House To Vote On Obamacare Repeal Bill Today
After failing twice in a month, House Republicans apparently think they have the votes to pass their bill to repeal and replace the Affordable Care Act.
After many fits and starts, the House Republican leadership plans to put the revised bill to repeal and replace the Affordable Care Act on the floor for a vote today:
House Republican leaders said Wednesday that they plan to bring their controversial plan to revise key parts of the Affordable Care Act to a vote on Thursday, capping weeks of fits and starts in their attempt to fulfill a signature campaign promise.
The flagging Republican effort to reshape the nation’s health-care system picked up steam Wednesday as GOP leaders tried to address concerns about people with preexisting medical conditions. But independent analysts remained skeptical that the new proposal would fully address the needs of at-risk patients who receive coverage guarantees under the Affordable Care Act, underscoring the contentious nature of the Republican effort.
Republican leaders huddled in the office of House Speaker Paul D. Ryan (R-Wis.) on Wednesday evening to figure out the next steps after a whirlwind day at both ends of Pennsylvania Avenue. Several said they would hold a vote this week only if they felt certain it could pass — meaning they now think they have the votes.
Exiting the relatively brief leadership meeting, House Majority Leader Kevin McCarthy (R-Calif.) guaranteed victory. “Do we have the votes? Yes. Will we pass it? Yes,” he told reporters.
Several Republicans said a vote is expected around lunchtime on Thursday. The House Rules Committee met late Wednesday to take procedural steps in advance of the floor vote, approving final GOP adjustments to the measure.
If the bill passes, it will face a steep climb in the Senate, where widespread disagreement remains among Republicans about how to proceed on health care.
Rep. Fred Upton, an influential Republican from Michigan, introduced the amendment that was key to resolving a major sticking point this week. It provides more financial assistance — $8 billion over five years — to help people with preexisting conditions pay for medical costs. Those people are at risk of losing protections under the GOP plan, which seeks to repeal and replace major parts of the ACA.
Just a day earlier, Upton said he could not support the Republican plan because of its stance on preexisting conditions. But he sounded an optimistic note after sketching out his fix Wednesday and meeting with President Trump at the White House.
Upton said Trump called him Tuesday afternoon. The two had a “good give and take,” he said, and Trump grew “a little angry” when Upton said he could not support the bill. But eventually, he said, they came to an agreement on his amendment.
Rep. Billy Long (R-Mo.), who like Upton was against the bill earlier this week over the issue of coverage for preexisting conditions, was also in the White House meeting.
A Washington Post analysis showed 20 House Republicans either opposed to or leaning against the bill late Wednesday, and 36 more either undecided or unclear in their positions. If no Democrats support the measure, House Republicans can lose no more than 22 GOP votes to pass their bill.
Upton’s amendment was not met with resistance by the House Freedom Caucus, a key bloc of conservatives whose opposition to an earlier version of the health-care bill led GOP leaders to yank the measure.
“I don’t see any defections because of this particular amendment from our previous whip count,” said Rep. Mark Meadows (R-N.C.), the chairman of the group. Meadows and Upton both said they had been in touch.
Documents filed with the House Rules Committee showed the Upton amendment was co-sponsored by Long and four other Republicans who had been previously undecided, suggesting that the quartet would support Ryan’s bill on final passage.
Under the GOP plan, states could opt out of parts of the ACA, meaning people with preexisting conditions could be denied coverage or charged more. Such states would have to set up “high-risk pools” to absorb some of the costs.
Upton’s amendment would help some patients with expensive conditions, such as cancer or diabetes, pay premiums and out-of-pocket costs.
Some experts doubted that $8 billion was enough to aggressively address those costs over a five-year period. According to an analysis from the Kaiser Family Foundation, the temporary high-risk pool created by the ACA covered just 100,000 people; the government paid out $2 billion in subsidies to that pool in one year.
Far more people with preexisting conditions are likely to lose health coverage under the GOP health-care plan — some estimate about 5 million individuals. Depending on how many states apply for the funds, $1.6 billion a year could be spread thin.
“For subsidies to cover 68 percent of enrollees’ premium costs, as ACA tax credits do now in the individual market exchanges, the government would have to put up $32.7 billion annually,” Emily Gee, a health economist at the progressive Center for American Progress, wrote in an analysis of the plan. “Even after applying that subsidy, high-cost consumers would still owe $10,000 annually toward premiums.”
(…)
There was also uncertainty about how the bill would be scored by the nonpartisan Congressional Budget Office, which measures how much the legislation will cost and how many people stand to lose coverage.
