The House Budget Committee on Thursday narrowly advanced the the American Health Care Act in a 19 to 17 vote mostly along party lines, before debating numerous Democratic motions that failed.
The committee has 22 Republicans and 14 Democrats and three conservative Republicans joined in voting against the bill: Dave Brat of Virginia, Mark Sanford of South Carolina and Gary Palmer of Alabama.
All three have been identified in a Pew Research report as being among 36 members of the House Freedom Caucus. These Republican representatives are against the GOP bill to repeal and replace the Affordable Care Act saying federal cuts don't go far enough, calling the American Health Care Act "Obamacare Lite."
Democrats on the House Budget Committee often referred to the bill introduced by House Speaker Paul Ryan as "Trumpcare," though President Donald Trump has been slow to embrace the title and get fully behind the bill.
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Democrats introduced several motions that failed. For example, Democrats tried to prohibit the bill from taking effect until it could be shown that there would be no increase in the number of individuals losing health insurance.
They wanted to prevent the bill from being implemented until it fulfilled the stated provisions of President Trump who said everyone would have insurance and it would be less expensive and better. He also pledged Medicare and Medicaid would not be cut.
The bill removes $170 billion from Medicare trust fund and ends Medicaid expansion as put forward in the Affordable Care Act. States would decide whether to expand Medicaid and the program would be funded and capped based on the number of beneficiaries in the state.
Bruce Siegel, MD, president and CEO of America's Essential Hospitals said the administration's budget proposal deepens concern about the future for patients and for the ability of hospitals to care for vulnerable people.
"The proposed cuts to the Department of Health and Human Services budget, which include significant funding reductions for the National Institutes of Health and workforce training, would only add to cost pressures expected under the American Health Care Act," Siegel said. "The cumulative effect of this budget and the AHCA could be to undermine the ability of essential hospitals to meet their commitment to patients and communities and weaken efforts to respond to existing and emerging threats to the public health."
House Budget Democrats wanted to strike provisions in the bill that would end Medicaid expansion.
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Ending Medicaid expansion hurts families at the poverty level, seniors in nursing homes, children and people who are too disabled to work, they said.
Another motion wanted to strike increases total out-of-pocket costs.
They wanted to strike language that ended Planned Parenthood funding.
"Here we are again with a bill that attacks women and access to healthcare," said Democrat Barbara Lee of California.
Republican Representative Rob Woodall of Georgia said the American Health Care Act says nothing about Planned Parenthood, only about facilities that hold abortions.
"(The bill) doesn't pull the rug out from the middle class," Jason Smith of Missouri said. "Fourteen million will choose not to buy it. It will by their choice, not a mandate from Washington, DC."
The Congressional Budget Office has estimated that 24 million people would lose their health coverage over the next decade if the bill passes.
Older people will be priced out the market, Democrats said, as a 64-year-old making about $27,000 a year will be paying premiums of $14,000 a year compared to the current $1,700.
Chairman Diane Black of Tennessee, a Republican ordered the American Health Care Act reported to the House of Representatives with a favorable recommendation.
The bill reduces the deficit by $337 billion over 10 years, she said.
"This is the conservative vision we've been talking about for years," she said.
Twitter: @SusanJMorse