News & Events

Historic OK on health

House approves overhaul, sends measure to president; Republicans battle to the end

By Matt Viser and Susan Milligan, Globe Staff  |  March 22, 2010

WASHINGTON — The House last night overcame vociferous opposition and approved the largest expansion of health care coverage in four decades, after President Obama and Democratic leaders capped a frenzied day of negotiations and locked down a narrow majority to win a prized domestic policy goal.

Following a year of debate — and a generation of failed political efforts on similar overhauls — the White House helped broker a last-minute deal with abortion opponents to complete House passage and send, by a 219-to-212 vote, a sweeping overhaul bill to the president for his signature. The vote was met with cheers and chants of “Yes we did! Yes we did!’’ by representatives on the House floor.

Lawmakers in short order followed that with passage of compromise fixes that will be sent to the Senate for a debate starting this week. But with the first vote, Congress had already passed the point of no return, as the bulk of the historic legislation is now sitting on Obama’s desk.

Democrats were jubilant.

“Senator Kennedy wrote that access to health care was the great unfinished business of our society,’’ House Speaker Nancy Pelosi said as she wrapped up the emotional debate. “That is, until today.’’

No Republicans voted for the legislation. Representative Stephen F. Lynch, a South Boston Democrat, was one of 34 Democrats — and the only member of the Massachusetts delegation — who voted against the overall bill. But he then cast an “aye’’ in support of the compromise repairs that are going to the Senate.

“Once it’s passed, it’s my job to try to improve it,’’ Lynch said. “I think it did’’ make the Senate bill better.

Republicans throughout the day tried to use up as much time as they could, pushing debate late into the evening as they promised that Democrats would lose their seats in the upcoming congressional elections — and pledging that the bill could be overturned.

Minutes after the bill was approved, Senator Jim Demint, a South Carolina Republican, said he would file legislation this week to repeal it.

“Shame on us,’’ House Minority Leader John Boehner said on the House floor. “Shame on this body. Shame on each and every one of you who substitutes your will and your desires above those of your fellow countrymen.’’

But the victory was a major show of force by Obama and Pelosi, who was able to deliver the votes on a divisive and controversial issue.

Requiring Americans to obtain health insurance, expanding Medicaid, and providing subsidies for others who can’t afford insurance is expected to bring coverage to 32 million additional people over the next decade. It would be the biggest change to the US health care system since Medicaid and Medicare were approved in 1965.

It is not the single-payer government option that many Democrats have sought for years, but it is a big new social service program nonetheless, closely modeled on the pioneering Massachusetts health care overhaul approved by Beacon Hill in 2006.

House Democrats gained momentum in recent days, but the votes were not completely secured until leaders orchestrated a deal yesterday afternoon with a small group of antiabortion Democrats to secure their support. Under the agreement, Obama pledged that he would sign an executive order reaffirming that no federal funds can be used to cover abortions.

“We proved that we are still a people capable of doing big things,’’ the president said a short while after House passage, speaking from the White House in televised remarks. “We proved that this government — a government of the people and by the people — still works for the people.’’

Tensions remained high as the day unfolded, with a Capitol that is normally sleepy on a Sunday mobbed with scurrying lawmakers, demonstrators, and an unusually heavy police presence. A long line of people snaked around the hallways on the third floor of the building, hoping to get a seat in the House visitors’ gallery.

In one disruptive episode, two hecklers in the House gallery shouted down into the chamber, before the formal debate on the bill began. “The people said no!’’ one yelled. “You took an oath of office.’’

Some of the Republican lawmakers stood and cheered the protesters, who were from Massachusetts, stunning Democrats who said they had never seen lawmakers egg on people violating the rules from the visitors’ section.

“Those clowns are out there encouraging violation of the law and making the job of these guys up there harder,’’ Representative Barney Frank, Democrat of Newton, told reporters, referring to his House GOP colleagues and the Capitol police. “It’s really disgraceful.’’

Outside, a couple hundred demonstrators waved American flags and signs calling for the defeat of the package and shouting, “Kill the bill! Kill the bill!’’

Obama will sign the Senate version of the bill into law sometime early this week, while the fixes will go to the Senate. Because they are using a tactic called “budget reconciliation’’ to pass the changes, Democrats can avoid a Republican filibuster in the Senate and need only 51 votes for approval. Republicans are expected to deploy a variety of procedural weapons to slow down the process.

“Americans have sent a message to Washington for the past year, including with my election, that they are opposed to this multitrillion dollar health care bill,’’ Senator Scott Brown said last night in a statement.

Brown ran against the health care legislation, and his election in January to fill Kennedy’s seat threw the initiative into doubt. “The president and others have forced through, with an arrogance of power, a health care bill complete with sweetheart deals that our nation doesn’t want, and can’t afford,’’ Brown said. “The American people deserve better.’’

Still, passage of a health care package that Democrats have sought over the last year would advance the life’s work of Kennedy, who had long advocated for expanding coverage to all Americans and had laid much of the groundwork for the debate.

“As Ted Kennedy said, across the decades, in the best and the most discouraging hours, health care was the cause of his life,’’ Vicki Kennedy, wife of the late senator, said last night in a statement. “Tonight that cause becomes more than a dream, it becomes America’s commitment. . . . Ted knew we would get here, and all of us who loved him and shared his hopes for America are deeply grateful.’’

The coverage expansion, including subsidies for people who previously could not afford insurance, is expected to cost $940 billion over a decade, according to the nonpartisan Congressional Budget Office. The subsidized insurance would be sold through exchanges operated by individual states, a system that is the same as the Massachusetts model.

The nearly $1 trillion in costs would be more than offset by new taxes and $500 billion in cuts to Medicare, according to projections. The Congressional Budget Office’s estimate that the deficit would be reduced by $138 billion helped sell the measure to many Democrats, although Republicans have disputed some of the estimates.

Under the proposed new law, insurers would no longer be permitted to deny coverage based on preexisting conditions, and children would be able to stay on their parents’ health care plans until they are 26.

The legislation also includes significant changes to education grants, providing $36 billion in new financing for Pell grants to poor students over the next 10 years. The additional grant funds would be paid for by ending subsidies for private banks and instead having the federal government make the loans directly.

The goal of expanding coverage to nearly all Americans has proved elusive for past presidents dating to Theodore Roosevelt, who campaigned on the issue nearly a century ago.

Republicans argued that the Democrats are making a political miscalculation that will help the GOP retake the House and Senate in 2010, and potentially the White House in 2012.

But Democrats are betting that they will be able to persuade the public of the benefits of expanding health coverage to millions and rolling back many industry practices that anger consumers.

Globe correspondent Jeremy Herb contributed to this report. Matt Viser can be reached at