WASHINGTON – House Democrats are pushing to the brink of passage a landmark, $940 billion health care overhaul bill that would simultaneously deliver on President Barack Obama's promise to expand coverage while slashing the deficit, a strategy aimed at attracting support from the party's fiscal conservatives.
The 10-year plan would provide coverage to more than 30 million people now uninsured through a combination of tax credits for middle class households and an expansion of the Medicaid program for low income people. Release of the legislation later Thursday sets the stage for a House vote on Sunday.
It would restructure one-sixth of the U.S. economy in the biggest expansion of the social safety net since Medicare was created in 1965. It would also impose new obligations on individuals and businesses, requiring for the first time that most Americans carry health insurance and penalizing medium-sized and large companies that don't provide coverage for their workers.
Hospitals and doctors, drug companies and insurers would gain millions of new paying customers, but they would also have to adjust to major changes. Medicare cuts would force hospitals to operate more efficiently or risk going out of business. Insurance companies would face unprecendented federal regulation. Health care industries would be hit with new federal taxes. Upper-income households would face a new tax on investment earnings.
Rep. Steny Hoyer of Maryland, the Number 2 House Democrat, said the economy would be stronger in the long run. The bill is estimated to reduce federal deficit by more than $130 billion over its first 10 years — and $1.2 trillion in the second decade, he said. Hoyer called it the biggest deficit reduction bill since the 1990s, when President Bill Clinton put the federal budget on a path to surplus.
Authoritative numbers from the Congressional Budget Office were expected later Thursday, but Speaker Nancy Pelosi, D-Calif., was already pleased. "We loved their number," said Pelosi, who is privy to the estimates.
"I think the momentum is growing for this bill," said Hoyer. "The more and more people have looked at this bill...a greater number of people are becoming more comfortable."
The Democrats' drive took on a growing sense of inevitability, picking up endorsements Wednesday from a longtime liberal holdout and from a retired Roman Catholic bishop and nuns who broke with church leaders over the bill's abortion provisions.
"This is a magnificent bill for the American people," said the Democrat's top vote-counter, Rep. Jim Clyburn, D-S.C. Leaders appeared increasingly confident of getting the 216 votes they need to pass the bill.
But House Republican Leader John Boehner of Ohio said his party's lawmakers will "do everything that we can do to make sure this bill never, ever, ever passes."
The legislation would be vulnerable to attack after it passes, since the biggest changes would be phased in slowly. The major expansion of coverage would not come until 2014, when new health insurance marketplaces open for business.
In the meantime, the legislation calls for a series of new consumer benefits. Starting this year, insurers could not deny coverage to children because of an pre-existing health problem, nor could they place lifetime dollar caps on the amount of coverage. A nhigh-risk health insurance pool would provide coverage to uninsured people who can't get private coverage because of health problems.
Democrats are following a complicated two-track legislative strategy for passing the bill. First, the House will have to approve a Senate bill that many of its Democratic members object to. Then both chambers will quickly pass a package of fixes agreed to in negotiations with the White House.
Since the House will vote first, Hoyer said lawmakers are seeking assurances from their Senate counterparts that they have enough votes to pass the follow-up measure as well.
Democrats are promising 72 hours for lawmakers and the public to review the legislation once it's released, so that would push a House vote on the bill until Sunday at the earliest — "during daylight hours," said Rep. Henry Waxman, D-Calif.
Sunday is also the day Obama plans to leave for an overseas trip. Obama already has delayed the trip once so he can be present for the vote and help with the 11th-hour arm-twisting that inevitably will precede it.
Hoyer said Obama's travel plans would not interfere with Democrats' ability to pass the bill. "I think the president's presence helps, but is it needed?" said Hoyer. "You can dial a cell phone anywhere in the world."
Obama expressed optimism in an interview Wednesday with Fox News Channel. "I'm confident it will pass," he said. "And the reason I'm confident that it's going to pass is because it's the right thing to do."
In a last minute flurry Wednesday, Democrats were revisiting details of a planned tax on high-cost insurance plans that's been a sticking point for organized labor. Richard Trumka, head of the AFL-CIO, met with Obama at the White House on Wednesday, and officials said the labor leader raised concerns. Obama has proposed significantly softening the tax in keeping with an earlier deal with organized labor, and labor leaders want to preserve that accord, at a minimum.
Trumka was to brief members of the AFL-CIO's executive council on Thursday, and the federation was expected to announce whether it would support the legislation.
The long-anticipated measure is actually the second of two bills that Obama hopes lawmakers will send him in coming days, more than a year after he urged Congress to remake the U.S. health care system. The first cleared the Senate late last year but went no further because House Democrats demanded significant changes — the very types of revisions now being packaged into the second bill.
After heavy lobbying from Obama, liberal Rep. Dennis Kucinich, D-Ohio, announced his support Wednesday, becoming the first Democrat to declare he would vote in favor of the legislation after opposing an earlier version. Shortly after Kucinich's announcement, a letter was released from 60 leaders of religious orders urging lawmakers to vote for the legislation.
The endorsement reflected a division within the Catholic Church. The U.S. Conference of Catholic Bishops opposes the Senate-passed legislation, contending it would permit the use of federal funds for elective abortions.
Late Wednesday, however, retired Bishop John E. McCarthy of Austin, Texas, told The Associated Press he was urging approval of the legislation.
Reflecting growing opposition among states to the health care bill, Idaho Gov. C.L. "Butch" Otter, a Republican, signed a measure Wednesday requiring the state attorney general to sue the federal government if residents are forced to buy health insurance. Similar legislation is pending in 37 other states.