Obamacare repeal Bill far from a sure thing

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Republicans obtain just enough support to push American Health Care Act to Senate for consideration

WASHINGTON: The US House of Representatives on Thursday narrowly approved a Bill to repeal Obamacare, handing Republican President Donald Trump a victory that could prove short-lived as the healthcare legislation heads into a likely tough battle in the Senate.

The vote to repeal former president Barack Obama's signature domestic achievement, which enabled 20 million more Americans to get health insurance, was Mr Trump's biggest legislative win since he took office. It put him on a path to fulfilling one key campaign promise as well as a seven-year quest by Republican lawmakers.

It marked a reversal of fortune for Mr Trump, who suffered a stunning defeat in late March when House Republican leaders pulled legislation to scrap Obamacare after they and the White House could not resolve the clashing interests of Republican moderates and the party's most conservative lawmakers.

But despite holding the White House and controlling both houses of Congress, Republicans have found overturning Obamacare politically perilous, partly because of voter fears, loudly expressed at constituents' town-hall meetings, that many people would lose their health insurance as a result.

With Thursday's 217-213 vote, Republicans obtained just enough support to push the legislation through the House, sending it to the Senate for consideration. No Democratic House members voted for it.

Democrats said it would make insurance unaffordable for those who need it most and leave millions more uninsured.


They accuse Republicans of seeking tax cuts for the rich, partly paid for by cutting health benefits.

The legislation, called the American Health Care Act, is by no means a sure thing in the Senate, where the Republicans hold a slender 52-48 majority in the 100-seat chamber, and where only a few Republican defections could sink it.

As Republicans crossed over the vote threshold to pass the Bill, Democrats in the House began singing "Na na na na, na na na na, hey hey hey, goodbye", a rowdy suggestion that Republicans will lose seats in the 2018 congressional elections because of their vote.

In an analysis released on Thursday, healthcare consultancy and research firm Avalere Health said the Republican Bill would cover only 5 per cent of enrollees with pre-existing conditions in the individual insurance markets.

Republicans have argued that their Bill would give people more choice and reduce the role of government.

In a push to pass the Bill before members leave on Friday for a week in their home districts, the House voted before the Bill was assessed by the non-partisan Congressional Budget Office, which estimates its cost and effect on insurance rolls.

Nearly every major medical group, including the American Medical Association and the American Hospital Association, and the AARP advocacy group for older Americans, strongly opposed the Bill.

Many said last-minute amendments further eroded protection for the most vulnerable groups, including the sick and elderly.

"I've already made clear that I don't support the House Bill as currently constructed because I continue to have concerns that this Bill does not do enough to protect Ohio's Medicaid expansion population," said Republican Senator Rob Portman.

While the Bill's fate in the Senate is uncertain, its House passage could boost Mr Trump's hopes of pushing through other items on his agenda, such as tax reform. - REUTERS

Health Care Bill's main provisions


The Republican plan will maintain some of Obamacare's most popular provisions. It will allow young adults to stay on their parents' health plan until age 26.

The Bill will let states opt out of Obamacare's mandate that insurers charge the same rates for sick and healthy people.

It will also allow states to opt out of Obamacare's requirement that insurers cover 10 essential health benefits, such as maternity care and prescription drug costs.

The measure will provide states with US$100 billion (S$140.5 billion), largely to fund high-risk pools to provide insurance to the sickest patients.

The Bill also will provide US$8 billion over five years to help those with pre-existing conditions to pay for insurance.

It will let insurers mark up premiums by 30 per cent for those who have a lapse in insurance coverage of two months or more.

Insurers won a provision they had long sought: The ability to charge older Americans up to five times more than young people. Under Obamacare, they could charge up to only three times more.


The Bill will end Obamacare's income-based tax credits that help low-income people buy insurance. These will be replaced with age-based tax credits ranging from US$2,000 to US$4,000 a year that will be capped at upper-income levels. While Obamacare's credits gave more help to those with lower incomes, the Republican plan will be largely age-based.

It will repeal the mandate that larger employers must offer insurance to their employees.


Under Obamacare, more than 30 states, including about a dozen Republican states, expanded the Medicaid government health insurance programme for the poor.

About half of Obamacare enrollees obtained insurance through the expansion.

The Bill will allow the Medicaid expansion to continue until Jan 1, 2020. After that date, expansion will end and Medicaid funding will be capped on a per-person basis. - REUTERS

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