The U.S. House of Representatives answered "the call of history" put to it by President Obama Saturday and voted 220-215 in favor of the most sweeping expansion of health-care coverage since the enactment of Medicare and Medicaid Act of 1965.
House Democrats burst into sustained applause at 11:08 EST as the majority-making 218th vote was cast in favor of the the Affordable Health Care for America Act.
The measure ultimately received the votes of 219 Democrats.
Only one Republican, Louisiana's Joseph Cao, supported it. (Cao, who represents an overwhelmingly-Democratic district dominated by the city of New Orleans, frequently breaks with the GOP leadership. He was one of the few Republicans who was seriously lobbied by the White House and Democratic leaders in the House, and it worked.)
Thirty-nine Democrats joined 176 Republicans in rejecting reforms that polls suggest are broadly supported by Americans.
A handful of "no" votes came from Democrats who felt that the legislation promoted by the Obama administration and House leaders was an inadequate response to the health care crisis. Among the progressive "no" voters was Ohio Democrat Dennis Kucinich, a leading proponent of a single-payer "Medicare for All" system that would replace private insurance companies with a public program.
Said Kucinich:
This health care bill continues the redistribution of wealth to Wall Street at the expense of America's manufacturing and service economies which suffer from costs other countries do not have to bear, especially the cost of health care. America continues to stand out among all industrialized nations for its privatized health care system. As a result, we are less competitive in steel, automotive, aerospace and shipping while other countries subsidize their exports in these areas through socializing the cost of health care.
The reform plan shepherded through the House by Speaker Nancy Pelosi, is indeed flawed, as even the speaker acknowledges.
But it dramatically expands options for the tens of millions of Americans who are not currently covered by private insurers.
That was enough for Pelosi, who accepted what was for her a bitter compromise on the issue of abortion in order to secure the votes needed to pass the measure.
Late Saturday night, the speaker announced that her chamber had indeed "made history" with its endorsement of the reform plan.
Epic depictions of the House vote were commonplace Saturday, as Democrats compared their measure with historic legislation of the past.
"This is an historic moment for our nation. House passage of H.R. 3962, the Affordable Health Care for America Act, marks the first step toward ensuring health care for all Americans," said Wisconsin Democrat Tammy Baldwin, who helped craft the legislation as a member of the House Energy and Commerce Committee. "I truly believe that we'll look back years from now and view the passage of this Act to be as significant as the passage of the Social Security Act in 1935 and the Medicare and Medicaid Act in 1965."
In truth, the House merely wrote a first draft of history.
The Senate still must act on a very different reform proposal.
The House and Senate bills then must be reconciled, after which they will have to be approved once more by each chamber. Only after those final votes will the Obama have a chance to sign a health reform bill.
It will not be a quick or easy process, as was evident Saturday.
Before the House vote, Democratic representatives heard a "now is the time to finish the job" pep talk from Obama, which helped to achieve relative unity within a caucus that wrangled to the last minute over issues ranging from abortion to immigration to cost estimates for the $1 trillion bill.
Late Friday and early Saturday, bitter battling over the hot-button issue of abortion fight came close to derailing the debate.
House Democratic leaders were pressured by several dozen anti-choice Democrats to add language preventing federal funds from paying for abortions. To get the votes she needed, Pelosi found herself in the ugly position of bartering off assurances that low-income women would have access to reproductive health services.
The tortured final negotiations put serious cracks in Thomas Jefferson's "wall of separation" between church and state, as abortion foes such as Pennsylvania Democrat Jason Altmire openly acknowledged that they would not vote for health-care reform legislation unless they were told it was appropriate to do so by Catholic bishops in their home districts.
Pro-choice Democrats, led by Colorado Democrat Diana DeGette, pushed back.
That created a stalemate that Pelosi sought to break by allowing a vote on an amendment to establish limits on the funding of abortions within the new framework that would be established by the Affordable Health Care for America Act. Pro-choice Democrats opposed the amendment, with Illinois Democrat Jan Schakowsky, the co-chair of the Congressional Women's Caucus, urging her colleagues to vote against the move to restrict a woman's right to chose and force many women to pay more their insurance.
