House sets health care vote for Sunday after CBO report

WASHINGTON — Democrats plan to vote Sunday in the House of Representatives on a revamped health care overhaul bill aimed at insuring millions more Americans, providing more Medicare drug benefits and reducing federal budget deficits by $138 billion over the next 10 years.

On Thursday, President Barack Obama canceled his Asia trip, which had been scheduled to start Sunday, so he could make a last-minute push for the 216 House votes that are needed to pass the most important initiative of his 14-month-old presidency.

As of early Thursday evening, Obama had met with or called more than three dozen members of Congress to try to win their support, according to White House Press Secretary Robert Gibbs. Gibbs declined to confirm or deny lawmakers’ accounts that Obama considers the fate of his presidency at stake.

Though they appeared still short of the votes they need, House Democratic leaders were increasingly confident that they’ll triumph. Thirty-nine Democrats opposed the House version of the bill in November, but two more of them — Reps. Bart Gordon of Tennessee and Betsy Markey of Colorado — said Thursday that they’d switch. They joined Rep. Dennis Kucinich, D-Ohio, who said Wednesday that he’d vote yes.

In addition, the 23-member Congressional Hispanic Caucus announced Thursday that it backs the bill. They said that while the legislation wasn’t perfect, it would provide help to nearly 9 million American Latinos who are currently uninsured. Some caucus members previously had been undecided.

If the House approves the package, it will go to the Senate, where leaders hope to dodge procedural hurdles that Republicans are threatening and finish the bill next week. Republicans warned that they’ll fight hard to derail the plan.

At the Concord Coalition, an independent budget watchdog, executive director Robert Bixby questioned whether the legislation would produce the considerable savings it claims from Medicare, and whether some claimed future tax revenues really will go into effect.

An excise tax on high-end insurance policies, for instance, wouldn’t kick in until 2018.

“It’s already unpopular,” Bixby observed, particularly with labor unions, which raises questions about whether a future Congress will let it take effect in eight years.

The legislation would make historic changes to health insurance coverage, the most in decades. Insurers no longer would be able to deny coverage to anyone because of pre-existing conditions starting in 2014, and the provision would apply to children six months after enactment.

Health insurers also no longer would be able to put lifetime caps on coverage. Children would be able to stay on their parents’ policies until their 26th birthdays. Most people would be required to have health insurance by 2014, and most employers would be required to offer policies.

Under the legislation, an estimated 32 million people who now are uninsured would gain coverage, expanding coverage to about 95 percent of all Americans. Currently, 83 percent are covered.

The House plans to consider the legislation in two stages Sunday, after allowing 72 hours for the new bill’s provisions to be reviewed. First, it’ll vote on the rule governing debate — a rule that’ll say the health care version that the Senate passed Dec. 24 is deemed passed by the House upon adoption of the rule.

If the rule is approved, the House later will vote on the changes to that Senate bill that were announced Thursday; the bill containing those changes is called a reconciliation package.

The changes, which the Senate would consider next week, include:

— Ending the Medicare prescription-drug coverage gap. Medicare drug plans now stop paying for prescriptions each year once the government and the consumer have spent $2,830 on them. The benefit resumes once annual out-of-pocket spending reaches $4,550.The bill would close that so-called "doughnut hole” by 2020.

This year, beneficiaries who hit the doughnut hole limit would get $250 rebates.

— Broadening the reach of the Medicare payroll tax to cover wealthier people's unearned income, such as capital gains, dividends and interest. Singles with annual incomes above $200,000 and families that earn more than $250,000 would pay a 3.8 percent tax, up from the 2.9 percent that Obama originally proposed.

— Picking up all state costs of Medicaid, the state-federal program for lower-income people, from 2014 to 2016. The federal government then would pick up 95 percent of the costs in 2017, and reduce that share on a sliding scale until it hits 90 percent in 2020.

— Scaling back a new excise tax on high-end insurance policies so it wouldn't take effect until 2018. The Senate had wanted it to begin five years sooner. The tax would be applied to most premiums above $10,200 for singles and $27,500 for families, somewhat higher than the Senate-passed limits.

— Helping families that earn up to about $88,000 annually pay insurance premiums. The new bill would assure that no family that earns less than that pays more than 9.5 percent of its income for health insurance.

New Congressional Budget Office cost estimates Thursday triggered a new wave of debate, as the CBO forecast that the bills would reduce federal budget deficits by $138 billion over 10 years. Republicans and some independent analysts questioned the numbers.

House Majority Leader Steny Hoyer, D-Md., argued that “this bill is the biggest deficit-reduction bill any member of Congress has had the opportunity to vote on,” and Gibbs said the estimate gave “a significant boost” to prospects of passage.

However, Rep. Paul Ryan of Wisconsin, the top Republican on the House Budget Committee, called the legislation “full of spending gimmicks and hidden costs.” For instance, he said, it doesn’t include an estimated $70 billion that will be needed to implement the bill.


Comparison of Senate, House and president’s health care bills

Highlights of health legislation

House Nov. 7, 2009, roll call vote on health care plan


House plan to pass health care raises constitutional questions

Obama’s health care legacy hangs on 216 House votes

House Democrats struggling to win votes on health care

Obama delays Asia trip to push health care through Congress

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