The bill will now go to the Senate, where Republicans are already split over the measure and Democrats are unified in opposition. Republicans hold a narrow 52-seat majority in the chamber; because they will consider the bill under special budget rules that prevent a filibuster, the GOP will need only 51 votes to pass the health care bill.Thursday’s vote in the House was hastily scheduled and came after weeks of negotiations, hours of wooing wavering Republicans, and a last-minute sweetener added to the bill: an $8 billion amendment to help patients with pre-existing conditions pay for higher premiums and out-of-pocket costs.
"There's been a lot of drama, a little bit of trauma along the way," said Rep. Tom Cole of Oklahoma, a member of the House GOP leadership. Cole and other Republicans shrugged off questions about whether they were allowing lawmakers enough time to read the bill, debate it, and understand its impact.
“We can’t wait a moment longer than necessary to provide relief,” said Rep. Diane Black, R-Tenn. “Americans are suffering from rising costs. Under Obamacare, the situation is getting worse every day.”
Last-minute amendments to the legislation were only made public late Wednesday night, and GOP pushed ahead with Thursday’s vote without having a full analysis from the Congressional Budget Office, which is charged with estimating costs and benefits of proposed legislation. A previous CBO report estimated the bill would reduce the deficit by $150 billion over 10 years and cause an estimated 24 million people to forgo or lose their insurance by 2026.
The current House bill would not fully repeal the 2010 Affordable Care Act, but it would kill major elements of that Democratic law. For example, the American Health Care Act would nix the requirement that most Americans purchase insurance, but it would keep in place a provision allowing younger Americans to stay on their parents' health plans until age 26.
The Republican proposal would repeal the ACA’s tax credits, which are based on income and the cost of health insurance in their local market, and replace those with less generous tax credits based on age. The bill would also phase out Obamacare's Medicaid expansion starting Jan. 1, 2020, with those already enrolled allowed to stay on that government program but no further expansion permitted.
The most contentious element centered on how to deal with patients who have pre-existing conditions, such as cancer, asthma, or diabetes. The Affordable Care Act bars insurance companies from discriminating against those with pre-existing conditions. The GOP bill would weaken that protection by allowing states to seek a waiver for insurance companies to charge people with pre-existing conditions higher premiums than other consumers.
That change prompted a bevy of GOP moderates to shun the measure. To shore up support on Wednesday, GOP leaders and the White House agreed to include the extra $8 billion to help patients with pre-existing health problems. That last-minute amendment won over several crucial votes and gave Republicans momentum heading into Thursday’s vote.
“It protects people with pre-existing conditions and brings premiums down,” said Rep. Tom MacArthur, R-N.J., a moderate who helped negotiate the final package.
"This bill is fundamentally harmful to patients," the letter stated.Democrats echoed that in the debate, saying the last-minute changes would do next to nothing to help those with pre-existing conditions.
"The Republican health care bill is reckless and heartless," Rep. Rosa DeLauro, D-Conn., said. "It will have threatening consequences for millions of Americans. It will cost lives."With Democrats unified against the measure, GOP leaders could only lose about 22 Republicans and still pass the bill. They spent weeks in a tug-of-war between the moderate and conservative factions inside the House Republican Conference, adding provisions to appease each group in delicate political balancing act.
The vote count remained highly fluid even on Thursday morning as House leaders and President Trump lobbied individual holdouts and won over converts.
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