Senator Robert Byrd helped save the Affordable Care Act once already. In December 2009, the wizened West Virginia Democrat overcame fragile health to cast a crucial vote for the act’s passage. It was one of the last votes in the career of the Senate’s longest-serving member: Just weeks after President Obama signed the Affordable Care Act into law, Byrd died at age 92.

Now, nearly seven years after his death, Senator Byrd may ensure that the Affordable Care Act, also known as Obamacare, lives another day. One of Byrd’s many legislative accomplishments over a half-century in the Senate was the eponymous “Byrd rule,” which governs the process of budget reconciliation. Republicans on Capitol Hill are trying to use the reconciliation process to repeal and replace the Affordable Care Act. The Byrd rule stands in their way.

Reconciliation is a fast-track process that allows budget-related legislation to pass the Senate without the prospect of a filibuster. The Byrd rule prevents reconciliation from being used to pass any measure for which the budgetary effects — “changes in outlays or revenues” — are “merely incidental to the non-budgetary components.” Republicans know they lack the 60 votes to break a filibuster in the Senate, so they designed their repeal-and-replace bill to satisfy the Byrd rule’s requirements. Yet there is a surprising flaw in their design — one that has so far drawn little notice, but that Senate Democrats will surely seize on.

The flaw is found in a provision of the bill with the innocuous title “Encouraging Continuous Health Insurance Coverage.” Under that provision, individuals who go without coverage for more than two months must pay a penalty the next time they buy health insurance. The penalty is equal to 30 percent of their new plan’s premium. Significantly, individuals must pay this 30 percent penalty to their new insurer, not to the federal government.

And therein lies the problem. If the penalty were paid to the federal government, as with the individual mandate penalty under the Affordable Care Act, the provision would comply with the Byrd rule because it would have an obvious positive budgetary effect: Penalty payments would increase federal revenues. But the drafters of the repeal-and-replace bill chose not to adopt that approach, lest the penalty look too much like the Obamacare mandate. Instead, they are hoping that the threat of a future penalty averts an insurance market “death spiral,” in which healthy individuals run for the exits and the sick are left behind.

GOP’s 3-Bucket Strategy To Repeal And Replace Health Law Is Springing Leaks

Republicans in Washington working to overhaul the Affordable Care Act say their strategy consists of “three buckets.” But it appears that all three may be leaking.

The plan to dismantle and replace Obamacare emerged after the Republican congressional retreat in late January. The first bucket is a fast-track budget bill that needs only a simple majority to pass the Senate. Because of congressional rules, however, it can only address parts of the health law that have immediate impact on federal spending.

The second consists of changes to regulations and other policies put in place by the Obama administration that could theoretically be undone by new Health and Human Services Secretary Tom Price. And the third is separate legislation that would do things Republicans have been advocating for many years, such as imposing caps on medical malpractice damages and selling health insurance across state lines.

All three are proving problematic at this point — among Republicans.

http://thehill.com/homenews/house/322903-the-hills-whip-list-where-republicans-stand-on-obamacare-repeal-plan

Republican leaders are aiming to move quickly on legislation to repeal and replace ObamaCare, with a vote by the full House slated for Thursday.

But the plan faces a difficult path. Conservatives were quick to criticize the legislation, saying it falls short of full repeal and would create new entitlements. Centrist Republicans and many from districts won by Hillary Clinton in 2016 have also balked at measures rolling back the Medicaid expansion or defunding Planned Parenthood.

A number of conservative lawmakers in the Republican Study Committee, though, backed the bill after a Friday meeting with President Trump. Trump and GOP leaders are working on changes to the legislation that would change how it handles tax credits and create a work requirement for Medicaid.

Members of the conservative House Freedom Caucus, however, say those changes may not be enough.

With a vote in days, the margin for error is slim. Assuming all Democrats vote against the legislation, GOP leaders cannot afford more than 21 defections in the House and two in the Senate.

Here’s a list of how Republican lawmakers stand on the ObamaCare repeal and replace legislation.

http://khn.org/news/do-you-speak-repeal-and-replace/

President Donald Trump and many congressional Republicans campaigned on repealing the Affordable Care Act and replacing it with their own plan to overhaul the nation’s health care system. As the GOP develops its offering, its representatives are tossing around wonky health policy terms to describe their core strategies.

Below you’ll find some brief definitions. Click on the word bubbles in the photo above for KHN’s fuller translation of what each phrase means — for U.S. health care and for ongoing efforts to replace the ACA.

MEDICAID BLOCK GRANTS AND PER-CAPITA CAPS: The federal government gives states a set amount of money to pay for coverage for Medicaid recipients. This would be a shift from the current Medicaid program, where the federal government matches state Medicaid spending on a percentage basis. Learn more.

HEALTH SAVINGS ACCOUNTS: Also known as HSAs, these allow consumers to put money away on a tax-free basis as long as they use it for medical expenses. Learn more.

BUDGET RECONCILIATION: Legislative process that allows measures to pass with a simple majority in Congress. Budget reconciliation bills can’t be filibustered but must focus on provisions that have a budgetary impact. Learn more.

ESSENTIAL HEALTH BENEFITS: ACA-mandated categories of benefits that health plans must cover. They include emergency services, hospitalization and maternity care. Learn more.

INDIVIDUAL MARKET: Where people who do not have health coverage through the government or their employer purchase a plan directly from an insurer. It is sometimes called the non-group market. Learn more.

TAX CREDITS/SUBSIDIES: Financial assistance to help consumers purchase health insurance. Learn more.

HIGH-RISK POOLS: Insurance groups that cover individuals with high health insurance costs, such as people who have a past serious illness or a chronic condition. Learn more.

Visit Repeal & Replace Watch for more KHN coverage of the health law debate.