The great healthcare reform battle of 2009 and 2010, for the most part, is over.
Congressional Democrats today finally passed their bill.
The only thing it needs now is the signature of President Barack Obama to become the law of the land.
In a 219 to 212 vote, the House today approved a bill enacted by the Senate last December that represents the most sweeping government initiative in healthcare since the creation of Medicare and Medicaid in 1965.
Most notably, the legislation will require most Americans to acquire health insurance, help cash-strapped individuals and families purchase it through government-operated insurance marketplaces called exchanges, increase Medicaid enrollment by almost 50%, and impose regulations on private insurers that would prevent them from denying someone coverage based on preexisting conditions.
After the historic vote, the House is expected to turn today to a budget reconciliation bill that would amend the now-approved Senate bill more to the House's and the president's liking. Taken together with this reconciliation bill, the Senate reform package would extend insurance coverage to 32 million more Americans over 10 years at a cost of $938 billion, although it would reduce the federal deficit during that period by $143 billion, according to the latest estimates of the Congressional Budget Office (a few days ago, the CBO had released slightly different dollar amounts).
If approved by the House, the budget reconciliation bill will go before the Senate, where Senate Majority Leader Harry Reid (D-NV) says he has the minimum 51 votes required to pass it. Reconciliation bills — which adjust revenue and spending lines in the federal budget — cannot be filibustered in the Senate. It takes 60 votes in the Senate to override the endless speeches and procedural motions that characterize a filibuster and force a vote on legislation. Republican Senators, who unanimously opposed the reform bill approved by their chamber last year, command 41 votes.
Today's House Vote Makes History in More Ways Than One
In addition to dramatically reshaping the American healthcare system — which accounts for one sixth of the nation's economy — the legislation passed by the House today was historic for other reasons. For the first time, the American Medical Association supported a plan for government-orchestrated healthcare reform after having denounced earlier proposals, including legislation creating Medicare and Medicaid, as dangerous experiments in "socialized medicine." Other major medical societies that backed today's bill were the American College of Physicians and the American Academy of Pediatrics.
The fear of federalization still resonated, though, among Republican politicians who formed a thick stone wall against the legislation. Their arguments against what they called a government takeover of medicine at times reached rhetorical fever pitches that will be remembered for years.
Sarah Palin, the former governor of Alaska and the Republican vice presidental candidate last year, warned that under the Democrats' reform plan, bureaucratic "death panels" would deny care to the disabled and elderly in the name of cost-saving. Even though the likes of the AARP called these claims unfounded, the debate about complex healthcare policy soon featured the catch-phrase "pulling the plug on granny."
At the same time, the new Tea Party movement entered the fray, holding rallies, flooding congressional townhall meetings, and wavings signs with messages such as "Save Granny. Defeat Obamacare" and "Get Government Out of Our Lives." Such protesters showed up today in force in Washington, DC, as the House casts its vote.
Fiery denunciations of reform legislation also resounded inside the Capitol building up until the time of the vote.
"My colleagues are celebrating the birth of a great new entitlement program," said Rep. Marsha Blackburn (R-TN). "Only they see dependency on the federal government and the death of freedom as a cause for celebration. Freedom dies a little bit today."
Last-Minute Promise of Executive Order Against Abortion Funding Secured Key Votes
One obstacle to House Democrats rounding up enough votes for victory was the issue of federal funding of abortions in an overhauled healthcare system.
When House Democrats crafted and passed their own reform bill last year, they included language that would prohibit any woman receiving an insurance premium subsidy from purchasing a health plan that covered an abortion other than a federally sanctioned one to save the life of the woman or in cases of rape and incest. The Senate bill contains a complicated anti-abortion restriction that resembles the House version in intent, but Democratic reform advocates in the House like Rep. Bart Stupak (D-MI) who are also abortion opponents said the Senate language was not strong enough for them to support the bill in good conscience.
Earlier today, President Obama convinced Rep. Stupak and his coalition of like-minded Democrats to change their votes to "Yea" by promising to issue an executive order that would ensure no abortions would be federally funded under the reform bill before the House on Sunday. President Obama released the text of the order and said he would sign it as soon as the House passed the bill.
It was good enough for Rep. Stupak.
"We've been able to come to an agreement to protect the sanctity of life in healthcare reform," Rep. Stupak said Sunday.
Two Medical Societies Applaud Reform Bill, But Say More Legislative Work Remains
In a press release issued tonight, American Medical Association President J. James Rohack, MD, said that by extending health insurance to millions more Americans, the bill passed by the House "will help patients and the physicians who care for them."
"Every day physicians see the devastating effect being uninsured has on the health of our patients," Dr. Rohack said. "Physicians dedicate their lives to helping patients, and we have an historic opportunity now to do just that."
Similarly, Lori Heim, MD, the president of the American Academy of Family Physicians, hailed the bill's passage in a written statement. "As a result of today's vote, Americans can look forward to health security because they soon will have the chance to buy health insurance that meets their needs without emptying their bank accounts," Dr. Heim stated.
Both Dr. Heim and Dr. Rohack said that their societies will continue to work with Congress on what they see as the unfinished business of healthcare reform, particularly medical liability reform and a permanent solution to the problematic formula for setting Medicare reimbursement for physicians, which calls for a 21.2% pay cut this year.
[by Robert Lowes, Medscape Medical News]