United States

Pursuing “repeal and replacement” of Obamacare

The “repeal and replacement” of Obamacare—another of Trump’s central campaign pledges and a fundamental objective for the Republican Party during the Obama era—moved forward slowly, in fits and starts. In the absence of a detailed plan from the Trump administration, House Republicans, led by Speaker Paul Ryan, took the lead in advancing the American Health Care Act (AHCA), which was intended to reduce the federal government’s involvement in health care without eliminating the care provided for millions of Americans by the PPACA, long characterized by Republicans as a costly catastrophe. Introduced in March, the AHCA met with lockstep opposition from Democrats and proved contentious with Republicans. The bill did away with the PPACA’s requirement that most Americans obtain health insurance or pay a penalty, rolled back federal funding of Medicaid, and, as part of nearly $1 trillion in proposed tax cuts over 10 years, promised $274 billion in tax cuts for Americans earning at least $200,000 per year. According to estimates by the Congressional Budget Office, the AHCA would trim the federal deficit by some $337 billion over 10 years, but it would also leave an additional 24 million Americans without health insurance. The most conservative House Republicans argued that the bill did not go far enough in undoing Obamacare, while moderate Republicans feared that it would leave too many people unable to pay for health care. In response to this lack of consensus, Ryan pulled the legislation in March, before it was put to a vote, but at the beginning of May a revised version of the act was adopted by a 217–213 vote in which 20 Republicans joined the Democrats in opposition.