In a rare Sunday night session, the U.S. House of Representatives approved a national health care plan that would seek to provide health insurance to an estimated more than 40 million uninsured Americans.
The vote followed heated debate on the House floor with the final vote on HR 3950 pulling 220 votes for and 211 votes against. The measure needed 216 votes to pass, and all 220 votes were from Democrats. There are currently four vacancies in the 435-member U.S. House.
Congressman Vic Snyder (D) was the lone Arkansas representative voting in support of the measure. Congressmen Marion Berry (D), Mike Ross (D) and John Boozman (R) all voted against the bill.
The resolution now heads to the U.S. Senate where Democratic leaders say they have the votes to pass it. President Barack Obama is expected to sign the bill into law in the next few days.
• A Democratic summary of the bill:
The Patient Protection and Affordable Care Act will ensure that all Americans have access to quality, affordable health care and will create the transformation within the health care system necessary to contain costs. The Congressional Budget Office (CBO) has determined that the Patient Protection and Affordable Care Act, as amended, is fully paid for, provides coverage to more than 94 percent of Americans, bends the health care cost curve, and reduces the deficit by $118 billion over the next ten years, with additional deficit reductions in the following years.
The Patient Protection and Affordable Care Act includes immediate changes to the way health insurance companies do business to protect consumers from discriminatory practices and provide Americans with better preventive coverage and the information they need to make informed decisions about their health insurance.
Uninsured Americans with a pre-existing condition will have access to an immediate insurance program to help them avoid medical bankruptcy and retirees will have greater certainty due to reinsurance provisions to help maintain coverage.
New health insurance exchanges will make coverage affordable and accessible for individuals and small businesses. Premium tax credits and cost-sharing assistance will help those who need assistance.
Insurance companies will be barred from discriminating based on pre-existing conditions, health status, and gender.
A substantial investment in Community Health Centers will provide funding to expand access to health care in communities where it is needed most.
• A Republican summary of the bill:
H.R. 3590 is intended to expand access to health insurance, reform the health insurance market to provide additional consumer protections, and improve the health care delivery system to reduce costs and produce better outcomes.
While the bill would expand insurance coverage to 94 percent of the legal population (24 million Americans would still be without coverage) and could improve the functioning of the individual and small group insurance markets, many experts question whether it will effectively control costs or reform the health-care delivery system.
The Congressional Budget Office (CBO) estimates that the coverage provisions in the bill will cost $848 billion over 10 years (fiscal years 2010-2019). However, the major provisions in the bill would not take effect until January 1, 2014, meaning the bill uses 10 years of revenue to pay for six years of coverage. Republican staff on the Senate Budget Committee estimates that the total spending in the bill over 10 years of full implementation (FYs 2014-2023) would exceed $2.5 trillion.
To pay for the expansion of insurance coverage, the bill increases taxes by $493.6 billion, and reduces Medicare spending by $464.6 billion. Specifically, the bill would cut $134.9 billion from hospitals, $120 billion from Medicare Advantage (MA), $14.6 billion from nursing homes, $42.1 billion from home health agencies, and $7.7 billion from hospices.
Among the more prominent taxes, the bill includes a new 40 percent excise tax on health insurance plans that exceed $8,500 for individuals and $23,000 for families, raising $149.1 billion over 10 years; a new Medicare payroll tax on higher-income individuals that raises $53.8 billion; a $60.4 billion tax on health insurers; a $22.2 billion tax on drug manufacturers; and a $19.3 billion tax on medical device manufacturers.
The bill would create a tax on employers with more than 50 full time workers if their employees receive a subsidy through the exchange. This so-called “free rider” mandate would increase taxes on employers by $28 billion.