House Approves Bill to Replace Most of Affordable Care Act

The U.S. House approved legislation Thursday to replace most of the Affordable Care Act, giving new life to a bill that had faltered at many stages and taking a step toward fulfilling GOP leaders’ promise to overhaul the nation’s health-care system.

The bill passed 217-213, with 20 Republicans voting in opposition and no Democrats supporting it. The bill faces uncertain prospects in the Senate, where several Republicans have already voiced concerns over its major provisions.

Republicans have promised for years to repeal the Affordable Care Act, commonly known as Obamacare, but it took weeks for House GOP leaders to line up enough support to advance the bill. They came up short twice, including in late March, when leaders pulled the bill from the floor just hours ahead of a planned vote due to collapsing support.

Following the vote, dozens of Republicans gathered with President Donald Trump at the White House to mark the legislative victory.

“What a great group of people, and they’re not even doing it for the party, they’re doing it for the country,” Mr. Trump said of the lawmakers who won the bill’s approval. “Yes, premiums will be coming down, deductibles will be coming down.”

Now comes the Senate. Many Republicans there are divided over an array of issues, such as the bill’s changes to Medicaid. Senate Republicans control 52 of the chamber’s 100 seats, meaning they can lose no more than two votes if all the Democrats, as expected, vote against it.

Thursday’s vote marks a significant political victory for Mr. Trump and House Speaker Paul Ryan (R., Wis.), both of whom faced criticism for not wrangling the votes needed in their party to pass the bill earlier this year.

But the vote is bound to cast a long political shadow for House Republicans in the months leading up to next year’s midterm elections. Already, many GOP lawmakers face constituents back home upset over the prospect of changes to health-care benefits that affect millions.

In recent days, late additions to the legislation and personal lobbying by Mr. Trump shored up Republican support.

One set of changes was aimed at giving insurers more freedom, with state approval, to sell less-comprehensive health plans and to adjust their prices, an effort to create competition and drive down the cost of premiums.

Another set was aimed at cushioning the impact that the late changes could have on people with pre-existing medical conditions.

Democrats said the bill would leave more people uninsured and would raises costs and diminish coverage for people with pre-existing medical conditions.

Democrats are already seizing on the House health-care vote in preparation for the 2018 midterm elections. After the vote Thursday, the Democratic Congressional Campaign Committee announced it would be buying digital advertisements to attack vulnerable Republicans. The ads will run on Facebook and Instagram, social media platforms that allow for targeting via zip code, and interest groups (such as a political party).

Many criticized GOP leaders for rushing the bill to a vote without an updated estimate of its cost and impact on the country’s health coverage after Republicans spent years bashing Democrats for their maneuvering to pass the ACA.

“Other than being the height of hypocrisy, it’s surprising that they would do it this way,” said Rep. Juan Vargas (D., Calif.), who predicted his GOP colleagues from California would pay a political price for supporting the bill. “It means a few of them are not going to come back,” he said.

Rep. Nancy Pelosi of California, the House Democratic leader said on Thursday that Republicans were “maliciously again attempting to destroy health care and coverage for the American people.”

The Affordable Care Act, which was passed in 2010, was a signature legislative achievement during the administration of former President Barack Obama, a Democrat. The insurance exchanges allowing Americans to buy health insurance opened in 2013.

The percentage of uninsured Americans has fallen from 18% in 2013 to 11.3% in 2017, according to Gallup.

The House GOP bill would end the law’s requirement that employers of a certain size offer insurance to their workers and that most individuals carry insurance.

Insurers could, however, charge people higher premiums if they let their insurance lapse. The bill also would allow insurers to charge older people five times as much as their youngest customers, compared with three times as much under current law.

Health-Care Holdouts in the House

The bill would end the law’s system of subsides, aimed at helping people buy insurance if they don’t get it at work, and replace it with a new set of tax credits that would be less-generous for many who receive them now but available to a larger set of people. The new tax credits would be largely tied to age.

The bill would also reduce funding for Medicaid, the state-federal health program for low-income and disabled people.

The bill repeals several taxes on high-income earners and medical industries. Still, it retains several popular provisions of the law.

Insurance companies would still be required to sell health plans to people with pre-existing conditions, and people could still keep their children on their health plans until age 26. However, states could apply for waivers that would allow insurers to charge higher premiums to some people with pre-existing conditions.