House finally wins Obamacare repeal
Republicans breathe ‘sigh of relief’ after 217-213 vote to undo Affordable Care Act. Bill rolls back Medicaid expansion in states, faces uncertain future in Senate.
The House on WASHINGTON — Thursday narrowly approved a bill to repeal and replace major parts of the health care law, as Republicans recovered from their earlier failures and moved a step closer to delivering their promise to reshape U.S. health care without mandated insurance coverage.
The vote, 217-213, on President Donald Trump’s 105th day in office, keeps alive the Republican dream to unwind the signature legislative achievement of former President Barack Obama. The House measure faces profound uncertainty in the Senate, where the legislation’s steep spending cuts will almost certainly be moderated. Any legislation that can get through the Senate will again have to clear the House and its conservative majority.
Passage of the health care bill completed a remarkable act of political resuscitation, six weeks after House leaders failed to muster the votes to pass an earlier version of their bill, a blow to Trump and House Speaker Paul Ryan.
Ryan closed the debate saying that a continuation of the Obama health care law would be intolerable.
“It means even higher premiums, even fewer choices, even more insurance companies pulling out, even more uncertainty and even more chaos,” he said.
“What protection is Obamacare if there is no health care plan to purchase in your state?” Ryan asked.
Many Republicans were simply glad the fight was over — for now.
“We are all breathing a sigh of relief,” Rep. Chris Collins, R-N.Y., said. “We’re living up to a campaign promise we made, the Senate made, the president made.”
Democrats vowed to make Republicans pay a high political price for pushing such unpopular legislation. Twenty Republicans crossed the aisle to vote against the bill, which, like the health care law itself, passed without any votes from the minority party. As the Republicans voted, Democrats heckled them with “Nah nah nah nah, hey hey hey, goodbye.”
“I have never seen political suicide in my life like I’m seeing today,” said Rep. Louise Slaughter, D-N.Y.
Rep. Nancy Pelosi, the Democratic leader, warned moderate Republicans who supported the measure: “You have every provision of this bill tattooed on your forehead. You will glow in the dark.”
The House bill would eliminate tax penalties for people who go without health insurance. It would also roll back state-by-state expansions of Medicaid, which covered millions of low-income Americans.
In place of government-subsidized insurance policies offered exclusively on the health care law’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending mainly on age. A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making over $75,000 a year and families making over $150,000.
The nonpartisan Congressional Budget Office said the first version of the bill would trim the federal budget deficit considerably but would also leave 24 million more Americans without health insurance after a decade. Insurance premiums would spike next year before settling lower after a decade.
The vote Thursday, just before House members were to leave for an 11-day recess, shifts the focus to the Senate, where a number of Republicans have expressed significant concerns over the House plan.
Republican senators are certain to face pressure from governors worried about constituents on Medicaid losing their coverage. Republican leaders changed the House bill to woo hard-line conservatives, allowing state governments to roll back required coverage for “essential” services like maternity and emergency care. States could also seek waivers that would let insurers charge higher premiums for customers with pre-existing medical conditions. Those changes could be rejected by moderate Republican senators.
And Democrats are confident that some provisions of the House bill will not comply with special budget rules that Republicans must follow in order to skirt a Senate filibuster.
The House vote Thursday occurred before the Congressional Budget Office had released a new analysis of the revised bill with its cost and impact. Democrats angrily questioned how Republicans could vote on a bill that would affect millions of people and a large slice of the U.S. economy without knowing the ramifications.
The Republican bill, the American Health Care Act, would make profound changes to Medicaid, the health program for low-income people, ending its status as an open-ended entitlement. States would receive an allotment of federal money for each beneficiary, or, as an alternative, they could take the money in a lump sum as a block grant, with fewer federal requirements. The bill would also repeal many of the taxes imposed by the health care law on high-income people, insurers and drug companies.
Rep. Michael C. Burgess, R-Lewisville, chairman of the health subcommittee of the Energy and Commerce Committee, said, “The Affordable Care Act has left the individual market in shambles and has driven insurers away from offering coverage.”
Rep. Lloyd Doggett, D-Austin, said Republicans did not know how much the latest version of the bill would cost taxpayers or how many families would lose health coverage.
“They know only that the Pied Piper of Trump Tower is playing a tune today, and they must dance,” he said.