In a response that came hours after the U.S. House of Representatives passed the American Health Care Act (H.R. 1628), Bishop Frank J. Dewane of Venice, Florida, Chairman of the U.S. Bishops’ Committee on Domestic Justice and Human Development, called on the Senate to strip out “harmful” provisions of the bill when the chamber takes it up for consideration or else to essentially start over on Republican efforts to repeal and replace Obamacare.

“Even with efforts to improve the bill before passage, the American Health Care Act still contains major defects, particularly regarding changes to Medicaid that risk coverage and affordability for millions; it is deeply disappointing that the voices of those who  will be most severely impacted were not heeded,” said Bishop Dewane, speaking on behalf of the U.S. bishops on May 4. “The A.H.C.A. does offer critical life protections, and our health care system desperately needs these safeguards. But still, vulnerable people must not be left in poor and worsening circumstances as Congress attempts to fix the current and impending problems with the Affordable Care Act.

“When the Senate takes up the A.H.C.A., it must act decisively to remove the harmful proposals from the bill that will affect low-income people—including immigrants—as well as add vital conscience protections, or begin reform efforts anew. Our health care policy must honor all human life and dignity from conception to natural death, as well as defend the sincerely-held moral and religious beliefs of those who have any role in the health care system,” said Bishop Dewane.

The bishops reiterated “key moral principles in health care reform,” which they have repeatedly emphasized since discussions about repealing the Affordable Care Act began. Among them: access for all people to comprehensive, quality health care that is truly affordable, including extra consideration for pre-existing conditions; respect for life by preventing the use of federal funds for abortion or to purchase health care plans that cover it; and conscience protections. Prior to Thursday’s vote, Bishop Dewane had urged House members to insist on such changes, especially for the sake of those who are struggling.

In a statement which also followed the House vote this afternoon, Carol Keehan, D.C., president and C.E.O. of the Catholic Health Association of the United States, expressed deep disappointment “with today’s vote in the House of Representatives to approve legislation that threatens the health coverage millions of Americans have gained through the Affordable Care Act.” According to Sister Keehan, the A.H.C.A.-proposed restructuring and cuts to Medicaid “will have devastating consequences for the many poor and vulnerable populations who rely on the program. The most recent amendments to the bill did nothing to alleviate those concerns, and in fact have made the legislation even more troubling by jeopardizing important protections for those with pre-existing conditions.”

She added, “As this legislation moves now to the Senate, C.H.A. will continue to work with lawmakers to address these issues. And on behalf of those we serve in Catholic health care, we will continue to advocate a health care system in which accessible and affordable health coverage is available for everyone.”

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In a statement congratulating House members who had pushed the legislation through along party lines, Speaker of the House Paul Ryan said, “Today was a big day, but it is just one step in this process. An important step. We still have a lot of work to do to get this signed into law. And I know that our friends over in the Senate are eager to get to work.”

Mr. Ryan, a Republican from Wisconsin, said the stakes were high for Americans, adding, “just this week, we learned of another state—Iowa—where the last remaining health care plan is pulling out of 94 of their 99 counties, leaving most of their citizens with no plans on the Obama market at all.

“What kind of protection is Obamacare if there are no plans to choose from?…The truth is this law has failed, and it is collapsing.”

Critics have argued that uncertainty created by Congress over the future of Obamacare is itself contributing to the purported collapse of the A.C.A. Indeed the insurance company Mr. Ryan referenced, Medica, had not actually come to a decision on pulling out of the Iowa market in 2018, but suggested in a statement released on May 3 that it was close to following two larger carriers who had already determined not to sell policies in Iowa next year.

“Without swift action by the state or Congress to provide stability to Iowa’s individual insurance market, Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today,” company officials said.

Before the vote, House Minority Leader Nancy Pelosi of California said, “With only hours’ notice and no C.B.O. score, Republicans are maliciously, again, attempting to destroy health care and coverage for the American people. This is really almost, I would say, a welcome debate. I would hope that they realize that this is really bad for the country.  But I do say that it is good in one respect: It’s going to provide a great civics lesson for America.”

Ms. Pelosi warned House Republicans facing mid-term elections will “have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.” On the House floor she condemned the legislation as “a tax bill disguised as a health bill.”

“This is a bill that is the one of the biggest transfers of wealth in the history of the country, from the middle class to the richest people and corporations in America.”

An Urban-Brookings Tax Policy Center analysis indeed finds that the A.H.C.A.’s changes to federal taxes and health care benefits “would be very regressive.”

“Taking both tax reductions and benefit reductions into account, the average high-income family would be significantly better off and the average low-income family would be significantly worse off under the A.H.C.A.” According to the analysis, an average family with less than $10,000 income in 2022 would be $1,420 worse off, a net reduction of more than 30 percent of the family’s income. But “the average family with more than $200,000 of income in 2022 would be $5,640 better off, a net increase of 1.1 percent of the family’s income.”

Kevin Clarke is America’s chief correspondent and the author of Oscar Romero: Love Must Win Out (Liturgical Press).