GOP House votes to repeal ACA. 14 million could lose health insurance next year.

Pressure by president nudges replacement legislation across the line, gaining votes in last-minute deal with House Freedom Caucus

Seven years after the Affordable Care Act was signed into law, the U.S. House of Representatives has passed the American Health Care Act (AHCA), a plan to repeal or change spending-related provisions of the ACA.

While the legislation leaves many parts of the ACA untouched, it implements significant changes to Medicaid expansion, federal funding for Medicaid, and premium tax credits. It eliminates cost-sharing subsidies, and the penalties associated with the individual and employer mandates, and it delegates essential health benefits rule-making to states.

How did the House pass the AHCA?

  • The Congressional Budget Office projected that the AHCA would increase the number of uninsured by 24 million (the addition of the Manager’s Amendment to the bill did not change the CBO’s projection). That’s a big obstacle to overcome, but Congressional Republicans have been pushing to repeal the ACA for seven years, and many current lawmakers campaigned on a promise to repeal the law as soon as possible. Although the AHCA didn’t initially garner full support among Republicans, the prospect of being able to claim success in repealing the ACA — or at least portions of it — was apparently enough to overcome lawmakers’ qualms about the bill.
  • The Congressional Budget Office projected that the AHCA would reduce federal deficits by $150 billion over the next decade. Although this is smaller than the $337 billion reduction in the federal deficits that had been projected prior to the addition of the Manager’s Amendment to the AHCA on March 20, it’s still a savings, which appeals to fiscal hawks.
  • In last-minute meetings with the House Freedom Caucus, the Trump Administration offered to repeal the ACA’s essential health benefits requirements for individual market plans. After the meetings, Freedom Caucus members initially said that no deal had been reached, but enough of them voted for the legislation to pass it on to the Senate.

What happens next?

Who will lose coverage if the AHCA is enacted?


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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