By a razor-thin margin, the U.S. House passed sweeping changes to the Affordable Care Act on Thursday, handing a long-anticipated political win to President Donald Trump even as opponents warned it would haunt the GOP by leaving millions worse off, with older and low-income Floridians taking some of the costliest hits in the nation.
Trump called it a “great plan” and said it helps consumers because Obamacare was essentially “dead unless we pay lots of ransom money to the insurance companies.”
“This has brought the Republican Party together,” Trump said while surrounded by GOP lawmakers in the White House Rose Garden. “We’re going to get this finished.”
Passing by just a four-vote margin, 217-213, the American Health Care Act needed virtually every vote it could get from Republican lawmakers such as U.S. Rep. Brian Mast, R-Palm City.
“The American Health Care Act delivers relief for families by ensuring that you get to choose your coverage and the federal government can’t tax you based on what you think is best for your family,” Mast said. “The bill returns control of health care from Washington back to you and restores access to quality, affordable options that are tailored to your individual needs.”
The bill would let states allow insurers to charge older and sicker people more and offer less comprehensive plans, potentially bringing down costs for healthier, younger and higher-income people.
But it hands $1 trillion in tax cuts to corporations and the wealthy and hurts people who need care most, opponents said. All 193 House Democrats voted against it, joined by 20 Republicans.
“Shame on the Republicans for resurrecting this monstrosity of a health-care bill,” said U.S. Rep. Lois Frankel, D-West Palm Beach. “It guts the crown jewel of the Affordable Care Act: protection for the millions of Americans with a pre-existing condition. These cancer survivors, children with autism, diabetics, and pregnant women—among many others—will pay higher costs or worse, won’t get covered at all.”
The measure would remove penalties on federal health insurance mandates and lessen the tax bite from the 2010 Affordable Care Act, dubbed Obamacare after former President Obama.
The measure passed exactly six weeks after an embarrassing failure for Ryan and the Trump administration in their pursuit of campaign promises to “repeal and replace” Obamacare. That effort, which was supposed to have been passed on the ACA’s seventh anniversary, was instead scuttled when the rank-and-file members of the conservative Freedom Caucus refused to support it.
This time around, it was Republican moderates that were recalcitrant. They balked at what they considered an erosion of protections for people with pre-existing conditions in the reworked bill.
This was especially of interest to Florida, where on Wednesday the president of the American Medical Association warned there are 3.1 million people with pre-existing conditions in the state.
An amendment added to the bill providing $8 billion over five years to state high-risk pools was designed to allay those concerns, and persuaded a handful of Republicans to support the measure.
Opponents said that was a drop in the bucket compared to what would really be needed for such pools, which they said could exceed $100 billion.
Senior advocacy organization AARP warned before the vote that people with pre-existing conditions could have to pay additional costs of up to $25,000 or more a year in high-risk pools, based on past experience.
In addition, people 50 to 64 on lower incomes could pay up to $13,000 more in premiums and deductibles in what AARP officials call an age tax.
“These are unaffordable amounts,” said AARP legislative policy director David Certner said Thursday.
Florida has more people than any other state, 454,000, between the ages of 50 to 64 who receive subsidies in the ACA marketplace.
The state also receives the most subsidies in the country, $5.2 billion, to make premiums more affordable for people of all ages.
More than 1.5 million Floridians get coverage on the ACA marketplace, the most of any state that uses the federal exchange.
“There is a lot that Congress could work on to improve health care in America,” said Rep. Ted Deutch, D-Boca Raton. “Instead, Republicans forced a partisan bill through the House that will rip away health care from 24 million people.”
In many ways, the battle is just beginning on a bill that now goes to the Senate.
But it needed to happen, GOP House Speaker Paul Ryan said before the vote, with insurers pulling out of states including Iowa and Virginia.
In Florida, Mast noted only one insurer sold individual policies on the ACA exchange in Martin and St. Lucie counties.
“We will not falter,” Ryan said. “We will replace. Today is the day we’re going to do this.”
U.S. Rep. Doug Collins, R-Ga., said the bill would “gut Obamacare and rescue the American people.”
U.S. Rep. Tom Rooney, R-Okeechoboee, said, “I gave my word to my constituents who lost their coverage under Obamacare and were forced to work several part time jobs to pay for plans on the exchanges they couldn’t afford.”
The revised American Health Care Act has not been scored by the Congressional Budget Office, but Freedom Caucus chairman Mark Meadows, R-N.C., said it will “drive premiums down” for many people.
The original plan would have pushed 24 million out of coverage, CBO projected. Meadows said numbers in the revised bill could look “more attractive,” though the House did not wait for them before voting.
Democratic leader Nancy Pelosi, speaking on the House floor Thursday, said, “Forcing the vote without a CBO score shows the Republicans are afraid of the facts.”
Thursday’s vote will be “tattooed on their foreheads, she said.
Information from the Associated Press was used in this story.
Obamacare, Trumpcare: Talking Points
- The initial GOP House plan would have pushed 24 million out of coverage, the Congressional Budget Office projected. The numbers are not out on the revised version, and House leaders said they would be “more attractive.” The House did not wait for the new CBO projections before ushering Thursday’s vote.
- Senior advocacy organization AARP warned before Thursday’s vote that people with pre-existing conditions, including 3.1 million in Florida, could face additional costs of up to $25,000 a year or more in high-risk pools, based on past experience.
- In addition, people ages 50 to 64 and who have lower incomes could pay up to $13,000 more each year in premiums and deductibles in what AARP officials call an age tax.
- About 454,000 Floridians ages 50 to 64 who are enrolled and receiving tax credits in the Affordable Care Act marketplace stand to see higher health-coverage premiums than they pay under current law, AARP officials have said. That’s more than any other state.
- Under the Democrats’ Affordable Care Act, dubbed Obamacare, Florida receives the most money of any state, $5.2 billion, in federal subsidies to make premiums more affordable for lower-income consumers, the Kaiser Family Foundation calculated. Florida also has the most people who have enrolled in the federal marketplace, more than 1.5 million.
Comparing the plans
Obamacare – Forbids insurers from charging older people more than three times what they charge younger people.
Trump bill – Allows insurers to charge older consumers five times what younger consumers pay.
Obamacare — Prohibits denying coverage for pre-existing conditions.
Trump bill — Insurers cover pre-existing conditions, but could charge more if states allow.
Obamacare — Must buy health insurance or pay penalty.
Trump bill — Penalties go away, insurers can charge 30 percent more if consumer fails to maintain continuous coverage.
Obamacare — Requires “essential benefits” coverage such as maternity, preventive care, mental health and substance abuse.
Trump bill — Lets states seek waivers essential benefits rules.
Obamacare — Provides subsidies to cover consumer’s costs for those making up to about $64,000.
Trump bill — Gives tax credits up to $4,000 a year to those over 60, as low as $2,000 for those under 30.
Obamacare — Imposes taxes on insurance and health companies, higher-income people.
Trump bill — Repeals tax increases.