American Health Care Act Passes House, Now Heads To Senate

WASHINGTON, DC — Republicans in the House of Representatives passed the American Health Care Act Thursday by the slim margin of 217-213 with no Democratic votes. GOP leadership has partially recovered its wounded pride after its embarrassing first attempt to pass the bill ended in abject failure in March.

But the bill faces an uphill battle to pass the Senate. And the Republicans’ victory today may yet be undercut by the substance of the AHCA, which roused widespread opposition from interest groups, pundits and the public. If the bill becomes law and the critics prove correct, the effects of policy could unleash waves of resistance to the Republican governance as millions of people previously insured under Obamacare lose coverage. (For more information on this and other political stories, subscribe to the White House Patch for daily newsletters and breaking news alerts.)

As lawmakers left the Capitol following the vote, protesters chanted "shame."

Twenty Republicans voted against the bill.

President Trump invited the House members to the White House Rose Garden after the vote — a tradition usually reserved for the actual passage of a bill into law.

"I went through two years of campaigning, and wherever I went, people were suffering with the ravages of Obamacare," Trump said. "As far as I’m concerned, your premiums are going to start coming down. We’re going to get this passed through the Senate, I feel so confident."

He continued: "Make no mistake, this is a repeal and replace of Obamacare, make no mistake about it, make no mistake. And I think most importantly, premiums will be coming down, yes, deductibles will be coming down, but ultimately it’s a great plan."

House Speaker Paul Ryan spoke next: "Today was a big day, but it was just one step in this process," he said. "I know our friends in the Senate are eager to get to work."

Democrats remain deeply critical of the bill, with none of the liberal members of Congress voted for the AHCA.

"With only hours notice and no CBO score, Republicans are trying to maliciously destroy healthcare," House Minority Leader Nancy Pelosi said Thursday, referring to the non-partisan Congressional Budget Office. "Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with pre-existing conditions into the cold."

After the bill past, she said, "I guess [Republicans'] desire to give a tax break to the rich just trumped everything."

But despite a procedural defeat, Democrats think the vote today bodes well for their party's future. After the vote, they began singing to Republicans, "Na na na na, Na na na na. Hey, hey, hey, goodbye!" Many Democrats have argued that while they do not want AHCA to become law, it will be disastrous for the GOP's electoral chances if the bill passes.

Republicans still face many of the challenges with the bill that originally plagued their efforts to pass it in the House. These challenges include:

• The CBO concluded that the original version of the bill would add an extra 24 million people to the ranks of the uninsured by 2026.
• Most health care groups, doctors groups and hospital groups have come out in opposition to the bill.
• Few conservative pundits or health care wonks support the bill.
• It contains drastic cuts to Medicaid, which President Trump promised to protect.
• A poll found that only 17 percent of Americans wanted the AHCA to become law.
• The bill may not be able to pass the Senate.

But the AHCA now has two key amendments that leadership included to sweeten the deal and coax just enough Republican lawmakers to vote for the bill.

What are the two amendments? First, the MacArthur Amendment, which helped win over conservatives in the Freedom Caucus, allows states to opt out of Obamacare provisions, such as the "essential benefits" rule that requires insurers to provide coverage for a set of basic health care needs. Weakening these provisions rolls back some of the protections people with pre-existing conditions gained under Obamacare, but conservatives argue the plan will lower premiums. Patients with pre-existing conditions will have the option to enter so-called "high-risk pools."

The "essential benefits" provision also prevents insurers from charging women more for insurance than men, which many advocates view as a form of sex discrimination.

The downsides of the MacArthur amendment scared many moderate Republicans. That's why they introduced the second amendment.

Under the Upton Amendment, the government will provide an extra $8 billion over five years for the states' high-risk pools. In theory, this provides additional support to people with pre-existing conditions, who might otherwise be hurt by the repeal of Obamacare protections.

However, many argue that this amount is insufficient to provide significant coverage for those who need it. And states actually have significant flexibility on how to spend the funds, so it's not clear that it solves the problem.

There's still a lot we don't know about the law. The CBO hasn't had time to score the bill with the new amendments, so it's hard to say confidently what its effects will be. Reports suggest the CBO might release a score of the bill next week, after House Republicans have already voted.

As Sarah Kliff at Vox explains, the current version of the bill actually exempts congressional staffers and representatives from the MacArthur amendment, providing them coverage for pre-existing conditions that the law would allow insurers to deny to other people. This small part of the bill could fuel animus toward the GOP'S efforts to overhaul health care.

Opponents of the law made their voices heard throughout the day. Protesters across the country gathered to ask lawmakers to vote against the bill.

On Twitter, Joe Biden expressed his dissatisfaction with the GOP: "Day of shame in Congress. Protections for pre-existing conditions, mental health, maternity care, addiction services -- all gone."

These Republicans voted against the bill:

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Photo by Mark Wilson/Getty Images News/Getty Images