Bill to replace the 2010 Affordable Care Act, popularly known as Obamacare, is Donald Trump’s first legislative test and has triggered fast-emerging disorder

This article is more than 3 years old

This article is more than 3 years old

Republicans cleared the first hurdle early on Thursday in their plan for a massive overhaul of the US healthcare system backed by Donald Trump, despite Democratic concerns that the cost of the bill and its impact on the budget remain unknown.

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The House of Representatives ways and means committee approved the bill to replace Barack Obama’s Affordable Care Act along party lines on Thursday morning after debating the draft legislation for nearly 18 hours.

The chamber’s energy and commerce committee continued its own marathon session, two days after the proposal was unveiled by Republican leaders.

“This is an historic step, an important step in the repeal of Obamacare,” said Republican Kevin Brady, chairman of the House ways and means committee, after the committee voted 23-16 on the measure.

Congress is hoping to pass the bill, which would roll back much of the 2010 Affordable Care Act, popularly known as Obamacare, within a few weeks. The bill would remove the individual mandate for people to buy insurance, reverse most Obamacare taxes, introduce a new, smaller system of tax credits based on age rather than income, and overhaul Medicaid, the government health insurance program for the poor.

A glossary of key terms in US health care policy Co-pay

Out-of-pocket expenses ​for ​paid by patients for doctors’ visits, drugs or procedures. Deductible Amount a patient must pay out of pocket for prescriptions or healthcare before their insurance coverage kicks in. Healthcare exchanges The name for state insurance marketplaces created under the Affordable Care Act. Individuals shopping for health insurance can see what subsidies they may qualify for and sign up for a plan. ​But in some areas shoppers face a lack of options. ​ Individual mandate A penalty for people who don’t carry health insurance policies. ​As such it’s unpopular. But it’s also the linchpin to the Barack Obama health care law; w ​Without it, not enough healthy people would carry insurance to make a market. Medicaid A joint federal and state program that helps with medical costs for some people with limited income and resources. ​One of the largest payers for healthcare in the United States, with 70m enrollees. Spending accounted for 10% of the federal budget in 2015. Established by the Social Security Act, signed into law in 1965. ​ Medicare A federal health insurance program for people who are 65 or older, certain younger people with disabilities and others. ​The biggest public health care program by cost ($540bn in 2015, or 15% of the federal budget) with an enrollment of about 57m. Established by the Social Security Act, signed into law in 1965. ​ Premium If you need insurance, this is what it will cost you. The premium is a periodic payment for health or prescription drug coverage. Single-payer A pie-in-the-sky (for America) system in which a single payer, the government, would pay all health bills. Could that possibly work? The UK’s NHS is exhibit A. –Tom McCarthy

The committee, which was looking at the tax-related provisions of the bill, made no changes, despite dozens of attempts by Democrats to introduce amendments.

Hospitals, doctors, insurers and patient advocates had appealed to Congress after the draft was released on Monday to reconsider the broad cuts and how they would affect healthcare.

The bill is Trump’s first legislative test and the fast-emerging disorder around it comes after the chaos triggered by his travel ban on citizens from several Muslim-majority nations, which he later had to revise.

Trump and fellow Republicans campaigned last year on a pledge to dismantle the Obamacare healthcare law, the signature domestic policy achievement of Obama, calling it a government overreach that had ruined the more than $3tn US healthcare system.

Obamacare, condemned by Republicans since its passage in 2010, enabled 20 million previously uninsured people to obtain coverage, about half through an expansion – which the new bill would end – of Medicaid, the government health insurance program for the poor.

Republican lawmakers face resistance from conservatives within their own ranks who say the bill, which would create a system of tax credits to coax people to buy private insurance on the open market, is not radical enough.

Democrats denounce it as a gift to the rich and say informed debate on the plan is impossible without knowing its cost.

“Republicans should not advance Trumpcare until Congress and the people we represent understand the full scope of its impact,” Senator Chris Van Hollen, a Democratic member of the Senate budget committee, said in a statement on Wednesday.

Democrats mounted four adjournment motions on the floor of the House on Wednesday, threatening to disrupt the two committee debates, in protest at the lack of analysis of the bill by the non-partisan Congressional Budget Office (CBO).

“This is decision-making without the facts, without the evidence … afraid of the facts,” the House Democratic leader, Nancy Pelosi, told reporters.

‘Constructive improvements’

Republicans said they had asked the CBO to “score” the bill – provide a preliminary estimate on its cost – and expect to have that analysis by the time it hits the House floor.

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“We’re all God’s children and we all want a CBO score,” said Republican representative Joe Barton from Texas.

Dan Holler, spokesman for Heritage Action, a powerful conservative action group, also called for more information. “Americans deserve full transparency, which includes the full budget score,” he said.

But some Republicans have cast doubt on the accuracy of CBO estimates, suggesting its initial assessment of the cost of Obamacare had proved far wide of the mark.

“If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” the White House spokesman, Sean Spicer, said on Wednesday.

Trump and Vice-President Mike Pence met with leaders of conservative groups who have concerns about the bill on Wednesday and a White House official later said they were “open to constructive improvements that maintain the core principles and get the bill over the goal”.

Once the two committees have approved their parts of the legislation, both will go to the House budget committee, which is expected to merge them into one bill that will then be voted on by the full House of Representatives.

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The House speaker, Paul Ryan, wants that vote to happen this month so the bill can move to the Senate for consideration.

The top US doctors’ organization and several hospital groups have come out strongly against the Republican plan, saying it would probably cause many patients to lose insurance and raise healthcare costs.

Andrey Ostrovsky, the chief medical officer of Medicaid, said on Twitter he was aligned with other experts in opposition to the bill, breaking with the health and human services secretary, Tom Price, who has called it “a work in progress”.