It was a GREAT day for the United States of America! This is a great plan that is a repeal & replace of ObamaCare. Make no mistake about it. pic.twitter.com/fYtghBlXxS— Donald J. Trump (@realDonaldTrump) May 5, 2017
After the American Health Care Act passed the House on Thursday, Republicans were quick to celebrate their hard-fought political victory.
“Welcome to the beginning of the end of Obamacare,” Vice President Mike Pence declared during a press conference in the White House rose garden.
President Donald Trump was similarly enthusiastic, saying “we’re going to get this past the Senate; I’m so confident.”
However, healthcare policy experts told FierceHealthcare that the legislation, which the House passed on a razor-thin margin, will face an uphill battle on its journey to the president's desk.
“It’s very clear that what passed the House is not going to pass the Senate,” said Julius Hobson, a healthcare lobbyist and attorney with the Washington, D.C., law firm Polsinelli.
For one, the amendments made to the bill may not comply with the Senate’s so-called Byrd Rule that governs what can be included in a budget reconciliation measure, he said.
In addition, Hobson pointed out that members of the Senate have already suggested that they are going to start from scratch rather than take up the House version of the bill.
“I’ve talked to a couple of key senators on this,” he said, “and to the last one, they said, ‘we will definitely have amendments,’ sort of laughing, as if to say, you know, ‘we’re not taking up that crap.’”
Sally Pipes, president and CEO of the right-leaning Pacific Research Institute, also pointed out that conservative senators such as Rand Paul, Mike Lee and Ted Cruz might prove difficult to win over.
Thus, “I think that it could be changed significantly at the Senate level,” she said.
Major hurdle in Medicaid
One of the major sticking points, Hobson said, will not be the AHCA’s individual market changes—which were the focus of amendments to the bill—but rather what it has in store for the Medicaid program.
“Medicaid will be a bigger issue in the Senate than it was in the House,” Hobson predicted.
For example, Sen. Rob Portman, R-Ohio, and Sen. Lisa Murkowski, R-Alaska, whose states both embraced Medicaid expansion, have already come out against what the House did in terms of cuts to the program, he noted.