Sweeping Health Care Plan Passes House/Abortion Was at Heart of Wrangling

Sweeping Health Care Plan Passes House
By CARL HULSE and ROBERT PEAR
Copyright by The New York Times
Published: November 7, 2009
http://www.nytimes.com/2009/11/08/health/policy/08health.html?_r=1&th&emc=th


WASHINGTON — Handing President Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation’s health care system on Saturday night, advancing legislation that Democrats said could stand as their defining social policy achievement.

After a daylong clash with Republicans over what has been a Democratic goal for decades, lawmakers voted 220 to 215 to approve a plan that would cost $1.1 trillion over 10 years. Democrats said the legislation would provide overdue relief to Americans struggling to buy or hold on to health insurance.

“This is our moment to revolutionize health care in this country,” said Representative George Miller, Democrat of California and one of the chief architects of the bill.

Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks.

Many of them hope to make changes to the amendment during negotiations with the Senate, which will now become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.

Democrats say the House measure — paid for through new fees and taxes, along with cuts in Medicare — would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.

Republicans condemned the vote and said they would oppose the measure as it proceeds on its legislative route. “This government takeover has got a long way to go before it gets to the president’s desk, and I’ll continue to fight it tooth and nail at every turn,” said Representative Kevin Brady, Republican of Texas. “Health care is too important to get it wrong.”

On the House floor, Democrats exchanged high-fives and cheered wildly — and Republicans sat quietly — when the tally display showed the 218th and decisive vote, after the leadership spent countless hours in recent days wringing commitments out of House members.

“We did what we promised the American people we would do,” said Representative Steny H. Hoyer, Democrat of Maryland and the majority leader, who also warned, “Much work remains.”

The successful vote came on a day when Mr. Obama traveled to Capitol Hill to make a personal appeal for lawmakers to “answer the call of history” and support the bill.

Only one Republican, Representative Anh Cao of Louisiana, voted for the bill, and 39 Democrats opposed it. The House also defeated the Republicans’ more modest plan, whose authors said it was a more common-sense and fiscally responsible approach.

The Democrats who balked at the measure represent mainly conservative swing districts, signaling that those who could be vulnerable in next year’s midterm elections viewed voting for the measure as politically risky.

“Today’s may be a tough vote, but it was in 1935 when we passed Social Security,” Representative John Dingell, Democrat of Michigan and the dean of the House, said as the debate drew to a close late Saturday.

Some Democrats said they voted for the legislation so they could seek improvements in it. “This bill will get better in the Senate,” said Representative Jim Cooper, a Tennessee Democrat who has been outspoken in his criticism of some provisions of the bill but decided to support it. “If we kill it here, it won’t have a chance to get better.”

After the vote, Mr. Obama issued a statement praising the House and calling on the Senate to follow suit. “I am absolutely confident it will,” he said, “and I look forward to signing comprehensive health insurance reform into law by the end of the year.”

Senator Harry Reid of Nevada, the majority leader, said he would bring a bill to the floor as soon as possible.

The vote came on the third anniversary of the 2006 Democratic takeover of the House, and the passage moves the bill well beyond the health care overhaul attempted by President Bill Clinton in 1993.

Lawmakers credited Mr. Obama with converting a final few holdouts during his appearance at a closed-door meeting with Democrats just hours before the vote. Democratic officials said that Mr. Obama’s conversation Saturday with Representative Michael H. Michaud, Democrat of Maine, was crucial in winning one final vote.

Many Democrats also credited Speaker Nancy Pelosi for pulling off a victory that proved tougher than many had predicted. “She really threaded the needle on this one,” said Representative Jim McGovern, Democrat of Massachusetts.

A critical turning point was the decision by Ms. Pelosi late Friday night to allow anti-abortion Democrats to try to tighten restrictions on coverage for the procedure under any insurance plan that receives federal money. That concession eased a threat by some Democrats to abandon the bill, but also left Democrats who support abortion rights facing a choice between backing a provision they bitterly opposed or scuttling the bill. The new abortion controls were added to the measure on a vote of 240 to 194.

