House approves historic health care legislation
Nov. 8--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 said 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 Democrat Skelton. Reps. Emanuel Cleaver and Moore 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 have 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.
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."
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Cracking open the bill Three key points of the House's health care reform bill:
1. REQUIRED INSURANCE
You must have insurance, and your employer has to pay for some of it.
2. SUBSIDIES AND A PUBLIC OPTION
You'll get premium subsidies if you qualify and a public option for insurance.
3. TAX INCREASES AND MEDICARE CUTS
The rich will pay higher taxes, and you may lose some Medicare benefits.
ON PAGE A10
--Q&A with nuts and bolts on the bill
--Four local congressmen explain their votes
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The complex facets of the health care debate Four local members of Congress were good examples of the complicated politics of health insurance reform. Liberal and moderate Democrats had different priorities, while Republicans stayed united in opposition. Last week, The Star talked with the local lawmakers. They explained how they would vote and how they reached their conclusions.
REP EMANUEL CLEAVER, MISSOURI DEMOCRAT VOTE: Yes
WHY: He backed a government-run insurance option and said his Kansas City congressional district did, too. The bill still included a public option, but it's a pale shadow of what it could have been.
"It is not now as weak as water, but it's certainly not as strong as bourbon. I know that some have the goal of getting something onto the president's desk. They believe a watered-down bill is better than no bill."
Cleaver doesn't hold out much hope that the Senate will include one in its bill.
CONCERNS: He said Democrats face political trouble next year because many of their core supporters are disappointed and a strong health reform bill would help galvanize them.
"A weak bill is not going to energize the base. They're going to know what we approved is not what we set out to do. The right wing of the Republican Party is energized through anger, so they're out working."
REP. SAM GRAVES, MISSOURI REPUBLICAN VOTE: No
WHY: He objected to the mandates on private insurers to provide coverage, which he said will raise their costs, the public option, which he believes would lead to a government takeover of health care, and the $1.1 trillion price tag.
He said he also doesn't believe the Congressional Budget Office conclusion that the plan would actually help reduce the deficit.
"Please. That is such garbage. You don't add a trillion dollars to the budget and don't see an increase."
CONCERNS: He worried about the public option because he said the private market can't compete with the government, which can set the price for services.
REP. IKE SKELTON, MISSOURI DEMOCRAT VOTE: No
WHY: Skelton opposed the public option because there were too many unanswered questions.
"I ... have serious concerns about its unintended consequences for Missourians who have private insurance plans they like. I would like to see something pass Congress where the American people would say we've done a good job and this has been an outstanding accomplishment. With the uncertainty that surrounds this bill, I worry about that not being the case."
CONCERNS: Skelton said that while the health care system has a lot of problems, a better way might be "to tackle 1-2-3 issues at a time and get bipartisan support." He also was concerned about the bill's effect on rural hospitals and doctors.
Skelton is chairman of the House Armed Services Committee and re-elections are usually a breeze. But the Republicans recently have been singling him out for a lot of criticism. He acknowledged that the bill was a tough vote.
REP. DENNIS MOORE, KANSAS DEMOCRAT VOTE: Yes
WHY: "I think it's the right thing to do for our country. We should have adopted a health care package 40 years ago. If we had, we'd be in a much stronger and better position. But we have to look to the future."
CONCERNS: Moore is a member of the Blue Dog Coalition, a group of 52 fiscally conservative House Democrats, but still supported a public option. He said private insurance needs price competition.
He worried about the reform plan's costs, but said that doing nothing about the rising health costs would mean more serious financial problems in the future.
"But if we do it right, we will end up saving a lot of money. I've told people back home that 36 million don't have any kind of insurance. They get sick; they stay home until they can't stay any longer and then get so ill they end up in an emergency room. That's the most expensive kind of care and everybody in the country ends up paying for that as taxpayers."
Moore comes from a swing district and has always been a top Republican target. His vote will do nothing to change that.
To reach Dave Helling, call 816-234-4656 or send e-mail to dhelling@kcstar.com. To reach David Goldstein, call 202-383-6105 or send e-mail to dgoldstein@mcclatchydc.com.
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