Advocates were quick to denounce the May 4 move by the House of Representatives to pass (217-213) the American Health Care Act, which repeals the Affordable Care Act enacted under President Obama. The Center on Budget and Policy Priorities’ Bob Greenstein said in a statement, “I have been in Washington, D.C. for 45 years. But I have never seen members of Congress vote to so deeply hurt so many of their own constituents.” CHN’s Deborah Weinstein called it, “a day of shame for the United States House of Representatives.” Diane Randall, Executive Secretary of the Friends Committee on National Legislation, said, “The AHCA inflicts the most damage on children, on individuals who are sick, people with disabilities, seniors, and low-income families struggling just to get by.” Bread for the World’s Rev. David Beckmann predicted that, “The American Health Care Act will push millions of people into hunger and poverty.”

According to CBPP and others, the bill will strip coverage from 24 million Americans; require millions more people to pay thousands of dollars more each year for coverage and care; rip $800 billion out of Medicaid over the next decade by ending the Affordable Care Act’s Medicaid expansion and by cutting federal support for state Medicaid programs, forever ending the program in its current form; gut protections for people with pre-existing conditions; eliminate the national requirement that health plans cover basic benefits; and let employers and insurers impose lifetime and annual limits on coverage. It would also give billions of dollars in tax cuts to millionaires, with the wealthiest 400 Americans getting an average tax cut of $7 million a year each. The $8 billion over 5 years for high-risk pools that was added to the bill to garner additional GOP support was called “a fig leaf that falls woefully short of what would be needed.” In fact, experts say $8 billion over five years is enough to help just 160,000 with their premiums – a tiny fraction of the millions of Americans with pre-existing conditions who are in the individual market or uninsured. (The original bill had allocated $130 billion over 10 years to the high risk pools; the small addition does not come close to reaching the $327 billion over 10 years that analysts at the Center for American Progress estimated would be necessary to cover the cost of covering people with conditions that would place them in the high risk pool.)The Center for Law and Social Policy said other last-minute changes made to entice GOP Representatives, such as allowing states to waive the essential benefits package and allowing health plans to charge people with preexisting conditions more for health insurance, “made a terrible bill even worse.”

The path forward for the bill remains unclear. Using a special process known as reconciliation, a bill could pass the Senate with only 51 votes, but it is highly unlikely that there are 51 Republican Senators who would vote for the House bill in its current form. Reports are that GOP Senators may make revisions to the House bill or write their own bill. Even if the Senate wanted to take up the House bill, it could not do so before the Congressional Budget Office, the nonpartisan scorekeeper in Congress, provides an estimate of the fiscal and coverage impact of the House bill, which could happen late this week or next week. Some language in the House bill may also run afoul of Senate rules for legislation passed under the reconciliation process. Some reports are that the Senate may not move on repeal legislation until June. Advocacy organizations have been busy in the days following the House vote encouraging advocates to contact their Senators to urge them to keep the Affordable Care Act, protect Medicaid and the subsidies in the ACA, and ensure coverage for individuals with pre-existing conditions.

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