In summary

In a vote likely to upend both political fortunes and insurance markets across California, the House passed the American Health Care Act today, a bill that would repeal and replace Obamacare. California, which invested heavily in participating in Obamacare, would be particularly affected if the bill becomes law.

In a vote likely to upend both political fortunes and insurance markets across California, the House today passed a bill that would repeal and replace Obamacare by a slim 217-213 margin.

Though 21 Republicans did not support the controversial American Health Care Act, California’s GOP delegation voted as a bloc along with the GOP leadership. That includes vulnerable members such as Darrell Issa, who won his seat by only 1,621 votes last fall and whose district in Orange County went easily for Hillary Clinton. “Obamacare is doing real harm to California’s families and struggling businesses, and constituents are counting on me to deliver real relief,” Issa said in a press release. “Now is the time to make it right.”

The bill now moves onto the Senate, where it is likely to see considerable revisions before being passed back to the House. But even if the Republicans long-awaited repeal-and-replace plan does not become law, Democrats across the state are already singling out those lawmakers who voted for this unpopular bill.

“Kevin McCarthy and California Republicans in Congress chose Donald Trump and Paul Ryan over the needs of their own constituents,” Assembly Speaker Anthony Rendon said in a statement, calling out the House Majority Leader from Bakersfield by name. “They should be ashamed and they must be held accountable.”

Prior to the vote, Gov. Brown tried unsuccessfully to shame the California Republican delegation into breaking from their party’s leadership. “Just look at the districts of Representatives David Valadao (R-Hanford), Jeff Denham (R-Turlock) and Steve Knight (R-Lancaster) where 111,000, 109,000 and 76,000 Californians, respectively, are at risk of losing coverage because of this legislation,” the governor’s office said in an email blast two hours before the bill passed.

Though the bill was passed before the Congressional Budget Office had time to estimate its overall impact, an analysis of an earlier version of the Republican health plan by the non-partisan scorekeeper projected that 24 million more people nationwide would lose or opt out of coverage within ten years.

California, which invested heavily in the future of the Affordable Care Act nicknamed Obamacare, would be particularly affected if the bill becomes law. The UC Berkeley Center for Labor Research and Education estimates that the state would be forced to either spend an additional $10 billion annually or drop more than 3 million people from Medi-Cal, the state’s Medicaid program for poorer people, starting in 2020. That’s because the new health plan begins phasing out federal payments for Obamacare’s expansion of Medicaid at the end of the decade.

Californians who have purchased insurance through the Covered California health exchange could also see abrupt changes in coverage. While the new plan offers tax credits to those who buy insurance on their own, these credits are generally less generous than those offered by the Affordable Care Act, and are structured to increase with a person’s age. Exchange subsidies under Obamacare are tied to a person’s income, increasing as income declines.

Plus, as the Los Angeles Times has reported, the bill would also prohibit tax credits from being used for plans that cover abortion, which the vast majority of policies in the state do. If the bill becomes law, we can expect yet another lawsuit between California and the federal government.

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Ben covers housing policy and previously covered California politics and elections. Prior to these roles at CalMatters, he was a contributing writer for CalMatters reporting on the state's economy and...