House passes AHCA: 7 things to know

The House voted 217-213 Thursday afternoon to approve the American Health Care Act, which guts and replaces the ACA, according to C-SPAN.

Here are seven things to know about the vote and the bill.

1. The vote passed by a narrow margin. A total of 216 yes votes were needed to pass the bill, meaning Republicans could only afford 22 defectors. Republicans lost just 20 votes within their own party, according to coverage from The Wall Street Journal. No Democrats voted for the bill.

And while Republicans cheered its passage, Democrats could be heard singing "Na na na na, hey hey hey, goodbye," according to a video clip from WSJ. Rep. Emanuel Cleaver, D-Mo., told WSJ they sung the song "Na Na Hey Hey Kiss Him Goodbye" as a taunt, referencing the anticipated difficultly some representatives may face in keeping their seats in the 2018 election after voting for the bill.

2. The second time's the charm. In March when an earlier version of the AHCA came up for a vote, Republican leadership decided to pull the bill from the floor because they felt it wouldn't pass. Conservative Republicans were a large roadblock, despite last-minute additions to repeal the ACA's essential health benefits — a move intended to sway them. However, some moderate Republicans also opposed it. The GOP also neared a vote last week, but decided to wait until they gained more support.

3. Two key changes made in the past week gave the bill an edge. The first amendment was proposed by Rep. Tom MacArthur, R-N.J. It would allow states to seek federal waivers from the ACA's essential health benefits requirement and its community rating rule. This means payers in states with waivers would not be required to cover specified services and would be able to charge premiums based on age, gender or health status. Under the MacArthur amendment, states would also be able to opt out of an AHCA provision that allows payers to charge a 30 percent penalty to enrollees who do not maintain continuous coverage. Under this amendment, states with waivers would be required to set up programs to ensure affordable coverage is still available for people with preexisting conditions. Suggested programs include government-subsidized high-risk pools. The amendment allots $130 billion for high-risk pools and other programs that fulfill the requirement.

However, after negotiations, Reps. Fred Upton, R-Mich., and Billy Long, R-Mo., proposed another amendment to expand funding for the high-risk pools, which would add $8 billion more over five years. This appeared to be the final push the GOP needed to whip the vote.

4. The original bill undoes a good portion of the ACA. The bill keeps the most popular parts of the ACA: Insurers are still prohibited from denying coverage to Americans with preexisting conditions and adults up to age 26 can stay on their parent's health plans. Otherwise, the AHCA repeals the individual mandate requiring health insurance coverage, phases out Medicaid expansion, restructures tax credits so they are age-based rather than income-based and cuts ACA taxes like the surtax on investment income for high-earners.

5. The latest version has not been scored by the Congressional Budget Office. The first version of the AHCA was scored by the CBO. This estimate was updated in late March after initial changes were made, but it does not include the Upton and MacArthur amendments. In this estimate, the CBO projected the AHCA would reduce the federal deficit by $150 billion and reduce health insurance coverage by 24 million over the next decade. Fourteen million people would lose coverage within the first year, according to the CBO.

6. The bill now heads to the Senate. The Senate has been less optimistic about the bill, according to The Hill. Republicans hoped to use the budget reconciliation process to pass the bill in the Senate, which shields it from a filibuster and only requires 51 votes to pass. However, this process requires that the bill only address budgetary items, meaning the state waivers created under the MacArthur amendment may not survive, The Hill reports. The House's version will have to be reworked, and Sen. John Cornyn, R-Texas, told The Hill the Senate has not set a timeline yet for the legislation.

7. The House also voted Thursday to pass a sidecar bill that would end an exemption from the law for members of Congress and staff, according to WSJ. The original AHCA included a provision that would make Congress and staff exempt. Representatives on both sides of the aisle hated this provision. Due to specific Senate rules, however, the provision had to be addressed in a separate bill. It passed with bipartisan support, WSJ reported.


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