Landmark Health Care Reform: Historic legislation passes into law, changing the domestic policy landscape in the United States, and handing President Obama and House Speaker Pelosi a political victory
Introduction:
Landmark health care reform legislation was on the political agenda in the United States for President Barack Obama as well as the Democratic-ruled bicameral Congress. When the issue of health care reform was first broached in the first months of his administration, President Barack Obama had hoped that legislators in Congress could forge bipartisan concurrence on legislation, aimed at ameliorating the health insurance regime and insuring many Americans not currently covered by health care. This objective faced grave difficulty, given Republicans' resistance to a public health care option (i.e. the concept of a government-run health care exchange to compete with private insurers), which progressive Democrats demanded. The general consensus was that the prospects for successful passage of health care reform would rise and fall on the willingness of both sides to compromise or the ability and desire of Democrats to pass health care reform without the help of Republicans. But with November 2010 mid-term elections at hand, the ability of Democrats to cobble together the necessary votes from members of Congress in swing districts promised to be a challenge. In the Senate, the by-election of a Republican to the late Edward Kennedy's seat meant that the Democrats in that body no longer had a filibuster-proof majority. Thus, the complicated parliamentary procedures, including reconciliation, were now under consideration as the president aimed to push through his most ambitious domestic policy initiative after close to a year of legislative wrangling. Those efforts ultimately paid off with Democrats garnering enough votes to pass this legislation, and President Obama and House Speaker Pelosi winning a significant political victory. Republican leaders, such as Minority Leader John Boehner, were warning of deleterious consequences for Democrats at the polls in November 2010 as a consequence of passing legislation his party deemed to be undesirable for the American people.
Summary on Legislation:
The United States House of Representatives passed its version of health care reform on Nov. 7, 2009. The health care bill -- H.R. 3962, the Affordable Health Care for America Act -- gained just enough votes to pass in the lower house of Congress, given the reservations of moderate Democrats in conservative districts ahead of the 2010 mid-term elections. The final vote was 220-215 with a lone Republican adding his bipartisan support. Passage of this legislation meant that comprehensive health care reform crossed a significant hurdle on the way to finally achieving the most sweeping domestic policy change in decades in the United States. That being said, the House legislation would still have to be reconciled with the Senate version, which itself was expected to face notable obstacles in the upper chamber before passage. To that end, the Senate version of the bill was at risk of being filibustered not by the Republicans, who appeared unified in their opposition, but from conservative members of the Democratic Party. Controversial wrangling gained their support. Indeed, the concurrence in the upper legislative chamber had been crafted to keep liberal Democrats on board, while also bringing conservative Democrats into the fold, at the expense of the public option. As such, the bill moved forward in the upper chamber of the United States' legislative body with a 60-vote filibuster-proof super-majority and with Republicans united in their opposition to the legislation. On Dec. 24, 2009, the United States Senate passed the historic $871 billion health care reform bill. The bill passed with the support of every Democrat and Independent in the Senate. The vote was 60-39 and allocated along strict partisan lines, with one Republican missing the vote.
Summary of Recent Developments:
At the close of 2009, health care reform seemed on track for passage. At that time, the passage of health care reform legislation in both chambers of Congress effectively handed President Obama a policy victory on Christmas Eve by actualizing his administration's most significant domestic policy initiative. Following the historic vote, President Obama hailed the development saying, "We are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people." But such political ascendancy was short-lived as a result of the realities of the political landscape.
As of 2010, the two chambers were yet to harmonize components of their respective bills in conference committee before the final bill could be passed into law and signed by the president. While the Democrats acknowledged the intrinsic difficulties in completing this process, they were also counting on their filibuster-proof majority in the Senate to meet their objectives. They certainly were not counting on losing that filibuster-proof majority when a centrist Republican, Scott Brown, won the by-election in Massachusetts for the late Senator Edward Kennedy's seat. That political blow to the Democrats placed the passage of health care legislation in grave jeopardy and risked their party being marked by failure ahead of the mid-term elections.
With an eye on the likely pitfalls ahead, President Obama tabled his own health care proposal. A mixture of the House and Senate versions, the president's proposal would mandate health care coverage, provide subsidies in the interests of affordability, establish a competitive insurance market for small businesses and individuals, establish an extended care insurance program, and address the coverage gap in the Medicare prescription benefit. Funding would be provided via a mix of tax increases and savings from Medicare waste.
