By the slimmest of margins, the House of Representatives passed the Republican plan to replace Obamacare Thursday afternoon, sending the measure to a skeptical Senate where it will be almost certain to take on a completely different form. Republicans passed the bill by a vote of 217 to 213, just one vote over the 216 needed.
Six weeks ago, House Republicans failed spectacularly to pass their regressive health care plan, the GOP's crusade appeared to be over. House Speaker Paul Ryan (R-Wis.) declared, "Obamacare is the law of the land.... We're going to be living with Obamacare for the foreseeable future."A lot can change in six weeks.
In all, health-care proponents needed 22 Republicans to break ranks and oppose the bill. In end, 20 did.The moral depravity of the legislation should be obvious. The American Health Care Act is projected to take health care coverage from tens of millions of Americans, gut protections for those with pre-existing conditions, slash Medicaid and insurance subsidies, all while handing the rich a massive tax cut.The process through which the legislation passed is equally obscene. Republicans didn't bother to wait for a score from the Congressional Budget Office, so in an ostentatious display of willful ignorance, GOP lawmakers voted without having any idea how much their bill cost or its expected impact. Republicans didn't even have a chance to read the bill they voted to advance.The question, however, is what happens now.If you or your family are poised to be severely punished by the Republicans' legislation, don't panic just yet. Donald Trump, who understands this bill about as well as a garden slug would, is eager to sign the GOP measure, but there's one big chamber in between today's vote and the president's signature.In the Republican-led Senate, GOP lawmakers have already laid the groundwork to pass their health care bill through the reconciliation process with 51 votes. (This is in stark contrast to the Democratic effort in the Obama era, who passed the bulk of the Affordable Care Act with 60 votes.) There are 52 Republicans in the Senate -- and a Republican vice president who can break tie votes -- so health care supporters have reason to be concerned.That said, the bill passed by the House today will face immediate skepticism in the upper chamber, even from Senate Republicans. Indeed, by most estimates, the AHCA has no realistic chance of passing -- in its current form, as-is -- in the Senate.It creates a dynamic in which one of a few things will happen:1. The Senate passes the House bill and the country is screwed. The odds are clearly against this.2 The Senate votes on the House bill, kills it, and everyone moves on. Don't dismiss this as a possibility. In March, it sounded as if it's what Senate Majority Leader Mitch McConnell (R-Ky.) wanted to do.3. The Senate passes its own version, and sends it back to the House. This seems plausible, too, although the only way to get many House Republicans on board with today's version was to make it almost cartoonishly malevolent. A Senate GOP version that can pass would probably be less ridiculous, which means it'd face long odds in the House.4. The Senate passes its version, and the chambers head to a conference committee to work out the differences. At that point, it's anybody's guess what conferees would agree to and/or whether such a bill could pass either chamber.Republicans are celebrating today -- as are, oddly enough, many Democrats who believe the GOP just committed political suicide -- but the process is just now getting started.Buckle up.