The House passed a trillion dollar bill that will force Americans to buy health insurance, force even small businesses to provide health coverage, and require insurance companies to cover pre-existing conditions. (The last, as I have previously argued, makes it something other than “insurance.”)
Lori Montgomery and Shailagh Murray for WaPo:
Hours after President Obama exhorted Democratic lawmakers to “answer the call of history,” the House hit an unprecedented milestone on the path to health-care reform, approving a trillion-dollar package late Saturday that 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 that included 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 and had been the target of a last-minute White House lobbying campaign. GOP House leaders had predicted their members would unanimously oppose the bill.
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 M. 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.
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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-care coverage through their jobs.
Carl Hulse and Robert Pear for NYT:
Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.
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Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks.
Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.
Democrats say the House measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.
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Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”
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The House legislation, running almost 2,000 pages, would require most Americans to obtain health insurance or face penalties — an approach Republicans compared to government oppression. Most employers would have to provide coverage or pay a tax penalty of up to 8 percent of their payroll. The bill would significantly expand Medicaid and would offer subsidies to help moderate-income people buy insurance from private companies or from a government insurance plan. It would also set up a national insurance exchange where people could shop for coverage.
This measure barely passed the House, where Democrats enjoy a solid majority in which most Members are Gerrymandered into uncompetitive seats. And there are many Jim Coopers among the Yeas: People who would have voted Nay if they were not so confident the Senate would produce a much less radical bill, ensuring any measure that reaches the president’s desk will be less mild. I’m pretty sure they’re right.
Still, this is a rather staggering measure passed by the House. If this became law, the poor would be significantly poorer and small businesses would be even less competitive with the big box stores. During a very weak economy with an unemployment at ten percent, no less. Oh, and insurance rates will go up for the rest of us, too, as companies amortize the cost of absorbing people who have costly illnesses — who will by definition be a net drain on the pool from Day 1 — by passing it on to the rest of us.
Presumably, the rationale behind these moves is to wreck the current system entirely, making a government system the only alternative. Certainly, it’s not a good faith measure to improve the current system.
I get that the status quo is far from perfect. Young, healthy people often can’t afford health insurance. (I went without during my graduate school days, for example, unable to justify spending $250 a month out of a $750 stipend to cover the incredibly unlikely event of getting seriously sick.) The poor clog up our emergency rooms. People are stuck at their job because they’d lose coverage at an otherwise preferable job. Dealing with insurance companies can be a nightmare.
This bill helps address some of those problems, at least at the margins. But it exacerbates others.
Moreover, this plan does nothing to address the fundamental problem with the status quo: The unsustainable skyrocketing in health care costs. If the Senate were to somehow pass the identical bill, we’d cover more people — a good thing in and of itself — but at a higher per unit cost. That means an even greater share of GDP would go to health care from the beginning with no additional constraints on the escalation of costs.
