The AHCA – What Happens Now?

By the narrowest of margins, the American Health Care Act (AHCA) has passed the House of Representatives on a party line vote, with Republicans backing the measure to repeal and replace the Affordable Care Act (ACA) and Democrats opposing it. There were many last-minute wheelings and dealings to get the votes needed to pass, and the final bill has not yet been measured by the Congressional Budget Office for its potential impact.

The bill next proceeds to the Senate for consideration, and it will be a hot potato of a topic for lawmakers there. The Senate is also controlled by Republicans who will be under immense pressure to pass a repeal of the ACA – an action the party has promised to take, and has tried to take, since the ACA became law in 2010. However, Senate Republicans are not, in general, as conservative as their House counterparts, and they may wince at some of the AHCA’s provisions which weaken protections for preexisting conditions.

Read: High-Risk Pools Likely To Return.

Republicans have narrow control of the Senate with 52 seats; this is versus 46 seats which are in Democratic hands and 2 seats which are in left-leaning independent hands (Vermont Senator Bernie Sanders and Maine Senator Angus King). In the case of a tiebreaker, Vice President Mike Pence can cast a vote to break the deadlock. This means that Republicans can’t lose more than two Republican Senator votes for this bill.

That’s not the only hurdle facing the bill. In the Senate, lawmakers can filibuster a bill; filibustering essentially means talking a bill to death. The only way to stop a filibuster is to have 60 Senators vote to end it, and Republicans don’t have that kind of a head count in the Senate. They laid the groundwork to get around this problem earlier this year by passing initial repeal-and-replace legislation as part of a budget package; this invokes a rule known as cloture. Cloture is complex, but the important thing to know is that it allows lawmakers to pass a bill by a simple majority.

But…cloture only works if a bill does not substantially add to the national deficit in the near term – this is known as the Byrd Rule. Bill-watchers believe that parts of the AHCA violate the Byrd Rule, which gets us right back to the threat of a filibuster.

Read more: What the MacArthur Amendment Means for People with Diabetes

Except….that the Senate doesn’t have to vote on the AHCA as is. In fact, there’s no way it will. Senators can gut the AHCA legislation, rewrite it, and then pass it. If the bill gets this far, then a committee is set up between the House and the Senate to iron out the differences between the two chambers. Both House and Senate have to approve those changes.

It then gets sent to President Donald Trump’s desk. All indications are that he will sign the AHCA if it is backed by Republicans in the House and the Senate. Of course, very little about President Trump’s first 100 days have been what you could call predictable, so you just never know.

We’ll keep you posted on the bill’s progress in the coming days.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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