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Excerpt: "House Republicans narrowly passed a controversial bill to revise Affordable Care Act, claiming fulfillment of a major campaign promise but sending the measure to an uncertain fate in the closely divided Senate."

Speaker Paul Ryan. (photo: Andrew Harnik/AP)
Speaker Paul Ryan. (photo: Andrew Harnik/AP)

House Republicans Narrowly Pass Controversial Bill to Revise Affordable Care Act

By Ed O'Keefe, Paige Winfield Cunningham and Amy Goldstein, The Washington Post

04 May 17


ouse Republicans narrowly passed a controversial bill to revise Affordable Care Act, claiming fulfillment of a major campaign promise but sending the measure to an uncertain fate in the closely divided Senate.

Passage in the House by a vote of 217 to 213 capped weeks of fits and starts for the GOP and represented an enormous victory for President Trump, who repeatedly pledged on the campaign trail last year to repeal and replace Obamacare but has struggled to secure legislative wins early in his presidency. The vote was also a big win for House Speaker Paul D. Ryan (R-Wis.), who has been working on the legislation since January but has failed to unite his ideologically divided caucus.

“This bill delivers on the promises that we have made to the American people,” Ryan said on the House floor moments before the vote. “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. Are we going to meet this test? Are we going to be men and women of our word?”

Several White House aides began Thursday morning by texting each other and reporters with two words: “game day.”

Democrats, meanwhile, predicted that the measure would be devastating for Americans’ health-care coverage but also, on a political level, for Republicans who voted for it.

House Minority Leader Nancy Pelosi (D-Calif.) noted that many Americans can’t name their member of Congress — but that Thursday’s vote is set to capture the nation’s ire.

“You will glow in the dark on this one,” Pelosi warned. “So don’t walk the plank, especially unnecessarily.”

The vote caps a haphazard debate that included few public hearings and the hasty revision of key sections of the bill during closed-door meetings at both ends of Pennsylvania Avenue. The effort was designed to secure votes from skeptical conservatives and moderates initially unwilling to support the legislation.

Despite more than six years of campaign pledges to undo the ACA and the recent changes to the legislation, several Republican lawmakers admitted Thursday that they have not read the bill or ignored questions about their understanding of it shouted by reporters. Republicans have accused Democrats in the past of ramming their health-care bill through without giving members a chance to absorb it — but on Thursday they insisted that they are not doing the same thing.

They argued that their health-care bill is only several hundred pages long, compared with the size of the Affordable Care Act, which ran several thousand pages.

Democrats “put a 2,000-page bill on the table they knew no one had time to read, and we’re not doing that,” said Rep. H. Morgan Griffith (R-Va.).

“This is a rough and tumble exercise that the Founding Fathers anticipated,” he added.

House Freedom Caucus Chairman Mark Meadows (R-N.C.) said he was willing to abandon his previous demands that leaders allow hearings and discussion of the legislation because members had opportunities to weigh in on amendments over the past several days. The decision marks a significant shift for hard-line Freedom Caucus members, who have insisted that leaders give them ample time to read legislation and weigh in before a bill comes up for a vote.

“We’ve had members working with members to come up with real amendments that are getting adopted today,” Meadows said. “I can tell you that I have read the bill no less than six times. If they haven’t read the bill it is because they haven’t spent the time to do that.”

Republicans also disregarded the absence of a final cost estimate from the nonpartisan Congressional Budget Office — Congress’s official scorekeeper — on how much the bill would cost and how many people would receive health-care coverage. Several said that last-minute changes to the legislation won’t significantly change the final estimates.

“We’re still comfortable we’re saving billions and billions of dollars,” said Rep. Chris Collins (R-N.Y.).

Though Republicans have for years spoken of repealing the ACA as a prime goal, the legislation would stop short of outright eliminating the 2010 health-care law enacted by a Democratic Congress and the Obama administration. Nevertheless, it would make a significant dent in large portions of current law.

