- House Republicans postponed a vote they had planned for their bill to replace the Affordable Care Act (ACA) on Thursday when it became clear they didn’t have the votes to pass the American Health Care Act (ACHA).
- President Donald Trump gave lawmakers an ultimatum: The vote will take place Friday or the ACA will remain the law of the land. He tried to appease hardline conservatives in the House Freedom Caucus by rolling back the essential health benefits under the ACA, leaving that up to individual states.
- The final text of the bill was still not available Friday morning as negotiations continued, but the Congressional Budget Office (CBO) released an updated score showing the AHCA would still lead to 24 million fewer insured while reducing the deficit by only half as much as the original bill.
The delay of the vote on Thursday (which not coincidentally was the seven year anniversary of the ACA being signed into law) was a big blow to Trump, who prides himself on his ability to successfully close deals. But there is a major dilemma for Republicans. Any changes to appease the most conservative members will almost certainly turn off the moderates.
Members of the House Freedom Caucus remained opposed to the AHCA because they say it does not do enough to repeal the ACA. Meetings throughout the day Thursday to negotiate did not yield a compromise and Republican leaders were forced to admit they did not have the votes. Freedom Caucus chariman Mark Meadows (R-NC) said however the caucus is "desperately trying to get to yes." Moderates in the GOP are also against the bill, concerned with removing insurance from so many Americans.
Voters don’t like it either. A Quinnipiac poll shows 56% disapprove of the AHCA and even among Republicans support is only at 41%. “Replacing Obamacare will come with a price for elected representatives who vote to scrap it, say many Americans, who clearly feel their health is in peril under the Republican alternative," said Tim Malloy, assistance director of the Quinnipiac University Poll.
Removing the requirement that plans cover essential health benefits such as maternity care would lead to insurers selling stripped down plans with skimpy coverage and create a race to the bottom as young healthy people are cherry picked. Older and sicker people would face extra charges and expensive coverage.
It would also essentially remove protections for people with pre-existing conditions. That would affect more than a quarter of non-elderly adults, according to the Kaiser Family Foundation.
The outcome of the vote Friday is still very much in question as Trump and House Speaker Paul Ryan try to twist arms and get more members to vote for the AHCA. But even with House passage, the Senate would be a much tougher battle, especially if the CBO score continues to get worse.