House Republicans are set to vote on a bill to repeal and replace President Obama’s signature health care legislation on Thursday. The public announcement on Wednesday indicated that the GOP has enough votes to pass the American Health Care Act (AHCA) and send it to the Senate.
“We’re gonna pass it,” House Majority Leader Kevin McCarthy (R-Calif.) told Fox News, adding that the bill had the support of the required 216 members to pass the House of Representatives.
Here are five things to know about the AHCA.
1. It failed before.
In March, after a great deal of fanfare and attempts to rush AHCA through Congress without debate, House Speaker Paul Ryan cancelled the vote scheduled for March 24 when it became clear that there would not be enough votes in the House to pass the bill.
Senator Rand Paul (R-Ky.) declared that he would not vote for “Obamacare lite.” In late February, Paul joined Senators Ted Cruz (R-Texas) and Mike Lee (R-Utah) in declaring that the 2015 repeal of Obamacare, passed by the GOP Congress, “should be the floor, the bare minimum.”
In response to this criticism, President Donald Trump assured conservatives that “there will be multiple phases” of Obamacare repeal: the AHCA, regulatory reform spearheaded by Secretary of Health and Human Services (HHS) Tom Price, and another bill which would address, among other things, the ability to buy health insurance across state lines.
This did not address conservatives’ concerns.
2. Conservative groups opposed it.
March also saw the spectacle of conservative nonprofit groups fighting tooth and nail against a Republican president and Congress. Americans for Prosperity (AFP) denounced the AHCA as “Obamacare Lite” or “Trumpcare.”
“Republicans in the House promised to fully repeal the law, all the mandates and all the taxes, everything. This proposal from last night simply does not do that. It does not do the job,” AFP President Tim Phillips declared.
AFP hosted a rally and sent supporters to Capitol Hill to urge Congress not to pass the legislation. Other groups joined them, including the Heritage Foundation, the Club for Growth, and Freedom Partners.
3. The state waiver amendment.
In early April, Vice President Mike Pence proposed a state waiver to allow states to opt out of Obamacare’s insurance rules for a period of ten years. This is the “MacArthur Amendment,” proposed by Congressman Tom MacArthur (R-N.J.).
States could secure waivers from Obamacare’s “essential health benefits” requirement — the mandatory 10 categories of health benefits. Under the amendment’s language, the waivers would be virtually automatic.
This amendment started a sea change among conservative groups. The Club for Growth announced a $1 million ad buy supporting the AHCA. Even the Heritage Foundation’s Robert Moffit said this waiver suggestion was a major improvement — but he added that the bill still needs improvement.
Among other things, Moffit suggested Congress resurrect the successful pre-Obamacare provisions which encouraged people in the group health insurance market to maintain continuous coverage. He also suggested a “premium support” solution for able-bodied Medicaid beneficiaries, allowing them to enroll in private coverage of their choice. Finally, Moffit called for changes to “the unfair, inefficient, and inequitable federal tax treatment of health insurance.”
Even so, members of the holdout group the House Freedom Caucus suggested that the McArthur Amendment addressed their most important concerns about the AHCA. The upcoming vote seems to signal that this caucus is now fully on board.
4. No CBO score.
Despite the evolving support of conservatives, the AHCA still has many problems. Critics note that the updated bill has not been scored by the Congressional Budget Office (CBO).
When the CBO analyzed the original health care bill, it found that while the AHCA would reduce federal deficits by $337 billion over the next decade, it would also leave more than 14 million without health insurance. This should be taken with a huge grain of salt, however, as the CBO botched prediction after prediction on Obamacare.
HHS Secretary Tom Price also argued that the CBO report was incorrect, as it “looked at a portion of our plan but not the entire plan.” The report “ignored completely the other legislative activities that we’ll be putting into place that will make certain that we have an insurance market that actually works.”
“So we disagree strenuously with the report that was put out,” Price said. “We believe that our plan will cover more individuals at a lower cost and give them the choices that they want for the coverage that they want for themselves and their families, not that the government forces them to buy.”
Even if the updated version had a CBO score, it might not change much in terms of support among the GOP Congress.
5. What happens next?
If the AHCA passes on Thursday, it would next go to the U.S. Senate. The Senate would further amend the bill, and debate would continue. The good news for conservatives is that the trio of senators mentioned earlier — Rand Paul, Ted Cruz, and Mike Lee — would be able to stop the AHCA from passing, if necessary.
Unfortunately, if the AHCA passes both chambers and is signed into law by President Donald Trump, that will not fully repeal Obamacare. Worse, if the negative results of Obama’s health insurance legacy continue or are not fully alleviated under the Republican law, Republicans will suddenly own the health care problems in this country.
Americans should be wise enough to realize that Republicans are not to blame for Obamacare’s failures, but political winds shift easily. On the other hand, Republicans are under pressure to repeal and replace Obamacare, and voters will see this bill as at least a partial fulfillment of that promise.
Obamacare has been a disaster, increasing premiums across the country and breaking basic promises like “If you like your doctor, you can keep your doctor.” The problem is, health care is complicated and without a 60-vote majority Republicans in the Senate cannot pass the kind of legislation required to straight repeal Obamacare.
This bill might be the best conservatives can get, but the health care battle isn’t even close to over.