House Passes Landmark Legislation Overhauling U.S. Health Care

March 21, 2010, 10:55 PM EDT

March 21 (Bloomberg) -- The U.S. House passed the most sweeping U.S. health-care legislation in four decades, rewriting the rules governing medical industries and ensuring that tens of millions of uninsured Americans will get medical coverage.By Laura Litvan, James Rowley and Kristin Jensen.The 219-212 vote marks the biggest victory yet for President Barack Obama, who will soon sign the bill into law. Only Democrats voted for the legislation, underscoring a partisan divide that promises to make health care the defining issue in November’s congressional elections.Lawmakers hailed the action as a historic follow-on to the 1965 creation of the Medicare program for the elderly and a way to mitigate soaring health costs that make up a sixth of the U.S. economy. It came after a last-minute deal with anti- abortion Democrats and a lobbying trip by Obama to the Capitol.“It is with great humility and with great pride that we tonight will make history for our country and progress for the American people,” House Speaker Nancy Pelosi said just before the vote. “We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans.”To get it done, House Democrats approved a Senate bill passed in December while preparing for another vote on a measure that would amend the Senate legislation to fix provisions they don’t like. The Senate must also pass this second bill under a budget process called reconciliation that requires a simple majority vote. The chamber plans to act next week.

Total Costs

The two bills together will cost $940 billion over 10 years and cover 32 million uninsured Americans, the Congressional Budget Office estimated. That’s more than made up for with a new tax on the highest earners, fees on health-care companies and hundreds of billions of dollars in Medicare savings, which will reduce the federal budget deficit, the CBO said.Companies such as health insurer WellPoint Inc. of Indianapolis, medical-device maker Medtronic Inc. of Minneapolis and drugmaker Pfizer Inc. of New York will get millions of new customers with the extension of coverage. Their industries will also face billions of dollars in new fees.As part of the overhaul, drugmakers agreed to help the elderly more easily afford medicines. Insurers, who opposed the legislation, will have to take all customers, regardless of pre- existing conditions, and face limits on how much revenue can be spent beyond covering medical expenses.

Personal Penalties

Americans, in turn, will have to buy insurance or pay a penalty, with the possibility of tapping new purchasing exchanges and government aid for lower-income Americans.Republicans said the costs will balloon, criticized the increases in government programs and held out the possibility that private insurance and medical care would be hurt.House Minority Leader John Boehner said prior to the vote that the legislation was a health-care bill “that no one in this body believes is satisfactory. We have failed to listen to America, and we have failed to reflect the will of our constituents.”Business groups including the U.S. Chamber of Commerce also lobbied against the legislation, and Peoria, Illinois-based Caterpillar Inc. sent a letter to leaders saying the bills would raise its costs by $100 million in the first year alone.The House’s two-step process became necessary after Democrats lost the 60th vote in the Senate generally needed to push through major legislation.Just weeks after the Senate’s party-line 60-39 vote, Democrats were almost finished drafting a House-Senate compromise bill when Massachusetts Republican Scott Brown won a Jan. 19 special election to fill the seat left vacant by the death of Democrat Edward M. Kennedy.

Majority Vote

The use of the budget-reconciliation tool opens the door for the Senate to pass the second bill with 51 votes, as long as it can withstand Republican challenges and the rulings of a parliamentarian, who will take out any provision he decides have only an incidental impact on the federal budget.Any changes in the Senate would force a new House vote on the reconciliation bill, further complicating the effort. House Democrats particularly want to scale back a tax on high-end, or so-called Cadillac, insurance plans because they say it would affect too many workers.

Ready to ‘Tackle’

Illinois Senator Richard Durbin, a member of the Democratic leadership, said today that his party is prepared for challenges and any amendments Republicans might file.

“We’re ready to tackle that if that’s what they want to do,” Durbin said on CBS’s “Face the Nation” program. “We’re ready to deal with honest amendments. There will come a time when the American people say enough, this is about politics.”Obama, who faced criticism for largely leaving the drafting of the legislation to Congress, swung into high gear in recent weeks. He hosted a Feb. 25 bipartisan summit at the White House, proposed detailed final compromises and lobbied dozens of undecided Democrats. He postponed a trip to Asia to remain in Washington for today’s vote.

Obama benefited in part from the votes of Democrats who are leaving Congress and who were willing to switch sides after voting “no” on a House version in November.

He also won support from Democrats including Representative Dennis Kucinich of Ohio, who had threatened to oppose the final measure because it didn’t include a new government program, or public option, to compete against private insurers.

The legislation will expand the Medicaid government program for the poor to cover those up to 133 percent of the federal poverty level, and offer subsidies for millions of other Americans to buy insurance through an online exchange offering policies at more-affordable group rates.Many employers with more than 50 workers that don’t offer coverage will be subject to a penalty. The reconciliation bill will change the penalty to $2,000 per worker, from $750 in the Senate bill, and subtract out the first 30 employees.The overhaul is financed in large part through new taxes. The reconciliation bill would add a 3.8 percent Medicare tax on investment income imposed on individuals who earn more than $200,000 a year and joint tax filers who have more than $250,000 in earnings. That adds to a higher Medicare payroll tax already in the Senate bill.--With assistance from Kristin Jensen, Brian Faler, Nicole Gaouette, Julianna Goldman, Catherine Dodge and Ryan J. Donmoyer. Editors: Mark McQuillan, Jim Kirk.

To contact the reporters on this story: Laura Litvan in Washington at llitvan@bloomberg.net; James Rowley in Washington at jarowley@bloomberg.net; Kristin Jensen in Washington at kjensen@bloomberg.net