Health CareSave the ACA

The Narrow, Tortured House Passage of the GOP Health Bill Reflects a Much Larger Struggle Ahead

The Narrow, Tortured House Passage of the GOP Health Bill Reflects a Much Larger Struggle Ahead

Health Care | Save the ACA | May 4, 2017

A Blog Post for Indivisible Activists by Ron Pollack

When President Donald Trump was elected along with Republican majorities in the Senate and House, most commentators assumed the Affordable Care Act (ACA) would be quickly repealed. Republicans had campaigned for such a repeal for almost seven years, and congressional leaders assumed a repeal bill would be sitting on the President’s desk, awaiting his signature, when he returned from the inaugural ceremonies. That obviously didn’t happen.

More startling, virtually nobody assumed that such a repeal bill would have difficulty passing in the very conservative House. After all, there already had been dozens of such votes in previous years. Indeed, as ACA and Medicaid program supporters initially strategized about their repeal bill opposition, all eyes were on the Senate. It was hardly imaginable that an ACA repeal bill could be stalled in the House—that is, until activists effectively voiced their concerns at town-hall meetings across the country.

What a huge difference several months have made!

Activist opposition to the GOP health bill has mushroomed. Key organizations representing patients, seniors, children, doctors, nurses, hospitals, insurers, people of faith, and many others publicly expressed their strong condemnation about the pending bill. Public opinion has shifted, with more than three times as many people feeling the ACA should be preserved or tweaked rather than repealed. And even rank-in-file Republicans oppose the recent bill modification that jeopardizes the health care and lives of people with pre-existing health conditions.

While President Trump and Republican leaders will celebrate the narrow House passage of the GOP health bill today, its tortured history shows that ultimate enactment is anything but certain. The road to ACA repeal and Medicaid decimation will be strewn with huge obstacles. A road map about what lies ahead makes that quite clear.

Before any bill can get to the President’s desk, at least four very difficult steps need to be taken, each step more difficult than the previous one: (1) passing the bill in the Senate with its narrow Republican majority; (2) bridging the likely huge differences between the House and Senate bills in a House-Senate Conference Committee; (3) re-passing the Conference Committee bill in the House; and (4) doing likewise in the Senate. Each step will be daunting, especially as public opposition to the legislation grows.

Perhaps not surprisingly, therefore, House Republican leaders rushed this revised bill to a vote even though it hadn’t been publicly available even 24 hours earlier. More significantly, the vote occurred before the non-partisan Congressional Budget Office (CBO) had a chance to assess its impacts. This deliberate refusal to allow such a pre-vote CBO analysis reflected the House leadership’s fear that any such assessment would expand and stiffen public opposition.

No doubt, as a CBO post-vote analysis is circulated, and as more people learn about the enormous damage the bill would cause, the road to enactment will become much more difficult. It will also cause congressional Republican supporters of the bill, especially those in states and districts where Hillary Clinton won a majority of the vote, to gain an increasing appreciation that they have jeopardized their re-election prospects.

The CBO analysis will reaffirm that the bill would cause tens of millions of people to lose health coverage. It will show that premiums are expected to skyrocket for the near-elderly and moderate-income families. It will document how many millions of people with histories of cancer, heart disease, diabetes, high-blood pressure, asthma, or other health problems would find insurance premiums unaffordable and coverage much more sparse. It will show that state budgets would be afflicted with considerably fewer federal Medicaid funds. And it will reaffirm that the bill is a classic example of Robin-Hood-in-reverse, with hundreds of billions of dollars taken away from care for impoverished children, seniors, and people with disabilities and transferred to tax breaks for the rich.

As a result, the delayed and torturous House passage of the GOP health bill is less a victory for ACA opponents and more a precursor of the problems that lie ahead. As this becomes clearer in the weeks ahead, those of us who oppose the ACA’s repeal, as well as huge cuts in Medicaid, must, and certainly will, re-double our efforts to hasten this prediction’s reality.


For more than three decades, Ron Pollack was the Founding Executive Director, and is now the Chair Emeritus, of the consumer health advocacy organization Families USA. He continues to play an active, independent role on progressive health and economic policy issues, and his blogs and tweets (@Ron_Pollack) provide up-to-date personal commentaries about those developments.