House Passes Historic Health Care Legislation 21MAR10

I watched the debates and the votes and that God this passed! Thank you Speaker Nancy Pelosi and all the brave Democrats and especially Rep. Bart Stupak! Click the header for the story on NPR. And following is the story about what parts of the law go into effect right away...copy and paste the link to go to that story.

Capping a year of legislative activity and ending decades of Democratic frustration, the House on Sunday passed a bill that would extend health care coverage to more than 30 million Americans.

"We have come to a defining moment in our nation's history," said James Clyburn (D-SC), the House Democratic whip. "This is the civil rights act of the 21st century."

As the GOP promised, not a single Republican voted for either health care measure before the chamber. "This is truly a remarkable moment in the life of this nation. Some say we’re making history. I say we’re breaking history, breaking with our best traditions," said Mike Pence (R-IN), who chairs the House GOP Conference. "Only in Washington, D.C, can you spend a trillion dollars and say that you’re saving the taxpayers money."

With a vote count of 219 to 212, the House gave its approval to a measure initially passed by the Senate on Christmas Eve. Thirty-four Democrats joined 178 Republicans in voting no. That bill now goes to President Obama for signing.

Quoting a letter from the late Sen. Ted Kennedy (D-MA) to President Obama, House Speaker Nancy Pelosi said, "Passing health care is the great unfinished business of our country." She added, "That is, until today."

The House also passed a so-called reconciliation measure on a 220 to 211 vote that makes significant changes to the main health care bill. Thirty-three Democrats voted against the bill, along with 178 Republicans. The measure now goes to the Senate, which is expected to begin debate within days.

Senate action will be marked by extensive parliamentary maneuvering. But Democrats are optimistic about their chances in that chamber.

And, for now, they are giddy about passing landmark legislation to provide insurance to 32 million Americans.

"There are not too many times in politics that you get to do something monumental," said Rep. Doris Matsui (D-CA). "Today is the day."

Obama watched the vote in the White House's Roosevelt Room with Vice President Joe Biden and about 40 staff aides. When the long sought 216th vote came in on the reconciliation bill — the magic number needed for passage — the room burst into applause and hugs. An exultant president exchanged a high-five with his chief of staff, Rahm Emanuel.

A Fundamental Transformation

Democratic presidents — as well as occasional Republicans including Richard M. Nixon — have long sought to enact universal health care legislation. President Bill Clinton's failed effort in 1993-94 had taken the issue off the table for over a decade.

President Obama has received considerable criticism for having "over-learned" the lessons of Clinton's experience. In contrast to Clinton's strategy of crafting a highly-detailed proposal, Obama let Congress work its will.

That looked like it might have been a mistake as legislation bogged down at various points — especially when it appeared to have been nearly derailed by the special election of Republican Sen. Scott Brown of Massachusetts in January, costing Democrats their 60-vote, filibuster-proof majority in the Senate.

But Democrats have now successfully jumped through most of the procedural hoops. Passage of the bill represents the biggest change in domestic policy since the enactment of Medicare and Medicaid in 1965, says Sara Rosenbaum, who chairs the department of health policy at George Washington University.

"We have now fundamentally transformed American society," she says. "We have gone from assuming many people will not have insurance to expecting that people will have insurance."

Highlights Of The Bill

We have come to a defining moment in our nation's history. This is the civil rights act of the 21st century.

The $940 billion bill seeks to extend health coverage to most Americans. Medicaid, the federal-state program that provides health insurance to the poor and disabled, will be expanded to cover all adults earning less than 133 percent of the federal poverty level.

Private health insurance will be made available to individuals and small companies through exchanges that will be run by the states. Individuals who do not buy insurance face fines, as do most employers who do not offer coverage to workers.

Bill sponsors predict that all but about 5 percent of non-elderly Americans will ultimately be covered. Half of those currently uninsured will receive coverage through the expansion of Medicaid and half through private insurance through the exchanges — often with subsidies that make up the bulk of the legislation's projected costs.

