House Republicans finally passed Trumpcare 3.0 on Thursday, with a razor-edge party-line vote, passing it with exactly 217 votes.
It was their third attempt to pass the legislation, after earlier versions were pulled from consideration by leadership when it became clear they couldn’t marshal the votes — in part because the bill didn’t go far enough to appease the far-right Freedom Caucus, who derided the bill’s first iteration as “Obamacare lite.”
In order to pass the bill, then, GOP leadership gutted protections for people with preexisting conditions and mandates to cover essential health benefits, including such basic needs as hospitalizations and ambulance rides.
The bill they voted on on Thursday wasn’t finalized until Wednesday, and has yet to be analyzed by the non-partisan Congressional Budget Office (CBO)— meaning that lawmakers were voting on legislation that could have a sweeping impact over the physical well-being of millions of Americans and affect 1/6 of the economy without an estimate of what, exactly, that legislation would do.
White House spokeswoman Sarah Sanders defended the vote, absent a CBO score, by saying that the bill is “impossible to score.” The CBO, by contrast, says they’ll have a score on the newest version of the legislation by next week — while lawmakers are in their home districts during the congressional recess.
The CBO estimation of the first iteration of the bill projected that it would cause 24 million people to lose their health insurance in the next 10 years. The White House’s own projection was even harsher, estimating a drop in overall coverage to the tune of 26 million.
Since then, the legislation has been tweaked to allow states to opt out of Obamacare’s essential health benefits mandate, which requires health plans to cover some pretty basic services: things like hospitalizations, emergency room visits, prescriptions, and maternity care.
The revised bill also allows states to opt out of protections for people with preexisting conditions. About half of Americans could thereby be excluded from those protections. The definition of preexisting conditions includes gender-based factors, such as post-partum depression, and even being a survivor of rape or domestic violence.
Under Trumpcare, states could opt out of Obamacare’s current provisions and get a waiver instead. In that case, people with preexisting conditions who ever had a gap in their health insurance coverage could then be charged exorbitant rates by insurers, or kicked into “high-risk pools.”
Republicans have touted such high-risk pools as protection for people with pre-existing conditions, but in the past, such pools often offered long waiting lists for coverage, skimpy plans, and sky-high costs. To pass Trumpcare, Republicans claimed that an extra $8 billion they added to cover high-risk pools would prevent this from being the case. However, that number falls far short of the $200 billion a Center for American Progress analysis estimated would be required.
According to Kaiser Family Foundation Senior Vice President Larry Levitt, the $8 billion might cover “a few hundred thousand high-risk enrollees, out of millions who might need it.”
Even under pretty conservative estimates, a minimally adequate high-risk pool could cost $25 billion per year nationwide.
— Larry Levitt (@larry_levitt) May 3, 2017
All of which means that Trumpcare 3.0 could be even worse than Trumpcare 1.0 — a plan that, according to estimates, would have caused millions to lose coverage, and would have likely resulted in many Americans paying more for their health insurance.
Now the legislation goes to the Senate, where its future is uncertain. Republicans have a narrow majority, and can’t afford to lose more than three members of their caucus. They also need to pass it as a budget bill, so that they can do it with a simple majority, without fear of a Democratic filibuster.
In the Senate, one of three things will happen: either the bill will be voted down, it will pass, or it will be changed substantially in an effort to get it pass — in which case it either goes back to the House for a vote, or the House and Senate need to work together to reconcile the two different versions. Whichever way, it is likely to be an ongoing fight.