GOP leaders mark major victory as House passes Obamacare repeal After narrow triumph, skeptical Senate is next
WASHINGTON — Delivering at last, triumphant House Republicans voted Thursday to repeal and replace the “Obamacare” health plan they have reviled for so long, overcoming united Democratic opposition and their own deep divisions to hand a major win to President Donald Trump.
The 217-213 vote was a narrow victory, and ultimate success is seen as far from assured since the measure must still make its way through a highly skeptical Senate. But after seven years of campaign promises and dozens of show votes, Republicans finally succeeded in passing a health care bill that has a chance of becoming law.
They weren’t waiting for final passage to celebrate, even as unease and uncertainty were settling over many Americans with serious illnesses.
“What a great group of people!” Mr. Trump exclaimed at the White House, arms raised to salute the dozens of lawmakers who hurried to join him in the Rose Garden immediately after the vote. And as the president later took a victory lap in New York City during his first trip home as president, set aside for the moment were the feuds and philosophical divides that nearly sank the bill time and again.
And at the same time, the Republicans had begun to show that perhaps they can come together and govern the country now that they control Washington in full.
“Make no mistake, this is a repeal and a replace of Obamacare, make no mistake about it,” Mr. Trump declared in Washington. “Premiums will be coming down, deductibles will be coming down, but very importantly it’s a great
plan.”
“People are suffering so badly with the ravages of Obamacare,” Mr. Trump later said in New York, adding that he was “so confident” that the measure would pass the Senate.
Democrats countered that the GOP bill would have the opposite effect from what Mr. Trump predicted, pointing to estimates it will kick millions off the insurance roles while imperiling coverage for people with pre-existing conditions who had gained protections that prevents insurers from rejecting people or charging higher rates based on their health under then-President Barack Obama’s Affordable Care Act.
“Many people with pre-existing conditions will have a hard time maintaining coverage because it just won’t be affordable,” said Larry Levitt, a health insurance expert with the Kaiser Family Foundation, which studies health care issues.
Democrats also forecast that Republicans will pay a steep political price for passing legislation that’s polled poorly and takes concrete benefits away while offering only promises of more choices and lower costs.
“You will glow in the dark on this one,” House Minority Leader Nancy Pelosi dramatically warned, predicting Republicans will be radioactive with voters in the 2018 midterm elections.
Indeed Democrats seemed practically giddy as the vote closed on the House floor, jeering at Republicans with chants of “nah, nah, nah, nah, hey, hey, goodbye” — an echo of how protesters serenaded Democrats seven years ago when they passed Mr. Obama’s bill.
The GOP health bill would eliminate the fines Mr. Obama’s law imposed on people who don’t buy coverage, and erase tax increases in the Affordable Care Act on higher-earning people and the health industry. It would cut the Medicaid program for low-income people and let states impose work requirements on Medicaid recipients. It would transform Mr. Obama’s subsidies for millions buying insurance, now based largely on their incomes, making the funding skimpier and tying it to consumers’ ages.
And states could get federal waivers freeing insurers from other Obama coverage requirements. With waivers, insurers could charge people with pre-existing illnesses far higher rates than healthy customers, boost prices for older people to whatever they wish, and ignore a mandate that they cover specified services like pregnancy care.
The bill would block federal payments to Planned Parenthood for a year, considered a triumph by many anti-abortion Republicans.
The Congressional Budget Office estimated in March that the GOP bill would end coverage for 24 million people over a decade. The House voted without a CBO estimate for the latest version of their bill.
Although it’s focused mostly on the minority of Americans who buy health coverage in the individual market, the GOP bill could also significantly impact the many who are covered by large employer plans. In one little-noted provision, employer plans could take advantage of state flexibility under the legislation to pick and choose which states’ rules to live by. That could allow them to impose annual and lifetime coverage limits, which are prohibited under Obamacare, and get rid of certain annual out-of-pocket spending caps.
Meanwhile, the future of the bill remains highly uncertain as Senate Republicans expressed deep reservations about the potential that Americans will lose their health care coverage under the measure.
Several Senate leaders, including health committee Chairman Lamar Alexander, R-Tenn., indicated Thursday they wanted to take a very different approach, proceeding slowly with a new bill that would not jeopardize coverage for as many people as the House measure.
“To the extent that the House solves problems, we might borrow ideas,” said Mr. Alexander, who added that Senate Republicans have been quietly working for several months on their own bill. “We can go to conference with the House, or they can pass our bill.”
That means that any Senate progress on health legislation could probably take weeks, if not months, and could pose a serious challenge if it must be reconciled with the House version, which was crafted to win over the most conservative wing of the party.
Senate Republicans will face some of the same dynamics that stymied the House for weeks. Moderate senators will demand concessions, which in turn could alienate a trio of hardliners: Sens. Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah.
In the House, of 20 Republicans who voted no, four were from Pennsylvania: U.S. Reps. Ryan Costello of Chester County, Charlie Dent of Allentown, Pat Meehan of Delaware County and Sean Fitzpatrick of Bucks County.
In Western Pennsylvania, as in most of the rest of the country, members — including Tim Murphy, R-Upper St. Clair; Mike Doyle, D-Forest Hills; Rep. Keith Rothfus, R-Sewickley; and Mike Kelly, R-Butler — voted along party lines.
Protesters were on hand for Thursday’s vote, shouting “Shame on you! Shame on you!” and “2018! 2018!” as Republicans boarded buses outside the Capitol to head to the White House.
The White House had pushed hard for a vote, and Mr. Trump got personally involved in last-minute maneuvering. He helped bring wavering moderates on board after a deal secured by conservatives last week scared them off by limiting protections for people with pre-existing conditions. The final change, agreed to just Wednesday at the White House, was to add $8 billion over five years to help people with pre-existing conditions, a sum critics called a relative pittance.
Indeed, despite assurances by GOP leaders that their legislation would rescue a failing health care system, it was opposed by nearly all medical and consumer groups, from the American Medical Association to AARP. The Chamber of Commerce supported the bill.