News & Events

Democrats offer $940b health bill for final test

Obama delays Asia trip for Sunday’s tally

By Susan Milligan, Globe Staff  |  March 19, 2010

WASHINGTON — House Democrats yesterday unveiled a $940 billion compromise health care package they said would reduce the deficit and vastly expand health insurance coverage, continuing a march toward what leaders predicted will be final House passage Sunday of a sweeping overhaul that has bitterly divided both Congress and the public.

President Obama canceled his planned Sunday departure to Asia so he could be in town for what could be the historic House vote.

And while wavering lawmakers were still being lobbied feverishly by their colleagues and the White House, Democratic leaders said they were confident they will eke out the 216 yeas needed to approve the package.

“Every vote around here is a heavy lift,’’ said House Speaker Nancy Pelosi, Democrat of California. But after months of uncertainty, a clear sense of momentum took hold of the House proceedings, and Republicans were already anticipating a showdown in the Senate next week.

Pelosi said a new analysis by the nonpartisan Congressional Budget Office that the bill would reduce the deficit by $138 billion over the next decade would seal the deal for some undecided lawmakers. The analysis also said the measure would extend health insurance coverage to an additional 32 million Americans by 2019, meaning that 95 percent of Americans not already covered by Medicare would ultimately have health insurance.

Republicans in both chambers of Congress railed against the bill as too expensive.

“The president shouldn’t scrap his trip to Indonesia. He should scrap this bill and start over on a bill that Americans can embrace and that lawmakers from both parties will actually be proud to vote for,’’ Mitch McConnell of Kentucky, the Senate Republican leader, said on the Senate floor.

America’s Health Insurance Plans, an industry group, issued a statement against the bill. The Massachusetts Hospital Association, meanwhile, called for its passage, saying the bill “puts patients first.’’

The bill released yesterday would give Massachusetts a big boost in Medicaid assistance to help pay for insurance coverage for lower-income people, sending an additional $2 billion to the state over the next ten years.

The provision, which would compensate all states for covering more Medicaid patients, would send even more additional money to the Bay State than a Senate-approved “special deal’’ that Obama insisted be removed. The Senate deal would have granted Massachusetts $500 million over three years, with no guarantee of extra assistance after that.

“This is a huge deal,’’ Senator John F. Kerry said in an interview. “This is not a special deal for Massachusetts. What it is, is a fix that is going to take place across the country,’’ said Kerry, who has been negotiating with the White House and colleagues on the Medicaid issue throughout the process.

The House bill would include a tax on high-end, so-called Cadillac health insurance plans, but it raises the threshold to plans costing more than $10,200 a year for individuals and $27,500 for families. Pelosi said the new formula made it a “Platinum Rolls Royce tax.’’ It also would not begin until 2018. The AFL-CIO, which had fought the concept of taxing Cadillac plans for months, said yesterday that it supported the new plan.

About 8,600 of Massachusetts’ 6.2 million insured people would be subject to that tax, according to Representative Edward J. Markey, Democrat of Malden.

Starting in 2013, wealthier Americans (individuals earning more than $200,000 and couples with more than $250,000) would get hit with new taxes: a 3.8 percent Medicare tax on investment income and an additional .9 percent on existing Medicare taxes on wages.

Some other parts of the proposed overhaul, ones with appeal to voters, would start earlier.

The “doughnut hole’’ in Medicare prescription drug coverage would be gradually closed. Currently, Medicare covers prescription drug costs up to $2,700 a year and beyond $6,100, leaving a gap seniors must pay out of pocket. Nearly 81,000 Massachusetts seniors are affected by the doughnut hole, Markey said.

Six months after the law would take effect, insurance companies would be prohibited from denying children coverage based on preexisting conditions. The ban would apply to everyone starting in 2014.

Parents, meanwhile, would be allowed to keep their children on their family plans until the younger patients reach 26.

Employers would not be required to offer insurance to workers. But small businesses would get immediate tax credits to help pay for employee health coverage.

To approve the package, the House must pass the Senate bill many House Democrats dislike and the compromise “fixes’’ revealed yesterday, which are packaged in a so-called budget resolution measure. The package would then go to the Senate, which would need just a simple majority to pass it under a process called “reconciliation.’’ Senate debate would be limited to 20 hours, because budget resolutions cannot be filibustered.

House leaders are still deciding whether to ask their members to vote up or down on the Senate bill first, or approve it as part of a “self-executing rule’’ that deems the Senate bill passed as part of the package of compromise fixes.

Republicans have strongly objected to that possible tactic, calling it a sneaky parliamentary trick, and many Democrats on the fence are concerned about the appearance of the maneuver.

With the clock ticking down to a scheduled Sunday vote, Capitol Hill was enmeshed in frantic, emotional lobbying by supporters and opponents alike. Obama worked the phone and hosted fence-sitters at the White House, talking in person or on the phone to more than three dozen lawmakers this week.

But Pelosi has a proven record of pushing controversial measures such as climate change, financial regulation, and the stimulus package through the chamber.

“It’s the politics that have confused or scared people,’’ said Brian Higgins, a New York Democrat who plans to vote for the measure. “What is being lost here is the substance of the bill. The individual components of this bill have overwhelming support.’’