WASHINGTON – A deeply divided House of Representatives on Sunday approved historic legislation aimed at providing Americans with near-universal health care, handing President Barack Obama a huge victory on one of the most polarizing domestic policy issues in the United States.
Following a final day of high stakes political brinkmanship inside the U.S. Capitol and outbursts of angry protest outside, Democrats won a narrow 219-212 vote on a bill that will extend medical coverage to more than 32 million people over the next decade.
The health reform package, which had already been passed by the U.S. Senate before Christmas, can now go the White House for the president’s signature into law.
House lawmakers then immediately moved to separately pass a series of White House-prescribed “fixes” to the original legislation. Those changes will now go back to the Senate for final approval, likely this week. The legislation’s total cost is expected to reach $940 billion US.
In pushing through a bill that only two months ago seemed doomed, Obama achieved a feat that eluded several presidents before him, including Bill Clinton, whose failed attempt at health care reform in 1993-94 cost Democrats their congressional majority.
Several historians have described Obama’s health-care package as the most far-reaching piece of social welfare legislation since the Medicare program for American seniors was created in 1965.
“Today is the day that is going to rank with the day we passed the civil rights bill in 1964,” said Michigan Democrat John Dingell, a veteran lawmaker who had introduced a universal health care bill in Congress every year since 1956. “This is a day that we could all be proud of.”
In a symbolic gesture, House Speaker Nancy Pelosi carried the same gavel used during the Medicare debate 45 years ago with her on Capitol Hill.
“This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people. This is an American proposal that honours the traditions of our country,” Pelosi said.
But Obama’s victory came at a cost, and brings no small measure of risk to him and his fellow Democrats. Not a single Republican voted in favour of the legislation, underscoring just how contentious the health care debate became in the year since Obama made the issue his top domestic priority.
GOP leaders promised put health care at the centre of the coming midterm election campaign this fall.
“This debate is not about the uninsured. It is about socialized medicine,” said California Republican Devin Nunes. “Today Democrats in this House will finally lay the cornerstone of their socialist utopia on the backs of the American people.”
Passage of the legislation was assured only after a hectic round of last-minute negotiations between the White House and pro-life Democrats who worried the bill would expand access to abortions.
Obama agreed to issue an executive order to establish an “enforcement mechanism to ensure that federal funds are not used for abortion services” except in cases of rape or incest, or when a woman’s life is in danger.
Representative Dale Kildee, an 80-year-old pro-life Democrat from Michigan, said Obama’s order satisfied his concerns. He called his support for the legislation a “vote for the born and the unborn.”
The legislation ushers in the most significant changes in almost half a century to a health-care system that has ballooned in cost to $2.5 trillion a year while leaving millions without insurance coverage.
The final bill imposes an “individual mandate’’ requiring Americans to buy health insurance at risk of being fined if they do not. To make insurance more affordable, the legislation offers federal subsidies for lower and middle-class Americans. It also expands funding to states for Medicaid, the public insurance plan for the nation’s poorest citizens. Children will be able to stay on their parents’ insurance plans through age 26.
The bill immediately bars insurance companies from denying coverage to sick children and – by 2014 – will make it illegal to withhold insurance from anyone with a pre-existing medical condition. It also includes provisions to prevent massive premium hikes and to eliminate the practice of setting lifetime limits on coverage.
For individuals and small businesses currently priced out of the private insurance market, the legislation seeks to lower the cost by creating a series of health-care exchanges that would allow people to shop around for better deals.
For all its promised benefits, however, the legislation is less than what many liberal Democrats had hoped for when the health care debate began. The bill does not include the creation of a new government-run insurance plan, and instead builds reforms into the existing system of private insurance that dominates the U.S. health care market.
According to the non-partisan Congressional Budget Office, savings included in the legislation would ultimately reduce the U.S. deficit by about $130 billion in the first decade.
The cost savings come largely by provisions in the bill to eliminate fraud in the existing Medicare program for U.S. seniors, by placing a Medicare tax on unearned income and eventually taxing high-cost “Cadillac” insurance plans.
Several recent polls have shown a narrow majority of Americans disapprove of the health-care legislation and Obama’s handling of the issue.
Several hundred of the most passionate opponents crowded the streets outside the U.S. Capitol on Sunday, chanting “Kill the bill” and hurling insults at passing lawmakers including Pelosi.
But the atmosphere was not quite as ugly on Sunday as it had been a day earlier, when black and homosexual lawmakers said they were taunted with racial and anti-gay epithets. One African-American congressman, Emanuel Cleaver, said one protester spat on him as he passed.
The focus of the health care debate now turns to the U.S. Senate, where one final drama will play out. Although the health bill will become law with Obama’s signature, House Democrats and the White House want a series of changes to add benefits to some Americans, modify tax provisions and remove several pork-barrel deals cut to benefit particular senators.
Because Democrats lack a 60-vote “supermajority” to overcome a Republican filibuster, they plan to pass the final legislation with a simple 51-vote majority using a tactic known as ‘reconciliation.’