In broad strokes, the bill represents an attempt to shift to a more conservative vision for the nation’s health-care policies. It would move from the federal government to states power to set important health insurance rules. It would end the ACA’s subsidies for most people who buy health plans through marketplaces created under the law, creating, instead, new tax credits with clear winners and losers. And it would rescind several taxes that have helped pay for the law, including ones imposed on Americans with high incomes, health insurers, medical devices and tanning salons.

The bill faces a steeper climb in the Senate, where widespread disagreement remains among Republicans about how to proceed on health care. First, the Senate’s parliamentarian — or rules-keeper — cannot review the legislation and determine the rules of debate until the CBO submits its official estimate, which could take several more weeks to complete, according to congressional aides. That would mean that official Senate debate on the bill could not begin until June.

Even then, the issue of health care reform is expected to be treated much more skeptically by Republican senators.

“A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution,” Sen. Lindsey O. Graham (R-S.C.) tweeted on Thursday ahead of the House vote.

Among many other concerns, GOP senators from states that have expanded Medicaid under the ACA have voiced concerns about rollbacks to that program included in the House bill. A trio of conservative senators — Ted Cruz (R-Tex.), Mike Lee (R-Utah) and Rand Paul (R-Ky.) — who often buck GOP leaders are another wild card. With just a 52-48 advantage over Democrats, Senate Republicans have a smaller margin for error than their House counterparts.

The House measure may run into other procedural roadblocks in the Senate. The original proposal initially left many of the ACA’s insurance regulations alone — with the goal of ensuring it would pass muster with the Senate parliamentarian — but not all of them. The House’s version of the bill would undercut the ACA’s insurance regulations even more. That might make it difficult for Republican senators to pass the measure under a procedural maneuver known as “reconciliation,” which is usually reserved for budget legislation.

The legislation does not eliminate the ACA’s requirement that most Americans carry health insurance, but it would undercut that requirement by erasing the penalty for not having coverage. Instead, the bill would create a deterrent: enabling insurers to charge 30 percent higher premiums for one year to customers who have had a gap in coverage of at least about two months.

In the week leading up to the vote, a tug of war has played out among different wings of the House GOP over how much power states should have over insurance regulations. In the end, the bill incorporates two features advocated by the hard-right House Freedom Caucus. One would allow states to eliminate parts of the ACA that require insurers to include specific “essential health benefits” in health plans sold to individuals and small businesses, and set their own coverage requirements or none at all. The other would let states get federal permission to let insurers return to their old practice of charging more to customers with preexisting medical problems — a practice that the ACA outlaws.

An amendment last week freeing states to drop the same-price requirement for healthy and sick customers produced a backlash among some in the GOP conference. In the end, the bill includes $8 billion intended to be spread over five years to states that back out of this part of the ACA.

Medicaid would also be transformed in two ways. For the 31 states that, under the ACA, have expanded the safety-net program to include people with slightly higher incomes, the government would immediately stop paying for any one new to enroll under the expansion and would eventually stop the extra money the ACA has provided for that purpose. And starting in a few years, Medicaid would end its half-century tradition as an entitlement program in which the government pays a certain share for each person who enrolls, switching to a “cap” with a fixed amount per person — a change that would lessen federal funding.

Much of the recent contention among Republicans revolved around how to protect patients with expensive, preexisting conditions, prompting several amendments to the bill. Energy and Commerce Chairman Greg Walden presented those changes as improvements to the bill, in a slide presentation Thursday morning to his colleagues.

According to the slides, insurers could charge such patients more only if a number of conditions were met. States would have to get a waiver from the federal government and the individual would have to be uninsured and buying their coverage on the individual market.

