Update: The U.S. House of Representatives passed the Republican health care bill that would repeal and replace many parts of the Affordable Care Act, giving a victory to President Trump and the GOP leadership. The U.S. Senate will vote on the bill next.
This story was originally on May 4 at 3:30p.m.
Will the second time be the charm for President Trump and Republican leadership?
In a startling turnabout, GOP members say they're ready to push their prized health care bill through the House and claim a victory for President Trump, six weeks after nearly leaving the legislation for dead, and days after support from Republican moderates seemed to crumble anew. The controversial legislation would repeal and replace large parts of the Affordable Care Act, commonly known as Obamacare. House leaders planned to vote Thursday on the legislation that was revamped in an attempt to attract hard-line conservatives and GOP centrists.
In a final tweak, leaders added a modest pool of money to help people with pre-existing medical conditions afford coverage, a concern that caused a near-fatal rebellion among Republicans in recent days.
"We will pass this bill," House Majority Leader Kevin McCarthy predicted late Wednesday. His view was echoed Thursday morning by the chairman of the House Freedom Caucus, Rep. Mark Meadows, who said in a television interview that "we're optimistic that we'll pass it out of the House today ."
The health care vote was scheduled after the White House and congressional leaders barraged rank-and-file holdouts with pressure in recent days. A wafer-thin margin seemed likely, thanks to opposition expected from every Democrat and more than a dozen Republicans, plus lobbying against the bill by the AARP seniors organisation, doctors, hospitals, and patients' groups.
Just Tuesday, The Associated Press had counted 21 Republicans saying they would oppose the bill — one short of the 22 defections that would kill it if all Democrats voted no. Many others were undecided.
House approval would edge Republicans closer to repealing much of President Obama's health care law, which would represent at least partial redemption of campaign pledges by GOP candidates — including Trump — since its enactment in 2010.
Passage would also send it to an uncertain fate in the Senate, where some Republicans consider the House measure too harsh. Polls have shown Obama's much-maligned law has actually gained in popularity as the debate over a replacement health care program has accelerated. (As of early April, Obamcare had a 55% approval rating.)
"House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable," said House Minority Leader Nancy Pelosi.
The Republican bill would eliminate tax penalties in Obama's law, which has clamped down on people who don't buy coverage, and it erases tax increases in the Affordable Care Act on higher-earning people and the health industry. It cuts the Medicaid program for low-income people and lets states impose work requirements on Medicaid recipients. It also transforms Obama's subsidies for millions buying insurance — largely based on people's incomes and premium costs — into tax credits that rise with consumers' ages.
The measure would retain Obama's requirement that family policies cover grown children until age 26.
But states could get federal waivers freeing insurers from other Obama coverage requirements. With waivers, insurers could charge people with pre-existing conditions far higher rates than healthy customers, boost prices for older consumers to whatever they wish, and ignore the mandate that they cover specified services like pregnancy care.
The bill would also block federal payments to Planned Parenthood for a year, considered a triumph by many anti-abortion Republicans.
Obama's overhaul has extended health insurance to around 20 million Americans. The nonpartisan Congressional Budget Office (CBO) estimated in March that the GOP bill would end coverage for 24 million people over a decade. That office also said the bill's subsidies would be less generous for many, especially lower-earning and older people not yet 65 and qualifying for Medicare.
A CBO estimate for the cost of the latest version of their bill will not be ready before the House conducts its vote.
House Speaker Paul Ryan pulled the plug on a March 24 vote as conservatives opposed the bill for not fully repealing Obama's law and GOP moderates considered its cuts too severe. That was a jarring setback for Trump and Ryan, but leaders gradually rebuilt support. Hard-line conservatives were won over by provisions establishing the coverage waivers crafted by Reps. Tom MacArthur, a leader of the moderate House Tuesday Group, and Mark Meadows, head of the House Freedom Caucus.
Earlier this week, moderates objected that constituents with pre-existing conditions could effectively be denied coverage by insurers charging them exorbitant premiums. At least a dozen of them said Wednesday they would oppose the legislation.
But GOP leaders seemed to win over a raft of wavering lawmakers after another tweak by moderate Reps. Fred Upton and Billy Long that added $8 billion over five years for state high-risk pools, aimed at helping seriously ill people pay expensive premiums. That was on top of $130 billion already in the bill for states to help customers, though critics said those amounts were insufficient.