Republican leaders were willing to move ahead with a vote even before obtaining an updated score. Speaking on the House floor Wednesday afternoon, McCarthy brushed off a Democrat’s concerns about a new score, noting that a previous version of the bill had already been reviewed by the CBO.
The CBO projected in late March that a revised GOP health-care plan would result in 14 million more people being uninsured in 2018 than under current law. It projected the plan would slash the federal deficit by $150 billion between 2017 and 2026.
The House is slated to go on recess Thursday until May 16, which forced GOP leaders to make a quick decision about whether to try to hold a vote before leaving town.
The White House has been putting heavy pressure on Ryan to swiftly pass a health-care bill, amid fears that Republicans will lose their opportunity if the effort continues to drag out.
The announcement late yesterday that a vote will be held today on the revised version of the American Health Care Act came after weeks in which Republicans worked largely behind the scenes to come up with a bill that could satisfy both the conservatives in the caucus represented by groups such as the House Freedom Caucus and more moderate members such as the members of the Tuesday Morning Group. Conservatives objected to the original version of the bill that failed in March largely due to the fact that it retained many of the more popular provisions of the Affordable Care Act, such as the coverage guarantee for pre-existing conditions and the provisions which allowed parents to keep their children on employer-provided policies until the age of 26, among others. To address those objections, the revised AHCA will apparently allow states to opt-out of those provisions as long as they agree to participate in the “high-risk” pools that the law establishes. However, as noted above, it’s not entirely clear that the changes to insurance markets that the law will make would even give people with pre-existing conditions in states that have opted-out any real options when it comes to coverage other than high-premium, high-deductible plans that many people will find unaffordable. It was because of this that many House moderates were objecting to the revisions to the bill and either committed to voting against it or threatening to do so. To address the concerns of that group, the bill now provides an additional $8 billion to help states fund the aforementioned high-risk pools, although it isn’t at all clear that this will be anywhere near enough money to address the additional coverage costs that people with pre-existing conditions may face in states that choose to opt-out of the coverage mandate.
While nothing is official until there’s actually a majority vote in favor of the bill, it’s unlikely that House leadership would go forward with a vote unless they were fairly certain that they have the votes they need plus a few insurance votes for good measure. So, unless the bill is pulled at the last minute, which is, of course, a possibility, it looks as though the House will pass this bill today shortly before heading out of town for a recess that will last until May 16th. That recess will be interesting to watch mostly because it will be interesting to see if we get a replay of the scenes we saw earlier this year at Congressional Town Halls where constituents confronted many Republican Members of Congress over the prospect of what could happen to their health care coverage if the Republican repeal and replace bill passes.
As for the bill itself, it will move on to the Senate where prospects of passage are murky at best. For one thing, the changes that have been made to the bill have many observers questioning whether the version of the bill likely to pass the House would qualify for Senate reconciliation status that would permit Republicans to pass it with a simple majority rather than having to gain sixty votes to invoke cloture on the bill as is the case with most other legislation. If it doesn’t qualify for reconciliation, then the bill is most assuredly dead in the Senate in its present form unless there were eight Democrats willing to break with their party to invoke cloture, which seems unlikely Even if it does qualify for treatment under reconciliation, though, the prospects for the bill in the Senate don’t look good at all. Conservative Republicans such as Rand Paul, Ted Cruz, and Mike Lee have voiced many concerns about the House bill in the past, for example, and moderate Republican Senators have done the same, raising concerns not just about the pre-existing condition issue but also the impact the bill would have on states that have adopted the Medicaid expansion made available under the PPACA. Additionally, while reconciliation does do away with the sixty vote bill, it allows virtually unlimited amendments to whatever legislation the Senate is considering. Finally, there is some talk on Capitol Hill that the Senate could choose to essentially ignore the substance of the House bill and come up with its own bill. In any case, the process in the Senate is likely to take much longer than it did in the House, and likely to result in something quite different. This means that the two chambers will be required to take the matter to a Conference Committee to try to cobble together a bill that can pass both chambers, a process that will take months at least and which will likely be slowed down by the need to deal with matters ranging from the Federal Budget for the next Fiscal Year, tax reform, and what is apparently the Trump Administration’s upcoming infrastructure plan. This puts a final vote closer to the 2018 election, of course, and that means that, in the end, the fate of this effort to replace and replace the PPACA still isn’t complete.
