WASHINGTON — House Republicans voted Thursday to advance their long-promised replacement for the Affordable Care Act, overcoming weeks of stumbles and delivering a significant measure of progress for themselves and President Trump.
The vote to pass a repeal bill was a major step toward undercutting a law that has fueled Republican voters, who complain it raised costs and let the government intrude on people’s health care.
It was approved 217-213.
“We can continue with the status quo or we can put this collapsing law behind us,” Speaker Paul Ryan said on the House floor before the vote, which GOP leaders were confident would succeed after days of wrangling.
Republicans had voted dozens of times in years past to kill the law commonly called Obamacare. But with Trump in the White House, this was the first time they had pushed through legislation that, if it clears the Senate, actually has a chance to become law.
The effort to erase Obamacare appeared to have fallen short in March. It was brought back to the forefront largely through the effort of Rep. Tom MacArthur, a South Jersey Republican who represents much of Burlington and Ocean Counties. But he was the only Philadelphia-area Republican to support the amended measure.
The razor-thin margin in the House illustrated the sharp divides over the policy, and some GOP worries that they could ultimately pay a political price for rolling back a law that has gained in popularity and helped millions of Americans obtain health insurance.
It also foreshadowed a difficult road in the Senate, where Republicans have an even slimmer, two-vote margin, and where some of the House provisions may be stripped. Republicans there plan to use rules that let them pass a repeal with a simple majority, but those rules also limit the scope of the legislation.
Democrats said the GOP plan would erase critical protections provided by Obamacare, including provisions that hold down health insurance prices for people with costly pre-existing conditions. It could also scale back a Medicaid expansion that has helped more than 1 million people in Pennsylvania and New Jersey obtain health coverage.
And the Congressional Budget Office, Congress’ official analyst, estimated that an earlier version of the bill could increase the ranks of the uninsured by 14 million next year and 24 million over the next decade. It also estimated steep price hikes for older and poorer Americans, while cutting the federal deficit and many taxes associated with the Affordable Care Act. Some of the deficit savings have since been reduced by new spending meant to soften the bill’s impact.
There were enough concerns, particularly about Medicaid and protections for people with pre-existing conditions, to scare off most Republicans from the moderate Philadelphia suburbs.
Democrats attacked the plan leading up to the vote.
— Paul Ryan (@SpeakerRyan) May 4, 2017
“The @HouseGOP bill is a disaster for middle-class families in Pennsylvania- costs up, coverage down, services cut,” Sen. Bob Casey (D., Pa.), wrote on Twitter before the vote. “Really, we shouldn’t call this GOP health care bill a ‘plan.’ It’s a scheme to cuts taxes for millionaires & big corporations.”
Gov. Wolf wrote to Pennsylvania’s Congressional delegation urging them to oppose the bill, saying it would harm vulnerable, older Pennsylvanians.
“For consumers, your decisions could mean the difference between being able to afford health care and being able to keep the lights on in their homes,” he wrote.
Democrats also quickly signaled how they would use the vote as political fodder in next year’s elections, much as Republicans used Obamacare’s passage to fuel their wave of victories in 2010. The Democratic National Committee put out a list estimating the number of people with pre-existing conditions in competitive Congressional districts.
But Republicans argued that they were reversing rising premiums and deductibles that made Obamacare coverage too expensive for too many, and offered limited choices.
“Death spiral!” Trump tweeted Thursday morning, linking to a news story about the insurer Aetna pulling out of the Obamacare marketplace in Virginia.
The vote arrived before the CBO had estimated the impact and cost of its latest iteration, and with little time to review its final changes. But Republican leaders, who for years have attacked Democrats for the procedures they used to pass Obamacare, were eager to advance the bill before lawmakers returned home for a week-long recess, where they would likely face intense scrutiny and pressure from voters.
For MacArthur, the vote provided a signature moment in just his third year in Congress. He broke with the centrists he usually aligns with and negotiated a deal with conservative holdouts that brought them on board and gave the measure new momentum. His amendment, which dominated talk on Capitol Hill this week, would let states opt out of the provision restricting insurers from charging higher prices to people with pre-existing conditions. He said other safeguards would remain in place.
A final change from his GOP colleagues Wednesday seemed to assuage enough Republicans to pull the bill over the finish line — though not without stern objections.