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President Trump and congressional Republicans are one step closer to fulfilling their campaign pledge to repeal and replace the Affordable Care Act. The House voted along party lines today to advance a bill to get rid of major parts of the law.
KELLY MCEVERS, HOST:
The bill would do away with all of the taxes and mandates in Obamacare. It also eases the requirements on what health care services insurance policies must cover. To talk about this, we have NPR congressional correspondent Susan Davis and NPR White House correspondent Scott Horsley. Hello to both of you.
SUSAN DAVIS, BYLINE: Hey, Kelly.
SCOTT HORSLEY, BYLINE: Hi.
MCEVERS: So Sue, this is the bill that collapsed more than a month ago, right? What's changed?
DAVIS: Well, there's both policy and political reasons for that. On the policy side of things, Republicans essentially added in language that goes even further to repeal Obamacare. It now also includes language that would let states seek waivers from the federal government on what benefits insurance policies have to cover and what they get to charge people for those policies.
Politically speaking, too many Republicans were saying it's just not tenable to not even vote on what has essentially been the single unifying campaign promise of the Republican Party for the past seven years. House Speaker Paul Ryan spoke to that on the floor today before the vote. This is what he had to say.
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PAUL RYAN: This bill delivers on the promises that we have made to the American people. You know, a lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote to repeal and replace Obamacare.
DAVIS: Most Republicans agreed with the speaker. All but 20 Republicans voted for this bill. And of course every single Democrat voted against it.
MCEVERS: I understand it was pretty dramatic on the floor after the bill passed this afternoon. Democrats were taunting Republicans with a song, suggesting they're going to lose the House next year over this. What's the political calculation there?
DAVIS: OK, we need a little bit of history here because this is referencing a famous moment from the House in 1993. That was when Pennsylvania Democrat Marjorie Margolies-Mezvinsky cast the deciding vote for President Clinton's budget. And at the time, Republicans sang a similar song, waving and jeering to her, the implication being this vote is going to cost you your seat. And it did. She lost in the 1994 election.
So Democrats doing this today was essentially a similar warning, saying, you could lose the House. And House Minority Leader Nancy Pelosi spoke about the political consequences. This is what she had to say.
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NANCY PELOSI: You vote for this bill. You have walked the plank from moderate to radical. And you're walking the plank for what, a bill that will not be accepted by the United States Senate? Why are you doing this? Do you believe in what is in this bill? Some of you have said, well, they'll fix it in the Senate, but you have every provision of this bill tattooed on your forehead.
DAVIS: We're going to get an early sense of how this is going to go over. The House left today for a weeklong recess. They're going to be holding meetings with their constituents, and we'll see soon how it's playing back home.
MCEVERS: It was a major setback for President Trump when he basically forced Republicans to go ahead with this bill in March, and yet they couldn't get it passed. Today he invited them over to the White House to celebrate. Let's hear a little bit of what he said.
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PRESIDENT DONALD TRUMP: A lot of people said, how come you kept pushing health care knowing how tough it is? Don't forget; Obamacare took 17 months. Hillary Clinton tried so hard - really valiantly, in all fairness - to get health care through - didn't happen. We've really been doing this for eight weeks if you think about it. And this is a real plan. This is a great plan. And we had no support from the other party.
MCEVERS: And Scott Horsley at the White House, I want to ask you, how involved has the President been in bringing this bill back to life?
HORSLEY: Very involved. He personally was working 15 to 20 lawmakers. You know, Donald Trump is not deep in the weeds of the policy behind this bill. In fact he's still making promises about coverage and co-payments that are really hard to reconcile with what this bill would actually do. But in terms of schmoozing and cajoling and closing the sale, those are skills this president has brought to bear. And for better or worse, he has certainly kept the pressure on the House members to get this done before they leave for that recess.
MCEVERS: And Scott, talking about the policy, I mean what are some of the fundamental parts of Obamacare that this bill aims to change?
HORSLEY: Yeah, well, there are big changes to Medicaid. Not right away, but over time, it caps the federal contribution. And that could force states to either cut their Medicaid rolls or offer skimpier coverage or both. Forecasters at the Congressional Budget Office estimate 14 million fewer people will be covered on Medicaid by 2026.
There are also changes in the individual insurance market both in the way insurance is priced and the subsidies offered by the government. That could result in cheaper policies for young, healthy people. But older, sicker people are likely to end up paying more especially in rural areas. And that includes a lot of Trump voters. And finally, this bill's a big tax cut, especially for the wealthy. You know, Obamacare taxed the rich to extend health insurance to the poor. This bill is Robin Hood in reverse.
MCEVERS: And Sue, we heard Nancy Pelosi mention how this bill will now head to the Senate. What kind of changes are they looking at, and what's the timeline for this bill over there?
DAVIS: Well, as Scott said, the provisions affecting Medicaid are going to be a big issue in the Senate. There's a lot of opposition to changing that program there and a lot of hope from House Republicans that the Senate will actually improve the Medicaid provisions 'cause there was wariness on this side. But they said, I'm a yes conditional today except - expecting that the Senate's going to make this a little bit better of a bill.
Senate Majority Leader Mitch McConnell today said they're not going to take it up until the Senate goes through sort of procedural and budget considerations. And you know, the - couple people to watch over there are conservatives like Senator Rand Paul of Kentucky who's been very skeptical of this bill and Maine Senator Susan Collins, a moderate who has been very influential in bills like this in the past.
MCEVERS: NPR's Susan Davis at the Capitol and NPR's Scott Horsley at the White House, thanks to both of you.
DAVIS: Thank you.
HORSLEY: You're welcome. Transcript provided by NPR, Copyright NPR.