"There will be a broad public education effort, so that people understand what's in the legislation," says Ron Pollack, executive director of Families USA, a consumer group that lobbied for the bill. "As a result, I think there's going to be growing and substantial support for the reform."

Rep. Bart Stupak (D-MI) says an agreement reached with President Obama on Sunday banning use of federal funds for abortions will clear the way for the Democrats to have enough votes to pass the House health care bill.

The Congressional Budget Office has estimated that the legislation will reduce the federal deficit by $143 billion over the next 10 years and by some $1.2 trillion over the following decade.

"It's the biggest deficit reduction we will be able to vote on in this Congress, and other Congresses as well," said Steny Hoyer (D-MD), the House majority leader.

Critics of the bill say such savings are a fiction, as they are dependent on future Congresses sticking to plans to impose major cuts in Medicare and unpopular new taxes on health plans. "We are creating a massive new entitlement," Rep. Lincoln Diaz-Balart (R-FL) said during floor debate Sunday.

Pledging To Repeal

Republicans who are unanimous in their opposition to the legislation will continue their efforts to stymie it in the Senate. They have also vowed to make the issue the centerpiece of their campaign to regain control of Congress come November.

"This debate is not about the uninsured, it is about socialized medicine," said Rep. Devin Nunes (R-CA). Alluding to the ghosts of totalitarianism in the Soviet Union, he said, "With passage of this bill, they will haunt Americans for generations."

Two hundred Republican candidates and members of Congress have signed a pledge, promulgated by the Club for Growth, an anti-tax group, to repeal the legislation upon the party's return to power.

"If this bill passes, we will have an effort to repeal the bill," House GOP Leader John Boehner (R-OH), said on NBC's Meet the Press Sunday. "I'd have a bill on the floor the first thing out."

But even if Republicans do regain control of one or both chambers, they still would have to contend with Obama's potential veto of any major changes to the law, at least for two more years. And getting such changes to the president's desk might be just as problematic as passing the health bills in the first place.

"What are they going to be able to repeal without 60 votes?" says Robert L. Laszewski, president of Health Policy and Strategy Associates. "The 60-vote rule suddenly works to their disadvantage."

Constitutional Challenges

The legislation will face legal challenges as well. On Wednesday, Butch Otter (R-ID) became the first governor to sign a law requiring the state attorney general to sue the federal government if it forces individuals to buy health insurance – a central tenet of the legislation. Other states are likely to pass similar measures, including Arizona, where the question will be put directly to voters.

Challenges on states' rights grounds are not likely to succeed. But because of the novelty of the requirement that individuals buy insurance, other constitutional challenges are certain.

Two attorneys for the Congressional Research Service determined last summer that Congress is on shaky ground relying on its authority to regulate interstate commerce to create the so-called individual mandate.

"Whether such a requirement would be constitutional under the Commerce clause is perhaps the most challenging question posed by such a proposal," they wrote, "as it is a novel issue whether Congress may use this clause to require an individual to purchase a good or a service."

— With reporting from the Associated Press

What Are The Immediate Effects Of Health Bill Passing?
Julie Appleby and Kate Steadman
http://www.npr.org/templates/story/story.php?storyId=124999058&ps=rs
March 21, 2010

Obama administration officials and wonks call them "early deliverables." They're the benefits of the health legislation that would kick in this election year.

The provisions, which could just as easily be called the Democrats' "Incumbents' Protection Plan," suddenly are everywhere—touted on liberal blogs, on the Rachel Maddow Show, in talking points by Health and Human Services Secretary Kathleen Sebelius.

They're designed to counter Republican denunciations that the legislation is a government takeover of the health care system that will drain the federal treasury.

But the question for Democrats is whether promoting the early changes will be more persuasive with voters than the Republican arguments. The answer may determine whether the Democrats retain their congressional majority.

