May 04, 2017
4 min read

House narrowly passes Republican health care bill to replace Obamacare

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The U.S. House of Representatives today narrowly approved legislation to overhaul the nation’s health care system, voting by a slim margin to replace the Affordable Care Act, or ACA, with a refurbished version of a Republican-penned bill that was pulled just weeks ago because of a lack of support.

All 217 “yea” votes for the American Health Care Act (AHCA) — one more than was needed for passage — came from Republicans. Twenty GOP members and all 193 Democrats voted against the bill, which now moves to the Senate for consideration.

“Today, we take the next step to repeal and replace Obamacare,” House Speaker Paul D. Ryan (R-Wis.) said.

Republicans planned to vote on the bill in March on the seventh anniversary of the signing of the ACA, President Barack Obama’s signature health care plan, which has been a target of GOP lawmakers for years. But the legislation was pulled after President Donald J. Trump and other GOP leaders failed to secure enough votes to get it passed.

Trump campaigned heavily on repealing and replacing the ACA, and the no-vote was seen as a blow to the new administration. At the time, Ryan said the ACA would “remain the law of the land until it’s replaced. We are going to be living with ACA for the foreseeable future.”

On Thursday, Republicans delivered quite another message as they gathered at the White House for a celebratory news conference in the Rose Garden.

“We’re going to get this passed through the Senate. I feel so confident,” Trump said. “This is a great plan. I actually think it will get even better. This is a repeal and replace of ACA, make no mistake about it.”

The initial AHCA push failed because of discord within the Republican party, as conservative and moderate factions opposed the bill for different reasons. But those divides apparently narrowed over the following weeks. The conservative Freedom Caucus changed tack, supporting the AHCA based on an amendment offered by Rep. Tom MacArthur (R-N.J) that allows states to apply for waivers for certain patient protections guaranteed under the ACA.

The U.S. House of Representatives voted to replace the Affordable Care Act (ACA) with the Republican-sponsored American Health Care Act (AHCA).

Under the MacArthur amendment, states could apply to waive the mandate forbidding insurers from charging patients more money based on their health status. Critics have said this will leave individuals with pre-existing conditions facing unaffordable premiums, thus effectively stripping them of coverage. The Freedom Caucus said the amendment “will grant states the ability to repeal cost driving aspects of ACA left in place under the original AHCA.”

Other Republicans were apparently convinced to vote for the bill by an amendment providing an additional $8 billion over 5 years for high-risk pools subsidized by states and the federal government for patients who may be riskier to insure, including those with pre-existing conditions. Critics, including the ACP, have said the pools, which are touted as a way to lower costs for healthy people, will not make coverage more affordable for patients with pre-existing conditions.

“We have a lot of groups, but they all came together,” Trump said.


The AHCA — dubbed “Trumpcare” — would strip coverage for 10 essential health benefits mandated by the ACA, including emergency services, maternity and newborn care, and mental and behavioral health benefits. It would eliminate the insurance mandate established by the ACA requiring Americans to have health care or face a tax.

“It was dead. It died. It died right here on the floor,” House Minority Leader Nancy Pelosi (D-Calif.) said Thursday of the AHCA. “Now it’s come back to life like a zombie, even more scary than before.”

ACP President Jack Ende, MD, MACP, said he was “extremely disappointed” that the legislation passed.

“This vote makes coverage unaffordable for people with pre-existing conditions, allows insurers to opt-out of covering essential benefits like cancer screening, mental health, and maternity care, and cuts and caps the federal contribution to Medicaid while sunsetting Medicaid expansion,” Ende said in a statement. “As a result, an estimated 24 million Americans will lose their coverage, and many more will be at risk of paying higher premiums and deductibles.”

The AHCA has been criticized by numerous other medical organizations, including the AMA, which said “tweaks” made to the legislation since March do not change what is fundamentally wrong with it. The AMA said millions of Americans would lose coverage under the bill.

The Congressional Budget Office (CBO) has not scored the most recent version of the AHCA, leaving its full cost and impact difficult to determine. However, in March, the CBO estimated that the Republican plan would lead to 24 million more uninsured people by the year 2026 than under the current law and said it would slash federal funding for Medicaid and increase premiums for older patients.

HHS Secretary Tom Price, MD, a former Republican congressman, called Thursday’s vote “a victory for the American people” and “the first step toward a patient-centered health care system.” But the legislation still has a long way to go to become a law. It will likely be revised in the Senate, where Republicans hold 52 of 100 seats, before facing approval again in both houses of Congress.

Sen. Lamar Alexander (R-Tenn.), who chairs the Committee on Health, Education, Labor and Pensions, said his goals for the AHCA include rescuing patients from what he called “collapsing” ACA health care exchanges, lowering premiums, giving states flexibility on Medicaid without “pull[ing] the rug out” from patients who rely on the program, and guaranteeing coverage for patients with pre-existing conditions.

“The Senate will now finish work on our bill, but will take the time to get it right,” Alexander said in a statement.

Republicans have repeatedly condemned the ACA since it was signed in 2010 and voted dozens of times to repeal it while Obama was in office, saying the law has raised health care costs and led to fewer options for patients.

Democrats accused Republicans of rushing the most recent version of the AHCA to a vote without appropriate debate. In a speech on the House floor, Rep. Richard E. Neal (D-Mass.) said the strategy had “all the charm of a ransom note.” – by Gerard Gallagher