By Lisa Wangsness and Susan Milligan, Globe Staff | November 8, 2009
WASHINGTON – House Democrats, overcoming nearly united Republican opposition and dozens of defections within their own ranks, narrowly approved a historic health care expansion last night. The bill would provide coverage for 36 million Americans, establish a limited public insurance plan, and prohibit insurers from discriminating against people with preexisting conditions.
Speaker Nancy Pelosi was forced to make an 11th-hour concession restricting federal funding for abortion coverage in order to secure the support she needed from her large but fractious majority; even so, 39 Democrats voted no. She appeared elated and relieved when the bill passed, 220 to 215, and the House erupted in cheers.
“President Obama’s leadership gives our nation hope,’’ she told the chamber in a floor speech. “Today, with this legislation, we will give them health.’’
Passage was a test of the political strength of the president, who made a rare Saturday trip to Capitol Hill to meet with House Democrats and make a final push for his top domestic priority.
“When I’m in the Rose Garden, signing a piece of legislation to give health care to all Americans, we’ll look back and say this was our finest moment,’’ Obama told lawmakers, according to a senior aide who took notes in the closed session.
Democrats repeatedly compared last night’s victory to passage of Social Security and Medicare, but their work is hardly done. The focus of the debate now turns back to the Senate, where leaders are struggling to devise a compromise that can win support.
The vote in the House capped a grueling day of wrenching negotiations among divided Democrats, vociferous opposition from the minority Republicans, and a barrage of last-minute phone calls and e-mails from interest groups and constituents calling for the bill’s passage or defeat.
Only one Republican, Anh “Joseph’’ Cao of Louisiana, voted for the measure. Otherwise Republicans held firm against the bill, which they characterized as a government takeover of the US health care system that would create enormous deficits and kill jobs. They unsuccessfully sought to pass a much cheaper alternative that included medical malpractice legislation, would allow people to buy insurance across state lines, and make it easier for small businesses to pool together to buy insurance. But Democrats said it would not have done much to reduce the ranks of the uninsured.
“In the face of 10.2 percent unemployment, Americans want jobs, they want less government spending and more economic security,’’ said House minority whip Eric Cantor. “The majority’s bill shows they have not listened.’’
The debate at times grew raucous. One Republican repeatedly objected when a Democrat sought to make remarks on the floor, causing Representative John Dingell, an 83-year-old Democrat of Michigan and the longest-serving member of the House, to slam down his gavel in exasperation.
“This Congress is so reckless, it’s like watching a drunk, broke gambler trying to double down to break even,’’ said Representative Devin Nunes, Republican of California, complaining about the cost of the bill.
With Democrats bickering over abortion, immigration, and other issues that threatened the fragile coalition for the measure, Pelosi spent days trying to cobble together the minimum 218 votes she needed from her 258-member caucus to pass it.
In the end, almost no one seemed happy with the bill. Liberals had hoped for a stronger government role, abortion-rights advocates denounced the compromise language they felt was too restrictive of abortion, and conservative Democrats worried about the cost.
But Democrats said they would accept the deal in the interests of trying to achieve health care overhaul the country has not seen in 40 years.
“I think we’re getting the best possible bill that can pass,’’ said US Representative James P. McGovern, a Democrat from Worcester who called yesterday’s vote “one of those FDR moments.’’
“Getting the best possible bill that can’t pass – that isn’t legislating, that’s a therapy session,’’ he said.
Every member of the Massachusetts delegation supported the bill.
The difficulty House leaders had in securing yesterday’s fragile majority only underscored the sobering challenge ahead as the sprawling legislation makes its way through the Senate, a conference committee, and a final vote in both chambers.
With several moderate and conservative members withholding critical support, Senate Democrats are expected to have an even tougher task when they begin debate, probably next week.
Insurers and business groups fought hard against the proposal, airing a battery of TV ads warning that it would cause premiums to skyrocket and unduly burden employers. But the bill won critical support from several lobbies that carry weight with voters – including the AARP, which represents seniors; the American Medical Association, which represents doctors; and the Consumers Union, which publishes Consumer Reports.
