In a narrow vote cast on May 4, the Republican-controlled U.S. House of Representatives passed legislation to repeal and replace several aspects of former President Barack Obama’s Affordable Care Act. The 217-to-213 vote comes on the heels of the GOP’s March decision to refrain from bringing similar legislation to the House floor for a vote, after House Speaker Paul Ryan (R-Wisc.) was rebuked by the party’s Freedom Caucus. The bill now moves to the Senate, where Republicans hold a 52-to-48 majority, although the measure is likely to face considerable resistance in that chamber.

The bill, as currently formulated, would provide Americans with tax credits that could be used to purchase insurance plans; the bill would also rescind previous efforts to expand Medicaid coverage. Notably, the bill would effectively free insurers from existing obligations to cover certain pre-existing conditions; however, limited funding would be available for high-risk pools, somewhat mitigating the impact of this provision. 

The Congressional Budget Office, the nonpartisan agency tasked with “scoring” individual pieces of legislation, estimated that the earlier version of the bill would have ultimately shed 24 million Americans from insurance rolls. 

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