Republicans’ attempt to repeal the Affordable Care Act passed another major hurdle on Thursday afternoon after it was approved on a party-line vote by the House energy and commerce committee.
The committee’s backing for the bill followed an early morning vote by the House ways and means committee, the other congressional committee currently reviewing the draft legislation.
The American Health Care Act has been the subject of bipartisan controversy since it was unveiled by the House speaker, Paul Ryan, on Monday. Democrats have universally opposed the effort to repeal the healthcare law, often called Obamacare, while many conservative Republicans object that the draft legislation doesn’t do enough to dismantle it.
One prominent Republican critic, Senator Tom Cotton of Arkansas, tweeted on Thursday morning: “House health-care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast.”
Democrats also objected to the pace at which the AHCA was pushed through the committee process. In particular, they were upset that the Congressional Budget Office had not yet delivered its verdict on the costs of the scheme and its effects on insurance coverage. The CBO’s “score”, the best estimate of winners and losers from the proposed legislation, is expected on Monday.
However, Donald Trump and Ryan, the most senior Republican in Congress, have focused far more on recalcitrant Republicans than on any efforts to woo Democrats. Trump held a meeting on Wednesday with conservative activists opposed to the healthcare bill in an attempt to win them. The president will also have members of the Freedom Caucus, the conservative bloc among House Republicans, over to the White House for bowling next week in an attempt to persuade them.
Trump will also be holding events throughout the country to sell the legislation, including a rally scheduled for next week in Nashville, Tennessee. “Despite what you hear in the press, healthcare is coming along great. We are talking to many groups and it will end in a beautiful picture!” he tweeted on Thursday.
Meanwhile, Ryan held a televised news conference where he spent 25 minutes laying out his argument for the AHCA via a PowerPoint presentation. The House speaker said that many of the imperfections in the draft legislation were because of the tight focus of the reconciliation rule, a Senate procedure to avoid filibusters on legislation that deals exclusively with the budget.
The Wisconsin Republican insisted that much of the concern on the right stemmed from fellow conservatives not understanding that “this reconciliation rule is pretty tight”. He also warned Republicans opposed to the AHCA: “This is the closest we’ve been to repealing and replacing Obamacare and the closest we will get.”
Conservative critics were unconvinced. Congressman Justin Amash of Michigan tweeted shortly after the press conference: “‘Binary choice’ fallacy is a tool partisans on both sides use to quash policy debate and avoid difficult job of persuading and legislating.”
However, Republican supporters of AHCA are using other tools besides PowerPoint. The American Action Network, a conservative group connected with House leadership, will begin running television ads pushing 30 conservative skeptics of the bill to support it.
The bill would eliminate the current healthcare law’s individual mandate, which requires Americans to have health insurance or pay a fine; cut the number of people insured under Medicaid; and allow insurance companies to charge the elderly up to five times more than the young. It would require insurers to cover so-called pre-existing conditions but would allow them to add a 30% surcharge to premiums if people go without insurance for too long.
Obamacare was the former president’s signature domestic policy achievement and enabled 20 million previously uninsured people to obtain health coverage, about half from an expansion of Medicaid that the new bill would end. It established subsidized state marketplaces for health insurance, which have struggled with rising monthly fees, set out what coverage insurers must offer, and barred insurance companies from excluding the sick from coverage.
Republicans consider it an example of huge government overreach and have spent seven years vowing to overturn it.
The two party-line votes in committee are not the last obstacles before the AHCA can reach the House floor. It still has to be considered by the House budget committee and the terms of debate before the full chamber still need to be determined by the House rules committee.