Health-care reform in America
Claiming a victory
Nov 9th 2009
A bill to reform health care squeaks through the House. The action moves to the Senate
THE House of Representatives narrowly passed a health-care bill on Saturday November 7th, a big step for those who want to reform America’s $2.5 trillion health-care system. Barack Obama spent part of his Saturday making a rare visit to Capitol Hill to press some hesitating Democrats into giving their support, although in the end the tally of 220-215 in favour of the legislation, with 39 Democrats voting against, was a tight margin. The bill picked up the support of just one Republican, Joseph Cao, a first-term congressman from New Orleans who faces a tough battle for re-election next year. After securing the lone Republican’s support, Steny Hoyer, the Democrat’s majority leader, jokingly declared that there had been “a bipartisan vote”.
Success in the House, however, is just one part of a long process. Senators must next debate their own health-care proposals, which could be brought to the Senate floor before the end of this month. If they manage to pass a bill then differences between the House and Senate versions would need to be hammered out before a final act is sent to the president to sign. Nevertheless, the House bill marks a step towards America getting the most significant piece of health-care legislation through Congress since Medicare in 1965, creating near-universal coverage for health insurance. Veterans of past health-care battles are delighted.
John Dingell, the longest-serving member of the House, suggested that the House bill would produce $1,260 in annual savings for a family of four through lower premiums, according to research by an economist at the Massachusetts Institute of Technology (MIT). The cost to the public purse is another matter. The Congressional Budget Office published a report on November 6th suggesting that the bill, if enacted, would carry a net cost of $1.05 trillion between 2010 and 2019, but that this would be offset by higher taxes on the rich and other measures, resulting in a net reduction of $109 billion to the budget deficit over that period.The House bill as it stands would overhaul America’s health-insurance system. Any firm with a payroll higher than $500,000 would be obliged to offer insurance to its workers or face a stiff penalty. States would be compelled to extend Medicaid, the government health plan used by the very poor, to an additional 15m people. A new mandate would require every individual to have health insurance, but those on low and middle incomes would be eligible for subsidies to obtain cover through an insurance market. And although the idea had been written off as little as a month ago, the “public option” of a government-run insurance scheme would compete with private insurers in the new exchange. The bill would also stop insurers from denying coverage to people with debilitating pre-existing conditions.
Pro-abortion choice groups were furious, however, with amendments in the legislation that ban anyone who receives a federal subsidy from using it towards private insurance that covers abortion procedures and disallows the public plan from offering the same. The amendments came after frantic negotiations between Nancy Pelosi, the speaker (pictured above), and conservative Democratic representatives, whose support for the bill was essential. Dozens of Democrats ended up backing the abortion restrictions. Diana DeGette, a leader of the Pro-Choice Caucus in the House, told Roll Call that the amendments represented the biggest restrictions on a woman’s right to an abortion that she has yet seen. Assuming that the restrictions survive the conference stage of the negotiations, court action surely looms.
The passage of the bill represented welcome news for Mr Obama. He was unable to escape some of the blame for the Democratic losses of governors’ offices in New Jersey and Virginia earlier in the week and there were more gloomy figures on jobs. In the past the president’s hands-off approach to health-care reform has raised pertinent questions about his leadership style, but, despite the narrow margin of victory, passing the bill marks solid progress and at last gives the Democrats something to cheer.
A big question remains in the Senate, however, where the action will now lie. Republicans insist that the current legislation restricts individual choice, but it is conservative Democrats in the chamber who could do most damage to the hopes of the reformers. A narrow victory in the House is not necessarily a harbinger of success in the Senate.