115th Congress on the Better Care Reconciliation Act of 2017

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115th Congress, 2017-2018 Issues

Domestic policy Key votes • Energy and the environment • Healthcare • Immigration

Economic policy and government regulations Key votes • Budget • Financial policy • Taxes • Trade

Foreign policy and national security Key votes • Iran nuclear deal

115th Congress, 2017-2018 Healthcare policy

For more on healthcare policy, view the following articles:

•Healthcare overview

•Graham-Cassidy Obamacare replacement plan

•Republican effort to repeal the ACA, July 2017

•Better Care Reconciliation Act of 2017 (Senate bill)

•115th Congress on the Better Care Reconciliation Act of 2017

•Republican senators on the BCRA

•American Health Care Act of 2017 (House bill)

•House's second attempt to pass the AHCA, April - May

•House's initial attempt to pass the AHCA, March

•House roll call vote on the AHCA

•Republicans who were likely to vote against the AHCA, March

•Timeline of ACA repeal and replace efforts

•Federal policy on healthcare, 2017-2020

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See also: 115th Congress on the American Health Care Act of 2017 (April - May)

On June 22, 2017, the U.S. Senate released the Better Care Reconciliation Act of 2017 (BCRA), its version of the House bill, the American Health Care Act (AHCA). The bill was a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. On July 13, 2017, the Senate released a revised version of the bill that included changes, such as $45 billion to address the opioid epidemic and allowing the sale of health plans that do not comply with ACA standards. For detailed information on the BCRA, click here.

On July 17, 2017, after weeks of negotiating the bill, Senate Majority Leader Mitch McConnell (R-Ky.) said that his party was unable to agree on a replacement bill for the ACA, but the bill was revived two days later. During the last week of July, the Senate voted on three major proposals to repeal and replace the ACA. A procedural vote on the BCRA was rejected by a vote of 43-57. A proposal to repeal the ACA and delay the effective date for two years to provide time for a replacement bill failed by a vote of 45-55. The final major amendment—the "skinny bill"—was rejected by a 49-51 vote. It contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions.

After the skinny bill failed, McConnell said, “it is time to move on,” and he called the final defeat disappointing.

What did Senate Republicans think of the bill?

See also: Republican senators on the Better Care Reconciliation Act of 2017 (BCRA)

The Senate bill encountered the same issues the AHCA encountered in the House: namely, disagreements between the moderate and conservative wings of the party. Senators from both the moderate and conservative wings voiced opposition to the bill in its initial and revised forms. To view the comments of each Republican member of the Senate on the BCRA, click here.

What did Senate Democrats think of the bill?

All Senate Democrats expressed opposition to the BCRA. Senate Minority Leader Chuck Schumer (D-N.Y.) said, "The truth is ... the Republicans cannot excise the rotten core at the center of their healthcare bill." Schumer also listed some actions Senate Republicans would have had to take in order for Democrats to work with them: "Abandon tax breaks for the wealthy, abandon cuts to medicaid [sic], abandon repeal, and we can sit down and talk about improving health care."

Senator Dick Durbin (D-Ill.) said that he would negotiate with Republicans if they committed to increasing access to healthcare and bringing down the cost of insurance.

How did Republicans try to pass the bill?

The BCRA was a reconciliation bill. Reconciliation bills primarily deal with changes in taxes or spending and can bypass potential filibusters in the Senate. Reconciliation bills can pass the Senate with a simple majority of votes (51-49) rather than the 60-vote threshold required to end a Senate filibuster. This means that Senate Republicans would have needed at least 50 votes to pass the bill, with Vice President Mike Pence casting the tie-breaking 51st vote.

On June 27, 2017, Senate Majority Leader Mitch McConnell (R-Ky.) delayed a vote on the bill until after the July 4 recess to give the party more time to negotiate on differences between the moderate and conservative wings of the party. Senate GOP leadership had previously expressed intent to vote on the bill by the July 4 recess.

