Breaking News - Congress clears historic health care bill

WASHINGTON – Summoned to success by President Barack Obama, the Democratic-controlled Congress approved historic legislation Sunday night extending health care to tens of millions of uninsured Americans and cracking down on insurance company abuses, a climactic chapter in the century-long quest for near universal coverage.

Widely viewed as dead two months ago, the Senate-passed bill cleared the House on a 219-212 vote. Republicans were unanimous in opposition, joined by 34 dissident Democrats.

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 — 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 second, smaller measure — making changes in the first — was lined up for passage later in the evening. It would then go to the Senate, where Democratic leaders said they had the votes to pass it.

The nonpartisan Congressional Budget Office said the legislation awaiting the president's approval would extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138 billion over a decade. If realized, the expansion of coverage would include 95 percent of all eligible individuals under age 65.

For the first time, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.

Far beyond the political ramifications — a concern the president repeatedly insisted he paid no mind — were the sweeping changes the bill held in store for millions of individuals, the insurance companies that would come under tougher control and the health care providers, many of whom would face higher taxes.

Crowds of protesters outside the Capitol shouted "just vote no" in a futile attempt to stop the inevitable taking place inside a House packed with lawmakers and ringed with spectators in the galleries above.

Across hours of debate, House Democrats predicted the larger of the two bills, costing $940 billion over a decade, would rank with other great social legislation of recent decades.

"We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans, said Speaker Nancy Pelosi, partner to Obama and Senate Majority Leader Harry Reid, D-Nev., in the grueling campaign to pass the legislation.

"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.

Republicans readily agreed the bill would affect everyone in America, but warned repeatedly of the burden imposed by more than $900 billion in tax increases and Medicare cuts combined.

"We have failed to listen to America," said Rep. John Boehner of Ohio, leader of a party that has vowed to carry the fight into the fall's midterm elections for control of Congress.

The final obstacle to the bill's passage was cleared at mid-afternoon when Obama and Democratic leaders reached a compromise with anti-abortion lawmakers whose rebellion had left the outcome in doubt. The White House announced he would issue an executive order pledging that no federal funds would be used for elective abortion, satisfying Rep. Bart Stupak of Michigan and a handful of like-minded lawmakers.

A spokesman for the U.S. Conference of Catholic Bishops expressed skepticism that the presidential order would satisfy the church's objections.

Republican abortion foes also said Obama's proposed order was insufficient, and when Stupak sought to counter them, a shout of "baby killer" could be heard coming from the Republican side of the chamber.

The measure would also usher in a significant expansion of Medicaid, the federal-state health care program for the poor. Coverage would be required for incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014.

The insurance industry, which spent millions on advertising trying to block the bill, would come under new federal regulation. They would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions and from canceling policies when a policyholder becomes ill.

Parents would be able to keep children up to age 26 on their family insurance plans, three years longer than is now the case.

A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion would go into high gear.

For the president, the events capped an 18-day stretch in which he traveled to four states and lobbied more than 60 wavering lawmakers in person or by phone to secure passage of his signature domestic issue. According to some who met with him, he warned that the bill's demise could cripple his still-young presidency.

After more than a year of political combat, Democrats piled superlative upon superlative across several hours of House debate.

Rep. Louise Slaughter of New York read a message President Franklin Roosevelt sent Congress in 1939 urging lawmakers to address the needs of those without health care, and said Democrat Harry Truman and Republican Richard Nixon had also sought to broaden insurance coverage.

Republicans attacked the bill without let-up, warning it would harm the economy while mandating a government takeover of the health care system.

"The American people know you can't reduce health care costs by spending $1 trillion or raising taxes by more than one-half trillion dollars. The American people know that you cannot cut Medicare by over one-half trillion dollars without hurting seniors," said Rep. Dave Camp, R-Mich.

"And, the American people know that you can't create an entirely new government entitlement program without exploding spending and the deficit."

Obama has said often that presidents of both parties have tried without success to achieve national health insurance, beginning with Theodore Roosevelt early in the 20th century.

The 44th president's quest to succeed where others have failed seemed at a dead end two months ago, when Republicans won a special election for a Massachusetts Senate seat, and with it, the votes to prevent a final vote.

