House passes health reform bill

Last night the House of Representatives voted 219 to 212 in favor of the Senate health reform bill. Republicans unanimously opposed the bill and were joined by 34 Democrats. The bill now goes to President Obama’s desk for his signature. The House also voted 220 to 211 in favor of changes to the legislation that came out of negotiations between the House, Senate, and White House. The Senate must approve these changes.

This bill is a major expansion and improvement of the U.S. health care system. This long overdue legislation is the result of almost a century of organizing and political action. It is a considerably weaker bill than we started with about a year ago, though. There is no public option included, surely a win for insurance companies but a loss for the rest of us, and it is not without very serious problems.

The bill would:

  • Expand coverage to 32 million uninsured in the U.S.
  • Create insurance exchanges. The uninsured, self-employed and small businesses could purchase insurance through state-based exchanges. There are subsidies to help purchase insurance through the exchange for those who make between 100 and 400 percent of the federal poverty level.
  • Expand Medicaid to cover those who make up to 133 percent of the federal poverty level. Undocumented immigrants are not eligible for Medicaid.
  • Close the so-called Medicare “donut hole,” a costly gap in prescription drug coverage for seniors.
  • Ban higher premiums and denial of coverage because of preexisting conditions.
  • Ban higher premiums for women.
  • Require coverage of maternity care.
  • Allow children to continue being covered by their parent’s plans through age 26.
  • With some exceptions, require all U.S. citizens to purchase insurance or face a $695 annual fine.
  • Require those with 50 or more employees to insurance or pay a $2000 fine per employee every year if any employee receives federal subsidies for purchasing insurance. The actual employer mandate was removed by the Senate.
  • Ban undocumented immigrants from purchasing insurance with their own money in the new exchanges.
  • Ban the use of federal funds to pay for abortion in the exchange, which experts say will eventually eliminate even private insurance coverage for abortion.

Additional summaries of the bill can be found here and here. Many more documents, including the full bill and summaries, can be found at the Speaker of the House’s website.

I want to be overjoyed by the passage of this bill. It’s so much less than we started this process with, but it is still a major expansion of health insurance coverage. In many ways it’s a big human rights win. But the severe restriction of abortion access and exclusion of undocumented immigrants from coverage are unconscionable. The limits on abortion access go back on a commitment by democrats that this legislation would maintain the (horrible) “status quo” on abortion coverage. This legislation is about giving people in the U.S. access to what should be a basic, fundamental human right: health care. I am so glad that 32 million people who are uninsured will be able to receive care. But abortion is health care. Women who need abortions and undocumented immigrants are just as deserving of basic human rights as anyone else. This legislation fails to recognize these facts, so I have a very hard time celebrating the aspects of the bill that are clearly a victory.

What are your thoughts on the bill passed by the House?

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35 Comments

  1. JoanOfArc
    Posted March 22, 2010 at 9:17 am | Permalink

    I’m disappointed about the abortion thing, but thrilled about the coverage until 26 thing! It means I will be covered for the next 2 years, for most of my graduate school education. And the fact insurance companies will not be able to deny me coverage because of my high school health problems is a great relief. The bill is not perfect. But it is a foot in the door and better than nothing.

  2. Brianna G
    Posted March 22, 2010 at 9:25 am | Permalink

    Well, at least if I’m not $100,000 in debt from a car crash or cancer, the $300 I need to have an abortion is a little more manageable.
    This is not done. They’ll add to it and change it. If we focus on the negative, those who opposed the bill will easily claim that it is a failure and strongly disliked by the public; by focusing on the successes of the bill and celebrating it we encourage our lawmakers to expand it and refine it.
    I chose to say yay! to the bill, and follow it with, “now let’s get abortion coverage.” Or, “now let’s get coverage for immigrants.” To do otherwise would be like saying, “Well, they allowed women to vote, but we don’t have protection from sexual harassment, so I struggle to celebrate my voting rights.” Or “They decriminalized sodomy, but homosexuals can’t marry or adopt children, so I have trouble celebrating that victory.”

  3. SamLL
    Posted March 22, 2010 at 10:39 am | Permalink

    There are subsidies to help purchase insurance through the exchange for those who make between 100 and 400 percent of the federal poverty level.
    I am confused by this statement. Did you mean between 0 and 400 percent, or is there some other procedure for those who are at and below the poverty level?

