The self-imposed House deadline to vote to repeal the Affordable Care Act (ACA) on the 7th anniversary of the law's enactment came and went on March 23rd amid a week packed with high-level negotiations, harsh words from lawmakers on both sides of the aisle, and increasing angst from Republican leadership as they saw support for the repeal bill eroding. A vote on the bill was originally scheduled for Thursday afternoon, which was pushed out twice, and ultimately cancelled. Negotiations faltered after hard line conservative members of the House Freedom Caucus refused to pledge their votes for anything less than a full repeal of the ACA. As every Democrat is expected to vote against the bill, Republicans can only lose 21 votes and still pass it.
President Trump issued an ultimatum on Thursday night, saying that if the House did not approve the bill on Friday that he would move on to other legislative priorities and leave the ACA in place. Speaker of the House Paul Ryan (R-WI) made a terse statement to the press Thursday evening saying that the vote would proceed on Friday. He did not respond to reporters' questions asking whether he had the votes to pass the bill. To make the bill more palatable to the conservative wing of the party, amendments were announced which include the repeal of essential health benefits (which will impact mental health and substance use coverage, among other services), the delay of the repeal of the Medicare high income tax by six years, and add $15 billion to the stablization fund. These changes are aimed at bringing more conservative votes on board, but may result in more moderate Republicans pulling their support. A revised CBO report scored the changes, and found that while the same number of people would remain uninsured (24 million as of 2026), the bill would ultimately cost more, netting a savings of only $150B over ten years rather than $337B. The costs savings would still result largely from reducing federal spending on Medicaid by $840B. (See WICs article, "CBO Predicts 24 Million Fewer People Covered, $880B in Medicaid Cuts Under GOP ACA Repeal Plan," March 19, 2017.)
The House is expected to begin debate on the American Health Care Act (AHCA) Friday afternoon, with a vote expected to start around 3 pm. If the legilslation passes the House, it faces a very tough path forward in the Senate, as certain provisions may be technically disallowed due to the "Byrd Rule" which does not permit "extraneous" issues to be considered as part of a budget reconcilliation bill, which this is. Additionally, several moderate Republican senators had already said they would not support the House bill as it stood before the last minute amendments, and are less likely to given the substance of the changes. However, some sources are reporting that if the bill passes the House today that it would be take up immediately by the Senate on Friday.
Things are moving very quickly and changing hour to hour, so make sure to join us at 12:30 pm EST on Friday for our member briefing (check Weekly Update for instructions on how to join!) We will continue to keep members informed on all the latest actions!
Source: The Washington Post