Obamacare replacement under congressional scrutiny, as Democrats delay for budget verdict while Republican senator predicts legislation will not pass as is

The Republicans’ replacement for Barack Obama’s Affordable Care Act faced skepticism from both the left and the right on Wednesday, as Democrats deployed delaying tactics to try to slow the bill and another GOP senator expressed pessimism about its chances of passing without changes.

Ted Cruz, the Texas senator who clashed with Donald Trump last year when both were running for the Republican nomination but eventually endorsed him, told reporters: “As drafted, I do not believe this bill would pass the United States Senate.” Cruz and his wife, Heidi, were scheduled to have dinner with Trump at the White House on Wednesday night.

Many conservatives view the legislation as “Obamacare lite” and a continuation of what they see as the big government excesses of the last president’s Affordable Care Act.

How Republican opposition to healthcare reform is taking shape Read more

On Wednesday, the American Health Care Act also came under fire from the left, as congressional hearings on the bill began.

Democrats, who do not have the votes to stop the repeal without Republicans, are using stalling tactics to slow the debate over the bill – perhaps even delay a committee vote until the Congressional Budget Office (CBO) can deliver its verdict on the costs of the scheme and its effects on insurance coverage.

Representative Ben Luján, a Democrat from New Mexico, said they would push to extend the hearing for “as long as it takes to ask important questions”. He would not say if Democrats were aiming to slow-walk the hearing until a score was announced by the CBO, a non-partisan legislative office that assesses the impact and cost of the legislation.



“We’ll see what our Republican colleagues determine to do. Don’t forget that in 2010 Chairman Walden led an effort … that demanded that the bill be posted for 72 hours before it was voted on,” he said. “The Republicans have given us 40 hours before this bill is up today.”

Before entering the hearing room to resume debate, Luján took a selfie with an artist wearing a shirt that said “CBO score??”

Richard Neal of Massachusetts, the ranking Democrat on the House ways and means committee, insisted that “to consider a bill of this magnitude without a CBO score is not only puzzling and disconcerting but irresponsible”. Sander Levin of Michigan described holding hearings on the bill before the score was released publicly as “a sneak attack” on the American public. The CBO verdict, the best estimate of winners and losers from the proposed legislation, is expected on Monday.

Meanwhile, amid raucous scenes in the House energy and commerce committee, which is also examining the legislation, Democrats insisted on the 123-page bill being read in full, a process that took an hour and ended with a round of applause.

“For seven years Republicans claimed to have a better way,” Frank Pallone, a Democrat from New Jersey, said in his opening remarks to the committee. “But it turns out that is nothing more than an empty slogan. After seven years of sabotaging and obstructing the ACA, Republicans have finally presented a repeal bill – less than two days ago – and it is incredibly destructive to the little guy.”

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

He said the Democrats would table “about 100” amendments.

Republicans focused their fire on the current healthcare law, with some expressing optimism that any shortcomings in the replacement proposal would be ironed out during the current committee process.

“Let’s first be clear why we’re here: Obamacare has failed the American people,” said Steve Scalise, the House majority whip.

In the ways and means committee, which made slightly more progress in the first few hours of the hearing, debate became testy over a provision allowing health insurance companies to write off as a business expense the entire amount of their executives’ salaries on their taxes, and not just the first $500,000, as is the case now under the Affordable Care Act.

No Republicans spoke up as Democrats railed against the provision, which would cost taxpayers an estimated $400m over the next 10 years. Lloyd Doggett of Texas deplored the fact that “no member of the insurance industry had the courage to come” to testify in favor of the provision.

Democrats on the committee spent much of the afternoon alternating between railing against Trump’s foreign ties and offering trolling amendments to place Republicans in awkward positions. Representative Joe Crowley of New York offered an amendment that required every member to state if they had read the bill in its entirety. The same amendment had previously been proposed word for word by Kevin Brady, the current Republican chair of the ways and means committee, during the debate on Obamacare. The amendment failed on a party line vote.

Under House procedure, the energy and commerce committee deals with elements of the AHCA relating to Medicaid while the ways and means committee discusses the legislation’s tax aspects.

The bill would eliminate the individual mandate, which required Americans to have health insurance or pay a fine; cut the number of people insured under Medicaid; and allow insurance companies to charge the elderly up to five times more than the young. It would require insurers to cover so-called pre-existing conditions, but would allow them to add a 30% surcharge to premiums if people go without insurance for too long.

Non-partisan outside groups such as the AARP senior citizens’ lobby group and the American Medical Association have come out against the legislation.

Donald Trump has called the bill “wonderful” but said it was “out for review and negotiation”, and officials, such as the health secretary, Tom Price, have called it “a work in progress”.

Trump met late on Wednesday at the White House with leaders of influential conservative groups that came out early against the bill, including the Heritage Foundation, Club for Growth and Americans for Prosperity. Attendees ignored questions shouted by the press as they exited the White House.

“I was encouraged because he was listening,” the Club for Growth president, David McIntosh, later said on Fox News, referring to the president.

But Republican leaders have stood firm in defending it, with the House speaker, Paul Ryan, the most senior Republican in Congress, insisting to reporters on Wednesday morning: “This is what good, conservative healthcare reform looks like.”