After seven long years of pledging to repeal and replace the Affordable Care Act (ACA), House Republicans have made good on their promise to pass legislation dismantling the signature achievement of the Obama administration.  Today’s 217 to 213 vote – which comes just six weeks after House GOP leaders were forced to pull their reform bill from the floor because of a lack of support from rank-and-file Republicans – illustrates the depth of partisan discord within Congress as it pertains to the future of federal health care policy.  In the end, the California congressional delegation voted strictly along party lines.

To secure the necessary support to clear the bill, GOP leaders agreed to make several changes to the legislation (HR 1628).  For example, the revised measure includes amendment language that would allow states to apply for waivers that would let insurance companies charge considerably higher premiums for people with pre-existing conditions if those individuals do not maintain continuous coverage.  Under the legislation, high-risk pools would be available to cover those particular costs, though most health economists have noted that high-risk pools have failed in the past.

The modified bill also would allow states to establish their own requirements for essential health benefits, beginning in 2020.  Under current law, insurers must abide by a list of 10 benefits that were mandated by the ACA.

Read our joint letter of opposition here.

It should be noted that the changes to HR 1628 do not address California counties’ underlying concerns with the repeal and replacement package, including the elimination of the Medicaid (Medi-Cal) expansion – which would take place beginning in 2020.  In addition, the legislation would place a per-capita cap on federal Medicaid spending and institute a number of other changes that would make it more difficult to enroll and maintain individuals on Medi-Cal.  Accordingly, if enacted, the measure would shift tens of billions of dollars in costs to counties in California.

As was the case with the initial version of HR 1628, the Congressional Budget Office (CBO) has not had the opportunity to fully evaluate the amended bill’s potential effect on both the federal budget and the uninsured rate.  Consequently, congressional Democrats and a number of Republicans have decried the lack of an official fiscal analysis from the nonpartisan congressional scorekeeper.

Looking ahead, the GOP reform legislation faces an uphill climb in the Senate where at least eight Republicans are opposed to various elements of HR 1628.  Notably, several GOP senators from states that have expanded their Medicaid programs have expressed concerns with the House bill’s rollback of the program.

Additionally, while the goal of congressional Republicans has been to design a bill that could be brought up in the Senate under the budget “reconciliation” process (which insulates legislation from the threat of a filibuster and allows a bill to advance on a simple majority vote), the House-passed measure includes provisions that could be deemed outside of the scope of reconciliation.  Those particular decisions will lie with the Senate parliamentarian, who is required to have a CBO score in hand prior to initiating a legislative review.