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Why Senate Democrats could help replace the ACA

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Democrats in the Senate might start the 115th Congress with hopes of creating their own brand of health policy gridlock, but they could still end up compromising.

Scott Behrens, a compliance specialist at Lockton Cos., a Kansas City, Missouri-based insurance broker, makes that case in new commentary on why Republicans have a shot at replacing the Affordable Care Act, not simply repealing parts of its using the budget reconciliation process.

Some Senate Democrats are up for reelection in 2018 in states that supported Trump, Behrens writes.

“The Democrats want desperately to protect those seats, and might conclude they can’t afford to be cast as the party that wouldn’t help put a replacement plan in place,” Behrens writes.

Related: Health cost council rates ACA component life expectancy

Behrens says the Republicans face risks, too.

“The election provided Republicans with political capital to quickly move on repealing the ACA, but they recognize that bungling the repeal and replacement effort would quickly exhaust that capital,” he says.

Republicans could also change their rhetoric about a quick ACA repeal if the political risks of a quick repeal appear to outweigh the benefits, he says.

Republicans will control the White House, the House and the Senate, but they have only a narrow, 52-48 majority in the Senate. Supporters of a normal bill need 60 votes to get it to the Senate floor for a vote.

Republicans can get budget bills through the Senate with just 51 votes through a special budget reconciliation process.

Republicans could get budget-related cuts to the ACA through the Senate quickly with a budget reconciliation measure, but they may still need 60 votes to change other provisions, such as the existence of the ACA public health insurance exchange system. 


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