On June 30, 2017, ten Republican senators wrote a letter to McConnell asking him to delay or cancel the recess so that they could spend more time working on major pieces of legislation. They wrote, "There are five imperatives which must be accomplished this year. We must complete the first phase of Obamacare repeal and replace. Next, we have to pass a budget that serves as a reconciliation vehicle for reforming our outdated tax code. Before September 30th, we must agree on an appropriation that responsibly funds the government. Also, we must deal with our debt limit before that approximate date. If we successfully navigate those priorities, we can finally get to our once in a generation opportunity on tax reform. Growing the economy, repairing our infrastructure, and rebuilding our military are all dependent on accomplishing the tasks before us." Sens. John Kennedy (R-La.), David Perdue (R-Ga.), Joni Ernst (R-Iowa), Dan Sullivan (R-Alaska), Mike Rounds (R-S.D.), Thom Tillis (R-N.C.), James Lankford (R-Okla.), Mike Lee (R-Utah), Steve Daines (R-Mont.), and Luther Strange (R-Ala.) signed the letter. Sen. Ben Sasse (R-Neb.) also sent a letter to President Donald Trump asking him to cancel the August recess.

On July 11, 2017, McConnell delayed the start of the Senate's August recess to the third week in August in order to complete work on the BCRA and other items on the legislative agenda.

On July 17, 2017, McConnell said that his party was unable to agree on a final version of the BCRA and would instead vote on a bill to repeal, but not replace, the ACA. The following day, McConnell "emphasized that his proposal is the same as the vote held to repeal the Affordable Care Act in 2015," according to CNBC. In 2016, Congress passed the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015. The bill would have repealed several parts of the ACA, but the bill was vetoed by President Barack Obama on January 8, 2016.

During the last week of July, the Senate voted on three major proposals to repeal and replace the ACA. A procedural vote on the BCRA was rejected by a vote of 43-57. A proposal to repeal the ACA and delay the effective date for two years to provide time for a replacement bill failed by a vote of 45-55. The final major amendment—the "skinny bill"—was rejected by a 49-51 vote. It contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions.

For more on the effort to repeal and replace the ACA, click here.

Background on the Better Care Act

The Better Care Reconciliation Act of 2017 (BCRA) was released by the Senate on June 22, 2017. The bill was the Senate's version of the American Health Care Act of 2017 (AHCA), which was passed by the U.S. House of Representatives on May 4, 2017. The bill was a reconciliation bill, meaning it would have impacted the budgetary and fiscal provisions of the Affordable Care Act (ACA)—commonly known as Obamacare—and did not contain a provision to repeal the law in its entirety. The bill would have repealed the individual and employer mandates, adjusted the ACA's system of tax credits, and ended the ACA's Medicaid expansion. Medicaid funding would also have been converted from an open-ended entitlement to a per-member amount.

Some other details of the bill included the following:

• Medicaid funding would have increased each year by annual inflation in the price of medical care plus 1 percentage point until 2025, then would have increased according to inflation each year thereafter.
• The bill would have funded cost-sharing reduction payment reimbursements through 2019. The cost-sharing reduction program would have ended in 2020.
• The bill would have suspended for one year federal funding available for a certain category of community health centers that included Planned Parenthood.

A full summary of the BCRA can be viewed here.

Summary of revised bill

On July 13, 2017, the Senate released a new version of the BCRA. The bill included the following changes:

• Any individual could have purchased a catastrophic health plan (under the ACA, this is restricted to individuals under 30 or those who meet a hardship exemption).
• Tax credits could have been used to purchase catastrophic plans.
• An additional $70 billion between 2019 and 2026 would have been provided to states for individual market stabilization.
• The ACA's 0.9 percent payroll tax for Medicare would have been retained.
• The ACA's 3.8 percent tax on investment income would have been retained.
• Withdrawals from HSAs could have been used to pay health insurance premiums.
• A total of $45 billion would have been provided to address the opioid epidemic.
• Individual health plans in effect after January 1, 2019, would have been required to enforce a six-month waiting period on coverage for individuals who were unable to prove that they had continuous health insurance for the previous 12 months.
• Health insurers could have offered plans off the exchanges that did not comply with ACA standards if they also offered one gold-level and one silver-level plan on the exchanges.
• A fund would have been established that reimbursed health insurers for the cost of covering high-risk individuals.
• In determining the base period for per capita Medicaid funding, states that expanded their Medicaid programs after June 2015 could have used a period of less than two years but no fewer than 12 months.
• Between 2020 and 2025, up to $5 billion in state Medicaid expenditures could have been excluded from the funding cap if the secretary of HHS declared a public health emergency. States that chose the block grant option would have been eligible for additional funding during public health emergencies.

