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The House of Representatives on Saturday night approved landmark legislation designed to accomplish President Obama’s goals of reducing health care costs, increasing choices for consumers and guaranteeing access to quality, affordable insurance for all Americans. The final vote tally was 220-215. Thirty-nine Democrats broke with their party to vote against the bill, and only one Republican, Rep. Anh Cao [R, LA-2], voted in favor.

Previous Congresses and Administrations have tried several times over the past 40 years to revamp the U.S. health care system, but they have never come this far. The bill passed in the House represents the biggest change to the health care system and the biggest expansion in coverage since Congress created Medicare and Medicaid in 1965.

The bill’s passage was secured in large part by a vote that took place earlier in the evening on an amendment from Rep. Bart Stupak [D, MI-1] to strengthen language in the bill banning the use of federal funds for abortions. The amendment, which was approved by a vote of 240-194, essentially restricts all low and middle-income people purchasing insurance with federal subsidies from buying a plan that covers abortions besides those resulting from rape or incest, or in cases where the mother’s life is endangered. A bloc of about forty conservative Democrats had been threatening for weeks to vote en masse to kill the bill if they weren’t allowed to vote on Stupak’s amendment.

President Obama also threw his full support behind the bill today in a plea to help House Democrats round up the final few votes they needed to get it passed. Speaking to the full House Democratic Caucus but gearing his remarks towards conservative Democrats, Obama said that voting against the bill wouldn’t protect them from partisan attacks. “None of you can expect the Republicans not to go after you if you vote against this bill,” Obama said at the meeting according to Rep. Henry Waxman [D, CA-30]. “They want this bill to go down for their own partisan reasons.”

The bill – known as the Affordable Health Care for America Act – seeks to expand health care coverage to the approximately 40 million Americans who are currently uninsured by lowering the cost of health care and making the system more efficient. To that end, it includes a new government-run insurance plan to compete with the private companies, a requirement that all Americans have health insurance, a ban on denying coverage because of a pre-existing condition and, to pay for it all, a surtax on individuals with incomes above $500,000. More thorough summaries of the bill can be found here.

The Senate is still weeks away from beginning debate on their own health care bill. The final details of their bill are still being negotiated, but whatever bill comes out of the Senate will be more conservative than the House’s bill in several ways. It is not clear that the Senate bill will end up containing a public option, and if it does, unlike the House bill it will allow individual states to opt out of offering it to their residents. The Senate’s bill will also provide fewer subsidies to help low and middle-income people buy insurance, and it will not include a surtax on the rich to offset its new spending.

The abortion issue that threatened to bring down the House bill so far has not been a problem in the Senate. Pro-choice Democrats are hoping to keep the Senate’s bill containing language that would allow people to use affordability credits to buy insurance that covers abortions, provided that the abortion part of the plan is fully paid for by individual premiums. The Senate language would then have to be reconciled with the House’s more conservative language by a joint-chamber conference committee that would be in charge of producing a final, merged bill. The final version will need one more vote from each chamber before it can be sent to President Obama to be signed into law.

The House Rules Committee met from 2 p.m. until 1 in the morning on Friday to strike a deal on the health care debate that will take place in the House today. Though the health care bill is 2,000 pages long and overhaul’s one-sixth of the nation’s economy, the committee’s epic session revolved around just one thing: abortion.

The Democrats’ biggest threat to passing their health care bill comes from one of their own. Pro-life Rep. Bart Stupak [D, MI-1] says he has commitments from about 40 other Democrats to vote against the bill unless it’s language restricting the use of federal funds for abortions is amended and strengthened. With every single Republican expected to vote against the bill, Stupak’s pro-life bloc holds enough leverage to kill the bill. They have been threatening to vote against the “rule” governing the floor debate, effectively blocking the debate from beginning, if they are not allowed a floor vote on their amendment.

