Congress clears way for health-law repeal,

Republicans far from consensus on what comes next.

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 largely party-line 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.

The vote, coming a week before President-elect Donald Trump’s inauguration, places Republicans squarely in position to accomplish their long-held goal of dismantling Obama’s signature domestic achievement.

But the quick action by Congress adds urgency to the vexing question of what comes next. While pursuing repeal with zeal, Republicans are far from a consensus on how to go about replacing the health care law, under which more than 20 million Americans have gained health insurance.

Republicans have repeatedly pledged to repeal the Affordable Care Act. Now they say they are intent on keeping their promise to Americans who have been crushed by soaring premiums and other unintended effects of the law, which was adopted without any Republican votes.

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

Democrats warned that repeal of the 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.

The Senate had approved the budget blueprint early Thursday by a vote of 51-48.

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 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 provisions repealing major sections 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.

In the House debate Friday, Republicans and Democrats offered wildly differing views of health care and health insurance.

Echoing a complaint from their colleagues in the Senate, Democrats asked how Republicans planned to go about replacing the law — a complex, arduous task, as many Democrats know from their own experience developing and passing the health law.

“When you put pen to paper, all hell is going to break loose on your side,” said Rep. Peter Welch, D-Vt.

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

Over and over, after a Republican member spoke out against the law, Yarmuth, the senior Democrat on the House Budget Committee, offered several alarming data points specific to the member’s home state, including how many people would lose insurance.