The sweetener which changed Upton and Long’s votes was $8 billion over 5 years, or $1.6 billion per year to pay for the high risk pools for those with pre-existing conditions.
Before ACA was enacted, it was estimated that 64% of people between 50 and 64 have pre-existing conditions. This is the second half of the baby boom, and there were over 4 million births per year, and there are about 58 million people in this age range, of whom about 37 million would be expected to have pre-existing conditions. Of these, about 16% are currently either uninsured or purchase insurance by themselves.
Doing the math, this means that the amount added to support high risk pools is about $260 per person with pre-existing conditions and who does not currently get insurance from their employer, Medicare or Medicaid per year. Somehow, I doubt this puts a dent in the cost of their care.
Let’s see, no CBO score, newly added provisions being discovered this very morning that jeopardizes care and services for millions (by allowing states to bring back lifetime caps and gutt essential benefits and by capping Medicaid funds that provide care to special needs kids in schools), countering taking $1TRILLION out of the Health Care system by adding in $8BILLION in insanely inadequate high risk pools…
Livid isn’t a string enough description of the way I feel about the House GOP.
Oh,m and if you think you are safe because you have empoyer-sponsored coverage and live in a Blue State, think again.
tl;dr version: Existing regulation allows Large Employer plans get to pick any state’s “benchmark plan” for its essential benefits and the bar on lifetime caps only applies to essential benefits. The new AHCA bill allows states to get waivers from the mandatory essential benefits as long as they set up wildly underfunded high risk pools.
So if Alabama or Kansas get the waiver, a “large employer” (one with more than 500 employees – so not that large really), can base their plan on that waived state and screw you.
@SKI:
WSJ also covering this discovery: Little-Noted Provision of GOP Health Bill Could Alter Employer Plans
The bill is horrible and it’s filled with idiotic hate that appeals only to the inferior. Take it conjunction with Trump’s moronic belief in strongmen and his musings about libel and archaic processes, and god knows what’s going to happen.
The only good thing is that these people are so f—ing dumb and incompetent.
@SKI:
How in the hell is that legal? “Oh hey, I have nothing to do with Missouri but they screw their workers the most so we’re gonna be like Missouri now! Screw you, New York where I actually do business, I’m a Southerner now!”
A gross violation of states’ rights from the party that loves to scream about them. Think of the precedent it would set – the SC would kill that MF so fast….
@KM:
Federal Preemption through ERISA.
That part isn’t new actually. Large Employers with self-funded plans haven’t been subject to state insurance requirements since ERISA passed in the 70’s.
@KM:
This is nothing new. For decades large Massachusetts employers have been allowed to pay Mississippi rates on group policies for their employees. Individual subscribers pay the full Mass. rate, which is the highest in the country.
And what happens when the CBO comes back and shows that this new improved version will kick 30 million or even more Americans off the insurance rolls? “Oops, we goofed”?
I guess Americans are going to have to learn the hard way that IGMFY is a rotten way to run an economy. Suspect that quite a lot of the chumps banging the drum for this abortion are going to be quite surprised when they discover that that nice rural hospital that they were counting upon to provide them with health care has gone out of business.
But then, these are the same chumps ranting “get Government out of my Medicare!”
The important thing is that we get rid of Obamacare and achieve a victory in the game we play in Washington. The impact on the American people is not something we think about.
FTFY
This is why it is so dumb that “moderate” Republicans are voting for this. They are going to be on record for voting for this bill and the Senate might not be able to save them because this bill likely won’t get through reconciliation thanks to the Byrd Rule.
This people just slit their own throats and honestly it couldn’t happen to a better group of people. At least the Freedom Caucus believes in their terrible policies, these “moderate” Republicans are just craven cowards.
I really don’t even know what to say. How is it we’re even having this conversation? Literally every other first-world nation provides a guarantee of health care coverage to its people, and we’re going backwards. Americans experience a stress–some, including people I hold very dear, an enormous, life-threatening stress–that people in no other developed economy have to experience. And for what? To pay twice as much per capita for the same or worse quality of care as everyone else…and, in fact, for many, there’s no real care at all.
It’s simply horrendous and disgusting that this is happening.
Kevin Drum summarizes the bill as follows:
“There have been no public hearings.
There’s no final text.
There’s no updated CBO score.
It is opposed by virtually every patient advocacy group and everyone in the health care industry.
Congress is still exempted from the new rules that allow states to waive essential benefits.
It raises premiums dramatically for older people.
It removes Obamacare’s protection against being turned down for a pre-existing condition.
