What’s Next for Republican Health Care Plan

Republicans leaders want to push their bill repealing and replacing much of the 2010 health care law through Congress by April. But the GOP must navigate a complicated path to get the proposal to President Donald Trump’s desk.


GOP leaders say the House will consider the bill Thursday. Three House committees — Ways and Means, Energy and Commerce, and Budget — already moved the legislation ahead. Top House Republicans were working on eleventh-hour changes designed to get them the 216 votes needed for passage. If Democrats unanimously oppose them as seems likely, the bill would fail if 22 Republicans vote no. (There are five vacancies in the House, meaning they need 216 votes for passage.)


If passed in the House, the legislation then moves to the Senate, where a tighter 52-48 Republican majority makes the outlook less certain.

Normally, legislation requires 60 votes to overcome a filibuster and pass the Senate. The GOP-run Congress has already voted to let the Senate use a procedural maneuver to pass the bill on a simple majority.

That won’t be easy. Five GOP senators have said they oppose the measure: Sens. Susan Collins of Maine, Ted Cruz of Texas, Dean Heller of Nevada, Mike Lee of Utah and Rand Paul of Kentucky. Others have criticized it. That all but ensures changes will be needed.


Republicans must maneuver through some complicated intra-party politics.

Conservatives think the measure’s tax credits to help people afford coverage are too expensive. They also want the bill to be far more aggressive in repealing former President Barack Obama’s statute, including its requirement that insurers cover 10 specified types of services. They say those requirements drive up premiums.

Moderates want to protect the 11 million people who’ve gained Medicaid coverage under Obama’s law. The GOP bill would phase out that expansion and limit future spending for the program.

Many Republicans want to shift more aid to older people, after nonpartisan congressional analysts concluded their out-of-pocket costs would surge. House Speaker Paul Ryan, R-Wis., said he would adjust the measure to address that concern.


Democrats, under pressure from their base to resist every part of Trump’s agenda, are standing united against the repeal effort.

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