What to watch for: Nail-biter on repealing health law

A sizable number of House Republicans have been either opposed to the bill or undecided in recent days. But Republican leaders now say they have the votes to pass the legislation, called the American Health Care Act.

Here’s a look at what to watch as the repeal plan moves toward the House vote.

Do Republicans have the votes?

The House majority leader, Kevin McCarthy of California, told reporters Wednesday night that Republicans do indeed have enough votes to pass the bill.

Yet suspense remains.

First, a reminder about the math. If all members vote, and all Democrats oppose the bill, Republicans can lose no more than 22 members to approve the repeal.

In recent days, roughly 20 Republicans have said they opposed the measure, but that number shrank slightly on Wednesday. How much it ultimately shrinks remains to be seen.

But numerous other members have been undecided about the bill, or their positions have been unknown. So the math is not as simple as counting up the number of Republicans who say they oppose the health care plan.

McCarthy said the full House vote would take place early Thursday afternoon, after what is surely to be an impassioned debate.

Will the bill’s changes prove enticing?

House leaders have made changes to their bill in an attempt to win passage.

One amendment, drafted by Rep. Tom MacArthur, R-N.J., would allow states to apply for waivers to opt out of certain insurance requirements of the health care law.

That won over the conservative House Freedom Caucus. But it worried more moderate House members, who feared it would make insurance unaffordable for people with pre-existing medical conditions.

Another amendment, offered by Rep. Fred Upton, R-Mich., aimed to ease those concerns. It would provide $8 billion over five years to help states cover people with pre-existing conditions.

What about the Democrats?

Democrats are not pleased.

But they do not have the numbers to stop the bill. All they can do is air their grievances and hope enough Republicans heed their warnings and vote against it.

Expect to hear complaints from Democrats on two fronts: The substance of the bill and the process by which Republicans are passing it.

For one thing, the vote will occur without a new analysis from the Congressional Budget Office, the official scorekeeper on Capitol Hill.

Rep. Jim McGovern, D-Mass., complained on Wednesday night about what he described as “fixes upon fixes to fix the fixes to fix the fixes.”

This process, McGovern said, is a mess. “I don’t know how anybody can defend it,” he added.

What comes next?

Even if the House passes the bill Thursday, the health care law will remain in place — at least for now.

The repeal bill would then head over to the Senate, where it is not likely to be met with great celebration.

Yes, Republican senators share their House colleagues’ desire to repeal major parts of the Obama-era health law.

But they might not agree on exactly which parts.

Already, Republicans in the Senate have aired a variety of concerns about the House plan, including how it would affect states that expanded Medicaid under the health law and whether it would raise premiums to unaffordable levels for older Americans.

In other words, expect to see plenty of changes to the House bill — and, in the long run, plenty more fits and starts.