  4. hindeviola
    Posted March 22, 2010 at 10:42 am | Permalink

    I am in a similar situation: just finishing my undergrad, was looking forward to a year of no insurance before grad school, but now am more optimistic. My question: does the provision that makes insurance companies keep us on our parents’ insurance go into effect immediately, in 6 months, or in 2014? I ask this because this NY Times article seems to indicate 6 months, and would that mean we would be uninsured for 4 months this summer? (Meaning our insurance would drop us when we graduate and then have to pick us up in September again when six months have passed). That seems sort of weird to me…
    The article:
    http://www.nytimes.com/interactive/2010/03/21/us/health-care-reform.html
    The passage I’m referring to:
    “Within six months, the plans will have to stop some practices, like setting lifetime limits on coverage and canceling policy holders who get sick. They will also have to allow children to stay on their parents’ policies through age 26 and cover children with pre-existing conditions, but can still deny adults with medical problems until 2014.”
    Any experts out there who could clear this up?

  5. Tracey T
    Posted March 22, 2010 at 10:46 am | Permalink

    My big problem with this bill is that I feel it actually limits what we can change in the future. The country is unlikely to be receptive to more overhauls in the future that expand government intervention after what was suppose to be a grand overhaul like this one.
    Also, for what the bill accomplishes it is being tauted as way to big an achievement and could have been accomplished a lot quicker and with less grandstanding (especially given that the Dems ended up conceding to almost all the conservative demands). The bill is good, except for fining people for not having healthcare but refusing to have a public option/universal, but it is far from complete overhaul and shouldn’t be tauted as such. I hope they change the poverty level or I may be one of the ones receiving a fine I can’t afford to pay.
    In addition, the bill is too costly for what it accomplishes and there may be some redundancy in the bill that could be cut to save money but likely want be because of grandstanding (continuation of SCHIP). What the bill does do is pretty great, especially for those with pre-existing conditions, but I still think the way it has been handled purposely pushes back the fight for reform.
    Abortion coverage is the least of why I dislike the process that has led to this bill and what it likely means.

  6. Em
    Posted March 22, 2010 at 11:02 am | Permalink

    “I want to be overjoyed with the passage of this bill.” Exactly. I am so, so glad that people who need healthcare coverage will receive it in some form – as has been stated, that’s so much better than nothing. Also, I am pleased that I can stay on my mom’s healthcare until I’m 26 and almost out of grad school – nice perk. But my heart’s just…sad because of the lack of abortion coverage.
    Brianna G – your solution is wonderful, for me, at least. I’ll celebrate now and keep fighting for the abortion coverage all women deserve.

  7. uberhausfrau
    Posted March 22, 2010 at 11:13 am | Permalink

    yep. my insurance had “abortion coverage” however, it did not have a list of abortion providers – neither clinics, nor ob/gyns who would do the procedure. i was told i would just have to call every doctor on my list. after 10 shady-feeling calls, and all being directed to planned parenthood, who i was told didnt take my insurance, i just gave up, found a local clinic and shelled the money out of pocket. when i found out the doctor who performed my abortion was actually one of the first doctors on the list (who i avoided calling as i was trying to find a female ob/gyn) i tried submitting a claim, but the clinic didnt using the coding needed to get proper reimbursement. so the abortion coverage im technically paying for was useless.
    im in texas, ymmv.

  8. Chelsa
    Posted March 22, 2010 at 11:36 am | Permalink

    Some thoughts from a Canadian:
    -Fines for not buying insurance? Ouch. I don’t understand that if the gov’t is “forcing” people to buy health insurance, why it can’t just be a part of the taxes people pay.
    -It sucks that reproductive health care got thrown under the bus. But I think it’s fair to note that even in Canada, where abortion is only vehmently opposed by less than 20% of the population, abortion isn’t covered by health care plans unless you buy a supplementary plan (which, many people can’t afford)… or you’re lucky enough to live in one of 2 provinces that cover it through provincial funding.
    -SO HAPPY that pre-exisiting conditions are not a barrier to access. That maternity coverage is required. That women can’t be charged double just for having a uterus.
    -Still blows my mind that people are afraid of “nationalizing health care”. Like, I understand, some people love the free market… but companies wanting to make a bottom line should NEVER be involved in providing basic services to people, because profits come before service pretty much all the time, and only the people suffer. Health care needs to be seen as BASIC human services! I don’t understand why every keeps clinging to the notion that it be a profit-based industry. I’m not saying it shouldn’t make money or be efficient. But obviously, it’s failing a good chunk of Americans to do it the way it’s being done.

