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House Gives Final Approval to Historic Health Care Bill

March 21, 2010 - by Donny Shaw

On a party-line vote of 219-212, the House of Representatives has passed the Patient Protection and Affordable Care Act that fulfills President Obama’s goals of reducing health care costs, increasing choices for consumers and guaranteeing access to quality, affordable insurance for all Americans. The bill has already passed the Senate and will be sent to President Obama immediately to be signed into law.

“At a time when pundits said it was no longer possible, we rose above the weight of our politics,” President Obama said after the vote. “This is what change looks like.”

The bill is widely considered the biggest domestic policy achievement by any President or session of Congress since Lyndon B. Johnson signed the Social Security Act of 1965 into law 45 years ago, creating Medicare.

Contrary to the attacks of some conservatives, this bill is in no way a “government take-over” of the health care system (citation: Politifact’s “Top Five Lies About Reform”). It keeps the fundamental system of private insurance in place and, in fact, will strengthen the already-enormous health care industry by delivering them millions of new customers.

What is so historic about this legislation is that, for the first time ever in U.S. history, it codifies an assumption that all people should have health insurance, regardless of age, income, health or employment status. Over the next ten years, it is estimated to achieve coverage of 95% of the population through a combination of cost controls, regulations, government subsidies, an expansion of government insurance, and mandates.

(Above, Speaker of the House Nancy Pelosi, accompanied by members of the House Dem. caucus, walks to the U.S. Capitol for today’s votes carrying the gavel that was used when Medicare was passed by the House in the 1960s.)

UPDATE: The House also approved the Reconciliation Act of 2010, which contains about 150 pages of “fixes” to the health care bill, by a vote of 220-211. The reconciliation bill now goes to the Senate. According to reports, they will continue debating and voting on it Tuesday.

Here are some of the key components of how the health care bill works.

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.

Obviously there is more to the bill than this, but these are the basic provision for understanding the mechanics in the bill to expand insurance coverage. The House Whip, Rep. James Clyburn [D, SC-6], has posted tons more information on the bill at his website.

The House will now take up the budget reconciliation bill containing 153 pages of fixes and tweaks to the health care bill. Read here to find out what you can expect. We’ll update as soon as it passes.

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