Late Sunday night, the House of Representatives made history by passing the Senate version of health care overhaul legislation. KHN’s Mary Agnes Carey and The Fiscal Times’ Eric Pianin report on the scene during the vote on Capitol Hill, what’s next in the Senate and what health reform may mean for consumers.
JACKIE JUDD: Good day, I’m Jackie Judd with Health on the Hill. Well, it is done. Late Sunday night, the House passed the bill, overhauling the Nation’s Health Care System, and then the package of fixes to that bill, which the Senate must now approve. President Obama, who saw his number one domestic priority written off as dead more than once over the past year, addressed the nation, saying the vote proves this government still works for the people.
PRESIDENT BARACK OBAMA: Most importantly, today’s vote answers the prayers of every American who has hoped deeply for something to be done about a health care system that works for insurance companies, but not for ordinary people. For most Americans, this debate has never been about abstractions, the fight between right and left, Republican and Democrat, it’s always been about something far more personal.
It’s about every American who knows the shock of opening an envelope to see that their premiums just shot up again when times are already tough enough. It’s about every parent who knows the desperation of trying to cover a child with a chronic illness only to be told no, again and again and again. It’s about every small business owner forced to choose between insuring employees and staying open for business. They are why we committed ourselves to this cause.
The President is expected to sign the historic Bill in the coming days. Here to discuss all of this as they have been over the past year, Mary Agnes Carey, of Kaiser Health News, and Eric Pianan, of the Fiscal Times. Welcome to you both, as always. Mary Agnes, you were on the Hill, on the House side Sunday night, as all of this was happening. Give us a sense of how it felt.
MARY AGNES CAREY: You knew that you were part of history. The place was packed. Of course all the members were on the floor. The Press gallery was packed. The public galleries were packed. On the floor, you had tons of staff who worked on this for years. There were several veterans who said it felt even bigger than any State of the Union they had ever covered. You knew that this was the night and this was the vote. Passions were high.
Republicans firmly believe that this bill is bad for America and they made that case loudly. Democrats on the other hand feel this is a very good thing for consumers. It is the right thing to do, and this is what their place will be in history. But you could feel the passion build. As the afternoon went on, the question was did they have the votes? And when Bart Stupak, the Congressman from Michigan, came out and said there was a deal on the abortion issue with an executive order from the President, you kind of knew they had it. It was just a matter of time.
But as the vote built, and as the vote happened, you had members of Congress, Democratic members walking around getting signatures on the bill from key committee chairs. They were hugging. They were very excited, and they really felt like this is a crowning accomplishment for their party.
JACKIE JUDD: Eric, you have covered Capitol Hill for decades. And you described this very well. You said last night, very much exposed kind of the dual view of the world the Democrats and Republicans have.
ERIC PIANIN: That’s right. It was almost like two parallel universes in politics talking about the same legislation, but a viewer would be kind of confused as to know just what was that bill all about? I mean, if you listen to John Boehner, the leader of the Republicans, it was Armageddon. It was the beginning of the end of Western civilization as we know it.
It is legislation that will raise taxes and raise premiums and kill jobs and kill the economy and undermine the health care system. You go oh my God. And then you listen to Nancy Pelosi who wrapped up the debate last night and it was a historic moment, something akin to passage of social security, or Medicare, extending health care insurance to 32 million Americans who are suffering without it.
So it was really kind of a peculiar debate in that respect, but also very angry kind of ugly side to the body politic and a lot of very uncalled for epithets and exchanges on the floor, not to mention some of the really ugly demonstrations going on outside the Capitol.
JACKIE JUDD: Well, let’s talk about the nuts and bolts of the legislation that will soon become the law of the land. It rolls out in a couple of different waves. First there is the immediate impact. Walk us through those changes.
MARY AGNES CAREY: Here are some of the things the Democrats and the President will be talking about in the days ahead. A dependent child could stay on their parent’s health insurance policy until age of 26. A child cannot be discriminated against, and insurer could not say I will not cover this child if they have a pre-existing condition to age 19.
The doughnut hole in Medicare, again this gap in coverage, seniors will get $250 this year to help cover the donut hole and of course they will phase that out over the next ten years. There is a high risk pool. That is for people now that do not have health insurance and they have a problem getting it, there will be a high risk pool setup to help them get coverage.
There is also going to be tax credits for some small business, we are talking about businesses that are 25 or fewer employees, average wages of about $50,000 or fewer, they will get some immediate help. Those are the more immediate things in the bill.
JACKIE JUDD: And then the longer range plans, I think they kick in at about 2014.
MARY AGNES CAREY: That is right. That is when you are going to see the health insurance exchanges, the market places to help consumers find affordable coverage, the subsidies that will be given to people to help them find coverage, the Medicaid expansion; those are some of the key elements that will come later.
