After years of debate, the House on Thursday voted to repeal key parts of the Affordable Care Act and replace them with new provisions.
The vote, which President Donald Trump was planning to tout as a big victory, sends the Republican-sponsored bill to gut Obamacare to the Senate for consideration.
But winning approval for the bill could be even more difficult in the Senate than it has been in the House, where Republican leaders struggled for nearly two months to wrangle enough votes in their caucus to secure its passage.
The bill passed by a vote of 217 to 213, which was one more “yes” vote that was needed for passage.
All 193 Democrats voting opposed the bill. They were joined by 20 Republicans voting “no.”
“A lot of us have waited seven years to case this vote,” House Speaker Paul Ryan, R-Wis., said shortly before the voting began. “Many of us are here because we pledged to cast this vote: to repeal and replace Obamacare.”
“This bill delivers the promises we have made to the American people,” Ryan said.
House Majority Whip Steve Scalise, R-La., told MSNBC shortly before the vote began, “We were elected to do this.”
After the vote, protesters outside the Capitol building yelled, “Shame, shame!” at members of Congress walking down the front steps.
The bill — which would dramatically change the way the federal government funds purchases of individual health plans and Medicaid — is expected to dramatically increase the number of people without health insurance if enacted into law.
Effect on pre-existing conditions
Thursday’s vote came a week after the bill was amended to include a provision that won support from conservative holdouts. That provision would, under certain conditions, undo Obamacare’s ban on letting insurers charge people with pre-existing health conditions more for their insurance plans than healthy people.
Moderate Republicans initially blanched at that provision. But on Wednesday a number of them agreed to support the bill after the addition of another amendment that would increase funding designed to reduce the impact of the higher premiums on people with pre-existing conditions. Analysis questions how far that funding may go to cut costs for those Americans.
The bill, known as the American Health Care Act, would remove the Obamacare rule requiring most Americans to have health coverage of some kind.
Highlights of the GOP bill
Increase the amount of premium subsidies for younger adults, and reduce the amount for older adults, while allowing subsidies to be used to buy individual plans outside Obamacare exchanges.
Allow older adults to be charged premiums that are five times higher the premiums charged younger adults, instead of the 3:1 ratio established by Obamacare.
Impose a premium penalty for people who do not maintain continuous health coverage.
Convert Medicaid funding for states to a block-grant system.
Give states power to request waivers for insurers that allow them to charge people with pre-existing health conditions higher premiums if they let coverage lapse.
Establishes funding for states that can be used for “high-risk” individuals, or other purposes.
Obamacare has been credited with expanding insurance coverage to about 20 million Americans, and with giving people who have pre-existing health conditions a protection against being denied coverage or charged higher rates by insurers.
The law also established a set of minimum essential health benefits that insurers were required to offer in their plans.