But the White House, Pelosi and Reid soon came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both houses pass a fix-it measure incorporating numerous changes.

To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000. A new excise tax on high-cost insurance policies was significantly scaled back in deference to complaints from organized labor.

In addition, the bills cut more than $500 billion from planned payments to hospitals, nursing homes, hospices and other providers that treat Medicare patients. An estimated $200 billion would reduce planned subsidies to insurance companies that offer a private alternative to traditional Medicare.

The insurance industry warned that seniors would face sharply higher premiums as a result, and the Congressional Budget Office said many would return to traditional Medicare as a result.

The subsidies are higher than those for seniors on traditional Medicare, a difference that critics complain is wasteful, but insurance industry officials argue goes into expanded benefits.

Obama order on abortion locks in health care votes

President Barack Obama and House Democratic leaders struck a last-minute deal Sunday with abortion foes to secure the final few votes needed to remake America's health care system, writing a climactic chapter in a century-old quest for near universal coverage.

The House argued its way through a thicket of Republican objections toward an evening vote on the bill to extend coverage to 32 million Americans who lack it, ban insurers from denying coverage on the basis of pre-existing medical conditions and cut deficits by an estimated $138 billion over a decade.
A shouting band of protesters outside the Capitol dramatized their opposition, and one man stood up in the House visitor's gallery shouting, "Kill the bill" before he was ushered out — evidence of the passions the yearlong debate over health care has stirred.
Passage of a central health care bill already cleared by the Senate would send it to Obama for his signature. That still would leave one more step, a companion package of changes would go to the Senate.
Obama lobbied by phone from the White House, then took the crucial step of issuing an executive order that satisfied a small group of Democrats who demanded that no federal funds be used for elective abortions. "We're well past 216" votes, a majority, said Rep. Bart Stupak of Michigan, swinging behind the bill after leading the holdouts in a rebellion that had left the outcome in doubt.
Democratic aides confirmed his vote count.
After more than a year of political combat — certain to persist into the fall election campaign for control of Congress — debate on the House floor fell along predictable lines.
"The public has been grievously and purposely lied to," by Republicans in their efforts to defeat the legislation, said Rep. Louise Slaughter, D-N.Y., a clear reference to GOP accusations that included the claim that there would be death panels for elderly patients.
Republicans opposed the measure as a takeover of government health care that would cut Medicare and raise taxes by nearly $1 trillion combined. Rep. David Dreier, R-Calif., criticized the Democrats for their tactics on the House floor, but said, "the greatest outrage has always been for the bill itself."
Over and over, Democrats stressed the historic nature of the day.
"Health care isn't only a civil right, it's a moral issue," said Rep. Patrick Kennedy, D-R.I. He said his late father, Sen. Edward M. Kennedy, D-Mass., had worked his entire career for nationwide health care, and President John F. Kennedy before him.
Slaughter, read a message President Franklin Roosevelt sent Congress in 1939 urging lawmakers to address the needs of those without health care, and said Democrat Harry Truman and Republican Richard Nixon had also sought to broaden health insurance coverage.
Obama has said often that presidents of both parties have tried without success to achieve national health insurance, beginning with Theodore Roosevelt early in the 20th century.
The 44th president's quest to succeed where others have failed seemed at a dead end two months ago, when Republicans won a special election for a Massachusetts Senate seat, and with it, the votes to prevent a final vote.
But the White House, House Speaker Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., soon came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both houses pass a fix-it measure incorporating numerous changes.
Under the order of the day, set down by Democrats, the House was voting first on the Senate-passed bill, sending it to Obama for his signature. A final vote on the fix-it bill would follow. Its passage would set up a final showdown in the Senate, where Reid says the votes are in hand for its final approval.
Under the legislation, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.
The legislation would also usher in a significant expansion of Medicaid, the federal-state health care program for the poor. Coverage would be required for incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014.
The insurance industry would come under new federal regulation. They would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions and from canceling policies when a policyholder becomes ill.
Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear.
Once enacted, the two bills would create a series of so-called "insurance exchanges" beginning in 2014 where consumers could shop for individual coverage that meets federal standards.
To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000. A new excise tax on high-cost insurance policies was significantly scaled back in deference to complaints from organized labor.
In addition, the bills cut more than $500 billion from planned payments to hospitals, nursing homes, hospices and other providers that treat Medicare patients. An estimated $200 billion would reduce planned subsidies to insurance companies that offer a private alternative to traditional Medicare.
The insurance industry warned that seniors would face sharply higher premiums as a result, and the Congressional Budget Office said many would return to traditional Medicare as a result.
The subsidies are higher than those for seniors on traditional Medicare, a difference that critics complain is wasteful, but insurance industry officials argue goes into expanded benefits.

