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WASHINGTON – Hours after President Obama exhorted Democratic lawmakers to “answer the call of history,” the House voted to approve a trillion-dollar package late Saturday.
The legislation seeks to overhaul private insurance practices and guarantee comprehensive and affordable coverage to almost every American.
After months of acrimonious partisanship, Democrats closed ranks on a 220-215 vote despite 39 defections, mostly from the party’s conservative ranks. But the bill attracted a surprise Republican convert: Rep. Anh “Joseph” Cao of Louisiana, who represents the Democratic-leaning district of New Orleans.
Democrats have sought for decades to provide universal health care, but not since the 1965 passage of Medicare and Medicaid has a chamber of Congress approved such a vast expansion of coverage. Action now shifts to the Senate, which could spend the rest of the year debating its version of the health-care overhaul. Majority Leader Harry Reid, D-Nev., hopes to bring a measure to the floor before Thanksgiving, but legislation may not reach Obama’s desk before the new year.
At the Capitol, Obama urged the few Democrats who were still wavering on Saturday afternoon to put aside their political fears and embrace the bill’s ambitious objectives. “Opportunities like this come around maybe once in a generation,” he said afterward. “This is our moment to live up to the trust that the American people have placed in us. … This is our moment to deliver.”
The House legislation would for the first time require every individual to obtain insurance, and would require all but the smallest employers to provide coverage to their workers. It would vastly expand Medicaid and create a new marketplace where people could obtain federal subsidies to buy insurance from private companies or from a new government-run insurance plan.
Though some people would receive no benefits – including about 6 million illegal immigrants, according to congressional estimates – the bill would virtually close the coverage gap for people who do not have access to health coverage through their jobs.
The debate on the House floor extended for about 12 hours and settled into a civil, if predictable, pattern, after a heated start.
Republicans had blasted the bill as an ominous blueprint for a budget-busting government takeover of the private health-care system that would impose unprecedented mandates on individuals and employers, raise an array of taxes and slash projected spending on Medicare, the federal health program for the elderly.
House Speaker Nancy Pelosi focused on corralling at least 218 of 258 Democrats to push the bill across the finish line. That task appeared to grow easier after party leaders broke a weeks-long impasse over abortion by agreeing to hold a vote on an amendment – offered by anti-abortion Democrats – that would explicitly bar the public plan from covering the procedure.
Attention will now shift back to the Senate. If the Senate acts, negotiations to iron out differences between the two chambers could be wrenching.
Among the toughest issues: whether the public option should include an “opt out” clause for states, as Reid has proposed; whether to require employers to provide coverage to their workers or take the less punitive approach preferred by Senate moderates; and whether to tax the rich or tax high-cost health-care policies, as the Senate proposed – a provision economists call the most important provisions in either bill for reining in costs.
