Health Care Reform Legislation Clears House by Narrow Margin

On Saturday, the House voted 220-215 to approve the chamber's 1,990-page health care reform bill (HR 3962), the AP/Atlanta Journal-Constitution reports.

Thirty-nine Democrats and 176 Republicans voted against the legislation, with Rep. Joseph Cao (R-La.) providing the sole Republican vote for the legislation (Werner, AP/Atlanta Journal-Constitution, 11/8).

Cost, Coverage Estimates

According to the Congressional Budget Office, the bill would cost $1.1 trillion over 10 years and reduce the federal deficit by $104 billion (Wayne, CQ Today, 11/7).

Congressional Democrats say the bill would extend coverage to 36 million U.S. residents currently without insurance by expanding Medicaid eligibility. The bill also would establish a national health insurance exchange, where individuals could purchase private coverage or a public health insurance plan (Hulse/Pear, New York Times, 11/8).

The legislation would leave 18 million uninsured by 2019, six million of whom would be undocumented immigrants (Montgomery/Murray, Washington Post, 11/8).

Insurer Provisions

Under the bill, health insurers starting in 2010 would be:

• No longer exempt from federal antitrust restrictions on price fixing and market allocation (AP/Atlanta Journal-Constitution, 11/8);
• Prohibited from denying coverage based on pre-existing conditions;
• Banned from placing lifetime caps on coverage;
• Forbidden from rescinding policies once a person becomes sick;
• Required to disclose and justify premium increases to regulators; and
• Not allowed to remove adults younger than age 27 from parental coverage.

The House bill also would offer discounts on prescription drugs to Medicare beneficiaries and begin reducing the gap in Medicare Part D coverage, which would close entirely by 2019.

Until the public health insurance option and the insurance exchange are established, the House bill would allow uninsured residents who cannot find coverage to join high-risk insurance pools. In addition, unemployed workers would be allowed to keep their COBRA benefits.

Mandates, Subsidies

Under the House bill, starting in 2013:

• Individuals would be required to purchase health insurance or pay a fine of as much as 2.5% of their incomes;
• Employers with payrolls exceeding $500,000 would be required to offer their employees coverage or pay a fine of 8% of their payrolls (Washington Post, 11/8);
• Medicaid eligibility would be expanded to individuals and families with incomes up to 150% of the federal poverty level; and
• Families with incomes up to 400% of the federal poverty level would qualify for federal subsidies to purchase health insurance on the exchange (CQ Today, 11/7).

Paying for the Bill

In order to avoid large deficit increases, the House bill aims to cut more than $400 billion from Medicare Advantage plans over the next decade.

It also would impose a 5.4% surcharge tax on incomes exceeding $500,000 for individuals and $1 million for couples. The tax initially would be levied on 0.3% of taxpayers but would increase because the threshold is not indexed to inflation (Washington Post, 11/8).

In addition, the House bill would levy a 2.5% excise tax on the sale or lease of medical devices (CQ Today, 11/7).

Stupak Abortion Provision Added

A critical turning point for the legislation came on Friday evening, when House Speaker Nancy Pelosi (D-Calif.) agreed to allow Rep. Bart Stupak (D-Mich.) to offer an amendment that would explicitly bar the public health insurance option from covering abortion services. In addition, the amendment would prohibit people who receive subsidies from purchasing private plans that cover such services.

Pelosi's move "cleared the way for dozens of antiabortion Democrats to back the package," the Washington Post reports (Washington Post, 11/8).

The amendment, which was endorsed by the U.S. Conference of Catholic Bishops, passed on a 240-194 vote (O'Connor, Politico, 11/7).

Sixty-four Democrats voted in favor of the amendment and one Republican, Rep. John Shadegg (Ariz.), voted present (Dennis/Bendery, Roll Call, 11/7).