The House passed the first ma­jor ex­pan­sion of the Af­ford­able Care Act, com­pelling Se­nate Repub­li­cans to cast an elec­tion-year vote.

The Washington Post - - FRONT PAGE - BY AMY GOLD­STEIN amy.gold­stein@wash­post.com

The House Mon­day passed the first sig­nif­i­cant ex­pan­sion of the Af­ford­able Care Act since its birth a decade ago, pro­vid­ing Democrats a high-wattage plat­form to cas­ti­gate Pres­i­dent Trump for his ef­forts to over­turn the land­mark law dur­ing a pan­demic and an elec­tion year.

The 234-to-179 vote, al­most en­tirely along party lines, was a hol­low ex­er­cise in terms of any chance the bill would be­come law and re­shape fed­eral health pol­icy. Mo­ments after the de­bate be­gan, the White House an­nounced the pres­i­dent would veto the leg­is­la­tion if it reached his desk, though a wall of Se­nate Repub­li­can op­po­si­tion to the mea­sure makes that a moot point.

Still, the vote was laden with po­lit­i­cal im­pli­ca­tions. Less than five months be­fore pres­i­den­tial and con­gres­sional elec­tions, it forced Repub­li­cans to go on the record about the ACA and showed anew the par­ties’ highly charged ide­o­log­i­cal dif­fer­ences on health care — an is­sue that con­sis­tently polls as a prime con­cern among U.S. vot­ers. Democrats por­trayed them­selves as cham­pi­ons of ac­cess to af­ford­able care at a crit­i­cal time. Repub­li­cans char­ac­ter­ized the op­pos­ing party as au­thors of a failed law and pro­po­nents of tax in­creases.

His­tor­i­cally, Democrats en­gen­der greater pub­lic trust than Repub­li­cans on their han­dling of the is­sue, and ar­gu­ments that the GOP sought to de­prive con­sumers of health care helped Democrats take the House ma­jor­ity two years ago.

Mon­day’s vote sym­bol­ized that House Democrats have a path to make health in­sur­ance and treat­ment more ac­ces­si­ble at a mo­ment when the novel coro­n­avirus — and the jobs the pan­demic has cost — has strained the U.S. health sys­tem, robbed mil­lions of Amer­i­cans of health ben­e­fits and caused nearly 125,000 deaths na­tion­wide.

The leg­is­la­tion would add to some of the ACA’S cen­tral el­e­ments by ex­pand­ing el­i­gi­bil­ity for in­sur­ance sub­si­dies to those at higher in­comes and pres­sur­ing more than a dozen states to ex­pand Med­i­caid. It also would blunt some of the ways the Trump ad­min­is­tra­tion has wa­tered down the law.

The hours of de­bate be­fore the vote al­lowed Democrats to point out, again and again, that the Trump ad­min­is­tra­tion is seek­ing to in­val­i­date the ACA in a law­suit be­fore the Supreme Court that was ini­ti­ated by a group of Repub­li­can at­tor­neys gen­eral who con­tend the en­tire law is un­con­sti­tu­tional.

“As lives are shat­tered by the coro­n­avirus, the pro­tec­tions of the Af­ford­able Care Act are more im­por­tant now, more than ever,” said House Speaker Nancy Pelosi (D- Calif.). Not­ing that both Trump and con­gres­sional Repub­li­cans prom­ise to pre­serve the law’s pro­tec­tions for peo­ple with pre­ex­ist­ing med­i­cal con­di­tions, she said: “Oh re­ally? Then why are you in the United States Supreme Court to over­turn them?”

Three years after a Repub­li­can Congress failed to pass a se­ries of ACA re­peal plans, House Ma­jor­ity Leader Steny H. Hoyer (D-MD.) ac­cused Repub­li­cans of pro­duc­ing no sub­sti­tute for the ACA.

Repub­li­cans, who have tried more than 70 times in the past decade to re­peal the ACA or un­der­cut it, cast the ACA as a fail­ure in not mak­ing health care more af­ford­able. The ACA is the “most un­pop­u­lar health care plan in Amer­i­can his­tory,” said Rep. Kevin Brady (R-tex.), se­nior Repub­li­can on the House Ways and Means Com­mit­tee.

