Congress takes first step toward dismantling the Affordable Care Act

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U.S. House Speaker Paul Ryan and House Republican Whip Steve Scalise (R-LA) introduce Representative Steve Stivers (R-OH), Representative Jason Smith (R-MO) and Representative Luke Messer (R-IN) as new members of the House Republican leadership team after their caucus held leadership elections on Capitol Hill in Washington, U.S. November 15, 2016. REUTERS/Jonathan Ernst - RTX2TUMR

U.S. House Speaker Paul Ryan and House Republican Whip Steve Scalise (R-LA) introduce Representative Steve Stivers (R-OH), Representative Jason Smith (R-MO) and Representative Luke Messer (R-IN) as new members of the House Republican leadership team after their caucus held leadership elections on Capitol Hill in Washington, U.S. on Nov. 15, 2016. Photo by Jonathan Ernst/Reuters

WASHINGTON — Ascendant Republicans drove a budget through Congress on Friday that gives them an early but critical victory in their crusade to scrap President Barack Obama’s health care overhaul.

The vote trains the spotlight on whether they and Donald Trump can deliver on repeated pledges to not just erase that statute but replace it.

Demonstrating the GOP’s willingness to plunge into a defining but risky battle, the House used a near party-line 227-198 roll call to approve a measure that prevents Senate Democrats from derailing a future bill, thus far unwritten, annulling and reshaping Obama’s landmark 2010 law. The budget, which won Senate approval early Thursday, does not need the president’s signature.

“The ‘Unaffordable’ Care Act will soon be history!” Trump tweeted Friday in a dig at the statute’s name, the Affordable Care Act. Trump takes the presidential oath next Friday.

The real work looms in coming months as the new administration and congressional Republicans write legislation to erase much of the health care law and replace it with a GOP version. Republicans have internal divisions over what that would look like, though past GOP proposals have cut much of the existing law’s federal spending and eased coverage requirements while relying more on tax benefits and letting states make decisions.

Friday’s vote was preceded by debate that saw hyperbole on both sides and underscored how the two parties have alternate-universe views of Obama’s overhaul. Democrats praised it for extending coverage to tens of millions of Americans, helping families afford policies and seniors buy prescriptions, while Republicans focused on the rising premiums and deductibles and limited access to doctors and insurers that have plagued many.

House Speaker Paul Ryan, R-Wis., said the health care law was “so arrogant and so contrary to our founding principles” and had not delivered on Obama’s promises to lower costs and provide more choice.

“We have to step in before things get worse. This is nothing short of a rescue mission,” Ryan said.

“Our experimentation in Soviet-style central planning of our health care system has been an abject failure,” said freshman Rep. Jodey Arrington, R-Texas.

House Minority Leader Nancy Pelosi, D-Calif., said Ryan was peddling “mythology” and said the GOP was moving toward worsening health care for consumers.

“They want to cut benefits and run. They want to cut access and run,” she said of Republicans.

“This is a sad day in the history of this country as Republicans begin the process of destroying health care in America,” said Rep. Hakeem Jeffries, D-N.Y., arguing that the GOP has no replacement in hand. “All you have is smoke and mirrors, and the American people are getting ready to get screwed.”

Nine Republicans joined all voting Democrats in opposing the budget.

The budget’s approval means Senate Democrats won’t be allowed to filibuster the future repeal-and-replace bill — a pivotal advantage for Republicans. They control the Senate 52-48, but it takes 60 votes to end filibusters, or endless procedural delays that can scuttle legislation.

Republicans have made annulling Obama’s law and replacing it a top goal for the past seven years. GOP rifts and an Obama veto prevented them from achieving anything other than holding scores of votes that served as political messaging.

Trump, too, made targeting Obama’s overhaul a primary target during his campaign. At his news conference Wednesday, Trump — who’s supplied few details of what he wants — said his emerging plan will be “far less expensive and far better” than the statute.

Despite their conceptual unity, plenty of Republicans have shown skittishness in recent days about the political repercussions of charging into a battle that, with Trump in the White House, puts enacting new laws within reach.

Many expressed opposition to leaders’ initial emphasis on first passing a repeal bill and then focusing on a replacement — a process that could produce a gap of months or longer. Trump has also pushed Congress to act fast.

Numerous Republicans have insisted on learning how their party will re-craft the nation’s $3 trillion-a-year health care system before voting to void existing programs. Twenty million Americans are covered by Obama’s expansion of Medicaid or by policies sold on exchanges, and millions of others have benefited from the coverage requirements it has imposed on insurers.

There are internal GOP chasms over leaders’ plans to use their bill to halt federal payments to Planned Parenthood and pare Medicaid coverage. There are also disagreements over how to pay for the GOP replacement, with many Republicans leery of Ryan’s proposal to tax part of the value of some health insurance provided by employers.

Even with their disputes, the GOP’s rallying behind their budget spotlighted the political imperative facing Republicans to deliver on a battle cry that has sustained them for years.

Moving ahead on the budget was “a bottom-line, party survival vote,” said Thomas P. Miller, a health care authority at the conservative American Enterprise Institute.

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