WASHINGTON — Attention has shifted to the Senate following the House’s narrow passage of legislation to repeal and replace significant parts of the Affordable Care Act.
The House approved the bill 217 to 213 with no Democratic support and 20 Republicans joining the opposition. The legislation would overturn many of the law’s popular consumer protections, eliminate the individual mandate and recast the insurance market. It faces an uphill battle in the less conservative Senate, where its sharp spending cuts — including Medicaid rollbacks — will almost certainly be softened. And any legislation the Senate passes will have to be reconciled with the House version.
“The Senate will now finish work on our bill, but will take the time to get it right,” said health committee chairman Lamar Alexander (R., Tenn.).
He said that he favored gradually giving states more flexibility on Medicaid “in a way that does not pull the rug out from under people” and … “making sure those with preexisting conditions have access to insurance.”
Reservations about Medicaid cuts also have emerged from GOP senators whose states expanded the entitlement program under the ACA, including Rob Portman of Ohio, Lisa Murkowski of Alaska, Cory Gardner of Colorado and Shelley Moore Capito of West Virginia.
“I continue to have concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse,” said Portman.
Senators also said the implications of the House legislation were not immediately clear. “Don’t know what’s in it,” Lindsey Graham (R., S.C.) said hours prior to the vote, according to The New York Times. “Waiting to see if it’s a boy or a girl.”
Graham later said the vote showed that congressional Democrats were committed to protecting the ACA. “They refuse to face up to the fact that Obamacare is on the verge of collapse. Until they accept this reality, I believe they will refuse to work with President Trump and Republicans on health care reform.”
For their part, House Republicans reveled in their rebound following their failure in March to garner sufficient votes to approve an earlier version of their legislation, called the American Health Care Act.
“This bill delivers on the promises that we have made to the American people,” said House Speaker Paul Ryan, (R., Wis.). “A lot of us have been waiting seven years to cast this vote … to rescue people from this collapsing law.”
Ryan and other Republicans said the GOP plan would boost competition, cut costs, and return power to states and individuals. Keeping Obamacare, Ryan said, would mean “even higher premiums, even fewer choices, even more insurance companies pulling out.”
Democrats said the bill would deprive the poor and middle class of health insurance.
“Trumpcare eviscerates essential health benefits,” such as maternity care and prescription drug coverage, House Minority Leader Nancy Pelosi (D., Calif.) commented, “and guts protections for people with preexisting conditions.”
The vote came after last-minute arm twisting, with moderates appeased by an $8 billion amendment for a high-risk pool to help patients with existing conditions pay for higher premiums and out-of-pocket costs.
Republicans went ahead with the vote without a full analysis of the legislation from the Congressional Budget Office. The CBO estimated the bill’s earlier version would cause an estimated 24 million people to forgo or lose insurance by 2026.
“There’s been a lot of drama, a little bit of trauma along the way,” said Rep. Tom Cole (R., Okla.) a member of the House GOP leadership, according to USA Today.