Obamacare is one-third replaced

Bill squeezed through chamber with a 217-213 vote

WASHINGTON — More than 50 years after Canada moved toward universal health coverage, and 70 years after it happened in England and France, the U.S. Congress took a baby step in the other direction Thursday, advancing a bill that would eliminate health care for millions.

It won’t likely make it through the Senate in its current form.

But the passage of that bill through the House of Representatives was greeted as a momentous event by both parties: By Republicans as proof their majority could get something done, by President Donald Trump as a legislative win, and by Democrats as an electoral gift.

Democrats in fact erupted in mock celebration the instant the bill squeezed through the chamber with a 217-213 vote — teasing their Republican rivals, waving, singing, ”Na na na na, hey hey, goodbye.”

That’s because they’re counting on Republicans being turfed in next year’s midterm elections over what they say the bill does: help the wealthy, the biggest winners in hundreds of billions in tax cuts; hurt the poor, millions of whom would lose coverage; increase premiums for people with pre-existing conditions like cancer; and anger the nation’s main seniors’ lobby group.

“You have walked the plank,” predicted Nancy Pelosi, the Democratic leader in the chamber.

“You have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.”

The bill’s effects are hard to gauge.

It was rushed to a vote before the congressional budget watchdog had a chance to assess it. An earlier evaluation of the bill in a previous form concluded it would have removed insurance from 24 million people.

Another reason it’s hard to predict the impact is because key coverage decisions would belong to the states. One such decision involves whether to restrict access to the U.S. Medicaid program, which provides coverage for the very poorest Americans.

Republicans savoured the moment.

Trump invited the victorious party over to the White House for a celebratory press conference. Desperate for a legislative win, he wanted something passed by the chamber, so he could move onto more politically popular issues — like tax cuts and infrastructure.

Earlier efforts crashed.

Previous versions of the bill kept stumbling into opposition from the party’s right wing, or its left wing — ultimately satisfying neither, clogging up valuable congressional time, and undermining Trump’s personal brand as a deal-maker.

The Republican House leader cast it as a simple matter: keeping promises. Republicans pledged repeatedly to undo Barack Obama’s unpopular bill. In fact, they rode the tsunami of popular anger to congressional gains in 2010, 2014 and 2016.

“A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote,” said Paul Ryan, the House Speaker.

“Are we going to be men and women of our word? Are we going to keep the promises we made?”

The other Republican rationale for this bill was that the current Obamacare system is falling apart and unsustainable. Republicans pointed to the skyrocketing number of counties without insurance competition, with just one provider or none.

Trump referred to those problems in a ceremonious get-together in the White House Rose Garden: ”Wherever I went (in the campaign), people were suffering so badly, because of the ravages of Obamacare… It’s dead.”

That only tells part of the Obamacare story.

The rate of Americans without health insurance has declined, from 18 per cent to 10 per cent, under Obama’s 2010 health reform. Democrats say it would be even better, had the project not been sabotaged by Republicans — who, for instance, removed federal protection for struggling insurance plans.

The bill has now completed one-third of its journey with Thursday’s vote.

It still must pass the Senate, and can do so with a simple majority vote under the rules for financial measures. But it’s expected several Republicans will demand changes. Then the bill would go to a reconciliation conference, where both chambers negotiate a final version.

Senate Republicans aren’t thrilled with the current bill.

Ohio’s Rob Portman said he agrees with the general objective of replacing Obamacare with a more sustainable alternative. But he said he doesn’t support the current version, as he fears the watering-down of Medicare will worsen the opioid crisis.

”These changes must be made in a way that does not leave people behind,” he said in a statement.

Alexander Panetta, The Canadian Press

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