The House voted on Thursday to pass the Republican health care bill, a top-flight priority the party nearly left for dead six weeks ago. The victory edged Republicans closer to addressing their long-time pledge to repeal President Barack Obama’s health care law.
After heavy lobbying by the White House and top Republicans and revisions aimed at nailing down support, House leaders sent the measure to an uncertain fate in the Senate.
Republicans have promised to erase Obama’s law since its 2010 enactment, but this year — with Donald Trump in the White House and in full control of Congress — is their first real chance to deliver. But polls have shown a public distaste for the repeal effort and a gain in popularity for Obama’s statute, and Democrats — solidly opposing the bill — said Republicans would pay a price in next year’s congressional elections.
"You will be held accountable for the cruel and unusual punishment you have inflicted on the American people," said Rep. Hakeem Jeffries, D-N.Y.
U.S. Rep. Carlos Curbelo, whose district has one of the highest Obamacare enrollments in Florida, was publicly undecided until his yes vote on Thursday afternoon.
"We all know that the status quo in healthcare is unacceptable in this country. Premiums are rising, counties like Monroe, right here in South Florida, only have one health insurance provider left," he said. "Now, this bill's not perfect. And I made it clear that if I was going to continue supporting this legislation, changes needed to be made to it in the Senate."
Curbelo said what turned him into a supporter, in part, was money promised to high-risk pools and living in states that would no longer be mandated to protect those with pre-existing conditions.
"Late in the process an amendment was filed delivering an additional $8 billion in case any state opts out of the federal protections to help people who could be vulnerable," he said.
The bitter health care battle dominated the Capitol even as Congress prepared to give final approval to a bipartisan $1 trillion measure financing federal agencies through September. The House passed that legislation Wednesday, and certain Senate passage will head off a weekend federal shutdown that both parties preferred to avoid.
House Speaker Paul Ryan, R-Wis., canceled a March vote on the health care bill because disgruntled conservatives said the measure was too meek while GOP moderates said its cuts were too deep.
Over the past few weeks, the measure was revamped to attract most hard-line conservatives and some GOP centrists. In a final tweak, leaders added a modest pool of money to help people with pre-existing medical conditions afford coverage, a concern that caused a near-fatal rebellion among Republicans in recent days.
The bill would eliminate tax penalties Obama’s law which has clamped down on people who don’t buy coverage and it erases tax increases in the Affordable Care Act on higher-earning people and the health industry. It cuts the Medicaid program for low-income people and lets states impose work requirements on Medicaid recipients. It transforms Obama’s subsidies for millions buying insurance — largely based on people’s incomes and premium costs — into tax credits that rise with consumers' ages.
It would retain Obama’s requirement that family policies cover grown children until age 26.
But states could get federal waivers freeing insurers from other Obama coverage requirements. With waivers, insurers could charge people with pre-existing illnesses far higher rates than healthy customers, boost prices for older consumers to whatever they wish and ignore the mandate that they cover specified services like pregnancy care.
The bill would block federal payments to Planned Parenthood for a year, considered a triumph by many anti-abortion Republicans.
GOP candidates including Trump have made repealing Obama’s statute an epitome of their campaign pledges, claiming it’s a failing system that’s leaving people with rising health care costs and less access to care.
Republicans will "gut Obamacare and rescue the American people," said Rep. Doug Collins, R-Ga.
Democrats defended Obama’s law, one of his crowning domestic achievements, for expanding coverage to 20 million Americans and forcing insurers to offer more generous benefits. They said the GOP measure would toss millions off coverage while delivering tax cuts to the wealthy.
"How can you do this to the American people, how can you do this to the people you represent?" asked Rep. Jim McGovern, D-Mass.
The nonpartisan Congressional Budget Office estimated in March that the GOP bill would end coverage for 24 million people over a decade. That office also said the bill’s subsidies would be less generous for many, especially lower-earning and older people not yet 65 and qualifying for Medicare.
A CBO estimate for the cost of latest version of their bill will not be ready before the House conducts its vote.
Earlier this week, moderates objected that constituents with pre-existing conditions could effectively be denied coverage by insurers charging them exorbitant premiums. At least a dozen of them said Wednesday they would oppose the legislation, including GOP Reps. Charlie Dent of Pennsylvania, a moderate leader, Leonard Lance of New Jersey and New York’s Dan Donovan.
But GOP leaders seemed to win over a raft of wavering lawmakers after adding $8 billion over five years for state high-risk pools, aimed at helping seriously ill people pay expensive premiums. That was on top of $130 billion already in the bill for states to help customers, though critics said those amounts were insufficient.
To snuff out a glaring political liability, Republicans planned to approve a second bill. It would delete language in the health care measure entitling members of Congress and their staffs to Obama’s coverage requirements, even if their home states annul them.