GOP hopes budget will lead to replacing ACA

WASHINGTON—With their late-night vote last week, Senate Republicans have joined their House counterparts in passing budget blueprints that set the stage for a fierce battle with the White House over the shape of the nation’s healthcare system and appropriate levels of taxation and spending.

The Republican plans to repeal the Affordable Care Act, significantly change healthcare programs and balance the budget within a decade contrast sharply with the vision laid out by President Barack Obama. But key differences also remain, particularly on Medicare, between the House and Senate plans.

Republicans now need to fill in the details—and large financing gaps—of their budget resolutions and try to reach an agreement between the two chambers. Appropriation committees will begin that process when they return to Washington in mid-April.

The Senate blueprint, in particular, leaves a lot of details unspecified. Robert Greenstein, president of the leftleaning Center on Budget and Policy Priorities, said there’s a “magic asterisk” in the GOP plans that eliminates about $1 trillion in revenue from the ACA without providing any replacement funding or corresponding cuts.

House and Senate Republicans will have to square their differences over Medicare before passing a final budget. The House calls for transforming the program into a defined-contribution model, which Republicans call premium support. That change would take effect starting in 2024. Senate Republicans, some of whom are eyeing presidential runs, have taken a less explicit approach to the popular senior program. Their plan calls for the same level of Medicare spending cuts—$400 billion over 10 years—that were included in the president’s budget. But they offered no details on how to achieve those savings.

The House blueprint proposes turning Medicaid into a capped state blockgrant program and slashing federal spending by nearly $1 trillion over 10 years. The Senate was less explicit, although it’s expected Republicans there will embrace the House approach.

If Republicans in the two chambers can agree on a budget, they could use the so-called budget reconciliation process to avoid a Senate Democratic filibuster and pass legislation to repeal and replace the ACA if the U.S. Supreme Court in June strikes down premium subsidies in roughly two-thirds of the states. They hope that legislation would form the basis of negotiations with the White House on revamping the healthcare reform law.