JACKIE JUDD: The bill, as Eric noted, covers an additional 32 million people currently without insurance. By what year will those 32 million have coverage or have access to coverage?
MARY AGNES CAREY: Well, that will certainly begin, I guess you could make the argument if you do not have coverage right now, and you go into a high risk pool, that is some help. 2014 you are going to get more help, but by the end of implementation over the next ten years, that is where you are going to reach your 95-percent coverage level that is in the bill that CBO has talked about.
JACKIE JUDD: Eric because this does play out over the course of so many years, what are some of the uncertainties about implementation of the bill and therefore the financing of the bill?
ERIC PIANIN: Well, I think the greatest uncertainty is whether Congress will make good on its promises to raise taxes in certain areas and cut spending in others, and I think this is where the Republicans have been focusing their criticism. The legislation really hinges on Congress eventually making deep cuts in the Medicare Advantage program to help offset some of the costs of the subsidies.
It also requires down the road raising taxes on these high-end health care insurance programs that employers are providing. And the Republicans are saying big talk, but we will see whether when the time comes Congress will make good on it. If they do not make those cuts and raise those taxes, then that will significantly add to the deficit and undermine all these projections for deficit reduction, both in the short-term and the long-term.
JACKIE JUDD: Do we have any sense yet of when President Obama will sign what the House passed last night?
MARY AGNES CAREY: Well, Henry Waxman, who is head of the House Energy and Commerce Committee, said within the next two days, and this was shortly after midnight, this morning, that within the next two days the President would sign the Senate Bill. So I do not think they have said officially when they are going to, but the thought is they will sign that and make it law, and then of course as you mentioned earlier, the Senate has to also approve the package of fixes the House passed last night.
JACKIE JUDD: And I have heard estimates on that ranging from several days, a week to a month before the Senate votes on the so-called “fix it” or reconciliation package, what do you think?
ERIC PIANIN: I think that it is more likely that it will drag on through this week and then they will wrap it up. I think Harry Reid –
JACKIE JUDD: Because they are coming up to a recess.
ERIC PIANIN: They are coming up to a recess but also there is a certain momentum now. The House sort of pulled up its socks and passed the legislation and passed the fix and now the focus is on Harry Reid and the Senate Democrats. Can they make good on their pledge to deliver by passing this legislation of fix and reconciliation?
I think my guess is by the end of the week they will do it, but there is a real danger. If there is even the slightest change, modification of this legislation, this reconciliation, if the Republicans make one inroad in the legislation, then that bill has to go back to the House for yet another round of debates and approvals. So, there is a lot riding on Harry Reid making good on his promise to the House Democrats.
JACKIE JUDD: Well, Mary Agnes, you wrote a really masterful article for Kaiser Health News today about all of the different ways in which the Republicans could upset the Democrats plan. Walk us through a couple of those.
MARY AGNES CAREY: Well, for example they are going to raise a challenge to a provision in the bill, the Cadillac Tax, which they think impacts on the high-end cost plans, which they feel impacts Social Security, which is not allowed under the reconciliation instructions, for example. That is one challenge.
They are going through the bill, they being Republicans, meeting with the Parliamentarian just as the Democrats have, to see what is to, to quote a phrase, “Byrdable.” What provisions can you take out that violate the Byrd rule which governs reconciliation instructions? And here we are talking about revenues, spending, taxing, it has all got to be related to those financial issues.
So, Republicans have a few things up their sleeve. They have been talking about their challenge to the Cadillac Tax. My guess is they have a few more areas where they are going to try to take elements out of the package and then, as Eric said, it has to go back to the House, but several of us were talking to House members yesterday, House Democrats, saying to them what if the Senate takes out provisions, won’t it be hard to move this Bill again? They do not seem too worried at this point, but we have to see where it all goes.
JACKIE JUDD: They feel that the hardest votes took place on Sunday.
MARY AGNES CAREY: Exactly. The hardest vote, you know, we were talking about a week ago they had this “deem and pass” strategy for the House Democrats to avoid the vote on the Senate bill. They changed their minds about that and so once their members have taken that vote on the Senate bill, they have taken a vote on the reconciliation package, I think most of them feel like they could do that again.
ERIC PIANIN: One other point that we ought to make in closing, Nancy Pelosi and Steny Hoyer deserve enormous credit from the White House for delivering on this package and in the darkest days when it looked as if this thing was going down, after Scott Brown’s election in Massachusetts to the Senate, a lot of people thought let’s pull back, let’s break this into several pieces and try to pass it piecemeal, and Nancy Pelosi said no, we are going to stick to our guns and we are going to pass this, and she has succeeded.
JACKIE JUDD: Okay, thank you both so much, Eric Pianan, Mary Agnes Carey. Thank you for watching, as always. I’m Jackie Judd and this has been Health on the Hill.