  9. Lydia
    Posted March 22, 2010 at 11:51 am | Permalink

    I agree with you. The abortion restrictions frustrate me to no end and the bill is not everything I wanted but I can’t help but feel elated at its passing. We were never going to get everything we wanted at once and we were never not going to have swallow a couple bitter pills. The way I’m trying to look at it is that executive orders come and go but this bill will redefine the status quo in far-reaching ways. I really do think that once people realize what benefits and rights they now have–like not being denied based on pre-existing conditions–they’ll never want to give them up again. They’ll also see that Obama signing this bill isn’t unleashing the four horsemen of the apocalypse upon the land. We have a long ways to go but now the ball is finally rolling and that is great news.

  10. Lydia
    Posted March 22, 2010 at 11:57 am | Permalink

    I think the opposite. I think once people realize that the world didn’t end as a result of this bill and that it actually does improve their lives the might be MORE receptive to future changes. It might be a lot easier to make a case for the public option once the reforms of this bill are taken for granted because it will be next logical step. History does not support the idea that you’ve got one shot at making major legislative changes and then you’ve cashed on all your popular support chips. Both Medicare and the Civil Rights Act were incomplete when they were first passed. This isn’t over.

  11. nikki#2
    Posted March 22, 2010 at 12:03 pm | Permalink

    People keep talking abot how this bill excludes undocumented immigrants, but don’t insurance companies already do that? I don’t see how it could be legal to give insurance to people who are not in the country legally.

  12. JoanOfArc
    Posted March 22, 2010 at 12:32 pm | Permalink

    It happens now. Not later.

  13. Phenicks
    Posted March 22, 2010 at 12:39 pm | Permalink

    The cost of an abortion is so much cheaper than the cost of maternity care which is now required so I don’t see the sense in insurance companies forcing the cost of maternity care AND not being able to drop you because of it. That makes no sense from a cost effective standpoint in business at all.

  14. Brianna G
    Posted March 22, 2010 at 1:09 pm | Permalink

    Well, you can, because BCBS could technically insure a Canadian if the Canadian wanted them to. Insurance companies would be able to– and would– cover illegal immigrants, except the cost is usually prohibitive for them. However, it does make some amount of sense that the government wouldn’t use tax money to cover anyone who wasn’t paying taxes, legal or not.
    Of course, the cost of illegal immigrants in our healthcare system right now justifies it anyway.

  15. Brianna G
    Posted March 22, 2010 at 1:11 pm | Permalink

    It’s a PR thing, and good PR makes a good business model.

  16. ecarden
    Posted March 22, 2010 at 1:13 pm | Permalink

    I believe Medicaid covers those who are under the (ridiculously low) poverty level.

  17. supremepizza
    Posted March 22, 2010 at 1:23 pm | Permalink

    Rome wasn’t built in a day…Neither was Social Security, Medicare, Medicaid/SCHIP, the Civil Rights Act, or ENDA. This last one is a good example. Just because ENDA doesn’t currently protect LGBT status doesn’t mean we should scrap the protections it does have. It simply means we should expand it.
    All of these Progressive laws started out much, much smaller than they are now. Governing is as much about starting progress as it is about finishing it.

  18. supremepizza
    Posted March 22, 2010 at 1:34 pm | Permalink

    My best friend and I, who’s Canadian, go back and forth over this all the time. As happy I am that this passed, there’s no small amount of trepidation that the good coverage that I already have through my employer will suffer as a result. Perhaps greatly so. Just take the “common sense” idea of forcing employers to cover children up to 26yrs of age. How is this paid for? Health insurers will raise their premiums to pay for this increased cost. Employers in turn will do one of two things: Either pass that on to employees, slash their coverage (already happening), or drop coverage altogether (happening more & more now). And this is about the least controversial aspect of the bill.
    As for “companies should NEVER be involved in providing basic services to people”, in light of the blows to abortion rights we just took, you can just as easily make the argument that ” craven politicians should NEVER be involved in providing basic services to people”…
    As for Canada after being hit by a car, my friend was denied an X-Ray three times before she finally got one. If you have insurance in America that would never happen.

  19. Grace
    Posted March 22, 2010 at 1:41 pm | Permalink

    Really? I saw that the age 26 thing didn’t take effect until September 1 (which sucks, because it means I could only get back on my parents’ insurance for like 4 months), I hope I’m wrong!

  20. Arvilla
    Posted March 22, 2010 at 1:42 pm | Permalink

    Huh? Why would someone’s immigration status impact whether you can sell your product to them or not?

