House GOP Narrowly Passes Obamacare Repeal Bill

House GOP Narrowly Passes Obamacare Repeal Bill
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After fits and starts and embarrassing setbacks, House Republicans notched a significant victory Thursday, passing their bill repealing and replacing major portions of Obamacare on a narrow 217-213 vote.

The vote was the result of seven weeks of intense negotiations within the conference and with the White House, bringing hesitant members on board through a combination of arm-twisting and amendments to the legislation.

Ultimately, the vast majority of the Freedom Caucus, who were frustrated the original bill wasn’t conservative enough, and a significant number of moderates who were wary of the effect on their constituents’ coverage, supported the bill. Twenty Republicans voted against it, as did all Democrats.

In remarks at the White House, Speaker Paul Ryan thanked a number of the lawmakers and administration officials for getting the bill out of the House, and thanked Trump and Vice President Mike Pence for their hands-on effort.

“Today was a big day, but it is just one step in this process," Ryan said. "An important step. We still have a lot of work to do to get this signed into law. And I know that our friends over in the Senate are eager to get to work."

The mood for Republicans was jubilant in the Capitol Thursday – Rep. Mark Walker, the chairman of the conservative Republican Study Committee, said it was “a lot of energy and excitement today, not a sigh of relief.”

But there’s also the realization that while this fixes longstanding internal divisions within the House GOP conference for now – and secured a vote on their seven-year pledge to vote to repeal and replace the Affordable Care Act – this was just the latest shot in an ongoing battle. 

“I’m a Hoosier and it’s race season so I would say we all recognize that while today is a very important step, it’s also a start of our true goal here, which is to repeal Obamacare and replace it with something better,” said Rep. Luke Messer, a member of party leadership. “We’ve got to get it through the Senate as well and signed on the president’s desk.”

Democrats, who were jubilant when Republicans failed to pass their health-care legislation in March, made their displeasure at Thursday’s outcome known.

“They have this vote tattooed on them. This is a scar they will carry,” Minority Leader Nancy Pelosi said at a news conference before the vote. “It's their vote. It's not the Senate vote; it's their vote they are taking. That is really a poor choice -- cowardly choice, I might add. Why would they vote for it, if they don't think it's worthy of support because the Senate will change it?”

Indeed, there are major hurdles in the Senate, where there is concern not just about some of the amendments to the legislation – including waivers allowing states to bypass certain Obamacare regulations on pricing for those with pre-existing conditions and required “essential” health benefits – but also about the underlying bill. Some Republicans in the Senate are pushing for more funding for the tax credits meant to help individuals afford health insurance, and an easier transition away from the Medicaid expansion built into the ACA.

The Senate will also wait for the nonpartisan Congressional Budget Office to review the final House legislation. While the CBO’s initial review estimated as many as 24 million people could lose insurance, the House voted on the new bill without an updated review, which could reset the politics of the legislation and keep it from reaching Trump’s desk. 

Sen. Lindsey Graham sent a shot across the bow of the House in a series of tweets just before the vote took place:

“I appreciate the apparent progress on health care reform in the House of Representatives. I will admit, I’m concerned with the process.

“A bill -- finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate -- should be viewed with caution.”

Most House members expect some changes and acknowledge that they will have to entirely re-evaluate their positions on the legislation in the coming weeks or months. But for now, they are just happy to have the bill through their chamber and across the Capitol.

“They’ll probably go through the same process we did, and God bless them, it wasn’t fun,” said Rep. Lou Barletta.  

And while the vast majority of the conference supported the underlying bill from the beginning, there remains serious disagreement about the implications of the changes made to bring conservatives on board. Members of the Freedom Caucus viewed the ability for states to seek waivers on Obamacare regulations as the only way the legislation could lower premiums, assuming that states will seek those waivers.

“If a state is irresponsible enough that they don’t want to take advantage of the tools that we have given them in this bill, those governors need to actually go to their public and explain why the state of Idaho is doing it and having lower premiums and their state isn’t,” said Rep. Raul Labrador.

But there was serious concern among moderates that those waivers could imperil people with pre-existing conditions – and it took an amendment from Rep. Fred Upton adding $8 billion in funding for anyone who lost insurance because of the waivers to bring some back on board. Upton said he assumes most states won’t seek waivers. Rep. Carlos Curbelo, a moderate in a swing Florida district who is likely to face a difficult re-election in 2018, echoed this.

“I would highly doubt that any governor, especially a governor of a large state like Florida, would seek a waiver,” said Curbelo, who voted for the bill.

The vote also solved – at least temporarily – the internal divisions within the House conference. The Freedom Caucus, which has often frustrated leadership with recalcitrant “no” votes on legislation its members view as insufficiently conservative, overwhelmingly supported this legislation. Rep. Mark Meadows, the group’s chairman, was critical in negotiating changes to bring votes on board after the initial failure in March. But that could reshuffle the internal politics of the House GOP for future negotiations.  

Walker, who chairs the conservative, but not far-right, Republican Study Committee, said the health-care vote could “mask [divisions] temporarily until the next issue.”

Rep. Scott DesJarlais, a Freedom Caucus member who supported the legislation, said it was unique to see the “outliers in the conference” in the moderate and conservative wings come together on legislation. But he also said it empowered conservatives going forward.

“I would say President Trump and the White House administration, moving forward, should see that the pathway to success does run through the Freedom Caucus, not through the Republican establishment,” DesJarlais said.

The bill also has major implications for Speaker Ryan, who took his share of criticism after deciding to cancel the earlier vote on health-care legislation because it lacked enough Republican support. Rep. Bill Flores said that Ryan could have easily crafted a complete repeal and significant replacement of the Affordable Care Act, but that bill would have gone nowhere in the Senate for both procedural and political reasons.

“He got hit for things that were beyond his control,” Flores said of Ryan. “This shows that not only can he weather the fire, but he can maintain the poise of a great, mature leader and then still bring us together.”

Correction: An earlier version of this story incorrected stated that Rep. Carlos Curbelo voted against the bill.

James Arkin is a congressional reporter for RealClearPolitics. He can be reached at jarkin@realclearpolitics.com. Follow him on Twitter @JamesArkin.

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