In nail-biter vote, House Republicans advance health care bill to replace Obamacare

May 4, 2017 GMT

WASHINGTON — After weeks of stops and starts, deal-making, concessions, arm-twisting and downright begging, House Republican leaders and President Donald Trump barely secured the votes to pass legislation to repeal and replace the Affordable Care Act.

The GOP bill, formally known as the American Health Care Act, passed Thursday on a 217-213 vote despite having gone through a series of last-minute changes that many lawmakers did not have a chance to process.

It also lacked an updated cost estimate from the Congressional Budget Office.

Republicans could only afford 22 defections from their own ranks to secure passage; they lost 20, along with every Democrat.

Every Republican in the South Carolina congressional voted for it, holding the party line.

U.S. Reps. Tom Rice of Myrtle Beach and Joe Wilson of Lexington — both loyalists to leadership — always intended to vote for the health care bill, though Wilson admitted Thursday morning he was still reading through the new amendments.

U.S. Rep. Trey Gowdy of Spartanburg had also intended to vote for the original iteration of the AHCA before House Speaker Paul Ryan canceled the vote on March 24 at the 11th hour in an admission it didn’t have the support to pass.

U.S. Rep. Jeff Duncan of Laurens was at first leaning “no.” But at the time the bill was pulled he had also come around, swayed by leadership’s agreement to repeal Obamacare’s “essential health benefits,” which require insurance providers to cover, among other things, maternity care, emergency room visits and mental health services.

The longest journey, however, has been for U.S. Rep. Mark Sanford of Mount Pleasant. After a series of emotionally exhausting town halls, long nights poring over dense facts and figures, demoralizing visits to the White House and direct threats of reprisal from Trump, Sanford was one of several members who said the most recent round of revisions turned their support.

It was not without caveats.

“Despite all the hyperbole on the Republican side, this bill does not repeal Obamacare,” Sanford told The Post and Courier. “It’s important to shoot straight with people about what this does and doesn’t do. ... It furthers debate. It is not a perfect product. And I want to underscore that.”

On Thursday morning, he noted on Facebook it seemed appropriate the vote on the health care bill would coincide with National Prayer Day.

“It’s fitting that this is the case, given the enormity of the debate before us in Congress today,” Sanford wrote. “Some people are excited about the possibility of change with the Affordable Care Act; others are frightened to death of what they believe this might mean for them and their families. It would take Solomon and all of his wisdom to get the conflicting viewpoints aligned.”

Following the vote, Sanford told reporters he recognized the gravity of the House’s action. He suggested now isn’t the time to clink glasses in the Majority Whip’s office or catch one of several buses en route to the White House for a celebration with Trump.

Democrats in his district, however, didn’t seem inclined to cut him a break. After praising him for helping sink the first version of the bill, they blasted him for supporting the second.

“Congressman Sanford just voted to increase premiums and strip health insurance coverage from thousands of constituents in the First Congressional District,” read a statement from the Charleston County Democratic Party. “For the next 18 months we will be sure that the mothers and fathers he voted against are reminded of Sanford’s terrible vote today.”

The South Carolina delegation’s lone Democrat, House Minority Leader Jim Clyburn, delivered scathing remarks during floor debate, saying the so-called “Pay More For Less Health Care Bill” would “institutionalize inhumanity and egregiousness.”

Last-minute changes

Much has changed in the bill since March 24 when Republicans’ failure to advance the measure supposedly meant efforts to repeal and replace Obamacare were officially over.

For that original bill, the Congressional Budget Office estimated premiums would spike and 24 million would lose their health insurance over 10 years. Moderate lawmakers balked at the impact the numbers would have on their constituents. Conservatives argued it did not do nearly enough to lower costs and free individuals from the burdens of Obamacare.

Over the course of the past week, however, lawmakers were able to hammer out a compromise to win over just enough members to move ahead. To woo conservative holdouts in the House Freedom Caucus, new language was added to allow states to obtain waivers to opt out of offering certain essential health benefits.

To lure centrists, a section was included to allow $8 billion to be dispersed over five years to any state that waives protections for people with pre-existing conditions, or charges these individuals more for their coverage.

Lawmakers Thursday also voted to remove a portion of the bill that carved out an exemption for members of Congress and their staff from some provisions.

Next steps: doubt in the Senate

At the White House victory lap press conference, Ryan said he expected his Senate colleagues were “eager to get to work.”

In fact, across the Capitol even Republicans are eyeing the House GOP bill with skepticism. In Senate hands the AHCA is expected to undergo significant changes — if the chamber takes up the bill at all.

The most likely scenario involves GOP senators writing their own Obamacare replacement bill. If senators do consider acting on the House measure, they wouldn’t start the process until the CBO returns a new cost estimate. If the report is negative, senators could decide it’s not worth putting their vulnerable majority at risk by moving ahead.

Some House bill provisions might even run afoul of the Senate rules, meaning what made the legislation palatable in the House would not survive.

On Thursday, U.S. Sen. Lindsey Graham, R-S.C., was less than impressed.

“A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution,” he tweeted.