On Thursday, the U.S. House of Representatives narrowly passed a controversial new measure to repeal and replace the Affordable Care Act. The bill is a virtual repeal of the current ACA at a state level and was passed without a comprehensive CBO analysis.

Back in March, a similar house measure was taken off the table by senior Republicans before it could go to a vote due to fears that it would not gain the support necessary to pass.

Some of the changes made to the last Obamacare repeal bill include state waivers for the current ACA requirement that insurance providers charge customers with pre-existing conditions at the same rate as customers without them.

The original measure simply did not allow insurance providers to charge any group of customers differently. The change alienated some house republicans who supported the first version.

Another change adds $5 billion over the course of five years that will go to support pools of “high-risk” consumers living in states that have opted out with respect to pre-existing conditions.

The actual effectiveness of this compensatory addition has yet to be determined. Some have argued that it will not do enough for those in the so-called “high-risk” consumer group. What it did do was gain back some of the voting support lost with the waiver change.

A handful of Republicans voted “no.” House Democrats also voted uniformly against, and even went so far as to chant together “na na na na, na na na na, hey hey hey, goodbye!” as it came nearer to passing. Several prominent Democrats have said that those who voted for the measure are doomed politically.

House Minority Leader, Nancy Pelosi warned, for example, “You vote for this bill, you’ll have walked the plank from moderate to radical […] You will glow in the dark on this one.”

The bill will surely worry many. It allows insurance providers to charge customers with pre-existing conditions more. It also gives those providers more freedom in determining their range of covered treatments. Additionally, the prospect of several million more uninsured Americans in a few years now looms.

The measure will now go to the Senate, where it will face serious resistance from both sides of the aisle. Some Republican senators have expressed dissatisfaction with part of the bill, which would eliminate the Medicaid expansion included under the Affordable Care Act.

It is likely that the Senate will eventually vote on its own version. The creation of this new measure will no doubt be hotly contested.

The Senate battle over the measure promises to be most convoluted on the Republican side. Moderate Republican senators will surely request a softening of the house version to bolster its palatabity.

An effort to give the measure a broad appeal, however, will have its own problems, among them the potential of losing the support of more conservative Republican senators, like Ted Cruz.

President Donald Trump has reached out to prominent Republican senators, asking them to aid in fostering cooperation in regard to the bill. Fundamentally, though, the Senate has a drawn out struggle ahead. It is still unclear how cooperative Senate Republicans will be and what form the bill could eventually take.

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