In their seemingly quixotic effort to repeal and replace Obamacare, House Republicans were third time lucky. The latest version of their American Health Care Act squeaked by in the House 217 to 213, although no one knows how much it will cost or how many people it would cover.
Two previous versions of the American Health Care Act were pulled from the floor of the House after it became clear the Republicans didn't have enough votes to pass it. Democrats were united in opposition, and conservative and moderate Republicans split over whether the bill went too far or not far enough and sank the vote. This time, a compromise on requiring coverage for people with pre-existing conditions brought together those factions (but without enticing Democrats).
What happens now:
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— Obamacare remains in place for the moment.
— The bill heads to the Senate, where it is ultimately not expected to pass. One Republican senator put the chances at less than 20 percent in the bill's current form.
— Republican senators plan to use a process called budget reconciliation to avoid a Democratic filibuster and pass the AHCA with only 51 votes. Democrats argue that what the bill does goes beyond what is allowed in budget reconciliation — a total connection to taxes or spending — and deserves a full vote that subjects it to the filibuster. They will likely win that argument: Even Senate Leader Mitch McConnell says it'll be "a real tough challenge on the Senate side."
— Even if the bill is substantially changed enough to gain Democratic support in the Senate, the House is not expected to approve those changes.
— The bill did not receive a CBO (Congressional Budget Office) score, so it is unknown how much the plan will cost or how many people will lose health insurance were it to be enacted. That score is expected soon, but not this week. (The CBO estimated that the original version of the AHCA would have removed 24 million people from the insurance rolls and caused health-insurance premiums to rise 15 to 20 percent.)
— Democrats will continue to be dismayed. "TrumpCare spells heart-stopping premium increases for Americans with anything from asthma to cancer," House leader Nancy Pelosi said in a statement yesterday. "But tomorrow, House Republicans are going to tattoo this moral monstrosity to their foreheads, and the American people will hold them accountable."