James Capretta, a top budget official in the George W. Bush administration, is skeptical. He says he assumes the people who would benefit by the changes before November are in the "single-digit millions," not enough to have a big impact. "There aren't enough people in those categories to say, 'Yes, the increased taxes are worth it.'"

But Chris Jennings, a consultant who was the Clinton administration's senior health policy advisor, says the legislation includes "many important, immediately available policies that people will care about." He adds: "If we can’t market them well, then we will have deserved to fail."

Changes that would occur this year include:

- Dependent children could remain on their parents' health insurance plans until age 26.

- Senior citizens would get more help paying for drugs in Medicare.

- People with health problems that left them uninsurable could qualify for coverage through a federal program.

These are among the more than a dozen features of the new health care overhaul law that would take effect in 2010 under the measure passed Sunday. (Although the Senate bill approved Sunday by the House would become law with President Barack Obama's signature, Senate action is needed on the separately-passed House measure that would amend that law.) Other first-year items include a ban on lifetime limits on medical coverage, more oversight of premium increases and tax credits for some small businesses.

The big changes in the law – the ones that could affect tens of millions of people – don't kick in until at least 2014. Those include insurance marketplaces called “exchanges"; rules requiring insurers to accept all applicants, even those with health problems, and an expansion of state Medicaid programs.

Capretta says that the legislation has big downsides for Democrats, including the sharp cuts to Medicare Advantage. Benefits in this private-plan part of Medicare likely will be pared because the bill includes payment reductions intended to make the program similar to traditional Medicare. Medicare Advantage, Capretta says, "is going to get hammered, and it's hard to see how they avoid taking the blame."

Stuart Rothenberg, editor of the The Rothenberg Political Report, a nonpartisan newsletter, has some sympathy for Capretta's argument. "The public is unhappy," he says. "The idea that suddenly after the bill passes that Democratic leaders could start talking about it and people would be happy strikes me as Pollyannaish at best."

Americans have been sharply divided over the legislation – Democrats hope attitudes toward it will swing in their favor as people focus on the details. While some of the more popular elements of the legislation go into effect quickly, some less popular items – such as the requirement that nearly all Americans carry insurance or face a fine – won’t occur until well after the election.

Meanwhile, Republicans are keeping up a steady drumbeat of their concerns, saying the legislation will harm more Americans than it helps by raising government spending in a time of record deficits. Many in the GOP want to build support for repealing the law.

Public opinion of Congress – aimed at both partie—-- and the legislative process is low. The deal-making to garner votes during the year-long health care debate, such as special payments to specific states, coupled with last-minute maneuvering after Democrats lost their filibuster-proof majority in the Senate, soured voters.

Some of the items that go into effect in the first year include:

New help for some uninsured: People with a medical condition that has left them uninsurable may be able to enroll in a new federally subsidized insurance program that is to be established within 90 days. The legislation appropriates $5 billion for this, although that may not be enough to cover all who apply; it's not clear how much consumers would pay as their share of the cost. About 200,000 people are covered in similar state programs currently, at an estimated cost of $1 billion a year, says Karen Pollitz, a research professor at Georgetown University.

Discounts and free care in Medicare: The approximately 4 million Medicare beneficiaries who hit the so-called "doughnut hole" in the program’s drug plan will get a $250 rebate this year. Next year, their cost of drugs in the coverage gap will go down by 50 percent. Preventive care, such as some types of cancer screening, will be free of co-payments or deductibles starting in 2010.

Coverage of kids: Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014.

Tax credits for businesses: Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.

Changes to insurance: All existing insurance plans will be barred from imposing lifetime caps on coverage. Restrictions will also be placed on annual limits on coverage. Insurers can no longer cancel insurance retroactively for things other than outright fraud.

Government oversight: Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases.

This story was produced through collaboration between NPR and Kaiser Health News (KHN), an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.