Despite last-ditch efforts by President Donald Trump and House Speaker Paul Ryan to drum up support for the American Health Care Act (AHCA), it is unclear whether the bill will pass the House ahead of a vote today, CNN reported.
Proposed changes to the bill intended to appeal to hardline conservatives may deter support from more moderate Republicans like Charlie Dent (R-PA), who voiced his opposition following a Wednesday night meeting with Speaker Ryan.
- Assuming no Democrats vote for the bill, it would take defections from only 21 House Republicans to defeat the bill and at least 24 have strongly indicated they would not vote for the AHCA as of Wednesday night, according to CNN.
Republicans are stuck between a rock and a hard place. Promises to repeal the Affordable Care Act and to replace it with something better propelled them to the White House and majorities in the House and Senate. However, as their first attempt at overhauling healthcare has proven, these promises will be hard to keep.
The AHCA has drawn some support from business groups like the U.S. Chamber of Commerce and the National Federation of Independent Business. Some forward-looking Republican lawmakers have pointed to long-term projections from the Congressional Budget Office (CBO) that show premiums declining in the future.
However, the reaction has been mostly negative. Passage of the bill would almost certainly result in millions of people losing health insurance even if the 24 million projected by the CBO didn't come to pass. These losses would be driven by cuts to Medicaid and restructuring of tax credits that would negatively affect older and lower-income patients. Total annual out-of-pocket spending for all Americans would increase by $33 billion over the next ten years, according to an Economic Policy Institute analysis.
Several powerful interest groups, including the American Medical Association (AMA) and the AARP, have aggressively pushed back against the bill. In a letter addressed to Congress on Wednesday, the AMA warned again about the effects of the AHCA on uninsured rates and discouraged lawmakers from voting for the bill.
Earlier this week, Republican leaders said they were amending the bill to create a reserve fund allowing for more generous tax credits for older people not yet on Medicare. They also changed the bill to allow states to choose between a per capita cap for Medicaid or a block grant. The amendments were meant to garner more support for the AHCA, but they haven't been enough for most in the GOP who oppose the bill.
There is still hope for Republicans that the bill passes in the House. Rep. Mark Meadows, chairman of the conservative Freedom Caucus and one of the House Republicans to publicly oppose the bill, tweeted Wednesday: “I'm still hopeful we can change the bill — I'll continue working around the clock to do so.” However, if Trump and Republican leadership tweak the bill more to appease hardline conservatives, they risk alienating more moderate Republicans.
Even if the AHCA passes the House, it faces stiff resistance in the Senate. Of course, Republicans could scrap the bill, return to the drawing board, and make a push for healthcare reform at a later date. On the other hand, it is not clear what they would push for. “There is no plan B,” White House Press Secretary Sean Spicer said on Wednesday. There's plan A and plan A. We're going to get this done.”