WASHINGTON — With Idaho Congressman Mike Simpson wielding the gavel, the U.S. House voted Thursday to roll back key provisions of the Affordable Care Act and replace it with a new plan.

“The speaker asked him to preside for the debate and vote,” his spokeswoman Nikki Wallace said. “He is very experienced and skilled at managing the floor.”

Simpson, whose district includes the Magic Valley and who is in his eighth term in Congress, isn’t a stranger to presiding over debates — he was Speaker of the House when he was in the Idaho Legislature. He has also presided over the U.S. House before, including once in 2011 for a reading of the U.S. Constitution and in February of this year when Democrats made an unsuccessful attempt to pass a resolution to force President Donald Trump to release his tax returns.

“They put him in the chair when they have a vote that’s going to be difficult, or the debate would be,” Wallace said, because of his extensive knowledge of parliamentary procedure.

Both Simpson and Idaho’s only other congressman, U.S. Rep. Raul Labrador, voted for the GOP’s American Health Care Act, which passed 217-213 with 20 mostly purple-district Republicans opposed.

“I voted against the passage of Obamacare and I have voted to repeal it over 60 times,” Simpson said in a statement after the vote. “Many members promised the American public that they would repeal and replace Obamacare and this vote is the first step to fulfilling that promise. I believe in keeping my promises.”

Simpson cited a Congressional Budget Office estimate that the bill would reduce premiums by 10 percent and said it also eliminates “the most burdensome Obamacare mandates” such as some of the taxes in the Affordable Care Act and the mandates that individuals must buy health insurance or pay an extra tax and that employers with more than 50 workers must offer insurance.

“The Affordable Care Act is unsustainable given its current trajectory,” Simpson said. “The thought of a total collapse in the health care market is simply too dangerous to ignore given the stakes. The question today was to stick with Obamacare or to start the process of fixing our broken health care system. The American Health Care Act is the only opportunity we have to start that replacement process. It is not perfect given the limited scope of reconciliation rules, but to fix health care we need to start somewhere.”

By reconciliation rules, Simpson was referring to the fact that the bill was written as a budget bill, the purpose being that spending bills can’t be filibustered and can pass the Senate with a simple majority rather than the 60 votes that would be needed to break a filibuster.

Labrador, whose House Freedom Caucus opposed a previous version of the bill on the grounds that it didn’t go far enough, said Congress’ work on health care is “far from done,” and he is still committed to a total repeal of the ACA, but that the AHCA is the best way to get there eventually.

“The bill we passed today strikes down Obamacare’s prohibition on less expensive health care plans and the knot of insurance regulations and mandates that are making health coverage so unaffordable,” Labrador said. “Meanwhile, it sets up a national $130 billion invisible high-risk pool to help offset the cost for those with pre-existing conditions.”

The group Close the Gap Idaho, which has been lobbying for Medicaid expansion, released a statement blasting the vote, citing estimates that it could lead to 24 million people losing their insurance over the next decade and weaken protections for the more than 662,000 Idahoans who are estimated to have pre-existing conditions.

“The (Idaho Medical Association’s) goal is to ensure that all Idahoans have health care coverage,” CEO Susie Pouliot said in a statement. “Unfortunately, passage of the AHCA through the U.S. House today takes us in the wrong direction by causing millions of Americans to lose the health insurance they now have. Further, the AHCA puts chronically ill people at risk of being priced out of the insurance market, if they can even find coverage at all. IMA is disappointed with this outcome that will hurt many Idahoans.”

Idaho is one of 19 mostly red states that opted not to expand Medicaid under the Affordable Care Act. It is, however, one of the few Republican-run states to have created its own state-run exchange rather than rely on the federal market. The exchange’s creation was supported by Gov. C.L. “Butch” Otter and most of the “establishment” wing of the state party, and even Republican lawmakers often point to it as a model of a well-run exchange other states could learn from.

Your Health Idaho Executive Director Pat Kelly told the exchange’s board in March that a previous version of the bill could have resulted in almost 60,000 Idahoans leaving the exchange by 2020 — more than half of the roughly 106,000 enrollees — due both to the repeal of the individual mandate and to cuts in the tax credit subsidies people use to buy coverage, saying the credit received by a family of four with a $50,000 a year income would drop by 23 percent.

Kelly, who was in Washington Thursday to meet with lawmakers, said it was “difficult to speculate” at this point how the changes would affect Idahoans.

“We will continue to work with policymakers and review input from the Congressional Budget Office and the Senate in the weeks to come,” Kelly said in an email. “For now, it’s business as usual at Your Health Idaho. Idaho has one of the most successful and cost-efficient health insurance marketplaces in the country. As changes are made, we are confident that by working with our partners at the state and federal level, we can once again provide the right solution for Idahoans. Our technology, processes, partners, and people are ready to adapt.”

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