The U.S. House of Representatives narrowly passed a bill to repeal and replace the Affordable Care Act Thursday, fulfilling a campaign promise that has been a staple of Republican congressional candidates for years.
Four of Kentucky’s six congressmen supported the bill, a second attempt for House Republicans as they’ve struggled to deal with former President Barack Obama’s signature legislation. The bill now goes to the Senate for consideration.
U.S. Rep. Thomas Massie, R-Vanceburg, and U.S. Rep John Yarmuth, D-Louisville, voted against the bill, while U.S. Rep. Andy Barr, R-Lexington, U.S. Rep. Brett Guthrie, R-Bowling Green, U.S. Rep. Hal Rogers, R-Somerset, and U.S. Rep. James Comer, R-Tompkinsville, all voted for it.
Moderate Republicans in the House and conservatives in the Freedom Caucus came to an agreement last week that would allow states to opt out of a rule that limits price differences based on pre-existing medical conditions. To do so, states would have to set up high-risk insurance pools to help patients with pre-existing conditions keep access.
Opponents of the bill claim that the provisions will kick people off their insurance and that the high-risk pools would make insurance unaffordable for people with pre-existing conditions. In Kentucky, 33 percent of adults under 65 have pre-existing conditions, the third highest rate in the country.
The political threat of supporting a bill that could reduce coverage for poor and sick people made the vote tough for several moderate Republicans in the House but, for the most part, Kentucky’s delegation didn’t blink.
Massie and Yarmuth voted against the bill for reasons on opposite ends of the political spectrum.
Massie, who has heavily criticized the bill, felt it didn’t go far enough to repeal the Affordable Care Act.
“In weighing my vote, I heeded the wise advice that ‘one should not let the perfect be the enemy of the good,’” Massie said in a written statement. “If this bill becomes law, it could result in worse outcomes, fewer options, and higher prices for Kentuckians who seek health care. In summary, I voted against this bill not because it’s imperfect, but because it’s not good.”
In a speech on the House floor, Yarmuth called the bill a tax cut for corporations and millionaires. He also cited a Congressional Budget Office report that said 24 million people would lose their coverage if an earlier version of the bill passed. The CBO has not yet had a chance to analyze the current bill.
“Now that House Republicans have recklessly rushed this legislation through without any hearings or analysis, I trust that the American people will come to the same conclusion that our nation’s doctors, nurses, hospitals, patient advocates, and seniors groups have all reached: this bill weakens health care protections for most Americans and leaves families worse off,” Yarmuth said in a written statement.
The way the bill cuts coverage is a bit complicated. People who became eligible for Medicaid because of the Affordable Care Act would be able to keep their insurance under the new law, but if they leave the program and then come back, they’d no longer be eligible after 2020. Congress would also reduce the amount of federal funding for expanded Medicaid in 2020, thus reducing the amount of people eligible for coverage.
Barr has been an ardent supporter of the bill, facing off against angry constituents in town halls across his Central Kentucky district, in large part because of how much the bill reduces Medicaid costs for the federal government.
“Since I first ran for Congress, I promised the people of the Sixth District that I would vote to repeal this broken law and replace it with reforms that will actually lower costs and expand access to care through patient-centered, market-based reforms,” Barr said in a written statement. “The American Health Care Act accomplishes these goals and more.”
Like Barr’s, Comer’s vote on the bill was never really in question.
“This bill, which President Trump supports, will make health insurance more affordable across the board, allow states to better manage their unsustainable Medicaid programs, and repeal job-killing taxes and regulations, while still protecting people with pre-existing conditions,” Comer said in a written statement.
Guthrie said he supported the bill because it would give patients more control over their health care.
“As vice chair of the Health Subcommittee, I was proud to work closely with the Trump administration and my colleagues in the House to craft the American Health Care Act, which is a crucial first step towards fixing our health care system,” Guthrie said in a written statement.
Rogers was on the fence about the bill during the lead-up to a vote. While Rogers usually toes the Republican Party line, he serves a district that significantly benefited from the Medicaid expansion.
“The American Health Care Act redirects the future of health care by repealing unaffordable taxes and eliminating the impossible mandates that set Obamacare on its destructive path,” Rogers said in a written statement. “This bill is part of a multiphase process, and I look forward to working with my colleagues to finalize a package that protects quality health care options while providing relief from Obamacare.”