Mr. Obama made his rare weekend appearance on Capitol Hill as part of an all-out effort to rally Democrats to support the biggest health care legislation since the creation of Medicare for the elderly four decades ago.

During the private meeting with Democrats in the Cannon Caucus Room, the president acknowledged the political difficulty of supporting major legislation in the face of unanimous Republican opposition and tough criticism from conservatives.

But, those present said, he urged them on, saying, “When I sign this in the Rose Garden, each and every one of you will be able to look back and say, ‘This was my finest moment in politics.’ ”

Republicans said the measure was too costly and would end up burdening the nation for decades to come. Some Democrats expressed the same view in explaining their opposition.

“This bill is a wrecking ball to the entire economy,” said Representative Jack Kingston, Republican of Georgia. “We need targeted specific reforms to help people who have fallen through the health care cracks.”

But Democrats said that Republicans were intent on protecting the status quo in health care and that the new Democratic approach would vastly improve the ability of Americans to gain affordable health insurance.

“Now is the chance to fix our health care system and improve the lives of millions of Americans,” Representative Louise M. Slaughter, Democrat of New York and chairwoman of the Rules Committee, said as she opened the daylong proceedings.

The wall of Republican opposition gave Democrats little room to maneuver, and they worked to corral as many party members as they could. But the preliminary approval to clear the way for the debate came on a 242-to-192 vote, suggesting that Democrats had a victory within reach.

The House vote was a significant step in the long-sought Democratic goal of enacting broad changes in the way health care is delivered in the nation. But the Senate has yet to bring its own emerging measure to the floor for debate, and the two chambers will still need to negotiate and approve a final bill in the weeks ahead.

The struggle House Democrats had in lining up the minimum number of votes for the measure was a clear indication of how difficult it would be to get final legislation to the president’s desk.

The House legislation, running almost 2,000 pages, would require most Americans to obtain health insurance or face penalties — an approach Republicans compared to government oppression.

Most employers would have to provide coverage or pay a tax penalty of up to 8 percent of their payroll. The bill would significantly expand Medicaid and would offer subsidies to help moderate-income people buy insurance from private companies or from a government insurance plan. It would also set up a national insurance exchange where people could shop for coverage.

Republicans forced a House vote on their much more modest plan that would expand coverage to just three million of the uninsured. But its authors said it would bring down the costs of private insurance premiums, which they argued was the chief concern of most Americans.

“More taxes, more spending and more government is not the plan for reform the people support,” said Representative Virginia Foxx, Republican of North Carolina and one of the conservatives who relentlessly criticized the Democrats’ plan.

But Democrats said their proposal was long overdue, would relieve the mounting anxiety of Americans struggling to get and retain health insurance, and would ultimately improve the economy by bringing spiraling health care costs under control.

“Our plan is not perfect, but it is a good start toward providing affordable health care to all Americans,” said Representative Peter A. DeFazio of Oregon.



David M. Herszenhorn contributed reporting.







Abortion Was at Heart of Wrangling
By DAVID M. HERSZENHORN and JACKIE CALMES
Copyright by The New York Times
Published: November 7, 2009
http://www.nytimes.com/2009/11/08/health/policy/08scene.html?hpw


WASHINGTON — It was late Friday night and lawmakers were stalling for time. In a committee room, they yammered away, delaying a procedural vote on the historic health care legislation. Down one floor, in her office, House Speaker Nancy Pelosi desperately tried to deal with an issue that has bedeviled Democrats for more than a generation — abortion.

After hours of heated talks, the people she was trying to convince — some of her closest allies — burst angrily out of her office.

Her attempts at winning them over had failed, and Ms. Pelosi, the first woman speaker and an ardent defender of abortion rights, had no choice but to do the unthinkable. To save the health care bill she had to give in to abortion opponents in her party and allow them to propose tight restrictions barring any insurance plan that is purchased with government subsidies from covering abortions.

The restrictions were necessary to win support for the overall bill from abortion opponents who threatened to scuttle the health care overhaul.

The results of that fight, waged heavily over two days, were evident as one liberal Democrat after another denounced the health care plan because of abortion restrictions, even though they were likely to hold their noses in the end and vote for the bill itself.

