What’s next for health reform after the House passed their bill, H.R. 3962?

Originally published in MedPage Today

by Emily P. Walker, MedPage Today Washington Correspondent

The House of Representatives voted 220 to 215 to pass historic healthcare reform legislation late Saturday night, after 11 hours of debate before a packed gallery of spectators.

H.R. 3962 passed by a narrow margin: Democrats needed 218 votes to pass the bill and wound up with just two more than that, after 39 Democrats jumped ship and voted “Nay.” Only one Republican — Anh “Joseph” Cao from Louisiana voted for the measure.

Once the vote count hit 218, Democrats cheered loudly. Applause continued as the final votes trickled in during the few minutes that remained of the 15 allotted for the vote. When the clock ran down, the chamber erupted in elated applause, the hugging, kissing, and cheering abating only for the few minutes it took for Speaker of the House Nancy Pelosi to declare “The bill is passed!”

The $1.1 trillion bill would expand insurance coverage to an additional 38 million people over the next decade by requiring that almost all citizens have insurance and providing subsidies to those who can’t afford it. The measure also contains a public option that would allow doctors and hospitals to negotiate with the government over reimbursement rates for treating patients enrolled in the public plan.

The unusual Saturday session was characterized by hours of theatrically partisan debate, and crowds of spectators waited hours in line to get five-minute glimpses of the floor proceedings.

Democrats called attention to the historic nature of the vote.

“Leaders of every party and political philosophy as far back as Teddy Roosevelt have called for healthcare for the American people,” Pelosi said. “Today the call will be answered.”

Republicans repeatedly called the measure a “freedom-killing, job-killing bill” that would bankrupt the government for future generations and criminalize people who do not have insurance. Speakers used a number of props — including a baby and a pair of handcuffs — to drive home their points.

The final vote came just minutes after approval of a controversial abortion amendment. Sponsored by anti-abortion Democrats Bart Stupak of Michigan and Brad Ellsworth of Indiana, the amendment would bar the government from offering abortion in its public plan, and make it illegal for private insurers that participate in the exchange from providing abortion coverage, except in the case of rape, incest or when the woman’s health is in danger.

The amendment passed by a vote of 240 to 194, with support from 64 Democrats and all but one Republican — John Shadegg of Arizona, who cast a vote of “present.”

A 1977 law, known as the Hyde Amendment, already prevents use of federal money to fund abortions. Stupak said his amendment simply applied the Hyde amendment to H.R. 3962, but opponents said it would go much further. Not only would it mean the new public plan can’t pay for abortions, opponents charged, but none of the private insurance plans that participate in the exchange could provide abortions either because government money would pay for the creation of the exchange.

Low- and moderate-income women who receive government subsidies to purchase health insurance would not have coverage for elective abortions because they would be required to purchase insurance from the exchange.

“The amendment has no impact on individuals with a private plan who do not receive a subsidy,” Stupak explained.

Women in the public plan, or who have a plan through the exchange, could choose to buy a separate abortion-coverage plan using their own money, which Rep. Jan Schakowsky called “a ridiculous and unworkable approach since no woman plans an unplanned pregnancy.”

There was language in H.R. 3962 — authored by Rep. Lois Capps (D-Calif.), a nurse — that specified that if plans in the exchange wanted to provide abortion coverage, it would have to be funded through premiums paid by the individual, not government money. That language was an effort to placate anti-abortion members of Congress, but they said it didn’t go far enough.

Capps spoke out against the Stupak/Pitts amendment.

“It will be the only language in the entire legislation that restricts coverage of a legal medical procedure,” she said.

Stupak maintained that his amendment is just cementing current law.

“I am not writing a new federal abortion policy,” he said.

Abortion rights groups like NARAL and Planned Parenthood blasted the amendment, while the United States Conference of Catholic Bishop’s Organization (USCCBO) praised it.

The amendment would have to be approved in the Senate, and then survive conference before it becomes law.

The final version of the House bill lacked a doctor payment fix, but a separate bill that would replace the sustainable growth rate (SGR) formula is expected to come to a vote next week.

The bill passed by the House on Saturday would require businesses with payrolls above $500,000 to offer health insurance to their employees.

It would also make a number of changes to insurance company practices, including a prohibition against denying coverage because of pre-existing conditions, outlawing lifetime caps on coverage, and requiring governmental review of rate increases.

The measure would also:

* Establish an “Innovation Center” within CMS to “pursue additional payment and delivery systems reforms”
* Begin to close the Medicare “doughnut hole” for drug costs immediately, and eliminates it completely by 2019
* Establish grant programs to test alternatives to the tort system in medical malpractice cases
* Immediately create a high-risk insurance program for those who haven’t had insurance for several months, or who were denied a policy based on pre-existing conditions
* End the antitrust exemption afforded to insurance companies
* Allow young people to continue to receive coverage on their parents’ insurance through age 27

Republicans attempted to have their own version of a healthcare bill adopted as an amendment, but that measure failed by a vote of 176 to 258, with Rep. Timothy Johnson (R-Ill.), casting the lone Republican vote against the GOP plan.

During a procedural vote known as a “motion to recommit,” Republicans attempted to have the bill sent back to committee for members to add medical liability reform language to the legislation, but that motion was rejected.

The Senate has yet to vote on its version of a healthcare reform bill.

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