A project of


115th Congress, Vote 169; Senate #1628

To repeal and replace the ACA by enacting the Obamacare Repeal Reconciliation Act of 2017

Official Title: To provide for reconciliation pursuant to title II of the concurrent resolution on the budget for fiscal year 2017.

Amendment 271 to H.R.1628: to repeal and replace the ACA by enacting the Obamacare Repeal Reconciliation Act of 2017
Rejected by Senate on July 27, 2017, 45-55.

Synopsis: On July 26, the day after the Senate agreed to take up H.R.1628 (the ACA repeal/replace bill that the House passed in May), and then rejected Amendment 270 (the Better Care Reconciliation Act), Senator Rand Paul (R, KY) put forth Amendment 271 to H.R.1628, which would essentially replace the text of the House bill with the Obamacare Repeal Reconciliation Act of 2017 (ORRA).

Amendment 271 would:

  • Eliminate ACA premium tax credits for plans that cover abortion, other than to save the life of the mother or rape/incest situations. (Note that the ACA already requires the abortion coverage on such plans to be separately billed and not covered with premium tax credits.)
  • Cut off funding for Planned Parenthood for one year.
  • Sunset the small business premium tax credit after 2019.
  • Eliminate the individual and employer mandate penalties, retroactive to the start of 2016.
  • Eliminate enhanced federal match for Medicaid expansion after 2019.
  • Delay implementation of the Cadillac Tax until 2026.
  • Repeal various other ACA taxes.
  • Allocate funding for community health centers and opioid abuse treatment
  • Allocate funding for cost-sharing reductions , but only through 2019. After that, cost-sharing reductions would be eliminated altogether.

The ORRA is essentially identical to 2015's H.R.3762 (which passed the House and Senate but was vetoed by President Obama ), and is often referred to as "repeal and delay." It would repeal various provisions of the ACA, generally with a two-year implementation delay. But it does not establish any sort of replacement framework – that would supposedly be addressed during the two-year delay (although if lawmakers weren't able to reach a consensus within that time, the repeal would simply go into effect with nothing to replace it).

The Senate rejected the bill on a 45-55 vote. The Senate's 46 Democrats, two Independents (who both caucus with the Democrats) and seven Republicans voted against Amendment 271. The Republicans in opposition were Lamar Alexander (Tennessee), Susan Collins (Maine), Dean Heller (Nevada), John McCain (Arizona), Shelley Moore Capito (West Virginia), Lisa Murkowski (Alaska), and Rob Portman (Ohio).

Why supporters pushed for this bill

  • Amendment 271, ie, the ORRA, is considered by supporters to be a "clean" repeal of the ACA, as it simply repeals, but doesn't replace, various provisions of the law. Senator Rand Paul has long championed the idea of full repeal of the ACA , and although that's not possible with budget reconciliation, a measure like the ORRA is the closest thing to full repeal that's possible under reconciliation.
  • Since ACA opponents have spent seven years pushing for repeal, many were ready to pass any legislation that would accomplish that.

Why opponents tried to stop the bill

  • Democrats universally opposed Amendment 271. The CBO projected that the ORRA would result in 32 million additional uninsured Americans by 2026, and that average individual market (nongroup) premiums would increase by 25 percent in 2018, and by 100 percent by 2026 (ie, premiums in 2026 would be twice as high under the ORRA than they would be if the ACA were to remain intact).
  • The ORRA would have cut Medicaid by $842 billion over the next decade according to the CBO. Democrats and moderate Republicans in the Senate were opposed to the Medicaid cuts, as they would result in states having to cut benefits, eligibility, or both.
  • The "repeal and delay" strategy would have resulted in larger premium increases and a bigger spike in the uninsured population than any other bill GOP lawmakers have proposed. Supporters ostensibly note that the two-year implementation delay would be so that lawmakers could develop a replacement bill in the meantime. But given the discord on Capitol Hill regarding health care reform, it's distinctly likely that there would never be a replacement at all.
07/26/2017 Status: Senate amendment rejected

More: select a member to see his or her other key health care votes.

Yes (45)
R Dan Sullivan AK
R Richard Shelby AL
R Luther Strange AL
R John Boozman AR
R Tom Cotton AR
R Jeff Flake AZ
R Cory Gardner CO
R Marco Rubio FL
R John Isakson GA
R David Perdue GA
R Joni Ernst IA
R Charles Grassley IA
R Michael Crapo ID
R James Risch ID
R Todd Young IN
R Jerry Moran KS
R Pat Roberts KS
R Mitch McConnell KY
R Rand Paul KY
R Bill Cassidy LA
R John Kennedy LA
R Roy Blunt MO
R Thad Cochran MS
R Roger Wicker MS
R Steve Daines MT
R Richard Burr NC
R Thom Tillis NC
R John Hoeven ND
R Deb Fischer NE
R Benjamin Sasse NE
R James Inhofe OK
R James Lankford OK
R Patrick Toomey PA
R Lindsey Graham SC
R Tim Scott SC
R Mike Rounds SD
R John Thune SD
R Bob Corker TN
R John Cornyn TX
R Ted Cruz TX
R Orrin Hatch UT
R Mike Lee UT
R Ron Johnson WI
R John Barrasso WY
R Michael Enzi WY
No (55)
Our pick
R Lisa Murkowski AK
R John McCain AZ
D Dianne Feinstein CA
D Kamala Harris CA
D Michael Bennet CO
D Richard Blumenthal CT
D Christopher Murphy CT
D Thomas Carper DE
D Chris Coons DE
D Bill Nelson FL
D Mazie Hirono HI
D Brian Schatz HI
D Tammy Duckworth IL
D Richard Durbin IL
D Joe Donnelly IN
D Edward Markey MA
D Elizabeth Warren MA
D Benjamin Cardin MD
D Chris Van Hollen MD
R Susan Collins ME
I Angus King ME
D Gary Peters MI
D Debbie Stabenow MI
D Alan Franken MN
D Amy Klobuchar MN
D Claire McCaskill MO
D Jon Tester MT
D Heidi Heitkamp ND
D Margaret Hassan NH
D Jeanne Shaheen NH
D Cory Booker NJ
D Robert Menendez NJ
D Martin Heinrich NM
D Tom Udall NM
D C. Cortez Masto NV
R Dean Heller NV
D Kirsten Gillibrand NY
D Charles Schumer NY
D Sherrod Brown OH
R Robert Portman OH
D Jeff Merkley OR
D Ron Wyden OR
D Robert Casey PA
D John Reed RI
D Sheldon Whitehouse RI
R Lamar Alexander TN
D Timothy Kaine VA
D Mark Warner VA
D Patrick Leahy VT
I Bernard Sanders VT
D Maria Cantwell WA
D Patty Murray WA
D Tammy Baldwin WI
R Shelley Capito WV
D Joe Manchin WV