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House to vote on health care bill Thursday afternoon; Paulsen a ‘yes’

The vote is expected to be close, meaning House leadership needs every yes it can muster.

Kevin Lamarque

UPDATE: The American Health Care Act passed the House on a 217—213 vote. Minnesota Republicans Reps. Jason Lewis, Erik Paulsen and Tom Emmer all voted yes. No Democrat supported the measure.

Today, the House of Representatives is in a position to do what eluded it in March, and what it tried in vain to do for six years: vote to repeal and replace the Affordable Care Act. The effort will receive the support of at least two Minnesota’s three Republican House members — Reps. Erik Paulsen and Jason Lewis — while Rep. Tom Emmer still has not issued an official position.

The House is expected to vote Thursday afternoon on the American Health Care Act, the GOP’s proposed replacement of Obamacare. House GOP leadership is confident that they have the votes necessary to pass the bill.

It’s been 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.

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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 put $8 billion into so-called high risk pools for insuring those with pre-existing conditions.

As with the bill it aims to overturn — which cleared its first hurdle in the House by a margin of five votes in 2009 — the vote on AHCA is expected to be very close. Unlike the ACA, members of the House will be voting on the AHCA with no assessment from the Congressional Budget Office. They are effectively in the dark as to exactly how much the bill will cost taxpayers. (CBO found that the first version of AHCA would have reduced federal deficits by $337 billion over a decade, but would have increased the ranks of the uninsured by 24 million.) 

Assuming unanimous Democratic opposition, the GOP can only afford to lose 22 votes on the bill. Earlier this week, the number of official “no” votes in the party was as high as 20, but that total has decreased. An important part of that was an amendment worked out by Michigan Rep. Fred Upton — formerly a no on AHCA — that seeks to mitigate fears over protections for those with pre-existing conditions.

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 would repeal 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 supports 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.

Sixth District Rep. Tom Emmer, like Paulsen, supported the first iteration of the AHCA. He has been largely silent during round two, with his office saying that he was speaking with constituents and industry members before making a decision.

Emmer’s office did not respond to an inquiry about his position on Thursday morning. Like Paulsen — who rooms with the GOP’s chief whip, Rep. Steve Scalise, when in Washington — Emmer is a generally solid ally of House leadership.

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As some in the press have observed, members like Emmer and Paulsen who were publicly undecided are leadership-friendly types concerned about the consequences of voting yes, but they would vote yes if needed in a close vote, which this is likely to be.

Meanwhile, Second District Rep. Jason Lewis supported the bill all along, backing the amendment allowing states to opt out of ACA provisions like community rating, and calling it in line with federalist principles.

All Democrats are expected to vote no as a bloc against the bill. Fourth District Rep. Betty McCollum slammed it as “dangerous and cruel”; even 7th District Rep. Collin Peterson, one of three remaining Democrats who voted against Obamacare in the House, is poised to vote no on AHCA.

Then what?

If the House passes the AHCA, President Donald Trump, Speaker Ryan, and other top Republicans will proclaim a major victory. But it would represent only the first milestone in what will be a long, difficult road if the AHCA is to become law. The U.S. Senate would then 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.

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 comes 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.