House poised to pass historic health-care reform bill

By DAVID LIGHTMAN

WASHINGTON — With a personal push from President Barack Obama, the House of Representatives Saturday inched closer to passing historic health care legislation that would guarantee virtually all Americans access to care.

Two key votes pointed to its passage: one, 242-192, authorized the bill to be debated, a key test of Democratic strength, and a second one that banned government-subsidized health insurance from covering elective abortions.

That vote was 240-194, with most Democrats opposing what opponents of the abortion limits called the greatest restriction on health care imposed on women in a generation. Republicans, however, overwhelmingly backed the amendment.

Passage of the amendment, however, was considered critical to win the support of anti-abortion Democrats for passage of the final health-care proposal, which needs 218 votes.

As the debate began, Obama visited Capitol Hill to meet for half an hour with House Democrats as the all-day debate was starting Saturday morning, and compared the health care effort to Democrats' championing of Social Security and Medicare.

"Now is the time to finish the job," Obama said later in brief remarks in the White House Rose Garden.

On the House floor, Democratic leaders appealed to members' sense of history, reminding them this is one of the most significant votes, short of war, they are likely to take.

"There are few moments when we have the opportunity to do so much good with one vote. This is one of those moments," said Majority Leader Steny Hoyer, D-Md.

Republicans countered with arguments that the health care plan did little to improve coverage or affordability.

"Astoundingly, Democrats are bringing to the floor a bill today that will not reduce the costs of health insurance. It will grow the size of government," said GOP Conference Chairman Mike Pence, R-Ind.

Democratic leaders scheduled a final vote on the bill late Saturday night, and were confident they had enough for passage after a last-minute abortion deal.

The House bill would make the biggest changes in the nation's health care system since Medicare was created 44 years ago to provide coverage for seniors and the disabled.

Passage of the bill by the House would be the first crucial step to overhauling health care; the Senate hopes to act by the end of the year, and the two Houses would then craft a compromise that would need the approval of each chamber.

The House measure would create a government-run health-care plan to compete with the private sector, bar insurers from denying coverage because of pre-existing conditions and set up health care "exchanges," or marketplaces where consumers could easily shop for coverage.

The changes are expected to mean that by 2019, 96 percent of eligible Americans would have health insurance, up from the current 83 percent.

Obama took no questions from lawmakers, but his presence was a vivid, and highly partisan, reminder that the president has put health care overhaul at the top of his domestic agenda - a change that has eluded presidents for nearly a century.

"He came here to say, 'This is what we said we would do in the campaign. Let's do it,' " Hoyer said.

Democratic leaders said that they doubted many votes would change as a result of the Obama appearance, but that "the energy he brought to this debate will be helpful," said Majority Whip Jim Clyburn, D-S.C.

A bigger boost likely came from the abortion deal.

As originally written, the House bill would have required insurers to separate public and private money, so that only private funds could be used for elective abortions. Abortion opponents were concerned that such a policy would effectively expand the government's role in improving access to abortion, and as many as 40 Democrats threatened to withhold support from the health care bill unless changes were made.

After tense negotiations Friday night - with White House officials and representatives of the U.S. Conference of Catholic Bishops as well as key Democratic members of Congress - House Democratic leaders agreed to allow a vote Saturday on sweeping changes to the abortion provision.

The change would permit abortion coverage for people receiving federal aid for their insurance only in the case of rape or incest or when the mother's life is endangered. That change is consistent with a 1970s-era federal law governing public funding of abortion.

Under the new provision, only people buying private insurance with their own funds would have an elective abortion covered.

Rep. Bart Stupak, D-Mich., a leader of the anti-abortion forces, said the new language is "strong," strong enough that he expected most of the approximately 40 anti-abortion Democrats to back the final bill.

But many abortion rights advocates were angry, and the brief debate often pitted Democrat against Democrat. "This amendment is government interference in the decision between a woman and her physician," said Rep. Lois Capps, D-Calif. "Unnecessary and reprehensible," added Rep. Nita Lowey, D-N.Y.

"Today we're on the brink of passing health care reform that honors and respects life in every state," countered Rep. Brad Ellsworth, D-Ind.

With the abortion agreement, House Democratic leaders said they were confident they had the 218 votes needed to pass. The Democrats control 258 seats, but 27 Democrats, most from conservative states or freshmen facing tough re-elections, were seen as solid "no" votes.

Republicans tried throughout the day to create more doubt and delay, loudly shouting objections to routine parliamentary requests by objecting when Democratic women tried to discuss their concerns on the House floor.

GOP members then pushed their own plan, which would make it easier for small businesses to band together to purchase competitively priced coverage, allow consumers to buy policies across state lines, and effect strong medical malpractice reforms.

A vote on that plan was expected later Saturday, but since the GOP controls only 177 seats, it was expected to fail.

The bigger obstacle for Democrats was fellow Democrats, as dozens of members continued to express reservations about the bill.

Some were freshmen elected by slim margins in conservative districts.

Rep. Walt Minnick, D-Idaho, wanted to see more cost-cutting. "Unfortunately, the new health-care bill in the House does not adequately meet those goals, so I will vote 'no,' " he said.

Some were veteran members of the Blue Dog Coalition, a group of 52 Democratic conservatives. Many objected to the bill's price tag and worried it would increase the federal deficit.

The House bill misses a critical opportunity to address access, quality and costs on the one hand, and solidify our fiscal future on the other hand," said Rep. Stephanie Herseth Sandlin, D-S.D.

The nonpartisan Congressional Budget Office estimated the bill's net cost would total $891 billion over 10 years and reduce the deficit by $109 billion. But many Democrats were wary.

"While the Congressional Budget Office predicts this bill is paid for over 10 years, there is no mechanism in the bill to force spending cuts if those complicated projections turn out to be wrong," said Rep. Chet Edwards, D-Texas.

But enough Blue Dogs and freshmen were expected to back the leadership - which was stressing how the bill could be changed later - that passage seemed likely.

In the Senate, where moderates' concerns have stalled progress, Democratic leaders are hoping for a debate and vote before the end of the year.

"My vote is not an endorsement of all the provisions of the bill, because I find much of the bill to be deeply flawed," said Rep. Jim Cooper, D-Tenn., a Blue Dog who backed the measure. "My reason for voting 'yes' is to advance the cause of health care reform by forcing the Senate to act."