What Happened?

Last Thursday, House Republicans voted 217 to 213 to pass the American Health Care Act or AHCA, the proposed replacement for the Affordable Care Act, otherwise known as “Obamacare.”

House Republicans introduced the AHCA on March 6, which proposed to localize and expand health care options at the state level and eliminate penalties inflicted on individuals without health care, according to a website created by the GOP for the bill

Twenty Republicans and all 193 Democrats opposed the bill, which ultimately passed 217 to 213, according to the Washington Post.

“The base of the Democrats believe in socialism and use health care as a policy area to advance public provision of service; Obama-Care was a step in that direction,” David Baggins, Professor Emeritus of political science at Cal State East Bay told the Pioneer. “The base of the Republicans believe Medicaid and Medicare were already too much of a step toward socialism and want to move the country back to capitalism. Health care is the battleground for a larger ideological clash.”

The AHCA bill sparked controversy after a report by the Congressional Budget Office released on March 13 found that 24 million people under age 65 would likely be uninsured by 2020 due to higher premiums, the elimination of penalties imposed on people without insurance and cutbacks in Medicaid and individual policies.

On March 24, the AHCA failed to pass and was pulled from the House floor, due to irreconciliation of the conservative Freedom Caucus—a congressional group of conservative Republicans within the GOP who vote together on bills and amendments—and the moderate Tuesday Group—a caucus of moderate Republicans, according to The New York Times.

After it’s initial failure, two new amendments were added to the bill in an effort to appeal to both caucuses, a strategy which resulted in the House’s passage of the bill, according to the Washington Post.

The Upton-Long Amendment aims to allocate $8 billion in resources over five years to protect enrollees with preexisting conditions, according to a GOP website dedicated to the AHCA. This amendment was added at the last minute in an effort to appeal to the Tuesday Group, which opposed discrimination against people with preexisting conditions in the bill’s first draft, according to The New York Times.

According to the CBO report, qualifications for insurance would be based on age rather than income and insurance companies would have the freedom to charge up to five times more for enrollees 65 and over than for younger people.

The MacArthur Amendment gives states the flexibility to control local insurance markets by allowing them to apply for waivers from federal insurance regulations that increase premiums, according to the GOP’s American Health Care Act website. According to the website, this was designed to lower costs for patients and protect those with preexisting conditions, as it prevents states from denying coverage to these individuals.

The MacArthur Amendment was created in a collaboration between Tuesday Group member Tom MacArthur and Mark Meadows, Chairman of the Freedom Caucus, in an effort to unify the Republican vote, according to CNN Politics.

Critics have expressed concerns over the AHCA’s rollback on the Obamacare protections of these cases and states’ independent control to decide what qualifies as a preexisting condition and increase premiums accordingly.

According to Money, a subsidiary of Time Magazine that covers on real estate and investment topics, these conditions can range from asthma and C-sections to postpartum depression and acne.

One of President Donald Trump’s major campaign promises was to repeal Obamacare, which was hailed “the most significant health care law in a half-century,” in a Jan. 13 article by The New York Times.

The bill was based on a model that Paul Ryan, speaker of the United States House of Representatives, released in In June 2016, titled “A Better Way: Our Vision for a Confident America.”

The model proposed five goals; repeal Obamacare, expand feasible healthcare options, protect patients with preexisting conditions, spur innovation and competition and preserve Medicare, according to the proposal.

“Republicans have campaigned hard against Obama-Care but now really do not have a plan for what should replace it, so they have punted a tweak so they can declare victory,” said Baggins. “This issue is far from over. Ultimately I expect the promise of giving health care and taxing to pay for it will prevail.”

The bill will now go to the Senate, where it must receive a majority vote of 51 out of 100 in order for it to pass, according to the U.S. House of Representatives. The bill will then undergo revisions by the House and Senate before it is sent to the president, who has 10 days to sign or veto it.

“It remains unclear that any measure can pass both House and Senate,” said Baggins. “Democrats view the inability of Republicans to master this policy area as their means to a return to power.”