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 Congress Nears Return Amid Talk of New ACA Repeal and Replace Progress

With renewed efforts from House Republicans to revive the previously failed American Health Care Act (AHCA), or Ryan bill, and a deadline looming to avoid a government shutdown, members of Congress will have a full agenda when they return from Easter recess next week.

Reviving the Affordable Care Act (ACA) “repeal and replace” proposal being shepherded by House Speaker Paul Ryan (R-Wis.) appears to be at the top of the agenda, bringing with it a new amendment introduced late last week.

The MacArthur Amendment, crafted by Reps. Mark Meadows (R-N.C.) and Tom MacArthur (R-N.J.) and originally obtained by Politico, would allow states to obtain limited waivers to opt out of certain health insurance provisions of the ACA—including the essential health benefit.

Other aspects of the bill continue to remain intact, including a component to allow states to block grant or set a per-capita cap on federal outlays for the Medicaid program, which serves low-income Americans, including the elderly or those with disabilities.

The new amendment is the latest in House Republicans’ efforts to give the bill momentum to pass the House with 216 votes before going on to the Senate.

One congressional watcher says the chances for Congress to move swiftly on a new version of the Ryan bill is possible, but not likely.

“The fact that Reps. Meadows and [Dave] Brat are saying that they think their conservative colleagues will get to ‘yes,’ does not make me think that the House is going to pass an ACA repeal-replace ‘reconciliation’ bill in the coming weeks,” says Christopher Condeluci, principal of CC Law and Policy and former Republican Senate staffer during the writing of the ACA.

“But, when you connect all of the dots, you can clearly see that both the White House and conservative Republicans are continuing to push-the-boulder-up-the-hill. And to me, that is significant.”

Timothy Jost, emeritus professor at the Washington and Lee University School of Law, writing in his Health Affairs blog on April 20, said the time element works against any new votes on health care legislation. “Congress will have to enact a bill to fund the federal government as soon as it returns, and it is hard to imagine that it will also try to enact legislation to amend the ACA,” he said.

A new resolution to fund the federal government must be completed by April 28. Members of the Senate are scheduled to return on April 24 and members of the House on April 25, leaving only a few days for lawmakers to come up with a deal to avert a government shutdown.

Jost noted, however, that anything is possible given reports President Trump would like something to happen on repeal and replace during his first 100 days in office, which end on April 29.

“It is also far from clear at this point, though, whether the AHCA as thus amended can pass the House. It will likely face an even harder time in the Senate, where it would have to garner at least 50 Republican votes and find some way of getting past the Byrd rule, which limits reconciliation legislation to provisions that affect the revenue or outlays of the U.S. more than incidentally,” he said.

To see a summary of the MacArthur Amendment, go to

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