Thursday, the House of Representatives successfully did what eluded it in March, and what it tried in vain to do for six years: pass a repeal and replacement of the Affordable Care Act. By a vote of 217 to 213, the House voted to advance the American Health Care Act, the GOP’s proposed alternative to Obamacare.
Twenty Republicans joined the entire Democratic House caucus in voting no on the measure. Minnesota GOP Reps. Erik Paulsen and Tom Emmer, who had been undecided on the AHCA until the eleventh hour, supported the bill.
Now, it is up to the U.S. Senate — where there had been considerable skepticism over the AHCA, even among Republicans — to take up a version of the health care bill before it can advance any further.
The political ramifications of the vote were immediately clear: as Republicans celebrated, Democrats crowed that their yes votes would come back to bite them, and taunted Republicans by singing and waving goodbye to them on the House floor after the vote.
Still, Thursday’s vote marks a surprising comeback for a bill that failed miserably two months ago, when various GOP factions — particularly moderates and hard-line conservatives — fled the long-awaited repeal and replace plan, forcing Speaker Paul Ryan to pull the bill shortly before a scheduled vote.
In the aftermath, the AHCA got new life thanks to two amendments to make it more appealing to conservatives and moderates: one to give states options to bypass key elements of Obamacare, and another to shore up so-called high risk pools for insuring those with pre-existing conditions.
The latter amendment, worked out by Michigan Rep. Fred Upton, who was formerly a no on the AHCA, seeks to mitigate fears over losing protections for those with pre-existing conditions by setting aside $8 billion over five years in support for high-risk pools.
Broadly, the AHCA would maintain some planks of Obamacare but gives states a way to get around them, such as the essential health benefits and community rating provisions, which prevent those with pre-existing conditions from being charged more by insurers.
Beyond that, the bill repeals the individual mandate for health coverage, the employer mandate to provide insurance to employees, and eliminates a host of taxes, such as the one on medical devices.
The Upton amendment may have been the gust that finally pushed undecided members off the fence and into the yes camp.
Count Third District Rep. Erik Paulsen among those blown off the fence on the latest version of the AHCA. Hours before a scheduled vote, Paulsen’s office confirmed that the congressman supported the bill. He supported the initial version of the AHCA and voted for it out of the Ways and Means Committee, but as new amendments were introduced, Paulsen avoided taking a position, and provided confusing answers to press questions.
Minnesota’s three Republicans, in interviews and statements after the vote, preferred to focus on the flaws of Obamacare instead of the concerns raised from both the right and the left over this bill.
In a statement, Paulsen said “the status quo under Obamacare is no longer acceptable… This is just the latest step in reforming our health care system to be more patient-centered.”
Rep. Tom Emmer — who said in a statement that the AHCA is “not perfect” — struck a similar tone in speaking with MinnPost after the vote.
“We’ve got people that are losing coverage options every day,” he said. “It’s important that we do something… The time for pointing fingers is long past.”
Emmer said his office received a lot of feedback from constituents — at one point on Thursday, callers could not get through to his D.C. office because it was so overloaded — but the message he took is that they wanted something done.
“For me, it’s not acceptable where we’re at. It’s not working. It’s collapsing.”
Second District Rep. Jason Lewis, who stood and cheered on the House floor once the AHCA passed the threshold for passage, said in a statement he “promised the people of the 2nd District that I would promote real health care reform that works for their families. I’m keeping that promise.”
After the vote on Thursday afternoon, President Donald Trump, Speaker Ryan, and a host of GOP congressmen — including Lewis —stood in the White House’s Rose Garden and proclaimed a huge victory.
But the AHCA’s passage in the House is only the first milestone in what will be a long, difficult road if the AHCA is to become law. The U.S. Senate will need to take up health care, and it’s clear that it is a far less hospitable chamber for the ideas outlined in the House plan.
Even though the health care plan is set up to pass along the guidelines of budget reconciliation — meaning only 51, not 60, votes are required for passage — enough Senate Republicans voiced their concern about the first version of the AHCA to cast real doubt on the health of the bill in the upper chamber.
Senators from red states that opted to expand Medicaid under the ACA — such as Arkansas Sen. Tom Cotton and West Virginia Sen. Shelley Moore Capito — will be lawmakers to watch in the upper chamber as they mull a projected $800 billion in Medicaid cuts over time in the House’s plan.
This time around, senators have been a bit more quiet, but observers are predicting they will come up with bill that could look much different from the one that came out of the House. Utah Sen. Orrin Hatch, a key player, told the Washington Examiner that “there are undoubtedly going to be some changes.”
Though several senators have broadly outlined changes they might want to make, they face a limited window to fashion a compromise. The budget reconciliation tactic has a shelf life that expires at the end of the fiscal year — Sept. 30, 2017 — so the House and Senate must approve a compromise bill and send it to the White House before then.
If they lost the battle today, Democrats are optimistic they can win the war. In statements and interviews, they excoriated the AHCA: Rep. Keith Ellison, in a statement, said the bill was a “$1,000,000,000,000 tax cut for the top 2% of households. Everyday Americans will be forced to pick up this tab, and they’ll pay for it with their health, their security, and in some cases, with their lives.”
First District Rep. Tim Walz, who is running for governor, called the bill “downright cruel,” and slammed Ryan for “rushing to a vote without holding any hearings and without an updated [Congressional Budget Office] score to show millions of Americans just how much their pocketbooks and well-being will suffer.”
(Indeed, the House voted to pass the AHCA without knowing its impact on the budget or on the number of insured people, though the CBO assessed the first version of the AHCA would save $337 billion from the deficit while 24 million people would lose their insurance.)
Democrats also promised to keep the heat on Republicans as the law goes forward, and to make sure voters remember all this in November.
Ellison — tasked with helping Democrats recoup their electoral losses next year as the deputy chair of the Democratic National Committee — told MinnPost “it’s a sad day for the American people, but we’re committed to making sure the American people know what they did and are held accountable for it.”
Eighth District Rep. Rick Nolan said Republicans could face a reversal of what happened to the Democrats in the 2010 midterms, in which anti-Obamacare sentiment fueled the defeat of 63 Democratic representatives, like Nolan’s predecessor, Jim Oberstar.
Nolan said he’s encountered “unbelievable awareness and deep concern” over the GOP health reform effort in his recent town halls in his District.
“It has people in my district really in a way I haven’t seen before,” he said. “The battle’s not over yet… It’s not going to go away quickly or easily.”
Voters should expect to hear a lot about today’s vote for the next 18 months: the parties’ various campaign arms moved quickly after the vote to advance their messages.
The Democratic Congressional Campaign Committee released digital ads Thursday afternoon attacking Paulsen and Lewis for their votes; while the National Republican Campaign Committee moved to defend Paulsen and Lewis with an email blast saying they had kept their promise to voters.