US House Republicans on Thursday voted to repeal and replace the “Obamacare” health plan, overcoming united Democratic opposition and their own divisions.
The 217-213 vote was a narrow victory, and ultimate success is far from assured since the measure must still make its way through a highly skeptical Senate, but after seven years of campaign promises and dozens of show votes, Republicans finally succeeded in passing a health care bill that has a chance of becoming law.
“Make no mistake, this is a repeal and a replace of Obamacare,” US President Donald Trump said. “Premiums will be coming down, deductibles will be coming down.”
Democrats countered that the Republican bill would have the opposite effect from what Trump predicted, pointing to estimates it would kick millions off insurance roles while imperiling coverage for people with pre-existing conditions who had gained protections under former US president Barack Obama’s Affordable Care Act.
They also forecast that Republicans would pay a steep political price for passing legislation that has polled poorly and takes concrete benefits away while offering only promises of more choices and lower costs.
“You will glow in the dark on this one,” House Minority Leader Nancy Pelosi said, predicting that Republicans would be radioactive with voters in next year’s midterm elections.
The health bill would eliminate the fines Obama’s law imposed on people who do not buy coverage; erase tax increases on higher-earning people and the health industry; cut the Medicaid program for low-income people; let states impose work requirements on Medicaid recipients; and transform Obama’s subsidies for millions buying insurance, now based largely on their incomes, making the funding skimpier and tying it to consumers’ ages.
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 people and ignore a mandate that they cover specified services like pregnancy care.
The bill would also block federal payments to Planned Parenthood for a year.
The Congressional Budget Office in March estimated that the bill would end coverage for 24 million people over a decade. The House voted without an estimate for the latest version.
The bill could also significantly affect many who are covered by employer plans.
In one provision, employer plans could take advantage of state flexibility under the legislation to pick which states’ rules to live by. That could allow them to impose annual and lifetime coverage limits and get rid of certain annual out-of-pocket spending caps.
Trump helped bring wavering moderates on board after a deal secured last week scared them off by limiting protections for people with pre-existing conditions.
The final change, agreed to on Wednesday, was to add US$8 billion over five years to help people with pre-existing conditions, a sum critics called a relative pittance.
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