By just a for vote margin of victory the Republican Congress has approved a measure to repeal and replace the affordable care act. The new American healthcare act includes an amendment that would at $8 million in federal money to state high-risk insurance pools. Many of the same provisions that made the bill impassable in the house last month are still in this version. Joining me as a national healthcare reporter with the LA Times Washington Bureau. Welcome to the program. Inc. you get to be with you. How important was this $8 million funding for high risk pools to getting this bill passed? I think it is clear to say it is critical until the chairman -- former chairman Fred Upton of Michigan came forward with it yesterday. He and a number of more centrist House Republicans were leaning pretty heavily against the legislation. The $8 million seem to be enough to get him and his fellow Republican lawmakers back to -- to back the bill. He recently wrote a report on how inadequate the high-risk insurance pool was in California before Obamacare. Is does that still apply? I think very much so. These high risk insurance pools were sort of common stock at measures that many states ran for years to try to cover the thousands of Americans that were routinely rejected by commercial insurance because they had pre-existing medical conditions. Plus the implementation of the affordable care act made those high-risk pools unnecessary because the current Mark -- law guarantees coverage for folks no matter what their pre-existing medical condition may be. The critical thing that changes in the house Republican Bill is a provision added toward the end of the discussion of the legislation that would give states the ability to waive a key protection that exists in Obamacare that prohibits insurers from charging people who are sick higher rates. So that means a family with cancer or diabetes or heart disease or some other illness could still be guaranteed coverage under the Republican alternative to Obamacare but they may be charged five or 10 or 20 or even more times as much for the same health plan service high-risk pools are coming back. So which rules are still in place? The issue -- the guarantees are still there but the issue is whether it means anything if the health care plan is no longer affordable. We still have rules stain on parents insurance is still there. What about federal subsidies for individuals? One is making cuts to Medicaid. It is responsible for it is responsible for much of the expansion and people will have health insurance. The house Republican Bill cut almost $1 trillion out of the states for Medicaid. The other thing that the builders is change the system of insurance subsidies that the federal government provides to help people buy insurance on these marketplaces and that changing subsidy means that many older and lower income consumers will be getting less financial assistance to buy health insurance on these market places. Based on the previous bill many Americans were going to lose insurance. Is that still the estimate? Do we have a new estimate? They did something very unusual in rushing forward with the vote today. There's an update of the analysis with the legislation. Is a change in the legislation over the last several weeks and stated that additional analysis since anything probably would have upped the number that would be closing the gap. What is the likelihood that this repeal and replace bill will pass in the Senate. In its current form there is virtually no chance it will pass. There are a lot of Senate Republicans have publicly expressed their reservations about the process that House Republicans used and about the scope of the cuts. Remember a lot of Senate Republicans come from states that have expanded Medicaid under the Obamacare Mike Ohio Nevada Arizona and others and those Republican senators see the benefits that the Medicaid expansion has had and they are focused on the opioid epidemic Republicans have focused a lot of most two healthcare issues. It's hard for the federal government to do much to enhance mental health or substance abuse treatment around the country if Medicaid use is scared -- scale back like it would be. I've been speaking with the national healthcare reporter from the LA Times Washington Bureau. Thank you so much. Good to be with You.
Delivering at last, triumphant House Republicans voted Thursday to repeal and replace the "Obamacare" health plan they have reviled for so long, overcoming united Democratic opposition and their own deep divisions to hand a major win to President Donald Trump.
The 217-213 vote was a narrow victory, and ultimate success is far from assured since the measure must still make its way through a highly skeptical Senate. But after seven years of campaign promises and dozens of show votes, Republicans finally succeeded in passing a health care bill that has a chance of becoming law.
They weren't waiting for final passage to celebrate.
"What a great group of people!" Trump exclaimed at the White House, arms raised to salute the dozens of lawmakers who hurried to join him in the Rose Garden immediately after the vote. Set aside for the moment were the feuds and philosophical divides that nearly sank the bill time and again.
And at the same time, the Republicans had begun to show that perhaps they can come together and govern the country now that they control Washington in full.
