The U.S. House of Representatives narrowly passed its Obamacare "repeal and replace" legislation known as the American Health Care Act by a 217 to 213 vote on May 4. The legislation effectively eliminates the employer and employee mandates; replaces Obamacare’s with tiered tax credits (increasing with age); allows states to apply for waivers to define their own essential health benefit requirements; expands the limits for Health Savings Account; discontinues Medicaid expansion in 2020; and repeals most of Obamacare’s taxes. The legislation also would delay implementation of the Cadillac Tax by five years, from 2020 to 2025, and it preserves the tax exclusion for employer sponsored insurance.
Twenty Republicans and all Democrats voted against the AHCA, which now will be considered by the U.S. Senate where its fate is far from clear.
There are several changes likely to be made to the package in the Senate, but the chamber’s ability to amend the legislation will be hampered by its own reconciliation rules, which will limit the bill to provisions that have a fiscal impact. These limitations allow the Senate to bypass its normal 60-vote threshold and pass the measure by a simple majority vote.
Republicans have a 52-seat majority and will only be able to lose two votes from their caucus. Democrats are expected to unite against the measure. Rumored changes to the package in the Senate could include increased subsidies, more money for high risk pools, and changes to Medicaid expansion provisions.
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