What is the ACA or Obamacare? The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act (ACA) or Obamacare, was signed into law by President Barack Obama (D) on March 23, 2010. The aim of the law was to provide health insurance coverage to more Americans, primarily through individual health insurance marketplaces and an expansion of the Medicaid program. Click here to read more about the healthcare law.

Congressional Budget office report

Revised bill

On July 20, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the revised version of the Better Care Reconciliation Act (BCRA). Key findings included the following:

• Federal budget: The revised BCRA would reduce the federal deficit by $420 billion between 2017 and 2026 due to a $903 billion decrease in direct spending and a $483 billion reduction in revenues.
  • The bulk of the deficit reduction would come from lower spending on Medicaid due to the repeal of the Medicaid eligibility expansion.
• Health insurance: Compared to the ACA, 15 million more people would be uninsured in 2018 under the revised bill, and 22 million more people would be uninsured in 2026.
• Effects on premiums: Premiums would be 20 percent higher in 2018 and 10 percent higher in 2019 than under the ACA. Premiums in 2020 would be 30 percent lower than under current law, and in 2026, they would be 25 percent lower. Premiums would be lower for younger people and higher for older people.
• Effects on deductibles: The average deductible for a benchmark plan for an individual, which under the BCRA would cover 58 percent of costs, would be $13,000 in 2026. Under the ACA, the average deductible for an benchmark plan for an individual, which would cover 70 percent of costs, would be $5,000.

Original bill

On June 26, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the Better Care Reconciliation Act (BCRA) as it was introduced and its impact on the number of uninsured. Key findings appear below.

• Federal budget: The BCRA would reduce the federal deficit by $321 billion between 2017 and 2026 due to a $1 trillion decrease in direct spending and a $701 billion reduction in revenues.
  • The bulk of the deficit reduction would come from lower spending on both Medicaid and health insurance tax credits.
  • The largest revenue reductions would come from the elimination or modification of the ACA's tax provisions, such as the annual fees imposed on health insurers. Other revenue reductions would come from the elimination of penalties on individuals who do not purchase health insurance and on employers who do not offer it.
• Health insurance: Compared to the ACA, 15 million more people would be uninsured in 2018 under the BCRA, and 22 million more people would be uninsured in 2026. In total, under the BCRA, 49 million people would be uninsured in 2026, compared to 28 million who would be uninsured under the ACA.
• Stability of the health insurance market: The individual insurance market would be stable in most states. According to the report, tax credits would maintain sufficient demand for insurance and grants to states would help cover individuals with high healthcare costs. Additionally, appropriated funding for cost-sharing reductions would provide certainty to insurers. The report found that a few rural areas would experience instability as reduced tax credits lead fewer people to purchase insurance.
• Effects of premiums:
  • The BCRA would increase premiums by about 20 percent in 2018 and 10 percent in 2019, compared to the ACA. This would be due to a lack of an individual mandate resulting in fewer healthy people purchasing coverage.
  • In 2020, premiums would be about 30 percent lower than under current law due to plans covering a smaller share of health costs and federal funding for the purpose of premium reduction.
  • In 2026, premiums would be about 20 percent lower than under the ACA. This would be a smaller reduction in premiums than in 2020 due to lower federal funding for reducing premiums. Some areas of the country could see substantially higher or lower premiums than the average due to states obtaining waivers from some of the law's provisions.

Timeline of ACA repeal and replace efforts

• July 28, 2017: The Senate voted on an amendment from Senate Majority Leader Mitch McConnell (R-Ky.), also referred to as the "skinny bill." The amendment contained the provisions to repeal the requirements for individuals to enroll in health insurance and for employers to offer it, among other provisions. The amendment was rejected by a 49-51 vote. Sens. Susan Collins (R-Maine), John McCain (R-Ariz.), Lisa Murkowski (R-Alaska) joined 48 Democrats in voting against the amendment.

• July 26, 2017: The Senate rejected a proposal to repeal the Affordable Care Act and delay the effective date for two years to provide time for a replacement bill. The proposal was similar to the repeal-only bill—the Restoring Americans' Healthcare Freedom Reconciliation Act—passed by Congress in 2015 and included an amendment from Sen. Rand Paul (R-Ky.) that would have prohibited the use of tax credits for health plans that covered abortion services. The proposal was rejected by a vote of 45-55, with Republican Sens. Shelley Moore Capito (R-W.Va.), Susan Collins (R-Maine), Dean Heller (R-Nev.), John McCain (R-Ariz.), Rob Portman (R-Ohio), Lamar Alexander (R-Tenn.), and Lisa Murkowski (R-Alaska) voting against the measure.

