House passes health insurance reform bill on close vote

By DAVE HELLING and DAVID GOLDSTEIN
The Kansas City Star

A pounded gavel, the votes, then four words: “The bill is passed.”

With that, House Speaker Nancy Pelosi announced narrow passage Saturday of historic legislation that would fundamentally change American health care for decades.

Democrats erupted in weary applause and cheers after a day-long debate. Republicans, equally tired, promised to continue opposing the $1.1 trillion plan.

The vote was razor close — 220-215. Thirty-nine Democrats, including Rep. Ike Skelton of Missouri, voted against the measure, while only one Republican, Rep. Anh “Joseph” Cao of New Orleans, voted for it.

Every Republican from Kansas and Missouri voted no, while every other Democrat, including Rep. Dennis Moore of Kansas, voted yes.

“Tonight, in an historic vote, 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 in a statement.

Republicans did not agree.“Tonight, the Washington Democrats…(rammed) through a budget-busting, 2,000-plus-page health care plan with bipartisan opposition,” said Rep. Roy Blunt, a Missouri Republican, in a statement.

The nearly 2,000-page bill isn’t law yet — the Senate is struggling with its version, which will have to be merged with the House bill before a final vote. But Democrats said a significant hurdle had been overcome.

“There are few moments when we have the opportunity to do so much good with one vote. This is one of those moments,” said Rep. Steny Hoyer, a Maryland Democrat.

The final vote was in doubt for much of the day. It took a visit to Capitol Hill by Obama — and a last-minute compromise allowing a vote on tougher restrictions on abortion funding — to persuade enough reluctant conservative Democrats to provide the margin of victory.

“When I sign this in the Rose Garden, each and every one of you will be able to look back and say, ‘This was my finest moment in politics,’” Obama reportedly told Democrats in the private meeting.

During the sometimes contentious debate, which lasted all of Saturday, GOP members repeatedly complained about the size and complexity of the measure, some feigning injury as they lugged a copy of the massive blueprint to the floor.

“We are going to have a complete government takeover of our health care system faster than you can say, ‘This is making me sick,’” said Rep. Candice Miller, a Michigan Republican.

The bill is complicated, although many parts are well known.

It requires almost everyone to get insurance, and for most employers to provide it.

It expands subsidies for people too poor to afford coverage and sets up a public company to compete with private insurers.

It raises taxes and cuts Medicare and prohibits insurers from denying coverage because of pre-existing medical conditions.

It would also provide health insurance to 96 percent of all Americans by 2019, according to the Congressional Budget Office.

But millions of Americans may soon learn how dramatically other, less familiar parts of the legislation would change virtually every part of the health care system, which now takes up 16 cents of every dollar in the U.S. economy.

The House bill:

Creates a Health Choices Administration to oversee health care reform.

Establishes a Health Benefits Advisory Council, chaired by the surgeon general, which will recommend an “essential benefits package” that people must buy and employers must pay for in part.

Creates the Center for Quality Improvement to develop national priorities for improving health care delivery.

Requires doctors, pharmacists, and other providers to disclose financial relationships with drug makers, equipment providers and other suppliers.

Phases out the State Children’s Health Insurance Program, known as SCHIP, and moves families either into Medicaid or onto health “exchanges” to buy subsidized coverage.

Doubles the penalty for withdrawing money from a health savings account to pay for non-health-related items.

Prohibits different insurance rates for men and women of the same age.

Allows drug makers exclusive rights to biologic drugs for 12 years before generic equivalents can be offered.

Gives money to the states to experiment with plans to reduce malpractice lawsuits.

Republicans argued Saturday that all of these provisions were too complicated and too expensive. One — Rep. John Shadegg of Arizona — held a toddler in his arms as he criticized the bill.

“We can’t afford it,” said Rep. Lynn Jenkins, a Kansas Republican.

The GOP offered an alternative measure that was dramatically cheaper, according to the CBO, but would have actually increased the number of uninsured Americans by 2019.

“This is a common-sense approach,” said Rep. John Boehner, an Ohio Republican. The House rejected the Republican alternative, 258-176. Democrats were able to avoid a collapse of the measure over the abortion issue, which has caused the leadership serious headaches in the past several days.

Rep. Bart Stupak of Michigan — a Democrat who opposes abortion rights — insisted on tougher language to prohibit use of subsidies and credits to purchase coverage that includes abortion services.

Early Saturday morning the House Rules Committee allowed Stupak to offer those tougher regulations as an amendment, prompting him and some other anti-abortion Democrats to drop opposition to consideration of the overall bill.

The Stupak amendment passed 240-194, with one member voting “present.” Liberal Democrats are expected to try and remove the amendment as the bill advances.

Republican Reps. Sam Graves and Jenkins voted for the amendment, as did the Democratic Skelton. Democratic Reps. Moore and Emanuel Cleaver voted no.

The final vote on the House reform package came as polls show increasing skepticism about health care reform. Since July, according to the Web site Pollster.com, a variety of surveys has shown a small but consistent majority opposing a health care overhaul.

The latest survey, from Ipsos/McClatchy, showed 49 percent of those questioned in late October were against the reform plan, while just 39 percent supported it.

The White House, which has called health care reform its top priority, pointed to recent endorsements from leading senior and physician organizations as a reason to support the plan.

“It’s crucial for the Obama administration,” said James Thurber, an expert on Congress at American University.

“It’s the first big step for a very tough bill.” That, in turn, has raised the stakes for Republicans and reform opponents, who long ago closed ranks against the measure.

Several thousand opponents from around the country descended on Capitol Hill last week under the banner of the tea party movement, shouting, “Kill the bill.”

Michael Franc, vice president of government relations at the Heritage Foundation, a conservative think tank, noted that by the government’s own accounting the bill would put Washington on the hook for more than half of the nation’s health care spending in less than a decade.

“The House bill clearly equals a government takeover of our health care sector,” he said.

Republicans in the Senate said Saturday they would step up efforts to stop the reform effort on the other side of the Capitol. Senate rules make it easier for the minority to block legislation, and some vowed to use those rules in the weeks ahead. Some experts, though, said passage in the House could increase pressure in the Senate to reach an agreement on a bill.

“It keeps the focus and momentum on reform and puts pressure on the Senate to craft a bill and get it up for a vote before the end of the year,” said Marcia Nielsen, former head of the Kansas Health Policy Authority now at the University of Kansas Medical Center.

Should health reform eventually get through the House and Senate and to the president’s desk experts said Democrats might reap political benefits.

“It’s pretty significant,” said John Holahan, director of the Health Policy Research Center at the nonpartisan Urban Institute, speaking about the House bill. “Nobody’s going to get a bill that they like every aspect of. It would do the country a lot of good.”