Health Bill Clears Hurdle, and Hints at Consensus
House Panel Approves Landmark Health-Care Bill
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: July 31, 2009
WASHINGTON ― House members headed home on Friday, leaving behind the outlines of a nearly $1 trillion health care overhaul that is sure to draw fire from a variety of interests, but also shows the beginnings of a consensus that would provide insurance for more Americans and give them new rights in dealing with insurers.
As a final act before recessing until September, one crucial panel, the House Committee on Energy and Commerce, approved landmark health legislation that could ultimately lead to coverage for about 95 percent of Americans and create a new government-run insurance program.
The 31-to-28 vote occurred at 9:05 p.m. Friday, at the end of a session that began at 10 a.m. Five Democrats joined all 23 Republicans on the panel in voting no.
Congress still has plenty of work to do in September to blend competing, sometimes contradictory health measures, but lawmakers have found a good deal of common ground on proposals that would profoundly change the health system.
Lawmakers of both parties agree on the need to rein in private insurance companies by banning underwriting practices that have prevented millions of Americans from obtaining affordable insurance. Insurers would, for example, have to accept all applicants and could not charge higher premiums because of a person’s medical history or current illness. All insurers would have to offer a minimum package of benefits, to be defined by the federal government, and nearly all Americans would be required to have insurance.
“The glory days are coming to an end for the health insurance industry,” Speaker Nancy Pelosi said Friday.
Ms. Pelosi predicted that insurers would not block passage of the legislation, President Obama’s top domestic priority.
Lawmakers also agree on the need to provide federal subsidies to help make insurance affordable for people with modest incomes. For poor people, Medicaid eligibility would be expanded.
The chaos on Capitol Hill, combined with bitter disagreements over how to pay for the legislation and the role of a public plan, has obscured the areas of potential consensus.
“There is wide agreement on the two elements of the legislation that the public cares about most: insurance market reforms and the expansion of coverage, with subsidies,” said Drew E. Altman, the president of the Kaiser Family Foundation, which focuses on health policy.
Details of the major House and Senate bills differ, but most employers would have to provide insurance or contribute to the cost of coverage for employees, with exceptions for some small businesses.
Democrats also agree that Congress should create some type of government insurance plan or nonprofit cooperative, which would compete with private insurers. Mr. Obama says the public plan would keep insurers honest, but Republicans say it could eventually drive private insurers from the market, leaving consumers with fewer choices.
Members of both parties in both chambers want to create health insurance exchanges, where people could shop for insurance and compare policies.
Lawmakers also agree on proposals to squeeze hundreds of billions of dollars out of Medicare by reducing the growth of payments to hospitals and many other health care providers. They are committed to rewarding high-quality care, by paying for the value, rather than the volume, of services.
The major bills offer the promise of more affordable insurance for people who are uninsured, including those with chronic illnesses. Under the legislation, it might be easier for people to switch jobs because they would not have to stay in less desirable jobs just to retain health insurance. The bills promise relief to people with huge out-of-pocket health costs and would eliminate co-payments for many preventive services.
But high-income people and some businesses would face new taxes. In an analysis of the House bill, the Congressional Budget Office estimated that people without insurance would pay $29 billion in penalties over the next 10 years, while employers not offering insurance would pay penalties totaling $163 billion.
The Energy and Commerce Committee was unable to deliver a bill when the nation last tried to guarantee universal coverage, under President Bill Clinton, in 1994. Asked what was different this time, the current chairman, Representative Henry A. Waxman, Democrat of California, said: “The leadership of President Obama. He made it a very strong, clear priority. He had a mandate from the American people to pass legislation that would provide every American with affordable coverage.”
Moreover, Mr. Waxman said: “The issue is a lot more severe than it was in the 1990s. Fewer stakeholders ― doctors, patients, hospitals or insurance companies ― want the present system to continue. It will bankrupt the country.”
House Democratic leaders said the health care bill would be on the floor in September, after they meld versions approved by three committees. The Senate will be in session next week, but the Finance Committee chairman confirmed Thursday that his panel was not ready to take up the issue.
Action by House committees gives Mr. Obama a fragile political victory. But it fell far short of his original goal, which called for both houses of Congress to approve the legislation before the August recess.
The Energy and Commerce Committee voted, 47 to 11, to establish a procedure for federal approval of generic versions of expensive biotechnology drugs. Representative Anna G. Eshoo, Democrat of California, said this change could save the government $9 billion over 10 years.
Democrats on the Energy and Commerce Committee cleared the way for approval of their bill by adopting a package of amendments bridging differences among liberal, moderate and conservative members of the party.
Mr. Waxman said the latest agreement supplemented a deal struck Wednesday with fiscally conservative Blue Dog Democrats on the panel.
To avoid cutting premium subsidies for low-income people, Mr. Waxman said, Democrats found additional savings elsewhere.
Representative Diana DeGette, Democrat of Colorado, said the Blue Dog deal would hold down costs. But, she said, “it was paid for on the backs of people who cannot afford health insurance,” so liberals objected.
Under the Democratic proposals, insurers would be required to get “prior approval from the government before increasing premiums over a certain amount.”
Representative Tammy Baldwin, Democrat of Wisconsin, said this requirement was needed to curb the growth of premiums.
“Over the last decade,” Ms. Baldwin said, “small businesses and individuals have experienced double-digit increases in premiums, and that contributes mightily to the level of uninsurance.”
The Democratic amendments stipulate that “savings generated by this package must go toward making premiums more affordable for lower-income people.”
Democrats on the Energy and Commerce Committee would also authorize the health and human services secretary to negotiate prescription drug prices for Medicare beneficiaries.
Carl Hulse contributed reporting.
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