President Obama also convened a bipartisan health care summit on Feb. 25, 2010, aimed at resurrecting the stalled health care process. There was some speculation that despite its bipartisan billing, the White House harbored no illusions that it would actually garner Republican support for health care reform. Indeed, the conventional wisdom in Washington D.C., was that the president wanted to offer a final overture of bipartisanship towards the Republicans, before blessing the reconciliation process, which would push legislation forward with a simple majority.
Perhaps not surprisingly, despite some areas of agreement, such as "recission" of insurance policyholders, allowing youth to remain on parents' policies for longer periods, and ending limits on benefits, the Republicans at the summit repeated their disapproval of the sweeping health care reform legislation and called for the already-lengthy process to be entirely restarted. Senate Minority Leader Mitch McConnell said he doubted one Republican would support the president's endeavor. That being said, a few Republicans intimated the possibility of limited bipartisan support. Notably, Senator John McCain of Arizona said his party would consider working on reform with President Obama, albeit only on a "step-by-step" basis, with a less sweeping changes at stake.
The Republicans also warned that using budgetary reconciliation to advance legislation by simple majority -- and by-passing filibuster-proof parliamentary procedures -- was unprecedented and should be rejected. Of course, this position was not supported by actual facts since the Bush administration, backed by a Republican Congress, used budgetary reconciliation to pass sweeping tax cuts only a few years earlier. As noted by several Democrats in Congress, reconciliation has been used throughout recent political history far more by Republicans than Democrats.
The Democrats in the House and Senate suggested they were ready to end the lengthy and laborious legislative process on health care. House Speaker Nancy Pelosi said during a news conference that there were "good prospects for passing" health care legislation regardless of Republican participation. She also took the opportunity to take a swipe at the Republicans for "accepting of the status quo" in which American consumers have often suffered at the hands of the health insurance industry. Senator Richard Durbin of Illinois, the second-ranking Democrat in the upper chamber signaled that movement of health care reform was imminent, saying, "We are not going to wait."
Days after the health care summit, the White House indicated it was looking for an "up and down vote" on health care reform in a bid to end the endless wrangling, and to facilitate improved health care to Americans. Indeed, the White House seemed intent on pressing forward with or without Republican support. White House Press Secretary Robert Gibbs said, "We know what happens if we do nothing: more and more people pay more. The president believes we still have to act." An actual statement from the Obama administration was still forthcoming but Gibbs said the president would soon announce "where he sees a path moving forward."
On March 12, 2010, United States President Barack Obama announced that he was delaying his scheduled trip to Indonesia and Australia, in order to concentrate on the passage of health care reform legislation. With the fate of health care reform hanging in the balance, the White House decided that the president's time would be best spent placing pressure on the two houses of Congress to pass legislation on this high stakes policy matter. President Obama had originally asked that legislation be passed ahead of March 18, 2010 when he was scheduled to depart on his trip. However, leading Democratic legislators had warned that the March 18, 2010 timeline would be difficult to meet. Now, it was hoped that health care reform legislation could be passed by March 21, 2010 -- the new departure date of the president. But even that date was purged when the White House announced that the president would be cancelling his trip entirely in favor of working toward the passage of historic health care reform.
Cost of Health Care Reform
There has been enormous focus on the costs of initiatives ensconced in the health care reform legislation at hand. The White House was hoping that the costs should remain in the vicinity of the $871 billion price tag attached to the Senate version, which was also paid for and was expected to reduce the deficit. These numbers, however, would have to pass the scrutiny of the non-partisan Congressional Budget Office (CBO). To that end, the initial findings from the CBO brought good news to Democratic leaders who wished to tout to fiscal benefits of the final bill. Indeed, the CBO said that the Democrats' health care plan would cost about $940 billion over a decade, and reduce the federal deficit by $138 billion over that same time horizon of 10 years. The letter from the CBO to House Speaker Nancy Pelosi also noted that the legislation would set the path for the provision of health care coverage to 32 million uninsured people by 2016. That would facilitate almost-universal (95 percent) health care coverage in the United States.