In the beginning of the day on Friday, the Rules Committee, which is basically an extension of the Democratic leadership, had several options on the table yesterday for resolving the abortion problem. But when the most promising compromise language on the issue was withdrawn by its sponsor, Rep. Brad Ellsworth [D, IN-8], they were left with only three options — add Stupak’s abortion amendment to the bill, call his bluff on voting down the “rule,” or let him have a floor vote on his amendment.

In the end, the leadership decided to give him a floor vote on his amendment. They hope that whether or not the amendment passes, the Democratic caucus will come together in the end to vote in favor of the bill on final passage. In other words, if the amendment fails, the fact that the leadership allowed it to happen might be enough to win votes from some of the 40 pro-life Democrats. And if it is adopted, pro-choice Democrats who oppose the amendment will likely still vote for the bill so as to not stand in the way of health care reform. (For a more detailed report on how the Rules Committee came to allow a vote on Stupak’s amendment, see Ryan Grim’s reporting.)

Senior Democrats believe the deal to allow a vote on the abortion amendment secure the votes needed to pass the health care bill. “You don’t go to the floor unless you’re there — and we’re there,” Rep. John Larson [D, CT-1] told the L.A. Times.

The Stupak Abortion Amendment

The amendment, which you can download and read in full here, would do three things.

First, it would codify the Hyde Amendment provisions in the bill so that the ban on federal funds being used for abortions besides those resulting from rape or incest, or in cases where the mother’s life is endangered would remain intact regardless of Hyde being reauthorized. As it’s currently written, the bill’s restrictions on the use of federal funds for abortion coverage would end if the Hyde Amendment, which has been reauthorized by Congress on an annual basis since 1976, is not reauthorized.

Secondly, it would not allow individuals purchasing insurance at least in part with federal affordability credits to buy a plan that covers abortions. The bill as currently written would allow individuals to use affordability credits to buy insurance that includes abortion coverage, but it requires any such plan to segregate the credits from individual premium payments and ensure that only the premium payments are used to fund the abortion services portion of the plan.

Affordability credits are available under the bill to people who don’t get insurance from work and earn between 150% and 400% of the Federal Poverty Level. The Stupak amendment would bar all people in this income bracket from purchasing insurance that covers elective abortions unless they can afford to pay for a separate abortion coverage plan on their own. People earning below 150% of FPL would already be ineligible for abortion coverage because they will be on Medicaid, which does not cover abortions under Hyde. There are no concrete numbers for how many people would be denied an abortion-coverage option under the amendment, but it would likely be at least 20 million.

Thirdly, the Stupak amendment would dictate that the government-run public option does not provide abortion coverage. The bill currently leaves the decision of abortion coverage in the public option up to the Secretary of Health and Human Services. Allowing the public option to cover abortions would not violate the Hyde Amendment because the public option is not government funded; will be entirely financed by individual premiums, just like the private plans.

Douglas Johnson of the National Right to Life Committee has called today’s vote on the Stupak amendment the most important abortion vote in Congress since Roe.

Planned Parenthood says the amendment would be a discriminatory abortion ban. “This amendment would violate the spirit of health care reform, which is meant to guarantee quality, affordable health care coverage for all, by creating a two-tiered system that would punish women, particularly those with low and modest incomes,” said Cecile Richards of Planned Parenthood.

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It’s now just one day before the House of Representatives is scheduled to vote on their bill to overhaul the health care system (H.R. 3962). Here’s a rundown of where things stand at this moment.

The Votes

The Democrats need a simple majority of 218 votes to pass the bill. This morning, House Majority Leader Rep. Steny Hoyer [D, MD-5] said they they didn’t quite have all the votes lined up yet, but that they were “very close.”

On Thursday, House Speaker Rep. Nancy Pelosi [D, CA-8] said confidently that she “will” have the votes lined up by Saturday. Take her seriously on this — in her three years as Speaker, she has only lost on one major vote (the Wall Street bailout bill). She’s been in the situation of scrounging up votes from wavering Democrats at the last minute many times, but when the votes get tallied she always seems to prevail.

