Washington – House Republicans on Thursday finally won approval for a health care bill aimed at repealing and replacing the Affordable Care Act, but the legislation faces an uncertain future in the Senate, which may not be able to take it up for weeks.
Every Democrat, including all five Connecticut members of the U.S. House, voted against the bill, which squeaked through, on a 217-213 vote, after it was amended to win the votes of a number of squeamish Republicans.
Republicans roared with approval after their win, and Democrats loudly sang, “Na Na Hey Hey Kiss Him Goodbye,” a song frequently heard at sporting events, to mock their GOP rivals’ prospects for re-election next year.
House Minority Leader Nancy Pelosi told Republicans, “You will have every position of this bill tattooed on your forehead. You will glow in the dark.”
Meanwhile, hundreds of protesters who gathered outside the U.S. Capitol shouted “shame.”
Rep. Jim Himes, D-4th District, tweeted “for the record, when the @GOP succeeded by one vote in taking healthcare from 24 million Americans, they cheered on the Floor. Don’t forget.”
An assessment by the Congressional Budget Office of an early version of the American Health Care Act said eventually about 24 million Americans would lose coverage under the bill.
The AHCA is an attempt to shift the responsibility for helping Americans procure health insurance coverage from the federal government to the states.
It also would shift responsibility for setting important insurance rules, including the basic benefits an insurance policy must offer – from the federal government to the states.
It would end the ACA’s subsidies for most people who buy health plans through marketplaces like Access Health CT, creating new tax credits based on age, not income. Federal payments to states for Medicaid reimbursements also would be cut, and federal payments to Planned Parenthood eliminated.
The American Health Care Act also would repeal taxes that have helped pay for the ACA, including ones imposed on Americans with high incomes, health insurers, medical devices and tanning salons.
“This is not a health care bill; this is a tax bill,” said Rep. John Larson, D-1st District, a member of the tax-writing Ways and Means Committee.
Larson said repeal of those taxes will lead to loss of subsidies and the elimination of coverage for 24 million Americans and people with pre-existing health conditions.
“You lose coverage, but they get a tax break,” Larson said.
To win the votes of conservative House Republicans, the bill was amended to let states allow insurers to increase premiums for people with pre-existing health conditions.
The GOP says the legislation also provides billions of dollars to states to help set up high-risk pools to provide affordable coverage for those with pre-existing conditions. Democrats say that’s not enough money nor a reliable safety net.
Rep. Elizabeth Esty, D-5th Dlstrict, said she found it “appalling” that Capitol Police buses were lined up outside the U.S. Capitol to take House Republicans to the White House to celebrate the vote.
She said the bill is “immoral” because it would result in a loss of coverage for many.
“Americans who are unlucky enough to be sick are going to suffer the most,” Esty said.
Gov. Dannel Malloy called the vote “appalling.”
“This action is a grave disservice to the people of our nation and undermines the core mission of the Affordable Care Act,” the governor said in a statement. “The fact remains – Trumpcare threatens coverage for some of our most vulnerable populations, including seniors, persons with disabilities, and all Americans with pre-existing conditions.”
In a joint statement issued before the vote, Connecticut Senate President Pro Tempore Martin M. Looney and Senate Majority Leader Bob Duff, both Democrats said Republicans were poised to “make the more than half a million adults under the age of 65 living in Connecticut with pre-existing conditions uninsurable … put people’s lives in danger, bankrupt families and further stress our social safety net.”
“If this bill moves forward as is, we expect it will create a significant additional problem in our state budget or force us to abandon meaningful reforms that are working,” the legislative leaders said.
State Comptroller Kevin Lembo echoed the concern over the health bill’s potential impact on Connecticut’s already stressed finances.
The bill “would mean cuts in the state’s Medicaid funding, devastating Connecticut’s budget at the worst possible time,” Lembo said. “This fight isn’t over and I look to the Senate to stop this bill.”
Still, Thursday’s vote was a victory for U.S. House Republicans who have been trying to repeal the ACA for seven years, and for President Donald Trump, who became personally involved in seeking votes for the bill, which failed to win enough GOP support last month.
“This has really brought the Republican Party together,” Trump said.
On to the Senate
The fight now shifts to the Senate where some GOP members are skeptical of the House-approved measure.
“A bill — finalized yesterday, has not been scored, amendments not allowed, and three hours final debate — should be viewed with caution,” said Sen. Lindsey Graham, R-S.C.
Another hitch is that the Senate’s parliamentarian cannot review the AHCA to determine the rules of debate until the Congressional Budget Office submits an official estimate on the cost and coverage impacts of the amended bill, which could take several weeks to complete.
The American Medical Association, the American Hospital Association and every major medical group opposed the bill, along with the politically influential AARP.
Marilyn Tavenner, president and CEO of America’s Health Insurance Plans, said the nation’s insurers are banking on the Senate to make substantial changes.
“The American Health Care Act needs important improvements to better protect low- and moderate-income families who rely on Medicaid or buy their own coverage,” Tavenner said. “We stand ready to work with members of the Senate and all policymakers, offering our recommendations for how this bill can be improved to ensure the private market delivers affordable coverage for all Americans.”
Among the changes insurers seek, Tavenner said, is elimination of the bill’s reduction in federal payments to the Medicaid program and an increase in tax credits for low- and medium-income people, those who are older and those who live in areas with high health care costs.
Insurers also are seeking the continuation of an Obamacare cost-sharing program that subsidizes co-payments and deductibles for low-income people. House Republicans oppose the program.