Republicans are excited about repealing Obamacare. They are not as excited about their legislation that will do it.
The House passed the American Health Care Act on Thursday afternoon by a razor-thin margin of 217-213 after Speaker Paul Ryan and his deputies engaged in an aggressive whipping operation, with President Donald Trump working the phones to move fellow Republicans into the “yes” category.
But Republicans have been saying this particular bill was set to pass because it’s a now-or-never situation — especially after the embarrassing collapse of the first effort in March — and they’re been finding solace in the idea that the legislation won't be the final product anyway.
Rep. Luke Messer, an Indiana Republican, called it a "green flag" and a "start."
Rep. Tom Cole (R-Okla.) also pushed the idea that Republicans just need to pull the trigger on this bill because it will change. “This thing is going to go to the United States Senate. It’s going to change in my view,” he said on NPR. “At some point you just have to move, and we think this is it. This will create some momentum.”
"We like the fact that it needs to be repealed," said Scott Reed, chief strategist at the Chamber of Commerce, when asked whether they support the legislation. "... We need to move the process forward."
As I mentioned before, the bill is, as written, a complete disaster for Americans, and above all a massive, trillion-dollar tax cut for the rich.
The bill would end the Medicaid expansion in 2020, a program that millions of Americans who earn less than 138 percent of the poverty line (about $15,000 for an individual) currently rely on. The end result would be that people eventually get moved into the individual market, where they would have to pay for private insurance coverage. They would get some help from AHCA’s tax credits, but likely not enough to afford to purchase a plan — keep in mind, these are people who are only earning $15,000 or less per year.
People already in the marketplace would see significant change, too. Right now, Obamacare’s tax credits are based on income, with those who earn less getting more help. Under Obamacare, people who earn less than 200 percent of the poverty line (about $24,120 for an individual or $49,200 for a family of four) get the most generous help, enough money so that a midlevel plan would cost no more than 6.4 percent of their income.
Under AHCA, which doesn’t base tax credits on income alone, those people would get substantially less help. The Congressional Budget Office estimates that the average 40-year-old who earns $26,500 would see her tax credit fall from $4,800 to $3,650 under AHCA.
For an older Obamacare enrollee, the problem would be even more acute, because insurers would be allowed to charge the oldest enrollees five times as much as the youngest enrollees. This would have the result of raising premiums for Obamacare enrollees in their 60s.
CBO estimates that a 64-year-old earning $26,500 would see their annual tax credit decline from $13,600 to $4,900. The amount they pay out of pocket for their premiums, meanwhile, would go up from $1,700 in annual premiums under current law to $14,600 under AHCA. Right now, with the tax credit, that person spends very little of her own money on a premium. Under the new bill, she’d spend nearly half her annual income on health insurance.
So what now? That's up to what Mitch McConnell can get through the Senate with budget reconciliation. That will most likely be the "real" bill, which will include most of the House provisions, and then the negotiations will begin. The problem is that the Senate has to pass something awful enough that the House will still vote for it.
This process still has a long way to go. But Republicans now own the first step for tens of millions to lose their health insurance. Whether or not voters decide to actually do anything about it in a midterm year, well the odds are extremely low of that coming to pass.