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It's Over! House Gives Final Approval to Health Care Reform

March 25, 2010 - by Donny Shaw

Pelosi and Reid celebrate health care reform passage

More than a year after Congress began their health care reform effort, it officially came to an end today as the Senate and House both gave final votes of approval to the Health Care and Education Affordability Reconciliation Act of 2010. The bill amends the bigger health care reform bill, the Patient Protection and Affordable Care Act, that President Obama signed into law earlier this week.

The Senate voted first this afternoon, passing the reconciliation bill on a 56-43 vote, with Sen. Ben Nelson [D, NE], Sen. Blanche Lincoln [D, AR] and Sen. Mark Pry or [D, AR] crossing the aisle to vote with all Republicans agains it. The vote capped a marathon session of voting, running late into the night Wednesday, during which 40 Republican amendments were rejected. However, the Republicans did succeed in their efforts to alter the bill by appealing to the Senate Parliamentarian under the Byrd Rule and managed to strip 12 lines of insignificant text from the 150+ page bill.

Though the change was insignificant, it was enough to force the bill back to the House because the Constitution requires both chambers to approve the exact same bill before it can be signed into law. After an hour and a half of debate, the House agreed to the Senate changes by a vote of 220-207.

The bill now gets sent to President Obama, who is expected to sign it into law sometime next week, closing the book on health care reform for the 111th Congress.

Here are some of the top-line changes that the just-passed reconciliation bill would make to the new health care law:

Removes special deals — The health care bill picked up a few sweeteners for specific states along the way on its year-long journey towards becoming law. For the most part, the special deals exempt states from changes in Medicare law. The reconciliation bill eliminates many of these.

Increases subsidies — Adds more money for helping people who earn under 400% of the Federal Poverty Level and aren’t insured through work to afford insurance. Under the bill that was signed into law, the average subsidy for a person buying insurance on the exchanges would be $5,800. The reconciliation bill ups that to $6,000.

Softens individual mandate penalty — Starting in 2014, people without insurance may have to pay a tax penalty under the bill’s individual mandate provision. The reconciliation bill lowers the size of the penalty from $750 to $695 and adds a bigger exemption for people who can’t get insurance due to financial hardship.

Closes the Doughnut Hole — the reconciliation bill adds a $250 rebate in 2010 for all Medicare Part D enrollees who enter the gap in prescription drug coverage that currently exists between $2,830 and $6,440 and closes this “doughnut hole” completely by 2020 through gradualy increasing the rebate amount.

Scales Back the Cadillac Tax — The reconciliation bill delays until 2018 the excise tax on high-cost “Cadillac” health plans and increases the premium threshold for triggering the tax.

Strengthens Fraud Fighting — Adds $250 million in funding for the Health Care Fraud and Abuse Control Fund.

Student Loan Reform — Incorporates much of the Student Loan and Fiscal Responsibility Act, which ends a program that provides government subsidies to student loan companies and use the saving to increase Pell Grants and other scholarship programs.

As a reminder, here’s my description of the core mechanics of the underlying health care reform law that I posted on Sunday:

Insurance Regulations — The bill would outlaw a number of the most abusive practices from insurance companies. Most prominently, they would no longer be allowed to deny coverage based on pre-existing medical conditions. The bill would also ban them from rescinding coverage to customers who get sick, eliminate lifetime and annual limits on benefits, cap how much money from premiums insurers can spend on things like profit, administrative costs and advertising, and require insurers to cover preventative services and immunizations.

Individual Mandate — Starting in 2014, all Americans would be required to have some form of health insurance. Uninsured individuals would be penalized with a tax of $95 in 2014, $325 in 2015 and $695 in 2016 and beyond. Religious groups that are “conscientiously opposed” to insurance, like the Amish and Old Order Mennonites, would be exempt from this requirement. Members of non-profit “Health Care Sharing Ministries” would also be exempt.

Affordability Credits — New tax credits would be available for people with incomes between 133 and 400 percent of the Federal Poverty Level to help them afford insurance coverage. The average subsidy for people receiving government assistance would be $6,000 per year.

Medicaid Expansion — The biggest government expansion in the bill would be in Medicaid. All individuals earning less than 133 percent of FPL would get free insurance through Medicaid. The CBO has estimated that this expansion will cover 16 million Americans by 2019.

Health Care Exchanges — All individuals buying insurance on their own and businesses searching for a plan to offer their employees, would do their shopping on new state-based “exchanges.” The exchanges would, essentially, be websites displaying the various plans that are available with prices and services laid out side-by-side in a standard format. Think for health insurance. States would be allowed to join together to form regional exchanges under the bill.

