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By ROBERT PEAR and DAVID M. HERSZENHORN
WASHINGTON — Congress gave final approval on Sunday to legislation that
would provide medical coverage to tens of millions of uninsured
Americans and remake the nation’s health care system along the lines
proposed by President Obama.
By a vote of 219 to 212, the House passed the bill after a day of
tumultuous debate that echoed the epic struggle of the last year. The
action sent the bill to President Obama, whose crusade for such
legislation has been a hallmark of his presidency.
Democrats hailed the votes as historic, comparable to the establishment
of Medicare and Social Security and a long overdue step forward in
social justice. “This is the civil rights act of the 21st century,”
said Representative James E. Clyburn of South Carolina, the No. 3
Democrat in the House.
After a year of partisan combat and weeks of legislative brinksmanship,
House Democrats and the White House clinched their victory only hours
before the voting started on Sunday. They agreed to a deal with
opponents of abortion rights within their party to reiterate in an
executive order that federal money provided by the bill could not be
used for abortions, giving the Democrats the final votes. Democrats
said that in expanding access to health coverage for uninsured
Americans, they were creating a new program every bit as important as
Social Security and Medicare, while also putting downward pressure on
rising health care costs and reining in federal budget deficits.
Republicans said the plan would saddle the nation with unaffordable
levels of debt, leave states with expensive new obligations, weaken
Medicare and give the government a huge new role in the health care
system.
The debate on the legislation has highlighted the deep partisan and
ideological divides in the nation and set up a bitter midterm
Congressional election campaign, with Republicans promising an effort
to repeal it or block its provisions in the states.
Representative Marcy Kaptur, Democrat of Ohio, said the bill heralded
“a new day in America.” Representative Doris Matsui, Democrat of
California, said it would “improve the quality of life for millions of
American families.”
But Representative Paul D. Ryan, Republican of Wisconsin, denounced the
bill as “a fiscal Frankenstein.” Representative Lincoln Diaz-Balart,
Republican of Florida, called it “a decisive step in the weakening of
the United States.” Representative Virginia Foxx, Republican of North
Carolina, said it was “one of the most offensive pieces of social
engineering legislation in the history of the United States.”
The passions swirling round the bill were evident Sunday on the
sun-splashed lawn south of the Capitol. Hundreds of protesters chanted,
“Kill the bill” and waved yellow flags declaring, “Don’t Tread on Me.”
They carried signs saying, “Doctors, Not Dictators.”
The health care bill would require most Americans to have health
insurance, would add 16 million people to the Medicaid rolls and would
subsidize private coverage for low- and middle-income people, at a cost
to the government of $938 billion over 10 years, the Congressional
Budget Office said.
The bill would require many employers to offer coverage to employees or
pay a penalty. Each state would set up a marketplace, or exchange,
where consumers without such coverage could shop for insurance meeting
federal standards.
The budget office estimates that the bill would provide coverage to 32
million uninsured people, but still leave 23 million uninsured in 2019.
One-third of those remaining uninsured would be illegal immigrants.
The new costs, according to the budget office, would be more than
offset by savings in Medicare and by new taxes and fees, including a
tax on high-cost employer-sponsored health plans and a tax on the
investment income of the most affluent Americans.
Cost estimates by the Congressional Budget Office, showing that the
bill would reduce federal budget deficits by $143 billion in the next
10 years, persuaded some fiscally conservative Democrats that they
should vote for the bill.
Democrats said Americans would embrace the bill when they saw its
benefits, including some provisions that take effect later this year.
Health insurers, for example, could not deny coverage to children with
medical problems or suddenly drop coverage for people who become ill.
Insurers must allow children to stay on their parents’ policies up to
their 26th birthday. Small businesses could obtain tax credits to help
them buy insurance.
