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Health plan gains support in House

Democratic leaders trumpet a compromise bill as a milestone for universal care -- and one that can pass.

October 30, 2009|Noam N. Levey and Janet Hook

WASHINGTON — House Democrats on Thursday closed in on the votes they need to pass sweeping healthcare legislation, as party leaders introduced a 1,990-page bill designed to guarantee near-universal coverage for the first time in the nation's history.

The legislation, which House Speaker Nancy Pelosi (D-San Francisco) officially unveiled in a ceremony outside the Capitol, represents a milestone for Democrats and advocacy groups.

After more than half a century of pushing to create a government healthcare safety net, Democrats are poised to bring a bill to the House floor next week. The full Senate will probably take up its version by the end of the year.

The House plan would cover an additional 36 million people by 2019, leaving only 4% of the nation without coverage, compared with the estimated 17% who do not have insurance now, according to a preliminary analysis by the nonpartisan Congressional Budget Office.

"Leaders of all political parties, starting over a century ago with President Theodore Roosevelt, have called and fought for healthcare and health insurance reform," Pelosi said. "Today, we are about to deliver on the promise of making affordable, quality healthcare available for all Americans."

Pelosi and her lieutenants have been working for months to find the 218 Democratic votes they need to get a bill through the House, negotiating a series of compromises that form the backbone of the legislation they introduced Thursday.

The revised bill swayed a number of wavering Democrats, convincing House leaders that they had enough support to move ahead.

"I feel very confident we will have the votes necessary," said Rep. James E. Clyburn (D-S.C.), who as the party whip is responsible for counting votes.

Among those who now back the legislation is Rep. Earl Pomeroy (D-N.D.), a fierce critic of an earlier provision that would have created a government insurance plan tying payment rates for hospitals and other providers to Medicare.

"There's been a lot of give and take," said Pomeroy, expressing support for a change that would require the government plan to negotiate its rates with providers, much as commercial insurers do.

"In the end, we negotiated successfully to resolve the situation," he said. "This bill represents a distinct improvement over the status quo."

Similar compromises were made to win over other potential "no" votes -- including Rep. Gerald E. Connolly (D-Va.), who had been concerned that a surtax on wealthy taxpayers could have a huge effect on his suburban Washington district. The tax was scaled back in the version unveiled Thursday.

Senior Democrats are still trying to resolve several divisive issues, including provisions to prevent the use of federal funds for abortion services -- a priority for many socially conservative House Democrats.

Democratic leaders also face questions about the cost of the legislation, which by one measure exceeds the $900-billion benchmark set by President Obama for the first 10 years, even though the new spending is expected to be fully offset over the next decade with cuts and new revenue. The CBO has estimated that the bill would reduce the deficit by $104 billion over the next decade.

Few if any Republicans are expected to back the House bill or its counterpart in the Senate, as party leaders have continued to criticize the Democratic healthcare campaign as a "government takeover."

"Over the last several months, the American people have spoken, and it's pretty clear that our Democrat colleagues have not listened," House Minority Leader John A. Boehner (R-Ohio) said Thursday. "Through the month of August and September, the American people let members of Congress from both sides of the aisle know that they wanted no part of a government-run healthcare plan."

Democrats also face opposition from the insurance industry and from many business groups -- 10 of which wrote a letter to lawmakers Thursday saying that the legislation "falls short of the bipartisan goal of controlling costs and jeopardizes employer-sponsored coverage."

Many business groups oppose provisions in the bill that require larger employers to provide a minimum set of benefits to their employees or pay a penalty. Businesses also have expressed concern that the bill does not do enough to control rising healthcare costs.

If the House approves the bill next week, it will have to be reconciled with whatever Senate Democrats can get through their chamber. Senate Majority Leader Harry Reid (D-Nev.) is working to rally his caucus behind a bill, a process that is expected to stretch into December.

Democrats underscored the sweep of the legislative journey Thursday by turning to Rep. John D. Dingell (D-Mich.), the longest-serving U.S. representative in history. Dingell presided over the House the day lawmakers voted in 1965 to create Medicare and Medicaid.

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