The struggle to provide Americans with affordable health insurance is an issue that politicians have attempted to address for decades. This month, Congressional Republicans put forward a bill called the American Health Care Act, that would replace the Affordable Care Act. The ACA, more commonly known as Obamacare, was the trademark legislation of the Obama administration. It enabled people with preexisting conditions to purchase health insurance by mandating insurance for all people and providing subsidies for people who could not afford insurance. The AHCA would repeal certain portions of Obamacare and replace them with a more free-market oriented program.

During the campaign, President Trump promised to “Repeal and replace [Obamacare] with something terrific.” While the AHCA fulfills the first part of the promise to repeal Obamacare, it remains to be seen whether the replacement is actually ‘terrific.’ When the new bill was announced, it quickly received criticism from many varied politicians and interest groups. Numerous conservative groups have come out against it, with Breitbart News even labelling the bill “Obamacare-lite.” Republican Senator Mike Lee of Utah and the Koch-backed PAC Americans for Prosperity are also among the prominent voices criticizing the bill from the right. The primary concern among conservatives is that the bill does not go far enough in reversing the ACA and reducing the subsidies and entitlements for the poor and elderly provided by Obamacare.

The bill has also, unsurprisingly, criticized by liberals, with Democratic minority leaders Nancy Pelosi of the House and Chuck Schumer of the Senate staunchly in the opposition. Liberal opponents have cited data that suggests the new plan would negatively and disproportionately impact lower income Americans, while providing huge tax cuts to the upper class. Their concern is rooted in a report by the Congressional Budget Office, a nonpartisan economic analysis agency, that estimated that a switch to the GOP-backed AHCA would lead to 24 million people losing health insurance. The majority of these people would be low income and between the ages of 50 – 64, just before the Medicare eligibility age.

The AHCA would also significantly scale back federal grants for Medicaid, which many states rely on to keep their entitlement programs afloat. Obamacare allowed states to expand eligibility for Medicaid through federal funding, and so this new bill has many Governors, including some prominent Republicans, such as John Kasich of Ohio and Eric Holcomb of Indiana, Vice President Pence’s former Lieutenant Governor.

Some prominent interest groups have also come out against the bill. As far as the electoral implications of the bill are concerned, the most important of these groups is the AARP. The AARP is an association of elderly people, a large, vocal group that consistently votes and tends to vote Republican. This is concerning for some GOP politicos, as the loss of health care for older people predicted by the CBO could lead to electoral losses in the 2018 midterm elections.

Later today, the House will vote on the bill. Speaker Paul Ryan and the rest of the GOP leadership has been working on whipping votes and establishing the party message for the past few weeks, however the vote is predicted to fail due to staunch opposition from Democrats, as well as almost 30 members of the very conservative House Freedom Caucus. The Republicans can only withstand 22 defections, assuming unity on the left, or the vote will fail.

UPDATE: On Friday, March 24, Speaker Paul Ryan pulled the American Health Care Act from consideration on the House floor and admitted defeat, saying that Americans are “going to be living with Obamacare for the foreseeable future.” Trump, conversely, spun the defeat as a victory, alleging that Obamacare was on the verge of a collapse, which would force the hand of legislators in the near future. Other Republicans disagreed, with Representative Mark Walker of North Carolina, the chairman of the conservative Republican Study Committee, saying Republicans “can’t pretend and say this is a win for us.”