Democrats unveil health care overhaul bill

New questions raised on cost; Floor debate next week

By Shailagh Murray and Lori Montgomery
Washington Post / October 30, 2009

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WASHINGTON - After six months of deal making, Democratic leaders introduced a health care bill yesterday that would expand coverage to almost all Americans and overhaul the insurance industry, while asking the wealthiest taxpayers to pay much of the tab.

House Speaker Nancy Pelosi of California announced the 10-year $894 billion package on the Capitol steps, surrounded by Democrats from all factions of her diverse caucus. “Leaders of all political parties starting over a century ago with President Theodore Roosevelt have called and fought for health care reform and health insurance reform,’’ Pelosi said. “Today we are about to deliver on the promise.’’

The House bill is similar to its Senate counterpart, although a handful of key differences could make for protracted negotiations later this year. For example, the House’s surtax on those earning more than $500,000 per year is a nonstarter in the Senate. Yet House Democrats oppose the Senate’s main revenue measure, an excise tax on high-value, or “Cadillac,’’ health-insurance plans. And while both bills include a government insurance plan, the Senate version would allow states to opt out.

Under the House bill, 36 million uninsured Americans without access to affordable health benefits at work would become eligible for coverage. About 15 million of the poorest children and adults would enroll in Medicaid. Another 21 million would purchase coverage on a new national insurance exchange, where private plans would compete with a “public option’’ backed by the federal government.

An analysis of the House bill released yesterday by the nonpartisan Congressional Budget Office estimated that 6 million people would choose a public plan, making it a relatively small player despite the issue’s outsize role in the debate.

The House bill would require most individuals to buy insurance and employers to provide coverage to workers or face a penalty, although firms with annual payrolls below $500,000 annually would be exempt.

John Boehner, Republican of Ohio and the House minority leader, mocked the bill’s 1,990 pages as 620 pages longer than President Clinton’s failed overhaul plan 15 years ago. The conservative Republican Study Committee warned of “higher taxes, job-killing employer mandates, choice-restricting individual mandates, government-run insurance, budget-busting entitlement expansions, and countless provisions that set Washington bureaucrats firmly between you and your doctor.’’

For weeks, House Democratic leaders have huddled behind closed doors, seeking to stitch together a 218-vote majority. Up to 40 conservative Democrats remain unhappy with abortion-related provisions and are still threatening to vote no. But with debate on the House floor expected to begin next week, most major differences appear to have been bridged.

Before the unveiling, House Democrats gathered in the basement of the Capitol for a final briefing with Pelosi and other leaders, where they agreed that the time for compromise had arrived. Representative Earl Pomeroy, Democrat of North Dakota, a prominent fiscal hawk, stood up to say he would support the measure, drawing a round of applause loud enough to be audible outside the room. “At the end of the day, we’ve got to pass something,’’ said Representative James P. McGovern, Democrat of Massachusetts.

The House measure would pare $104 billion from projected budget deficits over the next decade, according to the CBO, and would “slightly reduce’’ projected deficits in the following decade. The CBO’s forecast for the House bill is less rosy than for the bill that passed in the Senate Finance Committee earlier this month, but it is significantly more favorable than the analysis of the original House package, which predicted that costs would exceed revenues after 2019.

In addition to expanding coverage, the House bill would impose strict new rules on insurers, including a ban on denying coverage based on preexisting conditions. The legislation would end a federal antitrust exemption that has long protected the industry from investigations into price-fixing and other practices, and would institute a review process into premium increases.

The bill also retains the Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to “death panels’’ for seniors, the Associated Press reported.

The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death. It is supported by doctors’ groups and AARP. It was not included in health care bills passed by two Senate committees.

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