House and Senate sent to
President Obama a bill that
would have repealed the core of
the ACA. President Obama, as
expected, vetoed the bill, but it
could be a blueprint for how
Republicans will push their
repeal of ACA though budget
reconciliation. It withdrew fund-
ing for subsidies for individuals
to purchase insurance on the
exchanges, and eliminated the
individual mandate, the Cadillac
tax (a planned 40% excise tax
on high-cost insurance plans)
and Medicare expansion. All of
those provisions got through the
reconciliation process, so Republicans could quickly repeal
Obamacare's insurance exchanges through the same reconciliation
process once Mr. Trump takes office.
Making larger market reforms to the ACA that move beyond budget-
ary concerns will require new legislation passed with a 60-vote majority
in the Senate. That means 8 Democrats who are all but certain to toe
the party line will need to cross the aisle. Could Republicans come up
with a bill that will attract at least 8 Senate Democrats and pass muster
with Tea Party members? "The compromises they would have to make
to get Democrats onboard could alienate Republican hardliners such as
Ted Cruz from Texas and Mike Lee from Utah," says John E.
McDonough, DrPH, MPA, a professor of public health practice in the
department of health policy and management at the Harvard T.H. Chan
3 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • D E C E M B E R 2 0 1 6
"It's entirely possible
Republicans will be
able to complete the
repeal, but unable to
pull off the replace."
— John E McDonough, DrPH, MPA
