Update, 3:45 p.m. Friday: The AHCA has been pulled, after the Republicans were not able to secure enough votes to pass the legislation.
Update, 3:30 p.m. Thursday: After twice postponing, Paul Ryan canceled a scheduled press conference this afternoon. Per NBC, House leadership does not plan to hold the vote Thursday evening. Instead, the House GOP conference will meet to discuss next steps.
After seven years of hoarsely bellowing "repeal and replace!" into every microphone, TV camera and drive-thru speaker box they encountered, Republicans will finally have the chance to do the damn thing Thursday night. That's when their plan, the American Health Care Act, is slated to go before the House of Representatives for a vote.
Republicans had chosen to hold the vote on Thursday for the date's symbolism – seven years to day since President Obama signed the Affordable Care Act into law – but the timing was thrown into doubt after Donald Trump failed to strike a deal with the Freedom Caucus on Thursday afternoon.
Hours before the planned vote time, it is still unclear what exactly is in the bill – which was being furiously re-written overnight – and whether or not it will pass.
According to Paul Ryan, this is not just Republicans' first chance to replace the Affordable Care Act – it's also their last. "This is the closest we will ever get to repealing and replacing Obamacare," the House speaker said at a recent press conference. Ryan has maintained he has the votes to push the plan through, and White House spokesman Sean Spicer was similarly confident on Wednesday, telling reporters, "There is no plan B. There is plan A and plan A. We're going to get it done."
It's do-or-die time for this legislation. Here's what we know about it and its chances of survival.
No one knows exactly what's in the final bill.
Late Wednesday night, conservative Republicans in the House were still parlaying with Paul Ryan over some of the bill's key components. Most at issue were the ten essential benefits now required in qualifying plans – things like maternity care, hospitalization, vaccinations, mental health and addiction treatment – which members on the far right want stripped away. An early version of the bill eliminated the benefits, but they were restored in the most recent version, likely because, as Slate pointed out, losing them would dramatically worsen the plan's Congressional Budget Office score.
Tens of millions of Americans would lose coverage.
The nonpartisan CBO predicts 14 million fewer Americans would be insured by next year if the AHCA passes. By 2026, that number shoots up to 24 million, pegging the total number of uninsured Americans at 52 million. That's compared to the 28 million people expected to be uninsured at the same time under Obamacare.
More than one million more people would be uninsured under the Republicans' new replacement plan, according to CBO estimates, than if they just repealed the ACA outright.
Premium hikes would hit Trump voters hardest.
Under the GOP plan, younger Americans would see modest decreases in their premiums: a 21-year-old making $26,500 would pay $250 less a year, according to the CBO estimate. But older Americans would see their costs skyrocket: a 64-year-old making the same amount would see her premium jump from $1,700 to $14,600 – or more than twice her annual income. A majority of younger voters – 55 percent of 18- to 29-year-olds – broke for Clinton in November, while 53 percent of voters 65 and older chose Trump.
Everyone hates the bill.
The American Health Care Act has the unique distinction of bringing together groups that typically have trouble finding common ground, like Planned Parenthood and Heritage Action for America, which regularly campaigns to strip Planned Parenthood of its federal funding. In fact, all the conservative think tanks hate it. Americans for Prosperity is mad it's not a full repeal. FreedomWorks says it's "ObamaCare-lite." To the Club for Growth, it's a "warmed-over substitute for government-run health care." The CATO Institute calls it a "train wreck" waiting to happen.
The bill has also brought Breitbart News and its sworn enemies, the cucks at National Review, to the same side.
Non-partisan groups are similarly aghast. The AARP says the AHCA would increase costs for seniors while doing nothing to lower drug costs. The American Cancer Society worries it would leave the poorest cancer patients without access to "preventive, curative and follow-up health care." The AFL-CIO hates that it foists a "Cadillac tax" on people with employer-provided plans. The American Medical Association says, "We don't want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage." The list goes on.
"While I've been in Congress, I can't recall a more universally detested piece of legislation than this GOP health care bill," Republican Rep. Justin Amash tweeted Monday.
No one knows if it will pass the House.
On Wednesday afternoon, at least 29 Republicans were either definitely voting no on the bill or leaning that way, according to NBC – and it would take 21 Republican defections to sink the bill. By Thursday morning, though, all bets were off. Whip counts ranged from 36 no votes (Washington Post) to just 24 (CNN), and that was before the Freedom Caucus was headed to the White House for Trump's hard sell on the plan.
Trump's previous pitch, delivered to the House Republican Conference on Tuesday, didn't go over so well. More Republican members of Congress announced their opposition to the bill after the visit, during which the president promised he would "come after" those who voted against it. Most conventional wisdom says that Republicans' failure to pass an Obamacare replacement plan – a promise they've been campaigning on for seven years – while they control both houses of Congress and the White House, would constitute a failure for Trump, who stakes his reputation, and the rationale for his most outlandish policy proposals, on being an incomparable negotiator. (Other observers think successfully ramming the thing through would be a worse outcome for the president in the long term.)
Even if it does pass the House, it almost certainly lacks the votes to pass the Senate.
In the Senate, where Republicans can only afford to lose two votes, eight members of their party have already announced their opposition. In theory, House Majority Leader Mitch McConnell could take on the Herculean effort of reworking the bill in order to get six members of his caucus back on board – but he doesn't seem keen on the idea.
McConnell told reporters Tuesday that if the bill did make it to the upper chamber, he would waste no time calling for a vote. "We will reach a conclusion on health care next week," McConnell said. "We'll either pass something that will achieve a goal that we've been working on, or not."
As New York Magazine points out, that's a pretty zen, what-will-be-will-be sentiment – one that stands in stark contrast to how Ryan and Trump are reacting – and one that suggests he's already accepted the imminent death of the AHCA.