WASHINGTON -- Republicans in Congress began the process of repealing the Affordable Care Act as President Obama counseled Democrats on defending the landmark law.

The Fight to Repeal Obamacare Starts Now
On Tuesday, Sen. Mike Enzi (R-Wyo.), chairman of the Senate Budget Committee, brought forward a budget resolution for the new Congress that would begin the process of dismantling the Affordable Care Act, according to CNBC.

"The budget resolution is not law," explained Sarah Binder, PhD, a professor of political science at George Washington University, to Vox. It serves as a blueprint for various committees about how to craft a second piece of legislation, the actual "repeal bill" in the form of a budget reconciliation bill.

The GOP-led Senate hopes to approve the budget resolution next week, with a House version soon to follow, according to The New York Times. Assuming its approved, the next step, is the promised "repeal bill."

"The reconciliation bill essentially tells these committees [Senate Finance and Senate Health Education Labor and Pensions (HELP)], 'It's time to do your part now, and send us some language on how you're going to meet these [budget] targets.' And then the budget will be created to include those changes," Binder explained



In accordance with certain parliamentary rules, reconciliation bills can only include provisions that relate to spending, noted The Times. The bill can scratch both the individual and employer mandate (since both involve tax penalties) and repeal the subsidies for private health insurance. However, Republicans cannot repeal non-budgetary provisions such as the ban that prevents insurers from denying coverage to those with pre-existing conditions. The reconciliation bill requires only a simple majority, 51 votes, instead of 60.

Congress passed a trial run of repeal using this exact procedure in 2015. That bill was vetoed by President Obama.

On Wednesday, Vice President-elect Mike Pence visited Republicans on the Hill for a strategy meeting on repealing the ACA. President Obama, also on the Hill that day, urged Democrats not to "rescue" Republicans by passing replacement measures, according to CNN.

ACA Repeal: It Takes a Village of Congressional Committees
Congress is expected to name committee and subcommittee chairs in early to mid-January, and a few of these positions will have a major influence on important aspects of the anticipated repeal-and-replace agenda.

When it comes to ACA "repeal-and-replace," "procedurally it all starts with the budget committee," said G. William "Bill" Hoagland, senior vice president of the Bipartisan Policy Center here, told MedPage Today in a phone interview.

Currently, Rep. Tom Price (R-Ga.) chairs the House Budget Committee, but in December, President-elect Trump picked Price to serve as secretary of the Department of Health and Human Services (HHS). Price will likely continue in his current position until he's confirmed as HHS secretary, Tom Miller, JD, a resident fellow at the American Enterprise Institute here, told MedPage Today.

If Price is confirmed, Rep. Todd Rokita (R-Ind.), the current vice chair of the budget committee, would be the "logical person" to become chair, said Hoagland, adding that, "He would reflect the same principals and position that chairman Price has had."

Docs Urge Senate to Slow Down on ACA Repeal
The American College of Physicians (ACP) and the American Medical Association (AMA) have told Congressional leaders that it would be a mistake to begin dismantling the Affordable Care Act (ACA) until any planned replacement has been fully vetted.

In a letter sent Tuesday to Republican and Democratic leaders in the Senate, ACP President Nitin Damle, MD, MS, warned that using the 2017 budget resolution to effectively repeal Obamacare provisions could result in "tens of millions of Americans losing coverage, benefits, and other protections established by current law."

A similar letter from the AMA, signed by CEO James Madara, MD, called on Congress to "lay out for the American people, in reasonable detail, what will replace current policies."

Doctors, Nurses Still Divided on Tom Price
When President-elect Trump chose Rep. Tom Price (R-Ga.) to be Secretary of Health and Human Services, he poked an already buzzing hornet's nest.

Like the rest of the country, doctors, nurses, and medical students have very divided opinions about the government's role in healthcare. Price's nomination amplifies that division.

The American Medical Association backed Price then later qualified its support, after a petition circulated criticizing the AMA and Price's presumed agenda, such as "the dismantling of Medicaid" and "proposals to reduce funding" for the Children's Health Insurance Program.

Others like Jane Orient, MD, executive director of the Association of American Physicians and Surgeons, who practices in Tucson, Ariz., have enthusiastically backed Price and scoffed at concerns about health disparities.

"Instead of trying to have the optimal medical care for everybody and [giving] people the right to choose their own medical care and the right to control of their own money, they want to take these resources out of the hands of people making decisions for themselves and put it in the hands of bureaucrats who have this whole formula to decide what they think is equitable. And they don't think it's equitable for people to spend their own money for their own medical care," Orient said.

Next Week
On Monday, The National Press Club will host a luncheon with outgoing Health and Human Services Secretary Sylvia Burwell. On Thursday and Friday, the Medicare Payment Advisory Commission will meet to discuss Medicare policy issues. On Friday, the Pacific Business Group on Health, the American Enterprise Institute, and the Brookings Institution will host a discussion on "Fixing Health Care: Practical Lessons from Business Leaders."