ADvancing States published a primer on budget reconciliation and long-term services and supports (LTSS) programs. With the inauguration of President Trump on January 20, 2017, Republicans now control the White House and both branches of Congress. As the new leadership begins work to fulfill their campaign promise of repealing the Affordable Care Act (ACA), the parliamentary budget reconciliation process has become the focal point of legislative strategies. Congress has passed a budget resolution that sets the stage for ACA repeal, using budget reconciliation legislation as the vehicle. While reconciliation is a powerful tool that can be used to pass significant and sweeping legislation, it also has some stark limitations that restrict the type of changes that can be enacted. Nevertheless, reconciliation can be used to restructure significant components of Federal health and human services programs without requiring a 60-vote threshold in the Senate. Knowledge of the budgetary process and its associated rules will help constituents understand the types of changes that could be made to health and human services programs. 

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