Health system reform passes House 219-212

House approval of the Senate bill clears the way for President Obama's signature, but the upper chamber immediately will take up a set of revisions.

By David Glendinning, amednews staff. Posted March 21, 2010.

Washington -- The U.S. House of Representatives on March 21 cleared a package of comprehensive health system reforms that congressional Democrats have been pushing for more than a year, enabling President Obama to sign into law what is considered to be the most substantial overhaul of the system since the enactment of Medicare in 1965.

By a vote of 219-212 during the lengthy Sunday session, the House approved the Patient Protection and Affordable Care Act, the same reform bill that the Senate passed Dec. 24, 2009. By a subsequent vote of 220-211 the House also approved the Reconciliation Act of 2010, a set of consensus revisions to the underlying reform bill. Thirty-four Democrats and all 178 Republicans in the House voted against the health reform measure, projected to cost roughly $940 billion over 10 years.

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Topic: Health Reform

Democratic leaders in the closing hours of the debate were able to get the level of support for the bills over the crucial 216-vote mark in part due to a deal between a bloc of undecided anti-abortion Democrats and the White House. Under the agreement, Obama said he would sign an executive order attesting that the Senate bill is consistent with prohibitions on the use of federal funding for abortions.

In anticipation of the votes, Democratic supporters and the White House said passage of the legislation would be a major victory for the roughly 32 million uninsured Americans who are expected to receive coverage under the reforms. The measure would extend coverage to an estimated 95% of the legal U.S. population through a combination of individual and business mandates, public health expansions, and health insurance reforms.

Numerous physician organizations, including the American Medical Association, supported the reform package.

“While the House-passed bill isn’t perfect, we cannot let the perfect be the enemy of the good when it comes to something as important as the health of Americans,” said AMA President J. James Rohack, MD. “By extending health coverage to tens of millions of uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, this bill will help patients and the physicians who care for them.”

But Republicans were united in their opposition to the effort, saying it would bust the federal budget and lead to a costly government takeover of health care that the American people have made clear they don’t want. Even before enactment, GOP lawmakers were promising legal challenges, rollbacks of certain key provisions and attempts at a full repeal.

This year’s health reform effort is not finished. The package of House-passed consensus revisions — which include changes to government affordability credits, elimination of a Medicare drug coverage gap and higher Medicaid primary care pay, among many other changes — now heads to a vote in the upper chamber.

Senators will consider those changes under a relatively rare parliamentary process known as reconciliation that requires only 51 votes for passage instead of the 60 usually needed to cut off debate. Calling the plan a subversion of the deliberative process, Republicans vowed to derail the bill or send it back to the House through parliamentary points of order and a flood of amendments.

If the reconciliation process were to fail, the original Senate reform bill language would still have the rule of law, causing a potential political crisis for House Democrats, who had said they only supported the Senate bill with an assurance that the consensus revisions would go through.

In advance of the vote, the AMA on March 19 issued its qualified support for the Reconciliation Act of 2010. The AMA said reform would not be complete until Congress overhauls the Medicare physician payment system this year.

The Association is also looking for more changes to the new health reform law that could not be accomplished through reconciliation. That includes revisions to the Independent Payment Advisory Board that will be tasked with reducing health spending growth, possibly by cutting Medicare doctor rates on top of reductions already required by the sustainable growth rate formula.

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