Forty House Democrats are threatening to vote against the bill unless its provisions banning federal funding for abortions are strengthened. That’s just about enough to sink the bill. Add to that the fact that a handful of conservative Democrats are opposing the bill flat-out and it becomes clear that Pelosi will have to do more than peel off a few of the 40 pro-life Dems with arm-twisting and earmarks.

The Bill

The House Rules Committee is scheduled to meet today at 2 p.m. ET to determine the rules that will govern the health care floor debate and vote. They’ll decide what, if any, amendments will be voted on as well as any last-minute changes that will be made to the bill. The Rules Committee is generally considered an extension of the Democratic leadership, so any changes or amendments that are agreed to by the committee today will be done at the behest of the leadership in order to win over on-the-fence Democrats.

You can read all of the amendments that have been submitted to the committee here.

Adoption of the 42-page Manager’s Amendment that was released on Wednesday will be included in the “rule” that the Rules Committee decides on today.

It is likely that they will add some new language to the bill’s provisions on abortion funding. Igor Volsky at the Wonk Room has a very handy chart showing the current bill’s abortion provisions and a couple possible changes that have been floated by pro-life Democrats. There are basically two proposals — 1) prevent all middle and low-income people buying insurance with affordability credits to buy plans that cover elective abortions, and 2) tweak the bill’s language regarding the segregation of funds that would keep federal funds separate from the individually paid premiums that could be used for abortion coverage. If the Dem leadership determines that the latter option is enough to win over some of the 40 Democrats with concerns over the bill’s abortion provisions, that language will likely be included in the underlying bill that comes to the floor by the Rules Committee.

On this issue of floor amendments, it looks like the only one that will be voted on is the Republican substitute. Given its dismal score from the CBO, that likely will not attract any Democratic support and is not really a viable amendment. Rep. Anthony Weiner [D, NY-9] has dropped his demand that the full House votes on his amendment to replace the bill with a single-payer system that is supported by progressives. The House leadership has called Weiner’s choice to withdraw his amendment “enormously helpful in passing the health care reform package.”

The full text of the bill as it currently stands can be read here on OpenCongress.

The Debate

The House’s floor debate is scheduled to begin at 9 a.m. ET. The first matter of business will be a vote on the “rule” that will govern the debate. This might contain some new changes to the bill (we’ll report as soon as we know). If it doesn’t change the bill’s abortion provisions, pro-life Democrats are threatening to vote against the “rule,” potentially ending the floor debate and sending the bill back to the Rules Committee. However, with the two new House Democrats that are being sworn in today, the 40 Dems that have problems with the bill’s abortion provisions might no longer have the numbers to bring down the rule.

Once the rule is approved, the Democratic leadership is planning on genera floor debate, including a vote on the Republican substitute, to last until 6 or 7 p.m., at which time the House will take a final vote.

But, as Hoyer admitted this morning, this timeline is likely to be extended. Republicans are readying some dilatory tactics and the debate could be extended into Sunday or even next week.

Before the debate is over the Republicans will have one last chance to kill the bill through a motion to recommit. A motion to recommit is basically a procedural vote that allows the minority party one final chance before final passage to request that the bill is amended. The language of motions to recommit are generally not released to the public beforehand and they are only given a few minutes of floor debate.

If the Republicans put language regarding abortion coverage in their motion to recommit, they could potentially pick off enough Democrats to pass the motion. But any abortion language beyond what the Democratic leadership decides to include through the Rules Committee would likely have the effect of a “poison pill” and cause the overall bill to fail once a final vote is taken.

The Drudge Report is leading off today with an outrageous and false claim about the House health care bill from House Minority Leader John Boehner [R, OH-8]. “A monthly abortion premium will be charged of all enrollees in the government-run plan,” Boehner writes. It’s right there on line 16, page 96, section 213, under ‘Insurance Rating Rules.’  The premium will be paid into a U.S. Treasury account – and these federal funds will be used to pay for the abortion services."

