House Passes $1 Trillion U.S. Health-Care Legislation

House Passes $1 Trillion U.S. Health-Care Legislation

Nov. 8 (Bloomberg) -- The U.S. House approved the most far- reaching changes to the nation’s health-care system in four decades, voting to require all Americans to get coverage and to subject insurers to new restrictions and new competition from a government program.

The House voted 220-215 last night to approve the measure, which would cost more than $1 trillion over 10 years. Just one Republican, Representative Joseph Cao of Louisiana, backed the plan, and 39 Democrats broke ranks to oppose it.

Lawmakers hailed the step as a historic follow-on to the 1965 creation of the Medicare program for the elderly and disabled. They said the bill would cover 36 million uninsured Americans and curb costs. New rules would prevent insurers from denying coverage to people with preexisting conditions, and seniors would get help obtaining preventive care and medicine.

“The House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people,” President Barack Obama said in a statement after the vote. He urged the Senate to act as well to get him legislation to sign by the end of the year.

House Speaker Nancy Pelosi told reporters she spoke to Obama after the vote, which he helped cement with a visit to Capitol Hill earlier in the day. “He provided the vision and the momentum for us to get the job done,” Pelosi said.

With the House vote, Congress moved closer than ever to a goal of universal access to health care. The push for such legislation by then-President Bill Clinton and first lady Hillary Clinton, now secretary of state, never got past committee work in the early 1990s.

Spotlight on Senate

Even so, “much work remains,” said Maryland Representative Steny Hoyer, the No. 2 House Democrat.

The spotlight now moves to the Senate, where Majority Leader Harry Reid is struggling to get the votes to even begin debate on his version. Once the Senate passes a bill, lawmakers from each chamber would work together on a compromise for a new round of votes, a process likely to take months.

Reid last week wouldn’t commit to meeting Obama’s goal of signing a health-care bill into law by the end of the year. Already, it has been almost four months since four of the five congressional committees assigned to work on health care passed their versions of bills.

And House leaders can’t be sure of retaining all the votes they won last night. The bill passed over the objections of Democrats who favor abortion rights after an amendment put restrictions on the use of federal funds for the procedure for people using new insurance purchasing exchanges. Some Democrats said they wouldn’t back final legislation with the provision.

Debate Battles

The House vote came after a daylong session in which the battle over abortion funding threatened to derail the bill’s chances, and disputes over everything from illegal immigrants to the cost of the legislation peeled away enough Democrats to make the balloting close. Republicans attacked the bill, with leader John Boehner calling it a “government takeover of health care.”

The margin was narrow enough to prompt last-minute lobbying from Obama, who pressed lawmakers to “rise to this moment, answer the call of history” and pass his signature initiative.

Cao broke ranks with fellow Republicans and voted for the measure after speaking earlier in the day with Obama.

“I have always said that I would put aside partisan wrangling to do the business of the people,” said Cao, one of the most vulnerable freshmen. “My vote tonight was based on my priority of doing what is best for my constituents.”

Raucous Debate

The day began with a raucous debate over the ground rules for considering the legislation. Michigan Representative John Dingell, 83, presided over the proceedings, wielding the same gavel he used during the debate that led to the creation of Medicare to calm down lawmakers shouting over each other.

After more than 5 1/2 hours of general debate, the lawmakers turned to an amendment from Michigan Democrat Bart Stupak to further limit the use of federal dollars for abortions. It passed on a 240-194 vote.

They also rejected a Republican alternative bill by a 258- 176 vote. Democrats then erupted in cheers as they tipped over the 218 votes needed to pass the final legislation, counting down from 10 to 1 to mark the seconds ticking down on the clock to close the vote before exchanging more applause and hugs.

For most of the year, the biggest fight has been over the creation of a government-run insurance program, the so-called public option, to compete with private insurers such as Hartford, Connecticut-based Aetna Inc.

Compromise Proposal

Pelosi, a California Democrat, had to scale back her original proposal for the public option. Lacking votes for tying the program’s reimbursements to doctors to the lower rates paid by Medicare, she settled on a plan that would instead negotiate rates with providers, as private insurers do.

The Senate version calls for a similar program that would allow states to opt out. Still, Reid faces opposition to the public option from Senators Joe Lieberman of Connecticut, an independent aligned with the Democrats, and Olympia Snowe of Maine, the only Republican to vote for any proposal so far. At least four Senate Democrats have also been critical of the idea.

Reid needs all 60 votes controlled by the Democratic caucus to even begin debate, and it’s not certain he has them. He would then need 60 votes again to cut off debate and take a vote, amid battles over the public option and new taxes to pay for the expanded insurance coverage for Americans.

Lieberman’s Opposition

“We’re going to do this legislation as expeditiously as we can, but we’re going to do it as fairly as we can also,” Reid told reporters on Nov. 3.

Lieberman today reiterated his opposition to the current Senate bill and his intention to help block action on it.

If the public option remains in the Senate measure, “as a matter of conscience I will not allow this bill to come to a final vote,” Lieberman said on “Fox News Sunday.”

Mississippi Governor Haley Barbour, a Republican, predicted today that health-care legislation won’t get enacted, based in part on the close House vote on it.

That vote “augers what real trouble” Democrats are “going to have in the Senate” in trying to pass the bill, Barbour said on NBC’s “Meet the Press.”

Both the House and Senate bills require Americans to get insurance, add new restrictions on insurers and encourage greater use of preventive medicine, electronic records and research on the effectiveness of treatments.

Medicaid Expansion

Many of the House provisions take effect in 2010. The elderly would face no co-payments for preventive care and get help paying for drugs. The uninsured would get temporary aid until new purchasing exchanges are created, and young adults could stay on their parents’ plans until they turn 27.

House leaders also included an expansion of the government Medicaid program for the poor, which may cost the federal government less than providing subsidies to help people buy insurance. The plan would expand eligibility to people whose incomes are 150 percent of the official poverty level.

To finance their bill, House Democrats opted for a surtax on couples who make more than $1 million a year. They would also impose a 2.5 percent excise tax on medical devices that the congressional Joint Committee on Taxation estimates would raise $20 billion over 10 years.

Employer Mandate

The House bill also requires that employers offer insurance or pay a penalty, with exemptions for businesses with payrolls of less than $500,000. That is a subject of debate in the Senate, where the chamber’s health committee included a mandate and the finance panel rejected it.

The bill would make large businesses that self-insure their employees pay $2 billion in fees over the next decade. And it adopts a Senate proposal to set a $2,500 limit beginning in 2011 on contributions to tax-advantaged Flexible Spending Accounts used to pay out-of-pocket medical costs.

To address rising costs, the bill calls for the independent Institute of Medicine to make recommendations on how to fix the Medicare payment system and calls for Medicare to negotiate prices for drugs, potentially driving down prices.

Drugmakers managed to keep the negotiation provision out of the legislation that created the Medicare prescription drug program in 2003 and have fought it this year. The industry reached an agreement, now under fire, with Senate Finance Committee Chairman Max Baucus and the White House to pledge $80 billion to the overhaul effort and avert further contributions.

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