A transformative health care bill is headed to
President Barack Obama for his signature as Congress takes the
final steps in Democrats' improbable and history-making push for
near-universal medical coverage.
On the cusp of succeeding where numerous past congresses and
administrations have failed, jubilant House Democrats voted 219-212
late Sunday to send legislation to Obama that would extend coverage
to 32 million uninsured Americans, reduce deficits and ban
insurance company practices such as denying coverage to people with
pre-existing medical conditions.
"This is what change looks like," Obama said later in
televised remarks that stirred memories of his 2008 campaign
promise of "change we can believe in."
"We proved that this government - a government of the people
and by the people - still works for the people."
Obama will travel outside Washington on Thursday as he now turns
to seeing a companion bill through the Senate and selling the
health care overhaul's benefits on behalf of House lawmakers who
cast risky votes. It is most likely that he will sign the bill on
Tuesday, but the plans are not yet final, said a senior
administration official, who spoke on condition of anonymity to
discuss as-yet unannounced strategy.
Obama's young presidency received a much needed boost from
passage of the legislation, which would touch the lives of nearly
every American. The battle for the future of the health insurance
system - affecting one-sixth of the economy - galvanized
Republicans and conservative activists looking ahead to November's
midterm elections.
A companion package making a series of changes sought by House
Democrats to the larger bill, which already passed the Senate, was
approved 220-211. The fix-it bill will now go to the Senate, where
debate is expected to begin as early as Tuesday. Senate Democrats
hope to approve it unchanged and send it directly to Obama, though
Republicans intend to attempt parliamentary objections that could
change the bill and require it to go back to the House.
Sen. John McCain said Monday morning that Democrats have not
heard the last of the health care debate, and said he was repulsed
by "all this euphoria going on."
Appearing on ABC's "Good Morning America," McCain, who was
Obama's GOP rival in the 2008 presidential campaign, said that
"outside the Beltway, the American people are very angry. They
don't like it, and we're going to repeal this."
McCain, who is in a tough Republican primary fight in his home
state, said the GOP "will challenge it every place we can," and
said there will be reprisals at the polls, in Congress and in the
courts.
The complicated two-step approval process was made necessary
because Senate Democrats lost their filibuster-proof supermajority
in a special election in January, a setback that caused even some
Democratic lawmakers to pronounce the yearlong health care effort
dead. Under the relentless prodding of House Speaker Nancy Pelosi,
in particular, it was gradually revived, and the fix-it bill will
be considered under fast-track Senate rules that don't allow
minority party filibusters.
"We will be joining those who established Social Security,
Medicare and now, tonight, health care for all Americans," said
Pelosi, D-Calif., partner to Obama and Senate Majority Leader Harry
Reid in the grueling campaign to pass the legislation.
"This is the civil rights act of the 21st century," added Rep.
Jim Clyburn of South Carolina, the top-ranking black member of the
House.
GOP lawmakers attacked the legislation as everything from a
government takeover to the beginning of totalitarianism, and none
voted in favor. "Hell no!" Minority Leader John Boehner, R-Ohio,
shouted in a fiery speech opposing the legislation. "We have
failed to listen to America and we have failed to reflect the will
of our constituents."
Thirty-four Democrats also voted "no" on the Senate-passed
bill.
Sunday night's votes capped an unpredictable and raucous weekend
at the capitol, with Democratic leaders negotiating around the
clock for the final votes as hundreds of protesters paraded
outside, their shouts of "Kill the Bill! Kill the Bill!" audible
within the Capitol.
A last-minute deal with a critical group of anti-abortion
lawmakers Sunday afternoon sealed Democrats' victory. The leader of
the anti-abortion bloc, Rep. Bart Stupak, D-Mich., didn't get to
add stricter anti-abortion language to the underlying bill, but was
satisfied by an executive order signed by Obama affirming current
law and provisions in the legislation that ban federal funding for
abortions except in cases of rape, incest or danger to the life of
the mother.
Republican abortion foes said Obama's proposed order was
insufficient, and when Stupak sought to counter them, a shout of
"baby killer" was heard coming from the Republican side of the
chamber.
Far beyond the political ramifications - a concern the president
repeatedly insisted he paid no mind - were the sweeping changes the
bill held in store for Americans, insured or not, as well as the
insurance industry and health care providers.
The nonpartisan Congressional Budget Office said the legislation
awaiting the president's approval would cut deficits by an
estimated $138 billion over a decade. For the first time, most
Americans would be required to purchase insurance, and face
penalties if they refused. Much of the money in the bill would be
devoted to subsidies to help families at incomes of up to $88,000 a
year pay their premiums.
The second measure, which House Democrats demanded before
agreeing to approve the first, included enough money to close a gap
in the Medicare prescription drug coverage over the next decade,
starting with an election-season rebate of $250 later this year for
seniors facing high costs.
It also included sweeping changes in the student loan program,
an administration priority that has been stalled in the Senate for
months.
For the president, the events capped an 18-day stretch in which
he traveled to four states and lobbied more than 60 wavering
lawmakers in person or by phone to secure passage of his signature
domestic issue. He also postponed an overseas trip to remain in
Washington and push for the bill.
Obama watched the vote in the White House's Roosevelt Room with
Vice President Joe Biden and dozens of aides, exchanged high fives
with Rahm Emanuel, his chief of staff, and then telephoned Pelosi
with congratulations.
Now Obama will have to sell the bill to the public, and a White
House aide said he was likely to take at least one trip this
weekend to emphasize the legislation's benefits.
The measure would also usher in a significant expansion of
Medicaid, the federal-state health care program for the poor. The
insurance industry, which spent millions on advertising trying to
block the bill, would come under new federal regulation. Parents
would be able to keep children up to age 26 on their family
insurance plans.
To pay for the changes, the legislation includes more than $400
billion in higher taxes over a decade and cuts more than $500
billion from planned payments to hospitals, nursing homes, hospices
and other providers that treat Medicare patients.


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