But Boehner is either lying or completely misunderstanding what that section of the bill is all about. In fact, the section of the bill he is claiming would require a “monthly abortion premium” is actually part of a safeguard in the bill to ensure that no federal money is used for funding abortions.

The section, which you can read for yourself here, directs the Health Choices Commissioner to determine, on an actuarial basis, the per month cost of insurance coverage for elective abortions. The reason the government needs this information is because the bill requires federally-funded affordability credits to be segregated from individually-paid premiums for any insurance plan that covers elective abortions and is paid for in part by affordability credits. The government needs to know how much the abortion coverage portion of the plan costs so they can ensure that that that potion of the plan is fully paid for by private individuals, not by the government.

Read the section of the bill on segregating these funds here; you’ll see that it references the section directing the Commissioner to estimate the cost of abortion coverage. There is absolutely nothing in the section or anywhere else in the bill that says anything abortion premiums.

Boehner also makes another false claim in his article. “On line 17, p. 110, section 222, under ‘Abortions for which Public Funding is Allowed,’ the Health and Human Services Secretary is given the authority to determine when abortion is allowed under the government-run plan,” he writes.

This, also, is not true in any way. Read the actual text of that section:

(B) ABORTIONS FOR WHICH PUBLIC FUNDING IS ALLOWED- The services described in this subparagraph are abortions for which the expenditure of Federal funds appropriated for the Department of Health and Human Services is permitted, based on the law as in effect as of the date that is 6 months before the beginning of the plan year involved.

Under current law, the Secretary of Health and Human Services does not have any authority to determine what abortions can be paid for with federal funds. That authority belongs to Congress. Since 1976, Congress has passed a law every year (the Hyde Amendment) that bans federal funds from being used for abortions except in cases of rape, incest, or when the life of the mother is at risk. This is the law being referenced in the section of the health care bill Boehner refers to in his article. It is fully upheld by the House health care bill. Congress would have to end the Hyde Amendment in order for any decisions regarding federal funds for abortions to be given to the HHS Secretary, as Boehner falsely claims.

Pennsylvania Republican Rep. Todd Platts has submitted his name to be considered as the next comptroller general of the United States, the top post in the Government Accountability Office (GAO).

Platts is one of 18 candidates who have applied for the position, according to a congressional source and a letter Platts sent to a congressional commission that selects candidates for the job and forwards their names to the president, who makes the final choice.

“By way of this letter, I am honored to officially submit my name to you and the other members of the Congressional Comptroller General Commission for consideration of appointment to the position of Comptroller General of the United States,” Platts wrote.

It is rare for a sitting member of Congress to apply for the comptroller general position, but the agency has taken on greater importance in recent years during the country’s economic crisis and throughout two expensive wars.

The GAO is an incredibly important government body and is taking on increasing responsibilities as it watchdogs stimulus spending and waste and fraud in both Iraq and Afghanistan.

The position is ultimately decided by the President, after a panel of 10 lawmakers forwards final candidates to his office.

Were Platts to receive the position it would be unusual for how conservative the congressman has been through his career. The few Republicans who have received positions in the Obama administration have been known as relative moderates in the Republican Party (Ray LaHood, Bob Gates and John McHugh).

Congress messed up a bit when they approved their credit card reform bill back in May by giving credit card companies too much time before the bill’s new consumer protections take effect. They thought it was only fair to give the companies some time to adjust and prepare for the new regulations, so they gave them 9 months. But instead of playing fairly, the companies have been taking this time to jack up interest rates as much as they can before the new regulations take effect, banning arbitrary rate hikes.

Today, the House of Representatives is scheduled to vote on taking away the 9-month grace period. The Expedited CARD Reform for Consumers Act of 2009 they are voting on today would move implementation of the reforms up to December 1, 2009 (soon!). Congress Matters has posted the full list of the provisions that would be bumped up by the bill. You can see all the amendments to the bill that will be voted on by the House at the Rules Committee website.

