American Health Care Act of 2017

American Health Care Act of 2017
Shorttitle	American Health Care Act of 2017
Colloquialacronym	AHCA
Legislature	115th United States Congress
Introducedin	House of Representatives
Introducedby	Greg Walden
Committees	House Energy and Commerce, House Ways and Means
Passedbody1	House
Passeddate1	May 4, 2017
Passedvote1	217–213
Relatedlegislation	Patient Protection and Affordable Care Act, Health Care and Education Reconciliation Act of 2010

American Health Care Act of 2017 was a legislative bill introduced in the 115th United States Congress by Republican representatives, aiming to partially repeal and replace the Patient Protection and Affordable Care Act (ACA). Championed by Speaker Paul Ryan and the Trump administration, it represented the first major congressional effort to fulfill a longstanding Republican campaign promise following the 2016 election of Donald Trump. The bill underwent significant revisions to secure support from both moderate and conservative factions within the House Freedom Caucus before a narrow passage in the United States House of Representatives.

Background and legislative history

The push for the American Health Care Act emerged directly from the Republican Party's repeated legislative and judicial challenges to the Patient Protection and Affordable Care Act, often called Obamacare, since its passage in 2010. Following victories in the 2014 and 2016 elections, Republicans gained control of both chambers of Congress and the White House, creating a unified government. The effort was framed using the budget reconciliation process to avoid a filibuster in the United States Senate. Drafting was led by key committee chairs Greg Walden of the Energy and Commerce Committee and Kevin Brady of the Ways and Means Committee, with direct involvement from the White House Office of Legislative Affairs.

Major provisions

The bill sought to eliminate the ACA's individual mandate penalty and roll back associated taxes, including the Medicare surtax on high-income earners and taxes on medical device manufacturers. It proposed transforming the ACA's premium tax credit system into age-based tax credits and significantly restructuring federal funding for Medicaid by instituting a per capita cap or block grant system. The legislation would have repealed the ACA's cost-sharing reduction subsidies and allowed states to waive essential health benefits requirements and certain community rating protections, potentially affecting coverage for pre-existing conditions. It also included provisions to defund Planned Parenthood for one year.

Projected effects and analysis

The nonpartisan Congressional Budget Office (CBO) scored multiple versions of the bill, estimating the version passed by the House would increase the number of uninsured people by 23 million by 2026 compared to the ACA. The CBO also projected it would reduce the federal deficit by $119 billion over a decade but would lead to higher premiums for older and sicker individuals, particularly in states seeking waivers. Analyses from the Kaiser Family Foundation and the American Medical Association warned of potential coverage losses and instability in the individual insurance market, while supporters argued it would lower premiums for younger, healthier people and reduce federal regulatory burdens.

Legislative process and votes

The bill, designated H.R. 1628, was introduced on March 6, 2017, and quickly advanced through the House Energy and Commerce and Ways and Means Committees on party-line votes. An initial planned vote on the House floor was canceled in March due to insufficient support from the House Freedom Caucus and moderate members of the Tuesday Group. After negotiations involving the White House and Vice President Mike Pence, an amended version incorporating the MacArthur Amendment to allow state waivers secured enough votes. On May 4, 2017, the House passed the bill by a vote of 217–213, with 20 Republicans joining all Democrats in opposition.

Public and political response

The bill faced immediate and intense opposition from Democratic leaders like Nancy Pelosi and Chuck Schumer, as well as major medical and advocacy groups including the American Hospital Association and AARP. Protests occurred at congressional town halls across the country, and public opinion polls from Gallup and Pew Research Center consistently showed the bill to be unpopular. Within the Republican Party, the bill exposed fissures between conservative members of the House Freedom Caucus, who sought a full repeal, and more moderate members concerned about coverage losses and protections for pre-existing conditions. President Donald Trump celebrated the House passage in a Rose Garden ceremony at the White House.

Subsequent developments and legacy

Following passage in the House, the bill moved to the Senate, where the Republican majority, led by Mitch McConnell, deemed it untenable and began drafting their own legislation, the Better Care Reconciliation Act of 2017. The Senate's efforts ultimately failed in July 2017 after dramatic votes, including John McCain's decisive "thumbs-down" vote against a "skinny repeal" bill. The failure of the American Health Care Act and subsequent Senate bills left the ACA largely intact, though the Tax Cuts and Jobs Act of 2017 later repealed the individual mandate penalty. The legislative battle significantly impacted the 2018 midterm elections and set the stage for continued healthcare policy debates.

Category:2017 in American law Category:Health care in the United States Category:115th United States Congress