FW: Legislative Update: House Passes Historic Health Care Bill

November 10, 2009

House Passes Historic Health Care Bill

Late Saturday, the House of Representatives passed the first major health care reform bill (H.R. 3962, the Affordable Health Care for America Act) in 40 years, by a vote of 220-215. The razor-thin margin of only two votes beyond a majority of 218 was only possible after Democratic leaders negotiated with anti–abortion rights members of their party to amend the bill to restrict women from purchasing coverage for abortion care with their own funds in the health insurance exchanges and public plan that the legislation created.

With one lone exception, House Republicans opposed the health care bill and were joined by 39 Democrats who also voted against it. (To find out how your Representative voted on the bill, visit: THOMAS.) The rule setting the parameters for the debate allowed for just two amendments, a Republican alternative measure and the previously mentioned abortion-related amendment. As a result, Members of both parties were unable to offer floor amendments to the bill to add or change specific provisions.

n4a signed on to a number of coalition letters in support of specific provisions in the bill that would benefit older adults. The provisions of Project 2020 were not included in the House bill that went to the floor, and Rep. Bruce Braley (D-IA), the House sponsor of Project 2020, was unable to offer a planned floor amendment to add its provisions due to the “closed” rule process. Although n4a was glad to see that a robust CLASS Act insurance plan was included in the House bill.

We are hopeful that the House bill will be improved in the area of long-term services and supports during conference with the Senate as the process continues. We are interested in hearing what you think about the House bill as we continue to push for our priorities focusing on the core elements of the Project 2020 bill in health reform legislation. To share your feedback, visit n4a’s Advocacy Feedback web page.

Key Provisions of the House Bill

The bill would require most individuals to buy health insurance if they do not get it through their jobs, beginning in 2013. Families with incomes up to 400 percent of the federal poverty level could qualify for financial assistance.
Employers with annual payrolls over $500,000 would be required to provide coverage or contribute to a fund for such coverage. It would create an “exchange” in each state where individuals and certain small businesses could shop for insurance policies, and it would create a public insurance plan to compete with offerings from private companies.
Insurance companies could no longer refuse to cover customers with pre-existing medical conditions, impose annual or lifetime benefit limits or cancel a policy when someone files expensive claims.
The measure also would expand eligibility for Medicaid to individuals and families with incomes up to 150 percent of the poverty level.
Payments under the Medicare Advantage program would be reduced and the Medicare prescription drug program would be enhanced by phasing out the gap in coverage or “doughnut hole.”
The bill contains the provisions of the Community Living Assistance Supports and Services (CLASS) Act to establish a voluntary national long-term care insurance program to help adults who have or develop functional impairments to remain independent, employed, and stay a part of their community.
The bill would impose a tax surcharge of 5.4 percent on couples with gross incomes of more than $1 million and individuals with incomes of more than $500,000, and a 2.5 percent excise tax on the sale or lease of medical devices.
The Congressional Budget Office estimates that the gross cost of the bill would be almost $1.1 trillion through fiscal 2019, but the net cost, after taxes, fees and penalties are taken into account, would be $894 billion. CBO estimates the bill would actually reduce the deficit by $104 billion, as a result of tax provisions and spending reductions.
The House rule adopted for health care reform also sets up an upcoming debate on a separate measure to change the way Medicare reimburses physicians. The physicians’ pay bill would block a 21 percent reduction in the Medicare payment rates for physician services scheduled for January 2010, and would instead provide for an increase in those payments based on the Medicare economic index. The measure is expected to be considered on the House floor starting next week.

Next Step, the Senate

Action now turns to the Senate, which has been in a bit of a holding pattern on its version of health care reform. Behind the scenes, Democratic leaders are combining the bills passed earlier this year by the Senate Health, Education, Labor and Pensions (HELP) Committee (S. 1679) and the Senate Finance Committee (S. 1796).

While the committees have different jurisdictions, there are points of overlap that will require negotiation before being merged into one Senate bill. Also holding up the process is the wait for the “score” by the Congressional Budget Office (CBO). Senate Majority Leader Harry Reid (D-NV) requested a score from CBO in late October, but has not yet received those cost estimates.

The process for Senate passage will differ markedly from the House. Unlike the House’s tightly managed vote with virtually no ability to amend the bill on the floor, the Senate is expected to consider dozens of floor amendments. n4a is working to develop amendments to improve the bill’s prevention and wellness language, as well as incorporate S. 1257, Senator Cantwell’s Project 2020 bill. We will keep you posted as advocacy opportunities arise.

While timing predictions are very difficult to make, it seems that the Senate bill may come to the floor as early as next week, but it is just as likely that it will be early December before debate begins. The White House would like to keep up the momentum and have Congress pass a final bill before the end of the calendar year, but a more reasonable timeline would have a House-Senate compromise brokered over the holidays in order to send a bill to President Obama before his State of the Union address in late January.

à If you have questions or concerns, please contact n4a’s public policy and legislative affairs staff, Amy Gotwals and K.J. Hertz, at 202.872.0888 or agotwals@n4a.org, khertz@n4a.org.