With 217 yeas and 213 nays, House Republicans successfully passed the American Health Care Act, marking the first step towards repealing and replacing the Affordable Care Act. The AHCA will now head to the Senate where it faces a faction of skeptical Republicans and staunchly opposed Democrats. Thursday’s vote is already being leveraged as an attack ad for 2018 House races, and Senate Republicans are already discussing how they will need to change the bill in order to move forward.
Republican Senators represent states with some of the highest uninsured rates
The most recent report by the US Census on Health Insurance Coverage reveals 9.1% or 29 million Americans are living without health insurance. The percentage of uninsured per state ranges as low as 2.8% in Massachusetts to as high as 17.1% in Texas. Of the 22 states with an uninsured rate higher than the national average (9.4%), 16 are represented by Republican Senators, 1 by Democratic Senators, and 5 are split between Republican and Democratic Senators.
Florida leads the nation in percentage of residents enrolled in the ACA marketplace
There are more than 12 million Americans currently enrolled in the ACA marketplace. On average, 3.5% of a state’s total population is enrolled, ranging as high as 8.5% in Florida with 1.7 million enrollees to as low as 1.2% in New York with 242,880 enrollees. Of the 22 states with an enrollment percent higher than the national average (3.5%), 11 are represented by Republican Senators, 6 by Democratic Senators, and 5 are split between Republican and Democratic Senators.
(data from Kaiser Foundation: includes 39 states that use the federal HealthCare.gov eligibility and enrollment platform and the 12 State-Based Marketplaces (SBMs)that use their own eligibility and enrollment platforms).
At least 15 Senate Republicans have expressed the AHCA is in need of changes
While House Republicans had 20 votes to spare on the AHCA, their colleagues in the Senate are working with a narrow margin of 2. In the 48 hours following Thursday’s vote, at least 15 Senate Republicans expressed their concerns with the House bill and/or reiterated there is more work that needs to be done.
- Sen. Collins (R-ME) outlined a list of concerns.
- Sen. Alexander (R-TN) plans on taking time to make sure the Senate “gets it right.”
- Sen. Portman (R-OH) doesn’t support the bill as constructed and is concerned it doesn’t do enough to protect “Ohio’s Medicaid expansion population.”
- Sen. Cruz (R-TX) says the Senate will “continue to improve the bill.”
- Sen. Graham (R-SC) says there needs to be a “careful review” of the AHCA.
- Sen. Wicker (R-MS) says the current bill is “not the end of the conversation by any means.”
- Sen. Heller (R-NV) is confident the Senate bill will be “different from the House bill.”
- Sen. Cassidy (R-LA) expects the Senate to “do something different.”
- Sen. Cornyn (R-TX) says “we’ll make it better.”
- Sen. Paul (R-KY) says “it’s going to take a little bit of work to get me to a yes vote.”
- Sen. Hoeven (R-ND) called the AHCA a “work in progress.”
- Sen. Thune (R-SD) says the Senate will “continue to work on the bill.”
- Sen. Tillis (R-NC) (R- says the Senate will ”make major changes”
- Sen. Grassley (R-IA) said he’d like “a solution that can attract bipartisanship.”
- Grassley also told reporters, “I think it should go straight to the floor.”
- Sen. Ernst (R-IA), in an interview, said she “needs to talk to various Iowans who have expressed difficulties”
Breakout the Whip Board
Whether it’s appealing to conservatives like Sen. Cruz and Sen. Paul or meeting the concerns of moderates like Sen. Portman and Sen. Collins, Leader McConnell will look to strike a balance in the Senate’s reboot of the AHCA. That said, whatever changes the chamber makes – however minor or drastic – will still have to endure another round of consideration by Speaker Ryan’s House.