• July 25, 2017: The Senate rejected a procedural vote on the Better Care Reconciliation Act of 2017 (BCRA) by a vote of 43-57. Sixty votes were needed to secure passage. GOP Sens. Lisa Murkowski (R-Alaska), Tom Cotton (R-Ark.), Jerry Moran (R-Kan.), Rand Paul (R-Ky.), Susan Collins (R-Maine), Dean Heller (R-Nev.), Lindsey Graham (R-S.C.), Bob Corker (R-Tenn.), and Mike Lee (R-Utah) voted against the repeal and replace proposal. No Democrats voted for the motion. The proposal also included amendments from Sens. Rob Portman (R-Ohio) and Ted Cruz (R-Texas).

• July 25, 2017: The Senate held a vote on a motion to proceed to the American Health Care Act of 2017 (AHCA), the House-passed repeal and replace bill. The motion was approved 51-50. Republican Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) and all Senate Democrats voted against the motion. Vice President Mike Pence voted in favor of the bill to break the 50-50 tie. Sen. John McCain (R-Ariz.), who was diagnosed with brain cancer the previous week, returned to Capitol Hill to cast a vote in favor of the motion. Without his vote, the motion would have failed.

• July 21, 2017: The Senate parliamentarian ruled that the provision suspending funding for Planned Parenthood for one year in the revised BCRA did not meet the rules of reconciliation. She also ruled that the provision prohibiting the use of tax credits for plans that cover abortions in circumstances other than rape or incest or to save the life of the mother did not meet the requirements.

• July 20, 2017: The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the revised version of the Better Care Reconciliation Act (BCRA). Key findings can be viewed here.

• July 19, 2017: After meeting with Trump in the White House, Senate leadership attempted to revive the BCRA or a version of it.

• July 17, 2017: Senate Majority Leader Mitch McConnell (R-Ky.) said that his party was unable to agree on a final version of the BCRA and would instead vote on a bill to repeal, but not replace, the ACA.

• July 15, 2017: Senate Majority Leader Mitch McConnell (R-Ky.) said that the Senate would not vote on the BCRA until after Senator John McCain (R-Ariz.) recovered from his eye surgery. McCain was recovering at his home in Arizona.

• July 13, 2017: A revised version of the BCRA was released.

• July 11, 2017: Following a briefing with GOP senators, Senate Majority Leader Mitch McConnell (R-Ky.) delayed the start of the Senate's August recess to the third week in August in order to complete work on the BCRA and other items on the legislative agenda.

• June 27, 2017: Senate Republican leaders postponed a vote on the BCRA until after the July 4 recess.

• June 26, 2017: The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the Better Care Reconciliation Act (BCRA) and its impact on the number of uninsured. Key findings can be viewed here.

• June 22, 2017: The Senate released its version of the bill to replace the ACA, the Better Care Reconciliation Act of 2017.

• June 6, 2017: The Senate Budget Committee announced that the AHCA complied with the Senate reconciliation process. House Republicans were waiting for the committee's verdict on the AHCA before sending it to the upper chamber.

• May 24, 2017: The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released a report estimating the cost of the AHCA as amended and its impact on the number of uninsured. The AHCA would reduce the federal deficit by $119 billion between 2017 and 2026 due to a $1.1 trillion decrease in direct spending and a $992 billion reduction in revenues. Compared to the ACA, 14 million more people would be uninsured in 2018 under the AHCA, and 23 million more people would be uninsured in 2026. In total, under the AHCA, 51 million people would be uninsured in 2026, compared to 28 million who would be uninsured under the ACA.

• May 4, 2017: The House passed the AHCA by a vote of 217-213.

• May 3, 2017: House Majority Leader Kevin McCarthy (R-Calif.) said that the House would hold a vote on the revised version of the AHCA on May 4, 2017. He wrote in a tweet, "Doing nothing is not an option. The American people are tied to #Obamacare’s sinking ship, and we have to act now. #AHCA."

