UPDATE: House narrowly passes GOP health care bill
BY LEIGH ANN CALDWELL, NBC News
(NBC News) - By the slimmest of margins, the House of Representatives passed the Republican plan to replace Obamacare Thursday afternoon, sending the measure to a skeptical Senate where it will be almost certain to take on a completely different form. Republicans passed the bill by a vote of 217 to 213, just one vote over the 216 needed.
Republicans had been working to piece together a GOP-only coalition of votes ever since their attempt to repeal and replace much of the Affordable Care Act failed nearly two months ago and came into the vote with just 21 votes to spare.
House Speaker Paul Ryan took to the floor ahead of the vote to argue that Obamacare was failing. "We can continue with the status quo or we can put this collapsing law behind us and end this failed experiment," he said.
"This is a good day for the American people and the president of the United States. He personally engaged in a real way to make a difference," said Rep. Mark Meadows, R-N.C. before the vote. Meadows had been working his conservative members to agree to the measure as the vote neared. President Donald Trump threatened to run a primary against Meadows and fellow conservatives after the bill's failure in March.
Last minute deals, including promises to some members on future legislation and an additional $8 billion for people with pre-existing conditions in the current bill, helped to get squeamish moderates on board, a move that opened the doors for leadership to find enough votes.
The final tally, however, was close. It's a politically risky vote for many moderates in swing districts who could have tough re-elections in 2018 who are wary of campaign ads saying they voted to take away coverage for people with pre-existing conditions.
After all the wrangling to get through the house, the bill is sure to undergo extensive changes in the more moderate Senate.
Sen. Bob Corker, R-Tenn, said that the House bill has "zero" chance of passing the Senate.
"It's just-that's not the way it's going to work. To be honest," Corker said on MSNBC's "Morning Joe." "People are going to want to improve it. I don't see any way that it goes back in the form that it comes."
The Senate, however, will not need any Democrats to pass it because they are using a procedural mechanism that allows the bill to pass the Senate to pass with just 51 votes instead of the usual 60-vote threshold. There are 52 Republicans in the Senate.
The House measure came to the floor without an updated accounting of how much the bill will cost or its impact. The last assessment, which was done before the bill was altered, said that 24 million people would lose insurance, it would save $300 million and premiums would go down ten percent after ten years.
Rep. Barry Loudermilk, R-Georgia, said that having no updated CBO score is slightly concerning.
"It is a concern, but at this point we have to move forward. The American people are clear they want this done, so I think we have to strike when the iron's hot," he said.
Consumer advocacy groups have expressed concern for the bill, saying that it won't adequately protect patients. Meanwhile, the conservative, small-government political groups such as Club for Growth and Heritage Action have come out in support of the measure.
Rep. Raul Labrador, R-Idaho, one of the most conservative members of Congress, said he will vote for the bill. But when asked if he can guarantee that no one would lose coverage under the GOP plan, he could not.
"What I can guarantee is that more Americans will be helped by this plan than Obamacare has helped," he said. "More people will have their premiums lowered, more people will have lower out of pocket costs more people will have access to these high risk pools."
The legislation was made more conservative throughout the process to appeal to members like Labrador who wanted nothing short of a complete repeal of the Affordable Care Act.
Here are the key measures in the House bill:
Mandates: It guts the IRS requirement in Obamacare that people with purchase health insurance or face a fine.
Tax credits: The bill replaces subsidies for people to purchase insurance in the individual market in the Affordable Care Act based on income with refundable tax credits based on age. The impact is that it will provide more people with assistance but with fewer dollars, especially for the older Americans.
Medicaid: The Medicaid expansion is frozen immediately and in two years the states can start to adopt either a block grant for the program or a new formula based on population instead of need. In an attempt to make the bill more conservative, work requirements have been added for most able-bodied recipients who aren't pregnant or caring for a child under 6.
High risk pools: The bill provides $130 billion to states over ten years for high risk insurance pools to cover the most expensive to insure. A new amendment by Rep. Fred Upton of Michigan adds an additional $8 billion to assist people with pre-existing conditions.
State waivers: States can obtain waivers so insurers don't have to offer robust benefits packages that include maternity care and mental health coverage. Waivers can also be obtained to charge sicker people and people with pre-existing conditions more. Those people would most likely then go into the high risk insurance pools.
Taxes: It repeals every Obamacare tax including the .9 percent tax on couples making more than $250,000 and a 3.8 percent tax on investment income.
Health Savings Accounts: The measure increases the allowable contribution limits of Health Savings Accounts
Other: It keeps the Obamacare provision that people under the age of 26 can stay on their parents' insurance.