Rep. Greg Walden (R- Ore.), the se­nior Repub­li­can on the House En­ergy and Com­merce Com­mit­tee, said the bill would put “a dagger in the heart of in­no­va­tion” in treat­ments for dis­eases by al­low­ing the gov­ern­ment a stronger hand in ne­go­ti­at­ing drug prices — and would pro­vide in­sur­ance sub­si­dies to the wealthy.

Un­der the law, fed­eral in­sur­ance mar­ket­places and sim­i­lar state ones opened in 2014 for in­di­vid­u­als and fam­i­lies who can­not get af­ford­able health ben­e­fits through a job. The law pro­vides fed­eral sub­si­dies for in­sur­ance pre­mi­ums for those with in­comes up to 400 per­cent of the fed­eral poverty level — about $51,000 for an in­di­vid­ual and nearly $105,000 for a fam­ily of four.

The bill would elim­i­nate the 400 per­cent thresh­old, say­ing for the first time that no one would be re­quired to pay more than 8.5 per­cent of their in­come on the most pop­u­lar tier of mar­ket­place health plans.

The leg­is­la­tion would place fi­nan­cial pres­sure on states that have not ex­panded Med­i­caid, the in­sur­ance pro­gram for low-in­come Amer­i­cans run jointly by the fed­eral gov­ern­ment and states. The ACA orig­i­nally ex­panded Med­i­caid na­tion­wide, but a 2012 Supreme Court rul­ing, in which jus­tices up­held the law’s con­sti­tu­tion­al­ity, gave each state the choice of whether to ex­pand Med­i­caid.

For 14 states that have not ex­panded the pro­gram, the bill would re­duce fed­eral fund­ing for tra­di­tional Med­i­caid. It would also add an in­duce­ment, pay­ing for the en­tire ini­tial cost of an ex­pan­sion — as the law did when ex­pan­sions first were al­lowed in 2014.

Med­i­caid also would guar­an­tee that all women in the pro­gram would stay el­i­gi­ble for cov­er­age for a year after they give birth — a step to ad­dress the na­tion’s high rates of med­i­cal prob­lems and deaths among new moth­ers.

Among re­ver­sals of changes the ad­min­is­tra­tion has made to the ACA, the bill would undo a rule that al­lows skimpy in­sur­ance plans to be sold for up to 12 months, re­turn­ing them to a three-month max­i­mum.

It would pro­vide $100 mil­lion a year for out­reach and en­roll­ment as­sis­tance to en­cour­age con­sumers to sign up for ACA health plans — ac­tiv­i­ties the ad­min­is­tra­tion has slashed.

The bill also in­cludes a long­time Demo­cratic goal of al­low­ing fed­eral health of­fi­cials to ne­go­ti­ate the price of drugs un­der Medi­care, the vast fed­eral in­sur­ance pro­gram for older and dis­abled Amer­i­cans. Trump used to sup­port that idea but turned against it.

In its state­ment op­pos­ing the bill, the White House said the mea­sure “at­tempts to ex­ploit the coro­n­avirus pan­demic to re­sus­ci­tate tired, par­ti­san pro­pos­als” and would un­der­mine drug de­vel­op­ment in a way that is “im­pru­dent given the cur­rent fo­cus on de­vel­op­ing vac­cines and ther­a­peu­tics rapidly to help Amer­ica and the world com­bat the coro­n­avirus.”

En­ergy and Com­merce Com­mit­tee Chair­man Frank Pal­lone Jr. (D-N. J.) coun­tered the bill “is a com­mon­sense, fis­cally re­spon­si­ble one-two punch that uses the fed­eral gov­ern­ment’s sav­ings from low­er­ing pre­scrip­tion drug costs to lower health in­sur­ance costs for Amer­i­cans.”

MANUEL BALCE CENETA/AS­SO­CI­ATED PRESS

House Speaker Nancy Pelosi (D-calif.) speaks dur­ing a news con­fer­ence in Washington on Wed­nes­day.

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