• May 2, 2017: The House voted to approve waiving a rule requiring lawmakers to wait at least one day before voting on the AHCA. It would allow leaders in the House GOP to hold a vote on the AHCA as soon as they secured enough votes for passage.

• April 27, 2017: House Majority Leader Kevin McCarthy (R-Calif.) said that the House would not vote on the revised version of the AHCA before President Donald Trump 100th day in office.

• April 26, 2017: The House Freedom Caucus said that they would support the AHCA because of an amendment that would allow states to opt out of some provisions of the ACA.

• April 13, 2017: House Republicans added an amendment to the AHCA in an attempt to unite the party behind the bill. Rep. Tom MacArthur (R-N.J.), co-chair of the Tuesday Group, and Rep. Mark Meadows (R-N.C.), head of the House Freedom Caucus, introduced an amendment that proposed retaining the 10 essential health benefits as the federal standard for what health plans must cover, but would allow states to acquire a waiver from the requirement. Other provisions in the ACA that would be retained by the amendment included the prohibition on denying coverage for pre-existing conditions, the requirement to cover individuals on their parents' health plan until age 26, and limits on how much insurers may vary premiums for reasons such as age, gender, and health status (known as community rating). In addition to waiving the essential benefits standard, the amendment would allow states to obtain waivers from the community rating provisions, except for the rules limiting premium variance based on gender and age. States could only waive the limits on varying premiums based on health status if they had also established a publicly funded high-risk pool to cover individuals with costly conditions.

• April 3, 2017: White House officials discussed changes to the AHCA with the House Freedom Caucus. Officials proposed allowing "states to choose to apply for waivers to repeal two ObamaCare regulations that conservatives argue are driving up premiums. Those two regulations detail ObamaCare's essential health benefits, which mandate which health services insurers must cover, and 'community rating,' which prevents insurers from charging sick people higher premiums," according to The Hill.

• Rep. Mark Meadows (R-N.C.) said that the proposed changes would result in enough votes from Freedom Caucus members to pass the bill, but he said that he wanted to see the full text of the legislation before making a final decision.

• March 24, 2017: The House was expected to vote on the AHCA, but House Republican leaders withdrew the AHCA from consideration amid dwindling support.

• March 24, 2017: The House Rules Committee approved an amendment to the AHCA that would have repealed the ACA's requirement that insurers provide federally determined essential health benefits. Under the amendment, each state instead would have been required to determine which essential benefits insurers licensed in that state must cover. The amendment also would have provided $15 billion to states to promote access to preventive care, dental care, and vision care, and to provide maternity and newborn care and mental health services. The $15 billion would have been funded by maintaining a 0.09 percent Medicare tax on high-income earners for six years.

• March 23, 2017: The House was expected to vote on the AHCA, but the vote was canceled.

• March 20, 2017: The House added an amendment to the AHCA that provided for extra funding for tax credits for older Americans to help them pay their premiums and instructed the Senate to design the tax credits. It removed a provision in the original bill that would have allowed individuals to deposit leftover tax credit money into a health savings account. The amendment would have allowed states to establish work requirements for their Medicaid programs and would have allowed states to receive federal Medicaid funding in the form of a per-member amount or block grants, whichever they chose. The amendment would have repealed many of the ACA's taxes and fees and would have delayed the 40 percent excise tax on employer-sponsored plans until 2026. Finally, the amendment contained a provision specific to New York state: it would have prohibited New York from receiving federal reimbursement for Medicaid payments that counties make to the state in an attempt to shift more Medicaid spending to the state level.

• March 16, 2017: The United States House of Representatives Committee on the Budget voted 19-17 to approve the AHCA. Three Republicans—Reps. David Brat (Va.), Mark Sanford (S.C.), and Gary Palmer (Ala.)—voted against advancing the bill.

• March 9, 2017: The United States House of Representatives Committee on Energy and Commerce approved the AHCA.

• March 9, 2017: The United States House of Representatives Committee on Ways and Means approved the AHCA.

• March 6, 2017: Representatives Kevin Brady (R-Texas) and Greg Walden (R-Ore.) introduced the American Health Care Act of 2017, a reconciliation bill to modify the budgetary and fiscal provisions of the ACA. It did not propose completely repealing the ACA.

• January 23, 2017: Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) introduced S 191—the Patient Freedom Act of 2017. The legislation proposed replacing the ACA.

