House health care vote is just the first step

By DAVID LIGHTMAN

WASHINGTON — Any momentum from Saturday's historic House approval of a sweeping health care overhaul is likely to be short-lived as the focus moves to the Senate, where progress has been stalled for weeks.

Washington lawmakers on Sunday had two views of what the House's 220 to 215 vote means.

One was that the narrowness of the vote, with 39 Democrats opposed, showed the weakness of the bill. President Barack Obama, whose top lieutenants lobbied furiously, including a presidential visit to the Capitol 11 hours before the vote.

"Most of our constituents agree we have a very serious problem with the health care system, but in terms of how you fix it, the country is very divided," said Rep. Allen Boyd, D-Fla., one of the Democrats who voted no.

The other was that the House vote was a major victory, the furthest any proposed health care overhaul has gotten since Medicare was created in 1965. No final health care overhaul will be easy.

Obama, in a Sunday statement, praised "a courageous vote for many members of Congress."

"For years we've been told this couldn't be done," he said. "After all, neither chamber of Congress has been able to pass a comprehensive health insurance reform bill for generations. But last night, the House proved differently."

The bill would create a government-run health care insurance plan to compete with the private sector, bar insurers from denying coverage because of pre-existing conditions and require most people to obtain coverage.

In the Senate, the views of eight to 12 moderates must be accommodated before anything can move.

Congressional centrists, as well as many freshmen and sophomore House members in swing districts, have said for some time their constituents are questioning whether more government will help ease their immediate financial worries. The message was reinforced Tuesday, when Republican candidates won governorships in Virginia and New Jersey with the help of independent voters.

"More people in my district are expressing concern than support" for the House health care overhaul, said Rep. Rick Boucher, D-Va., who represents the more rural, far western part of the state. He, too, voted no.

Even some who supported the House bill Saturday explained they were doing so largely to keep the legislative process alive.

"My reason for voting yes is to advance the cause of health care reform by forcing the Senate to act," said Rep. Jim Cooper, D-Tenn. "Without passage of this House bill, the Senate could delay reform indefinitely."

Senate moderates have been just as wary.

"I don't see where we can reach any conclusions (about legislation) until we see the whole package," said Sen. Kent Conrad, D-N.D. "Until you've seen the whole bill, you just don't know," added Sen. Ben Nelson, D-Neb.

One of their qualms - similar to those of House swing district members, involves the new system's finances.

The nonpartisan Congressional Budget Office pegged the House bill's 10-year price at a net $891 billion and said it would cut the deficit by $109 billion. But skeptical lawmakers said they could hardly go home, where people are facing a still-ailing economy, and argue a new trillion dollar program is essential.

House Democratic leaders tried to counter those fears by issuing a 14-point list of provisions that take effect immediately, including a ban on lifetime coverage limits, a requirement that insurance programs allow young people to remain on their parents' policies until they're 27, and a reduction of the coverage gap, or donut hole, in the Medicare prescription drug program.

But other key features of the bill, and the ones that will cost the most, don't take effect until 2013.

People want help with their economic troubles now, some Democrats argue.

"The cost of this bill for the taxpayer is too high," said Rep. Ben Chandler, D-Ky.

And, some members said, while a fix is needed, it should be change that "doesn't fundamentally change a system with which most Americans are satisfied," said Rep. Bobby Bright, D-Ala.

Many moderates indicated they could back legislation if they could go home and explain, with ease, how the cost of health care would go down, pre-existing conditions would not be cause for higher premiums or rejection, and no one would face losing their life savings if they got a serious illness.

Rep. Stephanie Herseth Sandlin, D-S.D., a no vote, said she was "optimistic" that something can be worked out. So were others.

"Some on the far left would like to see the federal government run a socialized health care system. Some on the far right would get the government completely out of health care, which would mean the elimination of Medicare and Medicaid," said Rep. Chet Edwards, D-Texas. "I think both extremes are wrong."

The Senate is where those extremes tend to soften, since it takes 60 votes to overcome procedural hurdles, such as cutting off debate. Republicans signaled Sunday they don't like what Democrats are offering.

"Americans want lower costs, less government intrusion, a simpler approach and less spending," said GOP Leader Mitch McConnell, R-Ky.

There are some significant differences between the Senate and House approaches: The Senate's public option would allow states to "opt out," and a key fund-raiser would involve taxing so-called high end policies.

Still to be resolved is abortion policy. The House bill passed only after language was added guaranteeing no federal funds would be used to pay for abortions, except in cases of rape and incest or where the mother's life is in danger. While abortion has not been as controversial in the Senate, abortion rights advocates objected to the tough House version - 194 of the House's 258 Democrats opposed it - and it's sure to become a flashpoint again.

And one more reason there's a difficult road ahead.

"This bill touches every sector of the economy," said Cooper. "It touches every life. It's tough. If you had to vote on today's health system, even that would never pass."

(Halimah Abdullah contributed to this story)