Said Schakowsky:
This amendment goes far beyond current law which already bans the use of federal funding for abortions. It goes far beyond the language already in this bill that guarantees no federal dollars are used for abortion. This amendment says that a woman CANNOT purchase coverage that includes abortion services using her own dollars; middle class women, using exclusively their own money will be prohibited from purchasing a plan including abortion coverage in every single public OR PRIVATE INSURANCE PLAN in the new health care exchange. Her only option is to buy a separate insurance policy that covers only abortion - a ridiculous and unworkable approach since no woman anticipates needing an abortion. This amendment is a radical departure from current law and will result in millions of women losing coverage they already have. This health reform bill is about improving access to care, not further restricting a woman's right to choose. Our bill is about lowering health care costs for millions of women and their families, not further marginalizing women by forcing them to pay more for their care. This amendment is a back door way of overturning Roe v. Wade; it is a disservice and insult to millions of women throughout our country. I urge my colleagues to vote against this amendment.
Despite Schakowsky's appropriately impassioned argument, the amendment was approved on a vote of 240 to 194. Sixty-four Democrats voted with 176 Republicans to attach the amendment that De Gette condemned as "the greatest restriction of a woman's right to choose" passed by Congress "in our career."
"Party of 'No'" opposition to reform was such that even pro-choice Republicans joined their anti-choice colleagues in a fully-unified GOP vote for the amendment.
The abortion fight, like a battle over restrictions on the coverage of immigrants that particularly upset members of the Hispanic Caucus, made Saturday a difficult and at times uncertain day for Pelosi and her lieutenants.
But Obama was confident enough to expend political capital on a calm, yet effective, appeal for Democratic unity.
The president made a classic "no bill can ever contain everything that everybody wants" appeal for what the vast majority of House Democrats agreed was -- despite its less-than-robust public option and the ugly compromise of abortion rights -- an imperfect-but-necessary piece of legislation.
Said Obama:
The bill that the House has produced will provide stability and security for Americans who have insurance; quality, affordable options for those who don't; and lower costs for American families and American businesses. And as I've insisted from the beginning, it is a bill that is fully paid for and will actually reduce our long-term federal deficit. This bill is change that the American people urgently need. Don't just take my word for it. Consider the national groups who've come out in support of this bill on behalf of their members: The Consumers Union supports it because it will create -- and I quote -- "a more secure, affordable health care system for the American people."
The American Medical Association and the American Nurses Association support it on behalf of doctors and nurses and medical professionals who know firsthand what's broken in our current system, and who see what happens when their patients can't get the care they need because of insurance industry bureaucracies.
The National Farmers Union supports this bill because it will control costs for farmers and ranchers, and address the unique challenges rural Americans face when it comes to receiving quality care.
And the AARP supports it because it will achieve the goal for which the AARP has been fighting for decades -- reducing the cost of health care, expanding coverage for America's seniors, and strengthening Medicare for the long haul.
Now, no bill can ever contain everything that everybody wants, or please every constituency and every district. That's an impossible task. But what is possible, what's in our grasp right now is the chance to prevent a future where every day 14,000 Americans continue to lose their health insurance, and every year 18,000 Americans die because they don't have it; a future where crushing costs keep small businesses from succeeding and big businesses from competing in the global economy; a future where countless dreams are deferred or scaled back because of a broken system we could have fixed when we had the chance.
What we can do right now is choose a better future and pass a bill that brings us to the very cusp of building what so many generations of Americans have sought to build -- a better health care system for this country.
Most House progressives accepted the "what-we-can-do-right-now" line as a reasonable one.
California Congressman Pete Stark, a senior Democrat who has advocated for decades on behalf of replacing the current for-profit scheme with a "Medicare for All" system, summed up progressive sentiments when he explained why he was voting for a measure that was far weaker than he would have preferred.
"At my age," said Stark, "I've learned to take what you can, when you can get it."
© 2009 The Nation
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