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The House of Representatives will vote on the American Health Care Act on Friday after an ultimatum to GOP lawmakers from President Trump. The House will go through four hours of debate on the bill. The final vote is expected soon after 4 p.m. ET. Only 22 Republicans can vote against the bill, but conservatives and moderates have come out against the AHCA. House Speaker Paul Ryan went to the White House to tell Trump he did not have the votes to pass the bill.
Friday is judgment day for the Republican Party’s opening bid to repeal and replace the Affordable Care Act, aka Obamacare.
After President Trump issued an ultimatum to Republicans on Thursday, the House began debating their legislation to repeal and replace Obamacare in the early hours of Friday morning.
The GOP leadership originally wanted to vote on the AHCA on Thursday, the seventh anniversary of the Affordable Care Act being signed into law. But leaders were unable to garner enough support for the bill and delayed the vote.
Office of Management and Budget Director Mick Mulvaney told a group of Republicans on Thursday night that they had to pass the AHCA on Friday – or Trump would move on from the bill and leave them stuck with Obamacare.
It put the onus on House GOP members. But given reservations from conservatives who do not think the bill goes far enough in its repeal of Obamacare and moderates who think the AHCA does not solve the problems of the healthcare system, the outcome of the vote is unclear.
House Speaker Paul Ryan went to the White House early Friday afternoon to brief Trump on the latest with the healthcare bill.
Reports indicated that Ryan told Trump that the GOP did not have enough votes to pass the bill. Despite the possibility that the GOP leadership could pull the bill and not have a vote, White House press secretary Sean Spicer told reporters at the daily press briefing that the vote was still scheduled for 3:30 p.m. ET.
Republican Rep. Louis Gohmert of Texas, who has been against the AHCA, tweeted that the bill did not have enough votes to pass and the vote could be delayed again.
“Good chance vote may be postponed,” Gohmert tweeted at 12:45 p.m. ET. “Leadership hiding likely more NON-Freedom Caucus No votes than Freedom Caucus No votes.”
The final offer
The American Health Care Act has changed considerably from its introduction on March 6.
In an effort to win over conservative members of the House GOP, the final bill will have a provision that would do away with the ACA’s “essential health benefits.” Those mandate that insurance companies cover certain types of care, such as prenatal care and preventive screenings such as mammograms.
The effects of these changes on things like the federal budget, health-insurance marketplace, and premiums are unknown, as the nonpartisan Congressional Budget Office has not had the time to score the updated bill. Some health-policy experts have said that the recent changes would likely cause a further deterioration of the individual health-insurance marketplace.
Despite attacking Democrats for the process in which they passed the ACA, Republicans would likely introduce the completed bill and take a final vote the same day. The vote would come less than three weeks after the introduction of the original AHCA. By contrast, the ACA was introduced five months before the House passed the bill in 2009.
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Losing support on both sides
The problem facing the AHCA on its crucial day is that even with the concessions, both moderates and conservative Republicans have taken issue with parts of the bill.
Conservative members of the House Freedom Caucus have said the bill did not go far enough in its repeal of Obamacare’s insurance regulations, even with the end of essential health benefits.
Freedom Caucus members want to see more of the so-called Title 1 regulations stripped, including provisions preventing insurance companies from denying coverage based on preexisting conditions and the ability for a child to stay on their parents’ health insurance until they are 26 years old. Both provisions have proved very popular with the American public.
The White House has balked at the demands, which has left Freedom Caucus members at large decidedly against the bill. According to reports, the Freedom Caucus held a meeting Friday morning and many of its roughly 35-member caucus were still strongly in the “no” camp.
At the same time conservatives are asking for more parts of the ACA to be repealed, moderates have been coming out against the bill for going too far in disrupting the healthcare system.
One high-profile moderate defector was Rep. Rodney Frelinghuysen of New Jersey. Frelinghuysen, the chair of the House Appropriations Committee, wrote in a Facebook post that the changes to the essential health benefits persuaded him to vote “no” on the bill.
“Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey,” Frelinghuysen said. “In addition to the loss of Medicaid coverage for so many people in my Medicaid-dependent state, the denial of essential health benefits in the individual market raise serious coverage and cost issues.”
Other moderates have said the changes to Medicaid would prevent them for voting for the bill.
As of 11:30 a.m., The New York Times estimated that 32 Republicans have come out against the bill and 10 others are leaning against it.
What to expect
The White House and GOP leadership will continue to wrangle votes as debate on the AHCA continues for four hours, according to the rules set by the House Rules Committee on Friday morning. The Democrats and Republicans will have two hours apiece to debate the bill, in which House lawmakers can make their closing arguments about the proposal.
After the debate, the plan is for a final vote to be taken. A Republican source close to the process told Business Insider that the GOP leadership expected a final vote on the bill just after 4 p.m. ET.