News & Politics

"This Is What Change Looks Like": Congress Passes Health-Care Reform

Once Rep. Bart Stupak announced he would vote for the Senate version of the health-care reform bill that came before the House, Democrats had their votes.

Wielding the gavel used by Rep. John Dingell, D-Mich., to mark the passage of Medicare some 45 years ago, House Speaker Nancy Pelosi made history Sunday night as she ushered in a new era in health care. The late-night vote marked the final passage of the health-care reform legislation originally crafted by the Senate, now on its way to President Obama's desk. The bill passed with only three votes to spare, 219-212, with 34 Democrats voting against the bill.

After the Senate version of the health-care reform bill passed, the House voted, 217-209, a package of "fixes" to the Senate bill, which strip out several special deals made with specific senators in order to win their votes -- for example, a Medicaid windfall for the state of Nebraska -- and add changes to various thresholds for subsidies and taxes. That package will require a vote in the Senate in order to pass into law, but, as a budget reconciliation measure, that vote will require only a simple majority. Still, Republicans are promising mischief in the upper chamber once the reconciliation bill is taken up by that body, so the fate of those fixes remains a bit dicey.

Who's On First(s)?

It took the first African-American president and the first woman Speaker of the House to do what generations of politicians had failed to do: create a federally regulated health-care reform program that extends health insurance coverage to the majority of Americans. Given the vitriol and epithets hurled at Democratic lawmakers by anti-health-reform protesters this weekend, it appeared that the faces of those who led the health-care reform effort had more to do with the ground-level opposition represented by the Tea Party protesters than the actual substance of the bill, which was obscured by false accusations of a "government take-over of the health system" -- and worse.

"This is what change looks like," Obama told reporters after the House vote. "This isn't radical reform," he said, "but it is major reform."

While the bill doesn't come close to fulfilling the promise of the sort of universal, single-payer coverage favored by progressives, it will, according to the Congressional Budget Office, create access to health insurance to 32 million currently uninsured Americans. But the victory came at the expense of a further erosion of women's reproductive rights, even as it proscribed discrimination against women in premium costs and gender-specific pre-existing conditions.

As Tea Party protesters, whose collective narrative relies on the symbols and story of the American Revolution, chanted on the Capitol grounds, Pelosi pointedly invoked the words of the Declaration of Independence in her floor speech just prior to the vote. In passing the bill, Pelosi said, "we will honor the vows of our founders, who in the Declaration of Independence said that we are 'endowed by our Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.'  This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people.  This is an American proposal that honors the traditions of our country."

The Bill's Not Dead; It's Red

On both the House floor and on the grounds of the Capitol, the opposition's red-baiting was in full flower. During the debate preceding the bill, Rep. Ginny Brown-Waite, R-Fla., said that if the bill passed, " must now do things in [the Democrats'] socialist way, or face the wrath of the IRS." The part of her remark about the Internal Revenue Service apparently referred to the bill's mandate that all Americans purchase health coverage or be subject to a tax penalty.

Several Republican members emerged from the chamber to address, through a bullhorn, the Tea Party protesters who had gathered on the grounds of the Capitol Building. Rep. Todd Akin, R-Mo., shouted that the health-care bill represented "the poison of socialism."

"What the socialists are gonna find out is that freedom dies hard in America," he said to cheering activists. "They're gonna find out that freedom in America is watered by a spring that comes from our faith, and our rights come from God Himself. They're going to find that it's not so easy to put the golden chains of velvet socialism on [our wrists] and consign us to the goals of welfare state...We will not submit to any kind of socialistic deal.."

As he made his way through the crowd after his remarks, I heard him speaking to a protester of the need "to take our country back."

"We have to win back our hopes, our churches, our culture for God."

"Take it back from what?" I asked.

"Take it back from the people who have the worshipping of the big state that can give everybody everything -- the idea that socialism itself is, we trust government with all power. Government is a terrible force. That's why we have to have limited government," he said. "That's what this country was founded on."

"But is Medicare a socialist program?" I asked.

"It sure is socialist," he said.

High Drama: The Stupak Saga

It was a day of high drama, as Democratic leaders scrambled to find the 216 votes that were needed to pass the bill, which originated in the Senate. There was plenty in the bill for Democrats of both progressive or conservative stripes not to like. Progressives had to look past the bill's omission of a public health insurance plan, which was included in the bill that the House passed last November. But with the loss to the Republicans of the seat previously held by the late Sen. Ted Kennedy, D-Mass., the Democrats lost their 60-vote majority in the Senate, which is required to overcome the procedural obstacle called the filibuster -- a maneuver that allows a minority to block votes at will. So the only way to move forward was for the House to accept the bill the Senate had already voted in before the loss of Kennedy's seat to Republican Scott Brown.

