UPDATE: Around 3 p.m. Friday, President Donald Trump asked House Speaker Paul Ryan (R-Wis.) to postpone the scheduled afternoon vote on the bill.
PREVIOUSLY: WASHINGTON ― President Donald Trump’s last-minute push to repeal the Affordable Care Act propelled the effort over its first hurdle Friday morning, with the House passing a procedural measure that clears the way for a final vote in the afternoon.
Normally votes on rules, such as the one Friday morning, break predictably along party lines, but the bid to repeal a health care law that has reduced uninsured rates to historic lows has roiled the Republican Party, with moderates concerned about hurting their constituents, and hard-line conservatives demanding more extreme rollbacks.
An all-out push by the White House Thursday ended with a final take-it-or-leave-it offer from the president.
A four-page amendment to the American Health Care Act appeased conservatives by ending Obamacare’s nationwide guarantee of essential health benefits in insurance plans, such as mental illness coverage and maternity care. The amendment aimed to appease moderates by extending for six years a 0.9 percent Medicare surcharge on high-income earners. That would provide an extra $15 billion to states to cope with the negative effects of the repeal.
The effort is especially remarkable in that it has proceeded in just a few weeks, with no hearings involving experts or stakeholders. Most health care policy groups and experts have been highly critical of the AHCA.
Even the parts of the bill that had public markups earlier this month have been changed several times to try and win over angry conservatives and moderates. No hearings were held on any of the revisions beyond votes in the House Rules Committee, which determines how legislation will be handled on the House floor.
It was one of these procedural rules that passed 230 to 194 Friday morning, with six Republicans voting no.
The GOP bill has been changed so much that the usual Congressional Budget Office analysis, which would assess the final measure’s impact, does not yet exist. The most recent evaluation found that the bill would trim about $150 billion from the deficit over 10 years ($177 billion less than the original proposal), while adding some 24 million Americans to the ranks of the uninsured.
The effects of the new four-page amendment are unclear and have not been analyzed, but Democrats criticized the amendment as a scheme to allow insurance companies to sell plans that leave out basic services.
“These four pages are the worst four pages on this planet,” said Rep. Jim McGovern (D-Mass.). “It will be devastating for millions and millions of Americans.”
Still, the Republican push prevailed as GOP lawmakers repeated their well-worn complains about the Affordable Care Act.
“Obamacare has failed the American people,” said Rep. Pete Sessions (R-Texas), who noted that he was wearing a brown suit because the color was a good-luck charm for President Ronald Reagan.
“Our health care system today is broken and only getting worse under the current law known as the Affordable Care Act, or Obamacare,” Sessions said. “Simply put, Obamacare is collapsing, and is collapsing fast.”
In reality, the CBO’s estimates of the GOP bill have said the Affordable Care Act would remain stable if it is not repealed.