Breaking: Republican Health Care Bill Passes

May 4th 2017

Mike Rothschild

On Thursday, the House of Representatives passed the American Health Care Act — their answer to repealing and replacing Obamacare (the Affordable Care Act). 

Here's what you need to know:

  • The final vote was 217-213, with 216 needed for passage (218 is normally a majority, but there are four empty seats in the House)
  • No Democrats voted for the bill. There was a brief moment when C-SPAN had two Democratic yes votes, but this was a glitch.
  • After the first bill failed, publications are calling this "redemption" for House Speaker Paul Ryan and President Donald Trump.

The bill was controversial for several reasons. Here's what it does:

  • Roll Call calls it "a hodgepodge of provisions that repeal and replace parts of the 2010 health care law."
  • It was revealed by the Wall Street Journal on Thursday morning that the bill could impact employer plans by allowing companies to use waivers that exempt them from the bans on coverage limits provided by the ACA.
  • A host of conditions, some relatively minor, could now be used as the basis to deny insurance coverage. According to a leaked underwriting guideline from Blue Shield, some of these include acne, back pain, frequent ear infections or heartburn, migraine headaches, psoriasis, and minor injuries.
  • There are also concerns that the new bill will disproportionately effect women, allowing states to deny coverage to women who experienced sexual assault, c-sections, post-partum depression, and pregnancy. Some states had laws that allowed this, but it was barred by the ACA. The new bill would do away with those protections.
  • The bill massively cuts Medicaid to the tune of $880 billion, despite Trump repeatedly pledging to never touch it.
  • States can waive covering those with pre-existing conditions, while substantially increasing premiums for those who are able to get individual coverage. Both of these are barred by the ACA. As the Brookings Institution writes, the new law "would allow states to waive certain insurance market regulations that exist under current law, including the 'community rating' requirements that bar insurers from setting premiums based on health status."
  • In lieu of substantive pre-existing condition coverage, the AHCA gives limited funding (through the "Upton Amendment") to high-risk pools that those with serious illnesses or conditions can use to fund their insurance. However, according to the health insurance think tank the Commonwealth Fund, high-risk pools are extremely expensive for consumers to purchase, often running tens of thousands of dollars per year, and offer far less coverage than what the ACA provided.
  • The bill hasn't been evaluated by the Congressional Budget Office (CBO) yet. However, a CBO scoring of the previous iteration of the bill found that as many as 24 millions Americans would lose coverage over the ten years following its passage.

What happens next:

As NPR explains, the AHCA passing the House is only one step of what will likely be a lengthy and complex process. The bill passed by the House will go to the Senate for a vote. The Senate will, in turn, likely make substantial changes to the bill to satisfy its members, and then must pass it with a 60-vote threshold to shut down the inevitable Democratic filibuster to come. Without that margin, Republicans will have to use reconciliation to pass the financial aspects of the bill, and can only do so if a budget is passed.

If the Senate passes a version of the bill that's changed in any way, it has to go back to the House for another vote. Meaning this happens all over again.