• Cassidy discussed the bill, saying, "I would say what we’re doing is moving the locus of repeal to state governments. On the one hand, that is philosophically consistent with where Republicans are. States should have the right to choose. It is also consistent with our long-stated [principle], ‘If you like your insurance, you can keep it.’"

• January 13, 2017: The House passed S Con Res 3, a budget resolution to begin rolling back the ACA, by a vote of 227-198. Nine Republicans joined every Democratic member of the House to vote against the budget resolution. The nine Republicans were: Justin Amash (Mich.), Charlie Dent (Pa.), Brian Fitzpatrick (Pa.), Walter Jones (N.C.), John Katko (N.Y.), Raul Labrador (Idaho), Thomas Massie (Ky.), Tom MacArthur (N.J.), and Tom McClintock (Calif.).

• January 12, 2017: The Senate passed S Con Res 3, a budget resolution to begin rolling back the ACA, by a vote of 51-48. Sen. Rand Paul (R-Ky.) was the only Republican who voted against the budget resolution because he said that it increased the federal debt. Paul added, “I won’t vote for a terrible budget just to repeal Obamacare. … If I have to weigh the two problems, I actually think the debt is a more important problem than Obamacare.”

• January 4, 2017: The Senate passed S Con Res 3, a motion to begin debating a budget bill, by a vote of 51-48. The budget resolution proposed repealing parts of the ACA that related to the budget and taxes. The final legislation was expected to eliminate provisions that provided tax credits for low-income individuals to obtain health coverage, required all individuals to obtain coverage, and required employers to provide coverage to their employees.

Political background on the ACA

In 2010, the ACA passed Congress with only Democrats voting in favor of the bill. Although Democratic lawmakers expressed a desire to revise parts of the law, they opposed any effort to repeal the ACA. Republicans attempted to repeal or change the ACA on multiple occasions but were unsuccessful. After Republicans took control of Congress and the White House in 2017, Republican lawmakers said that one of their main goals was to change President Barack Obama's signature healthcare law.

Supporters of the law, such as House Minority Leader Nancy Pelosi (D-Calif.), have argued that healthcare is a right that the passage of the ACA helped guarantee. Pelosi, who was integral in getting the ACA passed, said, "Because of this landmark law, the uninsured rate has fallen to historic lows and health care costs are growing at the slowest rate in 50 years. Children, women, workers and families across the country have newfound health and economic security thanks to the ACA. With the Affordable Care Act, we have made monumental progress toward ensuring that health care is a right, not a privilege, for all Americans."

Critics of the ACA, such as Senate Majority Leader Mitch McConnell (R-Ky.), have said that the law is fundamentally flawed and that the exchanges were poorly designed. In remarks made on the Senate floor in September 2016, McConnell said, "Obamacare is a direct attack on the Middle Class. It hurts the very people it was supposedly designed to help. It raises costs, crushes choice, and is now crashing down all around us. It simply isn't working." Critics have also said that the regulations embedded in the law made health insurance expensive and unattractive to young, healthy people and that provisions intended to keep premiums affordable and maintain an optimal mix of healthy and sick enrollees have not worked. Critics have also said that the law has worsened the quality of care by disrupting the doctor-patient relationship.

Previous attempt to repeal the ACA through reconciliation

The Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 was a budget reconciliation bill that would have repealed several parts of the Affordable Care Act, commonly known as Obamacare, that impacted the federal budget, such as the advanced premium tax credits and the Medicaid expansion. It also would have suspended federal funding for Planned Parenthood for one year.

The bill was passed by Congress on January 6, 2016, but was vetoed by President Barack Obama (D) on January 8, 2016. If the measure had been enacted, many of the changes would have gone into effect in 2018, and Republicans said they would have used the two years in between to implement a replacement of the law.

Continue reading about the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 here.

See also

• Better Care Reconciliation Act of 2017
• Republican senators on the Better Care Reconciliation Act of 2017 (BCRA)
• 115th Congress on healthcare, 2017-2018
• House roll call vote on the American Health Care Act of 2017
• 115th Congress on the American Health Care Act of 2017 (March)
• Republicans who were likely to vote against the AHCA, March 2017
• Federal policy on healthcare, 2017-2020
• American Health Care Act of 2017
• Alternative proposals to the Affordable Care Act (Obamacare)
• Obamacare overview