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House passes health-care reform bill without Republican votes

The amendments

The House of Representatives passed landmark legislation to overhaul the nation's health-care system, approving a Senate bill and a separate package of amendments.

Many provisions of the Senate bill would be altered by a separate package of amendments that the House also approved Sunday, by a vote of 220 to 211. That package now goes across the Capitol to the Senate under special rules, known as reconciliation, that protect it from a Republican filibuster.

Compared with the Senate bill, that measure would offer more generous subsidies to people eligible for federal help buying insurance. Tax credits would be available to families earning as much as 400 percent of the federal poverty level -- or about $88,000 a year for a family of four -- who would be assured of spending no more than 9.5 percent of their income on insurance premiums in 2014.

The reconciliation package would also gradually close the gap known as the "doughnut hole" in Medicare prescription drug coverage, which leaves many seniors to pay the full cost of expansive medications.

House Democrats also insisted on changing major sources of funding for the legislation, particularly the Senate's proposal to impose a 40 percent excise tax on the most generous employer-provided policies, starting in 2013. That tax would hit many middle-class families, including many union members, so the House reconciliation package proposes to delay its implementation until 2018.

The additional cost of the reconciliation package would be covered instead by increasing Medicare taxes for high earners and by imposing a new 3.8 percent Medicare tax on investment income for those families.

The package would also change the penalty on people who fail to purchase insurance, requiring them to pay at least $695 a year or as much as 2.5 percent of their income. And it would increase the fines for large employers that fail to offer affordable coverage to $2,000 per worker.

Combined with the Senate bill, the package would increase the overall cost of expanding insurance coverage to $940 billion over the next decade. But the two measures combined would also lower budget deficits by $143 billion by 2019.

Democrats have spent weeks scouring the package to make sure it can clear the complicated procedural hurdles that face any reconciliation bill in the Senate, but Republicans are just starting their review of the final package. Sen. Judd Gregg (N.H.), the senior Republican on the Senate Budget Committee, has already identified at least one provision that he believes could bring the entire bill down, arguing that a new tax on high-cost insurance policies would have an impact on the Social Security trust fund -- a violation of reconciliation rules.

Senate Democrats believe they can overcome that challenge, and Senate Majority Leader Harry M. Reid (D-Nev.) on Saturday publicly assured House Democrats that he has the votes to pass the bill.

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