When the American Health Care Act (AHCA) was passed in the House of Representatives, there seems to be an expectation that it will be "fixed" in the senate.

So it seems the vote in the House was voting in favour of a "change of some sort" but not specifically what the change would be.

So my question is, how much can the Senate change the bill? Can they only make changes to details that is already mentioned in the bill? Can they only make amendments to health care? At the extreme, could they say completely re-write the bill so that it is no longer even about health care at all but about climate change (or just another unrelated issue altogether)? I'm thinking more an example of if one party controls the House and the other controls the Senate.

My question is, once the bill goes to the Senate, what guarantees are given to the House that the bill they approved will be the one voted into law?

  • 1
    +1 Interesting question. To improve the question, I would remove the part about representatives not reading bills, as that is an entirely different matter (but of course they don't, that's what their staff is for; hopefully, they read a summary of it).
    – tim
    Commented Jun 1, 2017 at 22:07
  • 1
    You might recall that the ACA itself was originally a completely unrelated bill that the Senate gutted, rewrote, and then sent back to the House. Commented Jun 2, 2017 at 0:52

2 Answers 2


If the bill is changed in the Senate, it has to go back to the House of Representatives for a new vote (and vice versa). Other than that, there are no limitations upon the Senate as to how much it can change the bill. That said, the Senate itself has rules that limit changes in practice.

As an example, the Patient Protection & Affordable Care Act (PPACA; colloquially known as Obamacare) was originally a bill that had nothing to do with health care. The House passed a bill (House Resolution 3590) that included some kind of tax change. As such, it had to originate in the House (and did). The Senate took that bill, removed all the original text, and replaced the whole thing with the PPACA text. Even though PPACA included taxes, this was constitutional because the bill had originally had tax changes.

The Senate passed this bill with sixty votes (all members of the Democratic caucus). It went back to the House, which amended it and sent it back to the Senate. The Senate then used a process called Reconciliation to agree to the budget related changes made by the House with a simple majority vote.

Currently the House and Senate want to pass the American Health Care Act (AHCA) under Reconciliation. To do that, the bill must be a budget bill and can't make changes unrelated to the budget. This is why they can't make many of the changes that they want to make, e.g. selling insurance across state lines, in this bill. They expect to have to pass a separate bill later.

If there are sixty votes in the Senate, the Senate could change the entire bill. Without sixty votes, the Senate can only make Reconciliation compliant changes. Because sixty votes seems unlikely for this particular bill (AHCA), it is almost certain that they will thus limit amendments so as to be consistent with Reconciliation.

One of the issues during passage of PPACA was that it could be argued that it would impact Social Security. As this was not allowed under Reconciliation, a ruling to that effect would have sent the bill around for another round of amendments. The Senate Parliamentarian did not agree with that particular argument though.

They also have a separate option, often called the nuclear option. Basically that is that they would change the rules such that the bill could pass by a simple majority in the Senate. For various reasons, Senators are unlikely to do that, but it is possible for them to do. In particular, they have already "nuked" the sixty vote requirement for presidential nominations to judicial and executive branch nominations.

At the extreme, could they say completely re-write the bill so that it is no longer even about health care at all but about climate change (or just another unrelated issue altogether)?

Yes, absolutely. As the HR 3590 example shows, they could remove the entire text of the current bill and make the bill about military housing tax changes. If they did that, the bill would have to go back to the House for a new vote. Note that the same happens even if they make a much smaller change. Both chambers have to pass the same bill. Until they do so, the bill can't be sent to the president nor become law.


The basics:


The exact same text must be passed in both houses.

When the bill is sent to the Senate only that text is able to be passed to the president to sign. Any change means the Senate sends it back to the house. And then the house can only send that text to the president.

An interesting point is that revenue bills (ACA is considered a tax) must start in the House. So the Senate can't start working on it until the House passes something.

If the House continues to work on the bill that doesn't slow the process down since it is expected to come back with changes anyway.

How far can the changes go? --Yes.

In the Senate "riders" are reasonably common. A rider is a separate issue attached to bill about something particular. The Senate has more lenient rules then the House for putting them on so the House could get back a healthcare and gun control bill (not likely). Still the same text must be passed in both houses.

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