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House Democrats unveil healthcare legislation including public option

The plan would offer a U.S.-run insurance program but drop cost controls backed by liberals. House Speaker Nancy Pelosi says the compromise would make healthcare more affordable for the middle class.

October 29, 2009|By Noam N. Levey and Janet Hook

Reporting from Washington — House Speaker Nancy Pelosi, unveiling the House's plan for a compromise on healthcare legislation today, said the bill would offer new insurance for tens of millions of Americans and lower costs for those who already have coverage.

The plan represents a compromise among various interests in the House, the speaker said. It also will lead to a planned House vote and position House leaders for negotiations with Senate leaders crafting their own plan.

"Here we are, for nearly a century -- it's really over a century -- leaders of all political parties . . . have called and fought for healthcare and health insurance reform," said Pelosi (D- San Francisco)

"Today, we are about to deliver on the promise of making affordable, quality healthcare available for all Americans."

Pelosi maintained that the House leadership's compromise would make healthcare more affordable for the middle class and more secure for seniors. The bill offers health insurance for an additional 36 million Americans, she said -- offering coverage for 96% of all citizens -- and its cost over 10 years, under $900 billion, would not increase the federal budget deficit.

"The drive for healthcare reform is moving forward," Pelosi said.

"This is an idea whose time has come," said Rep. Steny Hoyer (D-Md.), the House majority leader, adding that he's keeping a promise of "integrity of this progress by making this bill's full text available online."

It will be online for 72 hours before House members are asked to vote, he said.

Paving the way for a crucial vote on healthcare legislation in the next two weeks, the compromise unveiled by House Democratic leaders would create a nationwide government-run insurance plan but omit what many liberals consider the key to cost control.

According to senior lawmakers and aides, the so-called public option in the new compromise would not dictate what the plan can pay hospitals, doctors and other providers. Instead, the federal government would have to negotiate rates with providers, much as private insurers do.

Pelosi and her lieutenants made that concession in hopes of winning over conservative Democrats. Many of those lawmakers fear that payments based on lower Medicare rates -- the formula Pelosi originally supported -- would not be enough to sustain providers in rural areas.

Senior Democrats said that the concession represented real progress.

"Most of you all thought the public option was dead," said Rep. George Miller (D-Martinez), chairman of the House Education and Labor Committee and a Pelosi ally. "Rumors of its death were greatly exaggerated."

The decision to endorse the compromise ends weeks of heated and difficult debate among House Democrats. It comes just days after Senate Majority Leader Harry Reid (D-Nev.) threw his weight behind a slightly different public-option compromise that would give states the ability to opt out of a national government insurance plan.

Reid is working to persuade conservative Democrats to back his proposal -- which also would require the plan to negotiate with providers -- as Senate Democratic leaders think they are a few votes shy of the 60 they need. But with other parts of the bill still being developed, it appears increasingly unlikely that Reid will be able to move legislation through the Senate before Thanksgiving.

The House bill builds on legislation introduced this year.

It will include sweeping new regulation of the insurance industry, prohibiting companies from denying coverage to sick people. And it will provide subsidies to millions of Americans to help them buy insurance in a regulated exchange, where commercial insurers would offer plans alongside the government option.

It also mandates that Americans buy insurance, and requires large employers to provide their workers with health benefits.

All Americans making less than 150% of the federal poverty level -- $16,245 for an individual and $33,075 for a family of four -- would be eligible for Medicaid, the federal-state insurance program for the poor.

Earlier versions of the legislation had limited eligibility for Medicaid, which now primarily serves poor children and their families in many states, to people making less than 133% of the poverty level.

The bill will be funded largely by a combination of cuts in Medicare -- many of them designed to make the program more efficient -- and a 5.4% surtax on individual taxpayers making more than $500,000 and couples making more than $1 million.

And after 10 years, it will boost those covered by about 35 million people, according to estimates from the nonpartisan Congressional Budget Office. That is substantially more than the more conservative bill approved by the Senate Finance Committee this month, which would have dropped the number of uninsured by 29 million.

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