BY LINDSEY MCPHERSON AND ERIN MERSHON
House Republicans breathed a sigh of relief Thursday as they finally advanced their health care overhaul out of the chamber in a narrow 217-213 vote. No Democrats voted for the measure. They were joined by 20 Republicans who voted “no” as well.
Republicans clapped and cheered as they reached the 216 vote threshold needed for passage. The Democrats, convinced the vote would be politically hazardous to the GOP’s health, chanted, “Nah, nah, nah. Hey, hey, goodbye.”
Speaker Paul D. Ryan cast a “yes” vote for the measure. It is rare for the speaker to vote on legislation.
The relief, however, is likely only temporary as the bill could come back to them in a few weeks or months significantly changed by the Senate.
The GOP is still likely a long ways away from achieving their top campaign promise to repeal and replace the 2010 health care law, as the politics and procedures of the Senate are expected to prove far more dicey than those in the House.
But for now, Republicans in the House are happy to have the health care issue off their plate so they can turn their attention to other matters, such as the fiscal 2018 appropriations process and a rewrite of the tax code.
The House technically cannot act on a tax bill until the health care legislation is signed into law, because they need to dispense with the fiscal 2017 budget reconciliation measure before moving onto a fiscal 2018 reconciliation measure that would be the vehicle for the tax rewrite. But they can begin to hold hearings and vet their policy ideas more thoroughly than they did on the health care bill.
The rush to finalize the health care bill catapulted House Republicans into a chaotic legislative process more characterized by fits and starts than a slow plod toward Thursday’s passage. After early promises from President Donald Trump and Republican leaders that they would deliver first on a seven-year promise to repeal and replace the 2010 health law, Republicans have struggled at almost every turn.
Some members worked to disrupt even the initial budget resolution that kicked off the repeal process. The ultimate policies were released in rushed, late-night meetings just days ahead of marathon markup sessions. Ryan’s first attempt to pass the legislation ended in a spectacular failure for both him and Trump, as he pulled the bill from floor consideration when it became clear it didn’t have the votes to pass.
Indeed, it was only late Wednesday, after more than a month of negotiations and various proposals to tweak the bill, that any member of leadership said they had secured the votes.
The proposal that leaders are crediting with pushing the bill across the finish line is an $8 billion infusion of money to help reduce premiums and out-of-pocket costs for some individuals with pre-existing conditions that are widely expected to rise under provisions of the overall bill. Michigan’s Fred Upton offered the amendment, which switched him and Missouri’s Billy Long from a planned “no” vote to a “yes.”
Before the Upton amendment, which sought to bring on more moderates, roughly two dozen conservative House Freedom Caucus members flipped from a “no” to “yes” after securing their request to allow states to seek a waiver to opt out of certain insurance regulations Republicans claim have driven up the costs of insurance premiums.
The only Freedom Caucus member to ultimately vote against the bill was Arizona Rep. Andy Biggs. Liberty Caucus members Thomas Massie of Kentucky and Walter Jones of North Carolina, who frequently vote against leadership, also opposed the bill.
The waiver amendment was officially authored by New Jersey Rep. Tom MacArthur, co-chairman of the centrist Tuesday Group. It did not persuade many of his Tuesday colleagues who had opposed the plan. In fact, it moved many moderates who had previously committed to support the bill into the “no” or “undecided” categories.
The Upton amendment was designed to change the tide — and appeared to do so.
Tuesday Group Reps. Mario Diaz-Balart of Florida, Adam Kinzinger of Illinois, Elise Stefanik of New York, Brian Mast of Florida and John Faso of New York all had planned to vote “yes” before the MacArthur amendment and then, at least publicly, remained on the fence for the last week or so.
They all ultimately voted “yes” on the final bill, meaning the Upton amendment likely had some influence or they were planning to vote for it all along.
Still, several moderates felt more comfortable opposing the bill, which Democrats have signaled they’ll use to attack vulnerable Republicans in the 2018 midterm elections. Already Democratic campaign organizations have started running ads against lawmakers who supported the package in earlier stages.
Tuesday Group co-chairman Charlie Dent of Pennsylvania and other group members Leonard Lance of New Jersey, Mike Coffman of Colorado, Dan Donovan of New York, Pat Meehan of Pennsylvania, Barbara Comstock of Virginia, Jaime Herrera Beutler and Dave Reichert of Washington, John Katko, Ryan Costello of Pennsylvania, Frank A. LoBiondo of New Jersey, Ileana Ros-Lehtinen of Florida and Brian Fitzpatrick of Pennsylvania all voted “no.” Christopher H. Smith of New Jersey, Ohio’s Michael R. Turner and David Joyce and Texas' Will Hurd voted “no” as well.
Other members who said they would have voted “no” on the version of the bill leadership pulled from the floor in the March ultimately voted “yes,” including Appropriations Chairman Rodney Frelinghuysen of New Jersey, Rob Wittman of Virginia and Don Young of Alaska.
The package itself is a patchwork of provisions that repeal and replace parts of the 2010 health care law, including the law’s current tax credits. New credits in the package would offer less help for most Americans who are not young or relatively wealthy. The bill slashes the Medicaid program by $880 billion over the next 10 years, among other changes. And it would make available some $115 billion for states, aimed at installing so-called high risk pools that Republicans say will help iron out high premiums.
An early analysis of the bill from the nonpartisan Congressional Budget Office showed that it would result in 24 million Americans becoming uninsured. CBO has not yet scored any of the later amendments to the package.
The next CBO score, however, looms large. The late changes could have a dramatic impact on the number of individuals insured and the Senate will not be able to take up the package until the CBO has scored it, under the rules of reconciliation.
Kerry Young and Rema Rahman contributed to this story.CORRECTION: An earlier version of this story misidentified Christopher H. Smith as a member of the Tuesday Group.