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WASHINGTON  — In a major victory for President Donald Trump, the House has voted to dismantle the pillars of the Affordable Care Act and make sweeping changes to the nation’s health care system.

The bill now heads to the Senate where it faces daunting challenges because of the same ideological splits between conservative and moderate Republicans that nearly killed it in the House.

Trump said he is confident the bill will pass the Senate, calling Obamacare “essentially dead.”

“This is a great plan. I actually think it will get even better. This is a repeal and replace of Obamacare. Make no mistake about it,” Trump said at a celebratory White House appearance with House Republicans.

After a dramatic week of negotiations, lobbying from Trump and Republican leaders, the vote ended with 217 GOP lawmakers backing the measure. Twenty Republicans opposed it, as did all House Democrats.

Trump argued the health care process has unified the GOP. “We’ve developed a bond,” he said. “This has really brought the Republican Party together.”

“As far as I’m concerned, your premiums are going to come down,” Trump said.

Thursday morning, Republicans were already in a celebratory mode. The theme song to “Rocky” played as members filed in to a meeting in the House basement.

Democrats were unable to stop the GOP vote aimed at President Barack Obama’s signature legislative achievement. But after the final vote was cast, they chanted “nah nah nah nah hey hey hey goodbye” to their Republican colleagues, with a few members waving, as they believe the vote will lead to many GOP lawmakers losing their seats in the November 2018 midterms.

Thursday marks a political milestone — one that has painfully eluded Trump and House leaders for months. The controversial health care bill delivered Trump the biggest political defeat of his short presidency in March, when the legislation had to be yanked from the House floor because it simply didn’t have enough support.

Under pressure from an antsy Trump looking to score a big political victory, Republican leaders tried again last week, hoping to to get to 216 votes ahead of the President’s symbolically important 100-day mark in office. That effort, too, failed.

Before the vote on the House floor, House Speaker Paul Ryan made the case that Republicans had no choice but to work to put Obamacare — what he called a “failing law” — behind them. “Let’s give people more choices and more control over their care.”

“Let’s return power from Washington to the states,” Ryan said.

“A lot of us have been waiting seven years to cast this vote.” Ryan said. Many lawmakers, he added are “here because they promised to cast this vote.”

What’s in the bill?

The GOP health care bill would eliminate Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan would provide Americans with refundable tax credits based mainly on age to purchase health insurance.

The legislation would also allow insurers to charge higher premiums to those in their 50s and early 60s, compared to younger consumers.

It would also significantly curtail federal support for Medicaid and allow states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults, and those that hadn’t expanded would be immediately barred from doing so.

And it would allow states to relax some key Obamacare protections of those with pre-existing conditions, which are among the health reform law’s most popular provisions. States could apply for waivers to allow insurers to offer skimpier policies that don’t cover the 10 essential health benefits mandated by Obamacare. Also, insurers would be able to charge higher premiums to those with medical issues if they let their coverage lapse. States requesting waivers would have to set up programs — such as high-risk pools — to protect insurers from high-cost patients.

An eleventh-hour amendment that helped seal the missing GOP votes would add $8 billion over five years to fund high-risk pools and go toward patients with pre-existing conditions in states that seek waivers under the Republican legislation. The legislation already included $130 billion in the fund.

However, the GOP bill doesn’t touch one another beloved piece of Obamacare — letting children stay on their parents’ insurance plans until the age of 26.

Oklahoma representatives celebrate vote

Oklahoma Gov. Mary Fallin released the following statement after the House passed the bill:

“I’m pleased that the U.S. House has passed the American Health Care Act, which repeals and replaces Obamacare. Our current health care system is collapsing, threatening to leave people across the country without access to health care coverage. Health insurance has become unaffordable. Obamacare has driven health insurance companies out of the market, and Oklahoma is down to only one insurance carrier on the federal exchange.
“Reforming the system is the only way to provide access to affordable and quality health care. I am working closely with my fellow governors to ensure the concerns and voices of Oklahomans are heard. Now it is up to the Senate to act and ensure our fellow Oklahomans, and Americans across the country, are able to access quality, affordable health care.”

“Obamacare is collapsing under its own weight,” said Congressman Frank Lucas. “Several states, including Oklahoma, are down to only one insurance provider on their state exchange and health premiums continue to rise at a staggering rate.”
“I support the American Health Care Act because it makes good on our promise to repeal Obamacare and restore our country’s health insurance market. Moving from Obamacare’s government-run bureaucracy to a patient-centered system means people will have the flexibility to choose the plan that meets their needs. And for the millions of Americans who were forced off their health plans through no fault of their own, this legislation paves the way for comprehensive and affordable health insurance options.”
“Today’s vote is an important step toward getting rid of Obamacare’s mandates, excessive taxes, and regulatory hurdles so that Americans can begin to access quality health care at a reasonable price.”

“It’s painfully obvious that the Affordable Care Act is not working,” said Rep. Tom Cole. “Premiums have risen through the roof, patient choices have dwindled, and taxes and penalties have increased dramatically. While the legislation we passed today isn’t a perfect solution, it will increase choices, reduce costs, and give consumers greater flexibility.”
“Oklahoma has been especially hit hard by Obamacare,” continued Cole. “The state currently has only one insurer and people in rural areas have lost their doctors. The legislation we passed today will provide a market-based health care system that will also give states more options to tailor their health care systems to better suit the needs of their citizens.”
“This legislation will certainly undergo changes as it moves through the legislative process, but there are solid provisions that will ensure healthcare is more affordable. We’ve included tax credits to provide flexible payment options and given states the authority to modernize and strengthen Medicaid. The burdens of the employer and individual mandates will be nullified, and block grants will be at the discretion of the states. Further, it includes a $15 billion fund to help states provide subsidies for high-risk patients, which will help stabilize the market for these patients.”
“Significantly, those with pre-existing conditions are guaranteed protection in the American Health Care Act. Patients with pre-existing conditions will not be denied insurance, nor should they ever be. To ensure that insurance remains affordable for patients with pre-existing conditions, we’ve included an $8 billion fund to help offset premiums costs for those patients.”
“The new system also retains some of the effective provisions of the Affordable Care Act, including allowing those under 26 years old to stay on their parents’ plans.”
“Finally, in order to make sure that Members of Congress and congressional staff are subject to the same regulations as all Americans, we also passed a stand-alone bill, H.R. 2192, to ensure this remains the case.”
“As the American Health Care Act is now sent to the Senate, Americans should be aware that the legislative process is not finished. The Senate will certainly have the opportunity to amend, and hopefully improve, the legislation passed by the House. I look forward to its passage by the Senate and its ultimate signing by the President,” concluded Cole.

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