  21. bifemmefatale
    Posted March 22, 2010 at 1:47 pm | Permalink

    For those below the poverty level, healthcare is free through Medicaid.

  22. bifemmefatale
    Posted March 22, 2010 at 1:55 pm | Permalink

    It’s perfectly legal for undocumented workers to purchase insurance, just like they can purchase anything else. It’s very common for illegal immigrants in my area to have no driver’s license but they do have car insurance.

  23. Auriane
    Posted March 22, 2010 at 2:11 pm | Permalink

    For nearly 15 years I have donated to Planned Parenthood and to other womens’ clinics, and I’ll continue doing it for decades to come. I encourage everyone here to do the same, and to tell supportive friends and family to as well. If the system doesn’t readily include you, and you can’t change it as soon as you’d like, then go around it. All it takes is $5, $10, or $20 per month from every single supporter of womens’ health.

  24. hindeviola
    Posted March 22, 2010 at 2:14 pm | Permalink

    How do you know this, though?

  25. Comrade Kevin
    Posted March 22, 2010 at 2:19 pm | Permalink

    As someone who has to rely on Medicaid, I am glad that the funding will finally be available to make the system work more efficiently. As it stands right now, I deal with a nightmare of red tape, inefficiency, cost cutting, lack of adequate coverage, and understaffing.
    People who are afraid of reform have no real reason to be, since they’ll never have to rely on the existing system. It’s the poor, and disproportionately minorities who really get shafted under the current system. One can really tell a lot about a society based on the way it treats those in poverty.

  26. makomk
    Posted March 22, 2010 at 2:31 pm | Permalink

    At least one version of the bill prohibited taking this cost saving into account when calculating the cost of offering abortion coverage.

  27. Suzann
    Posted March 22, 2010 at 2:55 pm | Permalink

    If employers have difficulty with the higher health insurance premiums they can just defer/deny raises ( like they did at the end of 2009) or use fewer employees and more freelancers. (Freelancers don’t get benefits of any sort. They are their own business.)
    One way or the other the cost will be absorbed – the way all other costs are.
    The upside is that now there will be no insurance-based reason to avoid hiring older/sicker/parental/otherwise expensive to insure people as apparently now they will cost no more than anyone else.

  28. Tracey T
    Posted March 22, 2010 at 7:04 pm | Permalink

    Funny, the same type of people where making the argument that we shouldn’t fight for abortion coverage in the bill because it was important that it pass. When I pointed out how the same type of people had been willing to initially let the public option slide for the same reason, they responded “oh, but the public option is vital.” There is no public option. Just another example of weak progressives willing to run at any sign of resistance.
    If the idea was to lay the building blocks for reform then there would have been no need to talk about the bill as a complete overhaul. Things such as a ban on discriminating against pre-existing conditions could have been done in pieces and in a way that didn’t completely drain the country’s energy. This bill wasn’t about building blocks, it was about complete overhaul.
    I do not believe this bill can be compared to Medicaid in the least. The people who instituted Medicaid had a goal in mind and they achieved their goal. They didn’t promise Medicaid as it is now and then chip away at the bill. Instead, they instituted Medicaid and over time others added to it. That is how you lay the foundation. This bill promised complete overhaul, then after a lengthy drawn out battle it was chipped down to a shadow of what it was suppose to be.
    I think Dems cared more about their legacy than laying a foundation for reform. When they saw reform wasn’t going to happen they could have scrapped the bill and laid the foundation brick by brick, instead they continued and instituted this so they can pat themselves on the back about what a great job they’ve done. This bill does some good things, but it also has downs and probably isn’t as fiscally responsible as needed.
    And I hope I’m wrong, but the way progressives operate is that any one who starts lobbying for further reforms is going to be shot down and accused of being “too radical” and “wanting to much.” I believe that based on the way this was handled Dems and progressives cared more about labeling something health care reform than actually reforming health care or laying the foundation to do so. The way this debate was handled was an absolute farce.

  29. Marj
    Posted March 22, 2010 at 7:53 pm | Permalink

    I’m semi with you on point one–we’ll have to see how the exchanges pan out. Hopefully, this reform will help keep prices down, so that people can actually afford it. If people can’t afford insurance, then having a fine isn’t going to do any good.
    However, if we’re requiring people to buy health insurance, there needs to be some penalty for ‘opting out’, or the law is meaningless.
    Personally, I’m partly just happy this is finally over (kind of). If nothing else, I’m tired of hearing “Look at how things are in Canada”. All else being equal, I’ll take the Canadian system over what I have now.