Pelosi Predicts a Health Bill Within 10 Days

WASHINGTON — Speaker Nancy Pelosi mobilized House Democrats on Friday for a final effort to pass an overhaul of health care, predicting approval in the next 10 days with help from President Obama, who delayed a trip abroad to try to win over wavering Democrats.
Speaker Nancy Pelosi said a proposed overhaul of the student loan program would be included in the final health care bill.
The White House said Mr. Obama would begin his trip to Indonesia and Australia a week from Sunday, three days later than scheduled, allowing him to be on hand for what is shaping up as the pivotal period for his top domestic initiative. Mr. Obama will travel to Ohio on Monday to push for passage.
But even as the yearlong battle hurtled toward a conclusion, approval of the bill was hardly certain, so lawmakers were preparing for a week of arm-twisting and high drama. Although they have been debating the issue for a year, some House Democrats said Friday that they could not say how they would vote because they had not seen the final text of the legislation or an official estimate of its cost.
Some issues that could swing blocs of votes, like insurance coverage for abortions, remain unresolved. House Democratic leaders said they had suspended their efforts to reach a compromise with party members who oppose abortion and the use of federal money to subsidize insurance that includes coverage of the procedure. That could cost them the votes of some House Democrats who supported the health care bill in the fall after it was amended to impose tight restrictions on abortion coverage.
The Capitol, normally quiet on a Friday, was abuzz as Democrats and Republicans readied for what is likely to be a frenetic push, leading to a series of climactic votes.
At the same time, members of both parties struggled to decipher a ruling by the Senate parliamentarian about how they would have to navigate through the complex rules governing the legislative technique being used by Democrats to win final approval of the bill. While their interpretations differed, Democrats said they believed they could meet its requirements with this sequence of events:
As soon as Thursday or Friday, the House would pass the health care bill approved by the Senate in December. The House would immediately approve a package of changes in a separate bill, using a procedure known as budget reconciliation, to avoid the threat of a Republican filibuster in the Senate.
Mr. Obama would sign the Senate health care bill, making it the law of the land. The budget reconciliation bill would go to the Senate, where Republicans intend to offer dozens of amendments and points of order in an effort to alter or stop it. Assuming they are able to fend off the Republican blocking efforts, Democrats could pass the reconciliation package with a simple majority vote, amending the health bill in a way that makes it acceptable to Democrats in the House and the Senate and to Mr. Obama. The president would then sign the reconciliation bill, completing the process.
The Senate Republican leader, Mitch McConnell of Kentucky, said Democrats were “twisting themselves into pretzels trying to figure some way to get this health care bill passed.”
“The reason all of this arm-twisting and deal-making and parliamentary maneuvering is going on is that people hate this bill,” Mr. McConnell said. “They are trying to convince their members, within eight months of an election, to ignore their constituents and do something that the public is opposed to.”
Ms. Pelosi said a proposed overhaul of the student loan program would be included in the reconciliation bill, a decision that cheered many Democrats. The education bill is popular in the House, and some Democrats said it could help win support for the overall package, in part because it cuts off subsidies to big banks at a time of populist anger against Wall Street.
“This is a controversial, difficult vote for a lot of people, me included,” said Representative Robert E. Andrews, Democrat of New Jersey. “The more things that you can go home and say are in the bill that are sort of universally popular, yeah, it helps.”
He noted, for example, that the bill would provide additional money for community colleges and Pell grant scholarships.
But another New Jersey Democrat, Representative Bill Pascrell Jr., criticized packaging the health care and education bills together. “We will be confusing the American people more than we already have,” said Mr. Pascrell, who supports both bills.
Ms. Pelosi welcomed Mr. Obama’s decision to delay his trip.
“I’m delighted that the president will be here for passage of the bill,” she said. “It’s going to be historic. And it would not be possible without his tremendous, tremendous leadership, his persistence, his concern for the American people, always guided by his statement that we will measure our success by the progress being made by America’s working families.”
The bill would provide coverage to more than 30 million people who are uninsured, would require most Americans to carry insurance and would prohibit insurers from denying coverage to people who are sick. In both houses, Republicans strenuously oppose the legislation, saying it would raise taxes, cut Medicare and lead to higher premiums for many people who are relatively young and healthy.
Though Democrats said the bill could come to a vote by the end of the week, they have missed many self-imposed deadlines on health care, and when pressed on the schedule, Ms. Pelosi said she could not guarantee final House action by March 21, when Mr. Obama is to leave on his trip.
“I’m hoping that it will be in that time frame,” she said, adding, “We stand ready to stay as long as it takes to pass the bill.”
Representative Anthony D. Weiner, Democrat of New York, expressed the optimism of many in his party after the House Democratic Caucus met Friday.
“There’s been a tidal change, I think, in the last 72 hours or so,” Mr. Weiner said. “People have become more confident that we’re going to get this done.”
Abortion is perhaps the most contentious outstanding issue. Representative Steny H. Hoyer of Maryland, the Democratic leader, said he had discussed the issue with Representative Bart Stupak of Michigan, a leader of the anti-abortion Democrats. But Mr. Hoyer said, “I made it clear I was not negotiating.”
House Democrats dislike the Senate health bill and do not want to vote for it without an assurance that the Senate will pass the budget reconciliation bill to eliminate politically unpopular provisions, like one giving Nebraska extra Medicaid money.

