WASHINGTON - The future of American health care is up for a vote on Thursday, with the House of Representatives expected to act on the GOP's bill to replace Obamacare.
The legislation would have big consequences in North Dakota, Minnesota and around the country. While House is set to vote on a newly amended version of the American Health Care Act - released Monday - estimates on a similar, earlier version were that 14 million fewer people would have coverage in 2018 if the bill were passed, with that number at 24 million fewer people by 2026. That draft would also have cut federal deficits by $337 billion in the coming decade.
Rep. Kevin Cramer, R-N.D., said he plans to vote for the bill, though he couldn't vouch for any 11th-hour changes that might crop up before a Thursday vote.
"Doing nothing is absolutely not an option," Cramer said, criticizing Obamacare's impact on insurance around the country. "We have heard hundreds of stories from people on skyrocketing premiums."
Rep. Collin Peterson of Minnesota is a no vote, according to his office, leaving the Red River Valley's House members apparently split. A spokeswoman for Peterson said the bill does not fix high premiums and deductibles.
The bill's impact on health care would be complicated. The new bill would shift nationwide policy from a model catering to income inequality to a system of subsidies that increase with age, according to health experts. The GOP plan would begin to roll back expanded Medicaid coverage beginning in 2020 by reducing federal funding for new patients or those with a lapse in participation. And it would replace the individual mandate that imposes a tax penalty on people without insurance with a premium increase for those who go too long without insurance.
Brad Gibbens is the deputy director of the Center for Rural Health at the University of North Dakota. He said that tens of thousands of North Dakotans have received insurance through Obamacare's individual marketplace and Medicaid expansion. And that funding expansion, he added, is all the more important because it helps drive revenues for rural hospital systems.
"I think the winners and losers - I'd say the winner for this (are) if you're young and healthy," he said. "And losers might be if you're older and lower income and have a lot of health conditions."
Cramer pointed out that the House has moved to address that earlier this week, with $75 billion allotted to tax credits that could be crafted by the Senate following House passage, with further funding made available to help the kinds of elderly patients who might need it.
Both North Dakota and Minnesota have seen health care reshaped significantly by Obamacare. Gibbens said 40,000 North Dakotans have acquired health insurance using provisions of the law, and the North Dakota Legislature is currently considering extending the state's Medicaid expansions into the next biennium. A paper co-authored by Lynn Blewett, a professor of health policy at the University of Minnesota, indicates that the number of uninsured Minnesotans dropped by 200,000 between 2013 and 2015.
Blewett said in a Tuesday phone interview that health care's current entrapment in a kind of political tennis match between partisan interests is bad in the long run.
"Honestly, it's not good for the country," she said, remarking on the detriment of the significant changes states would have to juggle to accommodate a new health care policy. "It's just untenable for the long term to do policy this way."
Gibbens said the GOP will have to walk a fine line to get anything passed, and it's not clear if they can do it at all. As of press time, the bill appeared to lack the votes to pass in the House.
But even if it does clear a first vote, it's not obvious if it could still succeed.
"I think a lot of the politics of this - you first have to get it through the House, and the House is a more conservative institution," Gibbens said of amendments to the bill. "But then the question becomes, do you lose more moderate Republicans in the Senate because of those changes?"
That was part of Cramer's concern. He said he's not even sure if the bill can pass the House or if there will even be a vote because what he called some colleagues' attempt to make "the perfect the enemy of the good."
"I think for Republicans, this is a Waterloo moment, because this is going to determine whether we can be a governing party or if we're going to be a party of no and opposition," Cramer said.