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House Republicans just voted to repeal and replace Obamacare

“I don’t think time would be our friend. We want to get it over to the Senate so they can start their job,” said Rep. Chris Collins of New York.

But as a legislative blueprint, the House bill significantly weakens the protections established under Obamacare for Americans with preexisting conditions. It also will cut aid to lower-income Americans, making health care subsidies based on age, rather than income.

Those who stand to gain immediately include younger and healthier insurance buyers in the open marketplace, and the wealthiest taxpayers, who will see a significant tax cut.

The farthest-reaching effect of the American Health Care Act, however, may be provisions that roll back the expansion of Medicaid beginning in 2018. Obamacare expanded Medicaid for states who chose to opt-in to everyone making up to 138% of the poverty line, expanding coverage in those states by well over 10 million people.

Halting the Medicaid expansion in those states, combined with the bill’s restructuring of health insurance subsidies, will mean that people making minimum wage and slightly more will experience the sharpest drop in coverage.

“The AHCA would lead to catastrophic coverage losses among those right above the poverty line,” said Dr. Julie Donohue, director of the Medicaid Research Center at the University of Pittsburgh Health Policy Institute. “While individuals right above poverty-level could technically purchase coverage on the marketplace, such coverage will be out of reach for nearly all.”

President Trump has promised the bill would cover those with preexisting conditions, but the bill would allow states to let insurers charge people with preexisting conditions higher premiums.

Thursday’s House vote ensures that the Republican effort to repeal Obamacare does not end. But the Republican victory on Thursday may be setting lawmakers up for a major defeat in 2018.

The Republican health care bill is deeply unpopular, with just 17% of Americans approving of the bill, according to a poll from late March. The bill was opposed by AARP as well as the American Medical Association, health groups and hospitals. A majority of Americans want Congress to fix Obamacare rather than repeal it outright.

Democrats believe the bill’s passage on Thursday will help set up the party for a wave of congressional election victories next year. Even as they lambasted the Republican vote, Democrats were preparing to target the moderate Republicans in swing districts who voted for the bill.

“You vote for this bill, you’re walking the plank,” House Minority Leader Nancy Pelosi told Republicans on the house floor.

The bill “is going to provide a great civics lesson for America,” she said. “Most Americans don’t know who their Congressperson is. But they will now.”

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