Local politicians' reactions
"I congratulate the House on passage of its bill. The Senate will now finish work on our bill, but will take the time to get it right. My own goals for a Senate bill include: 1) rescuing the thousands of Tennesseans and millions of Americans who will be trapped in collapsing Affordable Care Act exchanges with few or even zero options for health insurance in 2018 unless Congress acts; 2) lowering premium costs, which have increased under the ACA law; 3) gradually giving states more flexibility on the Medicaid program, but doing this in a way that does not pull the rug out from under people who rely on Medicaid; and 4) making sure those with pre-existing conditions have access to insurance." - Sen. Lamar Alexander, R-Tenn. "For far too long Obamacare has hurt American families by not keeping its promises of lowering costs, while increasing patient choice. That is why I voted in favor of the American Healthcare Act. This bill will reduce premiums, stabilize the market, and ensure patient choice. While there is more work ahead to rebuild our broken healthcare system, passing this legislation was a critical first step. I look forward to collaborating with my Senate colleagues to give the American people the healthcare they deserve."- Rep. Chuck Fleischmann, R-Tenn. "We're helping President Trump to fulfill his promise to the American people, suffering under Obamacare. In Tennessee, my constituents have it especially bad. Health care costs are skyrocketing, and many have no choice of coverage at all. Allowing Obamacare to stand is not an option, and I'm glad we were able to strike the worst of its regulations from the first version of this legislation. Now it's time for the Senate to do its work and help us deliver the President a bill to sign." - Rep. Scott DesJarlais, R-Tenn. "I voted against Trumpcare today because it is harmful to the average American and will result in people dying because they don't have access to quality, affordable health insurance. Trumpcare is a wealth care bill, not a health care bill. It puts politics over improving our health care system. This bill is an excuse to give the wealthiest Americans huge tax breaks and proceed towards more tax cuts for the rich in the future. It should be called the 'Ebenezer Scrooge Act' because it enriches the wealthiest individuals and harms the less fortunate both fiscally and physically." - Rep. Steve Cohen, D-Tenn. "The first bill I introduced after I was elected to Congress in 2010 was legislation to defund Obamacare. Over the last seven years, we kept fighting, we never gave up, and now we're finally passing a bill to repeal and replace Obamacare that will hit the desk of a president who will sign it. This is Phase 1 of the President Trump's three phase healthcare plan. Taken together, the president's plan will reduce health insurance premiums, increase access to care and put patients first."- Rep. Tom Graves, R-Ga. "While today's health care legislation falls short of the full ObamaCare repeal that I called for and believe in, a partial repeal does more good for working American families than no repeal at all. I am proud that diligent House Freedom Caucus work has forced amendments that converted substantial increases in health insurance premiums into substantial cuts in health insurance costs for tens of millions of Americans. The AHCA repeals roughly twenty ObamaCare taxes that have hurt job creators and cut take-home pay. The AHCA repeals the ObamaCare individual and employer mandate penalties that undermine freedom of choice and liberty." - Rep. Mo Brooks, Ala.
WASHINGTON - Republicans are claiming a triumph by pushing their legislative centerpiece scuttling much of President Barack Obama's health care law through the House. It was a perilous journey, and its Senate pathway will be at least as bumpy with little doubt the measure will change, assuming it survives.
Thursday's 217-213 House passage - with 20 GOP defections - was preceded by several near-death experiences for the legislation, even though repealing Obama's statute helped guide Donald Trump's presidential run and multitudes of GOP congressional campaigns.
And that was in a chamber Republicans control 238-193. Had just two additional Republicans voted "no," the measure would have lost because bills need majorities to pass. Now, Republicans must try maneuvering the measure through a Senate terrain that is different politically and procedurally from the House.
"We must manage expectations and remain focused on the art of the doable as we move forward," said Senate Finance Committee Chairman Orrin Hatch, R-Utah, among several cautionary statements issued by Senate Republicans after the House vote.
The House bill would end the Obama law's fines on people who don't purchase policies and erase its taxes on health industry businesses and higher-earning people. It would dilute Obama's consumer-friendly insurance coverage requirements, like letting states permit insurers to charge higher premiums for customers with pre-existing medical conditions.
The measure would replace Obama's federal subsidies for lower-income insurance buyers with tax credits geared to consumers' ages. And it would cut Medicaid, the health insurance program for the poor and disabled, including ending extra federal payments 31 states are accepting to expand Medicaid to cover more people.
The notoriously understated Senate Majority Leader Mitch McConnell, R-Ky., lauded the House bill as "an important step" to erasing Obama's law but left the door open to changes.
"Congress will continue to act on legislation to provide more choices and freedom in health care decisions," McConnell said.
The House bill was written by Republicans representing districts often drawn to incorporate strong majorities of GOP voters. Senators represent entire states, and many tend to reflect more pragmatic views than their House colleagues.
Several come from northeastern and Midwestern states with large numbers of low-income people receiving Medicaid. Many of the 31 states that accepted Obama's expansion of that program are led by GOP governors, and senators have no interest in cutting their states' funds and taking coverage away from voters.
Republican senators also represent states ravaged by deaths caused by opioid abuse. The House measure would let states escape Obama's requirement that insurers cover anti-drug services.
"I've already made clear that I don't support the House bill as currently constructed," said Sen. Rob Portman, R-Ohio. He cited its Medicaid cuts, including for treating people with drug problems, and said he'd make sure that "those who are impacted by this epidemic can continue to receive treatment."
In March, Portman joined three other GOP senators in opposing Medicaid cuts in an early version of the House legislation. In a letter to McConnell, they wrote that the measure "does not provide stability and certainty for individuals and families" who use the program.
Sen. Susan Collins, R-Maine, said the House bill poses "more questions than answers about its consequences." She said there should be "no barrier for coverage" for people with pre-existing medical conditions and that the House's tax credits "do not adequately take into account income levels" or regional differences in health costs.
Collins and Sen. Lisa Murkowski, R-Alaska, have opposed cutting federal money for Planned Parenthood. The House bill blocks federal payments for a year to the organization, which provides abortions but doesn't use federal funds for them by law.
Other senators are also seeking changes. No. 3 Senate GOP leader John Thune of South Dakota is working on a plan to skew the bill's tax subsidies more toward lower-income people.
States that did not expand Medicaid under Obama's law are looking for additional funding for their programs. Sen. Lindsey Graham, R-S.C., whose state did not enlarge Medicaid, said he would not back a health care bill "that rewards people for taking Medicaid expansion at the expense of those who did not."
Then there are senators like Ted Cruz of Texas and Rand Paul of Kentucky, former presidential candidates who seldom back away from fights and have already signaled they're looking for changes.
The Republican edge in the Senate is just 52-48. Using special rules, the Senate could pass its version of the bill with just 50 votes and rely on Vice President Mike Pence to break a tie. But that means they can lose just two GOP senators assuming Democrats uniformly oppose scrapping Obama's signature domestic achievement.
Those same bylaws bar provisions that aren't chiefly aimed at federal spending or revenue, meaning some House language dealing strictly with policy changes could fall out.
"The Senate will now finish work on our bill, but will take the time to get it right," said Sen. Lamar Alexander, R-Tenn., who chairs the Senate health committee.