Burlington County Times

Health Care Legislation Squeaks Through U.S. House

Tom MacArthur authored a key amendment credited with reviving the legislation after it nearly sank six weeks ago.

Burlington County Times — May 5, 2017

By David Levinsky, staff writer

The Republican health care overhaul took a big leap forward Thursday after the U.S House of Representatives narrowly voted to pass the controversial legislation to dismantle much of the Obama administration's Affordable Care Act.

The American Health Care Act squeaked through the House with a vote of 217 to 213, close to the bare minimum needed for passage.

None of the chamber's 193 Democrats voted in favor of the legislation, and a group of 20 Republicans were also among the dissenters, including New Jersey Reps. Frank LoBiondo, Chris Smith and Leonard Lance.

Rep. Tom MacArthur, whose 3rd Congressional District encompasses all but four Burlington County towns, authored a key amendment credited with reviving the legislation after it nearly sank six weeks ago due to opposition among the GOP ranks.

He voted "yes" as expected, and was joined by Rep. Rodney Frelinghuysen, the chair of the powerful House Appropriations Committee.

The vote followed several hours of floor debate and intense lobbying by Republican leaders and President Donald Trump, who had pushed for a vote on the legislation intended to fulfill one of his central campaign promises.

"No matter where I went people were suffering with the ravages of Obamacare," Trump said following the vote at a ceremony at the White House attended by MacArthur and other Republican officials.

"Make no mistake this is a repeal and replace of Obamacare," Trump said, adding that the former president's signature law was "essentially dead."

"What we have is something very, very incredibly well-crafted," he said.

House Speaker Paul Ryan said the vote was an important step toward keeping the GOP's promise to end the Affordable Care Act, which he said was collapsing because of rising premiums and disappearing consumer choices.

"What kind of protection is Obamacare if there are no (health care) plans to choose from," he said. "The truth is this law has failed and it is collapsing."

The House's approval moves the debate to the Senate, where the health care bill faces an uncertain future.

Democrat senators have promised to continue the opposition in the upper chamber, and some Republicans have also expressed misgivings, particularly about the bill's proposed changes to Medicaid and a recent change to allow states to seek waivers from some, but not all, of the Affordable Care Act's insurance requirements, including one that prevents insurers from pricing people with pre-existing conditions differently from healthy consumers.

The bill also does away with most of the ACA's taxes and penalties, including those against people who don't buy coverage. It also seeks to cap the federal-state Medicaid program for low earners, which the Obama statute had expanded, but keeps a popular provision requiring insurers to permit parents to keep their adult children on family policies until they turn 26.

And while it continues to provide tax credits to help people pay for insurance or medical bills, those credits are expected to be generally smaller than what many Americans received from the ACA.

In a short speech on the House floor, Rep. Donald Norcross, D-1st of Camden, said the biggest beneficiaries of the legislation would be "billionaires and undertakers."

"Trumpcare brings us higher costs, less coverage, guts the benefits, crushing age tax and steals from Medicare," Norcross said. "Let's put this bill in a coffin, not Americans. Let's kill and bury this bill."

House Minority Leader Nancy Pelosi warned that voters would punish Republican members if they succeed in the repeal effort.

"You vote for this bill, you'll have walked the plank from moderate to radical," Pelosi said on the House floor. "You will glow in the dark on this one."

Among the Republicans most exposed is MacArthur, who took a lead role in crafting the legislation after originally voting against his own party's budget resolution in January because it set the state for a health care rewrite without input from the minority party.

MacArthur, a former insurance executive who co-chairs the centrist Tuesday Group caucus, has said he took on the high-profile role because he didn't want to be an obstructionist and because he believes the health care system will collapse if the government doesn't intervene.

During negotiations, he pushed for increased federal funding to assist seniors, expectant mothers, and drug addicts on Medicaid. He also lobbied for the federal government to maintain its increased cost share for Medicaid until 2020, when federal funding will be capped.

The congressman's so-called "MacArthur amendment" was also credited with reviving the GOP legislation after the party's first effort crashed and burned as a result of opposition from both conservative and moderate Republican members.

His amendment helped bring the conservative Freedom Caucus into the fold, but angered some moderate members and made him a target for Democrats and liberal groups.

MacArthur was among the Republican lawmakers that stood behind Trump at the White House after the vote Thursday. During the ceremony he said he was proud of his involvement.

"I've said from the beginning of this long process this has to be about people not politics," he said, citing his own experience watching his father struggle to pay off medical bills after his mother died when he was just 4.

MacArthur's first daughter, Gracie, was also born with severe special needs and passed away at age 11. Without insurance, he said his family would have faced more than $1 million in medical expenses.

"I'm very thankful to have had a small part in moving a bill forward that will help every American be able to afford insurance," the congressman said.

Like Trump, MacArthur was critical of the current law, saying it attempted to expand insurance with increased government control and restrictions.

"I'm proud to stand with a president with a different answer, a president who trusts the states and ultimately trusts the American people," he said. "So this is a big day. It's a first step, but an important step to make sure we keep our promise and take care of the American people."

Opponents remained critical, saying the legislation would force millions to pay more or drop coverage.

"Make no mistake about it: MacArthur must face the music, look his constituents in the eye, and answer for the mess he created. There is no question that this bill will cause incredible pain for hard-working Americans, particularly those fighting to make ends meet, and this vote will haunt MacArthur through Election Day," said Ben Ray Lujan, chairman of the Democratic Congressional Campaign Committee.

Maura Collinsgru, a leader with the liberal group New Jersey Citizen Action, called the vote "morally reprehensible and cruel" and that MacArthur and Frelinghuysen's votes put millions at risk.

"They voted to abandon those with pre-existing conditions, slash Medicaid funding, and shift health care costs onto families and state budgets in order to give a $600 million tax break to the very wealthy and big insurers and drug companies," Collinsgru said. "In doing so, the GOP has created a fiscal and health emergency in this country that is both unnecessary and cruel. The American Health Care Act doesn't improve America's health care —- it destroys it."

MacArthur stressed that his amendment provides states with some measure of flexibility, but that insurers cannot refuse to cover people because of any pre-existing health conditions.

The amendment does allow states to apply to waive the ACA's "community rating" rule, which prevents insurers from charging higher premiums based on consumers' health status, but a condition of the waiver is that states must agree to create their own "high-risk pool," or participate in a federal risk pool to help sick people obtain affordable coverage. The legislation provides over $100 billion for those risk pools, including an additional $8 billion included in a late amendment approved Thursday. However, critics contend the funding will not be enough to spare people with pre-existing conditions from higher insurance costs or reduced coverage.

MacArthur and other proponents of the legislation have insisted those with pre-existing conditions, and other vulnerable populations, would still be protected and able to obtain reasonably-priced insurance coverage.

A report from the nonpartisan Congressional Budget Office predicted that 24 million Americans would lose coverage under the original House bill, but the office was unable to deliver an estimate on the impact of MacArthur's amendments prior to Thursday's vote.

Opponents also attacked language in the amendment that would guarantee that members of Congress and their staffers, who are required to obtain insurance from the same ACA marketplaces where individuals and small organizations shop, would continue to have access to plans with essential health benefits, even if they reside in states where those minimum benefits are waived.

In a separate vote Thursday afternoon, members of the House approved legislation to eliminate that provision.

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