After marathon debate, draft of Obamacare repeal approved by House committee

An 18-hour day of debate over a draft repeal ended with its approval in the first of two House committees.

First Look

The repeal of Obamacare just cleared its first hurdle.

The House of Representatives Ways and Means Committee voted along party lines on Thursday to approve draft legislation that would overhaul the nation’s health care system, as the chamber’s Energy and Commerce Committee continued debate on the bill. 

The Ways and Means approval inched the bill closer toward consideration on the House floor, by which time Republicans also expect they will have a Congressional Budget Office estimate of its cost. And coming against a backdrop of significant Republican dissent and full-throated resistance from Democrats, the repeal poses the first legislative test for President Trump, who has busied himself primarily with a flurry of executive actions.

The House plan, as The Christian Science Monitor’s Francine Kiefer noted this week, would eliminate individual and employer mandates while letting insurers raise premiums for lapsed coverage, replace subsidies for low-income Americans with tax credits, draw down the Obamacare expansion of Medicaid after 2019, and keep two of Obamacare’s most popular tenets that cover young adults under their parents’ insurance until age 26, and prohibit denial of coverage for a preexisting condition.

But some independent analysts who have reviewed the plan say it could substantially reduce the number of people with coverage.

“This is going to be a difficult lift, and I don’t see Trump having much sway in this trek to repeal and replace,” G. William Hoagland, senior vice president of the Bipartisan Policy Center, told the Monitor, estimating that 8 million to 12 million fewer people could be covered under the GOP plan.

Several hospital associations, as well as the AARP, have come out against the bill, saying it would raise health care costs and cause many patients to lose their insurance. And the American Medical Association, the nation’s largest physicians’ organization, sent both House committees a letter this week expressing objections to the drafts.

"While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations," the group wrote.

During marathon debates on Wednesday, Democrats repeatedly tried to adjourn proceedings, protesting that decisions were being made before the CBO provided its analysis. And Democratic members on the Ways and Means Committee mounted dozens of attempts to tack on amendments to the bill, without success.

"This is decision-making without the facts, without the evidence," House minority leader Nancy Pelosi told reporters, according to Reuters.

Several key conservatives in the House and Senate have also attacked the bill’s system of tax credits, which they see as a rebranded version of entitlements, as well as its slow sunsetting of Medicaid expansion and leaving in place of some Obamacare taxes.

The White House disputes the accuracy of CBO estimates, with spokesman Sean Spicer saying on Wednesday that relying on it for accuracy would be “looking in the wrong place.” But Mr. Trump and Vice President Mike Pence met that day with conservative groups opposed to the repeal, after which a White House official said they were “open to constructive improvements that maintain the core principles” of the bill. 

House Speaker Paul Ryan (R) of Wisconsin has played down opposition from his party’s most conservative wing.

"We’ll have 218 when this thing comes to the floor, I guarantee it,” Representative Ryan said, according to USA Today, in reference to the number of votes needed for passage in the House.

This report contains material by Reuters.