Health-care bill clears House

WASHINGTON -- The House narrowly passed a landmark health-care bill yesterday that holds out the promise of coverage for millions more Americans.

Under the measure, most Americans would be required to carry insurance, and large employers would be obliged to cover their employees.

Last night's 220-215 vote came after President Barack Obama summoned Democrats to "answer the call of history" and approve the measure after months of struggle, capped by a final clash over abortion.

A triumphant Speaker Nancy Pelosi, D-Calif., likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later.

"It provides coverage for 96 percent of Americans," said Rep. John D. Dingell, D-Mich., who has introduced national health insurance in every Congress since succeeding his father in 1955. "It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it."

Passage clears the way for a Senate debate expected to begin in several days. Democratic leaders have been working on a self-imposed deadline for passing a final compromise, but Senate Majority Leader Harry Reid, D-Nev., signaled recently that that may slip.

United in opposition, minority Republicans yesterday cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health-care system faster than you can say, 'This is making me sick,'" said Rep. Candice S. Miller, R-Mich., adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.

"People have a grave concern about what Washington is doing to them, not for them," Virginia Rep. Eric I. Cantor, the No. 2 House Republican, said yesterday, citing last week's GOP gubernatorial election victories in Virginia and New Jersey.

About the bill: The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance-industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. The industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.

At its core, the measure would create a federally regulated marketplace in which consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.

Obama goes to Democrats: Debate on the House floor had already begun yesterday when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.

While the session was private, he later said he had told the rank and file "that opportunities like this come around maybe once in a generation. . . . This is their moment, this is our moment, to live up to the trust that the American people have placed in us."

"I urge members of Congress to rise to this moment. Answer the call of history, and vote yes for health-insurance reform for America," he said.

Abortion compromise: It appeared that a compromise brokered Friday night on the volatile issue of abortion may have secured the votes needed to pass the legislation.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

As first drafted, the measure denied the use of federal subsidies to purchase abortion coverage in policies sold by private insurers in a new insurance exchange, except in cases of incest, rape or when the life of the mother was in danger.

Democratic abortion foes sought far stronger restrictions that would rule out abortion coverage except in those three categories in any government-sold plan. It would also ban abortion coverage in any private plan purchased by consumers receiving federal subsidies.

When Pelosi's attempts to forge a compromise between Democrats on both sides of the abortion issue failed Friday night, she then pivoted to permit Reps. Bart Stupak, D-Mich., Brad Ellsworth, D-Ind., and others a chance during the debate to insert their more stringent restrictions into the bill.

Marshaling forces: Democrats hold a 258-177 majority in the House, meaning they could afford 40 defections and still be certain of having an absolute majority of 218.

Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.

The nation's drug companies generally support health-care overhaul. And while the powerful insurance industry opposed the legislation, it did so quietly, and the result was that Republicans could not count on the type of advertising campaign that might have peeled away skittish Democrats in swing districts.