Triumph: 217-213 House vote moves ‘Trumpcare’ to Senate
WASHINGTON — House Republicans on Thursday narrowly passed a controversial bill to overhaul the nation’s health care system, claiming a major victory even as the measure faces an uncertain fate in the closely divided U.S. Senate.
Under intense pressure to show they can govern and to make good on their promise to repeal and replace the Affordable Care Act, Republicans pushed the bill through after adopting a last-minute change that earned it just enough votes to pass. However, the House version fell significantly short of the GOP’s long-held goals, making major dents in large portions of the current law but not outright repealing it.
The bumpy, monthslong process that led to Thursday’s vote also violated some of the GOP’s promises on how it would govern.
The measure proceeded without the benefit of an analysis from the Congressional Budget Office of its cost and impact on insurance coverage, and it did so after many Republicans openly acknowledged that they hadn’t read the bill. President Donald Trump also promised “insurance for everybody,” which the measure will not achieve.
The American Health Care Act, which passed by a vote of 217-213, nonetheless represented a significant if incomplete political victory for Trump, who has struggled to secure legislative wins early in his presidency. The vote was also an important win for House Speaker Paul Ryan, R-Wis., who has spent years trying to dismantle “Obamacare” but has struggled in recent months to unite an ideologically divided caucus.
The House bill would shift power to states to set important health insurance rules. And it would end the ACA’s subsidies for eligible people who buy health plans through marketplaces created under the law, creating and substituting new tax credits. The measure also would rescind several taxes that have helped pay for the law, including ones imposed on Americans with high incomes, health insurers, medical devices and tanning salons.
Among the bill’s more contentious provisions is one that would allow states to let insurers return to their old practice of charging more to customers with pre-existing medical problems — a practice that the current law prohibits.
Republicans claimed credit for taking a first step toward meeting their promise with a televised celebration in the White House Rose Garden — which Trump attended after postponing a long-planned event in New York with Australian Prime Minister Malcolm Turnbull to commemorate the 75th anniversary of the Battle of the Coral Sea.
“We’re going to get this passed through the Senate — I’m so confident,” Trump said.
“This has really brought the Republican Party together,” he added.
Trump basked in adulation as lawmakers heaped praise on him. Ryan touted his leadership, thank- ing Trump and Pence for “working to get this right, for getting this done and getting us to where we are.” Rep. Mark Meadows, R-N.C., chairman of the conservative House Freedom Caucus, heralded Trump as “a president who wouldn’t give up, a president who got engaged.”
“How am I doing?” Trump asked, before answering his own question and posing another. “I’m president. Hey, I’m president. Do you believe it, right?”
Democrats, however, held their own celebration of sorts immediately after the vote, waving to Republicans on the House floor and chanting, “Hey, hey, hey, goodbye” — an apparent taunt suggesting that Republicans would lose elections next year as a result of the vote.
Before the vote, House Minority Leader Nancy Pelosi, D-San Francisco, noted that while many Americans can’t name their member of Congress, Thursday’s vote would earn their ire.
“You will glow in the dark on this one,” Pelosi warned. “So don’t walk the plank, especially unnecessarily.”
The political positioning over the bill started immediately, with the GOP claiming that it would lower premiums and increase access to health insurance and Democrats casting it as a huge transfer of wealth because it would eliminate many of the taxes imposed under the Affordable Care Act, including on wealthy Americans.
Every Democrat and 20 Republicans voted against the measure, the latter a mix of ardent conservatives upset that the bill didn’t fully repeal Obamacare and members from suburban swing districts worried about the political fallout. The wide-ranging interpretations of whether the bill would gut the current law — or wouldn’t — are likely to fuel the nature and intensity of that fallout.
For instance, the measure does not eliminate the ACA’s requirement that most Americans carry health insurance, although the penalty for not having coverage would be erased. In its place, insurers would be allowed to charge 30 percent higher premiums for one year to customers who have had a gap in coverage of roughly two months or more.
Medicaid would also be transformed in two ways. For the 31 states that expanded the safety-net program under the ACA to include people with slightly higher incomes, the government would immediately stop paying for anyone new to enroll under the expansion and would eventually stop the extra federal money that came with the expansion. Starting in a few years, Medicaid would also end its half-century tradition as an entitlement program in which the government pays a certain share for each person who enrolls, switching instead to a “cap” with a fixed amount per person.