Progressive Rep. Peter DeFazio, D-Ore., threatened to withhold his vote unless his state's low Medicaid reimbursement rates were adjusted upward; he won his point on Saturday, reaching an agreement with House leaders to include a fix for his and 16 other states that suffer low reimbursement rates from the federal government. But the vote came down to the wire on Sunday thanks to the threats of Rep. Bart Stupak, D-Mich., to not only withhold his own vote, but to lead other anti-choice Democrats to vote "no" on the legislation unless the already stringent anti-abortion measures of the Senate bill be replaced with the more draconian amendment he had succeeded in attaching to the version originally passed by the House last year. The Stupak amendment would functionally forbid anyone who receives a federal subsidy to purchase health insurance through the exchanges the bill sets up from buying a policy that covers abortion. (Sarah Posner offers an analysis of the back story at TAPPED.)

All day, it remained unclear whether Stupak would make good on his threat, and whether he actually controlled the votes of some 10 or so lawmakers he claimed to have in his bloc, though he refused to name them. Then, at 4:00, he called a press conference, announcing that he would indeed vote for the bill, based on a deal he worked out with the White House. According to the terms, President Obama will issue an executive order that will satisfy Stupak's demand that federal dollars will not flow to insurance policies that cover abortion. The order directs the Secretary of Health and Human Services and the director of the Office of Management and Budget to develop plans for the "segregation" of funds intended for abortions, and tightens restrictions on abortion services by federally funded community health centers.

Stupak, for months, held the line on his position, and it was his amendment to the original House bill that inspired the anti-abortion provision in the Senate bill that was negotiated by Sen. Ben Nelson of Nebraska. Stupak, backed by the United States Conference of Catholic Bishops, contended that Nelson's provision did not, in the end, actually prevent federal dollars from funding abortions, he said, even though it demands that women receiving federal subsidies for health insurance write a second check to their insurer for policies purchased through the government-administered exchanges for any portion of their policy that covers abortion.

For all his trouble, in the end, Stupak earned not only the fury of many of his Democratic colleagues, but also the ire of the Republicans who had cheered him on as a man of principle when his demands appeared to be gumming up the works as House leaders tried to move the bill forward.

Shaking hands along a veritable rope line of Tea Party protesters, Rep. Pete Hoekstra, R-Mich., was asked about Stupak's change of heart. "Just goes to show you," he said, "there's no such thing as a pro-life Democrat."

"When you go in," he added, "and your first vote is for Pelosi, she drives an agenda that is abortion."

Later, inside the chamber, after Democrats succeeded in passing the Senate version of health-care reform, Republicans tried to pass a "motion to recommit" that would have added the language of Stupak's original amendment to the Senate bill in the reconciliation process. In truth, it was intended as no favor to Stupak, but rather a poison pill that would either prevent progressive Democrats from voting for the reconciliation bill, or create a problem with the Senate parliamentarian, since abortion policy doesn't qualify for the reconciliation process.

Stupak rose to oppose the motion. "Baby-killer!" a Republican member shouted out -- though it remained unclear which one.

And a Rowdy Time Was Had By All

As if health-care reform didin't provide enough drama on its own -- what with the Tea Party crowd occupying Capitol Hill for the better part of the week, Sunday also brought some 200,000 to the nation's capital for a march in support of immigration reform, a cause adamantly opposed by most Tea Partiers, who embrace the nativist cause. At several points, arguments grew heated between immigration reformers and Tea Paritiers, as well as between the Tea Partiers and a sizeable contingent of demonstrators who turned out in support of the bill.

Inside the chamber, the debate was frequently interrupted by cheers and boos, in contradiction to the rules of House decorum, making the chamber seem more like a session of British Parliament -- or the stands in a British soccer match -- than a session of Congress.

By the end of the vote, with Republican dreams of "breaking" Obama vanquished for the time being, Minority Leader John Boehner seemed on the verge of losing control as he gave his closing speech before the vote for final passage.

In what is already being called the "Hell, No!" speech, Boehner accused the Democrats of ignoring the will of the people, and essentially of lying about the provisions of the bill.

"Shame on each and every one of you who substitutes your will and your desires above those of your fellow countrymen," Boehner said.

"Do you really believe that if you like the health plan that you have that you can keep it?" he asked. "No you can't!"

He then asked Democrats if they had actually read the bill, the manager's amendment and the reconciliation bill. "Hell, no, you haven't!" he shouted.

He looked as though he might cry. And that's when it hit me that, for all its shortcomings, what a phenomenal achievement this bill is. Republicans were so certain they could defeat it with a toxic brew of lies, fear-mongering and procedural roadblocks. It was to be, per Sen. Jim DeMint, R-S.C., a grand defeat for the president. And truth be told, many progressives believed him. This bill did seem to die a thousand deaths, and there is no small irony in the fact that it took the loss of health-care champion Ted Kennedy's seat -- and with it, the Democratic super-majority -- to get it passed.




Adele M. Stan is AlterNet's Washington bureau chief.