WASHINGTON _ House Republicans narrowly passed legislation Thursday to roll back the Affordable Care Act, delivering on a yearslong campaign promise despite mounting concerns from patient advocates and health care groups that the legislation would strip protections enjoyed by millions of Americans.
The tight vote, 217-213, with all Democrats opposed, underscored the limited appeal of the American Health Care Act, despite last-minute deal-making and the personal intervention of President Donald Trump.
After House GOP leaders shelved previous attempts to advance the bill because of a lack of support, Thursday's vote was a major legislative victory for Trump, likely providing momentum for his other priorities and establishing him as a leader who can govern with the Republican majority in Congress.
But the future of the bill remains highly uncertain as it now moves to the Senate amid deep reservations among Republicans there about the potential that Americans will lose their health care coverage under the measure.
House Minority Leader Nancy Pelosi, D-Calif., orchestrated a full-scale floor opposition Thursday against what she called the "moral monstrosity of Trumpcare," but in the end, Democrats were unable to block the measure.
The full cost and impact of the final changes to the bill remain unclear because GOP leaders called the vote without first waiting for a new analysis from the nonpartisan Congressional Budget Office. A previous analysis, before amendments were made to appease both conservative and centrist factions of the party, estimated the GOP plan would leave 24 million more Americans without health care coverage by 2026.
The legislation cuts more than a $1 trillion in federal health care assistance to low- and moderate-income Americans, primarily through a historic retrenchment in Medicaid, the half-century-old government health plan for the poor.
It stands to reverse an expansion of health care under Obamacare that has brought the nation's uninsured rate to the lowest level ever recorded _ an additional 20 million Americans have gained coverage.
Potentially faring best would be wealthy Americans and the insurance industry, which would benefit from as much as $600 billion thanks to the bill's elimination of taxes under Obamacare that have helped pay for the coverage expansion. Several studies have shown that Trump's own supporters, living in conservative, rural areas, would fare the worst, paying higher premiums or losing benefits.
A key change from the original bill sought by the conservative House Freedom Caucus allows states to apply for waivers from some of Obamacare's most popular requirements, including the ban on insurers charging more for patients with pre-existing medical conditions.
Advocates for patients with cancer, diabetes and other serious illnesses fear that would allow insurers to once again bill people with these diseases thousands of dollars more for coverage, effectively making coverage unaffordable.
Late Wednesday, another amendment was added to win back centrists worried about the impact of those state waivers. The late fix will pour an additional $8 billion into high-risk insurance pools to cover patients with preexisting conditions who can't obtain traditional coverage.
The additional money did little to convince those who work in health care, who have cautioned that these pools, which were common before Obamacare, have proved woefully inadequate to cover the medical needs of sick patients shut out of commercial health insurance.
Dr. Andrew W. Gurman, president of the American Medical Association, said the latest proposed changes "tinker at the edges without remedying the fundamental failing of the bill _ that millions of Americans will lose their health insurance as a direct result of this proposal."
