With 1/6th of the economy at stake, the vote happened after the CBO did not score the bill. The text of the AHCA was posted late Wednesday evening. The GOP House has a rule that text of a bill must be posted for three days prior to voting. Yet, House Republicans ignored their own standard and barreled forward.
As far as the bill itself, it does not completely repeal Obamacare. The MacArthur-Meadows amendment did move the bill in the right direction which grants states the right to seek waivers on some regulations. However, this is only a partial withdraw which still maintains a number of mandated Obamacare rules.
The waivers do lower premiums if states opt out of higher costs associated with coverages for individuals with pre-existing conditions and federal essential health benefits. Additionally, the individual and employer mandates are fully repealed. Freedom of choice is great but without the repeal of mandated regulations, this could leave insurance coverages in limbo.
This bill does not repeal but simply slows Medicaid expansion. It does not repeal the Cadillac Tax completely until 2026 and leaves in place the Economic Substance Tax.
Finally, it also keeps insurance company subsidies up to 130 billion dollars by the creation of the Patient and State Stability Fund. This fund creates bailout money to help persuade insurers who may otherwise get out of the market or raise rates due to previous Obamacare regulations and mandates. Think of this like an open-ended flow of money for insurers to ensure stability within the Obamacare structure.
Republicans have improved the bill since March, but this still falls way short of what should have happened. Congress should have fully repealed Obamacare and gotten rid of mandated regulations and rules that keep Washington in control of healthcare decisions.
Like I wrote over a month ago, that is disappointing. We need true reforms to Medicaid and an actual free market solution that drives down premiums. Health saving accounts and insurance that is portable across state lines would also be nice. Instead, Republicans in Washington continue to disappoint with lukewarm reforms. After Democrats jumped off a cliff with Obamacare in 2010, House Republicans are now doing the same in 2017.