WASHINGTON — Political arm twisting and tweaks to the Republican health care bill swayed GOP holdouts like Nevada Rep. Mark Amodei to support the controversial legislation and hand President Donald Trump a major legislative victory Thursday.
By a narrow margin, the House voted 217-213 to pass the American Health Care Act and send it to the Senate where a complete rewrite of the legislation is expected.
Trump delayed a flight to New York to celebrate the victory at the Rose Garden with House Republicans, who jumped on buses to travel across town from the Capitol after the vote.
“This has brought the Republican Party together,” Trump said. “We’re going to get this finished.”
Trump hailed House Speaker Paul Ryan, R-Wis., and other GOP leaders who mustered the votes to repeal and replace the Affordable Care Act, commonly referred to as “Obamacare.”
Democrats warned Republicans that they would pay political consequences in the 2018 mid-term elections for slashing patient protections provided by Obamacare.
As voting on the bill was ending, Democrats on the House floor sang the refrain to the popular song, “Na Na Hey Hey (Kiss Him Goodbye).”
The bill passed without support of a single Democrat. Twenty Republicans voted against it.
House Minority Leader Nancy Pelosi, D-Calif., said Republicans were playing politics with people’s health. She said the bill takes away benefits to the poor to provide a tax cut for the wealthiest.
“It’s Robin Hood in reverse,” she said.
Earlier bill pulled
GOP leaders were embarrassed in March when they were forced to pull their original health care bill from the House floor because they lacked enough Republican support for passage.
The non-partisan Congressional Budget Office found the original bill would cut $337 billion from federal budget deficits over the next decade, but increase the number of uninsured by 24 million people over the same period.
Republicans sweetened the bill with amendments to win over conservative and moderate GOP lawmakers who opposed the first draft.
Under Obamacare, insurers are required to accept all applicants regardless of pre-existing conditions. Conservatives complained that the original GOP bill kept that mandate. They were converted to supporters when the second bill allowed states to let insurers raise rates on applicants with those pre-existing conditions.
The rewritten GOP bill also included $130 billion to help cover costs of insurance for those whose costs were upped because of their health status. Rep. Fred Upton, R-Mich., a moderate, dropped his opposition to the bill when a last-minute increase of $8 billion was added to help pay those increased rates.
Medicaid cuts and a shift in the formula to pay states also prompted concern by Republican governors and senators.
Under Obamacare, Medicaid was expanded in 31 states to cover an additional 11 million people nationwide — including 400,000 in Nevada.
Medicaid coverage for newly eligible applicants was to be funded by the federal government at 100 percent until 2020, and then reduced to 90 percent for years beyond, according to the Kaiser Family Foundation.
Nevada Gov. Brian Sandoval lobbied Trump and lawmakers to maintain Medicaid coverage for those newly eligible people. He expressed concern about GOP changes to funding formulas in Medicaid that would shift the financial burden to states.
Amodei switches position
Amodei opposed the original House legislation because of Medicaid concerns. But after meetings this week with Vice President Mike Pence, Health and Human Services Secretary Tom Price and House leaders, Amodei announced his support for the new bill.
“I have concluded that the potential for Nevada deficits or expanded Medicaid enrollees being kicked off of Medicaid will be avoided,” Amodei said in a statement.
Following House passage of the bill, Sen. Dean Heller, R-Nev., who is up for election in 2018 and targeted by Democrats, said he would not support the House legislation because it “falls short.”
“We cannot pull the rug out from under states like Nevada that expanded Medicaid and we need assurances that people with pre-existing conditions will be protected,” Heller said.
Sandoval said he remains opposed to the legislation.
“My position on the House healthcare bill has not changed,” he said in a statement. “I will continue to stand with Nevadans and work with Senator Heller.”
Sen. Catherine Cortez Masto, D-Nev., said the House bill would cause premiums and cost of insurance for those with pre-existing conditions to skyrocket.
“The House Republicans’ effort to impose this extremely unpopular piece of legislation on the American people is a transparent attempt to score a win for the Trump administration,” Cortez Masto said.
The medical industry, patient advocacy groups and AARP, the lobby for retirees, opposed the House bill.
Every House Democrat voted against the bill, including Nevada Reps. Dina Titus, Ruben Kihuen and Jacky Rosen.
Titus said the House bill does nothing to improve health care for Nevadans, “but it will give a tax break to the wealthiest Americans and corporations.”
Rosen said that even with Republican changes, the bill still would force 24 million to drop their insurance and raise rates for coverage for people over age 50.
The Affordable Care Act was passed in 2010 along strict party-line votes in the House and Senate and signed into law by President Barack Obama.
Contact Gary Martin at email@example.com or 202-662-7390. Follow @garymartindc on Twitter.
How Nevada’s Congressmen voted:
Rep. Mark Amodei
Rep. Dina Titus
Rep. Ruben Kihuen
Rep. Jacky Rosen
Key elements of the health care bill:
—Ends tax penalties imposed on individuals who don’t purchase health insurance and on larger employers who don’t offer coverage to workers.
—Halts extra payments Washington sends states to expand Medicaid to additional poorer Americans, and forbids states that haven’t already expanded Medicaid from doing so. Changes Medicaid from an open-ended program that covers beneficiaries’ costs to one that gives states fixed amounts of money annually.
—Erases subsidies for people buying individual policies based mostly on consumers’ incomes and premium costs. Replaces them with tax credits that grow with age that must be used to defray premiums.
—Repeals taxes on people with higher incomes and on insurance companies, prescription drugmakers, some medical devices, expensive employer-provided insurance plans and tanning salons.
—Requires insurers to apply 30 percent surcharges to customers who’ve let coverage lapse for more than 63 days in the past year.
—Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like.
—States can get waivers exempting insurers from providing consumers with required coverage of specified health services, including hospital and outpatient care, pregnancy and mental health treatment.
—States can get waivers from a prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage.
—Provides $8 billion over five years to help states finance their high-risk pools. This is on top of $130 billion over a decade in the bill for states to help people afford coverage.
—Retains the requirement that family policies cover grown children to age 26, and the prohibition against varying premiums because of a customer’s gender.
Sources: U.S. Congress, The Associated Press, Kaiser Family Foundation