Debate Ends in Health Care Reform Victory

After more than a year of debate, health care reform will become the law of the land.

The House passed the Senate’s version of health care reform Sunday night by a 219-212 margin, sending it to President Barack Obama for his signature. All Republicans voted against the bill, joined by 34 Democrats.

“This isn’t radical reform, but it is major reform,” Obama said shortly before midnight. “This is what change looks like.”

The president said the bill would create a health care system “that works better for the American people.”

The legislation would enable an estimated 32 million additional Americans to obtain health insurance coverage by expanding eligibility for Medicaid, and providing subsidies for low- and moderate-income individuals to purchase private insurance.

Individuals and small businesses could purchase insurance through new state-based exchanges, which would offer plans that must meet minimum federal standards. Some small businesses with low-wage workers would be eligible for temporary tax credits to help them pay for insurance coverage.

Individuals would be required to obtain insurance coverage, and businesses that employ more than 50 workers would have to provide coverage or pay a penalty of $2,000 per worker if any of their employees receives government-subsidized coverage on their own.

The legislation also would impose a tax on high-cost insurance plans beginning in 2018. New taxes also would be imposed on insurance plans, medical device manufacturers and pharmaceutical companies. Individuals who make more than $200,000 would face additional Medicare payroll taxes.

Insurance companies would no longer be able to deny coverage based on pre-existing conditions or rescind coverage when someone gets ill. They also would be prohibited from capping the amount of benefits individuals could receiver over their lifetime.

Democrats said the bill would make insurance coverage affordable to all Americans and rein in abusive insurance company practices.

Republicans, however, contended insurance would become more expensive, thanks to the bill’s new tax on insurance companies and the requirement that plans meet minimum federal standards. They also argued that businesses would be afraid to hire more workers because of the financial penalties they would face if they don’t provide affordable coverage.

In the end, however, it was abortion -- not what the nation’s health insurance system should look like -- that determined the bill’s fate.

The House passed health care reform Sunday night at 10:49, but the outcome was determined nearly seven hours earlier. That’s when Democrat Bert Stupak of Michigan announced he and a handful of other anti-abortion Democrats would vote for the bill.

At issue was whether the bill would allow public funds be used to subsidize abortions. Stupak said an executive order from President Barack Obama would ensure that wouldn’t happen.

“I’m pleased to announce that we have an agreement,” Stupak said. “I’ve always supported health care reform.”

The abortion issue was the most serious threat to House passage of the bill, and Republicans wouldn’t let the issue go away even after Stupak’s announcement.

“If you vote for this bill, you can never call yourself pro-life again,” said Rep. Paul Broun, R-Georgia.

Republicans also said Obama’s executive order couldn’t be relied on because it could be rescinded at any time.

They also called into question the Senate’s ability to pass a separate bill fixing the House’s problems with the Senate’s health care reform legislation. To avoid the need to get 60 votes in the Senate, Democrats decided to have the House vote on the Senate-passed bill, and then approve a package of fixes through a budget-related process known as reconciliation, which only requires 51 votes to clear the Senate.

The problem, according to Republicans, is that the reconciliation bill would generate additional contributions to the Social Security Trust Fund, and changes to Social Security aren’t eligible for consideration in a reconciliation bill. That means the Senate bill, with its “Cornhusker Kickback” and other warts, might not be fixed, Republicans warned Democrats.

That argument didn’t sway any members. The House passed the reconcilation bill by a 220-211 margin.

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Kent Hoover is the Washington bureau chief for bizjournals.