The US House of Representatives voted narrowly for approval of the revised American Health Care Act on Thursday, finally passing legislation which had failed to gain a majority twice in recent weeks. The bill repealing and replacing the Affordable Care Act (Obamacare) passed by a vote of 217-213 – a scant one vote more than necessary – and now goes to the Senate, where it likely faces an even stiffer challenge and a fresh round of revisions.
A sufficient number of House conservatives and moderates who had opposed the original bill were persuaded in recent days to support this revised legislation, after significant concessions were made to allow individual states more control over various provisions in the bill. These amendments drew added support from the conservative House Freedom Caucus. Moderates concerned about their constituencies losing existing coverage were by most accounts the hardest to convince, and the last ones to pledge their support. President Trump and his point man for rounding up votes, Vice-President Pence, reportedly worked the phones heavily in these last days, trying to secure the remaining votes needed for passage.
Securing the repeal and replacement of Obamacare – especially in the House – should have been easy, or so said the conventional wisdom. Republicans had milked the issue of repealing and replacing Obamacare for seven years. They had squeezed every last drop of political juice out of the issue. Donald Trump had joined the chorus during his presidential campaign. And when Trump landed most unexpectedly in the oval office, the GOP had been gifted with their first clear opportunity to put their money where their mouth was.
But of course it did not happen. The GOP’s failure six weeks ago to push through the first iteration of their reform bill – bouncing the ball off the back rim on a slam dunk – demonstrated that, while there was broad if not universal agreement among Republicans on repealing the Affordable Care Act, no such consensus existed on replacement. The narrow margin of victoryl on Thursday drove home that point again.
House Republicans pushed to get an amended bill – version 2.0 – across the finish line before their Easter recess, but again failed to round up the 216 votes needed for passage. So it was back to the drawing board for the third time, which finally turned out to be the charm.
This House passage of the The American Health Care Act version 3.0 is no doubt a political victory, the first in the legislative sphere for President Trump. And it removes some of the stinging embarrassment for congressional Republicans who failed in their first two tries at repeal and replace. But we are nowhere near the end of the road to healthcare reform.
As much difficulty as the GOP had in getting this through the lower chamber, the House always figured to be the easy part of this reform effort. It was always the Senate – with its far more narrow and centrist Republican majority than in the House – which represented the bigger challenge. We will now get to see just how big an obstacle the Senate really is.