Seizing on this news, President Barack Obama declared that the bill represented "the most significant effort to reduce deficits since the Balanced Budget Act in the 1990s," when President Bill Clinton set the federal budget on a pathway to surplus. President Obama continued, "This is but one virtue of a reform that will bring the accountability to the insurance industry and greater economic security to all Americans."
It should be noted that an updated report from the CBO validated the initial scoring, and in fact highlighted even better deficit savings. That new CBO score showed that the federal deficit would be reduced by $143 billion (ten billion more than the initial score) in the first decade, and cost $(38 billion over a decade (two billion less than the initial estimate).
Final Legislative Process
Members of the House of Representatives were give 72 hours to study the legislation, once the costs of the proposed health care bill were made available. That meant that a likely vote in the House of Representatives would ensue on March 21, 2010, assuming that the Democratic leadership was able to cobble together at least 216 votes in its favor. Of course, as noted by House Republican leader John Boehner, efforts would be made on the other side of the aisle to "do everything that we can do to make sure this bill, never, ever, ever passes."
Typically, the procedure for the passage of bills into law includes the combination of two versions of legislation from both house of Congress into a single bill via conference committee, followed by the signature by the president on the conferenced bill, making it law. However, with the Senate now without the necessary 60th seat to by-pass the parliamentary hurdles, such as a possible filibuster by Republicans, Democratic leaders were now looking to pass health care legislation via reconciliation, requiring only simple majority.
At first, the Democratic leadership of the House was considering a procedure known as "deem and consent" in which members of the House of Representatives would vote on a self-executing rule or provision, that would automate the passage of the Senate bill. Technically, this procedure would preclude a direct vote on the health care bill; however, it would still entail an indirect vote tucked into the vote on the rule. Republicans railed against this idea, characterizing it was the passage of a law without a vote and as unconstitutional, irrespective of the fact that such provisions had been used by its own ranks before. Indeed, during the last Republican-controlled Congress, Rules Committee Chairman David Dreier (R-California) used the "deem and pass" rule more than 35 times.
House Majority Leader Steny Hoyer said on the ABC show, Good Morning America, "We are going to have a clean up or down vote on the Senate bill, that will be on the rule. This is a procedure, by the way, that was used almost 100 times under Newt Gingrich and over 100 times by Speaker Hastert, which my friend Mr. Cantor supported most of the time, if not all of the time. So this is not an unusual procedure. We're going to vote on a rule. It's simply like a conference report. Conference report comes back. You vote on it, with amendments." Republican Congressman Eric Cantor concurred, "Yes, Steny is right. The rules of the House allow for this type of deeming provision, it's called a self-executing provision which means that once the bill, the rule for the next bill passes, the Senate bill is automatically is deemed as having passed."
Nevertheless, on the eve of the vote in the House of Representatives, it was revealed that Democrats were abandoning the "deem and pass" procedure for straight up and down vote favored by President Obama. The final stage of the legislative process would commence with the adoption of a rule to provide for the consideration of the reconciliation bill -- essentially a package of reconciliation amendments intended to fix the Senate version of the bill so that it more palatable to the House. There would be two hours of debate on that reconciliation bill preceding a vote. In addition, the health care reform bill passed in the Senate would be presented on the floor of the House for a vote without debate in that case. It was expected that there would be enough votes to pass the Senate version in the House, whereupon it would be immediately sent to the president for signature. Meanwhile, the reconciliation bill would be advanced to the Senate, where Senate Majority Leader Harry Reid promised there were enough votes for it to be passed by via reconciliation. Accordingly, budgetary provisions would allow the bill to be approved by simple majority, rather than exposing the vote to filibuster by Republicans. Then the president would sign the amended bill.
Assuming the Democrats, indeed, had the necessary votes in both houses, this two-pronged process would essentially ensure that the amended version of the Senate bill (i.e. containing the "fixes" desired by the House and advocated by the president) would pass into law.
Latest Developments
In a final push for the passage of health care reform legislation, the Democratic leadership and President Barack Obama addressed all Democratic congressmen and congresswomen to rally support. For his part, Senate Majority Leader Harry Reid dismissed complaints by Republicans about legislative procedure, excoriated the insurance industry, and passionately asserted that "the lives and livelihoods of millions" were on the lone. He promised that "the most sweeping changes to Americans' health care will be law a matter of days." Reid also announced that he had the commitment of a significant numbers of senators to actualize this objective. House Majority Leader noted that the prospect of health care reform should come as no surprise, and said that there was "no illusion about what he [President Obama] would do" when the matter of health care was discussed in the 2008 presidential campaign.
