The House of Representatives in the US on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, otherwise known as Obamacare, as Republicans recovered from their earlier failures to hand over a first legislative victory to Donald Trump since he assumed office in January.
The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Whereas, twenty Republicans bolted from their leadership to vote no, but the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement.
The health care bill passed by the House faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch.
“To the extent that the House solves problems, we might borrow ideas,” said Senator Lamar Alexander of Tennessee, chairman of the Senate health committee. “We can go to conference with the House, or they can pass our bill.”
Even before the vote, some Republican senators had expressed deep reservations about one of the most important provisions of the House bill, which would roll back the expansion of Medicaid under the Affordable Care Act.
But a softening of the House bill, which could help it get through the Senate, would present new problems. For any repeal measure to become law, the House and the Senate would have to agree on the language, a formidable challenge.
After weeks of negotiations and false starts, Mr. Trump and House Republicans were not about to dwell on the tough road ahead. Passage of the health care bill completed a remarkable act of political resuscitation, six weeks after House leaders failed to muster the votes to pass an earlier version of the measure, a blow to Mr. Trump and Speaker Paul Ryan.
Mr. Trump quickly turned his attention to pressuring the Senate to act, calling the majority leader, Mitch McConnell, Republican of Kentucky, to talk about the way forward for the health plan.
Democrats, who voted unanimously against the bill, vowed to make Republicans pay a political price for pushing such unpopular legislation. As Republicans reached the threshold for passage, Democrats serenaded them with, “Na na na na, na na na na, hey hey hey, goodbye!”
“I have never seen political suicide in my life like I’m seeing today,” Representative Louise M. Slaughter, Democrat of New York, said on the House floor before the vote.
The House bill would eliminate tax penalties for people who go without health insurance. It would roll back state-by-state expansions of Medicaid, which covered millions of low-income Americans. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.
A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making over $75,000 a year and families making over $150,000.
The nonpartisan Congressional Budget Office said the first version of the bill would trim the federal budget deficit considerably but would also leave 24 million more Americans without health insurance after a decade. Average insurance premiums would be 15 percent to 20 percent higher in 2018 and 2019, but after that, they would be lower than projected under current law.
Republican senators are certain to face pressure from governors worried about constituents on Medicaid losing their coverage. Republican leaders changed the House bill to woo hard-line conservatives, allowing state governments to roll back required coverage for essential services like maternity and emergency care. States could also seek waivers that would let insurers charge higher premiums for some people with pre-existing medical conditions.
Democrats are confident that some provisions of the House bill will be found to violate special budget rules that Republicans must follow in order to scale through the Senate hurdle.
Republicans have promised for seven years to repeal the Affordable Care Act, under which around 20 million Americans gained health coverage. But they had no consensus on how much of the law should be repealed and had great difficulty devising a comprehensive replacement. Their doubts were reinforced by constituents who said the health law had saved their lives.
Doctors, hospitals and other health care providers joined patient advocacy groups like the American Cancer Society and AARP in opposing the repeal bill.
But House Republicans said that insurance markets in many states were already melting down, and they pointed to Iowa, where the last major insurer under the Affordable Care Act has threatened to pull out.
The bill in the coming days could face a long legislative battle as the Democrats have vowed to block it at the Senate level, saying it could result into a major health crisis in the US by taking away health insurance coverage from millions of Americans.
