The U.S. House of Representatives on Thursday passed a retooled version of a bill aimed at repealing and replacing parts of the Affordable Care Act (ACA), sending the legislation to an uncertain future in the Senate.

The House approved the American Health Care Act (AHCA) by a slim 217-213 margin. A timeline for consideration by the Senate is undetermined.

SDAHO, the American Hospital Association (AHA), LeadingAge and numerous other health care and consumer organizations oppose the bill, saying it will reduce citizens’ access to health care.

“The bill, in its current form, puts health coverage in jeopardy for millions of Americans and tens of thousands of South Dakotans,” said SDAHO President/CEO Scott A. Duke. “Recent amendments further put consumer protections at risk by allowing states to waive the essential health benefit standards, which could leave patients without access to critical health services and increase out-of-pocket spending.”

The GOP’s earlier attempt to pass the AHCA was pulled from the floor last month because it lacked the necessary votes for passage. No Democrats voted for the bill, but enough Republicans within the party’s far-right and moderate factions came together thanks in part to two compromises:

  • An amendment offered by Rep. Tom MacArthur of New Jersey a leader of the moderate Tuesday Group, helped win support from members of the conservative Freedom Caucus. The amendment allows states to waive certain insurance rules and consumer protections required under the ACA, particularly those related to essential health benefits and community rating. SDAHO, the AHA and LeadingAge say the amendment dramatically worsens the AHCA by putting consumer protections at greater risk and it could significantly raise costs for those with preexisting conditions.
  • House leaders won over enough moderate Republicans with an amendment from Rep. Fred Upton of Michigan that added $8 billion over 5 years for individuals with preexisting conditions in states that make that request. Critics say that figure is far too low to cover the costs of people preexisting conditions losing health coverage under the plan.

The revised legislation was brought to the floor even though it has not yet been scored by the non-partisan Congressional Budget Office (CBO). Such scores allow lawmakers to gauge a bill’s effect on the federal budget and deficit, and passage of a bill lacking an updated score leaves a high degree of uncertainty.

The CBO did score the AHCA in its original form and estimated that it would cause 24 million people to lose health insurance within a decade. The AHA has said it is unlikely the MacArthur amendment would improve the coverage estimates.

If the Senate takes up the AHCA, makes changes and passes the revised version, the typical process would be for the bill to go to a conference committee to work out differences. Alternately, the House could simply accept the Senate’s changes and the bill would go to President Donald Trump, who would likely sign the legislation.