"Make no mistake, this is a repeal and a replace of Obamacare, make no mistake about it," Trump declared. "Premiums will be coming down, deductibles will be coming down, but very importantly it's a great plan."
Democrats countered that the GOP bill would have the opposite effect from what Trump predicted, pointing to estimates it will kick millions off the insurance roles while imperiling coverage for people with pre-existing conditions who had gained protections under Barack Obama's Affordable Care Act.
They also forecast that Republicans will pay a steep political price for passing legislation that's polled poorly and takes concrete benefits away while offering only promises of more choices and lower costs.
"You will glow in the dark on this one," House Minority Leader Nancy Pelosi dramatically warned, predicting Republicans will be radioactive with voters in the 2018 midterm elections.
Indeed Democrats seemed practically giddy as the vote closed on the House floor, jeering at Republicans with chants of "nah, nah, nah, nah, hey, hey, goodbye" — an echo of how protesters serenaded Democrats seven years ago when they passed Obama's bill.
The GOP health bill would eliminate the fines Obama's law imposed on people who don't buy coverage, and erase tax increases in the Affordable Care Act on higher-earning people and the health industry. It would cut the Medicaid program for low-income people and let states impose work requirements on Medicaid recipients. It would transform Obama's subsidies for millions buying insurance, now based largely on their incomes, making the funding skimpier and tying it to consumers' ages.
And states could get federal waivers freeing insurers from other Obama coverage requirements. With waivers, insurers could charge people with pre-existing illnesses far higher rates than healthy customers, boost prices for older people to whatever they wish, and ignore a mandate that they cover specified services like pregnancy care.
The bill would block federal payments to Planned Parenthood for a year, considered a triumph by many anti-abortion Republicans.
The Congressional Budget Office estimated in March that the GOP bill would end coverage for 24 million people over a decade. The House voted without a CBO estimate for the latest version of their bill.
Although it's focused mostly on the minority of Americans who buy health coverage in the individual market, the GOP bill could also significantly impact the many who are covered by large employer plans. In one little-noted provision, employer plans could take advantage of state flexibility under the legislation to pick and choose which states' rules to live by. That could allow them to impose annual and lifetime coverage limits, which are prohibited under Obamacare, and get rid of certain annual out-of-pocket spending caps.
Protesters were on hand again for Thursday's vote, shouting "Shame on you! Shame on you!" and "2018! 2018!" as Republicans boarded buses outside the Capitol to head to the White House.
Yet as the 2016 election amply demonstrated, political outcomes can be difficult to predict. Republicans argued they would have had a still heavier price to pay if they failed to make good on an endlessly repeated pledge that helped them seize control of the House, the Senate and the White House in the years since the law passed.
Back in 2010, the Democrats held Congress and the White House and used their majorities to jam through an unpopular health care law on a partisan basis, just as Republicans have done now.
As lawmakers prepared to vote, House Speaker Paul Ryan told them: "Many of you have been waiting seven years to cast this vote. Many of you are here because you pledged to cast this vote."
"They expect us to govern — if we're going to be around," Republican Rep. Dennis Ross of Florida said of voters.
The White House had pushed hard for a vote, and Trump got personally involved in last-minute maneuvering. He helped bring wavering moderates on board after a deal secured by conservatives last week scared them off by limiting protections for people with pre-existing conditions. The final change, agreed to just Wednesday at the White House, was to add $8 billion over five years to help people with pre-existing conditions, a sum critics called a relative pittance.
Indeed, despite assurances by GOP leaders that their legislation would rescue a failing health care system, it was opposed by nearly all medical and consumer groups, from the American Medical Association to AARP. The Chamber of Commerce supported the bill.
The health legislation passed the House on a banner day for Republicans on Capitol Hill, as the Senate gave final congressional approval to a bipartisan $1.1 trillion spending bill to keep the government running through September, and a House committee approved legislation that would gut the Democratic-authored Dodd-Frank law that regulated Wall Street after the 2008 financial crisis.