The Democratic effort to secure the 216 votes needed for passage of the
legislation came together only after last-minute negotiations involving
the White House, the House leadership and a group of Democratic
opponents of abortion rights, led by Representative Bart Stupak of
Michigan. On Sunday afternoon, members of the group announced that they
would support the legislation after Mr. Obama promised to issue an
executive order to “ensure that federal funds are not used for abortion
services.”
Mr. Stupak described the order as a significant guarantee that would
“protect the sanctity of life in health care reform.” But supporters of
abortion rights — and some opponents — said the order merely reaffirmed
what was in the bill.
The procedural vote on Sunday, approving the terms of debate, had put
the House on track to approve the health care bill that was passed by
the Senate on Dec. 24, on a party-line vote. That bill will soon become
the law of the land, the White House said.
House Democrats were also poised to pass a separate measure that would
make significant changes and corrections to the Senate bill. That
measure would go to the Senate, where the majority leader, Harry Reid,
Democrat of Nevada, has promised to take it up in short order. Mr. Reid
said he had the votes to pass it, though he faces resistance from
Republicans.
The House galleries were full, and the floor was unusually crowded, for
the historic debate on health care. Passage of the bill would be a
triumph for Mr. Obama and Speaker Nancy Pelosi. Working together, they
revived the legislation when it appeared dead after Democrats lost
their 60th vote in the Senate and with it their ability to shut off
Republican filibusters.
Republicans said they would use the outcome to bludgeon Democrats in
this year’s Congressional elections. The White House is planning an
intensive effort to convince people of the bill’s benefits. But if
Democrats suffer substantial losses in November, Mr. Obama could be
stymied on other issues, including his efforts to pass major energy and
immigration bills.
The campaign for health care overhaul began as a way to help the
uninsured. But it gained momentum when middle-class families with
health insurance flooded Congress with their grievances. They
complained of soaring premiums. They said their insurance had been
canceled when they got sick.
“It’s not just the uninsured,” said Representative Jim McGovern,
Democrat of Massachusetts. “We also have to worry about people with
insurance who find, for crazy reasons, that they are somehow going to
be denied coverage.”
The drive for universal insurance coverage was sustained by lawmakers
like Representative Tammy Baldwin, Democrat of Wisconsin. Adding
urgency to the debate were the strident complaints of employers,
especially small businesses, who said they were being crushed by the
cost of employee health benefits.
In the end, groups like the United States Chamber of Commerce and the
National Federation of Independent Business tried to stop the bill,
saying it would increase the cost of doing business. But other groups,
including the American Medical Association and AARP backed it, as did
the pharmaceutical industry. Lawmakers agreed that Sunday’s debate was
historic, but they were poles apart in assessing the legislation.
Ms. Pelosi said the bill would free people to pursue their dreams
without having to worry about being bankrupted by medical bills or
losing health insurance when they switch jobs.
“It’s liberating legislation,” Ms. Pelosi said. “It’s to free Americans
to live their passion, reach their aspirations without being job-locked
because they have to have health care, especially if they have someone
in their family with a pre-existing condition.”
Representative Rodney Alexander, Republican of Louisiana, said, “You
cannot expect to expand coverage to millions of individuals and to curb
costs at the same time.”
Republicans said the picture painted by the budget office was too rosy,
because the new taxes and fees would start immediately, while the major
costs would not show up for four years.
Moreover, Republicans said Democrats would pay a price for defying
public opinion on the bill.
“Are you so arrogant that you know what’s best for the American
people?” Representative Paul Broun, Republican of Georgia, asked the
Democrats. “Are you so ignorant to be oblivious to the wishes of the
American people?”
Lawmakers spoke with deep conviction in explaining their votes.
“Health care is not only a civil right, it’s a moral issue,” said
Representative Patrick J. Kennedy, Democrat of Rhode Island, who
invoked the memory of his father, Senator Edward M. Kennedy, Democrat
of Massachusetts, a lifelong champion of health care for all.
Carl Hulse contributed reporting.
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