ACHA (TrumpCare) Passed the House with a Very Narrow Margin

May 04, 2017

By a vote of 217 to 213 the Republican effort to “repeal and replace” the Affordable Care Act passed the House this afternoon.  The bill now goes to the Senate where it will face significant revision.  There are a couple of important issues in the mechanics of this vote:

  • The House voted prior to having the impact statement from the Congressional Budget Office – they did not know how much the plan will cost nor how many will lose their insurance!

  • The narrow margin makes it much easier to target each of the Members who voted for the bill when the promises made are not promises kept and the individuals who lose benefits begin to suffer!


Here are the key measures in the House bill:

  • Mandates: It guts the IRS requirement in Obamacare that people with purchase health insurance or face a fine.

  • Tax credits: The bill replaces subsidies for people to purchase insurance in the individual market in the Affordable Care Act based on income with refundable tax credits based on age. The impact is that it will provide more people with assistance but with fewer dollars, especially for the older Americans.

  • Medicaid: The Medicaid expansion is frozen immediately and in two years the states can start to adopt either a block grant for the program or a new formula based on population instead of need. In an attempt to make the bill more conservative, work requirements have been added for most able-bodied recipients who aren’t pregnant or caring for a child under 6.

  • High risk pools: The bill provides $130 billion to states over ten years for high risk insurance pools to cover the most expensive to insure. A new amendment by Rep. Fred Upton of Michigan adds an additional $8 billion to assist people with pre-existing conditions.

  • State waivers: States can obtain waivers so insurers don’t have to offer robust benefits packages that include maternity care and mental health coverage. Waivers can also be obtained to charge sicker people and people with pre-existing conditions more. Those people would most likely then go into the high risk insurance pools.

  • Taxes: It repeals every Obamacare tax including the .9 percent tax on couples making more than $250,000 and a 3.8 percent tax on investment income.

  • Health Savings Accounts: The measure increases the allowable contribution limits of Health Savings Accounts

  • Other: It keeps the Obamacare provision that people under the age of 26 can stay on their parents’ insurance.


While many of our staff will be pleased that the health insurance mandate is gone, it will mean that some of our most vulnerable staff will not be able to get preventative care which currently is at no charge!  The other major concerns are, of course,  the state option for “waiving” some of the current mandates and coverage and the inevitable reduction in the federal share of the Medicaid payment when the “block grants” or per-capita caps are imposed.