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House Passes Historic Health Care Reform


House Speaker Nancy Pelosi (D-Calif.), carrying the gavel used to pass Medicare in 1965, and members of the House Democratic Caucus on Sunday (EPA/ZUMApress.com)

With the last-minute support of anti-abortion colleagues, House Democrats on Sunday passed historic legislation to extend health coverage to tens of millions of uninsured Americans, protect patients from the most flagrant abuses of insurance companies, and curb runaway health care costs. All told, the $940 billion reforms represent the most sweeping overhaul of the nation’s health care system since the creation of Medicare more than four decades ago.

[Congress1]The tally was 219 to 212 in support of reforms passed by the Senate on Christmas Eve, with 34 Democrats joining every Republican in the lower chamber in opposition to the measure. An accompanying reconciliation proposal — which tweaks the Senate bill to address what House leaders considered to be inherent weaknesses — also passed, 220 to 211.

Democratic leaders were quick to place the reforms among the most significant in the nation’s history — legislation on par with that establishing Social Security, Medicare and new civil rights protections. “This is an American proposal that honors the traditions of our country,” House Speaker Nancy Pelosi (D-Calif.) said just before the votes. “We may not have chosen the time, but the time has chosen us.”

The Senate bill now moves to the White House, where President Obama will sign it shortly into law. The separate reconciliation bill then goes to the Senate, where Democrats are hoping to pass it before the Easter recess, which begins Friday. Reconciliation rules prevent upper-chamber Republicans from filibustering the proposal, meaning that Democrats need just 51 votes — not 60 — to pass it.

For House leaders, the victory didn’t come easy. Sunday’s vote capped a tension-filled week in which some Democrats who’d previously supported health care reform announced their opposition; others who’d formerly opposed reform announced their support; and party leaders were left with the delicate task of counting heads to ensure they had the numbers to pass the bill.

Quite aside from the unified GOP opposition, anti-abortion Democrats, led by Michigan Rep. Bart Stupak, had vowed to oppose the bill over language they feared would allow federal funds to subsidize abortion services — something that’s been prohibited for more than 30 years. And they had the numbers to kill the proposal. Breaking the impasse required the muscle of the White House, which stepped in Sunday to issue an eleventh-hour executive order stipulating that nothing in the reform bill would dilute the decades-old prohibition on the federal funding of abortion. The move — while blasted by abortion rights groups — caused the abortion opponents to throw their support behind the proposals.

“The real winner,” Stupak said Sunday at a press conference announcing the deal, “is really the American people.”

The rare weekend vote came after more than a year of rancorous debate over how Congress should approach health care reform. The saga first pitted Democrats against Republicans, but later — when it became clear that no Republicans would support the bill — saw liberal Democrats and their moderate colleagues doing battle over the most contentious provisions of the enormous bill. In the end, party leaders, behind Pelosi, convinced enough Democratic critics — both liberal and conservative — that the proposals would at least take steps toward fixing a health care system that all sides agree has grown dysfunctional.

“This is not the bill I wanted to support,” Rep. Dennis Kucinich (D-Ohio), the liberal single-payer supporter, said recently in announcing his reluctant support for the bill. “Hopefully” he added, it will take the country “in the direction of comprehensive health care reform.”

At the center of the reforms are a series of provisions reining in the most controversial practices of the health insurance industry. Under the reforms, for example, insurance companies could no longer deny coverage based on pre-existing conditions. They could no longer drop coverage when a patient gets sick. They could no longer hike premiums indiscriminately. And they could no longer put caps — either annual or lifetime — on coverage benefits.

Among the other major provisions, the reform bills will:

  • Increase Medicaid coverage to most folks living below 133 percent of the federal poverty level ($29,327 for a family of four), while providing sliding-scale federal subsidies to those living below 400 percent of poverty ($88,200 for a family of four).
  • Require most Americans to buy health insurance or face financial penalties.
  • Take incremental steps to close the coverage gap in Medicare’s prescription drug benefit — the so-called doughnut hole — by 2020.
  • Hike Medicaid rates on primary care services to equal those of Medicare.
  • Extend funding for the Children’s Health Insurance Program through 2015.

To fund the changes, the proposals will:

  • Cut more than $500 billion from the Medicare program, largely targeting the private insurance plans that receive huge subsidies to cover Medicare patients.
  • Apply a 0.5 percent hike on Medicare’s payroll tax for individuals earning more than $200,000 and families earning more than $250,000.
  • Tax the most expensive insurance plans, those costing more than $10,200 for individuals and $27,500 for family plans. (That tax will take effect in 2018.)

The Congressional Budget Office, which has estimated that the bill will expand coverage to roughly 32 million uninsured Americans, said Saturday that the changes will reduce federal deficits by $143 billion over the next decade, and by roughly $1 trillion in the 10 years to follow. The analysis at once convinced some Democratic budget hawks to support the bill, and took the wind from the sails of Republican critics who have said the reforms will bankrupt the nation.

Not that it prevented GOP leaders from attacking the reforms to the last. Rep. Marsha Balackburn (Tenn.), the first Republican to speak on the floor Sunday, set the tone early, blasting the Democrats for reforms that Republicans say will steal patient choice.

“Only they see the death of freedom … as a cause for celebration,” Blackburn said. “It is their children who will pay for their greed.”

Rep. Nathan Deal, the senior Republican on the Ways and Means health subpanel and candidate to become Georgia’s governor, echoed those criticisms. He vowed that, if elected to the governor’s office, he’ll focus on nullifying the reforms, particularly the Medicaid expansion, which many Republicans have called an unconstitutional mandate on states.

“The problem with socialism,” Deal said Sunday, “is that you ultimately run out of other people’s money.”

But in the end, Republicans — while effective in slowing the pace of the legislation — were helpless to prevent its passage.

The historic nature of the vote was not lost on Democratic leaders. Pelosi, who presided over the final vote, waved the same gavel that was used when Medicare passed the lower chamber more than six decades ago. And Rep. Louise Slaughter (D-N.Y.), the head of the Rules Committee who managed part of the day’s debate, was brandishing her own copy of a 1939 letter to Congress from Franklin Delano Roosevelt, a letter urging lawmakers to include a national health care system as part of the Social Security program.

“Good health,” FDR had written, “is essential to the security and progress of the Nation.”

Seventy-one years later, Democrats are hoping he was right.

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