The House Republican leadership’s American Health Care Act, which would overhaul large parts of the US healthcare system, was introduced this week after years of debate within the GOP. But it still has a ways to go to become law.
The bill will face some tough pushback from not only Democrats, but conservatives within the Republican Party, as well. Conservatives are angry that the bill still includes tax credits to buy insurance and have dubbed the law “Obamacare lite,” while moderates are worried about potential cuts to Medicaid funding.
Add on opposition from conservative thinks tanks, medical groups, and insurance lobbyists and the AHCA could have a tough road to President Donald Trump’s desk.
To get a sense of where we are in the process, we’ve created a handy checklist for the AHCA’s passage to make it easy. Let’s break it down.
House goes first
The first step for the AHCA came in the two committees that oversee healthcare matters. The bill was introduced to the House Ways and Means and Energy and Commerce committees on Wednesday, which started a long debate process.
Democrats tried to add amendments to the bill but were rebuffed by the Republican-controlled committees. The process also allowed Democrats to express their displeasure and delay it from moving forward — the Energy & Commerce Democrats, for instance, had the entire bill read aloud by committee clerks — but not stop it.
The Ways & Means committee eventually approved the bill at around 4:30 a.m. ET on Thursday, while the Energy & Commerce committee dragged on until around 2:20 p.m. ET.
The bill will next go to the House Budget Committee, which will consider it in much the same way the others did. If it approved by the Budget Committee (also Republican-controlled), it will move on to the House floor.
So, once the three committees have approved the bill and any amendments, it advances to the House floor for consideration. The full body will debate the bill and attach amendments, and then vote.
On to the Senate
If the bill is passed by the House, it will move on to the Senate.
In theory, Senate committees with jurisdiction over the bill could go through and do their own review and amendments process. Senate Majority Leader Mitch McConnell, however, suggested Wednesday that Republicans may take the bill straight to the full Senate floor for a vote. McConnell aides later clarified that this was only a suggestion.
The Senate could be the biggest hurdle for the proposed legislation. Conservatives such as Sens. Rand Paul and Mike Lee have said they will not support it because of the tax credits included in the bill, and because they argue it does not truly repeal Obamacare.
On the other end, senators in states that expanded the Medicaid program under the ACA, like Tom Cotton of Arkansas, have bristled at the AHCA’s rollback of Medicaid expansion funding after 2019.
Since Republicans only hold 52 seats in the Senate, only a few defections would be needed to kill the bill.
If the Senate makes changes to the bill and passes it, but it differs from the House version, there would be another step added. A conference committee, made up of members of the House and Senate committees that oversee healthcare, would convene and craft a compromise bill.
This compromise bill would then have to be pass both the House and the Senate before the bill would go to President Donald Trump’s desk.
Trump has said that he supports the AHCA, so he would likely sign it if it came to his desk in its current form.
The only real hiccup would be if an amendment or compromise is added that he does not favour. If that were the case, he could veto the bill, sending it back to Congress. Congress would need two-thirds of both the House and Senate to override the president’s veto for the bill to become law. This would be unlikely, given Democratic opposition.
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