The American Health Care Act (AHCA) passed in the House of Representatives, 217-213, on May 4 after a dramatic late push that changed key votes.
 
The Affordable Care Act (ACA) replacement had previously gone down to defeat in the Republicans’ first attempt to push it through the House and seemed slated to fail again in a second attempt after the addition of an amendment that addressed only a few of the coverage shortfalls that had previously scared off support and doomed the bill.
 
But on May 3 two Republican holdouts, Fred Upton, R-Mich., and Billy Long, R-Mo., switched to “Yes” votes after Upton introduced his own amendment adding $8 billion to the fund for state risk pools. Upton and other Republicans claimed this would provide protection to beneficiaries with pre-existing conditions, an issue that had cost the bill support previously.
 
This was decisive because “[Upton] carries a lot of weight with [GOP] moderates” who had been hanging back from the bill, says John F. Williams, former press secretary for the House Committee on Government Reform and Oversight and former member of the Republican Senior Communications Staff Committee, now with law firm Hall, Render, Killian, Heath & Lyman in Washington, D.C.
 
Democrats contended that increasing funds for the risk pools was no substitute for a clear prohibition against refusing coverage based on pre-existing conditions, which the AHCA lacks. Senate minority leader Chuck Schumer, D-N.Y., compared it to “administering cough medicine to someone with stage 4 cancer.”
 
Multiple industry groups, including the AMA, opposed the amended bill.
 
“Those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” the AMA says in a statement.
 
No Democrats voted for the bill. Twenty Republicans voted against it. A Senate vote of the bill had not been scheduled as of press time.
 
U.S. budget has low impact for CMS 
 
A $1.1 trillion budget agreement proposed by the House — not yet reconciled with the Senate nor signed by President Trump as of press time — would give CMS a fiscal year 2017 budget of $354.2 billion, a raise of about $19.3 billion, or 5.4%, from 2016.
 
There are few meaningful adjustments at the individual budget line level for CMS.