Obama, who arrived at the Cannon House Office Building around noon yesterday, chastised Republicans for voting overwhelmingly against Democratic initiatives, and he warned Democrats in the closed-door meeting that they would derive little political benefit from opposing the health care legislation.
“He said, ‘None of you can expect the Republicans not to go after you if you vote against the bill,’ ’’ said Representative Henry Waxman, Democrat of California.
Obama has repeatedly expressed hope that GOP members would support the bill. But he departed from that bipartisan rhetoric yesterday, reminding Democrats that Republicans have refused to support virtually every major bill they have passed this year.
“Saying no, stopping progress, gumming up the works was their preferred strategy. Are we going to stop now, or push forward?’’ the president said, according to a senior Democratic House aide at the meeting.
“Push forward!’’ a dozen or so Democrats yelled in response, the aide said.
The House bill, modeled closely after the pioneering Massachusetts plan to expand health insurance, would require most Americans to obtain insurance or pay a penalty, force most employers to provide it or face fines, and offer government subsidies to help low-income people purchase plans. It would set up a new national insurance market similar to the Massachusetts Health Insurance Connector to help the uninsured and small businesses shop for insurance.
The measure would also create a national government insurance plan, but a weaker one than liberals had originally wanted; payment rates for doctors and hospitals would be set through negotiations rather than Medicare payments; and providers would not be forced to participate in the plan. Liberals who wanted rates tied to Medicare’s tried but failed to garner the votes they needed.
The plan will cost more over the next decade than the $900 billion limit Obama had set, but a combination of spending reductions and tax increases will more than offset those costs, so the plan would ultimately reduce the deficit by $104 billion by 2019, according to the nonpartisan Congressional Budget Office. The proposal would impose a 5.4 percent income tax surcharge on individuals making more than $500,000 and families earning more than $1 million.
The deal on abortion came together late Friday night in dramatic fashion, hours after an earlier agreement collapsed. About 40 antiabortion Democrats, represented by Bart Stupak of Michigan and Brad Ellsworth of Indiana, threatened to vote against the measure unless Pelosi included language that they said would apply the three-decade-old rule restricting the use of federal money for abortion procedures to the new insurance plans that will be available through the “exchange.’’
Pelosi ultimately agreed to allow a vote on an amendment forbidding the public option from covering abortion procedures except in the case of rape, incest, or threat to the woman’s life, and prohibiting insurance premium subsidies for low-income people from going toward purchasing insurance that includes abortion coverage.
“The speaker was getting it from both sides,’’ said Stupak. “It shows the ability of the speaker to take a rambunctious caucus like we are as Democrats and be able to put us together.’’
Democrats who oppose abortion rights said the provision simply preserves the status quo; current rules prohibit Medicaid and federal employees’ health insurance plans from covering abortion. Federal employees can buy supplemental abortion coverage, but Laura MacCleery, government relations director for the Center for Reproductive Rights, said few people do and therefore few plans offer it.
“The anti-health care reform strategy has been to divide and conquer,’’ she said. “The problem with this strategy is that millions of women will suffer as a consequence of the games being played in the political branches of our government.’’
A number of liberals said they would oppose the amendment, but if it passed, they pledged to hold their noses and vote for the overall bill.
Immigration became another side issue that also threatened to undo the package. The House bill prohibits illegal immigrants from receiving any government subsidies to purchase insurance. Some conservative Democrats also wanted to prohibit illegal immigrants from buying their own coverage through the exchange, as the Senate Finance Committee did, but House leaders opposed the idea and the issue never came up on the floor.
Some conservative Democrats resolved to vote against the bill, worried that their constituents will accuse them of enabling the “government takeover.’’
But other House members said Democrats are more likely to be punished if they go home empty-handed.
“A lesson learned from ’93-94 is that you fail to deliver on healthcare at your own peril,’’ said Gerry Connolly, a freshman Democrat from Virginia.