For his part, President Obama acknowledged the difficulty of the health care debate and the legislative process, and observed that the proposed health care bill was a centrist document. He said, "This is a middle of the road bill designed to help the American people, " that tracked with recommendations of both former Democratic Senator Tom Daschle as well as former Republican Senator Bob Dole. President Obama also attempted to shore up Democratic support for the legislation by urging lawmakers to act on the side of history rather than with political calculations in mind. To this end, he cited President Abraham Lincoln as he said, "I am not bound to win, but I am bound to be true. I am not bound to succeed, but I am bound to live up to what light I have." In a rallying cry to congressional representatives, he said: "Don't do it for the democratic party; do it for the American people." Whether or not his call would be heeded in the form of requisite votes was yet to be seen.
On March 21, 2010, Democrats appeared to be on track to pass historic health care reform. On the eve of the vote, the Democratic leadership appeared to be short a few votes of the requisist 216 needed to pass the bill. However, on the day of the vote, Democratic House Caucus leader John Larson said: "We have the votes. We are going to make history today." Pro-life Democratic Congressman Bart Stupak was able to forge a deal with the Democratic leadership, which would provide for an executive order reifying the existing Hyde Amendment, which prevents federal funding of abortions. Accordingly, Stupak and his pro-life Democratic cohorts announced their support for the bill, virtually ensuring passage of this landmark legislation with enough votes well over the 216 threshold.
In an interview with ABC News, Republican Minority Whip, Eric Cantor, promised unanimous Republican opposition to the health care reform legislation. He said: "The American people don't want this to pass. The Republicans don't want this to pass. There will be no Republican votes for this bill." That being said, Republican lawmakers appeared resigned to the inevitable and warned that they would use the health care legislation against Democrats in the 2010 mid-term election. Republicans have argued that the health care plan was unpopular with the American people and that Democrats would, therefore, pay a price at the polls.
Meanwhile, antagonists to health care reform outside the Capitol demonstrated in Washington D.C., with some protestors reportedly hurling racial and homophobic slurs at Democratic lawmakers. One arrest was made when a protestor spat at a Democratic lawmaker. Even House Speaker Nancy Pelosi was harrassed by anti-reform demonstrators as she made her way to the Capitol. However she brushed aside their anger saying: "We are doing this for the American people."
Ahead of the vote, President Obama characterized the potential shift in the American domestic landscape saying it was "the most important piece of social legislation since the Social Security Act passed in the 1930s." Assuming the vote went as hoped, it would be a significant political victory for the president, who was under fire for concentrating on this agenda item at a time when the country was also grappling with significant economic challenges, known as "the Great Recession."
Perhaps not surprisingly, those on the other side of the ideological divide held a very different view. Minority Leader John Boehner (R-Ohio) warned of an "armageddon" to come, should the legislation pass. He also said, "this bill will runin our country." Striking an equally ominous tone, Karl Rove, political adviser to former President George W. Bush, warned of "economic disaster" to come, should the bill pass. Several Republicans also warned that Democrats would pay a political price at the polls later in the year. Notably, Ed Gillespie said that there would be "blood on the floor."
Regardless of the ultimate outcome, March 21, 2010 would be marked as a significant day in American politics.
The Votes
H.R.3590 Title: "The Patient Protection and Affordable Care Act" --
H.R. 3590 was a motion to concur with the already-passed Senate bill. It passed with 219 votes in its favor and 2 12 against it. In this way, H.R.3590 was passed with only Democratic votes, and with all Congressional Republicans voting against it, as expected.
A motion to recommit, intended as a last measure by the Republicans to try to scuttle the bill, would send the legislation back to committee. That motion was defeated with 199 votes in its favor and 232 against it.
H.R.4872 Title: Reconciliation Act of 2010 --
H.R. 4872 was intended to establish the changes or "fixes" to the now passed health care bill. The reconciliation act was passed with 220 votes in its favor and 211 against it.
These votes essentially brought the Senate-passed bill into law upon signature by President Obama. The reconciliation bill was to be sent to the Senate for approval in that body, with passage establishing the amendments to the legislation.
