House GOP Advances Obamacare Fix

House Republicans rallied May 4 to appease skeptical lawmakers within the party and narrowly passed legislation to gut the Affordable Care Act.

After the first attempt crumbled in March, House Speaker Paul Ryan, R-Wis., declared “we’re going to be living with Obamacare” for the foreseeable future. But during the last six weeks, conservatives and moderates found common ground on a few key amendments to push the bill over the finish line.

The House passed the American Health Care Act on a vote of 217-213, with 20 Republicans joining Democrats to oppose the bill. The legislation now goes to the Senate, where more changes are likely to get the full support of the GOP’s razor-thin 52-48 majority.

Seven years ago, Democrats passed the Affordable Care Act with a 219-212 vote, without help or input from a single Republican. If four more Democrats opposed the legislation, it would have failed. Today, Republicans faced a similar situation with 193 House Democrats opposed: If two more GOP lawmakers defected, the bill would have tanked.

Ryan gave an impassioned speech on the House floor moments before lawmakers made their final decision.

“Many of us have been waiting seven years to cast this vote. But many of us are here because we pledged to cast this very vote. To repeal and replace Obamacare. To rescue people from this collapsing law,” he said. “Are we going to meet this test? Are we going to be men and women of our word? Are we going to keep the promises that we have made? Or are we going to falter?”

The bill House Republicans passed today was not the one many wanted.

Rep. Dave Brat, R-Va., who opposed the original bill in March, told me today’s vote did not fulfill Republicans’ promise to fully repeal and replace Obamacare. But he still called it a victory.

“It’s a relative victory, and we can make it better as we move on,” Brat said.

The original version of the American Health Care Act didn’t give states enough flexibility, Brat said, and failed to undo many of the burdensome regulations imposed under Obamacare: “Obamacare is the regulations, and if you haven’t touched the regulations you haven’t done a thing on Obamacare.”

After GOP leaders failed to drum up enough support to pass the first bill, they canceled the scheduled vote indefinitely and went back to the drawing board.

Ryan struggled to coalesce a diverse caucus with a myriad of opinions on how the healthcare system should work.

Reps. Mark Meadows, R-N.C., and Tom MacArthur, R-N.J., drafted a new amendment to grant states the option of pulling out of certain Obamacare regulations to help appease both sides. That way, conservative states would have the option of rolling back most of Obamacare’s reach, and the states that want to keep the regulations could.

But many moderate Republicans feared the compromise would leave patients with pre-existing conditions vulnerable to unaffordable premiums in states that chose to opt out.

Meadows said he and other Republicans underestimated the difference of opinions within the party.

“For me, it’s being understanding that a New Jersey district, or a Pennsylvania district, or a New York district, is different than mine in North Carolina,” he said. “It’s real easy to be unified when your vote doesn’t matter and you’re in the minority. It’s much more difficult to be unified when you’re in the majority.”

Meadows, Brat, and 38 other conservatives drafted a bill to fully repeal Obamacare like they promised voters, but without a viable replacement plan in place, it never got traction.

The bill passed today would make several key changes to the healthcare system that Republicans hope will begin to increase competition and coverage, and drive down costs.

The measure erases Obamacare’s unpopular individual mandate requiring Americans to purchase insurance whether they want it or not. But to keep the market stable, the bill allows insurers to charge a 30 percent premium surcharge to buyers who have a lapse in coverage for 63 days or more. Republicans hope that will encourage people to maintain coverage and restore confidence to providers, even after the individual mandate goes away.

The bill also ends many of the taxes in Obamacare that helped fund the law—which placed extra burdens on small businesses in particular.

And after Republicans conceded to continue funding Planned Parenthood in the latest government funding bill, the American Health Care act will defund the organization for at least one year, if the Senate retains that provision.

Because Congress is using the reconciliation process to avoid a Senate filibuster, the bill will face a strict review process in the upper chamber. The Senate parliamentarian can't review the American Health Care Act without a score from the nonpartisan Congressional Budget Office, which House Republicans didn’t wait for ahead of their vote. That means the Senate might have to wait until June before it can begin serious work on the bill.

The American Health Care Act likely will undergo significant alterations in the upper chamber, where senators can offer unlimited amendments.

If the Senate passes its version, the bill will return to the House for final approval.

Brat told me he’s hopeful the legislation won’t return in worse shape than what he voted for today but admitted a strong possibility of that happening.

“I should have a good joke for that in mind but I don’t,” Brat told me. “If the Senate does make some huge change—if it moves in the wrong direction in terms of lower price—then that will be hugely problematic.”