Is a Repeal of the ACA in Our Future?

News | Published: Friday, November 11, 2016 4:30 am

by MedAxiom


During his presidential campaign, Donald Trump vowed to eliminate the Affordable Care Act (ACA) in its entirety. Now, just days after the election, what do we really know and what can we anticipate? Marshall Brachman, lobbyist for the Cardiology Advocacy Alliance (CAA), offers his insights.

We will begin to know how this will all proceed when the House and Senate reorganize—starting the week of November 14. That is when decisions will be made regarding what Congress intends to do during the lame duck session. Since the Obama administration would likely veto any attempt to modify the ACA, it is almost certain that changes will not occur until 2017. Most likely, there would not be a one-stop total repeal, but instead a roll out of administrative actions by the Trump administration and attempts to roll back pieces of the ACA legislatively. Those roll back pieces would occur over a couple of years.

Here are some important points to keep in mind as we think about what may happen.

  • The House remained in Republican control; however, the Republican majority has narrowed somewhat (there are still 9 seats yet in play). There will be places where the Republican leadership will need the Democratic minority to pass legislation.
  • The Senate is held by the Republicans. Right now, with one seat undecided (Louisiana), the Republicans hold 51 seats, the Democrats hold 46 seats, and the independents hold 2 seats. The independents tend to vote with the Democrats.
  • It will be virtually impossible for the Republicans in the Senate to find 60 votes to break a filibuster holding up repeal of the ACA.
  • It is possible that the Senate Republicans could try to use the reconciliation mechanism to repeal the ACA. (That is what the Democrats used to pass it.) However, there are a lot of arcane rules related on how legislation is formulated in reconciliation. It will be tough to get full repeal in that process.
  • More likely, House and Senate Republican leadership will attempt to dismantle the ACA in pieces through other must-pass legislation over the next two years.
  • There are parts of the ACA that Republicans are reticent to repeal (pre-existing conditions, amongst others). Also, there is no substantive alternative that has been formulated to replace the ACA.
  • All of this will have to be done in the 115th Congress, since any repeal attempt in the lame duck session would be vetoed by Mr. Obama.
  • It will still be some time before we know who the new Secretary of HHS will be (press speculates Gingrich or Ben Carson or Rick Scott). Even then, confirmation and new senior political appointees at HHS will take some time to begin to be in a place to take action.

In summary, we know that Congress and the new administration are anxious to repeal and replace many of the mandates imposed by the Affordable Care Act; however, it will not be clear for a number of months how, and if, this can be accomplished. As always, we will keep you posted as details unfold.

Learn more about CAA member benefits at

Marshall Brachman has been the lobbyist for CAA since its inception. He has been lobbying for over 30 years on many public policy matters, including health care. Brachman was raised in Fort Worth, Texas, has an MBA from the University of Texas, lives on Capitol Hill and is on the Hill advocating for the issues affecting members of CAA every day.



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