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Displaying 1-30 of 33 total comments.

Dmdclossin 03/30/2010 6:41am
in reply to Dmdclossin Mar 30, 2010 6:41am

Do I think this is a great idea, no but I think it can help and I think that it souldn’t cost 940 billion to make it better. Every great Idea starts from one really bad one, just look at Ben Franklin flying a kite in a lightning storm lol.

Dmdclossin 03/30/2010 6:41am
in reply to justamick Mar 30, 2010 4:52am

lol no insult at all I under stand when I get stirred up about somthing I tend to go in about a million differnt directions at the same time. And yes this has been completely a miss understanding I think on both parts. I agree with your stand on regulation good and 940 billion bad 100%. I work for a Insurance managment company and it’s very hard to hear people bash their insurance coverage and in the same breath bash the fact the Government is trying ( yes once again not nearly the best solution) to do something that can help the Patient get care that they need and can afford. I agree not really the best practice to mandate coverage but then again the mandate doesn’t really take affect till 2014 and it dosen’t really sound like it’s going to be that harsh anyway lol.

justamick 03/30/2010 5:31am
in reply to justamick Mar 30, 2010 5:23am

And a 10% excise tax on medical tools? Really? I know that it’s not non-consumer available items, but still… that kind of excise tax is just going to drive health care cost up!

justamick 03/30/2010 5:23am
in reply to BenjaWiz Mar 29, 2010 3:07pm

yes, I agree, Health Care reform through regulation of the Insurance industry is exactly what is needed. Like I’ve said before, it can be done without all the “pork”.

justamick 03/30/2010 4:59am
in reply to Dmdclossin Mar 29, 2010 12:06pm

I’m sorry, I’m not even going to dignify this argument with a response. It’s absolutely ludicrous.

justamick 03/30/2010 4:52am
in reply to Dmdclossin Mar 29, 2010 12:06pm

I’m sorry, please dont take this as an insult but I’m having a very difficult time sifting through your logic here.

Your argument is that we send help to 3rd World Countries but we complain about a mandate to purchase insurance? Am I correct with this interpretation?

I think you’ve completly missed something here… I have no problem with the Government looking to itself and taking care of domestic issues. Part of the government’s job is governing which includes industry regulation. So I’m in no way shape or form against the govenrment regulating the insurnace industry. That’s great! Regulating the industry does not require a mandate or $940 Billion. Period.

nmeagent 03/29/2010 7:39pm
in reply to nmeagent Mar 29, 2010 7:39pm

Unfortunately, your ‘better than nothing’ solution will force insurance companies to cover those with pre-existing conditions and inflicts price controls and other anti-capitalist regulations on the industry, more or less destroying its entire foundation. Instead of insurance we will now have a price-controlled, subsidized, compulsory payment plan. Thanks.

nmeagent 03/29/2010 7:39pm
in reply to Dmdclossin Mar 29, 2010 12:06pm

“I am more than fine with somone telling me to get something that will protect me from going into insane dept just becasue I get sick.”

That’s the purpose of insurance. Actuarial statistics are the only thing that makes health insurance industry work and make a profit in the first place; the reason it is cheaper to buy insurance than the pay for the treatment is because not everyone gets sick at the same time. You are more likely to get sick as you age and so you are charged more. The length of your benefits when you do get sick are determined by your contract with the insurer…just like every other type of insurance. Anything sinister going on here was accepted by you when you signed the contract (if you don’t read them you deserve whatever you get).

BenjaWiz 03/29/2010 3:07pm

I must agree, Justamick your 100% correct when you said and I quote “The Government mandate is UNCONSTITUTIONAL because the government CANNOT compel you to buy a good or a service” with regard to healthcare the last time I looked the President has the duty to uphold the rule of law when it comes to the constitution however I personally believe some kind of healthcare reform was needed I know this bill is far from perfect but at least it’s a start.

Dmdclossin 03/29/2010 12:11pm
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in reply to Dmdclossin Mar 29, 2010 12:06pm

This is not nearly the perfect solution but it is better than all the people who complain about the solution than comming up with one themselves.

Dmdclossin 03/29/2010 12:06pm
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in reply to Dmdclossin Mar 29, 2010 12:06pm

Yes it is bad to have someone tell you that you have to buy something but you wouldn’t really complain if the government told you that you HAVE to buy food and water so until a bottle of asprin costs the same as an apple, I am more than fine with somone telling me to get something that will protect me from going into insane dept just becasue I get sick. As for the exchange beleive me you do really want that. Even if you don’t jump for joy about haveing to have Insurance beleive me it is a good thing to be able to choose what insurance you have to get.

