By Jon Taets

WASHINGTON – The House Republican bill meant to be the first move in a multi-step approach to repealing and replacing the Affordable Care Act (Obamacare) failed to win support in the House of Representatives last week. The bill, the American Health Care Act (AHCA), was pulled from the House floor before a vote was to take place to avoid its likely defeat.

The legislation was subject to much speculation and debate since the November 2016 elections, which resulted in Republicans controlling both chambers of Congress and the White House. Since its enactment seven years ago, Republicans pledged to repeal President Obama’s signature health-care law, and much of the 2016 election campaign was predicated on repealing and/or replacing the law.

Although the House failed to bring the AHCA to a vote, Senate passage also would have been problematic. Leading up to last week’s vote effort, House Republican leaders attempted to use a legislative procedure known as reconciliation to avoid filibuster in the Senate, which also restricts lawmakers to changing provisions that have a budgetary impact. This is known as the Byrd Rule and restricts senators from making policy changes to a bill unless those changes impact spending—in other words, several provisions that some conservative members want to get rid of in the AHCA could not be removed. By including some of those policy items, authors of the AHCA risked requiring the bill to reach the 60-vote threshold in the Senate for passage.

Despite these red flags, House Republican leaders and President Trump continued to move forward and attempt to gain votes from the Freedom Caucus, a group of the most conservative members in the U.S. House. Attempts were made to include language in the AHCA that would repeal a list of items that insurance companies are required to cover under the law, also known as the essential health benefits, as well as include repeal of both the individual mandate and the employer mandate. However, because these provisions violate the Byrd Rule, inclusion in the AHCA would have been fatal to the bill’s chance of passage in the Senate.

Support for the AHCA also dwindled from members of the so-called Tuesday Group, a group of GOP moderates who said they could not support the bill, mostly because of the dramatic changes to the Medicaid system.

Late Thursday, the White House announced that it was “done negotiating” with conservative members and the AHCA stood as a “take it or leave it” proposition. Further, President Trump insisted a vote would take place on Friday. Trump also took to Twitter to pressure reluctant conservatives to vote in favor of the bill. He also went so far as to announce that if the bill failed, the White House would move on from ACA repeal and the law would be left in place. These efforts ultimately proved futile: At 3:30 pm on Friday, around the time the vote was expected, Republican leaders pulled the bill from the floor.

With the future of Obamacare repeal and replace efforts in serious jeopardy, failure to pass the AHCA may endanger the success of the second big ticket item Congress has planned: A major overhaul of the U.S. tax system. The health-care bill included several tax provisions that would have reduced the tax baseline, making the job easier on those writing the overall tax reform proposal to find enough “pay-fors” to help smooth the work on that package. Without these provisions, tax writers will have a difficult time preventing the package from showing deficits beyond the standard 10-year budget window. This is another procedural issue under reconciliation that could endanger tax reform’s chance of success.

Jon Taets is government relations director at NACS. He can be reached at jtaets@nacsonline.com.