WASHINGTON (AP) — Determined House Republicans pushed ahead Thursday with divisive legislation to undo former President Barack Obama’s Affordable Care Act, holding marathon all-night voting sessions, despite Democratic protest and opposition from doctors and consumer groups.


The GOP scored a pre-dawn triumph in the Ways and Means Committee after nearly 18 hours of debate along party lines, as the panel approved legislation to reshape the way millions of Americans pay for medical care, including abolishing the tax penalty the ACA imposes on those who don’t purchase insurance.


Republicans claimed progress as the Ways and Means Committee voted its approval on the legislation.


“We voted repeatedly to end Obamacare’s crushing taxes and mandates and ensure patients have more power over their own health care,” said panel chairman Kevin Brady of Texas.


But the panel’s top Democrat, Richard Neal of Massachusetts, protested that the GOP bill “would drastically increase costs and lower coverage and quality care.”


Vice President Mike Pence joins the Senate GOP leadership as Republicans introduce their plan to repeal and replace the Affordable Care Act. (AP Photo/J. Scott Applewhite)

The GOP’s effort underscored its leaders’ desire to keep the momentum on their drive to undo the ACA after seven years of promises to voters. President Donald Trump is telling lawmakers he’s all-in on the endeavor, and he assigned Vice President Mike Pence to travel on Saturday to Louisville, Kentucky, home state of one of the most prominent GOP critics, Sen. Rand Paul.


The White House and Republican leaders face outside critics and a GOP divided over the party’s high-stakes overhaul campaign, including conservatives like Paul who say the party should simply pursue a repeal bill.


GOP Sen. Tom Cotton of Arkansas weighed in over Twitter Thursday against the House GOP effort, which leaders hope to send to the Senate in time for final passage by early April.


“House health care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast,” Cotton wrote, contending that Republicans are making the same mistake Democrats did when they passed the ACA in the first place — by moving forward with little time for review and without official cost estimates from the Congressional Budget Office.

Lining up against the bill

The American Medical Association, the American Hospital Association and AARP, the nation’s largest advocacy group for older people, were arrayed against the measure. Seven years ago their backing was instrumental in enacting the ACA.


A national association of hospitals — major employers in many districts — wrote lawmakers complaining about the bill’s cuts in Medicaid and other programs and said more uninsured Americans seem likely to result, adding, “We ask Congress to protect our patients.” Groups representing public, children’s, Catholic and other hospitals also expressed opposition.


America’s Health Insurance Plans, representing insurers, praised the legislation’s elimination of health industry taxes, but warned that proposed Medicaid changes “could result in unnecessary disruptions in the coverage and care beneficiaries depend on.”


The legislation would remove the requirement that everyone buy insurance by repealing the tax fines imposed on those who don’t, a penalty aimed at pressing healthy people to purchase policies. The bill would replace income-based subsidies the ACA provided with tax credits based more on age, and insurers would charge higher premiums for customers who drop coverage for more than two months.


Conservative lawmakers and allied outside groups claimed the bill was took too timid a whack the ACA. Numerous GOP centrists and governors were antagonistic, worried their states could lose Medicaid payments and face higher costs for hospitals having to treat growing numbers of uninsured people.


Outnumbered Democrats used the panels’ meetings for political messaging, futilely offering amendments aimed at preventing the bill from raising deficits, kicking people off coverage or boosting consumers’ out-of-pocket costs.

The White House gets involved

There were signs of growing White House engagement, and perhaps progress. Trump met late Wednesday with leaders of six conservative groups that have opposed the GOP legislation, and several voiced optimism afterward.


“I’m encouraged that the president indicated they’re pushing to make changes in the bill,” said David McIntosh, head of the Club for Growth, though he provided no specifics.


The extra billions Washington has sent states under the ACA to expand the federal-state Medicaid program is to start being curtailed in 2020, and spending on the entire program would be capped at per-patient limits.


The congressional measure would also repeal taxes the ACA imposed on segments of the medical industry to help pay for the ACA statute’s expanded coverage. Democrats said the Republicans would yank health coverage from many of the 20 million Americans who gained it under the ACA, and drive up costs for others because the GOP tax breaks would be skimpier than existing subsidies.

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