The American Health Care Act, backed by Donald Trump and Republican leaders, has passed the House of Representatives by a vote of 217 to 213 vote. (It needed 216 to pass.) The bill will now be taken up by the Senate.
A quick take on Thursday's winners:
Republicans, including Trump, who will call this a legislative victory.
Affluent and young/healthy people, who are now one step closer to paying less for health care (because the bill weakens Obamacare requirements that subsidize sicker/older individuals' care) and getting a tax cut.
Members of Congress, who are currently exempt from the bill's elimination of Obamacare protections, although they did pass a separate bill revoking that exemption (which will have to be passed separately by the Senate as well).
Thursday's losers:Rico says they'll live to regret it...
The estimated fourteen million Medicaid recipients who are now one step closer to losing their coverage because of the over eight-hundred billion dollars in Medicaid cuts the bill includes.
Other low-income and elderly individuals, who will get way less help paying their premiums than they would have under Obamacare. (The Congressional Budget Office's initial estimate says the bill will, overall, reduce the number of Americans who have health insurance by twenty-four million.)
Americans with pre-existing conditions, who are one step closer to seeing major reductions in the degree to which the Federal government protects their access to affordable insurance. (In particular, this means insurers will once again be allowed to charge more to women who've experienced such "pre-existing conditions" as sexual assault, domestic abuse, and pregnancy.)
Individuals with employer-sponsored coverage, because the AHCA appears to eliminate the requirement that employer plans include limits on what individuals can be asked to pay out of pocket
Congratulations to President Trump! (Intentional sarcasm?)
Paul Waldman, a contributor to The Plum Line blog, and a senior writer at The American Prospect, has a further article on the Republicans:
I won’t mince words. The health-care bill that the House of Representatives passed this afternoon, in an incredibly narrow 217-to-213 vote, is not just wrong, or misguided, or problematic or foolish. It is an abomination. If there has been a piece of legislation in our lifetimes that boiled over with as much malice and indifference to human suffering, I can’t recall what it might have been. And every member of the House who voted for it must be held accountable.
There’s certainly a process critique one can make about this bill. We might focus on the fact that Republicans are rushing to pass it without having held a single hearing on it, without a score from the Congressional Budget Office that would tell us exactly what the effects would be, and before nearly anyone has had a chance to even look at the bill’s actual text, and all this despite the fact that they are remaking one-sixth of the American economy and affecting all of our lives (and despite their long and ridiculous claims that the Affordable Care Act was “rammed through” Congress, when in fact it was debated for an entire year and was the subject of dozens of hearings and endless public discussion). We might talk about how every major stakeholder group— the American Medical Association, the American Hospital Association, AARP, the American Cancer Society Cancer Action Network, the American Heart Association, and on and on— all oppose the bill.
All that matters. But the real problem is what’s in the bill itself. Here are some of the things it does:
Takes health insurance away from at least twenty million Americans; that was the number the CBO estimated for a previous version of the bill; the number for this one is probably higher.It is no exaggeration to say that, if it were to become law, this bill would kill significant numbers of Americans. People who lose their Medicaid, don’t go to the doctor, and wind up finding out too late that they’re sick. People whose serious conditions put them up against lifetime limits or render them unable to afford what’s on offer in the high-risk pools, and are suddenly unable to get treatment.
Revokes the Affordable Care Act’s expansion of Medicaid, which provided no-cost health coverage to millions of low-income Americans.
Turns Medicaid into a block grant, enabling states to kick otherwise-eligible people off their coverage and cut benefits if they so choose.
Slashes Medicaid overall by over eight hundred billion dollars over ten years.
Removes the subsidies that the ACA provided to help middle-income people afford health insurance, replacing them with far more meager tax credits pegged not to people’s income but to their age. Poorer people would get less than they do now, while richer people would get more; even Bill Gates would get a tax credit.
Allows insurers to charge dramatically higher premiums to older patients.
Allows insurers to impose yearly and lifetime caps on coverage, which were outlawed by the ACA. This also, it was revealed today, may threaten the coverage of the majority of non-elderly Americans who get insurance through their employers.
Allows states to seek waivers from the ACA’s requirement that insurance plans include essential benefits for things such as emergency services, hospitalization, mental health care, preventive care, maternity care, and substance abuse treatment.
Provides hundreds of billions of dollars in tax cuts for families making over $250,000 a year.
Produces higher deductibles for patients.
Allows states to try to waive the ACA’s requirement that insurers must charge people the same rates regardless of their medical history. This effectively eviscerates the ban on denials for preexisting conditions, since insurers could charge you exorbitant premiums if you have a preexisting condition, effectively denying you coverage.
Shunts those with preexisting conditions into high-risk pools, which are absolutely the worst way to cover those patients; experience with them on the state level proves that they wind up underfunded, charge enormous premiums, provide inadequate benefits and can’t cover the population they’re meant for. Multiple analyses have shown that the money the bill provides for high-risk pools is laughably inadequate, which will inevitably leave huge numbers of the most vulnerable Americans without the ability to get insurance.
Brings back medical underwriting, meaning that just like in the bad old days, when you apply for insurance you’ll have to document every condition or ailment you’ve ever had.
Those deaths are not abstractions, and those who vote to bring them about must be held to account. This can and should be a career-defining vote for every member of the House. No one who votes for something this vicious should be allowed to forget it, ever. They should be challenged about it at every town hall meeting, at every campaign debate, in every election and every day as the letters and phone calls from angry and betrayed constituents make clear the intensity of their revulsion at what their representatives have done.
Perhaps this bill will never become law, and its harm may be averted. But that would not mitigate the moral responsibility of those who supported it. Members of Congress vote on a lot of inconsequential bills and bills that have a small impact on limited areas of American life. But this is one of the most critical moments in recent American political history. The Republican health-care bill is an act of monstrous cruelty. It should stain those who supported it to the end of their days.