5 questions about the health-care legislation
Reporting by Ben Pershing, Paul Kane and Alec MacGillis
As the House prepares to vote this weekend on the Senate's health-care bill and a reconciliation package of changes, we answer five questions about the bill, the process and what it ultimately means to the American people.
#1 What is the House voting on?
The House will probably vote Sunday on the health-care reform bill approved by the Senate in December, plus a separate package of changes negotiated by the two chambers that is designed to make the bill more palatable to House Democrats. The measure would cover more than 32 million uninsured Americans, expand Medicaid eligibility, set up new insurance exchanges and require nearly everyone to carry insurance or pay a fine. The bill would prevent the denial of insurance coverage for those with preexisting conditions, limit insurers' ability to enact large rate increases and provide subsidies to help lower-income people purchase insurance. The measure also closes the "doughnut hole" in Medicare prescription drug coverage, cuts subsidies for Medicare Advantage plans and allows children to stay on their parents' insurance plans up to age 26.
#2 How does this differ from the bill the House approved in December?
While the original House bill was funded mostly with a surcharge on individuals making more than $500,000 per year ($1 million per family), the Senate bill uses a tax on high-cost insurance plans. The reconciliation package would keep the Senate's tax but scale it back, while adding a new Medicare tax on wealthy taxpayers' interest and dividend earnings. The original House bill also included a government-run insurance option, which the Senate bill does not. The Senate bill imposes less strict requirements on employers, charging fees to companies with more than 50 employees if their workers receive government-subsidized insurance. And the House bill set up a national insurance exchange, while the Senate measure makes the exchanges state-based.
#3 How do the changes affect the politics of the bill?
No Republicans are expected to vote for the bill, so backers must find enough votes -- 216 are needed -- from House Democrats. The final version is more centrist than the one that narrowly passed the House in December, because it lacks a public insurance option and includes a tax on high-priced insurance plans that is anathema to organized labor. The final bill provoked grumbling from many liberal House Democrats, but they have mostly fallen in line behind it. Also falling in line were Hispanic members upset about a provision that would exclude illegal immigrants from using their own money to buy insurance in a new government-sponsored marketplace.
The biggest challenge remains getting enough votes from Blue Dogs and other moderate Democrats. Despite the Congressional Budget Office's finding that the bill would achieve tens of billions in deficit reductions, they remain concerned about its cost. There are also about half a dozen Democrats who voted for the last House bill who argue that this version is not sufficiently restrictive in banning federal funding for abortion.
#4 Why is the process so confusing?
The parliamentary route on this legislation is a far cry from the civics lesson enshrined in the old "School House Rock" song "I'm Just a Bill." Unable to overcome the likelihood of a GOP filibuster in the Senate since Sen. Scott Brown's Jan. 19 special election victory in Massachusetts, Democrats are using an obscure but commonly used tactic known as "reconciliation" to get the legislation through both chambers.
House Democrats are trying to approve the Senate legislation exactly as it is, which would send it to President Obama for his signature. At the same time, they are working on revisions to the Senate bill that involve compromises between Democrats in the Senate and the House. That legislation is using the reconciliation process so that, if the House passes it, Senate Democrats can approve those changes with just 51 votes and avoid a filibuster by Senate Republicans.
Confusing the process more, House Democrats will not actually vote on the Senate legislation. Instead, they will wrap the Senate bill and the revisionlegislation into one vote, "deeming" the first one approved without a specific vote on it if the overall vote succeeds. Republicans have protested these parliamentary maneuvers, although they have used them on other bills in the past.
#5 What happens now?
The final 48 hours before this vote is known as the "whip count," in which Democratic leaders send around a one-page sheet to each of the 253 Democrats asking where they stand on the issue. Those remaining undecided votes will get calls from Obama and his Cabinet secretaries, and have meetings with the House leadership.
If the Democrats prevail in what is expected to be a razor-thin vote, Obama will sign the legislation into law and the Senate will spend the next week trying to navigate its own parliamentary maze to enact the reconciliation bill. If the Senate does not enact those changes, the original Senate legislation would be the law of the land, because the House and Senate approved identical language. If the Senate made any changes to the reconciliation legislation, it would go back to the House for another vote.