It's over: Congress completes work on health overhaul with approval of 'fixes'

After more than a year of political wrangling, Congress finished its work on health care reform Thursday night when the House passed a Senate-changed bill of fixes to the new law.

The Associated Press reports that it was a busy day as both the Senate and House took up the health reconciliation bill, which makes changes to the overhaul law that President Barack Obama signed Tuesday. The Senate passed the reconciliation bill 56-43 Thursday afternoon. "The House added its approval a few hours later, 220-207, clearing the way for Obama's signature on the second of two bills that marked the culmination of what the president called 'a year of debate and a century of trying' to ensure coverage for nearly all in a nation where millions lack it. Obama is expected to sign the legislation early next week." The bill, which costs $938 billion, would reduce the federal deficit by $143 billion over a decade, according to the Congressional Budget Office. "The second of the two bills also presented Obama with another victory, stripping banks and other private lenders of their ability to originate student loans in favor of a system of direct government lending" (Espo, 3/25).

The Hill reports that Sen. Charles Schumer, D-N.Y., vice chairman of the Democratic Conference, said Democrats didn't expect to have so much support in the Senate. "Fifty-six is more votes than we thought we had," he told The Hill (Young and Hooper, 3/25).

The Washington Post: "Lawmakers are leaving Washington on a rancorous note. Members of both parties seethed over the political response to threats of violence against a number of House Democrats, and senators belittled one another during amendment votes that lasted nearly 21 straight hours." During debate in the Senate, Democrats defeated 41 amendment votes but were unsuccessful in passing the reconciliation bill unchanged after procedural challenges from Republicans changed 20 words in the bill, which meant it had to pass again in the House. "The 'fixes' bill adopted Thursday would alter major provisions of the health law. Uninsured people would receive more-generous subsidies to buy coverage; federal funding of Medicaid would increase; and seniors would see the 'doughnut hole' coverage gap disappear in their Medicare prescription drug policies. The amendments also speed up enactment of new insurance restrictions that will particularly benefit people with chronic medical conditions. And in six months, uninsured adults younger than 26 may be added to their parents' health plans" (Murray, 3/26).

The New York Times: "The bill also delays the start of a new tax on high-cost employer-sponsored insurance policies to 2018 and raises the thresholds at which policies are hit by the tax, reflecting a deal struck by the White House and organized labor leaders.…Many of the changes were intended to address the concerns of House Democrats, as well as to bridge differences between the original House and Senate bills and to incorporate additional provisions sought by Mr. Obama" (Herszenhorn and Pear, 3/25).

Politico: "But Republicans warned that Obama had overreached in his effort to pass the bill, which employed fast-track rules to get around the possibility of a Republican filibuster. 'The American people are asking, where are the jobs, but as we see today, the issue of government-run health will continue to be the focus on this body,' said House Republican leader John Boehner of Ohio. 'We're going to be back here fixing the flaws in this very flawed bill.' … In the Senate, three moderate Democrats voted against the reconciliation bill — Nebraska's Ben Nelson and the two senators from Arkansas, Mark Pryor and Blanche Lincoln. Lincoln faces a tough reelection fight this fall. Republican Johnny Isakson of Georgia is ill and wasn't in the chamber. No Republicans voted for the reconciliation bill in the House or the Senate, after just one Republican, (Rep.) Joseph Cao of Louisiana, voted in November for the underlying health reform law. Sen. John McCain (R-Ariz.) criticized the measure until the end, saying, 'It is the most unsavory sausage-making, Chicago-style bill I have ever seen'" (Budoff Brown, 3/26).

Roll Call: "Despite their ability to find two small provisions to strike, Republicans gave grudging respect to Democrats for their efforts to prevent the bill from falling victim to points of order. 'They did a pretty good job of scrubbing the reconciliation bill,' Sen. Richard Burr (R-N.C.) said Wednesday afternoon. Senate Budget Chairman Kent Conrad (D-N.D.) also seemed to compliment Republicans for their tenacity in looking for points of order that would force the House to revote" (Newmyer and Pierce, 3/25).

CongressDaily reports on the Democrats who voted no in the Senate, and why they voted against their party. "Nelson objected to the student loan language, and Lincoln did not support using reconciliation. Pryor objected to the substance, mainly, he said, that Arkansas' Medicaid costs for enrolling users will double, wealthy Americans will be taxed for unearned income, and employers who do not offer health insurance will face significantly larger fees. 'As more and more details of the package were released, I spent considerable time weighing the benefits and drawbacks to Arkansas,' said Pryor, who voted for the main overhaul bill. 'In the end, I believe this legislation is a step we don't need to take'" (Edney, 3/26).

Los Angeles Times: "Together, the reconciliation package and the health care legislation are expected to cover an additional 32 million Americans by 2019, boosting the percentage of non-elderly Americans with insurance to 94% from 83%, according to estimates by the nonpartisan Congressional Budget Office. The legislation also establishes a broad new framework of government regulation to prevent insurance companies from denying coverage to people who are sick and to require insurers to provide a minimum level of benefits" (Levey, 3/26).

USA Today recounts eight key moments in the struggle over the health overhaul (Fritze, Page and Wolf, 3/26).