‘Oba­macare’ re­peal in for bumpy ride

Cape Breton Post - - World -

Repub­li­cans are claim­ing a tri­umph by push­ing their leg­isla­tive cen­ter­piece scut­tling much of Pres­i­dent Barack Obama’s health care law through the House. It was a per­ilous jour­ney, and its Se­nate path­way will be at least as bumpy with lit­tle doubt the mea­sure will change, as­sum­ing it sur­vives.

Thurs­day’s 217-213 House pas­sage — with 20 GOP de­fec­tions — was pre­ceded by sev­eral near-death ex­pe­ri­ences for the leg­is­la­tion, even though re­peal­ing Obama’s statute helped guide Don­ald Trump’s pres­i­den­tial run and mul­ti­tudes of GOP con­gres­sional cam­paigns.

And that was in a cham­ber Repub­li­cans con­trol 238-193. Had just two ad­di­tional Repub­li­cans voted “no,” the mea­sure would have lost be­cause bills need ma­jori­ties to pass. Now, Repub­li­cans must try ma­noeu­vring the mea­sure through a Se­nate ter­rain that is dif­fer­ent po­lit­i­cally and pro­ce­du­rally from the House.

“We must man­age ex­pec­ta­tions and re­main fo­cused on the art of the doable as we move for­ward,” said Se­nate Fi­nance Com­mit­tee Chair­man Or­rin Hatch, R-Utah, among sev­eral cau­tion­ary state­ments is­sued by Se­nate Repub­li­cans after the House vote.

The House bill would end the Obama law’s fines on peo­ple who don’t pur­chase poli­cies and erase its taxes on health in­dus­try busi­nesses and high­ere­arn­ing peo­ple. It would di­lute Obama’s con­sumer-friendly in­sur­ance cov­er­age re­quire­ments, like let­ting states per­mit in­sur­ers to charge higher

pre­mi­ums for cus­tomers with pre-ex­ist­ing med­i­cal con­di­tions.

The mea­sure would re­place Obama’s fed­eral sub­si­dies for lower-in­come in­sur­ance buy­ers with tax cred­its geared to con­sumers’ ages. And it would cut Med­i­caid, the health in­sur­ance pro­gram for the poor and dis­abled, in­clud­ing end­ing ex­tra fed­eral pay­ments 31 states are ac­cept­ing to ex­pand Med­i­caid to cover more peo­ple.

On Fri­day, crit­ics of the leg­is­la­tion were us­ing the “I Am A Pre-ex­ist­ing Con­di­tion” hash­tag on Twit­ter to ex­press wor­ries that the bill would deny cov­er­age to peo­ple with

se­ri­ous ill­nesses like can­cer or post-trau­matic stress dis­or­der.

The House bill bars in­sur­ers from re­fus­ing poli­cies to ex­tremely ill peo­ple. But op­po­nents ar­gue it ef­fec­tively does that by let­ting in­sur­ers im­pose higher prices on some peo­ple with pre-ex­ist­ing ill­nesses and who let their cov­er­age lapse. The bill in­cludes bil­lions of dol­lars to help those peo­ple, but ex­perts say it’s un­likely to be enough.

The House bill was writ­ten by Repub­li­cans rep­re­sent­ing dis­tricts of­ten drawn to in­cor­po­rate strong ma­jori­ties of GOP vot­ers. Sen­a­tors rep­re­sent en­tire states, and many tend to

re­flect more prag­matic views than their House col­leagues.

Sev­eral come from north­east­ern and Mid­west­ern states with large num­bers of low-in­come peo­ple re­ceiv­ing Med­i­caid. Many of the 31 states that ac­cepted Obama’s ex­pan­sion of that pro­gram are led by GOP gov­er­nors, and sen­a­tors have no in­ter­est in cutting their states’ funds and tak­ing cov­er­age away from vot­ers.

Repub­li­can sen­a­tors also rep­re­sent states rav­aged by deaths caused by opi­oid abuse. The House mea­sure would let states es­cape Obama’s re­quire­ment that in­sur­ers cover an­tidrug ser­vices.

AP PHOTO

Peo­ple look on dur­ing a health­care rally Thurs­day, in Salt Lake City. Utah’s all-Repub­li­can House del­e­ga­tion voted Thurs­day in fa­vor of a health care over­haul. Congress may have passed the health law but now it faces a rocky ride in the U.S. Se­nate where some Repub­li­cans al­ready say they don’t like it.

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