When Will Trump's Healthcare Bill Become Law?

The Obamacare replacement is likely in for a long fight through the Senate.

Getty Images / Mark Wilson

House Republicans voted Thursday to pass a bill that would repeal and replace the Affordable Care Act if it’s signed into law by President Donald Trump. But when might that happen — if it ever does?

There’s no set or standard timeframe for the passage of a bill. Even though it’s cleared by the house, the next stages of debate over the AHCA could take months, even years, to resolve.

What’s Next for Trump’s Bill?

Before the American Healthcare Act (AHCA) ever sees the business end of the president’s pen, there are some substantial hurdles left for it to cross, the next of which is the Senate, which will have to either vote on the bill as it is now or implement some changes. Either scenario could result in a prolonged fight between both houses of the legislature.

In its current form, Trump’s much-pushed-for AHCA isn’t getting much love from anywhere on the political spectrum. Not a single Democrat — of whom there are 46, counting the two independents who caucus with them — will be voting for the bill. No surprise there. But there also seems to be precious few among the 54 Senate Republicans who are enthusiastic about the bill as well.

Some conservatives still don’t think the bill goes far enough. Others, the moderates, are concerned about the cutbacks to pre-existing condition protections and the Medicaid rollback. If the bill was voted on as is, it would likely fail. the bill will be dead in the water if the House, which could barely pass this compromised version (with a 217-213 vote), then refuses to change it.

If, instead, the Senate decides to change the bill — in all likelihood, moderating it by lessening the cuts to Medicaid and pre-existing condition protections — and passes that new form, the House will still need to have a say. It would then be a situation wherein each chamber has passed a different version of the bill. Per standard legislative procedure, a reconciliation process would begin with a goal of producing a bill that would be palatable for both the House and the Senate. But that will no doubt prove to be a difficult task, given the disparities in the priorities of Republican legislators who have already been put on display in the House debates.

And Republicans don’t have forever. If Democrats manage to retake either the House or the Senate in the 2018 midterms, getting the AHCA to Trump’s desk will be all but impossible.

How Does It Compare to Obamacare?

For perspective, former President Barack Obama’s Affordable Care Act took a little over a year, from start to finish, to become a law. Obama signed the final bill on March 23, 2010, after announcing his plans to work with Congress on a healthcare law in February of 2009, the month after he took office.

Its own process through the legislature wasn’t without trials and tribulations. And it was done under conditions much more favorable to Democrats.

Obama’s party had a majority in the House (larger than the one Republicans have now) and a supermajority in the Senate. They had 60 seats, enough to break a Republican filibuster, which was exactly what happened. The final vote to end debate in the Senate and pass the bill was 60-39. Then, in the House, the vote in favor of the ACA was 219-212, passing by only 3 more votes than Trump’s bill passed by on Thursday.

The difference? 34 House Democrats defected and voted against Obamacare, more than half again as many as the 20 Republicans who voted against the AHCA.

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