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House Clears Final Piece of Long-Fought Health Care Overhaul Package

By Edward Epstein, CQ Staff

March 25, 2010 -- Weary but excited Democrats wrote the final chapter Thursday night in their long effort to overhaul the nation's health care system, sending President Obama the final piece of their package.

The final act came on a 220–207 House vote, largely along party lines, that put in place the final piece of what had become a legislative jigsaw puzzle. The vote cleared the final version of a package of changes (HR 4872), considered under budget reconciliation rules, to the health care overhaul President Obama signed into law (PL 111-148) March 23. Thirty-two Democrats joined all participating House Republicans in voting no.

The final House action was required after Senate Republicans leveled a successful budget law challenge that deleted two provisions from a section of the reconciliation bill dealing with student loans.

The Senate passed the reconciliation bill earlier Thursday, 56–43. The House passed the initial version of the bill on March 21 by a 220–212 vote.

For Democrats, the package means that health insurance benefits will be extended to about 32 million Americans who now lack them. For Republicans — who plan to run this fall on a platform calling for a repeal of the new law — the overhaul represents a dangerous expansion of government control over the health care system.

"Just about everything has been said and everyone has said it," said Jim McGovern, D-Mass., as the House prepared for the final vote.

Unlike late on March 21, when the visitor galleries were packed and House members filled the chamber's seats, the final debate was a low-key event. The galleries were almost empty and members straggled in for the vote, which followed 10 minutes of debate.

"What we're doing today is historic," McGovern said. "I am proud to cast my vote, again, for the reconciliation bill."

But David Dreier, R-Calif., said Democrats had succeeded only in leading the country in the wrong direction.

"Wasting precious time while the American people wait for real health care reform is a tragic waste. This is a missed opportunity," he said.

The reconciliation legislation was designed to revise provisions in the Senate's version of the health care overhaul law that House members found objectionable.

For Republicans bitterly opposed to the Democrats' health care effort, Thursday night's House debate was their last opportunity to delay, if not kill, the final piece of the package.

Republicans used a meeting of the Rules Committee on the bill to try anew to put off passage. "I would just as soon go home for two weeks and listen to people and come back and vote on this," said Joe L. Barton, R-Texas.

"I don't see any evidence that anyone, including the great American people, want to see us debate this again," said Rules Chairwoman Louise M. Slaughter, D-N.Y.

Still, rehash old arguments is exactly what committee members did, with Republicans attacking Democrats' approach to health care and chiding them for sloppy legislative drafting.

"Its hasty construction resulted in errors that were bound to emerge," said John Kline of Minnesota, the top Republican on the Education and Labor Committee. "Who's to say that new glitches won't emerge?"

Frank Pallone Jr., D-N.J., said Republicans should vote for the reconciliation bill. "To not move forward with reconciliation at this point would be a huge mistake because we all agree it corrects a lot of the problems we saw in the Senate bill," he said. "We should all vote for it."

The reconciliation legislation increases federal subsidies in the new law to help low- and moderate-income families purchase health insurance starting in 2014. It also speeds the phase-out of the coverage gap, or "doughnut hole," in the Medicare Part D prescription drug program and revises the formula for providing federal matching funds to help states cover the law's expansion of Medicaid eligibility.

The bill also modifies the law's tax provisions, delaying and reducing the reach of a new excise tax on high-cost health insurance plans, increasing the Medicare payroll tax on high-income taxpayers, making investment income subject to taxation, and adjusting industry fees and taxes.

In an unrelated section, largely overshadowed by the contentious health care debate, the reconciliation bill makes the federal government the sole originator of college student loans and increases the maximum Pell grant for low-income students.

Senate Republicans successfully raised budgetary points of order against two minor provisions relating to the Pell grants, and they were removed from the bill.

Those changes sent the bill back to the House, which had to act again in order to send it to the president.

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