An amendment that gained crucial support for the bill from the conservative House Freedom Caucus lets states get waivers from some of Obamacare’s consumer protections. States could allow insurers to charge higher premiums to people with pre-existing conditions if they’ve had a gap in coverage as long as the state provides people priced out of commercial insurance with assistance, such as a so-called high-risk pool. States also could get waivers from a requirement that insurers provide health benefits deemed essential, such as maternity care.

House leaders gained the last few votes from reticent moderates this week by agreeing to another $8 billion over five years for the high-risk pools.

Health Group Opposition

Health organizations and patient-advocacy groups almost uniformly oppose the Republican proposal. American Medical Association President Andrew Gurman said in a statement that "millions of Americans will lose their health insurance as a direct result of this proposal." AARP, the senior citizens’ lobby, said the $8 billion added to the measure to fund care for people with pre-existing conditions was a "giveaway to insurance companies."

About 27 percent of adults have a pre-existing condition like cancer or heart disease that insurers refused to cover before Obamacare, said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation. “There are millions with pre-existing conditions,” he said.

The earlier version of the Republicans’ bill would cause 24 million people to lose health insurance in 2026, according to a report by the nonpartisan Congressional Budget Office, which didn’t have time to produce an updated analysis before the House vote.

“What did the majority do in the last six weeks? They made the bill worse,” said Representative Diana DeGette, a Colorado Democrat, during floor debate. “My Republican colleagues are going to be really, really sorry that they rushed this bill to the floor before they got the amended CBO score.”

Republican senators have said they won’t vote on the plan to repeal Obamacare until they have an updated CBO analysis.

Insurance Options

Part of Ryan’s argument for urgency in Thursday’s vote is his repeated assertion that Obamacare is collapsing. While insurers including Aetna Inc.,  UnitedHealth Group Inc. and Humana Inc. have pulled out of the individual market in some states, part of that decision stems from uncertainty about the future of the Affordable Care Act as Republicans seek to dismantle that law.