After seven years of opposition to the Affordable Care Act (ACA), President Donald Trump and Republican leaders in Congress were forced to pull their repeal bill from the House floor on Friday, March 24 in a major victory for healthcare advocates. Without enough votes to pass the repeal legislation in the House, Mr. Trump and Speaker of the House Paul Ryan (R-WI) conceded that, for the foreseeable future, “Obamacare is the law of the land” and that Congress will now turn its attention to another top priority for the president: tax reform.
The defeat of the H.R. 1628, “The American Health Care Act of 2017,” came after months of intense grassroots advocacy. At town hall meetings in their Congressional districts across the nation, Republican law makers faced strong opposition to ACA repeal efforts. New allies, including NLIHC, joined the effort to protect healthcare coverage for the lowest income people.
Without the support of a single Democrat, Mr. Trump needed nearly all House Republicans to vote to support the bill; instead, the repeal bill exposed deep divisions within the Republican party. According to Mr. Trump, the bill was defeated by 10 to 15 Republicans, including more conservative members of the Freedom Caucus, who opposed the bill because it did not go far enough in repealing the ACA, and more moderate Republicans, who were concerned that the bill would harm states that had expanded access to Medicaid and would result in steep cost increases.
H.R. 1628 would have eliminated important aspects of the ACA – including coverage of prescription drugs, maternity care, and mental health services. The bill would have also rolled back Medicaid expansion and allowed states to impose work requirements on Medicaid recipients. These changes would have been devastating for low income households, especially homeless individuals receiving supportive services through Medicaid.
The failure of Mr. Trump and Mr. Ryan to repeal the ACA will make it more difficult to enact comprehensive tax reform. Repealing the ACA would have generated cost savings that could have been used to help Republicans achieve their goal of lowering individual and corporate tax rates without increasing the deficit. Without ACA savings—and given the deep divide among Republicans over a border adjustment tax, which would have raised revenues—Republicans may not be able to substantially reform the tax code.