House passes health reform bill, debate moves to Senate

Democratic leaders prevailed with help from anti-abortion members of the caucus. The House could vote on Medicare physician pay the week of Nov. 16.

By David Glendinning — Posted Nov. 9, 2009

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The U.S. House of Representatives narrowly passed a landmark, $1 trillion health system reform bill during a rare Saturday late-night vote Nov. 7, capping a day of heated debate over issues that had divided the Democratic caucus and threatened chances for final passage.

By a vote of 220-215, the House approved the Affordable Health Care for America Act. The measure is projected to cover 96% of Americans through a combination of individual and business mandates, health insurance reforms, and new government coverage subsidies. Thirty-nine Democrats and all but one Republican voted against the bill, which would also implement a public insurance option that would compete with private plans through a new insurance exchange.

"It is a significant victory that the House has passed comprehensive health reform legislation for all Americans," said House Energy and Commerce Committee Chair Henry Waxman (D, Calif.). "This bill will at long last reform the health care system by expanding choices, reducing costs and providing people with peace of mind about their health insurance."

But Republicans and insurers blasted the outcome of the vote, saying it ignores the long-term financing issue and would force people into government-run plans. "Americans want a common-sense approach to health care reform, not Speaker Nancy Pelosi's 2,032-page government takeover that increases costs, adds to our skyrocketing debt, destroys jobs with tax hikes and new mandates, and cuts seniors' Medicare benefits," said House Minority Leader John Boehner (R, Ohio).

Karen Ignagni, president and CEO of America's Health Insurance Plans, echoed similar themes. "The current House legislation fails to bend the health care cost curve and breaks the promise that those who like their current coverage can keep it," she said in a post-vote statement.

House passage shifts the bulk of the health system reform debate back to the Senate, where leaders are still working to craft a final bill for floor consideration. Democratic leaders in the upper chamber have declined to say whether they thought their measure could pass the Senate before the end of the year.

The House also has not resolved the issue of Medicare payment for physicians. Leaders have introduced a separate bill to scrap the formula that determines doctor pay and to instead align rates more closely with practices' costs of providing care. House Majority Leader Steny Hoyer (D, Md.) said his chamber could consider that legislation the week of Nov. 16, after representatives return from a Veterans Day recess.

The American Medical Association supported the passage of the Affordable Health Care for America Act but said the separate Medicare pay piece must be approved as a companion measure. "As Congress considers new coverage commitments to the American people through health reform, it must ensure that commitments already made are fulfilled through passage of the Medicare Physician Payment Reform Act of 2009," AMA President J. James Rohack, MD, said in a statement following the Nov. 7 House vote.

Democratic leaders moved earlier that day to quell an uprising within their own ranks over the issue of abortion coverage. The agreement they brokered allowed consideration of an amendment stipulating that the public option would not cover abortion services and that recipients of government subsidies could not use them to buy health insurance that covers abortion. The amendment passed by a vote of 240-194.

By a vote of 176-258, the chamber defeated a Republican substitute bill that would have implemented health insurance cooperatives, allowed families and businesses to purchase insurance across state lines, and enacted comprehensive medical liability reforms.

President Obama visited House Democrats on Capitol Hill the morning of the vote in a final effort to garner support from those still sitting on the fence. Afterward, he said he told lawmakers that "opportunities like this come around maybe once in a generation."

After the vote, the president noted, "This is history."

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