The U.S. House of Representatives narrowly passed a massive overhaul of the American health care system Saturday night by a vote of 220 to 215. One Republican, Rep. Joseph Cao of Louisiana, crossed the aisle to vote for it, while 39 Democrats joined the Republicans in opposing the measure.
House Speaker Nancy Pelosi called passage of the bill
"an historic moment for our nation and for America's families," while Republicans warned that the bill will raise taxes, increase insurance premiums and make cuts to Medicare. An enormous round of applause broke out throughout the House chamber when the crucial 218th vote was cast to ensure the bill's passage.
The $1.3 trillion-dollar bill would require individuals to buy health insurance, and would also require medium and large businesses to provide it to their employees. Consumers would be able to buy their insurance on an exchange, which would include a public insurance option for people who do not have access to insurance through their jobs. Low- and middle-income families would receive government subsidies to purchase insurance, which would be be paid for through tax increases on individuals making more than $500,000 per year, as well as fees on medical providers. Finally, the bill would prohibit insurance companies from dropping or denying coverage based on pre-existing conditions or cost of care.
The day of the vote was punctuated by high drama, as the House gaveled into a rare weekend session with no indication of whether the Speaker had all 218 votes necessary to pass the bill. But a last- minute addition to the bill to appease pro-life Democrats, as well as a high-profile visit from President Obama to press Democratic members to vote for the measure, provided just enough momentum to pass it through the House with two votes to spare.
House Majority Leader Steny Hoyer began the debate by saying, "This is not a new idea, but it is an idea whose time has come." Hoyer said that the bill under consideration was not perfect, but was the result of "careful scrutiny, hard work, citizen input, and is the right response to this time of economic insecurity in which we find ourselves."
Pelosi added that the bill would also reduce drug costs for seniors, prevent insurance companies from charging women more than men for the same coverage, and would allow young adults to stay on their parents' insurance until their 27th birthdays. She also promised that the bill would add "not one dime to the deficit."
Republicans countered that the bill will in fact explode the deficit and give the federal government an out-sized and improper role in Americans' health care decisions. Rep. Joe Barton (R-Tx.) said, "I just don't think it's right that in the guise of helping Americans, we're telling Americans what they have to do."
Rep. Marsha Blackburn (R-Tenn.) said that the federal government is not capable of running many of the programs it is already responsible for, and should not be trusted with more responsibilities for Americans' health care: "We have talked to mothers who say, 'You can't even get the H1-N1 vaccine out there and you think you're going to handle the health care for my children?' " Manufacturers have not been able to supply enough of the vaccine because of the difficulty of producing it.
Rep. Phil Gingrey (R-Ga.) warned, "I have no doubt that although the American people may forget what was said here, they will never forget what was done here and who did it to them."
A crucial barrier to the bill was eliminated when the House passed an amendment by Rep. Bart Stupak (D-Mich.), a pro-life Democrat, by a vote of 240 to 192. Stupak's measure would prevent insurance companies from participating in the new government exchange if they also cover abortion. It would also require women enrolled in the exchange to purchase supplemental abortion insurance with private funds if they want to be covered for the service in the future.
Speaking on the House floor Saturday, Stupak called the existing House bill a "direct assault" on existing limits to federal funding for abortion, but pro-choice Democrats lined up in staunch opposition to his effort. Rep. Jan Schakowsky (D-Ill.) called Stupak's amendment "an insult to millions of American women," while Rep. Diana DeGette (D-Colo.) said, "To say that this amendment is a wolf in sheep's clothing would be the understatement of a lifetime. If enacted this will be the greatest restriction on a woman's right to choose in our careers."
Although Pelosi initially resisted the Stupak amendment, the congressman had garnered commitments from more than 40 fellow pro-life Democrats to derail the entire health reform effort without stricter abortion language in the bill. Despite Stupak's victory Saturday, opponents of his measure vowed to strip it from the final bill in the conference committee.
Before voting on final passage, the House defeated the Republicans' significantly smaller alternative health care reform proposal by a vote of 176 to 258, with one Republican, Rep. Tim Johnson, voting against it. The Congressional Budget Office estimated the measure would have cost $61 billion over ten years. It would have expanded high-risk insurance pools and would have revised and expanded the use of health savings accounts, but would not have changed insurance companies' policies of refusing coverage for pre-existing conditions.
Now that the House has passed its version of health care reform, all eyes will be on the Senate, where moderate Democrats have already balked at the Senate bill's cost and scope.
Because the Senate measure already differs significantly from the House bill on everything from the nature of the public option (the Senate lets states opt-out), to income taxes increases (only the House has them), yet another hurdle awaits in the conference committee, where the House and Senate versions will be combined before a final vote in both chambers.
In a statement late Saturday, President Barack Obama thanked the House for its work in passing health care reform and said he is "confident" the Senate will follow suit, adding, "I look forward to signing comprehensive health insurance reform into law by the end of the year."