WASHINGTON — House Republicans on Thursday narrowly approved a bill to replace the Affordable Care Act, sending a measure that had foundered just weeks ago to the Senate and handing President Donald Trump a major legislative success.
The House majority, after being cajoled and pressured in the past week by Trump and party leaders, provided the razor-thin margin of victory in a 217-213 vote, after 20 of its Republican members joined 193 Democrats in opposing the bill.
Hailing the bill’s passage as “the beginning of the end of Obamacare,” Vice President Mike Pence introduced Trump at a Rose Garden celebration, where the president pumped his fist and shook hands with House Speaker Paul Ryan (R-Wis.) and a group of Republican lawmakers.
“We won, and we’re going to finish it off,” Trump said. “It’s going to be an unbelievable victory when we get it through the Senate.”
But the House legislation faces a tough path through the Senate, where the 52-member Republican majority hopes to use a budgetary procedure called reconciliation to pass the measure with a simple majority, instead of risking falling short of the 60 votes needed to break a Democratic filibuster.
Senate Majority Leader Mitch McConnell (R-Ky.), who must corral Republicans unhappy with the House bill, said he would schedule consideration of the measure after getting budgetary and procedural reviews, but he offered no timeline.
Senate Minority Leader Chuck Schumer (D-N.Y.) promised unified Democratic opposition to scrapping the Affordable Care Act. “This bill is going nowhere fast in the United States Senate,” Schumer said.
The House bill’s passage came unexpectedly. The Republican effort to pass legislation was declared all but dead after the party’s conservative and more moderate blocs sank a vote on the Obamacare-repeal bill in March, a devastating blow to Trump.
But the president and House leaders surprisingly brought many of those GOP opponents on board by offering major concessions, twisting arms and making deals. Ryan then rushed the bill to the floor for a vote before House members left for a weeklong recess.
Recalling a futile seven years and more than 60 votes trying to deconstruct Obamacare, Ryan said he was hopeful that the Senate would pass the House bill, which he said creates a “marketplace for competition and lower premiums” to replace an act that “has failed and is collapsing.”
But Pelosi said Republicans can expect to face a voter backlash. Their House bill, she said, made “premiums and out-of-pocket go up, had a crushing age tax on those 50 to 64, had 24 million people fewer have access to . . . health insurance,” while recklessly undermining Medicare.
Long Island’s delegation split, voting along party lines.
Rep. Kathleen Rice (D-Garden City) said Republicans rushed the bill “to fulfill a campaign promise, give President Trump a win and dump this disaster off on the Senate.” Rep. Thomas Suozzi (D-Glen Cove) said he hopes the Senate doesn’t act as “irresponsibly.”
But Rep. Lee Zeldin (R-Shirley) said, “If anyone on the Senate side has an idea to make the bill better, I think that’s great and I welcome it.”
Rep. Peter King (R-Seaford) said he hopes the Senate can protect Medicaid expansion. If it doesn’t, he said, “We can always vote ‘no’ when it comes back” to the House.
The bill that passed ends a tax on higher-income earners, eliminates the mandate to buy health insurance or pay tax penalties, cuts Medicaid, allows states to impose work requirements on low-income people in return for Medicaid, and turns insurance subsidies into tax credits.
The measure retains the popular feature that allows parents’ polices to cover their children until age 26. But it also would block federal payments for a year to Planned Parenthood, which Republicans seek to defund because the group includes abortion among its health services.
With Emily Ngo
Highlights of the bill
The legislation passed by the House to roll back much of former President Barack Obama’s health care law would:
- End tax penalties Obama’s law imposes on individuals who don’t purchase health insurance and on larger employers who don’t offer coverage to workers.
- Halt extra payments Washington sends states to expand Medicaid to additional poorer Americans, and forbids states that haven’t already expanded Medicaid to do so.
- Erase Obama’s subsidies for people buying individual policies based mostly on consumers’ incomes and premium costs. Replaces them with tax credits that grow with age that must be used to defray premiums.
- Repeal Obama’s taxes on people with higher incomes and on insurance companies, prescription drugmakers, some medical devices, expensive employer-provided insurance plans and tanning salons.
- Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like.
- States can get waivers exempting insurers from providing consumers with required coverage of specified health services, including hospital and outpatient care, pregnancy and mental health treatment.
- States can get waivers from Obama’s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage. States could get those waivers if they have mechanisms like high-risk pools that are supposed to help cover people with serious, expensive-to-treat diseases.
- Provides $8 billion over five years to help states finance their high-risk pools.
- Retains Obama’s requirement that family policies cover grown children to age 26, and its prohibition against varying premiums because of a customer’s gender.
— The Associated Press