House passes AHCA, now fate of Obamacare is in the Senate
Republican leaders last week cleared a major hurdle in their pledge to undo the Affordable Care Act, but they still have miles to go before they can declare outright victory.
Senate GOP leaders immediately tempered any enthusiasm that may have burgeoned after the House’s narrow 217-213 approval of the American Health Care Act by cautioning that they will significantly overhaul the package, if not write their own version.
“As we work to fulfill our promise to our constituents to repeal and replace the law in the Senate, we will be guided by the important principles to address costs and give American families more choices,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said in a statement. “At the same time, we will be working to put together a package that reflects our members’ priorities with the explicit goal of getting 51 votes. Coupled with the constraints imposed by the budget reconciliation process, we must manage expectations and remain focused on the art of the doable as we move forward.”
Budget reconciliation allows the bill to pass with a simple majority rather than having to get 60 votes. Even so, Republicans can ill afford to have any defections. They’ll also have to clear a procedural hurdle known as the Byrd rule, which requires that a bill moving through budget reconciliation be focused on the federal deficit. Democrats and some advocacy groups indicated that they will raise concerns that provisions in the AHCA affecting such things as essential benefits and pre-ex- isting conditions fall outside of that scope.
This was the GOP’s first successful attempt to move legislation to repeal the ACA since President Donald Trump took office. The House had twice failed to garner enough votes to bring the bill to a vote.
“We can continue with the status quo under Obamacare. We know what that looks like,” House Speaker Paul Ryan (R-Wis.) said during the floor debate. “It means even higher premiums. Even fewer choices. Even more insurers pulling out. Even more uncertainty and chaos. We can put this collapsing law behind us. ... End this failed experiment.”
Senate leaders will press ahead, albeit at a more deliberate pace. Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor and Pensions Committee, promised to finish the work on replacing the ACA, “but it will take time to get it right,” adding that he wants to give states more flexibility on Medicaid, but doing so “in a way that does not pull the rug out from under people who rely on Medicaid.” Alexander said he also wants to ensure that people with pre-existing conditions continue to have access to insurance.
The House bill embraces the
“Coupled with the constraints imposed by the budget reconciliation process, we must manage expectations and remain focused on the art of the doable as we move forward.” Senate Finance Committee Chairman Orrin Hatch (R-Utah)
GOP mandate of handing states more authority in shaping health coverage, giving them the option of returning to a pre-Obamacare individual insurance approach of medical underwriting and high-risk pools.
Although the latest tweaks to the bill revolved around treatment of high- cost customers on the exchanges in an effort to win moderate votes, the ACHA’s biggest impact is effectively ending the Medicaid expansion after 2020. The majority of people who have gained coverage under the ACA have obtained it through Medicaid— about 14.5 million people— including 5 million who already qualified for the government health insurance but hadn’t previously applied for it.
“Rural hospitals will close, 2 million jobs will be destroyed across America, and all of this to give a massive tax cut to the richest in America,” House Minority Leader Nancy Pelosi said. “It’s Robin Hood in reverse.”
Beyond the debate over Medicaid, which has some GOP governors concerned as well, election math be a factor. Next year, eight GOP senators face re-election, including Sens. Jeff Flake (R-Ariz.) and Dean Heller (R-Nev.). Both hail from Medicaid expansion states. The rest of the GOP caucus won’t face reelection until 2020 or 2022, freeing them from some of the political pressure that faced their colleagues in the House.
If a bill clears the Senate, it will have to reconciled with the House bill. The Senate process is expected to take several weeks.