Washington » In a triumph for President Barack Obama, Democrats narrowly pushed sweeping health care legislation through a key congressional committee Friday night and cleared the way for a September showdown in the House.
The 31-28 vote in the House Energy and Commerce Committee, mostly along party lines, was weeks later than either the White House or Democratic leaders had hoped.
As part of a last-minute series of changes, the committee agreed to cap increases in the cost of insurance sold under the bill, and also to give the federal government authority to negotiate directly with drug companies for lower prices under Medicare.
The new provisions were part of an intensive effort Democrats made in recent days to satisfy the conflicting demands of liberals and conservatives on the panel, unity necessary to overcome a solid wall of Republican opposition.
"We have agreed we need to pull together," said Rep. Henry Waxman, D-Calif., the committee chairman who presided over hours of private negotiations and public committee meetings. Five Democrats opposed the bill.
The measure is designed to extend health insurance to millions who now lack it, at the same time it strives to slow the growth in medical costs nationwide -- Obama's twin goals.
While the pace of action was slower than party leaders had hoped, it was speedier by far than the timetable in the Senate.
There, Democrats said a deadline of Sept. 15 had been imposed on marathon talks aimed at producing a bipartisan compromise. Several officials said that Sen. Max Baucus, D-Mont., had informed fellow senators he intends to convene his Finance Committee to begin voting by then.
Without a bipartisan bill, Baucus would presumably have to produce a measure tailored to Democratic specifications, a step he has said repeatedly he would rather avoid. It wasn't clear how much the deadline was Baucus' idea, and how much it reflected growing impatience at the White House and on the part of Senate Majority Leader Harry Reid of Nevada.
The Energy and Commerce Committee was the third of three House panels to act on the legislation, a measure that numerous lawmakers note would rearrange one-sixth of the nation's economy. A vote in the full House is expected in September, after lawmakers return from a monthlong vacation.
In the run-up to final approval, the panel handed the drug industry a victory, voting 47-11 to grant 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. The decision was a setback for the White House, which had hoped to give patients faster access to generic versions of costly biotech medicines like the blockbuster cancer drug Avastin.
Democrats also turned back a Republican bid to strip out a provision allowing the government to sell insurance in competition with private industry. The vote was 31-28, reflecting the shaky majority Democrats had on a 59-person committee they nominally controlled with 36 members.
The Democrats who opposed the final bill were Reps. Jim Matheson, of Utah; John Barrow, of Georgia; Rick Boucher, of Virginia; Charlie Melancon, of Louisiana; and Bart Stupak, of Michigan.
Under the bill, insurance companies would be required to sell coverage to all seeking it, without exclusions for pre-existing medical conditions. The federal government would provide subsidies for lower-income families to help them afford policies that would otherwise be out of their reach.
The bills would set up so-called exchanges, in effect national marketplaces where consumers both with and without subsidies could evaluate different policies and choose the one they wanted.
The main expansion of coverage would not come until 2013 -- after the next presidential election.
Even so, the political stakes are enormous for Obama and the Democrats as they strive to pass legislation that has proven elusive for years. Republicans are overwhelmingly opposed to the approach they chose, and outside groups on both sides of the issue arranged a heavy dose of television advertising throughout August.
"Let me assure you: There will be a health care reform bill passed and it will make a big difference in the lives of the American people," Speaker Nancy Pelosi, D-Calif., said in an interview.
But the House Republican Leader, John Boehner of Ohio, countered that "Democrats are in for a long, hot summer once they return to their congressional districts, where Americans are lining up in opposition to a government takeover of health care."
On a vote that crossed party lines, abortion opponents failed in an attempt to bar insurance plans that offer abortion services from accepting customers with government subsidies. The vote was 31-27.
On Thursday night, the panel agreed on a provision saying the government could neither require nor prohibit abortion services in insurance plans sold in the exchange.
Waxman's announcement of a series of last-minute changes capped a tumultuous period that began more than two weeks ago when conservative and moderate Democrats on the panel sought changes.
Needing their votes, Waxman began negotiations that grew to include Pelosi and White House Chief of Staff Rahm Emanuel. An agreement at midweek excluded more businesses from a requirement to offer insurance to their workers and reduced subsidies for lower-income uninsured.
It also swiftly triggered a counter-revolt among liberals, who demanded the subsidies be restored in full.
The final deal accommodated them without sacrificing the concessions made earlier to the conservatives, and included numerous other provisions.
Matheson votes against health reform
Utah Rep. Jim Matheson bucked the Democratic majority and voted against a massive health reform bill Friday.
The House Energy and Commerce Committee still approved the bill on a vote of 31 to 28. Matheson was one of five Democrats who voted against the bill, as did all of the panel's Republicans.
