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Controversial new American Health Care Act struggles to survive and advance

March 2017

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The plan to repeal and replace “Obamacare,” more formally known as the Affordable Care Act (ACA), which was put in place by President Barack Obama, experienced a rough week in late March 2017, as more Republican leaders sided with Democrats who are feeling reticent about passing the controversial American Health Care Act (AHCA).

The defections come after Congressional Budget Office (CBO) reports that the bill would result in higher than expected coverage losses and result in a loss of coverage for 24 million people, but the bill managed to survive the House committee vote.

In the coming weeks, legislation will be considered by the House Rules Committee, which is working in tandem with the Trump administration to provide the legislation with a makeover before advancing it through committee.

After that, the bill heads to the House floor, which may happen as early as Thursday, March 30. Speaker Paul Ryan (a Republican) is unlikely to take the bill to the House floor unless he is certain he has enough votes for the passage, and Republicans must make sure they get the right mixture of changes from the Rules Committee since amendments will most likely not be allowed during the floor debate.

The CBO will be releasing their data next week, but the report that was released on March 20th, estimated that 24 million people would lose coverage by 2026. Staunch Republicans refuted the CBO’s estimates, challenging the CBO’s track record of accurately predicting coverage changes, and argued that the bill would reduce the deficit by $337 billion over ten years and the coverage losses would be the result of the elimination of the individual mandate which, they argued, forced people to purchase coverage they didn’t want.

The CBO did issue caveats with their conclusions, saying it expects the risk pool for most employers will stay relatively stable and employer subsidies will continue to make most employer-provided coverage more attractive than individual coverage. This hinges on the stability of the employer group market, which could change if the frequently-discussed proposal to tax employees and retirees on the value of their health coverage is included in the AHCA.

Should the legislation pass the House, it then moves on to the Senate, where Republicans plan to use the Budget Reconciliation rule to speed passage of the bill with only a simple majority vote. Republican leadership in the Senate wants to take the bill directly to the Senate floor for swift passage, but if additional amendments are necessary in the Senate, passage would be delayed until the House can consider and approve those amendments.

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