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The yearlong health reform fight comes to an end
March 31, 2010 -- On Tuesday, President Obama signed the second piece of his health care reform package into law.
What the second (so-called “reconciliation”) bill does
In addition to a number of minor and non-health related provisions, the reconciliation bill includes these significant adjustments to the Senate reform bill:
Past updates On Wednesday, the Senate debated the reconciliation bill, which takes only 51 – not 60 – votes to pass. In a late-night session, Senate Republicans found minor violations in two provisions of the health care bill. Now, lawmakers must remove these provisions, related to higher education, from the bill. Then the House must vote on the reconciliation bill again. Democrats say they expect the House to approve it quickly. Health reform passes Congress
Health reform enacted
March 24, 2010 -- Surrounded by a large, energetic crowd, President Obama signed the reform bill on Tuesday morning. A few hours later, the Senate began work on the reconciliation bill, which contains the House’s “fixes” to the bill the President signed.
Minor violations force another “fix-it” vote
However, no matter what happens during the reconciliation debate, the main bill has already become law. Find out more about how the new health reform law may affect Medicare Advantage.
March 23, 2010 -- After a long and sometimes contentious day of debate, at 10:45 p.m. Sunday night the House passed the Senate’s health reform bill (the “Senate bill.”) The vote was 219-212, with all Republicans and 34 Democrats voting no. Since this bill already passed the Senate on Christmas Eve, it became law when President Obama signed it this morning.
Less than an hour after the House passed the Senate bill, it passed a package of changes in the form of a budget reconciliation bill (the “reconciliation bill.”) That vote was 220-211.
Next steps
The reconciliation bill will now go to the Senate, and it’s hard to say if the process there will go fast or slow. Senate Majority Leader Harry Reid says he has the votes to move the reconciliation bill quickly, but Republicans may challenge whether some parts of it are appropriate for the reconciliation process, which only requires 51 Senate votes to pass. Regardless of which action the Senate takes on the recociliaton bill, the Senate bill is now law.
A closer look
The Senate bill would:
• Mandate everyone must have health insurance.
• Result in about 30 million additional people becoming insured.
• Subsidize coverage for people who can’t afford insurance – in part by increasing the number of people eligible for Medicaid.
• Raise money to pay for these changes through new fees and taxes, as well as cuts to the Medicare Advantage program.
• Change the payment formula for Medicare Advantage.
• Require health insurance companies to make coverage available to everyone, regardless of pre-existing conditions and health status. Also, insurance companies could not charge different rates based on gender or health.
If the Senate approves it, the reconciliation bill would adjust many of these provisions and when they would take effect, although the broad strokes of the Senate bill would remain the same.
Congress prepares for the final push
March 19, 2010 -- The U.S. House of Representatives is likely to vote on Sunday, March 22 on both the Senate health care reform package and a House reconciliation bill. The reconciliation bill could make major changes to the Senate package, including increasing the level of Medicare Advantage funding cuts to an estimated $132 billion over ten years. Assuming the House successfully passes both pieces of legislation and the President signs the Senate bill into law, the Senate will then consider the House's changes. Under reconciliation rules, only 51 Senate votes are required to pass legislation.
President kicks off health reform road trip
March 10, 2010 -- President Barack Obama is hitting the road to sell health reform to the American public, delivering what aides have called a "closing argument." On Monday, he pressed his case in a campaign-style stump speech at Arcadia University, outside Philadelphia.
The crowd there heard a familiar refrain. President Obama challenged health insurers, insisted that his health reform plan will control costs, and emphasized that it includes ideas from "across the political spectrum."
"We have debated health care in Washington for more than a year. Every proposal has been put on the table. Every argument has been made," Obama said. "What we've ended up with is a proposal that's somewhere in the middle, one that incorporates the best from Democrats and Republicans, the best ideas."
The president added, "I don't know how passing health care will play politically, but I do know that it's the right thing to do."
GOP rejects Obama's "closing argument"
Republicans were not on board. "President Obama's latest health care sales pitch is, just like all the others were, heavy on snake oil and light on the harsh reality Americans would face under his plan: higher taxes, reduced Medicare benefits, and lost jobs," House Minority Leader John Boehner of Ohio said in a statement.
The president's Pennsylvania appearance is part of a larger effort to mount what could be a final push for health reform. The president is scheduled to speak in St. Louis on Wednesday, and during his weekend radio and Internet address, he called on Congress to "schedule a final vote on reform." Read a transcript.
Time's running out for action on reform
The health care reform clock is ticking. Each passing day brings the 2010 mid-term election one day closer, and conventional wisdom says lawmakers are more likely to think about re-election and less likely to cast tough votes as Election Day comes into view.
At a briefing late last week, White House Press Secretary Robert Gibbs told reporters that the president would like to see the House vote on health reform by March 18, before he leaves on a scheduled trip overseas. House Majority Leader Steny Hoyer, D.-Maryland, has said he hopes a vote will happen before March 29, when Congress adjourns for its Easter break. Democrats are no doubt hoping to avoid a repeat of the August congressional recess, when contentious town hall meetings became a forum for health reform opponents.
First, Congressional Budget Office must analyze bill's cost
Before any vote, though, the president's proposal must be translated into legislative language, and the Congressional Budget Office (CBO) must analyze its cost impact. The current plan is for the House to first pass the same bill the Senate passed before Christmas. Then, the Senate and House would both pass a "sidecar" bill that tweaks the original bill through the controversial budget reconciliation process. Read more about reconciliation in this Q/A from USA TODAY.
Reportedly, House and Senate leaders are sending elements of the reconciliation bill to CBO and revising the draft bill in a piecemeal manner. That reconciliation bill would have to be introduced sometime this week in order to meet the administration's March 18 deadline for a House vote.
Democrats work to secure stray votes
Meantime, Democratic House leaders continue to count votes. They'll need at least 216 to pass the Senate's reform bill. But, few House members are willing to commit until they've seen the legislative language and CBO score. Many also want assurances that the Senate will follow-through with a reconciliation bill. One option under consideration is having 51 senators sign a letter pledging support.
President Obama also held two meetings late last week with key House Democrats -- one with liberals and the other with moderates -- in an effort to secure votes. Rep. Raul Grijalva, D-Ariz., said the president told the liberal Democrats that although a public option would never pass the Senate now, he is "personally committed" to pursuing it later.
At the same time, anti-abortion Democrats still have reservations about the Senate bill, which does not go as far to block federal funding of abortion. "I think given the vote dynamic, abortion may be the decisive issue," said Rep. Jason Altmire, D-Pa., on Fox News Sunday.
The administration's push comes in the face of public sentiment that's running against health reform. An average of recent health reform polls compiled by Real Clear Politics shows 41 percent of Americans in favor of the Obama plan, with 50 percent opposed. See the full analysis.
Where does your representative stand on health reform?
The Wall Street Journal analyzes the potential health reform vote of each House member in a new, online vote tracker.
Medicare doctor payments get a 31-day reprieve
March 10, 2010 -- On March 2, Sen. Jim Bunning, R-Ky., conceded to Democrats and many Republicans over an emergency aid bill that would extend unemployment benefits and Medicare physician payment rates for 31 days.
Bunning had blocked the bill because he was concerned that lawmakers made no provisions to pay for the roughly $10 billion cost in the face of soaring federal deficits.
Senators passed the bill on Tuesday night, March 2. Since the House had already passed it, it will go to the president for his signature.