Mea­sure al­lows Congress to act with­out threat from Democrats

Houston Chronicle - - FRONT PAGE - By Thomas Ka­plan and Robert Pear NEW YORK TIMES

WASHINGTON — The House gave fi­nal ap­proval Fri­day for speedy ac­tion to re­peal the Af­ford­able Care Act, putting Congress on track to undo the most sig­nif­i­cant health care law in a half cen­tury.

By a vote of 227-198, the House ap­proved a bud­get blue­print that al­lows Repub­li­cans to oblit­er­ate ma­jor pro­vi­sions of Pres­i­dent Barack Obama’s health care law with­out the threat of a Demo­cratic fil­i­buster in the Se­nate.

Pres­i­dent-elect Don­ald Trump, Speaker Paul Ryan and other Repub­li­can lead­ers face a much big­ger chal­lenge: de­vis­ing their own plan to en­sure broad ac­cess to health care and cov­er­age while con­trol­ling costs. While their party is far from a con­sen­sus on how

to re­place the health care law — un­der which more than 20 mil­lion Amer­i­cans have gained health in­sur­ance — they will need votes from Democrats in the Se­nate to en­act a ro­bust re­place­ment plan.

Repub­li­cans have ar­gued that Amer­i­cans have been crushed by soar­ing pre­mi­ums and other un­in­tended ef­fects of the law, which was adopted with­out any Repub­li­can votes.

The vote, com­ing a week be­fore Trump’s in­au­gu­ra­tion, places Repub­li­cans squarely in po­si­tion to ac­com­plish their longheld goal of dis­man­tling Obama’s sig­na­ture do­mes­tic achieve­ment.

“This is a crit­i­cal first step to­ward de­liv­er­ing re­lief to Amer­i­cans who are strug­gling un­der this law,” House Speaker Paul Ryan of Wis­con­sin said, adding of the health care law, “This ex­per­i­ment has failed.”

Democrats warned that re­peal of the health law would cause hard­ship for mil­lions of Amer­i­cans and cre­ate chaos in in­sur­ance mar­kets and in the health care sys­tem, which ac­counts for about 18 per­cent of the na­tion’s econ­omy.

“If we go down this path, we won’t have re­peal and re­place,” said Rep. John Yar­muth of Kentucky, the se­nior Demo­crat on the House Bud­get Com­mit­tee. “What we’ll have is re­peal and re­pent, be­cause we’re go­ing to owe a huge apol­ogy to the Amer­i­can peo­ple for the dam­age that we cause.”

“There’s still no plan for what comes next, threat­en­ing mas­sive dis­rup­tion to the en­tire health care sys­tem,” said Rep. Suzan DelBene, D-Wash.

In the days be­fore the House vote, some con­ser­va­tive Repub­li­cans as well as mod­er­ates ex­pressed dis­com­fort about sign­ing off on the bud­get mea­sure with­out hav­ing a clearer pic­ture of how and when Repub­li­can lead­ers planned to go about re­plac­ing the health care law. Nine House Repub­li­cans ended up vot­ing against the bud­get blue­print Fri­day. No Democrats voted for it.

The votes this week — essentially pro­ce­dural steps — rep­re­sented the first of sev­eral moves that Repub­li­cans plan to make as they de­mol­ish the law that Obama so fre­quently lauded.

In the next few weeks, they say, they will try to de­vise a re­place­ment, work­ing closely with Trump and the man he has cho­sen to lead the Depart­ment of Health and Hu­man Ser­vices, Rep. Tom Price, R-Ga.

Four com­mit­tees — two in the Se­nate, two in the House — will write lan­guage re­peal­ing ma­jor pro­vi­sions of the 2010 health law. The re­sult­ing leg­is­la­tion can be passed with sim­ple ma­jori­ties in both cham­bers and will be immune to a fil­i­buster in the Se­nate.

Then, Repub­li­cans say, they will pass one or more free-stand­ing bills to re­place se­lected pro­vi­sions of the Af­ford­able Care Act. In the Se­nate, where Repub­li­cans hold 52 seats, they will need 60 votes to pass such leg­is­la­tion and will there­fore need help from Democrats.

Trump voiced sup­port this week for re­peal­ing and re­plac­ing the health care law nearly si­mul­ta­ne­ously, though it re­mained to be seen how Repub­li­cans in the Se­nate would be able to win over enough Demo­cratic sup­port to put in place a ro­bust re­place­ment for the ex­ist­ing health care law, given the need for those 60 votes.

Democrats tried to draw at­ten­tion to what they said would be the dev­as­tat­ing con­se­quences of re­peal­ing the health care law.

Repub­li­cans, though, were ea­ger to de­liver on a cen­tral cam­paign prom­ise. Rep. John Shimkus, R-Ill., said no one should be sur­prised that Repub­li­cans were mov­ing swiftly to re­peal the health law be­cause they won con­trol of the House in 2010, the Se­nate in 2014 and the White House in 2016 with prom­ises to do just that.

“The pub­lic has ren­dered judg­ment,” Shimkus said.

Al Drago / New York Times

House Speaker Paul Ryan, R-Wis., and other Repub­li­cans are set to make good on their vows to re­peal the Af­ford­able Care Act. “This is a crit­i­cal first step to­ward de­liv­er­ing re­lief to Amer­i­cans who are strug­gling un­der this law,” Ryan said.

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