Landmark health care bill passes

; Late compromise on abortion allows passage of legislation that extends insurance to all Americans; cost seen as $940 billion over the next decade

March 22, 2010
By Daniel Malloy, Post-Gazette Washington Bureau

WASHINGTON — Aided by an 11th-hour compromise on abortion, Democrats in the House of Representatives narrowly passed a landmark health care bill Sunday night, capping a tumultuous debate that will resume this week in the Senate.

The $940 billion measure would expand health insurance coverage to 32 million Americans while imposing significant reforms on the insurance industry. Its passage was a major triumph for President Barack Obama — who postponed a foreign trip to see it through — and House Speaker Nancy Pelosi, who once again scraped together enough votes to pass a major, controversial piece of legislation.

“We proved that we are still a people capable of doing big things, tackling the biggest challenges,” said Mr. Obama, who will sign the Senate bill before the Senate takes up the reconciliation bill of alterations beginning Tuesday.

“We proved that this government — the government of the people, by the people — still works for the people. … This is what change looks like.”

The final tally to approve the Senate health care bill was 219-212, with 34 Democrats — including Rep. Jason Altmire, D-McCandless — joining a united Republican caucus to vote against a measure that was ferociously criticized as a massive entitlement expansion financed by unpopular cuts to Medicare and taxes on high-cost plans. A government mandate that all citizens carry health insurance was attacked as potentially unconstitutional and likely will face a court challenge if signed into law.

Among local lawmakers, Reps. Mike Doyle, D-Forest Hills, and Kathy Dahlkemper, D-Erie, voted for the bill; Reps. Tim Murphy, R-Upper St. Clair, Bill Shuster, R-Blair, Glenn Thompson, R-Centre, and Mr. Altmire voted against it.

The dual-vote strategy, crafted by Democratic leaders, called for the House to pass the Senate bill as is, along with a series of changes that can get through the Senate in the 51-vote reconciliation process. The House approved the reconciliation bill, 220-211.

The Senate passed its bill Dec. 24, but in the meantime Democrats lost their 60th vote when Republican Scott Brown won his special election in Massachusetts, prompting the parliamentary maneuver.

Its success remains uncertain.

Republicans have vowed to challenge whether the reconciliation bill passed in the House fits the specific, budget-related criteria of the process, and likely will offer numerous amendments to force tough votes and drag out the process.

The final hurdle in the House concerned abortion coverage, with Rep. Bart Stupak, D-Mich., and six colleagues, including Ms. Dahlkemper, D-Erie, negotiating a deal with the White House on Sunday in exchange for their support. Mr. Obama promised to issue an executive order strengthening the language in the bill that prohibits federal funding for abortions — including specifically mandating that funding for community health centers not go to abortions, a major concern of the anti-abortion bloc.

The language could not be altered in an amendment similar to the one Mr. Stupak pushed through when the House first passed health care reform in November, because the changes to the Senate health bill can deal only with budgetary matters if they are to pass the upper chamber again through a 51-vote reconciliation.

Major anti-abortion groups — and a couple House members — opposed the deal, saying that only a legislative fix could legally ensure that public money would not fund abortions, but Mr. Stupak and his cohorts said they were satisfied that the executive order stands on firm legal ground.

Ms. Dahlkemper said a slew of lawyers sifted through the implications of the language during the lengthy negotiations.

“I was always optimistic we would get this done,” she said.

A key player in making that happen was Mr. Doyle, who served as liaison between Mr. Stupak and the White House when debate heated up.

“Mike Doyle deserves a lot of credit,” Mr. Stupak said.

Mr. Doyle — who ranked Sunday’s vote with Bill Clinton’s impeachment and 9/11 in terms of historic moments since he arrived in Congress in 1995 — said he was a mere facilitator in the effort because of his good relationships with Mr. Stupak, House leadership and the White House.

“It struck me that Bart and a lot of other people wanted to see this bill passed, so if you share the end goal, a lot of these challenges are worth meeting to get to the end goal,” Mr. Doyle said, adding that the U.S. Conference of Catholic Bishops’ desired legislative fix was impossible to get through the Senate.

A Republican motion to insert language like the Stupak amendment failed after Mr. Stupak himself gave a speech in opposition.

The late afternoon announcement by Mr. Stupak sealed the bill’s success on the floor, though the vote once again was tight.

The highly sought after Mr. Altmire announced his choice Friday, saying that the bill did not do enough to bring down the cost of health care and his district was solidly opposed to it. He said he did not lobby his colleagues to vote against the bill but claimed partial credit for the Democrats’ abandoning the controversial “deem and pass” strategy, by which they could have passed the Senate bill without directly voting on it.

Mr. Altmire criticized the strategy in television appearances.

“That would be an example of me taking a lead role in changing the debate for the better,” he said. “I spoke out publicly against my party and against that rule.”

Mr. Murphy, a child psychologist and co-chair of the GOP Doctors’ Caucus, had similar though more forceful criticisms — saying the bill would become a burden on taxpayers and the national debt.

Sunday morning Mr. Murphy led a prayer service on the front lawn for a few hundred members of the throngs who descended on the Capitol to protest the health care bill. Mr. Murphy said he did not mention health care, choosing rather to pray for an end to the divisive rancor that has gripped Washington.

“It was about how we’re strong and courageous and have a base of faith, but we also have to think how we heal the divides among us and understand that we’re all working for the better part of our country,” Mr. Murphy said.

The prayers were not answered Sunday.

The picturesque spring day took on an almost circus-like feel. Chants of “Kill the bill” could be heard from just outside the House floor, and some Republicans took to the balcony to rally the protesters further — with one group of lawmakers unfurling a yellow “Don’t tread on me” flag that has become the emblem of the tea party movement.

Inside the chamber, lawmakers sniped at one another during debate time and, at one point, two spectators were tossed out for outbursts urging members to vote against the bill. Republican members cheered the ejected protesters.