It’s expected to pass, mostly with Democratic support, but it will also have to go through the Senate before it can become law. The Senate is generally a bit more bank-friendly than the more populist House, so passage there could be more difficult. Sen. Mark Udall [D, CO] introduced a version of the bill in the Senate on October 21st. So far, it has attracted 11 co-sponsors; all of them Democrats.

UPDATE: The bill has been approved, 391-92. The only Democrat who voted against the bill was Rep. Stephanie Herseth Sandlin [D, SD-0], who also voted against the original credit card bill. Federal law allows banks to ignore states’ individual usury laws and follow only the law of the state they are officially chartered in, and South Dakota has the most lax usury law in the country. Not surprisingly, a lot of the big credit card companies are chartered there.

From The Hill, the latest on H.R. 3548, the unemployment benefits, homebuyer tax credits and carry-back relief extension bill:

Senate Democrats succeeded on Wednesday at ending debate on a bill that would extend most Americans’ jobless benefits by at least 14 weeks.

The 97-1 cloture vote concludes a four-week standoff between the majority party and GOP leaders over the extension, a version of which passed the House in September.

Democrats now expect a final vote on the substance of the bill to take place late Thursday.

The lone “no” vote on today’s cloture vote was Sen. Jim DeMint [R, SC].

The final vote on passage will require a simple majority of 51 votes to be approved. After that it goes back to the House of Representatives, which is expected to agree to the Senate’s changes and send it to President Obama for his signature quickly.

Last night, the Democratic leadership released a Manager’s Amendment containing 42 pages of last-mute changes to their heath care bill (H.R. 3962), signaling that they are making progress in lining up the votes to pass it.

“With the completion of the Manager’s Amendment to the Affordable Health Care for America Act, we are now in the final stage of moving this critical bill through the House,” House Majority Leader Rep. Steny Hoyer [D, MD-5] said last night. The Democratic leadership has pledged to have the amendment posted online for at least 72 hours before beginning debate of the bill. According to the timestamp on the document, the amendment was officially filed at 8:53 p.m. ET on Tuesday night, meaning that the earliest debate could begin on the bill without breaking the pledge would be Friday night. It’s likely, however, that the debate won’t begin until next week. UPDATE: The vote is scheduled to take place on Saturday at 6 p.m. ET.

House Speaker Rep. Nancy Pelo si [D, CA-8] has posted a brief overview of the amendment at her blog. Other sites have already begun looking at it more critically. The Heritage Foundation says it includes a new $6 billion slush fund for Medicaid to dispense to nursing homes. The New York Times found language in the amendment to restrict the paper industry from getting a biofuel tax credit for using a fuel known as “black liquor.”

A lot of what’s in the amendment probably works like an earmark. By targeting incentives at districts served by on-the-fence representatives, the leadership typically uses these manager’s amendments to shore up the final votes they need to ensure passage of their bill.

Glenn Thrush at Politico says the amendment is also noteworthy for what it doesn’t include: changes to the bill’s restriction on the use of federal funds for abortions.

As it is currently written, the bill would prevent federal funds from being used for abortions by requiring insurers that provide abortion coverage to segregate any government affordability credits from individually-paid premiums so they can ensure that only the individual premiums are applied to abortion services. Rep. Bart Stupak [D, MI-1] is leading a group of about 40 pro-life Democrats who are threatening to vote en bloc against the bill unless language is added to disallow any insurer on the new Health Care Exchange that would be set up by the bill from covering abortions.

Hoyer has indicated that abortion language may be included in the “rule” that governs how the bill is brought to the floor. The text of the “rule” likely won’t be made public until a few hours before the debate begins, which Republicans say is a violation of the Democrats’ pledge to make the legislation public. “If Democrats continue to add closed-door deals to their bill after their manager’s amendment has been introduced, they will break their 72-hour promise,” said a spokesman for Minority Whip Rep. Eric Can tor [R, VA-7].

You can download a copy of the Manager’s Amendment here. If you find earmarks or anything else interesting, email me at donny at opencongress d0t org and I’ll post it to the blog.