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Health reform passes

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By CARL HULSE and ROBERT PEAR

The New York Times

Published: November 8, 2009

Updated: 11/08/2009 12:33 am

WASHINGTON - Handing President Barack Obama a hard-fought victory, the House narrowly approved a sweeping overhaul of the nation's health care system Saturday, advancing legislation that the Democrats said could be their defining social policy achievement.

After a daylong clash with Republicans over what has been a Democratic goal for decades, lawmakers voted 220-215 to approve a plan that would cost $1.1 trillion over 10 years and that Democrats said would provide relief to Americans struggling to buy or hold on to health insurance.

"This is our moment to revolutionize health care in this country," said Rep. George Miller, D-Calif., one of the chief architects of the bill.

Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage, a wrenching compromise for the numerous abortion-rights advocates in their ranks. They hope to make changes to that amendment during negotiations with the Senate, which will become the main battleground in the health care fight as Democrats there ready their own bill for what is likely to be extensive floor debate.

Democrats say the measure - paid for through new fees and taxes, along with cuts in Medicare - would extend coverage to 36 million people now without insurance and would create a government health insurance program. It would end insurance company practices such as not covering pre-existing conditions or dropping people when they become ill.

The successful vote came after Obama traveled to Capitol Hill just before noon Saturday to make a personal appeal for lawmakers to "answer the call of history" and support the bill.

Only one Republican, Rep. Anh Cao of Louisiana, voted for the bill, and 39 Democrats opposed it. The House also defeated the Republicans' more modest plan, whose authors said it was a more common-sense and fiscally responsible approach.

"Today's may be a tough vote, but it was in 1935 when we passed Social Security," said Rep. John Dingell, Democrat of Michigan and the dean of the House, as the debate drew to a close late Saturday.

Some Democrats said they voted for the legislation so they could seek improvements in it. "This bill will get better in the Senate," said Rep. Jim Cooper, a Tennessee Democrat who has been outspokenly critical of some provisions of the bill but decided to support it. "If we kill it here, it won't have a chance to get better."

House approval moves the bill well beyond the health care overhaul attempted by President Bill Clinton in 1993. Lawmakers credited Obama with converting a final few holdouts during his appearance at a closed-door meeting with Democrats just hours before the vote.

A handful of remaining undecided lawmakers swung behind the proposal. And slightly more than 30 House Democrats were publicly lined up in opposition - not enough to deny the party a victory on one of the president's top domestic initiatives, unless their ranks swelled by 10.

Another turning point was the decision by Speaker Nancy Pelosi late Friday night to allow anti-abortion Democrats to try to tighten restrictions on coverage for the procedure under any insurance plan that receives federal money. That concession eased a threat by some Democrats to abandon the bill, but also left Democrats who support abortion rights facing a choice between backing a provision they bitterly opposed or scuttling the bill. The new abortion controls were added to the measure on a vote of 240-194.

Obama made a rare weekend appearance on Capitol Hill as part of an all-out effort to rally Democrats to support the biggest health care legislation since the creation of Medicare for the elderly four decades ago.

During the private meeting with Democrats in the Cannon Caucus Room, the president acknowledged the political difficulty of supporting major legislation in the face of unanimous Republican opposition and tough criticism from conservatives.

But, those present said, he urged them on, saying, "When I sign this in the Rose Garden, each and every one of you will be able to look back and say, 'This was my finest moment in politics.'"

Republicans said the measure was too costly and would end up burdening the nation for decades to come. Some Democrats expressed the same view.

"This bill is a wrecking ball to the entire economy," said Rep. Jack Kingston, R-Ga. "We need targeted specific reforms to help people who have fallen through the health care cracks."

But Democrats said that Republicans were intent on protecting the status quo in health care and that the new Democratic approach would vastly improve the ability of Americans to gain affordable health insurance.

The wall of Republican opposition Saturday gave Democrats little room to maneuver, and they were working to corral as many party members as they could. But the preliminary approval to clear the way for the debate came on a vote of 242-192, suggesting that Democrats had a victory within reach.

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