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What's Next For The Republican Health Care Plan


It was a victory but a narrow and possibly temporary one. Yesterday, House Republicans passed their bill to repeal and replace nearly all of the Affordable Care Act. The bill now heads to the Senate, where top Republicans have already said they will make changes of their own.

Every House Democrat voted against it, and they say the vote will come back to haunt Republicans. In fact, as the last votes were being cast, a chorus of Democrats broke into a song implying Republicans will lose seats because of it in next year's elections. They waved farewell at Republicans from across the chamber and sang this.


UNIDENTIFIED DEMOCRATIC HOUSE REPRESENTATIVES: (Singing) Na, na, na - hey, hey, hey, goodbye.

MARTIN: Hey, hey, hey, goodbye. NPR's congressional correspondent Susan Davis is here. Hello, Susan.

SUSAN DAVIS, BYLINE: Good morning, Rachel.

MARTIN: That was quite a scene on the House floor - Democrats taunting Republicans outright. What is the evidence that Republicans will pay a price for supporting this bill?

DAVIS: Well, House Democrats believe the vote will be unpopular, specifically in the districts they have the best chances of picking up next year. Those are the 23 districts held by Republicans that Hillary Clinton won. One sign that they might have a point there is that 14 of those Republicans voted against the bill yesterday. And in other ways, history is on Democrats' side.

The president's party has lost seats in one or both Houses of Congress in the past four midterm elections. Although, and this is a bit of an understatement, I'm not sure I'm willing to apply historical trends to the Donald Trump era of politics.

MARTIN: Indeed. President Trump, speaking of the president, says he is the ultimate deal-maker, likes to talk a lot about his negotiating skills. Did this vote say anything more about his influence on Capitol Hill?

DAVIS: Yeah, you know, the president and the vice president's engagement really was key to getting the vote this week, particularly after it failed almost a month ago, and people thought it was dead. The president's engagement mattered a lot. He also told White House reporters yesterday that he believes his tweets helped get the health care bill passed. So I won't imagine any slowdown of social media as it goes to the Senate.

Here's the political flip side to Democrats on this - both the White House and Republican leaders believe that not even voting on what has been the party's signature campaign pledge for the past seven years would have been just as devastating to keeping their voters motivated and engaged. One thing about him stylistically, it's worth noting that he - it was a little bit odd and maybe a bit premature yesterday that he held a Rose Garden ceremony with Republicans to sort of spike the football on the House vote, considering that the bill still has a very long way to go before it can...

MARTIN: Halfway point.

DAVIS: ...Become a law.

MARTIN: Yeah, halfway point to be generous. So Republican Senator Lamar Alexander talked about the road ahead for this bill in the Senate. Let's listen to what he had to say.


LAMAR ALEXANDER: We'll carefully consider the legislation passed by the House. We will work together carefully to write our own bill. We will make sure we know what our bill costs when we vote on it. In fact, by law, we have to do that. We will get it right, and then we will vote.

MARTIN: Clearly, Senator Alexander getting in a little dig at his House colleagues. But what kind of changes are senators looking at with this bill?

DAVIS: And he was right. He did make a point - the Senate cannot move forward on this until they know the cost estimate, so we will see that soon, probably in weeks. You know, they sort of took the House bill and said thank you very much and pushed it off to the side. They've made very clear they're going to do their own thing on this. It's going to be a slower process. And it might be even harder. You know, the speaker in the House could lose up to 22 Republicans and still pass this bill.

Senate Majority Leader Mitch McConnell can only lose two Republicans and still get it through the chamber. So it's going to be equally as hard a battle over there. You know, there is agreement among Republicans on the core of this bill to repeal the mandate that requires people to buy insurance and repeal most of the taxes that pay for it. Senators are going to have issues with what the House did on pre-existing conditions and how it limits the scope of the Medicaid program. And so we're going to be hearing a lot more about that.

MARTIN: NPR's congressional correspondent Susan Davis. Thanks so much, Sue.

DAVIS: You're welcome. Transcript provided by NPR, Copyright NPR.

Susan Davis is a congressional correspondent for NPR and a co-host of the NPR Politics Podcast. She has covered Congress, elections, and national politics since 2002 for publications including USA TODAY, The Wall Street Journal, National Journal and Roll Call. She appears regularly on television and radio outlets to discuss congressional and national politics, and she is a contributor on PBS's Washington Week with Robert Costa. She is a graduate of American University in Washington, D.C., and a Philadelphia native.