WASHINGTON (AP) -- The House of Representatives have narrowly approved a bill to erase much of Obama's health care law, answering campaign pledge and sending the measure to the the Senate.
President Trump and House Republican leaders held meetings late Wednesday trying to broker a deal within their party between moderates and House Freedom Caucus conservatives who had been at odds over the direction of the GOP health care bill.
The breakthrough came after moderate Rep. Fred Upton (R-Michigan) proposed an amendment to add $8 billion over five years to help people with pre-existing conditions pay for insurance coverage.
"I support the bill with this amendment that's going to be included as part of the rules package," said Rep. Upton, who serves on the House Energy and Commerce Committee.
The issue came into the national spotlight, after late night talk show host Jimmy Kimmel broke into tears this week during a 13-minute monologue, saying his son was born April 21st with a heart defect and needed emergency surgery.
"I saw a lot of families there and no parent should have to decide if they can afford to save their child's life," Kimmel said, "If your baby is going to die and it doesn't have to. It shouldn't matter how much money you make. We all agree on that right?"
"Don't let their partisan squabbles divide us on something every decent person should want," Kimmel added, urging Congress to avoid repealing the provision in Obama's Affordable Care Act that prevents insurers from charging more for patients such as his son, who might be deemed more costly to cover.
A video of Kimmel's roughly 13-minute monologue on his Facebook page drew more than 14 million views within a day, news site Axios reported. It reached 18 million views by Wednesday, compared to his usual 1 million views. Former President Barack Obama tweeted about it ("Well said, Jimmy"), and Rep. Sheila Jackson Lee, D-Texas, referred to it on the House floor as she restated her opposition to Republicans' proposed overall of Obama's Affordable Care Act.
On Wednesday, Trump White House spokesman Sean Spicer was queried about Kimmel and said President Trump was fighting to improve the bill with protections for those with pre-existing conditions like Kimmel's child.
The Upton amendment would give financial aid to people with pre-existing conditions who might face higher insurance rates under the GOP bill. The Republican bill would eliminate the Obama ACA provision that banned insurers from denying coverage or charging higher rates to people with pre-existing conditions. Instead, Republicans would spend $130 billion to help states form insurance pools of high-risk patients.
Four Republican moderates including Upton, Representatives Billy Long of Missouri, Daniel Webster of Florida and David Young of Iowa reversed their opposition and announced support for the amended GOP health care bill. Conservatives agreed to stay on board.
"While this is not full repeal, it's the best we think we can get out of the House, we're willing to support it and then keep working for full repeal," said Ohio Republican Jim Jordan with the House Freedom Caucus.
At the Lifelong Urgent Care Center in Berkeley, Dr. Eric Henley says insurers could vary widely, though, in how they define pre-existing conditions.
"Cancer, heart disease, heart failure, previous heart attack, high blood pressure, diabetes, kidney disease," said Dr. Henley, listing some conditions that he says many insurers might cite as reason for charging higher rates.
"But sometimes insurers will make a big deal out of things that we would all think are not such a big deal. Maybe you've been treated for something 5 years ago, you had some anxiety or depression that was on your record, but was no longer an issue for you," Dr. Henley added, "It really runs the gamut from things we would consider relatively major to things we might think are minor or relatively common."
Dr. Henley says there is concern about whether the financial burden will be shifted to clinics and providers who must decide how to balance care with costs. There is also a concern, he says, over whether patients with no or inadequate insurance coverage will forgo care if they cannot afford to pay.
"Consultations from specialists, they may need to go to the hospital, they may need special imaging studies, if they're uninsured, they're on their own," said Dr. Henley.
"I just believe it's unfair because a lot of people ain't got money. Where is the money coming if they ain’t got it," said Disraeli Hives, a patient from Richmond with diabetes says she's concerned about her own coverage in the future.
"I think they should make it easier, more affordable, more convenient for people," said Dylan Roselius, 21, of Emeryville who says he has coverage under his mother's policy.
Republicans say the GOP bill preserves the Obama ACA provision that allows people up to age 25 to remain on parents' plans. The bill would let states escape requirements that insurers provide a menu of basic services like preventive care. Overall, the legislation would cut the Medicaid program for the poor, eliminate fines for people who don't buy insurance and reduce subsidies.
The American Medical Association, AARP and other consumer and medical groups are opposed. The AMA issued a statement saying the changes sought by Upton and Long "tinker at the edges without remedying the fundamental failing of the bill -- that millions of Americans will lose their health insurance as a direct result."
If the GOP bill became law, congressional analysts estimate that 24 million more Americans would be uninsured by 2026.
House Democrats questioned the cost, calling for a new congressional budget office assessment before any vote.
"We hope if it comes forward in a revised form that it is accompanied with a congressional budget office score so that members on both sides of the aisle might know the ramifications of the changes in the bill," said Maryland Congressman Stenny Hoyer.
"If Republicans have their way Americans with pre-existing conditions will be pushed off their insurance and segregated into high risk pools where they face soaring cost, worst coverage and restricted care," said House Minority Leader Nancy Pelosi of California.
GOP leaders can lose only 22 from their ranks and still pass the bill, and an Associated Press tally found 17 opposed.
The GOP has been tryingto repeal the Obama health care law even as around 20 million Americans gained coverage under it.
A successful outcome would make good on the GOP's No. 1 goal of undoing Obama's signature legislative achievement, and provide a long-sought win for Trump, who has been in office more than 100 days without a significant congressional victory save Senate confirmation of a Supreme Court justice.