WASHINGTON -- In a stunning last-minute move on Friday, House Republicans and the Trump Administration withdrew their bill to replace the Affordable Care Act when it became clear that they had not garnered enough votes to pass the controversial measure.
The House was finishing up its final debate on the bill, known as the American Health Care Act, at around 3:45 p.m. when a recess was suddenly called. The bill was ultimately pulled by the Republican leadership.
“We were very close. It was a very, very tight margin,” said President Donald Trump in a press conference in the Oval office, flanked by Vice President Mike Pence and Health and Human Services Secretary Tom Price, MD.
Just after saying he was willing to work with Democrats on “a real healthcare bill,” Trump blamed Democrats for the bill’s defeat.
“I think the losers are [House Minority Leader] Nancy Pelosi and [Senate Minority Leader] Chuck Schumer because now they own Obamacare. They own it — 100% own it,” he said.
“Just remember this is not our bill. This is their bill,” he added and then repeated that he was “willing to work” with the Democrats on a better bill. “We’re totally open to it.”
He thanked House Speaker Paul Ryan (R-Wis.), Price and Pence for all of their work on the bill.
In a separate press conference, Ryan conceded, “doing big things is hard.”
“All of us, myself included, we will need time to reflect on how we got to this moment and what we could have done to do it better.”
“I’m really proud of the bill that we produced. It would make a dramatic improvement in our healthcare system and provide relief [for] people hurting under Obamacare. What’s probably most troubling is the worst is yet to come with Obamacare.”
Minority Leader Nancy Pelosi (D-Calif.) and several of her colleagues took the mic after Ryan saying that the phone lines of Congress had been flooded with callers urging members to “kill the bill.”
“That message became very clear to our colleagues on the Republican side of the aisle,” she said.
“What happened on the floor is a victory for the American people, for our seniors, for people with disabilities, for our children, for our veterans… I think the mistake really was [Republicans] were so focused on embarrassing the Affordable Care Act rather than trying to improve it.”
When told by a reporter that Trump had blamed her and Schumer for the bill’s demise, she said smiling, “We’ll take credit for that.”
The debate over the bill, prior to its being pulled, was vigorous. “Obamacare is a sinking ship and it’s taking a lot of good people down with it,” said Rep. Kevin Brady (R-Texas) on Friday morning.
The Republican bill would "unburden" Americans of the mandates and taxes imposed by the ACA that Americans "don't want and can't afford," said Brady during a Rules Committee hearing just prior to the floor vote.
Rep. Pete Sessions (R-Texas), the House Rules Committee chairman, further described the ACA as a "self-defeating spiral of rising costs and less options" and "a government-created monopoly."
He noted that 19.2. million Americans chose to pay the individual mandate penalty or take an exemption rather than enroll in Obamacare plans.
As proposed the AHCA eliminates the taxes and mandates that financed the ACA -- including the individual and employer mandate penalty -- allows insurers to charge older adults and young people less, and replaces subsidies based on need with flat tax credits based primarily on an age. Over time, the plan would repeal the Medicaid expansion and put a ceiling on the entitlement program by shifting its structure to a per capita block grant -- which would increase as enrollee size increases -- or traditional block grant. The bill would also freeze federal funding for Planned Parenthood.
On Thursday evening, Republicans released a manager's amendment, which eliminated the requirement that insurance plans include essential health benefits, such as maternity care, prescription drugs, mental health treatment and substance use disorder treatment.
The amendment also added $15 billion to the Patient and State Stability Fund, a $100 billion fund that lets states decide how to deploy funding for healthcare. The extra funds were earmarked for maternity care, newborn care, substance use disorder treatment and mental health treatment.
In the days and hours leading up to today's vote, Democrats played the shame card by repeatedly characterizing Republicans as heartless. For example, Rep. Jim McGovern (D-Mass.) called an new amendment cutting essential benefits "probably the most dangerous four pages on the planet ... so cartoonishly malicious ... I can picture someone twirling their mustache as they drafted it."
The minority party further argued that provisions to widen the "age bands" from 1:3 to 1:5 -- allowing insurers to charge older people 5 times as much as younger individuals -- were an "age tax" and that the bill would further deplete Medicare, reducing its solvency by three years.
Perhaps most pointedly, Democrats argued that the AHCA stole $880 billion from Medicaid, a program that serves children, the disabled, the elderly, and people with HIV, while drastically cutting taxes for the wealthy.
The House Rules Committee met for 2 hours early Friday morning and decided on a "closed rule session" for the vote with 4 hours for debate -- no amendments are allowed during closed rule sessions.
Democrats' request for an open rule was denied in a 9-3 vote by the committee.
The minority party was disappointed by the "flawed process" they said Republicans had followed, refusing to hold a public hearing, refusing to wait for the Congressional Budget Office to issue a report on the bill's latest version, and denying all Democratic amendments.
At the meeting, Rep. Alcee Hastings (D-Fla.) was asked to lower his voice, after shouting criticisms of the bill. He would not tone it down he said, because he was "mad as hell."
"I don't have to be nice to nobody when you're being nasty to poor people," he said
Rep. Greg Walden (R-Ore.) said he was "offended" by the suggestion that Republicans did not care about poor people, saying he personally helped to implement and expand Medicaid in his state.
With regard to the criticism of the essential health benefits amendment, Walden said the changes only affected people who used the premium tax credits to buy insurance, and it would not affect those on employer-based plans or on Medicare.
He also argued that Congress had voted unanimously to approve a similar bill for businesses with 51-100 employees, and that Democrats co-sponsored that legislation.
Overall, Walden said the Republican bill would give states more flexibility including allowing any state that chose to, to keep all of the essential benefits.
He invited Democrats to "do nothing or join us."
Four previous manager's amendments were released earlier in the week, which shortened the window for non-expansion states to expand Medicaid, allowed states to impose work requirements on Medicaid enrollees and gave states a choice between a per-capita cap financing model or a traditional block grant. The amendments also tightened the timeline for repealing most of the ACA's taxes from 2018 to 2017.