It would steadily gut Medicaid spending for the very poorest.
It removes coverage from at least 24 million people, probably more.
It slashes taxes on the rich by about a trillion dollars over ten years.”
Note the first two. It makes Republican complaints distorting Nancy Pelosi saying “we need to vote on the bill to determine what is in it” seem quaint.
You really have to wonder what assurances the GOP leadership has provided to the representatives who are now breaking in favor of this repeal bill.
At the very least, I bet that it is a promise to flood their districts with dark money during the 2018 campaign cycle, so that they can fight off energized Democratic candidates.
Or maybe something even more aggressive.
@Yank:
As I noted on the earlier thread https://www.outsidethebeltway.com/house-republicans-making-yet-another-push-to-repeal-and-replace-obamacare/#comment-2204762,
He’s terrified of being primaried from the right, which is how he got the job away from Jean Schmidt, the Wicked Witch of East Cincinnati. I don’t think the Freedom (sic) Caucus are any different. They feel perfectly safe in the general, but they’re also terrified of being primaried from the right. The problem with crazy is that it has no boundaries. No matter how nuts, say Louis Gohmert, is, it’s possible to be even crazier right, and apparently his constituents are crazed enough to go for it.
The CBO score on this is not likely to be good.
Doug, James, Harvard, anybody? If the bill has already passed the House is CBO scoring automatic? Is there a way they can prevent it? Can they delay it ’til after reconciliation? Can they dictate magic asterisk assumptions to the CBO?
@gVOR08:
CBO is coming next week, supposedly. Which yes, means a bunch of Republicans are going to be explaining how they already voted for a bill that will deprive millions of their health insurance – all to ensure that I get a tax cut.
@Bokonon:
As you say, at the very least. More likely a threat to flood money to a primary challenger.
Those town hall meetings are going to be fun.
If the Democrats regain control of any legislative body or the White House in my lifetime they have every right to destroy the Republican Party as a whole. The media and centrists will cry but as the GOP has shown standards are simply a matter of taste. Bring in the IRS and go through expense accounts and tax returns and every conservative think tank and destroy them and put anyone you can in jail. Take their money and annihilate them. I honestly don’t think it would be that hard. There’s so much bad accounting and financial fraud in these low-rent idiots. The only reason they’ve survived for so long is that we’ve had to pretend that there’s some semblance of balance.
The media has this weird habit of treating both parties as if we are stuck in the 1980s. The GOP is still seen by many of them as a serious governing party, while the Democrats are considered the emotional yahoos.
This is how people like Paul Ryan, a charlatan and a fraud, can still be treated like a serious wonk. While Nancy Pelosi, a serious and skilled pol, every move is question by these clowns.
@Yank:
Not sure if I would call Pelosi a skilled politician, given that she and her party are in this position.
Drum forgot to mention that it cravenly exempts Congress and its staffers from the damage.
These are vile sociopaths but most Republicans are too tribal and innumerate to recognize what is happening.
@Modulo Myself: Pelosi is a very skilled pol. She is one of the best speakers the house has every seen. Just look how hard it has been Ryan (and Boehner before him….) to keep their caucus in check and then compare to how Pelosi keeps her caucus in check, both as a majority and minority in the house.
Pelosi (alongside Reid) oversaw the most productive US congress since the mid-1960s and pushed through major legislation that Democrats have wanted to do for decades.
From The Incidental Economist: http://theincidentaleconomist.com/wordpress/the-michigan-morsel/
Just an excerpt:
@Moosebreath:
The health care consulting firm Avalere did their own calculations, and found that combining the original $15 billion plus the additional $8 billion, there is enough for the high risk pools to cover about 5% of the individual health care purchasers with pre-existing conditions:
“New research from Avalere finds that the funding ($23 billion) specifically allocated in the American Health Care Act (AHCA) to assist individuals with pre-existing conditions will only cover approximately 110,000 individuals with a pre-existing chronic condition. If states were to allocate all the other funds in the Patient and State Stability Fund ($100 billion) toward providing insurance to people with pre-existing conditions, in addition to the funding described above (total of $123 billion), 600,000 individuals with pre-existing chronic conditions could be covered.
Approximately 2.2 million enrollees in the individual market today have some form of pre-existing chronic condition.”
@Yank: This.
She is her father’s daughter and understands the first rule: count the votes.
The Republican Party itself has become a moral blight upon this Nation.
Based almost solely on ignorance, rank with hypocrisy, saturated with mendacity.
