In summary

Today, House Republicans finally pulled back the curtain on their legislative effort to replace the Affordable Care Act.

We all knew this was coming.

House Republicans finally pulled back the curtain on their legislative effort to replace the Affordable Care Act. It’s a moment seven years in the making. Putting the kibosh on Obamacare was not only a central promise of both President Trump and the GOP’s 2016 campaign, it’s been a singular rallying point for the party since 2009. Now, at long last, the repeal and replace plan is ready for its close-up.

Or, as the President put it this morning:

“The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance,” House Speaker, Paul Ryan said in a statement.

Just how do House Republicans plan to do all of that? The incorrigibly wonkish can have a look at the full text of the legislation that emerged from two committees here and here, but these are the highlights:

  • Remove the ACA’s unpopular financial penalties on individuals and businesses who do not purchase health insurance—but replace them with a 30 percent premium surcharge applied to those who go without coverage for longer than two months
  • Phase out the Medicaid expansion (which currently covers over 3.5 million Californians) within three years
  • Replace the ACA’s insurance subsidies (which are higher for those who earn less) with individual tax credits (that rise with a person’s age)
  • Eliminate the ACA’s taxes on high-earners and costly medical devices
  • Prevents any health care service provider, including Planned Parenthood, from receiving federal funds through Medicaid if they perform abortions (a limit that would have particularly strong repercussions in California)

Though the House Republican bill takes a wrecking ball to the former President’s signature healthcare law, it does keep some of Obamacare’s most beloved goodies. It allows health insurance companies will still be barred from charging people more based on their pre-existing health conditions. Likewise, young Americans will still be able to stay on their parents’ healthcare plans until they turn 26.

How much all of this is going to cost (or save) the American taxpayer remains to be seen. According to the Washington Post, the Congressional Budget Office, the nonpartisan budgetary scorekeeper for all federal legislation, has not yet had time to estimate the bill’s price tag.

But the bill faces tough sledding ahead. In the House, a conservative uprising already is mounting against it, targeting among other features its use of tax credits—a.k.a. interference in the free market. One member of the Freedom Caucus dismissed it with a two-word tweet.

Earlier, four Republican senators—Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, and Lisa Murkowski of Alaska—sent a letter to Senate Majority Leader Mitch McConnell vowing to vote against any bill “that does not include stability for Medicaid expansion populations or flexibility for states.”  Whether McConnell can win the confidence of those four lawmakers, while also attracting the necessary eight votes from the Democratic caucus to break a near-certain filibuster and keep conservative firebrands in line, will require a formidable act of political tightrope walking.

No matter the ideological and tactical divisions that run through the GOP, Republicans have always been able to agree on one thing: Obamacare has to go. Whether they can agree on anything else will determine if and how millions of Californians get their health insurance in the years to come.

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Ben Christopher

Ben covers California politics and elections. Prior to that, he was a contributing writer for CalMatters reporting on the state's economy and budget. Based out of the San Francisco Bay Area, he has written...