WASHINGTON DC – All nine Republicans in Michigan’s U.S. House delegation voted for the federal health care bill that would repeal many of the provisions of the Patient Protection and Affordable Care Act like the penalty tax for those without coverage, reduce taxes on high-income earners and dramatically alter Medicaid coverage for the poor with all five Democrats opposing it.

With the bill passing with 217 votes, one more than the minimum needed, the votes of two Michigan members whose votes were in doubt this week proved critical as U.S. Rep. Justin Amash (R-Cascade Township) and U.S. Rep. Fred Upton (R-St. Joseph) both voted yes.

Democrats immediately excoriated the legislation, saying it would end insurance for 24 million nationwide and harm the ability of those with pre-existing conditions to obtain health insurance. With the bill on its way to the U.S. Senate, U.S. Sen. Gary Peters (D-Bloomfield Township) and U.S. Sen. Debbie Stabenow (D-Lansing) vowed to fight it.

Republicans cast their vote as fulfilling their longtime promise to repeal “Obamacare,” their term for the Patient Protection and Affordable Care Act. They said it would relieve major burdens on business and taxpayers and address the problems afflicting the exchanges set up under the ACA where people can buy insurance. Several insurers have pulled out of those markets with too many younger, healthier workers opting to pay the tax for not buying insurance, leaving most costly, sicker workers to insure. Premiums for those on the exchanges have risen substantially, though insurance costs were rising quickly prior to the enactment of the ACA too.

The legislation would mean massive changes to Medicaid, a huge component of state government. It would spell the end of Healthy Michigan, the program that expanded Medicaid eligibility to 133 percent of the federal poverty level once all those enrolled in the program in 2020 moved off of it, something experts say would take only a few years. Some 600,000 in Michigan current use that program for their health insurance. A new cap on standard Medicaid would mean as yet unknown changes there.

Upton emerged as a key figure in the waning days, both because he initially said he would vote no over how the legislation handled those with pre-existing conditions and then flipped once he agreed to $8 billion to fund high-risk pools for those with such conditions (a figure that several national reports say is well below what is necessary) and because he is considering challenging Stabenow for re-election in 2018.

“We know that Obamacare is broken,” Upton said in a statement. “Our legislation is a first step in the right direction to ensure all Americans have access to quality, affordable health care. We expand and enhance Health Savings Accounts. We provide a reasonable transition until 2020 for those on the Medicaid expansion and then grandfather all those folks until they’re off. We help young adults stay on their parents insurance until they’re 26. We provide a monthly tax credit for low and middle-income individuals and families who don’t receive insurance through work or government program.”

A major flashpoint of the bill is on how it handles those with pre-existing conditions. While the bill says insurers cannot deny coverage to those with pre-existing conditions, it would allow something the ACA forbade – charging some sick patients more for insurance.

The mechanism for this to happen is somewhat complex and would surely vary from state to state.

Each state would have the power, under the bill, to decide whether to seek a waiver from the law to craft their own plans, which could lead to a period of time where insurers could again consider a patient’s health history when calculating premiums. The question would then become in states that sought such waivers whether insurers would then charge these people more.

Republicans insisted their bill would protect those with pre-existing conditions. U.S. Rep. Mike Bishop (R-Rochester) pointed to the mechanism that replaces the individual mandate, a provision that enables to charge those who do not keep continuous coverage more money.

By incentivizing individuals to maintain coverage, insurers will not be able to deny, rescind, or raise the cost of coverage for a patient with pre-existing conditions,” he said.

Democrats, however, were furious and castigated the legislation as unconscionable.

U.S. Rep. Sander Levin (D-Royal Oak) said it amounted to a transfer of $1 trillion from those who rely on Medicare, Medicaid and tax breaks aiding them with health insurance premiums to insurance companies and the wealthiest Americans.

“The Affordable Care Act says insurance companies can’t exclude them, can’t limit their benefits, and can’t charge them more,” he said. “The GOP bill would effectively repeal those provisions. Republicans say not to worry – they will be covered by risk pools. But experts have repeatedly warned that risk pools won’t adequately protect Americans with pre-existing conditions.”

The Michigan Democratic Party tore into Upton as well as Bishop and U.S. Rep. David Trott (R-Birmingham), the latter two members the party is targeting in the 2018 elections.

“Mike Bishop and Dave Trott are on notice,” Michigan Democratic Party Chair Brandon Dillon said in a statement. “By voting to take affordable health care away from millions of Americans – including hundreds of thousands of their own constituents and residents of southeast Michigan with pre-existing conditions – just to pay for tax cuts for the rich, Congressmen Bishop and Trott just signed their own pink slips.”

Governor Rick Snyder, who has voiced concern about the bill’s implications for Medicaid but said he neither supports nor opposes the bill, walked a similar line in a statement he issued after the vote.

“Changes to the Affordable Care Act are necessary to continue to provide quality, affordable health care to Michiganders, and I appreciate the leadership of President Trump, his Administration and members of the Michigan congressional delegation in this effort,” he said. “I continue to have concerns about specifics of the legislation, especially about the impact on residents enrolled in the Healthy Michigan Plan, and I look forward to working with the Senate to improve the legislation.”

This story was published by Gongwer News Service. To subscribe, click on www.gongwer.com