  30. gypsy
    Posted March 22, 2010 at 9:15 pm | Permalink

    I’m cautiously optimistic.
    On one hand, I’m REALLY happy that they can’t deny/overcharge me anymore for having thyroid disease. It’s cheap and easy to treat, but I’m tired of having to choose between paying out of pocket for medicine and bloodwork I NEED or getting insurance. (Can’t afford both..)
    On the other hand, none of this bill will help me for 3 more years. That’s a long time, plenty of time for people to change things and mess them up. I’m also edgy about the requriement that my employer cover me… they’ve pretty much said in the past they’d “eliminate my position” rather than pay for benefits… I know my immediate bosses will go to bat for me, but they’re up against the state that I work for….
    A side note on Medicade – my state ONLY covers you if you are poor and over 65, or poor and pregnant or poor and have kids. That’s it. I’ve tried, and because I don’t meet any of those criteria, I’ve been denied…the individual states have a say in who can get Medicade…

  31. dondo.myopenid.com
    Posted March 22, 2010 at 9:52 pm | Permalink

    I think digby put it best: Democratic politicians believe you can’t pass legislation without punching the liberal hippies a couple times first. The abortion and immigrant clauses are the necessary hippie beating required to attempt satisfy the blood thirst of the far right. Never gets them anything, so I don’t understand it, but it definitely seems to explain a lot of what happens in Washington.
    That sad, i fully agree with Brianna G above. This is a huge victory for people with a conscience. It wasn’t what I hoped for, but it’s far, far better than I expected.
    Finally, and the real reason I’m commenting — I wanted to quickly add that the bill Alan Grayson introduced (www.wewantmedicare.com) creates a very simple, easy to understand path to a Federal health insurance program (unfortunately and inadequately popularized as a “public option”).
    “Let me buy insurance from Medicare. At cost.”
    Go sign the petition. I can’t imagine it passing — but I couldn’t imagine this one passing either!

  32. Arvilla
    Posted March 22, 2010 at 11:29 pm | Permalink

    No, it doesn’t make sense. The bill prohibits illegal immigrants from purchasing insurance through the exchanges the bill has allowed for. That means, even using their own money, receiving no support from the government, they cannot buy in.
    Additionally, the idea that illegal immigrants don’t pay taxes is a complete myth. They do. If they work, they have a payroll tax excised. Not to mention the sales and property taxes they pay just by virtue of living here and participating in our consumer economy.

  33. SamLL
    Posted March 23, 2010 at 9:59 am | Permalink

    Thank you to you both for the information!

  34. like_shipwrecks
    Posted March 23, 2010 at 5:22 pm | Permalink

    I was dropped from my parents insurrance when I turned 21. I’m 22 now, and I’m wondering if anyone knows if my coverage under my parents insurance will kick back in with this new bill. I’ve searched the internet and have come up empty handed…

  35. katicabogar
    Posted March 24, 2010 at 2:03 am | Permalink

    here in hungary we have an obligatory health allowance law. 27% of our supergross wages goes to the national health found, so everybody gets healthcare.
    BUT.
    i only get healthcare, where my home is. however, i work 200 km. away from my actual home, and i am keeping up a rented flat, where i do not have any home, as the owner would have to pay taxes after my rent. so i have to choose, if i want to get healthcare, or get work, as at my home is high unemployment.
    abortion.
    in hungary, abortion is covered by the healthcare in case of rape, incest, sickness of the mother or the fetus. right now, we had the “zsanett”-trial, where 2 policemen raped zsanett, while the 3 other policemen watching. this gang-rape trial found the policemen not guilty (police has shunned all evidence), and zsanett has to face prison for false accusation. regarding this, as incest-rape abortion has to be covered by police report (which means, that you have to risk prison for false accusation in case of not enough, or shunned evidence), that means that even in the case of rape, or incest you have to pay for your abortion.
    however:
    i have never ever seen any men in hungary being lawfully forced to pay for their gonorrhea, syphilis, or any other kind of treatment, that was caused by their sexual drive, and would have been preventable by using condom. NEVER. EVER. i guess, it’s the same in the us. it is very double standard, that a man can have sex, unprotected sex, and get socially covered treatment for the unwanted consequences, and women can have sex, uprotected sex, or sex against their will, and have to pay for the unwanted consequences.

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