House Speaker Paul Ryan managed to secure support both from moderate members and the conservative Freedom Caucus, which had effectively sunk Republicans’ first attempt at Obamacare repeal in late March.
“This bill delivers on the promises we have made to the American people,” Ryan said. “You know, a lot of us have been waiting seven years to cast this vote. 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.”
The vote was close: 217-213. And the bill’s prospects in the Senate aren’t certain.
The legislation, if signed into law, would remove key protections and subsidies contained in the Affordable Care Act, better known as Obamacare.
Obamacare created income-based subsidies that took into account the local cost of insurance in every state and for every age. The Republican plan offers consumers tax credits that are less generous and are calculated primarily based on age. The credits would increase based on inflation.
The Republican plan also provides hundreds of billions of dollars in savings for the wealthy over the next 10 years by removing all the taxes in Obamacare that helped pay for the subsidies. The taxes to be rolled back under the new law include a 3.8 percent tax on investment income.
The expansion of Medicaid across the country would end in 2020. After two years, states could either take a block grant from the federal government — which would likely be a flexible, reduced sum — or rejigger the formula that would offer assistance based on population, not need.
and expenditures — have since declined.
Under the Ryan-Trump plan, the federal mandate that insurance plans must cover 10 so-called essential benefits, like mental health and drug addiction treatment as well as maternity care, would become optional.
This new flexibility would do little in Vermont, which has mandated a comprehensive set of required health care benefits for residents, including maternity and preventive care.
States could obtain waivers to charge more for people with pre-existing conditions, but $138 billion would be provided over 10 years to create so-called high-risk pools and help offset costs for Americans with the most expensive health care needs.
Under the plan, states could also institute work requirements for Medicaid recipients, a policy change Gov. Phil Scott has ruled out.
The bill removes the federal requirement that citizens purchase insurance or pay a fine to the Internal Revenue Service, and it greatly restricts federal funding for Planned Parenthood by barring the organization from receiving Medicaid reimbursement money unless it stops providing abortions. Due to the 1976 Hyde Amendment, no federal money currently directed to Planned Parenthood supports abortion.
One of the few remnants of Obamacare would be the provision allowing people younger than 26 to stay on their parents’ insurance plans.
Various breakdowns estimate that young, healthy Americans would see price drops under the Republican bill while older, poorer, sicker individuals would see significant spikes in their premiums.
Vermont’s sole representative, Democrat Peter Welch, blasted the bill on the House floor early Thursday, citing a report from the nonpartisan Congressional Budget Office estimating that 24 million fewer Americans would have insurance if the Republicans’ plan passed. (The CBO has not yet released an analysis of the slightly tweaked version that passed Thursday.)
“This bill turns its back on rural America, the people who stand up for one another and believe we are in it together,” Welch said, later adding on Twitter that he would vote “hell no” on the bill.
.@POTUS won election on backs of rural Americans. This repeal & replace bill betrays rural America. I will vote HELL NO this afternoon! pic.twitter.com/atrA6RIVMZ
— Rep. Peter Welch (@PeterWelch) May 4, 2017
In a celebratory news conference Thursday afternoon at the White House, Trump called the plan “very, very incredibly well-crafted.”
“This has really brought the Republican Party together,” he said. “As much as we’ve come up with a really incredible health care plan, this has brought the Republican Party together. We’re going to get this finished.”
The chances of the Republican legislation becoming law remain far from certain. The bill now heads to the U.S. Senate, where a handful of moderate Republicans have expressed concerns with the popular benefits gutted in the bill.
Still, Republicans risk political backlash in 2018 should the legislation be passed in its current form. A March Quinnipiac poll found that only 42 percent of Republicans supported the first conservative reform plan, with a majority of Americans expressing anxiety that they would lose care under the plan.
Shortly after the bill passed on the House floor Thursday, a group of Democratic leaders joined in a chorus of “Hey, hey, hey — goodbye.”
As the legislation heads to the Senate, Vermont’s delegation derided the Republican health care plan and promised to fight it.
Sen. Patrick Leahy, D-Vt., called the legislation “a cruel and cynical hoax.”
“From clumsy start to appalling finish, House Republicans have shown no shame in advancing a bill that, in truth, is intended to give a massive tax cut to the wealthiest Americans, in the guise of a health care plan,” Leahy said in a statement Thursday. “It’s only gotten worse as House leaders have had to bargain for votes.”
“This bill would throw 24 million people off of health insurance – including thousands of Vermonters – cut Medicaid by $880 billion, defund Planned Parenthood and substantially increase premiums on older Americans,” Sanders said. “Meanwhile, it would provide a $300 billion tax break to the top 2 percent and hundreds of billions more to the big drug and insurance companies that are ripping off the American people.”
Sanders, long a proponent of single-payer, is expected to introduce legislation soon to transition America to a universal health care system.
“Instead of throwing tens of millions of people off of health insurance, we must guarantee health care as a right to all,” he said in a statement Thursday.
