US House passes health care bill

Democrats agree to broad anti-abortion amendment

By Kate Randall
9 November 2009

The House of Representatives narrowly passed legislation on Saturday to overhaul the US health care system, with the inclusion of an amendment that imposes strict bans on the use of federal funds to finance abortion. The bill must be reconciled with legislation still being finalized in the Senate before it can be signed into law by President Barack Obama.

The bill is the result of months of backroom deals between the Obama administration, Congressional figures and representatives of the health care industry lobby. The Congressional Budget Office (CBO) estimates the total cost of the House plan at $1.055 trillion over a decade, with a net cost of $894 billion after taking into account certain revenues.

The CBO also projects that the bill would lower the federal deficit by $104 billion by 2019. These savings would come mainly through deep cuts to federal programs, particularly to Medicare. The bill also includes a mandate that individuals and families obtain insurance or pay a penalty, guaranteeing that billions of dollars are funneled to the insurance companies in the form of new, cash-paying customers.

The legislation includes a watered-down version of a “public option” available for purchase alongside private insurance plans on an insurance exchange. Unlike under Medicare, where the government sets rates for payments to health care providers, the secretary of health and human services would have to negotiate rates for payments to hospitals and doctors.

The legislation passed the House in a 220 to 215 vote, only two votes more than needed for a majority, gaining the support of 219 Democrats and only one Republican. Thirty-nine Democrats voted against it.

In the end, the majority for passage was only achieved by adoption of an amendment to the bill put forward by anti-abortion Democrats and their Republican supporters that imposes strict bans on the use of federal funds to finance abortion, a medical procedure legalized nationally by the 1973 US Supreme Court decision in Roe v. Wade. The amendment was approved by 240 votes to 194, with 64 Democrats joining the near-unanimous Republican bloc in favor.

This deal cleared the way for dozens of Democrats to back the health care package. The actual margin of the vote was determined in cynical back-room deals with Speaker Nancy Pelosi, in which selected conservative Democrats were allowed to oppose the bill, depending on their vulnerability to Republican challengers in the 2010 election.

The anti-abortion amendment was advanced by Rep. Bart Stupak, Democrat of Michigan, and a fervent abortion opponent. It mandates that “No funds authorized or appropriated by this Act … may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion” except in cases where the woman faces death unless an abortion is performed, or in cases where the pregnancy is the result of an act of rape or incest.

The amendment bars payment for abortions for woman who select the public option or who receive a government subsidy to purchase private insurance on the exchange. It would also ban abortions for coverage obtained with assistance from a state’s matching Medicaid funds. To the extent that private employers begin to dump workers into the public option, if it is ultimately established, the Stupak amendment would have the long-term effect of drastically reducing access to abortion for lower-income working-class women.

House Speaker Nancy Pelosi, Democrat of California, a longtime public supporter of abortion rights, orchestrated the deal. Last Friday night, she met with Democratic abortion rights advocates—and supporters of the health care bill—in an attempt to gain their support for the amendment to ensure passage of the overall legislation. A number of them stormed out of her office, balking at the sweeping restrictions contained in the amendment.

However, the U.S. Conference of Catholic Bishops, a body with close ties to Pelosi, had mounted a concerted campaign over the last week and a half to demand that strong anti-abortion language be included in the legislation. Before putting the Stupak amendment forward for a vote, Pelosi met with the House Pro-Choice Caucus, then with staff members from the Conference of Catholic Bishops as well as two leading Catholic representatives, Democrats Mike Doyle of Pennsylvania and Brad Ellsworth of Indiana.

After passage of the Stupak amendment, the bishops issued a statement urging Catholics to “lend their full-throated support” to the healthcare bill, which they described as “unambiguously pro-life.” The bishops joined a line-up of dubious endorsers of the Obama healthcare plan that includes the American Medical Association, the American Association of Retired Persons (which operates a huge and profitable insurance business) and the drug industry lobby.

Liberal Democrats like Rep. Rosa DeLauro of Connecticut and Diana DeGette of Colorado spoke out against the anti-abortion amendment, but in the end provided the necessary votes to pass the House Bill with its inclusion.

President Obama met privately with House members on Saturday, courting their support for the legislation. According to ABC News, a source at the meeting quoted him saying, “It’s tempting to say, ‘I’m tired, it’s hard, I’m getting beat up back in the district, it’s just not worth it.’” The president reportedly argued that the Congressional battles over the creation of Social Security and Medicare were also difficult, and supporters of those bills had been attacked and called “socialists.”

Despite the ravings of the ultra-right Republicans, the healthcare restructuring bill is no more a “government takeover” of healthcare than the Wall Street bailout was a takeover of the financial system. The legislation will channel billions of dollars into the pockets of the giant insurers and pharmaceuticals, through a mandate requiring individuals and families to obtain insurance or face a penalty of up to 2.5 percent of income.

The CBO analysis estimates that the weak public option in the House plan might attract only about 6 million people, or about a fifth of the 30 people purchasing insurance on the exchange by 2019. The public option would also most likely attract the sickest people, who would end up paying higher premiums than those offered by private insurers.

According to CBO estimates, an individual earning $44,000 before taxes will have to pay $5,300 in annual premiums and an estimated $2,000 in out-of-pocket expenses, for a total of $7,300 a year—or about 17 percent of his or her pre-tax income. A family earning $102,100 a year before taxes would pay $15,000 in premiums plus $5,300 out-of-pocket, or $20,300 total—20 percent of the family’s pre-tax income.

If individuals or families earn less than these amounts, they would be eligible for government subsidies, calculated on a sliding scale, paid directly to their insurer.

While insurers will be barred from denying coverage or charging more for premiums for individuals with preexisting conditions, there are no restrictions on what insurers can charge overall. At the same time, the bill would cut $426 billion over a decade from federal health care programs, mainly Medicare.

While side-stepping comment on any of the particulars of the House bill, Obama called Saturday’s passage of the legislation “historic,” saying that lives of millions of Americans “are what’s at stake in this debate, and moments like this are why they sent us here.”

Obama postured as an advocate for universal health care during his presidential bid. One year since his election, he now supports legislation that would leave millions of Americans without insurance. Instead of a right of the people to healthcare, the bill would establish the right of insurance companies to collect premiums from a captive market, charging what they will.

The CBO estimates that the House bill would still leave 18 million people uninsured by 2019, including about 6 million undocumented immigrants. The Senate Finance Committee’s version of legislation, which Obama has broadly endorsed, would leave about 25 million without insurance, according to the CBO.

Although the House version of the legislation includes a public option, in the Senate, Majority Leader Harry Reid (Democrat, Nevada) has indicated he would support an even weaker “opt-out” version of the government-run option, where it would be included on the exchange, but states could choose not to participate in it.

In fact, there is no guarantee that any permutation of the “public option” will remain once a final Senate plan is reconciled with the House version of legislation.

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