Utah, who chairs the Finance Committee; both of these chairmen are in charge of lining up the votes to get a bill through the committee stage.

Meanwhile, Senators Bill Cassidy of Louisiana and Susan Collins of Maine have been reaching out to Democratic Senators to see if they can come up with a bipartisan solution to fix shortcomings in the Affordable Care Act. Hillary Clinton’s former running mate, Senator Tim Kaine of Virginia, has even praised Senator Cassidy for his efforts to bridge the partisan divide. Senators Cassidy and Snowe have proposed a bill which would keep most of the Affordable Care Act intact for states that want to keep it. This could be good news for states like California, where the Affordable Care Act has been a tremendous success.

The momentum for a bipartisan approach isn’t very strong right now, as partisanship is at an all-time high in Washington. However, if Senator Mitch McConnell can’t get 50 of his fellow Republican Senators on the same page by August, cooperation and bipartisanship may become the only option. That could save California from having to face billions in cuts to Medi-Cal and large health insurance premium hikes which would deprive millions of Californians of the affordable health coverage they currently enjoy. Again, this path is a longshot, but it gives us a better chance to achieving health and justice for all.