Just before 9:00 pm MST this evening (Saturday, November 7, 2009), a vote began on the floor of the House of Representatives on final passage of the ‘‘Affordable Health Care for America Act,’’ the consensus version of Health Care Reform before the House. Passage required 218 votes, cast electronically within a 15 minute window.
By 9:05, the vote was 213 in favor, while the votes of 9 Democratic congressmen were still outstanding. With crunch time just minutes away, those of us who had been crusading on this issue for years had no hope that any Republican would vote in favor of it. So we needed 5 more votes, and knew they had to come from the 9 Democrats who had not yet voted.
By 9:06, we needed 3 more votes out of 7 still not cast. Finally, at 9:07 the 218th Democrat voted in favor of the historic legislation, putting it over the top with about five minutes to spare. By the time the period for voting closed, 219 Democrats had voted in favor; 215 Republicans had voted in opposition.
Then, as a huge sigh of relief was let out by progressives across the land, a lone Republican, Joseph Cao – a new representative from Louisiana – in an act of either total confusion or decided courage joined with Democrats to make the final vote bipartisan, 220-215.
For the first time in the history of the Republic, one of the two houses of Congress had passed a bill enabling, in principle, affordable health care for almost every American. Already, 40% of people in the United States have access to quality health care – either free of charge or at an affordable cost from the government, through the Veterans’ Administration, TriCare for military personnel and their families, Medicare, or Medicaid. The provisions of this bill would push that to more than 96%.
The bill is a pretty ragged piece of legislation. The public option is badly flawed, but at least it’s there. Freedom of choice is not nearly as extensive as it should be. The bill raises eligibility for Medicaid, which is good because it means more low-income people will be included, but it’s bad in the sense that it imposes an added financial burden on the states.
Those of us who believe strongly that the gut-wrenching decision of if and when to terminate a pregnancy should be between a woman, her family, her physician, and her religious convictions, had to swallow a bitter pill, when an amendment offered by Bart Stupak (D-MI) was added to the bill, prohibiting a woman who receives any federal tax credits for health insurance from buying a policy, even at her own expense, that covers abortion. As the final tally would show, this amendment, which goes even beyond current law, was the price that had to be paid for passage.
Democrats also continue to abandon the moral high-ground by including in the bill incentives to states that remove caps on medical malpractice awards. Thus, states like Texas, whose tort-reform laws have significantly lowered the cost of malpractice insurance for doctors, would not be eligible for the incentive because awards for non-economic (punitive, or “pain and suffering”) damages are capped. The ample donations from trial lawyers, which overwhelmingly go to Democrats, may have something to do with that.
So the bill is far from perfect. But passage in the House is extremely significant, because it establishes a baseline for bargaining with the Senate. Even if the Senate, for instance, passes out a bill that does not include a public option, the conferees between House and Senate will have to consider putting it in, because the House has already voted for it.
Now the focus shifts to the Senate. While the two senators from Texas continue to wander in the wilderness on this issue, well cared for by a menu of affordable health plans provided to members of Congress while the state they represent has the largest uninsured population in the nation, we can only take heart in the fact that after they miss their appointment with history, no one will remember their names.
Attention instead will focus on those conservadems who may or may not allow debate to take place – senators like Mary Landrieu (D-LA), Blanche Lincoln (D-AR), and Ben Nelson (D-NE). Landrieu and Lincoln have been making hopeful signs that they will not support a filibuster. Joe Lieberman (I-CN) has said at one time that he won’t block debate, and at another that he might – so who knows? Nelson, at this point, is the biggest wild card.
Perhaps tonight’s vote will give wavering senators the sense of momentum they need to at least let the issue be debated on the floor of the Senate. Once that hurdle is cleared, a bill of some sort – one that in all likelihood will be more good than bad – will be voted out and the real, ultimate legislation will be crafted by the conference committee. Then and only then will we know what the actual law will look like.
Nancy Pelosi began her press conference this evening after the final vote with “What a night!” It was clearly relief as much as exhultation. But what a night, indeed!