Pelosi: House lacks votes to OK Senate health bill

Associated Press Writer – 37 mins ago
January 21, 2010
WASHINGTON – Speaker Nancy Pelosi says she lacks the votes to push the Senate's sweeping health overhaul bill through the House, a potentially devastating blow to President Barack Obama's signature issue.

The California Democrat made the comment to reporters Thursday after House Democrats held a closed-door meeting at which participants vented frustration with the massive version of the legislation.

Pelosi said, "In its present form without any changes I don't think it's possible to pass the Senate bill in the House. ... I don't see the votes for it at this time." Many House Democrats, reeling from their loss of the Massachusetts Senate seat in this week's special election, want the party to pursue a more modest health bill.
THIS IS A BREAKING NEWS UPDATE.
AP's earlier story is below.
WASHINGTON (AP) — Support for a White House-backed plan for salvaging the massive health care overhaul is eroding in the House as Democrats reeling from the loss of the Massachusetts Senate seat argue for a less ambitious approach.
The House leadership has made no decision on whether to press ahead with the Senate bill, but rank-and-file Democrats vented their frustration at a closed-door meeting Thursday. Emerging from the session, Rep. Michael Arcuri, D-N.Y., said: "The mega bills are dead. If we didn't see what happened Tuesday night, we have blinkers on."
Rep. Dennis Cardoza, D-Calif., said there was more support for refocusing on the health care changes with more popular appeal among American consumers. Republican Scott Brown captured the Massachusetts Senate seat, disrupting the Senate's power to move quickly on health care.

Obama, allies now seek pared-down health care bill

Associated Press Writer – 53 mins ago

January 20, 2010
WASHINGTON – Chastened by the Democratic Senate loss in Massachusetts, President Barack Obama and congressional allies signaled Wednesday they may try to scale back his sweeping health care overhaul in an effort to at least keep parts of it alive.

A simpler, less ambitious bill emerged as an alternative only hours after the loss of the party's crucial 60th Senate seat forced the Democrats to slow their all-out drive to pass Obama's signature legislation despite fierce Republican opposition. The White House is still hoping the House can pass the Senate bill in a quick strike, but Democrats are now considering other options.

