After an embarrassing Trump healthcare flop on May 3rd, 2017, the Republican controlled House of Representatives finally passed through the American Health Care Act. After careful analysis by the Congressional Budget Office, a nonpartisan group of economists, the bill is predicted to cause 14 million Americans to lose their health care coverage by 2018, and up to 26 million in 2026. Representative Don Beyer of Virginia dubbed the AHCA “a disaster,” while House Speaker Paul Ryan assured his colleagues and constituents, “I recognize and appreciate concerns about making sure people have access to coverage.” Many Republicans, however, looked at the CBO’s assessment as a triumph. Though as many as 26 million Americans may lose their healthcare, the CBO also reported a deficit decrease of $337 billion, a saving that might placate Senators still tentative in their support for the bill.

President Trump made the promise to “repeal and replace” Obama Care (or the Affordable Care Act), a key component of his campaign message. This new bill comes with his full endorsement and support despite the widespread loss of coverage. The AHCA dismantled several key aspects of the ACA, including the mandate that served as the glue to the entire system. By making health insurance mandatory for all Americans with fines and subsidies, the American Health Care act ensured that both the healthy and ill were paying monthly premiums. Now that the mandate is being stripped away (for both individuals and corporations), premium costs may rise up to 20%. In addition, funding for critical organizations (like Planned Parenthood) has been completely stripped, and insurance companies can now charge those of the same age different premiums based on their health (under the ACA, premiums were determined by age alone instead of pre-existing conditions).

Only two fragments of Obama Care remain—young adults may remain on their parents’ plan until they are 26, which covers the coverage gap between college graduation and employment—and no insurance company can turn someone away for a pre-existing condition (though they may have high premiums and deductibles).  

According to BBC News, “the pain from the cuts to coverage and subsidies will be more immediate and focused on the poor and the elderly.” Under the previous bill, the elderly could not be charged more than three times the premium of their younger peers, however now they are at risk of being charged five times that much. In addition, if the bill is made into law, by 2020 no states will be permitted to bring additional adults into the expanded Medicaid program (preventing as many as 10 million low income Americans from getting insurance by 2024).

Now that the House of Representatives have passed the AHCA, the bill moves on to the Senate floor. There it will remain for several months while they await the Congressional Budget Office’s estimate on the bill’s economic costs (how many votes the bill needs to pass depends on if it increases national debt). After this estimate, the Senators will make their own revisions to the bill, send it back to the House of Representatives for confirmation, and then on to the president for a signature.