ACA replacement bill pulled before House vote

In a victory for the major medical organizations which opposed it, a scheduled vote in the House on the American Health Care Act (AHCA) was called off as Republican leaders failed to convince enough of their own members to support the plan to replace the Affordable Care Act (ACA).

The bill’s fate was very much in doubt before a planned vote on March 23 was delayed. Then less than an hour before the rescheduled vote was expected, House Speaker Paul Ryan said he spoke with Trump and they agreed to withdraw the legislation.

“Moving to an opposition party to a governing party comes with growing pains, and well, we’re feeling those growing pains today,” Ryan said. “We came really close today, but we came up short.”

Republican supporters of the bill argued on the House floor that while the AHCA wasn't perfect—with members having reservations with its cuts to Medicaid and elimination of the ACA’s required benefits for insurance plans, like emergency care, pediatric services and hospitalizations—it fulfilled a promise to voters on repealing the ACA.

The inclusion of the repeal of essential health benefits, favored by conservatives, both failed to satisfy their demands and scared off a number of other Republicans, such as House Appropriations Committee Chairman Rodney Frelinghuysen, R-New Jersey.

“The legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey. In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues,” he said in a statement ahead of the planned vote.

The Democratic responses to Republican supporters on the House floor were largely the same: Labeling the bill as “Trumpcare,” pointing to the Congressional Budget Office (CBO) report which said it would lead to 24 million more uninsured by 2026 while encouraging health plans to offer “junk plans” with fewer benefits.

“What is the point of having insurance if it doesn’t cover anything?” said Rep. Gene Green, D-Texas, the ranking member of the House’s health subcommittee.

Every Republican’s floor speech on the AHCA was followed by New Jersey Democratic Rep. Frank Pallone reading an estimate of how many people in that Republican’s district who would lose insurance coverage under the bill. Rep. Bill Flores, R-Texas, called those numbers “absolutely false.”

“Those constituents are getting their freedom back to choose whether or not they want healthcare coverage and what kind of healthcare coverage they want,” he said.

The bill had been opposed by many major medical organizations, including the American Medical Association, the American Academy of Family Physicians and the American College of Physicians, along with patient groups like the American Diabetes Association.

Among conservative political groups, the decision to pull the legislation was also applauded, though for very different reasons. FreedomWorks President Adam Brandon said in a statement to HealthExec that Ryan should reintroduce the 2015 version of ACA repeal, which was passed with the assumption then-President Barack Obama would veto it.

“We urge him to bring up that bill again and add Medicaid reform, HSA expansion, and pursue repeal or sunset of ObamaCare regulations that are driving up the cost of health insurance,” Brandon said.

The next steps for repealing, replacing or, as Democrats favor, “repairing” the ACA, are unclear. Before the vote, Trump’s budget director Mike Mulvaney had said if the bill failed, the president would move on and “leave the ACA in place” while he focuses on other policy priorities, according to NBC.

Ryan said the ACA is “so fundamentally flawed” that he doesn’t believe it can be “propped up,” repeating his claim that the individual insurance market is in a “death spiral,” a condition the Brookings Institution has said doesn’t fit despite increases in premiums and major insurers exiting the marketplace.

“We’re going to be living with Obamacare for the foreseeable future,” Ryan said. “I don’t know how long it’s going to take us to replace this law. My worry is Obamacare’s going to be getting even worse.” 

After Ryan spoke, Trump told reporters in Oval Office the ACA market would “soon explode,” which he believes will motivate Democrats to work with the Republican majorities in Congress to craft a replacement. He added that he expects the next attempt at healthcare reform to be “a better bill,” though he declined to point at specific provisions he disliked in the AHCA or items he’d like to see in future legislation.

“I never said repeal it and replace it in 64 days,” Trump said, referring to how long he’s been in office, though he was off by one day. “I have a long time, but I want to have a great healthcare bill and plan and we will. It will happen and it won’t be in the too distant future. I really believe there will be some Democrat support.”