Dmdclossin 03/29/2010 12:06pm
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in reply to justamick Mar 29, 2010 9:09am

I think you missed the point on the Iraq comment and thus missing the whole point of the arguement. We as a country are so quick to send help to 3 world countries becasue they can’t help themselves but we complain about being told to step up to the plate and get insurance to keep our butts out of massive medical dept. For the first time in a long time the government is looking closer to home than worrying about what is going on half way around the world. So I guess the point is it ok that the government goes to other places in the world fight and implement our way of thinking BUT it is not ok for it to do so in it’s own house.

justamick 03/29/2010 9:21am
in reply to justamick Mar 29, 2010 9:18am

Here’s an article regarding Social Security and Obamacare.

justamick 03/29/2010 9:18am
in reply to Dmdclossin Mar 29, 2010 6:32am

“We the people” didnt/ have not screwed anything up on our own. The people in Washington did and continue to on a day to day basis. Sometimes they get things right. But alot of times they dont. They dont because everything is skewed by special interest groups or PACs corporations.

If Washington did things soo right, then why is it that SS payouts are at a tipping point where the govenrment is paying out more than it is taking in? How exactly is this doing it right? By the time I retire, I’m not going to have access into SS, but I will have paid in thousands of dollars! How is that doing it right? There is less than a 1% return on “investing” in SS, How is that right?

Let me correct your final statement… "Washington SHOULD be looking towards “WE THE PEOPLE” because they cant seem to get it right on their own."

justamick 03/29/2010 9:09am
in reply to justamick Mar 29, 2010 9:09am

On your Iraq comment, that’s what the VA is is for.

As for people helping people, that’s what charities are for. It’s not the Government’s job. Period.

justamick 03/29/2010 9:09am
in reply to Dmdclossin Mar 29, 2010 6:29am

Q: If a Government Mandate is so unconstitutional then why do we pay our taxes?
A: Taxes are levied in order to carry out it’s basic purpose… governing. They are not to provide goods or services. The reason why Social Security and Medicare are often regarded as constitutional is because they are mandated through the imposition of a tax, thus why you pay Medicare and Social Security Taxes. With ObamaCare, this is not the case. You are required to purchase coverage. If you fall within certain guidelines income wise the Government will supply subsidies in the form of rebates/ tax breaks etc. The fact of the matter is that the government is forcing you to buy a good/service. They are not afforded this power by the US Constitution. So, if you think about this logically then your argument about paying taxes has no basis in any sort of logical argument.

Dmdclossin 03/29/2010 6:32am
in reply to Dmdclossin Mar 29, 2010 6:29am

As for the 940 billion I completely agree, did you know a few years ago Doctors pharmacists and economists figured out it would take as much money as America spends on ICE cream in a year to cover the entire WORLD with enough to move everyone out of a poverty level. believe me I consider a lot of things but the fact is Health care needs help and as Americans (the nation who tries to consume as much as possible for our selves with as little effort as possible) we can’t do a lot on our own we do need a parent or some sort of figure to step in and say “hold on we have a problem and if the group isn’t willing to fix it then we will have to do something”. That’s why we look to Washington for leadership because we know “WE THE PEOPLE” will screw it up on our own.

Dmdclossin 03/29/2010 6:29am
in reply to justamick Mar 27, 2010 1:08pm

First they are exempt from the exchange because they don’t need to go and find other insurance .. your taxes pay for their plan (which by the way isn’t as great as most people think a little inside detail for you)As for the non-partisan issue I do beleive that there were some issue that were put on the bill form both parties (granted not enough to make the REP vote for it but they are there). If a Government Mandate is so unconstitutional then why do we pay our taxes? We may not be buying a good or serive for our selves (except when we retire and need SS or when something happens to us and we need food stamps, medicaid or need help when we are over 65 for medicare) but not just as Americans but as human beings are we not resposible for taking care of those who can’t help them selves HELLO IRAQ!

justamick 03/28/2010 3:30am
in reply to BenjaWiz Mar 28, 2010 3:18am


BenjaWiz 03/28/2010 3:18am

If your not Republican what are you? just curious.

justamick 03/27/2010 1:08pm
in reply to Dmdclossin Mar 27, 2010 8:58am

You know what? All that is perfectly fine. No problems with that. Here’s where the problem is. Ready? The Government mandate is UNCONSTITUTIONAL because the government CANNOT compel you to buy a good or a service. AND $940 Billion dollars is ALSO not needed to accomplish the things that you are specifying.

