House Republicans claim a major victory with passage of health-care overhaul
By Ed O'Keefe, Paige Winfield Cunningham and Amy Goldstein
May 4 at 6:09 PM - The Washington Post
House Republicans on Thursday narrowly passed a controversial bill to
overhaul the nationfs 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
through the bill after adopting a last-minute change that earned it just enough
votes to pass. However, the House version fell significantly short of the GOPfs
long-held goals, making major dents in large portions of the current law but not
outright repealing it.
The bumpy, months-long process that led to Thursdayfs vote also violated some
of the GOPfs own promises on how they 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 hadnft read the
bill. President Trump also promised ginsurance for everybody,h which the measure
will not achieve.
The American Health Care Act, which passed by a vote of 217 to 213,
nonetheless represented a significant if incomplete political victory for
President Trump, who has struggled to secure legislative wins early in his
presidency. The vote was also an important win for House Speaker Paul D. 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 ACAfs subsidies for eligible people who buy health
plans through marketplaces created under the law, creating and substituting new
tax credits. It 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 billfs more contentious provisions is one that would allow states
to let insurers return to their old practice of charging more to customers with
preexisting medical problems — a practice that 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.
gWefre going to get this passed through the Senate — Ifm so confident,h Trump
said.
gThis has really brought the Republican Party together,h he added.
Democrats, however, held their own celebration of sorts immediately after the
vote, waving to Republicans on the House floor and chanting, gHey, hey, hey,
goodbyeh — 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-Calif.) noted that
while many Americans canft name their member of Congress, Thursdayfs vote would
earn their ire.
gYou will glow in the dark on this one,h Pelosi warned. gSo donft walk the
plank, especially unnecessarily.h
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.
And the nationfs health insurance industry, which has been
lobbying for an aspect of the bill that would eliminate an ACA tax on insurers,
nevertheless reacted critically to the House vote. The legislation gneeds
important improvements to protect low- and moderate-income families,h said
Marilyn Tavenner, president of the trade group Americafs Health Insurance Plans.
She cited changes the bill would make to Medicaid and to tax credits for older
Americans who buy coverage on their own, as well as lingering uncertainty over
the fate of an ACA subsidy that helps nearly 6 million Americans with insurance
co-pays and deductibles.
Every Democrat and 20 Republicans voted against the measure, the latter a mix
of ardent conservatives upset that the bill didnft 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
wouldnft — are likely to fuel the nature and intensity of that fallout.
For instance, the measure does not eliminate the ACAfs 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 gcaph
with a fixed amount per person.
The vote capped a haphazard, months-long process that began before Trumpfs
inauguration but quickly became mired in intraparty disagreement over how
Republicans should make good on the campaign promise they had been running — and
winning — on since 2010, when then-President Obamafs signature domestic policy
achievement became law.
In March, Ryan pulled an earlier version of the measure after it became clear
that he did not have the votes to pass it — primarily because of strong
opposition from the conservative House Freedom Caucus.
After a two-week Easter recess, however, negotiations resumed, and
Republicans came up with a new proposal that garnered support from Freedom
Caucus members by allowing states to eliminate parts of the ACA that require
insurers to include specific gessential health benefitsh in health plans sold to
individuals and small business and to set their own coverage requirements or
none at all. The new version also added the language affecting customers with
preexisting medical conditions.
The new proposal, however, threatened support among members of the Housefs
more moderate Tuesday Group. That, in turn, prompted yet another tweak this week
to add $8 billion to help people with preexisting conditions pay for their
health-care costs.
The amendment prompted powerful objections from a wide range of health policy
experts and advocates, who questioned whether the amount of money was sufficient
to help all the Americans who would need it.
It also revived questions about the measurefs fate in the Senate, where
widespread disagreement remains among Republicans about how to proceed on health
care. First, the Senatefs parliamentarian — or rules-keeper — cannot review the
legislation and determine the rules of debate until the CBO submits its official
estimate, which could take several more weeks to complete, according to
congressional aides. That would mean that official Senate debate on the bill
could not begin until June.
Sen. John Cornyn (R-Tex.), the second-ranking Republican, declined to commit
to a schedule for when the Senate will begin consideration of the House health
care rewrite.
gThere is no timeline,h he said. gWhen we get 51 senators wefll vote.h
But other senators made clear that the process would be more deliberative in
the upper chamber of Congress.
gA bill — finalized yesterday, has not been scored, amendments not allowed,
and 3 hours final debate — should be viewed with caution,h Sen. Lindsey O.
Graham (R-S.C.) tweeted on Thursday before the House vote.
House Republicans insisted that they were not ramming their health-care bill
through without giving members a chance to absorb it — as they accused Democrats
of doing when the ACA was passed in 2010.
Democrats gput a 2,000-page bill on the table they knew no one had time to
read, and wefre not doing that,h said Rep. H. Morgan Griffith (R-Va.).
gThis is a rough and tumble exercise that the Founding Fathers anticipated,h
he added.
House Freedom Caucus Chairman Mark Meadows (R-N.C.) said he was willing to
abandon his previous demands that leaders allow hearings and discussion of the
legislation because members had opportunities to weigh in on amendments over the
past several days. The decision marked a measurable shift for hard-line Freedom
Caucus members, who have insisted that leaders give them ample time to read
legislation and weigh in before a bill comes up for a vote.
gI have read the bill no less than six times,h Meadows said. gIf they havenft
read the bill it is because they havenft spent the time to do that.h
Republicans also disregarded the absence of a final estimate from the
nonpartisan Congressional Budget Office — Congressfs official scorekeeper.
Several said that last-minute changes to the legislation were unlikely to
significantly change the final estimates.
gWefre still comfortable wefre saving billions and billions of dollars,h said
Rep. Chris Collins (R-N.Y.).
Meadows, who struggled for weeks to rally his caucus around the measure, said
the Senate will make changes he might not necessarily back.
Among other concerns, GOP senators from states that have expanded Medicaid
under the ACA worry about rollbacks to that program included in the House bill.
Then therefs a trio of conservative senators — Ted Cruz (R-Tex.), Mike Lee
(R-Utah) and Rand Paul (R-Ky.) — who often buck GOP leaders. With just a 52-48
advantage over Democrats, Senate Republicans have a smaller margin for error
than their House counterparts.
The House measure may run into other procedural roadblocks in the Senate. The
original proposal initially left many of the ACAfs insurance regulations alone —
with the goal of ensuring it would pass muster with the Senate parliamentarian —
but not all of them. The Housefs version of the bill would undercut the ACAfs
insurance regulations even more. That might make it difficult for Republican
senators to pass the measure under a procedural maneuver known as
greconciliation,h which is usually reserved for budget legislation.
Due to a series of resignations, Republicans needed just 216 votes to pass
the bill, but left nothing to chance. Even Rep. Jason Chaffetz (R-Utah),
recovering from recent foot surgery, flew back to Washington against his
doctorfs orders to vote for the bill.
gIt was a big important vote, and it was close. I didnft want to be the
reason it failed,h he told reporters.
While some Republicans were buoyant, others exhibited a palpable sense of
relief that health care is off their plates — at least for now.
gIt wasnft fun,h said Rep. Lou Barletta (R-Pa.).
Sean Sullivan, John Wagner, David Weigel, Kelsey Snell, Dino Grandoni, Elise
Viebeck and Robert Costa contributed to this report.