Upon passage of landmark health care reform, President Obama's office dispatched a message that read as follows: "For the first time in our nation’s history, Congress has passed comprehensive health care reform. America waited a hundred years and fought for decades to reach this moment." In a televised national address, President Obama, flanked by Vice President Biden, said, that the passage of health care reform legislation was "a victory for the American people" and "a victory for common sense." He noted that the bill would "not solve every problem" in the health care system, but that it would "move us in the right direction." President Obama also made the argument for effective governance saying, "We proved that we are still a people capable of doing big things. We proved that this government — a government of the people and by the people — still works for the people."
Commentary:
Health care has also been one of the core fault lines of American politics, dividing Democrats and Republicans for decades. For Republicans, health care reform has signaled a government take-over of the system, at the expense of the free enterprise system, which was in this case represented by the insurance industry. For Democrats, health care reform represented a reification of the belief in an activist government to mitigate corporatist forces. In many senses this debate brought into high relief the enduring schism between right and left --i.e. the tensions between markets and states respectively. That being said, for decades, both Republican and Democratic presidents have both acknowledged the need for health care reform on the American landscape, notwithstanding the differences on the path leading to that end.
When the fight for health care reform began, the central political calculation was as follows: Would the president finally succeed in advancing the Democrats' marquee domestic policy initiative? Or would health care reform bedevil President Obama as it did President Bill Clinton 16 years earlier? Would the Republicans succeed in derailing the president's agenda ahead of the next mid-term elections? In the early 1990s, Clinton's health care reform plan ended in failure and Democrats lost control of the House of Representatives soon thereafter. In effect, the actual beneficiaries of the failure of health care reform efforts in the 1990s were the Republicans at the polls in congressional races. Throughout, political analysts have argued that the fate of this policy agenda item was inextricably linked with the fate of the Democratic Party in forthcoming mid-term elections set for 2010, as well as the ultimate success of Barack Obama's presidency.
On the issue of the Obama presidency, journalist, Ronald Brownstein, asserted that the leader of the United States expended both time and political capital in the interests of health care reform. Brownstein wrote, "Win or lose, Obama has pursued health care reform as tenaciously as any president has pursued any domestic initiative in decades. Health care has now been his presidency's central domestic focus for a full year. That's about as long as it took to pass the Civil Rights Act of 1964, originally introduced by John F. Kennedy and driven home by Lyndon Johnson. Rarely since World War II has a president devoted so much time, at so much political cost, to shouldering a single priority through Congress." NBC analyst, David Gregory, noted hours before the vote that passage of the legislation would mark a victory to President Obama, who -- as noted by Gregory -- "kept his campaign promise in delivering sweeping health care reform."
Passage of this landmark legislation granted a massive victory to President Barack Obama, ensuring his place in history, and enshrining his policy legacy as the first president to successfully bring about health care reform in half a century. Significantly, President Obama will have accomplished what his presidential predecessors failed to achieve over the course of fifty years. It was also a victory for House Speaker Nancy Pelosi who was credited with shepherding the legislative process and actualizing the long-elusive Democratic goal of expanding federal health care guarantees to American citizens by offering health insurance coverage to 30 million more people. Indeed, it would mark the most substantial and transformative policy shift on the domestic landscape in decades -- since the enactment of Medicare and Medicaid almost half a century earlier. Making history, however, was no guarantee that the Democrats would not suffer at the polls in November 2010. As discussed above, leading Republicans warned of a host of deleterious consequences to come, not only in terms of the outcome of the forthcoming elections, but also as regards the very stability of the country.
-- Denise Youngblood Coleman Ph.D.
Houston, Texas
March 21, 2010
***
CountryWatch's coverage of global political events and developments is not intended to be an explicit endorsement of any country's political priorities or any political interest group's agenda. CountryWatch takes a politics-neutral approach and encourages users to consider the complex range of parameters when studying the international spectrum. CountryWatch does, however, embrace a global orientation, given its own essential purpose as a provider of international news, data and analysis.
***
For the most recent developments across the globe, see the CountryWatch News Wire. For information and analysis about Election 2008 in the United States, including the historic election of Barack Obama as president, see the "Special Report: Road to the White House 2008," available from the "Special Reports" tab located on the front page of the Country Watch website.
***