No matter when and how Senate debate begins, House Republicans exhibited a palpable sense of relief Thursday that the issue is off their plates — at least for now. your social media marketing partner


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+18 # mashiguo 2017-05-04 13:28
Thank you Debbie Wasserman Schultz
Thank you Hillary Clinton
Thank you DNC
Thank you superdelegates
This is what you have given us.
Thank you oh so very much for your greed, contempt, disdain and self-righteous incompetence.

Don't believe for a second that you will profit from this debacle.
You caused it.
-5 # ericlipps 2017-05-04 18:40
Thank you Sandroid Hillary-haters, who prayed night and day that something, somehow, would keep Hillary Clinton out of the White House. Thank you for throwing your votes away by voting for zero-chance candidates like Jill Stein; thank you to those of you who stayed home in a snit on Election Day rather than swallow your bile and cast a vote for the nominee of a party which didn't want to do what Republicans are now doing.

Thank you ever so much for your hate, your rage, your self-righteous contempt for those sinners who didn't repent and come over to the Bern side, your short-sightedne ss, your plain stupidity. YOU caused this, and on the night of the election at least some of you cheered Trump's victory and that of the Republicans in the House and Senate, because it meant Hillary Clinton and the Democratic establishment were getting it in the teeth.

Don't believe for a second that you will profit from this debacle. You caused it, and don't even have the decency to own it.
+13 # librarian1984 2017-05-04 15:43
It's difficult, but essential, to be a witness to evil .. when it is willing to show itself .. and here it was in technicolor. It's wise to remind oneself how easily politicians lie, how they tell you this is for your own good and you're gonna love it .. when you know they know they are sending people, including children, the elderly and poor, to suffering or death.

And for what? To give the very richest people in the country a tax cut. When the estate tax is repealed the Walton family gets $53 billion, the Kochs $34 billion, the Adelsons $13 billion and the Trumps $4 billion, and they'll get those billions at the expense of children and the poor and, by definition, the sick and injured.

It's sobering to see the evil humans are willing to inflict upon each other, to see how easily it's done, and with what pleasure. But the wickedness is not the sole preserve of Republicans.

The Democrats are not blameless, and they will not profit from the righteous anger of the people, which is coming. The Democrats were unwilling to stand up to the insurance companies when they had a chance. They took single payer off the table all on their own and even now they won't talk about Medicare-for-al l though any sane citizen can see it's the ONLY viable solution.

And the DNC and HRC, who in their arrogance stole and then lost this election .. they have their share in this too. No one in DC should be happy tonight. No one should feel safe in 2018.
+11 # swimdoc 2017-05-04 18:07
Now's the time! The Democrats need to be FOR something, not just against the Republicans' trashing of the ACA.

Medicare for ALL! Simpler, cheaper, better for everyone. Let's join the rest of the rich nations of the world with universal health coverage. You're here, you're human, you're covered.
0 # CDMR 2017-05-04 18:19
Seems like a do-nothing bill. The fesl needs are to decrease cost and expand coverage. This bill only reduces insurance company responsibilitie s.

Bad news for trump.
+1 # Wise woman 2017-05-05 02:36
What a bunch of BS this is! Our pathetic country is being led by the nose by a group of narcissistic fools whose only purpose is to make the obscenely wealthy wealthier when the Christian goal should be making people healthier. Bad news for those so-called Christians. It's even gotten perversely amusing watching these imbeciles struggling to undo the ACAA. Hey I have a suggestion - call one of the many countries that has single payer health care. They'll tell you all about putting it together. It's really easy if you have a functioning brain and a moral streak.
+2 # librarian1984 2017-05-05 08:21
Trending: #IAmAPreexistin gCondition
+1 # reiverpacific 2017-05-05 10:35
I'm really up to hear (hand OVER head) with seeing photos of that sneering, lantern-jawed hypocrite Ryan(d) as he luxuriates in his taxpayer-funded five-star care whilst denying it to those who pay for it and his obscene salary to defy the hippocratic oath ("Do no harm").
May his bollocks be ripped off by a rabid dawg!

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