House passes ACA repeal, replacement bill

Paul Ryan speaking on House floor
After its passage in the House, the American Health Care Act now goes to the Senate for consideration. (speaker.gov)

The House of Representatives voted 217-213 on Thursday to pass a bill that rolls back major provisions of the Affordable Care Act, sending the measure to an uncertain fate in the Senate.

The American Health Care Act’s passage in the House comes more than a month after Republicans’ first attempt to bring it to a vote on the House floor, an effort stymied at the last minute when the party came up short of the 216 votes it needed.

RELATED: House gives green light to amended AHCA; hospital, industry execs disappointed but not surprised

In his remarks on the House floor before Thursday’s vote, Speaker Paul Ryan said members have a choice between keeping the “collapsing” ACA intact or setting a new course for healthcare and for the nation.

“We can continue with the status quo, or we can put this collapsing law behind us,” he said. “Let us pass this bill to build a better healthcare system for American families. Let us pass this bill to leave this country better than we found it.”

But House Minority Leader Nancy Pelosi, who spearheaded the effort to pass the ACA, was just as impassioned in her speech, warning her Republican colleagues that “if you vote for this bill, you will walk the plank from moderate to radical.”

She also predicted that the passage of the bill would serve as a “civics lesson” for Americans who don’t know who their representative is, but will soon learn when they feel the AHCA’s effects.  

Among its slew of provisions, the budget reconciliation measure will:

  • End taxes levied by the ACA, including those on pharmaceuticals and medical devices. The taxes would continue for a year to pay for the law’s programs as they wind down.
  • Eliminate the ACA’s individual and employer mandates.
  • Replace the ACA’s income-based premium subsidies for individual market customers with age-based tax credits.
  • Start unwinding the ACA’s Medicaid expansion beginning in 2020.

Republicans succeeded Thursday where they previously failed after amending the bill to appease two recalcitrant factions: hardline conservatives and GOP centrists.

To win over the former, an amendment authored by moderate Rep. Tom MacArthur, R-N.J., and House Freedom Caucus Chairman Mark Meadows, R-N.C., allows states to apply for waivers to opt out of the ACA’s rule that prevents individual market insurers from charging sick consumers higher premiums than healthy ones. However, they would be required to set up mechanisms like high-risk pools to protect those with preexisting conditions.

Then in response to moderates’ concerns about that amendment, representatives Fred Upton, R-Mich., and Billy Long, R-Mo., added an amendment that would provide $8 billion over five years to help states finance high-risk pools. Yet some healthcare policy experts argued this was a mere “pittance” compared to the amount of funding needed to ensure functioning high-risk pools and a stable individual market.

The Congressional Budget Office has not scored the revised version of the AHCA, though its evaluation of the initial bill estimated that if implemented, the measure would increase the number of uninsured by 24 million by 2026 but shrink the federal deficit by $337 billion from 2017 to 2026.