Advocates celebrated on March 24 when House Speaker Paul Ryan (R-WI) canceled a vote scheduled for that day on the House GOP plan to repeal the Affordable Care Act and dismantle Medicaid. The vote was canceled after it became clear that Republicans did not have enough votes to pass the legislation, due in large part to the persistent work of advocates who made their opposition to the bill known to their representatives. Advocates objected to several key components of the bill, including the end of the Medicaid expansion allowed under the ACA, the dramatic reduction in subsidies that help low-income people afford coverage (with seniors hit especially hard), and huge tax cuts for the wealthiest Americans. While advocates had been vocal for months in their opposition to repeal efforts, opposition increased when the Congressional Budget Office estimated that 24 million more people would be uninsured in 2026 under the GOP plan.

Supported by advocates, Democrats on Capitol Hill were united in their opposition to the legislation. They were joined by many Republicans, including many from states that chose to expand Medicaid. Some members of the GOP’s extreme right wing said the legislation didn’t go far enough to repeal all of the ACA, and said they objected to the tax credits because of their cost and because they continued the current law’s establishment of an entitlement to health coverage. Many of them, however, were also barraged with opposition at town hall meetings and in phone calls and emails to their offices from constituents who wanted to see the Affordable Care Act remain intact.

The future of the GOP’s efforts to repeal the Affordable Care Act remains uncertain. Some reports are that Republicans want to shift focus to tax reform and an infrastructure bill, which some believe will garner more support, while other Republicans aren’t ready to give up the fight on health care and want to revive efforts to repeal the ACA. In order to be able to use the special process known as reconciliation by which a repeal bill could pass the Senate with just 51 votes, a bill would have to be enacted before Congress passes its FY18 budget resolution.

Advocates fear other attacks to health care and specifically to Medicaid may come in Congress’s and the Trump Administration’s FY18 budget, in a tax overhaul package, in smaller legislative “fixes” to the ACA, and/or in the form of administrative changes from Health and Human Services Secretary Tom Price. For example, the House GOP repeal bill would have imposed work requirements on some adult Medicaid recipients; HHS could instead grant waivers to states that could allow them to impose similar work requirements.

In the immediate future, at least, the Senate will turn its attention to additional cabinet confirmations and the Supreme Court nomination, and both chambers will need to focus on FY17 appropriations work (see related articles in this Human Needs Report for more information on these topics). For more information on the failed repeal efforts, see this statement from Families USA. For more information on the GOP plan, see the March 13 Human Needs Report.

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