GOP health care overhaul passes U.S. House

WASHINGTON — In a stunning reversal of momentum, Republicans salvaged long-held ambitions to unwind former President Obama's 2010 health care law, passing a major overhaul in the U.S. House of Representatives on Thursday afternoon. 

Republicans found legislative success on Thursday — after a previous effort fell apart in late March — by appealing to the conservative factions in their caucus. But such tactics will likely ensure a more difficult passage in the U.S. Senate before any overhaul can become law. 

It was a razor-thin victory: 217-213. With the exception of U.S. Rep. Will Hurd, R-Helotes, who voted against the plan, the Texas delegation votes broke down along party lines. 

Republicans greeted the victory with cheers, but there were more smiles and taunts on the Democratic side of the chamber. As the vote count ticked toward passage, Democrats smiled, waved and sang: "Na Na Na Na. Na Na Na Na. Hey Hey Hey. Goodbye" — implying that this vote will cost the GOP control of the U.S. House. 

U.S. Rep. Ted Poe, R-Humble, disagreed with that notion earlier in the morning. 

"This bill is the right thing to do, and so there's always consequences — a lot of votes there's consequences for," he said. "I think members are going to vote for the bill because they thought that's what they ought to do and then just deal with the political issues after it passes."

Political concerns aside, Republicans reveled in their first major legislative achievement of the Trump era. The bill was all but dead only a day ago.

The first stab at the resurrected bill moved the policy in a conservative direction compared to the failed March effort. But those changes alienated moderates and even Republicans with close ties to party leadership. In the end, many of those members fell in line once negotiators inserted a provision to add $8 billion to help individuals with pre-existing conditions afford premiums.

Hurd was quiet all week on the bill, and moments ahead of the vote his office released a statement saying he would vote against the measure. The move added suspense to the vote, but Republicans ultimately prevailed. 

Even U.S. Rep. Louie Gohmert of Tyler, a frequent critic of his party's leadership, backed the bill.

He described the bill as "something we can live with," and he was a cheerleader for passage on Fox Business Channel. 

"It is not a full repeal, but at least it moves us in the right direction," he said in a television interview. "We were very close to not doing anything. So that would have been worse." 

Democrats howled throughout the process, particularly because the legislation's public airing and vote occurred so swiftly that the nonpartisan Congressional Budget Office had yet to weigh in with cost predictions and estimates of the impact on how many people will lose their health coverage. 

But privately, there remained a sense that the bill would never be passed into law because of Senate resistance, and Democrats gleefully watched as Republicans from vulnerable districts squirmed before some eventually voted for the bill. 

Once the bill moves to the Senate, U.S. Sen. Ted Cruz will likely take center stage as a player. As the House tangled with division, Cruz spent most of the winter and spring avoiding alienating major GOP constituencies.

Now, with the House passing the bill on to the Senate, he will likely emerge a counter to moderating forces in the upper chamber.

On Thursday, the larger question in the halls of Congress revolved around the potential political consequences for House Republicans.

Back when Democrats ruled Washington in 2009, the House passed a politically toxic cap-and-trade bill that went on to die in the Senate. Dozens of Democratic incumbents lost re-election in the fall of 2010, in part because of television advertising hammering them for that vote — on a bill that never became law. 

Democrats say they will pummel any vulnerable House Republicans in the same way for an affirmative vote on Thursday, even if the overhaul dies in the other chamber. Some Democratic groups are already producing television advertisements accusing Republicans of taking away protections for individuals with pre-existing conditions. 

Hurd's vote against the bill could give him some protection against attack ads, but Democrats are making noise about expanding into traditionally safe Republican seats in Texas.

"I think it could be an impetus to changing some of the members of the Texas congressional delegation who've embraced this travesty," said U.S. Rep. Lloyd Doggett, D-Austin, predicting that the legislation will negatively affect suburban voters and could overcome the state's gerrymandered congressional districts. 

Doggett and his colleagues say the political consequences could expand the state's congressional battlefield to seats in Dallas and Houston.  

Despite the ominous political winds around the U.S. Capitol, most House Republicans had bounces in their step on Thursday. After all, this is the most important Republican policy goal of the last seven years. 

Poe, the Humble Republican, described the vibe on the House floor Thursday morning as "a lot of energy."

The policy impacts of this bill, if passed into law, could be felt more strongly in Texas than in other states.

One of the primary changes to the March legislation that helped the new bill pick up steam was a provision that would allow states to apply for waivers allowing insurers to charge higher premiums based on an individual's "health status," pre-existing conditions, in order to predict an individual's future medical costs.  

Gov. Greg Abbott's office did not immediately respond to requests for comment on whether Texas would seek such a waiver. But Doggett predicted Texas would pursue that option.

"I think it's almost certain," he said. 

Alex Samuels contributed to this report.