Supporting Republicans in any way, shape, or form is the sign of a sub-human being.
This used to be a proud party, of incalculable value to the Republic.
Today this group of people is nothing but a festering lesion of avarice, deviancy, and moral atrophy.
@Daryl’s other brother Darryl: The Republican Party itself has become a moral blight upon this Nation.
I would guess about half of the Republican house would support Hitler TODAY if he were in power in this country and was a Republican. Some idealogically (Steve King, almost any Texas GOP congressperson, etc.), and some strategically (Ryan, Chaffetz, Issa, etc.). They are morally bankrupt as a party and individually as people. They are disgusting human beings. If the ACHA passes the House the Democrats better start emptying their war chest to remind people of the effects, and warn the Senate that they are the last line of defense of having the spectacle of an orange piece of excrement having a signing celebration to ensure the deaths of hundreds of thousand of people from lack of access to health care.
Paul Ryan just gave a rousing speech on the House floor, vowing that voting for this bill will make America a better place (etc.). I’m not sure if he’s completely delusional, a complete jerk, or a combination of both. I am truly amazed at how bizarrely detached from reality and decency the Republicans have become.
@reid: I am truly amazed at how bizarrely detached from reality and decency the Republicans have become.
The GOP has become party of “whatever Obama did or was for we are against”. Eventually they should come up with an acronym. Or maybe go with “no Obama” a la the Simpsons “No Homers Club”.
@SenyorDave: Indeed. And it’s been getting to this point for many years. What amazes me is that they are so completely immune to any sort of pragmatic thought, any recognition of the real, negative repercussions of their actions. That’s the self-delusion at work… “Everything we do is right and good!” Nothing can pierce the bubble, it seems. Though, I guess there a few good ones.
@grumpy realist:
Suspect that quite a lot of the chumps banging the drum for this abortion are going to be quite surprised when they discover that that nice rural hospital that they were counting upon to provide them with health care has gone out of business.
That and only that is going to get them to vote against Republicans. It’s not just that they don’t give a crap about anyone else; it’s that far too many of them are gleeful at the thought of effing over the “others”.
Not until they get it good and hard – and closing the rural hospitals would do it – are they going to change.
How many where against gay rights only to change their positions only until a family member came out?
In the end it’s only about what affects them.
This isn’t a health care bill; it’s a tax cut for the rich, a tax cut that 10’s of thousands will die for.
And if you get your insurance thru the workplace, you are going to suffer too…it’s not just “the others”. Note that Republicans exempted themselves from this abomination.
Pottery Barn rule; you broke it, you bought it.
The GOP owns it now. The most symbolic picture I saw was Chaffitz wheeling himself in to vote after recovering from a surgery that was necessary because of a pre-existing condition. Of, course, as a member of Congress, his procedure was covered by insurance.
https://twitter.com/gkroberts/status/860157465970831360
The House passed it 217-213. All Democrats voted nay.
https://www.washingtonpost.com/powerpost/republicans-plan-health-care-vote-on-thursday-capping-weeks-of-fits-and-starts/2017/05/03/e7dd7c28-306d-11e7-9dec-764dc781686f_story.html
The really scary part of this is that the people who voted for this today want to get re-elected. And judging by the composition of the House since 2010 they are pretty good at it. As much disgust as I feel for the Republican House Representatives, they must truly believe that Republican voters are some sort of toxic combination of stupid and mean.
It is really time for Democrats to stop beating themselves up for not being understanding enough of Trump supporters. As always their actions have proven that nobody disrespects a Republican voter like a Republican politician.
@MikeSJ:
“Not until they get it good and hard – and closing the rural hospitals would do it – are they going to change.”
Along those lines, the top 11 states with people under 65 with pre-existing conditions all voted for Republicans for President in every election since 2000, except Indiana voted once for Obama.
I can’t wait till they CBO drops next week…….
@grumpy realist:
That hospital, with its satellite clinics is probably also the biggest employer in the area. But the Mighty Right Wing Wurlitzer will convince them it’s Obama’s fault, or immigrants, or something. This would all be hilarious if it weren’t so horribly tragic.
@gVOR08: Those medical workers aren’t coal miners so it doesn’t count when they lose their jobs and their insurance.
Christ, what a car wreck. The ACA has problems — it looks like Iowa will soon have no ACA insurers for individuals. And now the GOP comes up with a solution that:
1) makes things worse
2) could not be read before voting
3) has no CBO score
4) has all kinds of phantom provisions
This is a disgrace.