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The idea that Republicans could junk Obamacare with a simple majority vote may sound baffling, given that Barack Obama famously had to wrangle together all 60 Senate Democrats in late 2009 to push the law through in the first place.
What makes this possible is that Republicans aren’t actually going to repeal all of Obamacare, as my colleague Sarah Kliff has explained. But they’re going to repeal enough of it to reverse almost all of the coverage gains made under it.
The reconciliation process, explained in detail here, can only be used to pass bills that affect spending and revenue — budgetary matters, in other words. It was created in the 1970s to make it easier for Congress to keep a budget, by giving the Senate tools to more easily change laws regulating big mandatory spending programs like Medicare, Medicaid, and the like.
Last year, Republicans passed the Restoring Americans’ Healthcare Freedom Reconciliation Act, a repeal bill that uses the reconciliation process. The Senate parliamentarian ruled that all the parts of Obamacare that it repealed — Obamacare's insurance subsidies, Medicaid expansion, the law’s tax increases, and its mandate to purchase coverage — could be dismantled through reconciliation.
The bill, introduced by Georgia Rep. and Health and Human Services Secretary-designate Tom Price, left some parts of Obamacare standing, like the requirement that insurers cover young adults through age 26. (That provision is very popular, and possibly harder to tackle through the reconciliation process.) It also left the requirement to cover Americans with preexisting conditions partially intact (you can read more about that from Sarah Kliff).
The reconciliation process normally can’t be used to pass legislation that increases the deficit 10 or more years into the future; that’s why the Bush tax cuts in 2001 expired after 10 years. Since Obamacare reduced the deficit, it would stand to reason that repealing it increases the deficit in the long run, and runs afoul of this rule. To get around this, the reconciliation bill preserves Obamacare’s cuts to Medicare doctor payments, and so is scored as reducing the deficit, because those cuts plus the cost of the insurance subsidies and Medicaid expansion swamp the revenue loss from repealing all of Obamacare’s taxes.
The human consequences of this legislation are immense. The Congressional Budget Officeestimates that it would rip insurance away from 22 million people, mostly people getting coverage from the Medicaid expansion and who rely on subsidies in the insurance marketplaces.
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