He has argued against a government-controlled health insurance plan, which Democratic leaders have argued is a key way to control skyrocketing health costs. Matheson, a member of the conservative Blue Dog coalition, has instead favored state-based co-operatives as an alternative to traditional for-profit insurance plans.
Matheson also wanted the bill to encourage medical malpractice reform and health savings accounts.
Matt Canham
Who would be covered » Around 94 percent of nonelderly residents (those not covered by Medicare, which kicks in at age 65) would be covered -- compared with 81 percent today. Nearly half the 17 million non-elderly residents who remain uninsured would be undocumented immigrants.
Cost » About $1.5 trillion over 10 years.
How it's paid for » Revenue-raisers would include $544 billion over the next decade from new income taxes on single people making more than $280,000 a year and couples making more than $350,000; $37 billion in business tax increases; about $500 billion in cuts to Medicare and Medicaid; sizable penalties paid by individuals and employers who don't obtain coverage.
Requirements for individuals » Individuals would have to have insurance, enforced through a tax penalty with hardship waivers. The penalty would be 2.5 percent of income.
Requirements for employers » Employers would have to provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payroll under $250,000 annually would be exempt. That level could rise to $500,000 under a deal between House leaders and fiscal conservatives. Employers could apply for a two-year exemption from the mandate if they can prove that the requirements would result in job losses that would negatively affect their communities.
Subsidies » Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
How you'd choose your health insurance » Through a new Health Insurance Exchange open to individuals and, initially, small employers; it could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
Benefit package » A committee would recommend an "essential benefits package" including preventive services, mental health services, oral heath and vision for children; out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange and over time would become the minimum quality standard for employer plans. Insurers wouldn't be able to deny coverage based on pre-existing conditions.
Government-run plan » A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors, but under Wednesday's deal with the fiscal conservatives, the HHS secretary would instead negotiate rates with providers.
Changes to Medicaid » The federal-state insurance program for the poor would be expanded starting in 2013 to cover all non-elderly individuals with incomes up to 133 percent of the federal poverty level ($14,404).
Drugs » Would grant 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases.
Who would be covered » All children and many now-uninsured adults.
Cost » Estimates as high as $1.6 trillion over 10 years.
How it would be paid for » Obama proposed cuts within the health care system and raising taxes on households making more than $250,000 annually.
Requirements for individuals » Unlike his Democratic primary opponent Hillary Rodham Clinton, Obama did not propose an "individual mandate." Instead he would have required all children to be insured, making it the parents' responsibility.
Requirements for employers » Large employers would have been required to cover their employees or contribute to the costs of a new government-run plan.
Subsidies » Obama proposed giving subsidies to low-income people but didn't detail at what level.
Benefits package » Insurers participating in a new health exchange would have had to offer packages at least as generous as a new public plan. All insurers would have been prohibited from denying coverage based on pre-existing conditions and would have had to cover children through age 25 on family plans.
Government-run plan » A new public plan would have offered comprehensive insurance similar to that available to federal employees.
How you choose your health insurance » Through a new National Health Insurance Exchange, where individuals could buy the new public plan or qualified private plans.
Changes to Medicaid » Would have expanded Medicaid eligibility, but didn't specify income levels.
Who's covered » The House GOP's plan, in outline form for now, says it aims to make insurance affordable and accessible to all. There aren't estimates about how many additional people would be covered.
Cost » Unknown.
How it's paid for » No new taxes are proposed, but Republicans say they want to reduce Medicare and Medicaid fraud.
Requirements for individuals » No mandates.
Requirements for employers » No mandates; small business tax credits would be offered. Employers would be encouraged to move to "opt-out" rather than "opt-in" rules for offering health coverage.
Subsidies » Tax credits would be offered to "low- and modest-income" Americans. People who aren't covered through their employers but buy their own insurance would be allowed to take a tax deduction. Low-income retirees under 65 (eligibility age for Medicare) would be offered assistance.
Benefits package » Insurers would have to allow children to stay on their parents' plan through age 25.
Government-run plan » No public plan.
How you choose your health insurance » No new purchasing exchange or marketplace is proposed. Health savings accounts and flexible spending plans would be strengthened.
Changes to Medicaid » People eligible for Medicaid would be allowed to use the value of their benefit to purchase a private plan.
The House Energy and Commerce Committee acted on sweeping health care legislation on Friday. Here's a look at that bill in the Democratic-controlled House as well as the Republican counterproposal. Also, a look at President Barack Obama's campaign proposal as he pushes to overhaul the system, cover nearly 50 million uninsured Americans and contain rising costs.
