Why the House may have to vote on the AHCA again

Two weeks after the U.S. House of Representatives narrowly passed an Affordable Care Act (ACA) replacement plan, the bill hasn’t been sent to the Senate because potential procedural problems may force the House to amend the legislation and then vote on it again.

As first reported by Bloomberg, it depends on how much money the American Health Care Act (AHCA) saves as determined by the Congressional Budget Office (CBO), which is expected to issue its updated report on the bill the week of May 22.

Under the budget reconciliation process being used to pass the bill with only a simple majority in the Senate, it has to save at least $2 billion. The last CBO score said the AHCA would reduce the federal deficit $150 billion, but that was before the more recent changes allowing states to waive certain insurance requirements.

If the result is skimpier, the legislation may add $115 billion to federal spending, according to a report from the Committee for a Responsible Federal Budget.

Republican leaders, however, appear confident the bill will meet the requirement.

“The bill is just being held until CBO issues its final score,” a representative for House Speaker Paul Ryan told Business Insider.

Adding to those issues is a more complicated part of the Senate process. The $2 billion in savings is supposed to be split between two committees with policy jurisdiction over parts of the AHCA—the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee.

As explained by Vox reporter Dylan Scott, the problem may arise from the extra money added to the “stabilization fund” in the bill, which helped win over House Republican moderates in the final hours before the May 4 vote. That could cause the provisions under the HELP Committee’s jurisdiction to cost $6 billion, rather than save $1 billion—again violating the rules of the reconciliation process.

If CBO report shows large enough savings, however, none of that matters, and the bill can move onto the Senate. Some Republicans, however, were surprised these issues had forced their leaders to hold onto the bill.

“I had no idea," Rep. Dennis Ross, R-Florida, said to Bloomberg, adding that the prospect of another vote “does concern me.”

The Senate process was already promising to be a challenging one, with veteran healthcare lobbyist Julius Hobson Jr. telling HealthExec the House bill was “dead in the Senate as written.”