No decisions have been made, lawmakers said, but they laid out a new approach that could still include these provisions: limiting the ability of insurance companies to deny coverage to people with medical problems, allowing young adults to stay on their parents' policies, helping small businesses and low-income people pay premiums and changing Medicare to encourage payment for quality care instead of sheer volume of services.

The goal of trying to cover nearly all Americans would be put off further into the future.

Obama urged lawmakers not to try to jam a bill through, but scale the proposal down to what he called "those elements of the package that people agree on."

"We know that we need insurance reform, that the health insurance companies are taking advantage of people," the president said in an interview with ABC News. "We know that we have to have some form of cost containment because if we don't then our budgets are going to blow up. And we know that small businesses are going to need help."

One potential Republican convert for health care legislation remained an enigma. Sen. Olympia Snowe of Maine, who has been in regular contact with Obama, roundly criticized the Democrats' hard push to pass their bill. But she would not rule out voting for something in the end.

Asked if the Democratic bills are dead, Snowe responded: "I never say anything is dead, but clearly I think they have to revisit the entire issue."

Some Democrats weren't ready for that, despite the president's new words.

One option, still alive and stirring strong emotions, called for the House to quickly pass the Senate version of the broader bill — simply accepting it and therefore bypassing the Senate problem created by the loss of the Massachusetts seat to Republican Scott Brown. But that appeared to be losing favor.

"That's a bitter pill for the House to swallow," said the No. 2 Senate Democrat, Dick Durbin of Illinois.

"Full speed ahead is off the table," said Rep. Earl Pomeroy, a moderate Democrat from North Dakota. "We are still very much in the exercise of drawing meaning from the public disquiet."

Nevertheless, the quick approach remained on the table, despite some House members' deep misgivings. In fact, administration officials were working behind the scenes on that idea, which would be the fastest and cleanest route to getting a bill to Obama, said a senior administration official, who spoke on condition of anonymity to more freely describe private talks.

House Speaker Nancy Pelosi and other Democratic leaders were gauging support for the idea among liberals and moderates. The initial reaction was not encouraging.

"If you ran that Senate bill right now on the House floor, I'll bet you would not get 100 votes for it," said Rep. Bart Stupak, D-Mich.

It takes 218 votes to pass legislation. A majority of House Democrats oppose a tax on high-cost insurance plans in the Senate bill that unions see as a direct hit on their members. Stupak and other abortion opponents, backed by Catholic bishops, say the Senate bill falls short in restricting taxpayer dollars for abortion.

A week ago, House and Senate Democrats were working out the differences in their respective bills, and a quick resolution seemed likely. But feuding broke out after Brown's upset victory secured the seat held by the late Sen. Edward M. Kennedy for the GOP.

Some Democratic senators suggested it was up to the House to save the day by passing the Senate bill.

"The Senate has passed the health care bill. The House has to make a decision how they want to proceed," said Sen. Patty Murray, D-Wash., a member of the leadership.

Republicans said that would make their day.

Trying to push the Senate bill through would be a desperate ploy seen as such by voters, said Sen. John McCain, R-Ariz., Obama's 2008 presidential rival. "If they try to jam it through the House, they'll pay a very heavy price."

As the day wore on, those urging moderation seemed to be winning the argument.

"We're not going to rush into anything," said Senate Majority Leader Harry Reid, D-Nev. "We will wait until the new senator arrives."

Many Democrats are wary of starting over with the goal of drafting a bill that reaches for the political middle. They doubt they'll get any cooperation from Republicans.

"You cannot dance with someone if they are not willing to dance with you," said Sen. Robert Menendez, D-NJ. He called GOP complaints that the Democrats wrote a partisan bill "pretty lame, when they have made a political calculation that their path to victory is to have the president fail."
But House Majority Leader Steny Hoyer, D-Md., said a more modest approach would be a "reasonable alternative" that could appeal to the public even if Republicans still oppose it.
"Given the public concern, I think that we ought to focus on that which...the public can support and will be positive in terms of making health care more affordable and obtainable," he said.
Instead of one big bill, health care overhaul could be broken into chunks and passed over time.
"Medicare wasn't done in one fell swoop," said House Majority Whip Jim Clyburn, D-S.C. "You lay a foundation and you get this thing done over time."