House Democrats on Monday approved a major expansion of Obamacare, underscoring the health care law’s central role in their campaign pitch and drawing sharp contrast with President Donald Trump’s efforts to eliminate the entire law.
Two Republicans — New Jersey's Jeff Van Drew, formerly a Democrat, and Brian Fitzpatrick of Pennsylvania — joined virtually every Democrat in supporting the bill, which would expand the law’s subsidies for private health insurance, encourage hold-out red states to expand Medicaid and reverse Trump administration policies seen as undermining the Affordable Care Act. The Democrats’ bill, which will likely be shunned by the Republican-controlled Senate, also contains pieces of the party’s, including a requirement for the government to negotiate prices.
Progressive lawmakers who have pushed sweeping “Medicare for All” legislation largely backed the more moderate health bill, which is aimed at shoring up Democrats’ support in swing districts that were pivotal to the party retaking control of the House in the 2018 midterms. The vote comes shortly after Trump’s Justice Department urged the Supreme Court to overturn Obamacare in a case later this fall, despite warnings from some Republicans that voters would punish the party in November.
“Make no mistake, a vote against this bill is to weaken Americans’ health and financial security during a pandemic,” House Speaker Nancy Pelosi said ahead of the vote.
The bill steers to the right of former Vice President Joe Biden’s health care platform, leaving out the presumptive Democratic nominee’s support for a government-run insurance alternative. The bill doesn’t include a major expansion of Medicare or Medicaid coverage, but it was changed to let Dreamers — undocumented immigrants who were brought to the U.S. as children — qualify for government-backed coverage. In a statement Monday, the Congressional Progressive Caucus complained that the bill does not go far enough but praised House leaders for adding coverage for Dreamers.
“We support the important improvements that this legislation makes to strengthen the Affordable Care Act, but until we address the profiteering, exploitation, and inefficiencies in our health care system that make healthcare unaffordable for tens of millions of Americans, our work is not done,” wrote co-chairs Pramila Jayapal (D-Wash.) and Mark Pocan (D-Wis.).
Just one Democrat voted against the bill.
Monday’s floor debate replayed much of the typical partisan sparring that’s plagued Congress’ health care efforts for the past decade — though it came amid new pressures from a pandemic that's expected to leave millions more without health insurance. And after Trump's filing to the Supreme Court in the Obamacare case, Republicans are facing renewed scrutiny over their lack of a replacement plan should the law be struck down.
Republicans blamed Obamacare for “skyrocketing” health premiums, with House Minority Whip Steve Scalise (R-La.) framing the Democrats’ legislation as an insurer bailout and “bribe” to nudge people into the law’s coverage.
"The bill provides $100 billion in bailouts for insurance companies at a time when insurers are not paying for elective procedures due to Covid," said Oregon Rep. Greg Walden, the top Republican on the House Energy and Commerce Committee. "We all want to make premiums more affordable, but all signs indicate insurers do not need a bailout right now."
Republicans also suggested the bill’s drug pricing provisions, which they’ve derided as government controls, would deter pharmaceutical companies from investing in Covid-19 vaccines.
Democrats believe their defense of Obamacare — in particular, the law’s insurance protections for people with preexisting conditions — will again boost their electoral prospects. The bill approved Monday also targets the Trump administration’s expansion of short-term health insurance plans, which often exclude coverage of preexisting conditions. The bill also fixes long-criticized bugs in Obamacare, like the “family glitch” that blocks insurance subsidies to low-income families who can’t get workplace coverage.
Health care continues to top the polling of voter concerns in swing districts, according to the party’s House campaign arm. Democrats are defending 42 swing districts and are trying to flip 45 additional seats currently held by Republicans.
The pandemic and the resulting economic crisis are testing Obamacare’s role as a safety net in a health system based around employer-sponsored health insurance. It’s still unclear how many people who have lost their jobs because of pandemic-related shutdowns have switched to Obamacare coverage.
Hundreds of thousands of Americans have purchased health plans on the ACA marketplaces in recent months, fewer than analysts originally projected. Millions more are likely to become eligible for Medicaid, particularly in states that expanded their programs under the health care law. Trump has faced criticism from Democrats, as well as some moderate Republicans, for doing little to promote the law's coverage options during the pandemic.