Republicans took the first major step toward repealing Obamacare on Thursday as the House approved a bill that would replace the 2010 health care overhaul with a more market-friendly system that cancels intrusive government mandates, spurring millions of people to forgo health insurance.
The Republicans said they were on a rescue mission to save Americans from a rapidly deteriorating health care market wrought by President Obama. Democrats said the bill fell far short of Mr. Obama’s goals of expanded insurance coverage and more benefits and that Republicans are now responsible for whatever goes wrong with the chaotic health care system.
Republicans powered the bill through the House on a 217-213 vote and cheered as the gavel came down. Democrats, who unanimously voted against the repeal, serenaded them with chants of “Na na na na, hey, hey, hey, goodbye” — a prediction that Republicans who backed the plan would pay for it at the ballot box.
“A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote,” said House Speaker Paul D. Ryan, Wisconsin Republican, who called the bill a repayment for voters’ confidence in his party.
Rallying at the White House after the vote, President Trump said he expects the Senate to pass the bill as well.
“Make no mistake, this is a repeal and a replace of Obamacare. Make no mistake about it,” said Mr. Trump, declaring the program dead.
Republican senators have signaled that the bill will need a substantial rewrite to earn enough votes to pass in their chamber.
The vote Thursday was a major turnaround from five weeks ago, when Mr. Ryan and fellow leaders had to cancel a vote to avoid an embarrassing defeat on the House floor.
After that fiasco, Mr. Ryan and Mr. Trump declared Obamacare the law of the land — but rank-and-file Republicans urged them to try again, kicking off weeks of negotiations. Vice President Mike Pence shuttled to Capitol Hill to negotiate a deal between conservatives and centrists that allows states to waive some of Obamacare’s strict standards, so long as they set up separate pools of funding for high-risk consumers.
Last-minute objections were ironed out this week with another amendment throwing $8 billion into the pool of funds needed to help people with pre-existing medical conditions.
Most of the 20 Republicans who voted against the bill worried that they were breaking campaign promises by allowing insurers to charge sicker Americans more than healthy ones.
But Mr. Ryan insisted his plan would be better than Obamacare for people with pre-existing conditions. He said Obamacare is chasing consumers from the market with higher premiums and dwindling choices.
As written, the House Republican bill repeals most of Obamacare’s taxes and its mandate for Americans to hold insurance. It also replaces the 2010 law’s generous subsidies with refundable, age-based tax credits.
The bill includes a total overhaul of Medicaid, changing it from a payment-per-customer system to a block-grant model that will give states lump sums, then ask them to experiment with their rolls. That saves nearly $900 billion over the next decade, marking the biggest entitlement reform in history.
The legislation also prohibits abortion providers such as Planned Parenthood from collecting money under Medicaid.
Rep. Darrell E. Issa, a California Republican whose district favored Democratic presidential nominee Hillary Clinton in November, supported the plan, saying it was time to “stop pretending Obamacare is going to fix itself.”
But Rep. Mike Coffman, a Colorado Republican whose district also favored Mrs. Clinton, said he had to reject a plan that hadn’t been fully scored by the Congressional Budget Office and might leave people with pre-existing conditions vulnerable to higher costs.
Many of the Republicans who voted against the bill are from states that vastly expanded coverage under Obamacare and who fear pulling benefits from their constituents.
Three conservative Republicans — Reps. Andy Biggs of Arizona, Thomas Massie of Kentucky and Walter B. Jones of North Carolina — rejected the plan as inadequate or not fully vetted.
Democrats admonished Republicans from the sidelines, calling the plan heartless, hasty and shameful, and vowing punishment at the polls next year.
“I think they walked the plank,” said House Minority Leader Nancy Pelosi, California Democrat.
She and fellow Democrats said the Republican plan would impose an “age tax” by allowing insurers to charge older customers more for coverage and would effectively eliminate coverage for those with pre-existing conditions because their rates would rise so high that the policies would be unaffordable.
They said the solution is to increase government support for Obamacare, pouring billions of dollars into more generous subsidies to entice participation and creating a government-run option to pace the private market.
Obamacare ultimately extended coverage to more than 20 million Americans, but its insurance exchanges failed to attract enough young and healthy enrollees, causing insurers either to raise premiums or flee the marketplace.
Republicans pointed to more evidence of Obamacare’s failure in Iowa, where the likely withdrawal of Minnesota-based Medica will leave much of the state without anyone to write individual policies next year.
“Where is their plan to make this right?” Rep. Brian J. Mast, Florida Republican, a late supporter of the House bill, said of Democrats. “We’re going to make it right today, and we’re going to do something great today — couldn’t be more proud about it.”
The bill faces a challenge in the upper chamber, where roughly a dozen Republicans have cited serious concerns and Democrats have warned that the latest tweaks will not meet arcane budget rules Republicans are using to avoid a filibuster.
Sen. Dean Heller, a vulnerable Republican from Nevada, said the bill falls short in its current form. Others are worried about a part of the plan that freezes Obamacare’s vast expansion of Medicaid in 2020 before unwinding it.
“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, especially those who are receiving treatment for heroin and prescription drug abuse,” said Sen. Rob Portman, an Ohio Republican who won re-election in November.
The plan is also deeply unpopular off Capitol Hill. Hospitals, patient groups and the AARP said it left the sick and needy in the lurch and would let states duck crucial protections baked into Obamacare.
American Hospital Association CEO Rick Pollack said he was disappointed with House lawmakers and urged the Senate to “restart and reset” the discussion so “the most vulnerable are not left behind.”
The House paved the way for the health care vote by unanimously passing a separate bill clarifying that members of Congress and their staff members must live under the changes their overhaul will make. Republicans had carved Congress out of the waiver amendment authored by Rep. Thomas MacArthur, New Jersey Republican, to try to satisfy the Senate budget rules.
Rep. Dave Brat, a Virginia Republican who backed the plan after leaders moved it to the right, said the House did what it needed through the MacArthur amendment to start unshackling the marketplace.
“We got the ball rolling. We got some amendments that at least cracked the door open to some free market stuff and states’ ability to opt out of the [Obamacare regulations] and lower prices for people,” Mr. Brat said as protesters chanted in the distance. “So it’s a start, right? I mean Obamacare took years and years and years. We need to bring prices down. That’s the main deal.”
Copyright © 2017 The Washington Times, LLC.