Senate Republicans initially sought to pass the Better Care Reconciliation Act of 2017 (BCRA), a healthcare bill containing provisions largely similar to those of the AHCA.

[3][4][5] The ACA (colloquially called "Obamacare"), a major reform of health care in the United States, was passed in 2010 by the 111th Congress and signed by President Barack Obama in 2010 after nearly a year of bipartisan debate.

[6] The ACA draws from many conservative ideas proposed by The Heritage Foundation in the 1980s and 1990s, which included a mandate that all have coverage to prevent "free riders", subsidy tax credits, and Medicaid reform.

[20][21][22] Key provisions of the Republican Senate BCRA take effect over several years and include: Public opinion regarding the Republican House (AHCA) and Senate (BCRA) bills was very negative (i.e., opposed), with approval ratings between 12 and 38%, and disapproval ratings between 41% and 62%, measured between March and June 2017 (refer to "Specific poll results" table below for sources).

[33] There are many variables that affect premiums, deductibles, and out-of-pocket amounts, including (among others) age and health of plan participants, availability of subsidies, funding for high-risk pools, required insurance coverage elements, lifetime limits, maximum ratio of prices charged to older persons versus younger, and the quality of insurance offered.

[36] The Center on Budget and Policy Priorities (CBPP) reported that "The House bill would represent the largest transfer in modern U.S. history from low- and moderate-income people to the very wealthy."

CBO estimated that there would be 15 million fewer Medicaid enrollees relative to current law by 2026, the largest component of the reduced coverage discussed above.

[41] According to researchers at the Milken Institute School of Public Health at George Washington University, the AHCA legislation would lead to a loss of 924,000 jobs by 2026.

[20] Yale Law School professor Abbe R. Gluck, the director of the Solomon Center for Health Law and Policy, writes that Republican elected officials have taken a variety of steps to "sabotage" the ACA, creating uncertainty that has likely adversely impacted enrollment and insurer participation, and then insisting that the exchanges are in difficulty as an argument for repealing the ACA.

Individuals who wished to buy insurance but were outside of the coverage gap would have paid a 30 percent premium surcharge for one year and then return to standard rates.

[62] Representative Richard Neal, the ranking Democratic member of the House Ways and Means Committee, stated: "To consider a bill of this magnitude without a CBO score is not only puzzling and concerning, but also irresponsible.

[63] The bill next went to the House Budget Committee, which passed it on March 16 by 19 to 17 votes, with three Republicans from the conservative Freedom Caucus joining Democrats in opposition.

[69] The comparatively "lightning fast" legislative movement for the AHCA through the House was in contrast to the Affordable Care Act, which took months of negotiations, committee markup, and debate before passage in 2010.

[70] The quick process prompted complaints from Democrats "that the Republicans were rushing to approve a repeal bill without hearing from consumers, health care providers, insurance companies or state officials – and without having estimates of the cost or the impact on coverage from the Congressional Budget Office".

[72][73] The Freedom Caucus members, among their primary objections to the bill, were not convinced that the healthcare replacement effectively abolished some elements of the Affordable Care Act, most prominently the essential health benefits.

[74] Amid the division between the Republicans, the party leadership, which was led by House Speaker Paul Ryan, attempted to ease concerns among the Freedom Caucus and others.

[82] Shortly after the time of the expected vote it was announced that the Republicans were withdrawing the AHCA from consideration, a decision made after Ryan met with Trump.

[96] On May 3, House Republicans announced that they had enough votes to pass the bill, after amending it to include an additional $8 billion over five years to subsidize insurance for people with pre-existing conditions.

These included the: Under the various Senate bills, the CBO estimated that relative to current law, millions more would be without health insurance and the budget deficit would be reduced moderately (roughly 5% or less over a decade).

The effect on insurance premiums would vary widely in the exchange marketplaces (the non-employer market created by Obamacare) depending on the specific legislation.

Eligibility for premium subsidies would be tightened for middle-class recipients, but some aid would be extended to enrollees below the poverty level in states that did not expand Medicaid.

"[108] On July 17, Senators Mike Lee (R-UT) and Jerry Moran (R-KS) came out against the bill, joining Rand Paul and Susan Collins who already opposed it, making it impossible for Republicans alone to pass it through.

In a very climactic moment, he gave a thumbs down and the bill was rejected 49–51, with two other Republican senators, Susan Collins and Lisa Murkowski, siding with all Democrats and Independents.

[113] On September 13, 2017, Senators Graham, Cassidy, Heller, and Johnson released a draft amendment to the bill[114] that "repeals the structure and architecture of Obamacare and replaces it with a block grant given annually to states".

[121] The Koch brother-supported organizations Americans for Prosperity and Freedom Partners have indicated their intention to put together a multimillion-dollar fund in support of re-election campaigns for conservative lawmakers who take a stand against the bill.

Conservative groups, including Heritage Action, the Cato Institute, Americans for Prosperity, FreedomWorks, and Tea Party Patriots all oppose the bill.

[125] Economist and The New York Times columnist Paul Krugman stated that the bill's "awfulness is almost surreal", writing that what Republican congressional leadership "came up with instead was a dog's breakfast that conservatives are, with some justice, calling Obamacare 2.0.

But a better designation would be Obamacare 0.5, because it's a half-baked plan that accepts the logic and broad outline of the Affordable Care Act while catastrophically weakening key provisions.

Congressional Democrats and interest groups, such as the AARP, American Medical Association, ACLU, and Planned Parenthood, expressed their opposition to the bill.

[148] Lets state impose work requirements on Medicaid recipients Fee on health insurance providers firms based on plans 2.3% tax on medical devices