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 The vote to repeal former President Barack Obama's signature
domestic achievement, which enabled 20 million more Americans to get
health insurance, was Trump's biggest legislative win since he took
office in January, putting him on a path to fulfilling one of his
key campaign promises as well as a seven-year quest by Republican
lawmakers.
It marked a reversal of fortune for the Republican president who
suffered a stunning defeat in late March when House Republican
leaders pulled legislation to scrap Obamacare after they and the
White House could not resolve the clashing interests of Republican
moderates and the party's most conservative lawmakers.
Trump has called Obamacare a "disaster" and congressional
Republicans have long targeted the 2010 law, formally known as the
Affordable Care Act, calling it government overreach.
But despite holding the White House and controlling both houses of
Congress, Republicans have found overturning Obamacare politically
perilous, partly because of voter fears, loudly expressed at
constituents' town-hall meetings, that many people would lose their
health insurance as a result.
With Thursday's 217-213 vote, Republicans obtained just enough
support to push the legislation through the House, sending it to the
Senate for consideration. No Democratic House members voted for the
bill. Democrats say it would make insurance unaffordable for those
who need it most and leave millions more uninsured. They accuse
Republicans of seeking tax cuts for the rich, partly paid for by
cutting health benefits.
The legislation, called the American Health Care Act, is by no means
a sure thing in the Senate, where the Republicans hold a slender
52-48 majority in the 100-seat chamber and where only a few
Republican defections could sink it.
As Republicans crossed over the vote threshold to pass the bill,
Democrats in the House began singing "Na na, na na na na, hey hey
hey, goodbye," a rowdy suggestion that Republicans will lose seats
in the 2018 congressional elections because of their vote.
Within an hour of the vote, Trump celebrated with House lawmakers in
the White House Rose Garden.
"I went through two years of campaigning and I'm telling you, no
matter where I went, people were suffering so badly with the ravages
of Obamacare," Trump said. "We are going to get this passed through
the Senate. I am so confident."
PRE-EXISTING CONDITIONS
The treatment of people with "pre-existing" conditions was one of
the central issues in the House debate on the bill and is sure to
resurface in the Senate.
Obamacare prevented insurers from charging those with pre-existing
conditions higher rates, a common practice before its
implementation. It also required them to cover 10 essential health
benefits such as maternity care and prescription drugs.
The Republican bill passed on Thursday would allow states to opt out
of those provisions. While insurers could not deny people insurance
because of pre-existing conditions, they would be allowed to charge
them as much as they want.
In an analysis released on Thursday, healthcare consultancy and
research firm Avalere Health said the Republican bill would cover
only 5 percent of enrollees with pre-existing conditions in the
individual insurance markets.
Republicans have argued that their bill would give people more
choice and reduce the role of government.
In a push to pass the bill before members leave on Friday for a week
in their home districts, the House voted before the bill was
assessed by the non-partisan Congressional Budget Office, which
estimates its cost and effect on insurance rolls.
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Republicans have said the bill will be scored by the CBO and other
fixes will be made before the Senate votes.
Health insurers, such as Anthem Inc, UnitedHealth Group Inc, Aetna
Inc and Cigna Corp, have faced months of uncertainty over
healthcare's future. So have hospital companies, such as HCA
Holdings Inc and Tenet Healthcare Corp.
CHALLENGES AHEAD
Obamacare expanded Medicaid, the government insurance program for
the poor, provided income-based tax credits to help the poor buy
insurance on individual insurance markets set up by the law, and
required everyone to buy insurance or pay a penalty.
The Republican bill would repeal most Obamacare taxes, which paid
for the law, roll back the Medicaid expansion and slash the
program’s funding, repeal the penalty for not purchasing insurance
and replace the law’s tax credits with flat age-based credits.
In a sign of the challenges ahead for the legislation, nearly every
major medical group, including the American Medical Association and
the American Hospital Association, and the AARP advocacy group for
older Americans, strongly opposed the Republican bill. Many said
last-minute amendments further eroded protection for the most
vulnerable groups, including the sick and elderly.
"I've already made clear that I don't support the House bill as
currently constructed because I continue to have concerns that this
bill does not do enough to protect Ohio's Medicaid expansion
population," said Republican Senator Rob Portman.
While the bill's fate in the Senate is uncertain, its House passage
could boost Trump’s hopes of pushing through other big-ticket items
on his agenda, such as tax reform.
The previous failure to overhaul healthcare legislation had raised
questions about how much Republicans could work together to help
Trump fulfill his campaign pledges.
"Anything that they (the Republicans) get done, that they
accomplish, popular or unpopular, will show that they have the
ability to make progress and to get things done and work together,"
said Randy Frederick, vice president trading and derivatives at
Charles Schwab in Austin, Texas.
"This puts the idea of tax reform a little bit closer to reality,
simply because it's shown that they have figured out a way to
negotiate and work together," he added.
(Additional reporting by Amanda Becker, Eric Beech, Richard Cowan,
Michael Erman, Susan Heavey, Steve Holland, Roberta Rampton and Eric
Walsh; Writing by Arshad Mohammed; Editing by Frances Kerry and
Peter Cooney)
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