Yuri Gripas/Reuters
Thursday's the day.The House is finally set to vote on the American Health Care Act, the GOP plan to repeal and replace Obamacare, after nearly two months of stalled attempts at passage.
The House Rules Committee cleared the AHCA late Wednesday after House Majority Leader Kevin McCarthy told reporters that the bill would be brought to the floor, setting up a vote early Thursday afternoon.
The vote is expected to be close, with a number of Republican holdouts still expressing concerns over the bill's potential effects on people with preexisting conditions.
Despite the narrow count, McCarthy appeared confident Wednesday that the bill would pass.
"Do we have the votes? Yes. Will we pass it? Yes," McCarthy said.
The White House appears similarly confident in the bill's passage. A White House aide told attendees at a dinner with religious leaders that Republicans felt confident that they had 218 votes in the House and could have as many as 220, according to Bill House and Anna Edgerton at Bloomberg. The bill needs 216 votes to pass.
The blitz to secure the votes has gone to extreme lengths for some members. GOP Rep. Jason Chaffetz flew back from Utah on Wednesday to be in Washington, DC, for the vote after undergoing foot surgery.
The AHCA, which has also become known as "Trumpcare," was first called to the House floor on March 24, only to be pulled at the last minute when House GOP leadership could not persuade enough members of their party to vote for the bill.
After that failure, two amendments were added to win over recalcitrant members of the party - one aimed at conservatives and another at the party's more centrist members. Here's a quick rundown of the two additions:
- The MacArthur amendment: Introduced by centrist Rep. Tom MacArthur, the amendment would allow states to apply for waivers from the federal government to rescind some Obamacare regulations if they can prove it would reduce the costs for people in their states.
The amendment, which was seen as a step toward a fuller repeal of Obamacare, was enough to win over the conservative House Freedom Caucus and flip as many as 20 votes over to support for the AHCA.
The possible removal one of the two regulations, community ratings, could result in some people with preexisting conditions being charged more for insurance and priced out of the market, experts say. That possibility drove some moderates away from the AHCA, leaving the bill seemingly short of the needed votes. - The Upton amendment: Introduced by Rep. Fred Upton, the amendment would allocates an additional $8 billion over five years to states that receive waivers for additional funding for their own programs. While Upton said it was designed to help bring down costs for those with preexisting conditions, the amendment itself does not specify that the money must be used for those people. Instead, it says the funds are to be used to "reduce premiums or other out-of-pocket costs of individuals who are subject to an increase in the monthly premium rate for health insurance coverage as a result of such waiver."
Many health-policy analysts agree that the funding proposed by the amendment, in addition to the funds allocated in the original AHCA, would likely not be enough to run a sustainable high-risk pool for Americans with preexisting conditions.
This amendment was enough to flip Upton, along with other possible holdouts, including Reps. Billy Long, Steve Knight, David Valado, and Jeff Denham. With those additions, it appears the GOP has a more comfortable path to passing the bill.
The current iteration of the AHCA does not have a score from the Congressional Budget Office, so it is unclear how the two major changes to the bill could affect the federal budget, Americans' insurance coverage, or long-term insurance premiums. Upton told reporters "I wish that we had had" the CBO score, but since it would take a few weeks to get, they would forge on without it.
The lack of clarity has drawn extensive criticism from Democrats, including House Minority Leader Nancy Pelosi.
"Forcing a vote without a CBO score shows that Republicans are terrified of the public learning the full consequences of their plan to push Americans with preexisting conditions into the cold," Pelosi said.
The legislation, even with the additions, has also drawn the ire of a large swath of the major medical groups in the country including the American Medical Association, American Hospital Association, Blue Shield of California, the American Association of Retired Persons (AARP), and more.
Passage in the House does not guarantee smooth sailing for the AHCA in the Senate. The upper chamber is expected to make significant changes to the bill, as many GOP senators have expressed concern over various aspects of the law at points during the process. Some arcane chamber rules, such as the Byrd rule, may make the passage difficult, as well.