You know what else Obama promised? He promised that ALL sides would have input into this bill… He promised that this would be a Non-partisan bill… Guess what, my voice wasnt heard, neither were the voices of 150million other Americans.

Did you know that your lord and savior, Obama, and his cabinet are exempted from this bill? So if the exchanges and are these changes are good enough for us, shouldnt they be good enough for the President? Hmm?

So many aspects that you didnt consider, did you?

justamick 03/27/2010 12:52pm
in reply to justamick Mar 27, 2010 12:52pm

You should really go back and read this document called the U.S. Constitution. If you read and understood it’s purpose maybe you wouldn’t demean so much of us for being against this law.

It is amusing to me how often you were told by nmeagent that he wasn’t a republican, and yet, like the obvious ignorant leftist you are, ignored what he had to say. This is typical of the left and has been typical since the beginning of this debate.

justamick 03/27/2010 12:52pm
in reply to BenjaWiz Mar 26, 2010 10:51am

Nor am I republican.

I do thank you though BenjaWiz, you’ve show quite clearly the utter and complete ignorance that is frightfully obvious that resides with the left.

Just so you know, I’m not rich, I’m a “middle class American” that this law is supposedly going to help. I am still adamantly opposed to it. Does that make me greedy? No, it doesn’t. It means I have more sense than a lot of others in this country I’m sick and tired of GOVERNMENT run away spending, and this bill is yet again another run at bigger government and more spending.

It’s getting really old.

Dmdclossin 03/27/2010 8:58am

LMAO I just think that, Yes you should defy the Governmentwhen they do something that is unethical and flat out wrong but please just don’t be the person who complains and B****s when your employer sticks you with the cheapest plan they can find and quite possibly may just be as usless as not having Insurance at all. Please do not be the people that complain becasue you are getting collection calls because your kid broke their leg and get stuck with a $6k bill for just a MRI. Don’t be mad when your plan drops your butt when you get cancer and your plan tells you “sorry we’re only going to give you $100,000 for a lifetime benefit” when your Chemo run at $15k a treatment. As for the president himself, lets face it like him or hate him he promised this would be done and in just over a year it’s done unlike the other presidents who tried and failed over the past 40 years.

nmeagent 03/27/2010 7:27am
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in reply to BenjaWiz Mar 26, 2010 10:58am

“Republicans, in general, are a bunch of babies; they’re crying over small tax hikes like it’s going to stop their livelihood. Republicans have nothing to offer America, but they sure have a lot to offer themselves. LOL! It’s over and you were beaten again, so just accept the loss!”

I fixed that for you. Now doesn’t that sound much better despite the dubious content? Let me give you a piece of advice: if you don’t want to sound like a 16-year-old texting on his mother’s cell phone, do not write like one. You can at least try to sound like a literate adult.

nmeagent 03/27/2010 6:55am
in reply to BenjaWiz Mar 27, 2010 12:54am

And other thing: it’s not my party!

nmeagent 03/27/2010 6:52am
in reply to BenjaWiz Mar 27, 2010 12:54am

It’s funny how things like that can change, especially when we have this strange concept called elections. We have one of those coming up rather soon, too…I think you should check the opinion polls and return from fantasy land. Come back from the light, Carol Ann!

BenjaWiz 03/27/2010 12:54am
in reply to nmeagent Mar 26, 2010 3:55pm

I am on the losing side?? last time I checked Obama was elected president and the Democrats control congress so I believe friend your in denial that your party is weak and does not fight and another thing November isn’t hear yet so yeah it’s over health care past get use to it.

nmeagent 03/26/2010 3:55pm
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in reply to BenjaWiz Mar 26, 2010 10:51am

I don’t necessarily put much hope in the Republican Party as I’m not a Republican (though you could call me a republican).

It’s not over because this “law” is currently being challenged in federal court.

It’s not over because many state governments shall nullify this “law” and refuse to enforce it in any way.

It’s not over because I and many other individuals shall refuse to obey this “law”.

It’s not over because over a hundred million US citizens own and are frighteningly proficient with a wide variety of firearms and will, as an absolute last resort (i.e., hopefully never) protect and defend the Constitution against all enemies, foreign and domestic. Many of us swore an oath to do so and we really mean it.

We will not be enslaved, in total or in part. I’m afraid you’re on the losing side, friend.

BenjaWiz 03/26/2010 10:58am

Republican’s in general are a bunch of baby’s their crying over small tax hikes like it’s going to stop their lively hood Republican’s have nothing to offer America but they sure have alot to offer themselves lol it’s over and ya got beat again just except the loss.

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