Dive Brief:

• The Republican bill repealing major parts of the Affordable Care Act (ACA) passed the House on Thursday by a narrow vote of 217-213.
• The American Health Care Act (AHCA) dismantles key ACA provisions such as essential health benefits and pre-existing condition protections.
• The vote was held without a CBO score on the revised version of the American Health Care Act. The CBO's analysis of the original AHCA draft found an additional 24 million Americans would be uninsured in the next 10 years while also saving $337 billion in federal budget deficits.

Dive Insight:

After years of promising to repeal the ACA, the Republican party took a major step toward that goal Thursday with a bill that will revamp health insurance for most Americans.

The revised AHCA drastically changes the individual insurance market as well as Medicaid. As currently written, Medicaid expansion would be phased out and the public program would take a $880 billion hit over 10 years. The measure allows states to circumvent essential health benefits requirements, potentially exposing those with pre-existing conditions to higher out-of-pocket costs.

The GOP was determined to bring the measure to a floor vote. Republicans failed to hold a vote on the measure in March when the legislation was first drafted. However, ACA supporters had a short honeymoon for AHCA's failure as Republicans quickly returned to the bill in hopes to make good on their campaign promises to repeal the ACA.

However, most of the influential industry associations such the American Medical Association and the American Hospital Association oppose the AHCA.

“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question," AMA President Andrew Gurman stated after the vote. "Action is needed, however, to improve the current health care insurance system. The AMA urges the Senate and the administration to work with physician, patient, hospital and other provider groups to craft bipartisan solutions so all American families can access affordable and meaningful coverage, while preserving the safety net for vulnerable populations.” 

It was a morning of intense debate and a few late defections. Democrats did not mince words, and told the GOP their bill will result in unnecessary deaths. “Affordable healthcare is civil right and a fundamental right for everyone in our country, not just the privileged few," Rep. Nancy Pelosi (D-CA) said on the house floor before voting began. 

A recent "yes vote" convert was the influential Rep. Fred Upton (R-MI), who switched after tweaking an amendment so the legislation would include high-risk pools and fund them with $8 billion. Multiple health policy experts, however, say that would not be nearly enough to adequately protect people with pre-existing conditions.

The bill next goes to the Senate, but it is not clear whether the GOP has the votes in that chamber without major changes.