“If enacted, this amendment will be the greatest restriction of a woman’s right to choose to pass in our careers,” said Representative Diana DeGette, Democrat of Colorado, one of the lawmakers who left Ms. Pelosi’s office mad.

Representative Rosa DeLauro, Democrat of Connecticut, said the bill’s original language barring the use of federal dollars to pay for abortions should have been sufficient for the opponents. “Abortion is a matter of conscience on both sides of the debate,” Ms. DeLauro said. “This amendment takes away that same freedom of conscience from America’s women. It prohibits them from access to an abortion even if they pay for it with their own money. It invades women’s personal decisions.”

But Ms. DeGette, Ms. DeLauro and other defenders of abortion rights said they would nonetheless vote in favor of the health care bill and fight for changes in the final version, to be negotiated with the Senate.

The fight over abortion foreshadows difficult soul searching in the months ahead as Democratic lawmakers confront deepening divisions among their caucus on issues like abortion rights and gun control.

Through the 1980s, the Democrats struggled over abortion. But by the 1990s, the share of Americans supportive of abortion rights had grown. Democrats lost their majorities for 12 years, leaving the most liberal and pro-abortion rights members in office. As a result it seemed to fade as a public issue. Now, however, Democrats once again have a large and diverse House majority, with more members from conservative-leaning districts where anti-abortion rights groups are active.

It was that division that played out behind the scenes late last week, and into the weekend, and came powerfully in the open as the issue.

Earlier Friday, Ms. Pelosi and her supporters thought they had a deal that would quiet the fight between abortion foes. Representative Bart Stupak, Democrat of Michigan, an anti-abortion leader, said he thought so, too — until, that is, Ms. Pelosi called to tell him it was dead.

“We had an agreement at 7:30, 8 o’clock,” said Mr. Stupak, who added that he had called nearly 40 other lawmakers favoring tighter abortion restrictions to make sure they would back the deal. But then Ms. Pelosi called. “The deal’s off,” he quoted her as saying. “It’s not my choice. I can’t hold my side together.”

The sensitivity around the abortion fight — and the likelihood that it would not disappear from the health care debate — was evident from the start of floor proceedings on the health care bill on Saturday.

And it was part of the drama outside the Capitol as well. Roughly 300 protesters who rallied against the health care bill included a number of anti-abortion demonstrators with large placards showing grisly photos identified as aborted fetuses. Inside the building, House Democratic leaders had hoped to spend the day rallying their members around a historic vote. President Obama, visiting the Capitol to make a personal appeal to lawmakers, likened the bill to two of the party’s greatest achievements: Social Security under Franklin D. Roosevelt and Medicare under Lyndon B. Johnson.

Instead, Ms. Pelosi found her caucus caught up in the fierce dispute over abortion.

First, Ms. Pelosi met with leaders of the Pro-Choice Caucus, then she huddled with staff members from the bishops conferences, and with Mr. Stupak and two other leading Roman Catholic lawmakers, Representative Mike Doyle, Democrat of Pennsylvania, and Representative Brad Ellsworth, Democrat of Indiana.

The representatives of the nation’s bishops made clear they would fight the bill if there were not restrictions on abortion. In an extraordinary effort over the last 10 days, the bishops conference told priests across the country to talk about the legislation in church, mobilizing parishioners to contact Congress and to pray for the success of anti-abortion amendments.

The bishops sent out information to be “announced at all Masses” and included in parish bulletins, and urged priests and parishioners to tell House members: “Please support the Stupak Amendment that addresses essential pro-life concerns.” They added: “If these serious concerns are not addressed, the final bill should be opposed.”

In the end the abortion opponents had the votes, and Ms. Pelosi yielded, allowing Mr. Stupak to offer his amendment. At a news conference, Ms. Pelosi denied being angry about it.

“I was part of recommending that it come to the floor,” she said. “Both sides are whipping, the pro-choice side and others who want to support the amendment. But no, that was my recommendation to allow a vote on that amendment.”

Robert Pear and Elisabeth Goodridge contributed reporting.