House Approves Obamacare Repeal Bill

May 4, 2017 - By Kyle Cheney, John Bresnahan & Rachael Bade

The House passed legislation Thursday to repeal and replace Obamacare, as Republicans came closer than ever to realizing their seven-year pledge to overturn the Democratic law and remake health insurance for millions of Americans.

The plan, the American Health Care Act, was approved mostly along partisan lines, 217-213, with just one vote to spare. No Democrats backed the bill, and a slew of Republicans opposed it as well.

The vote is a major victory for President Donald Trump and Ryan after months of false-starts and intra-party dissension. Immediately after the vote, Republicans ditched the Capitol for the White House to celebrate alongside the president in the Rose Garden.

"A lot of us have been waiting seven years to cast this vote," Speaker Paul Ryan (R-Wis.) said on the House floor just before the vote, adding that many Republicans were elected on a promise to end the Democratic health care law. "Are we going to meet this test? Are we going to be men and women of our word?"

But the bill’s passage is far from assured in a skeptical Senate. The only guarantee so far is the seismic political impact. For House Republicans, it’s the fulfillment of a seven-year promise to backa bill gutting the 2010 health law. For Democrats, it’s a chance to harness surging energy of Obamacare defenders to oust Republican lawmakers from office.

In the moments after the vote, liberal activist groups claimed they raised hundreds of thousands of dollars, and Democrats made clear how they see the aftermath playing out: "Na na na na, hey, hey, hey, good bye!" they sang while waving at Republicans immediately after the vote closed. Protesters on the steps of the Capitol chanted "2018."

Some of their ripest targets who backed the bill — such as Rep. Darrell Issa (R-Calif.), Carlos Curbelo (R-Fla.) and Adam Kinzinger (R-Ill.) — hail from districts where Hillary Clinton won in November and were already high on Democratic target lists.
The bill now heads to the Senate where it awaits an uncertain fate. Many Senate Republicans have already signaled their concerns with the AHCA.

“A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution,” Sen. Lindsey Graham (R-S.C.) tweeted Thursday afternoon.

The vote was the product of high-pressure negotiations between various Republican factions, who often overcame a lack of trust to forge a tenuous accord. The hard-line House Freedom Caucus, which helped sink an initial version of the bill, delivered near-unanimous support for the final product after winning concessions to let states opt out of some central Obamacare regulations.

In the 24 hours before the vote, the House whip team was still squeezing support from moderates, who rebelled against the bill after the Freedom Caucus came aboard. But House vote-counters managed to corral last-minute support from members like Rep. Jeff Denham (R-Calif.) and David Valadao (R-Calif.).
Another holdout, Rep. Mark Amodei (R-Nev.), long a "no" vote, also dropped his objection late Wednesday, according to twoGOP sources. On Thursday morning, several other longtime undecided members came out in support of the bill, including Rep. John Faso (R-N.Y.) and Rep. Brian Mast (R-Fla.).

A series of high-profile Obamacare failures over the last few days also appeared to tip a few more Republicans into the "yes" column.

GOP leadership during their closed-door conference meeting Thursday pointed out that the last insurance company on the Iowa exchange just withdrew its participation this week, leaving thousands of Americans with no choice for insurance. They pointed to Aetna's withdrawal from the Virginia exchange, announced Tuesday. And they listed assorted premium increases on exchanges across the country, including one from a mega-insurance company on the Maryland exchange.

“Inaction is the worst thing we can do. There are people out there at risk of not having any coverage," Mast said as he exited the meeting. “If there are no providers out there, then people with preexisting conditions absolutely aren't covered. So this is the right thing to do."

Republicans had pleaded with colleagues to ensure the bill passed by more than a single vote, which would disarm Democratic attacks labeling them the "deciding vote" on the bill. In their closed-door conference meeting, Rep. Martha McSally (R-Ariz.) made precisely that argument, according to GOP insiders. And exiting the meeting, Rep. Chris Collins (R-N.Y.) also said he hoped the bill passed by at least two votes.

The AHCA would slash Obamacare's taxes, phase out its generous Medicaid expansion, cut down on its tax credits and — thanks to some last-minute maneuvering to win conservative support -— allow states to opt out of many of Obamacare's protections and coverage requirements.

To backers, it's a chance to throw off the regulatory yoke of the Democrat-passed law and create greater competition in health insurance. But critics, including Republican opponents, say the bill would undercut protections for the most vulnerable Americans — people with preexisting conditions who could be subject to premium spikes and reduced benefits if states opt out of the Obamacare framework.

"I’m excited about keeping the promises I made to Utah,” said Rep. Mia Love (R-Utah).

Rep. James Comer (R-Ky.), a freshman, said the sausage-making behind the AHCA was at times difficult to watch, but he's pleased with the end product, especially for his rural district.

"Thirty-one of the 35 counties in my district only have one insurance carrier — that’s Anthem. And Anthem is threatening to pull out," he said. "There is no individual insurance market in rural America."

The move to vote without a CBO assessment comes despite years of scolding attack ads from Republicans accusing Democrats of ramming through Obamacare without understanding its impacts. The CBO scored the Affordable Care Act before it was voted on. An assessment of an earlier version of the AHCA estimated that as many as 24 million more people could go without coverage under the AHCA.

It’s unclear what effect several rounds of amendments will have on the initial score, but a GOP leadership aide described thechanges as “narrow.”

A slew of medical groups and health care advocates lined up to pan the latest version of the GOP proposal, including the American Medical Association, the AARP and the American Cancer Society, which said it failed to protect people with preexisting conditions.

The vote was be particularly wrenching for Republicans who reside in districts won in November by Hillary Clinton, like Issa, Curbelo, Mike Coffman (R-Colo.) and Dave Reichert (R-Wash.) Coffman and Reichert both announced their opposition to the bill less than an hour before the vote.

Trump spent the week dialing reluctant Republicans and pleading for their votes. When two prominent lawmakers defected, threatening the latest version of the bill, Trump hosted them at the White House on Wednesday and blessed a last-minute change to the bill in order to bring them back.

"He has been an aerobic listener through this entire process," said Rep. Michael Burgess (R-Texas), one of the health care bill's top boosters in Congress, who joined Trump in the Oval Office on Wednesday to help broker the final amendment to the bill.

One daunting reality for lawmakers reluctantly backing the bill is the near-certainty that many of its most controversial provisions could be dropped by the Senate, leaving only House members on the hook for the political costs. Senate Republicans have signaled little interest in the House version of the bill.

"Today is a really big deal but it’s really a green flag, not a checker flag. This isn’t the end of the process," said Rep. Luke Messer (R-Ind.) "In many ways it’s the start. The bill will now go to the Senate. Then it will come back from the Senate."

In a sign of the convoluted process Republican leaders are taking to try to unwind Obamacare, the AHCA includes one provision that most members hate: an exemption from the law's impacts for members of Congress and their staffs. Though Republicans insist they don't want an exemption, technical Senate budgetary rules prohibit them from removing it without dramatically diminishing the chances of getting the bill through the Senate.

Immediately before voting on the AHCA, the House unanimously passed separate legislation to eliminate the exemption, but Democrats have pounced on the fact that the bill itself still includes it.

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