Health care bill clears the House

WASHINGTON - Hours after President Obama exhorted Democratic lawmakers to "answer the call of history," the House hit an unprecedented milestone on the path to health-care reform, approving a trillion-dollar package late Saturday that seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to almost every American.

After months of acrimonious partisanship, Democrats closed ranks on a 220-215 vote despite 39 defections, mostly from the party's conservative ranks, including Rep. Collin Peterson of Minnesota.

But the bill attracted a surprise Republican convert: Rep. Anh (Joseph) Cao of Louisiana, who represents the Democratic-leaning district of New Orleans and had been the target of a last-minute White House lobbying campaign. GOP House leaders had predicted their members would unanimously oppose the bill.

Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage.

Democrats, however, were forced to make major concessions on insurance coverage for abortions to attract the final votes, a wrenching compromise for the numerous abortion-rights advocates in their ranks. They hope to make changes to that amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate. Majority Leader Harry Reid, D-Nev., hopes to bring a measure to the Senate floor before Thanksgiving, but legislation may not reach the president's desk before the new year.

At the Capitol, Obama urged the few Democrats who were still wavering on Saturday afternoon to put aside their political fears and embrace the bill's ambitious objectives. "Opportunities like this come around maybe once in a generation," he said afterward. "This is our moment to live up to the trust that the American people have placed in us. Even when it's hard. Especially when it's hard. This is our moment to deliver."

The House legislation would for the first time require every individual to obtain insurance, and would require all but the smallest employers to provide coverage to their workers. It would vastly expand Medicaid and create a new marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.

Though some people would receive no benefits -- including about 6 million illegal immigrants -- the bill would virtually close the coverage gap for people who do not have access to health care coverage through their jobs.

"For generations, the American people have called for affordable, quality health care for their families," House Speaker Nancy Pelosi, D-Calif., said before the vote. "Today, the call will be answered."

12 hours of tension

The debate on the House floor extended for about 12 hours and settled into a civil, if predictable, pattern, after a heated start.

Republicans had blasted the 1,990-page bill as an ominous blueprint for a budget-busting government takeover of the private health care system that would impose unprecedented mandates on individuals and employers, raise an array of taxes and slash projected spending on Medicare, the federal health program for the elderly. At a time of record budget deficits, Republicans argued that the country could ill-afford a new entitlement program that would cost an estimated $1.05 trillion over the next decade.

"Big government doesn't mean better health care," said Rep. Kevin Brady, R-Texas. "This is not the reform families need. This is all about taking a giant first step toward a single-payer national health-care system."

Throughout the debate, Republicans warned that the legislation would rob Americans of their right to make choices about health care, cost the nation jobs and unfairly financially burden future generations.

But Democrats said their proposal was long overdue, would relieve the mounting anxiety of Americans struggling to get and retain insurance, and would ultimately improve the economy by bringing spiraling health care costs under control.

"Our plan is not perfect, but it is a good start toward providing affordable health care to all Americans," said Rep. Peter DeFazio, D-Ore.

Pelosi focused on corralling at least 218 of 258 Democrats to push the bill across the finish line. That task appeared to grow easier after party leaders broke a weeks-long impasse over abortion by agreeing Friday night to hold a vote on an amendment -- offered by antiabortion Democrats -- that would explicitly bar the public plan from covering the procedure. The amendment, approved 240 to 194, with 64 Democrats in favor, also would prohibit people who received insurance subsidies from purchasing private plans that covered abortion.

The deal cleared the way for dozens of antiabortion Democrats to back the package. The most passionate advocates of abortion rights were not happy, but few were prepared to vote down the legislation.

An overview of the bill

Under the legislation, starting next year, private insurers could no longer deny anyone coverage based on preexisting conditions, place lifetime limits on coverage or abandon people when they become ill. Insurers would be required to disclose and justify proposed premium increases to regulators, and could not remove adult children younger than 27 from their parents' family policies.

For the elderly, the House package would immediately offer discounts on prescription drugs and reduce a gap in Medicare prescription drug coverage, closing it entirely by 2019. Uninsured people who cannot get coverage could join temporary high-risk insurance pools, and unemployed workers would be permitted to keep their COBRA benefits until the public plan and insurance exchanges started in 2013.

In four years, the measure would establish a new insurance system. Businesses with payrolls exceeding $500,000 would be required to offer their workers insurance or pay a fine of as much as 8 percent of payroll. Individuals would be required to obtain insurance or pay a fine of as much as 2.5 percent of income. States would be required to extend Medicaid coverage to as many as 15 million additional people. Low- and middle-income individuals who still could not afford coverage could apply for federal subsidies through an insurance marketplace that would negotiate with private insurers to provide comprehensive policies alongside a government-run "public option."

Attention now shifts to the Senate. If the Senate acts, negotiations to iron out differences between the two chambers could be wrenching. Among the toughest issues: whether the public option should include an "opt out" clause for states; whether to require employers to provide coverage to their workers, and whether to tax the rich or tax high-cost health-care policies, as the Senate proposed -- a provision economists call the most important provisions in either bill for reining in costs.

Peterson, who also broke ranks with Democrats on the Obama administration's stimulus bill earlier this year, held out hope that he might be able to support a health care package negotiated with the Senate.

"Don't get me wrong," he said Saturday night. "I think the bill was trying to tackle the right problems and generally was going in the right direction, so I'm hopeful."