The US House of Representatives has passed a healthcare bill, bringing President Trump’s pledge to repeal and replace Obamacare a stride closer.
The American Health Care Act (AHCA) passed with a vote to spare, after weeks of cajoling within the Republican party to muster enough support.
It has been opposed by Democrats and several groups representing patients, doctors and hospitals.
The bill next heads to the Senate, possibly in June.
Republicans needed 216 votes in the House and it passed with 217. No Democrats voted in favour.
Its safe passage through the US lower chamber provides the new president with his first legislative victory, three months into his term.
And it marks a remarkable turnaround after the bill was left for dead in March when Republicans were unable to agree on its provisions.
But the speed at which it has been resuscitated since then, with several amendments aimed at winning over Republican rebels, has provoked criticism.
It is not known how much the revised bill will cost, nor how many people will lose coverage, because the nonpartisan Congressional Budget Office (CBO) has not had time to assess it.
Before the latest revisions, the CBO estimated 14 million more Americans would lose insurance in 2018 alone.
Obamacare v Republican plan compared
Why is Obamacare suddenly so popular?
Patients tell their Obamacare stories
About 20 million Americans gained healthcare coverage under President Barack Obama’s 2010 Affordable Care Act, nicknamed Obamacare.
But Republicans viewed it as an overreach of the federal government and said patients had less choice and higher premiums.
What has been the reaction?
There were shouts of “Shame on you!” from protesters directed at congressmen and women as they left Capitol Hill.
Democratic Minority Leader Nancy Pelosi said: “Very sad. One of the biggest transfers of wealth in the history of our country. Their desire to give a tax break for the rich just trumped everything.”
But Republicans were jubilant.
The White House Chief of Staff Reince Priebus said it was a “big win for Americans” and would deliver expanded access and lower costs.
Before the vote, the Republican leadership in the House played “Eye of the Tiger”, the pre-fight song in Rocky, at a closed-door meeting.
What has changed from Obamacare?
- The new bill repeals the individual mandate requiring those who can afford it to have health insurance. Those have who been without coverage for more than two months would face a 30% surcharge for new policy.
- It repeals Obamacare’s requirement for companies with 50 or more staff to provide insurance coverage for employees.
- It keeps the popular Obamacare element allowing children and young people to stay covered on their parents’ policies up until age 26.
- It would enable insurers to charge at least five times as much to older customers.
- It enables states to opt out of the guarantee to provide healthcare to people with pre-existing conditions.
What happens next?
The bill goes to the Senate, probably next month, where it faces a precarious passage.
Although the chamber is Republican controlled, their majority is a thin one and several of their senators have said the bill will need amendments.
The influential Senator Bob Corker said the present bill had “zero” chance of clearing the upper chamber.
Any new revisions made by the Senate would need approval from the House.