Even before U.S. Rep. Kevin Yoder cast his vote to repeal the Affordable Care Act on Thursday, about 60 protesters had converged on his district office in Overland Park, vowing to hold the Republican congressman accountable when he runs for re-election next year.
Yoder, an Overland Park Republican, was one of 23 Republicans in districts Hillary Clinton won in November who had to choose between breaking with their party over a bill that was controversial at home, or throwing their support behind it to ensure a much-needed victory for their party. Their decisions could come back to haunt them on the campaign trail.
“There are a lot of members that can’t win on this,” said U.S. Rep. Emanuel Cleaver, a Democrat from Kansas City. “Either way, they’re in trouble.”
In the end, lawmakers like Yoder from Clinton-won districts helped carry the GOP plan to repeal the Affordable Care Act — widely known as Obamacare — to narrow passage Thursday in the U.S. House. Fourteen of them voted yes. Nine voted no.
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The Republicans’ Affordable Health Care for America Act squeaked by with just two votes to spare on a largely party-line vote of 217 to 213. It would eliminate the Affordable Care Act’s individual mandate, loosen regulations on insurance companies and make major changes to Medicaid. The bill will now head to the U.S. Senate, where it is expected to face an uphill battle.
Just a few hours before the vote, Yoder’s office said he remained undecided.
“He’s usually a late decider, and there’s nothing wrong with that, it just means he’s thinking it all through and wants to make sure he does the right thing,” said Rep. Tom Cole, an Oklahoma Republican. “But you know, Kevin’s not someone who’s usually one that’s an automatic yes or an automatic no, and honestly that pretty much reflects his district, which is much more of a swingy district.”
It wasn’t until after Yoder cast his ballot that Yoder issued a statement. He declined a request for an interview with The Star.
“We are seeing the dangerous collapse of Obamacare play out across the country,” he said. “Rather than forcing Americans to buy plans they don’t want or can’t afford, regulating insurance providers out of the market altogether, or leaving people with no options to choose from, the (GOP health care bill) makes the necessary changes to repair our health care system that’s collapsing before our eyes. For these reasons, today I voted yes.”
He was joined by the three other members of the Kansas delegation and by every Missouri Republican in the House, including U.S. Reps. Sam Graves and Vicky Hartzler, who represent portions of the Kansas City suburbs.
Cleaver voted against the bill, calling it poorly conceived and warning that it would raise costs for people with pre-existing conditions.
In the Kansas City area and on social media, the backlash against Yoder’s vote already has begun, with the protest at his district office organized by the progressive group Indivisible Kansas City, and a flood of angry messages on Twitter and Facebook.
Ginny Krystel, a 62-year-old Leawood resident, said earlier Thursday in an interview that she made dozens of calls to Yoder’s office urging him to vote against the bill. Each time she was told by Yoder’s staff that the congressman had not made up his mind.
“I have written Yoder. I have called Yoder. I have gone to his office here in Overland Park,” Krystel said. “Let me put it this way: If Kevin Yoder is surprised that Ginny Krystel or many other people don’t want Trumpcare to pass, then I’m afraid he’s been asleep.”
Krystel, a breast cancer survivor, had difficulty obtaining insurance after leaving her job at Sprint in 2001. She was able to get coverage through a high-risk pool for $1,200 a month. The passage of the Affordable Care Act in 2010 reduced that monthly premium to $250, she said.
Other constituents were happy to see the bill pass.
Tammy Schrader, a 56-year-old single parent in Overland Park, said that she canceled insurance for herself and her two children this year because her premiums had become too expensive under the Affordable Care Act.
“It was anything but affordable to me,” said Schrader, who owns a small engineering consulting business. She said that her premium for an insurance plan with a $5,000 deductible increased from $161 a month in 2014 to $720 a month for the same plan this year.
“I don’t know what’s in this new bill. I just want the old one to go away,” she said.
The Republican bill bars insurers from outright denying policies to people with pre-existing conditions. But it allows states to opt out of ACA mandates that prevent insurers from charging people more based on those conditions. Health policy experts say that could make insurance prohibitively expensive for people with chronic conditions in states that opt out.
A poll conducted by Public Policy Polling, a Democratic-leaning firm, found that as of last week, 59 percent of voters in Yoder’s district opposed the bill and only 21 percent supported it.
Clay Barker, the executive director of the Kansas Republican Party, said that Yoder had faced pressure on the bill from both opponents and supporters.
He said that the bill’s passage was important to Republicans because it will be seen as a sign that the GOP-controlled Congress can move the party’s agenda forward with a Republican president in the White House.
“It’s more of a psychological issue, not so much the particular policies in the bill, but they want to see Congress pass something,” Barker said. “It’s important to a lot of Republicans just to show momentum.”
Patrick Miller, a political scientist at the University of Kansas, said the bill was passed through a “very sped-up process” that’s unusual for Washington, where gridlock dominates.
“You have Republican members openly saying they don’t know what’s on the bill,” Miller said.
Miller said that if protections for pre-existing conditions are weakened, as the bill’s critics contend, then it could become a political liability for its supporters in 2018.
At the same time, if Yoder wants to move up in congressional leadership he was wise to vote for the bill, Miller said.
“In Congress, much more so than state legislatures, there is punishment for dissenting from the party,” he said.
David Jordan, the executive director of the Alliance for a Healthy Kansas, a group that has pushed to expand Medicaid in Kansas, said that lawmakers could face significant political fallout for supporting the legislation.
“This really is a terrible bill all around that impacts patients, every Kansan and impacts providers. And it really could have a disastrous impact on the state budget,” he said.
The legislation would block Kansas from expanding Medicaid — something that the majority of Kansas state lawmakers support — and would lead to reduced federal dollars for the state by shifting Medicaid funding to a per-capita system, Jordan said.
He cited a study from the Urban Institute, a Washington, D.C.-based think tank, that found that the policy change will cost Kansas $1 billion in federal aid over a 10-year period. Missouri will miss out on $3 billion in federal aid, according to the same study.
Older Americans will pay considerably more for insurance under the bill, according to Jim Torres, a program manager who has been enrolling people into the ACA marketplace for four years at the Samuel U. Rodgers Health Center in Kansas City. Current law restricts insurers from charging older customers more than three times as much as younger customers, but the bill enables insurers to charge older customers five times as much as younger customers and enables states to set their own ratios.
“Even with the tax credit subsidy, they (older customers) are going to pay more,” Torres said.
The Missouri Hospital Association said in a statement that the bill will reduce health insurance for more than 200,000 Missourians by 2020 and that states, such as Kansas and Missouri, that did not expand Medicaid “will be harmed disproportionately as the Act takes effect.”
The bill could face significant changes in the U.S. Senate. Sen. Claire McCaskill, a Missouri Democrat up for re-election in 2018, panned the bill shortly after its House passage, saying that “cutting protections for Missourians who’ve had the nerve to be sick before and have a pre-existing health condition, and making older Missourians pay more for their care, isn’t a solution. It’s a disaster for Missouri families.”
The Star’s Andy Marso and Eric Adler contributed to this report